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  • 151.
    Hollman Frisman, Gunilla
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Psychosocial status and health related quality of life in relation to the metabolic syndrome in a Swedish middle-aged population2009In: EUROPEAN JOURNAL OF CARDIOVASCULAR NURSING, ISSN 1474-5151, Vol. 8, no 3, p. 207-215Article in journal (Refereed)
    Abstract [en]

    Background: The Metabolic Syndrome (MS) is a combination of risk factors related to increased risk of cardiovascular disease. Psychosocial factors and stress have been suggested to be important determinants. Aim: To analyse how psychosocial factors, perceived stress and health related quality of life are related to MS, and assess if observed associations are dependent of life-style. Methods: A cross-sectional study of a random sample of 502 men and 505 women aged 45-69, front southeast Sweden, including fasting blood samples, blood pressure, anthropometrics, self-reported data of life-style, psychosocial status and health related quality of life (SF-36). Linear regression models were adjusted for age and, in a second step, also for life-style. Results: Men and women with MS reported lower levels of physical activity, lower scores on physical and social dimensions of SF-36, and women with MS reported stronger effect of social change compared to those without MS (p andlt; 0.05), but we found no differences for mental health or perceived stress. The major part of observed associations was lost after adjustment for effects of life-style. Conclusion: Our data speak against a direct effect of social stress on MS via psychological strain but suggest an indirect pathway via a sedentary life-style.

  • 152.
    Hollman, Gunilla
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    The prevalence of the metabolic syndrome and its risk factors in a middle-aged Swedish population - mainly a function of overweight?2008In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, no 1, p. 21-26Article in journal (Refereed)
    Abstract [en]

    Background: The prevalence of obesity, one risk factor for developing the metabolic syndrome (MS), has increased during the last decades. It has therefore been assumed that the prevalence of MS would also increase.

    Aims: The aim was to analyse the prevalence of MS and its risk factors in a middle-aged Swedish population.

    Methods: Data were obtained between 2003 and 2004 from a random population based sample of 502 men and 505 women, 45-69 years old. Measures of plasma glucose, serum lipids, blood pressure, weight, height, waist circumference and self-reported data concerning presence of disease, medication and lifestyle were obtained.

    Results: The prevalence of MS was 14.8 % among men and 15.3 % among women, with an increase by age among women only, 10 % to 25 % (p=0.029). Among individuals with MS the most frequent risk factor was large waist circumference, present in 85 % of men and 99 % of women, followed by high blood pressure, high triglycerides, high glucose and HDL cholesterol (38 % and 47 % respectively).

    Conclusion: The prevalence of MS was 15 %, increasing with age only among women.

    Overweight was a dominant characteristic, and only half of the individuals with MS had glucose/HDL cholesterol levels beyond defined cut points of the syndrome.

  • 153.
    Holmqvist, Marika
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Addressing Alcohol: Alcohol Prevention in Swedish Primary and Maternity Health Care and Occupational Health Services2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Alcohol consumption in Sweden has reached its highest levels of the past 100 years in the wake of the country’s entry into the European Union in 1995. Increased alcohol prevention efforts in Swedish health care settings have been given high priority by the authorities. The Swedish parliament’s national action plan up to 2010 emphasises that public health must be protected by achieving reductions in alcohol consumption and limiting the negative physical, psychological, and social effects of alcohol.

    This thesis aims to investigate various aspects related to the current alcoholpreventive activity in 2006 among health care professionals in three important health care settings: primary health care (PHC), occupational health services (OHS), and maternity health care (MHC). The thesis includes four studies based on a total population mail questionnaire survey.

    Results from the studies show that alcohol issues in both PHC and OHS were addressed less frequently than all other lifestyle issues, i.e. smoking, physical activity, overweight, and stress. Important barriers to alcohol-preventive activity in these settings were perceived lack of time, scepticism regarding the effectiveness of addressing the issue of alcohol, fear of potentially negative patient responses, uncertainty about how to ask, uncertainty about how to give advice regarding alcohol, and uncertainty concerning where to refer the patient.

    OHS professionals generally considered themselves more skilful than their PHC counterparts in achieving change in patients’ alcohol habits and more knowledgeable about providing advice to patients with risky alcohol consumption. The overall frequency of initiating discussions about alcohol with patients in PHC and OHS was positively associated with self-assessed skills, knowledge, and education for all professional categories.

    Slightly more than one-third of the MHC midwives used a questionnaire to assess the woman’s alcohol intake before the pregnancy; AUDIT was the most commonly used questionnaire. Their perceived knowledge concerning alcohol and pregnancy matters was generally high, but the midwives considered themselves less proficient at detecting pregnant women with risky alcohol consumption before the pregnancy.

    MHC midwives had participated in more continuing professional education in handling risky drinking than all other categories investigated. PHC nurses was the category that had the highest proportion of professionals who lacked education in handling risky drinking. Professionals in PHC, OHS, and MHC to a large extent believed that provision of more knowledge about counselling techniques to use when alcohol-related symptoms are evident could facilitate increased alcohol intervention activity.

    List of papers
    1. Asking patients about their drinking: A national survey among primary health care physicians and nurses in Sweden
    Open this publication in new window or tab >>Asking patients about their drinking: A national survey among primary health care physicians and nurses in Sweden
    Show others...
    2008 (English)In: Addictive Behaviors, ISSN 0306-4603, Vol. 33, no 2, p. 301-314Article in journal (Refereed) Published
    Abstract [en]

    Aims: To investigate the extent to which Swedish primary health care (PHC) general practitioners (GPs) and nurses discuss alcohol issues with their patients, their reasons for and against addressing alcohol issues, their perceived importance of these issues, and factors that could facilitate increased alcohol intervention activity among the PHC professionals.

    Methods: All Swedish GPs and nurses who have the authority to issue prescriptions were surveyed with a postal questionnaire. The questionnaire was returned by 1821 GPs (47% response rate) and 3125 nurses (55% response rate).

    Results: Fifty percent of the GPs and 28% of the nurses stated that they “frequently” discussed alcohol with their patients. The two most common reasons for asking patients about their drinking were that the GPs and nurses considered it part of their routines and the belief that the patient had alcohol-related symptoms. GPs said that improved opportunities for referral to specialists and provision of more knowledge about counselling techniques for use when alcohol-related symptoms are evident were the most important facilitators to increased intervention activity. Concerning the nurses, 93% stated that more time devoted to health-oriented work could facilitate increased alcohol intervention activity.

    Conclusions: The findings highlight a considerable gap between the recognition of the significance of the alcohol problem and Swedish PHC intervention activity.

    Keywords
    Primary health care; Alcohol intervention; Risk consumption
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16799 (URN)10.1016/j.addbeh.2007.09.021 (DOI)18029104 (PubMedID)
    Available from: 2009-02-19 Created: 2009-02-19 Last updated: 2009-08-18Bibliographically approved
    2. Towards increased alcohol intervention activity in Swedish occupational health services.
    Open this publication in new window or tab >>Towards increased alcohol intervention activity in Swedish occupational health services.
    2008 (English)In: International journal of occupational medicine and environmental health, ISSN 1232-1087, Vol. 21, no 2, p. 179-187Article in journal (Refereed) Published
    Abstract [en]

    Objectives: To investigate the extent to which Swedish occupational physicians and nurses discuss alcohol issues with their patients, their reasons for and against addressing these issues, their amount of education in handling risky drinking, and factors that they believe could facilitate increased alcohol intervention activity in OHS.

    Methods: All Swedish physicians and nurses in OHS were surveyed with a postal questionnaire. The questionnaire was returned by 313 physicians (response rate 54%) and 759 nurses (response rate 69%).

    Results: As much as 70% of the physicians and 85% of the nurses reported that they "frequently" discussed alcohol problems with their patients. The majority of both physicians (81%) and nurses (69%) admitted participating in a maximum of a half-day training in handling risky drinking. Among the physicians, the most common reason for asking patients about their alcohol consumption was the clinical relevance (57%). Seventy-three per cent of the nurses initiated discussions about alcohol on the basis of questionnaire responses. Both the physicians (72%) and nurses (90%) said that the knowledge about counselling techniques to use when alcohol-related symptoms are evident was the most important facilitator to increased intervention activity.

    Conclusions: OHS professionals usually discuss alcohol-related issues with their patients. Nonetheless, they are interested in gaining further education and knowledge in this respect. The study results indicate that OHS is an important setting for alcohol prevention.

    Keywords
    Occupational health care, Alcohol intervention, Risky consumption
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16802 (URN)10.2478/v10001-008-0012-1 (DOI)18715842 (PubMedID)
    Available from: 2009-02-19 Created: 2009-02-19 Last updated: 2009-04-30Bibliographically approved
    3. Alcohol prevention activity in Swedish primary health care and occupational health services: Asking patients about their drinking
    Open this publication in new window or tab >>Alcohol prevention activity in Swedish primary health care and occupational health services: Asking patients about their drinking
    Show others...
    2008 (English)In: Nordic Studies on Alcohol and Drugs, Vol. 25, no 6, p. 489-504Article in journal (Refereed) Published
    Abstract [en]

    Aims

    To investigate the alcohol preventive activity in Swedish Occupational health services (OHS) and Primary health care (PHC) in relation to education in handling risky drinking, perceived skills in achieving change in patients’ alcohol habits, and knowledge in alcohol issues among the physicians and nurses in these two settings.

    Design and Methods

    All Swedish physicians and nurses in OHS and PHC having the authority to issue prescriptions were surveyed with a postal questionnaire. The questionnaire was returned by 313 OHS physicians (response rate 54%), 759 OHS nurses (69%), 1821 PHC physicians (47%), and 3125 PHC nurses (55%). Regression analyses were used to assess the independent and interacting effects of skills, knowledge, education, sex, age, and years in practice, patient encounters per week, and location of unit.

    Results

    OHS professionals were more active in initiating discussions about alcohol with their patients than their colleagues in PHC. OHS professionals considered themselves more skilful and knowledgeable than PHC professionals. OHS nurses and PHC physicians were the professional categories that had received most education in handling risky drinking. Skills were positively associated with activity for all categories except OHS physicians. Knowledge and education were positively associated with activity for all categories except OHS nurses.

    Conclusions

    OHS professionals were more active than the PHC professionals in addressing alcohol issues with their patients. Education, knowledge, and skills were positively associated with activity for most professional categories in the two settings.

     

    Keywords
    Occupational health care, primary health care, alcohol intervention, risk consumption, Sweden
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16804 (URN)
    Available from: 2009-02-19 Created: 2009-02-19 Last updated: 2009-03-02Bibliographically approved
    4. Approaches to assessment of alcohol intake during pregnancy in Swedish maternity care-a national-based investigation into midwives' alcohol-related education, knowledge and practice
    Open this publication in new window or tab >>Approaches to assessment of alcohol intake during pregnancy in Swedish maternity care-a national-based investigation into midwives' alcohol-related education, knowledge and practice
    2010 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 26, no 4, p. 430-434Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: to evaluate how much education midwives in Sweden have undertaken to help them assess alcohol intake during pregnancy, and what tools they use to identify women who may be at risk of drinking during pregnancy. DESIGN: a national survey was conducted in March 2006, using a questionnaire constructed by a Swedish team of researchers and clinicians. SETTING: maternity health-care centres in Sweden. PARTICIPANT: 2106 midwives. FINDINGS: nearly all midwives stated that they had excellent or good knowledge concerning the risks associated with drinking during pregnancy. They considered themselves less knowledgeable about detecting pregnant women with risky alcohol consumption before pregnancy. The majority of the midwives had participated in some education in handling risky drinking. Almost half of the midwives assessed women's alcohol intake before pregnancy. Important facilitators for increased activity concerned recommendations and decisions at different levels (national, local and management) on how to address alcohol with expectant parents and work with risky drinkers. KEY CONCLUSIONS: more education was associated with more common use of a questionnaire for assessment of women's alcohol intake before pregnancy, and more frequent counselling when identifying a pregnant woman whose pre-pregnancy consumption was risky.

    Keywords
    Maternity health care; Risk consumption; Alcohol intervention; Addressing alcohol
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16813 (URN)10.1016/j.midw.2008.10.009 (DOI)000279742400009 ()19185397 (PubMedID)
    Available from: 2009-02-19 Created: 2009-02-19 Last updated: 2017-12-13Bibliographically approved
  • 154.
    Holmqvist, Marika
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Spak, Fredrik
    Department of Social Medicine, Institute of Community Medicine, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
    Rommelsjö, Anders
    Centre for Social Research on Alcohol and Drugs, Stockholm, Sweden.
    Geirsson, Magnus
    Norrmalms Health Center, Skövde, Sweden.
    Nilsen, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Asking patients about their drinking: A national survey among primary health care physicians and nurses in Sweden2008In: Addictive Behaviors, ISSN 0306-4603, Vol. 33, no 2, p. 301-314Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate the extent to which Swedish primary health care (PHC) general practitioners (GPs) and nurses discuss alcohol issues with their patients, their reasons for and against addressing alcohol issues, their perceived importance of these issues, and factors that could facilitate increased alcohol intervention activity among the PHC professionals.

    Methods: All Swedish GPs and nurses who have the authority to issue prescriptions were surveyed with a postal questionnaire. The questionnaire was returned by 1821 GPs (47% response rate) and 3125 nurses (55% response rate).

    Results: Fifty percent of the GPs and 28% of the nurses stated that they “frequently” discussed alcohol with their patients. The two most common reasons for asking patients about their drinking were that the GPs and nurses considered it part of their routines and the belief that the patient had alcohol-related symptoms. GPs said that improved opportunities for referral to specialists and provision of more knowledge about counselling techniques for use when alcohol-related symptoms are evident were the most important facilitators to increased intervention activity. Concerning the nurses, 93% stated that more time devoted to health-oriented work could facilitate increased alcohol intervention activity.

    Conclusions: The findings highlight a considerable gap between the recognition of the significance of the alcohol problem and Swedish PHC intervention activity.

  • 155.
    Holmqvist, Marika
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Hermansson, Ulric
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Spak, Fredrik
    Nilsen, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Alcohol prevention activity in Swedish primary health care and occupational health services: Asking patients about their drinking2008In: Nordic Studies on Alcohol and Drugs, Vol. 25, no 6, p. 489-504Article in journal (Refereed)
    Abstract [en]

    Aims

    To investigate the alcohol preventive activity in Swedish Occupational health services (OHS) and Primary health care (PHC) in relation to education in handling risky drinking, perceived skills in achieving change in patients’ alcohol habits, and knowledge in alcohol issues among the physicians and nurses in these two settings.

    Design and Methods

    All Swedish physicians and nurses in OHS and PHC having the authority to issue prescriptions were surveyed with a postal questionnaire. The questionnaire was returned by 313 OHS physicians (response rate 54%), 759 OHS nurses (69%), 1821 PHC physicians (47%), and 3125 PHC nurses (55%). Regression analyses were used to assess the independent and interacting effects of skills, knowledge, education, sex, age, and years in practice, patient encounters per week, and location of unit.

    Results

    OHS professionals were more active in initiating discussions about alcohol with their patients than their colleagues in PHC. OHS professionals considered themselves more skilful and knowledgeable than PHC professionals. OHS nurses and PHC physicians were the professional categories that had received most education in handling risky drinking. Skills were positively associated with activity for all categories except OHS physicians. Knowledge and education were positively associated with activity for all categories except OHS nurses.

    Conclusions

    OHS professionals were more active than the PHC professionals in addressing alcohol issues with their patients. Education, knowledge, and skills were positively associated with activity for most professional categories in the two settings.

     

  • 156.
    Holmqvist, Marika
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hermansson, Ulric
    Swedish National Institute of Public Health, Östersund, Sweden.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Towards increased alcohol intervention activity in Swedish occupational health services.2008In: International journal of occupational medicine and environmental health, ISSN 1232-1087, Vol. 21, no 2, p. 179-187Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the extent to which Swedish occupational physicians and nurses discuss alcohol issues with their patients, their reasons for and against addressing these issues, their amount of education in handling risky drinking, and factors that they believe could facilitate increased alcohol intervention activity in OHS.

    Methods: All Swedish physicians and nurses in OHS were surveyed with a postal questionnaire. The questionnaire was returned by 313 physicians (response rate 54%) and 759 nurses (response rate 69%).

    Results: As much as 70% of the physicians and 85% of the nurses reported that they "frequently" discussed alcohol problems with their patients. The majority of both physicians (81%) and nurses (69%) admitted participating in a maximum of a half-day training in handling risky drinking. Among the physicians, the most common reason for asking patients about their alcohol consumption was the clinical relevance (57%). Seventy-three per cent of the nurses initiated discussions about alcohol on the basis of questionnaire responses. Both the physicians (72%) and nurses (90%) said that the knowledge about counselling techniques to use when alcohol-related symptoms are evident was the most important facilitator to increased intervention activity.

    Conclusions: OHS professionals usually discuss alcohol-related issues with their patients. Nonetheless, they are interested in gaining further education and knowledge in this respect. The study results indicate that OHS is an important setting for alcohol prevention.

  • 157.
    Holmqvist, Marika
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Nilsen, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Approaches to assessment of alcohol intake during pregnancy in Swedish maternity care-a national-based investigation into midwives' alcohol-related education, knowledge and practice2010In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 26, no 4, p. 430-434Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to evaluate how much education midwives in Sweden have undertaken to help them assess alcohol intake during pregnancy, and what tools they use to identify women who may be at risk of drinking during pregnancy. DESIGN: a national survey was conducted in March 2006, using a questionnaire constructed by a Swedish team of researchers and clinicians. SETTING: maternity health-care centres in Sweden. PARTICIPANT: 2106 midwives. FINDINGS: nearly all midwives stated that they had excellent or good knowledge concerning the risks associated with drinking during pregnancy. They considered themselves less knowledgeable about detecting pregnant women with risky alcohol consumption before pregnancy. The majority of the midwives had participated in some education in handling risky drinking. Almost half of the midwives assessed women's alcohol intake before pregnancy. Important facilitators for increased activity concerned recommendations and decisions at different levels (national, local and management) on how to address alcohol with expectant parents and work with risky drinkers. KEY CONCLUSIONS: more education was associated with more common use of a questionnaire for assessment of women's alcohol intake before pregnancy, and more frequent counselling when identifying a pregnant woman whose pre-pregnancy consumption was risky.

  • 158.
    Hudson, Diana
    et al.
    Karolinska institutet, Stockholm.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Dahl, Eilif
    Karolinska institutet, Stockholm.
    Mode, Nicolle
    Karolinska institutet, Stockholm.
    Ekman, Robert
    Karolinska institutet, Stockholm.
    Factors associated with injuries occurring aboard vessels in Alaska: differences between residents and nonresidents.2006In: Journal of Travel Medicine, ISSN 1195-1982, E-ISSN 1708-8305, Vol. 13, no 2, p. 67-72Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Over the past decade, visitors to Alaska have spent increasing amounts of time engaged in water-based recreational activities aboard vessels of various sizes. Serious vessel-related injuries to travelers in Alaska involve not only medical care from unfamiliar health care providers and facilities but also entail the loss of vacation time and the need for injured travelers to return to their homes under less than optimal traveling conditions. METHODS: This study employed a retrospective, case-comparison analysis to identify differences in factors associated with recreational injuries acquired aboard watercraft that resulted in hospitalizations of residents and nonresidents of Alaska during 1991 to 2000. Tests of proportions were conducted to elucidate differences in demographic characteristics and injury precursors between the two subgroups. Specific injury outcomes were then tested for significance using odds ratios. RESULTS: Alaska residents and nonresidents demonstrated significant differences for both demographic factors and factors describing events leading to injuries, and for injury outcomes. Nonresidents were more likely to be 65 years or older, female, and aboard cruise ships when injuries occurred. Nonresidents were more likely to suffer fracture injuries, to suffer injuries with Abbreviated Injury Scores greater than 2, to experience posthospital discharges to sites other than their homes, and to experience postinjury disabilities. CONCLUSIONS: Alaska residents and nonresidents in this study showed significant differences in demographics, precipitating events, and injury outcomes. The findings lend support for targeted safety promotion programs.

  • 159.
    Hudson, D.S.
    et al.
    Karolinska Institute, Department of Public Health Sciences, Division of Social Medicine, Norrbacka, Stockholm SE-171, Sweden.
    Nilsen, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Johnson, J.S.
    State of Alaska, Department of Natural Resources, Division of Parks and Recreation, 550 W. 7th Avenue, Suite 1370, Anchorage, AK 99501-3561, United States.
    Mode, N.A.
    Statistician, Anchorage, AK 99507, United States.
    Moore, M.A.
    State of Alaska, Department of Health, Social Services, P.O. Box 110610, Juneau, AK 99811-0610, United States.
    Bensyl, D.M.
    Statistician, Tucker, GA 30084, United States.
    Ekman, R.S.
    Karolinska Institute, Department of Public Health Sciences, Division of Social Medicine, Norrbacka, Stockholm SE-171, Sweden, Swedish Rescue Services, Skola Skövde, Box 96014, Skövde 541-06, Sweden.
    Hospitalizations for immersion-related injuries in Alaska 1991-20002006In: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 44, no 6, p. 479-489Article in journal (Refereed)
    Abstract [en]

    Objective: This study analyzed factors associated with injuries to hospitalized victims of nonfatal immersion-related events in Alaska from 1991 through 2000. Data: Alaska Trauma Registry (ATR) records of victims of nonfatal immersion events requiring hospitalization were examined to identify factors associated with injury outcomes. Subjects were divided into two groups: the "immersion only" (IO) group had no additional injuries associated with their immersion-related events, while subjects in the "associated injury" (AI) group incurred additional trauma during injury events. Results: There were 176 ATR records of nonfatal immersion events. In 87 (49.5%) cases, hospitalizations were due to the effects of immersion only (IO group). In 89 (50.5%) cases, hospitalizations were due not only to the effects of immersion, but also due to additional injuries occurring immediately before or while immersion took place (AI group). The final logistic regression model revealed statistically significant relationships between age greater than 12 years, female gender, white ethnicity, and operation of water transport vehicles, and increased risk for associated injury outcomes (p < 0.05). Discussion: This study is the first of its kind to analyze factors associated with the most severe nonfatal immersion-related injuries in Alaska, and identifies target populations for future safety campaigns. © 2005 Elsevier Ltd. All rights reserved.

  • 160.
    Hägglund, Martin
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Epidemiology and prevention of football injuries2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aims of this thesis were to study the incidence, severity and pattern of injury in male and female elite football players; to study time trends in injury risk; to identify risk factors for injury; and to test the effectiveness of an intervention programme aimed at preventing re-injury.

    All studies followed a prospective design using standardised definitions and data collection forms. Individual training and match exposure was registered for all players participating. Time loss injuries were documented by each team’s medical staff.

    The amount of training increased by 68% between the 1982 and 2001 Swedish top male division seasons, reflecting the shift from semi-professionalism to full professionalism. No difference in injury incidence or injury severity was found between seasons. The injury incidence was 4.6 vs. 5.2/1000 training hours and 20.6 vs. 25.9/1000 match hours. The incidence of severe injury (absence >4 weeks) was 0.8/1000 hours in both seasons.

    The Swedish and Danish top male divisions were followed during the spring season of 2001. A higher risk for training injury (11.8 vs. 6.0/1000 hours, p<0.01) and severe injury (1.8 vs. 0.7/1000 hours, p=0.002) was observed among the Danish players. Re-injury accounted for 30% and 24% of injuries in Denmark and Sweden respectively.

    The Swedish top male division was studied over two consecutive seasons, 2001 and 2002, and comparison of training and match injury incidences between seasons showed similar results. Players who were injured in the 2001 season were at greater risk for injury in the following season compared to non-injured players (relative risk 2.7; 95% CI 1.7-4.3). Players with a previous hamstring injury, groin injury and knee joint trauma were two to three times more likely to suffer an identical injury to the same limb in the following season, but no such relationship was found for ankle sprain. Age was not associated with an increased injury risk.

    The effectiveness of a coach-controlled rehabilitation programme on the rate of re-injury was studied in a randomised controlled trial at amateur male level. In the control group, 23 of 79 injured players suffered a recurrence during the season compared to 10 of 90 players in the intervention group. There was a 75% lower re-injury risk in the intervention group for lower limb injuries (relative risk 0.25; 95% CI 0.11-0.57). The preventive effect was greatest during the first weeks after return to play.

    Both the male and female Swedish top divisions were followed during the 2005 season. Male elite players had a higher risk for training injury (4.7 vs. 3.8/1000 hours, p<0.05) and match injury (28.1 vs. 16.1/1000 hours, p<0.001) than women. However, no difference was observed in the rate of severe injury (0.7/1000 hours in both groups). The thigh was the most common site of injury in both men and women, while injury to the hip/groin was more frequent in men and to the knee in women. Knee sprain accounted for 31% and 37% of the time lost from training and match play in men and women respectively.

    List of papers
    1. Exposure and injury risk in Swedish elite football: a comparison between seasons 1982 and 2001
    Open this publication in new window or tab >>Exposure and injury risk in Swedish elite football: a comparison between seasons 1982 and 2001
    2003 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, Vol. 13, no 6, p. 364-370Article in journal (Refereed) Published
    Abstract [en]

    The long-term development of injury risk in Swedish male elite football was studied. Two prospective cohort studies from seasons 1982 and 2001 were compared with respect to exposure to football, injury incidence and injury severity.

    The mean number of training sessions during the season had increased by 68% between 1982 and 2001 (142 vs. 238, P<0.001), whereas teams played more matches in 1982 (49 vs. 41, P=0.02). The total exposure to football had increased by 27%. Three out of four players incurred an injury in both seasons. In 2001, players suffered more training injuries due to an increased training exposure. Accounting for risk exposure, there was no difference in injury incidence or severity between the two seasons. The incidence was 8.3 injuries/ 1000 h of total exposure (4.6 in training and 20.6 in matches) in 1982, compared to 7.8 1000 h−1 (5.2 in training and 25.9 in matches) in 2001. Major injuries accounted for 9% of all injuries, corresponding to an incidence of 0.8 /1000 h of football, in both seasons.

    A trend from semi-professionalism to full professionalism in Swedish elite football was seen during the last two decades. The injury risk did not change over the same period.

    Keywords
    sports injuries, soccer injuries, incidence, epidemiology, prospective study
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14339 (URN)10.1046/j.1600-0838.2003.00327.x (DOI)
    Available from: 2007-03-14 Created: 2007-03-14 Last updated: 2014-02-11
    2. Injury incidence and distribution in elite football - a prospective study of the Danish and the Swedish top divisions
    Open this publication in new window or tab >>Injury incidence and distribution in elite football - a prospective study of the Danish and the Swedish top divisions
    2005 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, Vol. 15, no 1, p. 21-28Article in journal (Refereed) Published
    Abstract [en]

    The Danish and Swedish male top football divisions were studied prospectively from January to June 2001. Exposure to football and injury incidence, severity and distribution were compared between the countries.

    Swedish players had greater exposure to training (171 vs. 123 h per season, P<0.001), whereas exposure to matches did not differ between the countries. There was a higher risk for injury during training in Denmark than in Sweden (11.8 vs. 6.0 per 1000 h, P<0.01), whereas for match play there was no difference (28.2 vs. 26.2 per 1000 h). The risk for incurring a major injury (absence from football more than 4 weeks) was greater in Denmark (1.8 vs. 0.7 per 1000 h, P=0.002). The distribution of injuries according to type and location was similar in both countries. Of all injuries in Denmark and Sweden, overuse injury accounted for 39% and 38% (NS), and re-injury for 30% and 24% (P=0.032), respectively.

    The greater training exposure and the long pre-season period in Sweden may explain some of the reported differences.

    Keywords
    sports injuries, soccer, incidence, epidemiology, re-injury
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14340 (URN)10.1111/j.1600-0838.2004.00395.x (DOI)
    Available from: 2007-03-14 Created: 2007-03-14 Last updated: 2014-02-06
    3. Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons
    Open this publication in new window or tab >>Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons
    2006 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, Vol. 40, p. 767-772Article in journal (Refereed) Published
    Abstract [en]

    Background: Previous injury is often proposed to be a risk factorfor football injury, but most studies rely on players reportingtheir own medical history and are thus potentially subject torecall bias. Little is known about the natural variation ininjury pattern between seasons.

    Objectives: To study whether prospectively recorded injuriesduring one season are associated with injuries sustained duringthe following season, and to compare injury risk and injurypattern between consecutive seasons.

    Methods: The medical staffs of 12 elite Swedish male footballteams prospectively recorded individual exposure and time lossinjuries over two full consecutive seasons (2001 and 2002).A multivariate model was used to determine the relation betweenprevious injury, anthropometric data, and the risk of injury.

    Results: The training and match injury incidences were similarbetween seasons (5.1 v 5.3 injuries/1000 training hours and25.9 v 22.7/1000 match hours), but analysis of injury severityand injury patterns showed variations between seasons. Playerswho were injured in the 2001 season were at greater risk ofany injury in the following season compared with non-injuredplayers (hazard ratio 2.7; 95% confidence interval 1.7 to 4.3,p<0.0001). Players with a previous hamstring injury, groininjury, and knee joint trauma were two to three times more likelyto suffer an identical injury in the following season, whereasno such relation was found for ankle sprain. Age was not associatedwith an increased injury risk.

    Conclusions: This study confirmed previous results showing thatprevious injury is an important risk factor for football injury.Overall injury incidences were similar between consecutive seasons,indicating that an injury surveillance study covering one fullseason can provide a reasonable overview of the injury problemamong elite football players in a specific environment. However,a prolonged study period is recommended for analyses of specificinjury patterns.

    Keywords
    risk factor; injury; re-injury; football; soccer; multivariate model
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14341 (URN)10.1136/bjsm.2006.026609 (DOI)
    Available from: 2007-03-14 Created: 2007-03-14 Last updated: 2014-02-05
    4. Lower re-injury rate with a coach-controlled rehabilitation program in amateur male soccer: A randomized controlled trial
    Open this publication in new window or tab >>Lower re-injury rate with a coach-controlled rehabilitation program in amateur male soccer: A randomized controlled trial
    2007 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 35, no 9, p. 1433-1442Article in journal (Refereed) Published
    Abstract [en]

    Background: Soccer injuries are common, and athletes returning to play after injury are especially at risk. Few studies have investigated how to prevent reinjury.

    Hypothesis: The rate of reinjury is reduced using a coach-controlled rehabilitation program.

    Study Design: Randomized controlled trial; Level of evidence, 1.

    Methods: Twenty-four male amateur soccer teams were randomized into an intervention (n = 282) and control group (n = 300). The intervention was implemented by team coaches and consisted of information about risk factors for reinjury, rehabilitation principles, and a 10-step progressive rehabilitation program including return to play criteria. During the 2003 season, coaches reported individual exposure and all time loss injuries were evaluated by a doctor and a physiotherapist. Four teams (n = 100) withdrew from the study after randomization, leaving 10 teams with 241 players for analysis in both groups.

    Results: There were 90 injured players (132 injuries) in the intervention group, and 10 of these (11%) suffered 14 reinjuries during the season. In the control group, 23 of 79 injured players (29%) had 40 recurrences (134 injuries). A Cox regression analysis showed a 66% reinjury risk reduction in the intervention group for all injury locations (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.16–0.72, P = .0047) and 75% for lower limb injuries (HR 0.25, 95% CI 0.11–0.57, P < .001). The preventive effect was greatest within the first week of return to play. Injured players in the intervention group complied with the intervention for 90 of 132 injuries (68%).

    Conclusion: The reinjury rate in amateur male soccer players was reduced after a controlled rehabilitation program implemented by coaches.

    Keywords
    soccer, football, recurrent injury, prevention, rehabilitation
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14342 (URN)10.1177/0363546507300063 (DOI)
    Available from: 2007-03-14 Created: 2007-03-14 Last updated: 2017-12-13
    5. Injuries among male and female elite football players
    Open this publication in new window or tab >>Injuries among male and female elite football players
    (English)Manuscript (Other (popular science, discussion, etc.))
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14343 (URN)
    Available from: 2007-03-14 Created: 2007-03-14 Last updated: 2013-09-04
  • 161.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Atroshi, Isam
    Hassleholm Hospital.
    Preventing knee injuries in adolescent female football players - design of a cluster randomized controlled trial [NCT00894595]2009In: BMC MUSCULOSKELETAL DISORDERS, ISSN 1471-2474, Vol. 10, no 75Article in journal (Refereed)
    Abstract [en]

    Background: Knee injuries in football are common regardless of age, gender or playing level, but adolescent females seem to have the highest risk. The consequences after severe knee injury, for example anterior cruciate ligament (ACL) injury, are well-known, but less is known about knee injury prevention. We have designed a cluster randomized controlled trial (RCT) to evaluate the effect of a warm-up program aimed at preventing acute knee injury in adolescent female football. Methods: In this cluster randomized trial 516 teams (309 clusters) in eight regional football districts in Sweden with female players aged 13-17 years were randomized into an intervention group (260 teams) or a control group (256 teams). The teams in the intervention group were instructed to do a structured warm-up program at two training sessions per week throughout the 2009 competitive season (April to October) and those in the control group were informed to train and play as usual. Sixty-eight sports physical therapists are assigned to the clubs to assist both groups in data collection and to examine the players acute knee injuries during the study period. Three different forms are used in the trial: (1) baseline player data form collected at the start of the trial, (2) computer-based registration form collected every month, on which one of the coaches/team leaders documents individual player exposure, and (3) injury report form on which the study therapists report acute knee injuries resulting in time loss from training or match play. The primary outcome is the incidence of ACL injury and the secondary outcomes are the incidence of any acute knee injury (except contusion) and incidence of severe knee injury (defined as injury resulting in absence of more than 4 weeks). Outcome measures are assessed after the end of the 2009 season. Discussion: Prevention of knee injury is beneficial for players, clubs, insurance companies, and society. If the warm-up program is proven to be effective in reducing the incidence of knee injury, it can have a major impact by reducing the future knee injury burden in female football as well as the negative long-term disabilities associated with knee injury.

  • 162.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Exposure and injury risk in Swedish elite football: a comparison between seasons 1982 and 20012003In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, Vol. 13, no 6, p. 364-370Article in journal (Refereed)
    Abstract [en]

    The long-term development of injury risk in Swedish male elite football was studied. Two prospective cohort studies from seasons 1982 and 2001 were compared with respect to exposure to football, injury incidence and injury severity.

    The mean number of training sessions during the season had increased by 68% between 1982 and 2001 (142 vs. 238, P<0.001), whereas teams played more matches in 1982 (49 vs. 41, P=0.02). The total exposure to football had increased by 27%. Three out of four players incurred an injury in both seasons. In 2001, players suffered more training injuries due to an increased training exposure. Accounting for risk exposure, there was no difference in injury incidence or severity between the two seasons. The incidence was 8.3 injuries/ 1000 h of total exposure (4.6 in training and 20.6 in matches) in 1982, compared to 7.8 1000 h−1 (5.2 in training and 25.9 in matches) in 2001. Major injuries accounted for 9% of all injuries, corresponding to an incidence of 0.8 /1000 h of football, in both seasons.

    A trend from semi-professionalism to full professionalism in Swedish elite football was seen during the last two decades. The injury risk did not change over the same period.

  • 163.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Injuries among male and female elite football players2009In: SCANDINAVIAN JOURNAL OF MEDICINE and SCIENCE IN SPORTS, ISSN 0905-7188, Vol. 19, no 6, p. 819-827Article in journal (Refereed)
    Abstract [en]

    All 12 female football clubs (228 players) and 11 of 14 male clubs (239 players) in the Swedish premier league were followed prospectively during the 2005 season. Individual exposure (playing time), injuries (time loss), and injury severity (days lost due to injury) were recorded by the team medical staffs. Injury incidence was higher for male players during both training (4.7 vs 3.8 injuries/1000 h, P=0.018) and match play (28.1 vs 16.1, P andlt; 0.001). However, no difference was found in the incidence of severe injury (absence andgt; 4 weeks) (0.7/1000 h in both groups). The thigh, especially the hamstrings, was the overall most commonly injured region in both sexes, while the hip/groin was more commonly injured in male players and the knee in female players. Knee ligament injuries accounted for 31% and 37% of the total time lost from football for male and female players, respectively. In conclusion, male elite players had a higher injury incidence than their female counterparts although no difference was observed in the incidence of moderate to severe injury. We recommend that preventive measures should be focused on hamstring and knee ligament injury in order to reduce the overall injury burden.

  • 164.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Injuries among male and female elite football playersManuscript (Other (popular science, discussion, etc.))
  • 165.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Injury incidence and distribution in elite football - a prospective study of the Danish and the Swedish top divisions2005In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, Vol. 15, no 1, p. 21-28Article in journal (Refereed)
    Abstract [en]

    The Danish and Swedish male top football divisions were studied prospectively from January to June 2001. Exposure to football and injury incidence, severity and distribution were compared between the countries.

    Swedish players had greater exposure to training (171 vs. 123 h per season, P<0.001), whereas exposure to matches did not differ between the countries. There was a higher risk for injury during training in Denmark than in Sweden (11.8 vs. 6.0 per 1000 h, P<0.01), whereas for match play there was no difference (28.2 vs. 26.2 per 1000 h). The risk for incurring a major injury (absence from football more than 4 weeks) was greater in Denmark (1.8 vs. 0.7 per 1000 h, P=0.002). The distribution of injuries according to type and location was similar in both countries. Of all injuries in Denmark and Sweden, overuse injury accounted for 39% and 38% (NS), and re-injury for 30% and 24% (P=0.032), respectively.

    The greater training exposure and the long pre-season period in Sweden may explain some of the reported differences.

  • 166.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lower re-injury rate with a coach-controlled rehabilitation program in amateur male soccer: A randomized controlled trial2007In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 35, no 9, p. 1433-1442Article in journal (Refereed)
    Abstract [en]

    Background: Soccer injuries are common, and athletes returning to play after injury are especially at risk. Few studies have investigated how to prevent reinjury.

    Hypothesis: The rate of reinjury is reduced using a coach-controlled rehabilitation program.

    Study Design: Randomized controlled trial; Level of evidence, 1.

    Methods: Twenty-four male amateur soccer teams were randomized into an intervention (n = 282) and control group (n = 300). The intervention was implemented by team coaches and consisted of information about risk factors for reinjury, rehabilitation principles, and a 10-step progressive rehabilitation program including return to play criteria. During the 2003 season, coaches reported individual exposure and all time loss injuries were evaluated by a doctor and a physiotherapist. Four teams (n = 100) withdrew from the study after randomization, leaving 10 teams with 241 players for analysis in both groups.

    Results: There were 90 injured players (132 injuries) in the intervention group, and 10 of these (11%) suffered 14 reinjuries during the season. In the control group, 23 of 79 injured players (29%) had 40 recurrences (134 injuries). A Cox regression analysis showed a 66% reinjury risk reduction in the intervention group for all injury locations (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.16–0.72, P = .0047) and 75% for lower limb injuries (HR 0.25, 95% CI 0.11–0.57, P < .001). The preventive effect was greatest within the first week of return to play. Injured players in the intervention group complied with the intervention for 90 of 132 injuries (68%).

    Conclusion: The reinjury rate in amateur male soccer players was reduced after a controlled rehabilitation program implemented by coaches.

  • 167.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons2006In: British Journal of Sports Medicine, ISSN 0306-3674, Vol. 40, p. 767-772Article in journal (Refereed)
    Abstract [en]

    Background: Previous injury is often proposed to be a risk factorfor football injury, but most studies rely on players reportingtheir own medical history and are thus potentially subject torecall bias. Little is known about the natural variation ininjury pattern between seasons.

    Objectives: To study whether prospectively recorded injuriesduring one season are associated with injuries sustained duringthe following season, and to compare injury risk and injurypattern between consecutive seasons.

    Methods: The medical staffs of 12 elite Swedish male footballteams prospectively recorded individual exposure and time lossinjuries over two full consecutive seasons (2001 and 2002).A multivariate model was used to determine the relation betweenprevious injury, anthropometric data, and the risk of injury.

    Results: The training and match injury incidences were similarbetween seasons (5.1 v 5.3 injuries/1000 training hours and25.9 v 22.7/1000 match hours), but analysis of injury severityand injury patterns showed variations between seasons. Playerswho were injured in the 2001 season were at greater risk ofany injury in the following season compared with non-injuredplayers (hazard ratio 2.7; 95% confidence interval 1.7 to 4.3,p<0.0001). Players with a previous hamstring injury, groininjury, and knee joint trauma were two to three times more likelyto suffer an identical injury in the following season, whereasno such relation was found for ankle sprain. Age was not associatedwith an increased injury risk.

    Conclusions: This study confirmed previous results showing thatprevious injury is an important risk factor for football injury.Overall injury incidences were similar between consecutive seasons,indicating that an injury surveillance study covering one fullseason can provide a reasonable overview of the injury problemamong elite football players in a specific environment. However,a prolonged study period is recommended for analyses of specificinjury patterns.

  • 168.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Risk Factors for Lower Extremity Muscle Injury in Professional Soccer: The UEFA Injury Study2013In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 41, no 2, p. 327-335Article in journal (Refereed)
    Abstract [en]

    Background: Muscle injury is the most common injury type in professional soccer players. Despite this, risk factors for common lower extremity injuries remain elusive.

    Purpose: To evaluate the effects of various player- and match-related risk factors on the occurrence of lower extremity muscle injury in male professional soccer.

    Study Design: Cohort study; Level of evidence, 2.

    Methods: Between 2001 and 2010, 26 soccer clubs (1401 players) from 10 European countries participated in the study. Individual player exposure and time loss muscle injuries in the lower extremity were registered prospectively by the club medical staffs during 9 consecutive seasons. Hazard ratios (HRs) were calculated for player-related factors from simple and multiple Cox regression, and odds ratios (ORs) were calculated for match-related variables from simple and multiple logistic regression, presented with 95% confidence intervals (CIs).

    Results: There were 2123 muscle injuries documented in the major lower extremity muscle groups: adductors (n = 523), hamstrings (n = 900), quadriceps (n = 394), and calf (n = 306). Injuries to the adductors (56%; P = .015) and quadriceps (63%; P< .001) were more frequent in the kicking leg. Multiple analysis indicated that having a previous identical injury in the preceding season increased injury rates significantly for adductor (HR, 1.40; 95% CI, 1.00-1.96), hamstring (HR, 1.40; 95% CI, 1.12-1.75), quadriceps (HR, 3.10; 95% CI, 2.21-4.36), and calf injuries (HR, 2.33; 95% CI, 1.52-3.57). Older players (above mean age) had an almost 2-fold increased rate of calf injury (HR, 1.93; 95% CI, 1.38-2.71), but no association was found in other muscle groups. Goalkeepers had reduced injury rates in all 4 muscle groups. Match play on away ground was associated with reduced rates of adductor (OR, 0.56; 95% CI, 0.43-0.73) and hamstring injuries (OR, 0.76; 95% CI, 0.63-0.92). Quadriceps injuries were more frequent during preseason, whereas adductor, hamstring, and calf injury rates increased during the competitive season.

    Conclusion: Intrinsic factors found to increase muscle injury rates in professional soccer were previous injury, older age, and kicking leg. Injury rates varied during different parts of the season and also depending on match location.

  • 169.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Til, Lluis
    FC Barcelona, Olympic Training Center, Sant Cugat del Vallès, Barcelona, Spain.
    Pruna, Ricard
    FC Barcelona, Barcelona, Spain.
    The importance of epidemiological research in sports medicine2010In: Apunts Med Esport, ISSN 1886-6581, Vol. 45, no 166, p. 57-59Article in journal (Refereed)
  • 170.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Zwerver, Johannes
    University Medical Center Groningen.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Epidemiology of Patellar Tendinopathy in Elite Male Soccer Players2011In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 39, no 9, p. 1906-1911Article in journal (Refereed)
    Abstract [en]

    Background: Patellar tendinopathy is common among athletes in jumping sports and in sports with prolonged repetitive stress of the knee extensor apparatus. The epidemiology in soccer is not well described. less thanbrgreater than less thanbrgreater thanPurpose: This study was undertaken to investigate and describe the epidemiology of patellar tendinopathy in elite male soccer players and evaluate potential risk factors. less thanbrgreater than less thanbrgreater thanStudy Design: Cohort study; Level of evidence, 2. less thanbrgreater than less thanbrgreater thanMethods: Between 2001 and 2009, the authors followed 51 European elite soccer clubs (2229 players) from 3 different cohorts: the Swedish First League cohort (SWE) and Union of European Football Associations (UEFA) Champions League cohort (UCL), both playing on natural grass; and the Artifical Turf cohort (ART), playing on third-generation artificial turf. Individual player exposure in training and matches and time-loss injuries were recorded. less thanbrgreater than less thanbrgreater thanResults: In total, 137 patellar tendinopathies were recorded, comprising 1.5% of all injuries and corresponding to an incidence of 0.12 injuries/1000 hours. Each season, 2.4% of players were affected, with most injuries (61%) resulting in absence up to 1 week or less. Twenty percent of tendinopathies were recurrent complaints. No significant difference in season prevalence (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.60-1.44; P = .74) or incidence (rate ratio [RR] 1.20; 95% CI, 0.82-1.75; P = .36) was observed between teams playing on artificial turf and natural grass, respectively. Multivariate logistic regression showed that a high total exposure hours (OR, 1.02 per 10-hour increase; 95% CI, 1.00-1.04; P = .033) was a significant risk factor for patellar tendinopathy, and increased body mass was borderline significant (OR, 1.15 per 5-kg increase; 95% CI, 1.00-1.33; P = .055). In addition, 2 acute partial tendon ruptures were recorded, but no total rupture. less thanbrgreater than less thanbrgreater thanConclusion: Although mainly mild in nature, patellar tendinopathy is a fairly common condition in elite soccer and the recurrence rate is high. Exposure to artificial turf did not increase the prevalence or incidence of injury. High total amount of exposure was identified as a risk factor for patellar tendinopathy.

  • 171.
    Hörnquist, J. O.
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hansson, B.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Leijon, Margareta
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Mikaelsson, Bo
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Repeated short-term sick-leave and quality of life: An evaluation of a clinical socio-medical intervention1990In: Scandinavian Journal of Social Medicine, ISSN 1403-4948, Vol. 18, no 2, p. 91-95Article in journal (Refereed)
    Abstract [en]

    The primary aim of this study was to evaluate a clinical socio-medical supportive program for repeated short-term sickleavers who exhibited no evident reason for their prolonged absence. Attention was drawn to changes in the quality of life of the participants. Ninety-nine persons took part in the full program. The sex distribution was even and the mean age was 32 years. The average number of days of sick-leave during the year preceding the entrance into the program was 28. The most common self-stated diagnosis was upper respiratory infection or gastro-intestinal problems. The evaluation showed a significant change for the better in the quality of life and well-being of the patients, although more than every other patient did not explicitly attribute any personal benefit to the intervention itself. The results coincide irrespective of measuring method and, are by and large, consistent over most areas of life and components of well-being assessed. Thus the design and the results of the evalution look very promising concerning reliability, validity and especially sensitivity. A corresponding model may be applicable more generally when evaluating health- and medical care.

  • 172.
    Irestig, Magnus
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Eriksson, Henrik
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    The Impact of Participation in Information System Design: A comparison of contextual placements2004In: Proceedings of Participatory Design Conference 2004, 2004Conference paper (Refereed)
  • 173.
    Irestig, Magnus
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Politics and technology in health information systems development: A discourse analysis of conflicts addressed in a systems design group2008In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 41, no 1, p. 82-94Article in journal (Refereed)
    Abstract [en]

    Different types of disagreements must be managed during the development of health information systems. This study examines the antagonisms discussed during the design of an information system for 175,000 users in a public health context. Discourse analysis methods were used for data collection and analysis. Three hundred and twenty-six conflict events were identified from four design meetings and divided into 16 categories. There were no differences regarding the types of conflicts that the different participants brought into the design discussions. Instead, conflict occurrence was primarily affected by the agendas that set the stage for examinations and debates. The results indicate that the selection of design method and the structure used for the meetings are important factors for the manner in which conflicts are brought into consideration during health information system design. Further studies comparing participatory and non-participatory information system design practices in health service settings are warranted. © 2007 Elsevier Inc. All rights reserved.

  • 174.
    Irestig, Magnus
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Towards responsible system development in health services: A discourse analysis study of design conflict resolution tactics2010In: JOURNAL OF BIOMEDICAL INFORMATICS, ISSN 1532-0464, Vol. 43, no 1, p. 137-143Article in journal (Refereed)
    Abstract [en]

    We set out to examine design conflict resolution tactics used in development of large information systems for health services and to outline the design consequences for these tactics. Discourse analysis methods were applied to data collected from meetings conducted during the development of a web-based system in a public health context. We found that low risk tactics were characterized by design issues being managed within the formal mandate and competences of the design group. In comparison, high risk tactics were associated with irresponsible compromises, i.e. decisions being passed on to others or to later phases of the design process. The consequence of this collective disregard of issues such as responsibility and legitimacy is that the system design will be impossible to implement in factual health service contexts. The results imply that downstream responsibility issues have to be continuously dealt with in system development in health services.

  • 175.
    Jacobsson, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Ekberg, Joakim
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Kowalski, Jan
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Nilsson, Sverker
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Renstrom, Per
    Karolinska Institute.
    Design of a protocol for large-scale epidemiological studies in individual sports: the Swedish Athletics injury study2010In: BRITISH JOURNAL OF SPORTS MEDICINE, ISSN 0306-3674, Vol. 44, no 15, p. 1106-1111Article in journal (Refereed)
    Abstract [en]

    Background Epidemiological studies have mainly been performed on team sports. The authors set out to develop a protocol for large-scale epidemiological studies of injuries among elite athletics athletes. Methods An argument-based method for investigation of complex design problems was used to structure the collection and analysis of data. Specification of the protocol was preceded by an examination of requirements on injury surveillance in individual sports and iterated drafting of protocol specifications, and followed by formative evaluations. Results The requirements analysis shows that the central demand on the protocol is to allow for detailed epidemiological analyses of overuse injuries, which subsequently requires regular collection of self-reported data from athletes. The resulting study protocol is centred on a web-based weekly athlete e-diary enabling continual collection of individual-level data on exposure and injuries. To be able to interpret the self-reported data on injury events, collection of a wide range of personal baseline data from the athlete, including a psychological profile, is included in the protocol. Conclusions The resulting protocol can be employed in intervention programmes that can prevent suffering among both adult elite and youth talent athletes who have made considerable life investments in their sport.

  • 176.
    Jacobsson, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Kowalski, Jan
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsson, Sverker
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekberg, Joakim
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Renström, Per
    Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden.
    Injury patterns in Swedish elite athletics – part 1: annual incidence and injury types2013In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 15Article in journal (Refereed)
    Abstract [en]

    Objective To estimate the incidence, type and severity of musculoskeletal injuries in youth and adult elite athletics athletes and to explore risk factors for sustaining injuries. Design Prospective cohort study conducted during a 52-week period. Setting Male and female youth and adult athletics athletes ranked in the top 10 in Sweden (n=292). Results 199 (68%) athletes reported an injury during the study season. Ninety-six per cent of the reported injuries were non-traumatic (associated with overuse). Most injuries (51%) were severe, causing a period of absence from normal training exceeding 3 weeks. Log-rank tests revealed risk differences with regard to athlete category (p=0.046), recent previous injury (>3 weeks time-loss; p=0.039) and training load rank index (TLRI; p=0.019). Cox proportional hazards regression analyses showed that athletes in the third (HR 1.79; 95% CI 1.54 to 2.78) and fourth TLRI quartiles (HR 1.79; 95% CI 1.16 to 2.74) had almost a twofold increased risk of injury compared with their peers in the first quartile and interaction effects between athlete category and previous injury; youth male athletes with a previous serious injury had more than a fourfold increased risk of injury (HR=4.39; 95% CI 2.20 to 8.77) compared with youth females with no previous injury. Conclusions The injury incidence among both youth and adult elite athletics athletes is high. A training load index combing hours and intensity and a history of severe injury the previous year were predictors for injury. Further studies on measures to quantify training content and protocols for safe return to athletics are warranted.

  • 177.
    Jacobsson, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Kowalski, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsson, Sverker
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekberg, Joakim
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Renström, Per
    Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden.
    Injury patterns in Swedish elite athletics – part 2: risk indicators2012Manuscript (preprint) (Other academic)
    Abstract [en]

    Objective: To examine the risk indicators associated with sustaining musculoskeletal injuries in youth and adult elite athletics athletes competing at national and international levels.

    Design: Prospective cohort study conducted during a 52-week period starting in March 2009. A web-based athlete electronic diary was administrated every week by email to athletes for self-reporting of data on training, competition and injuries.

    Setting: Male and female youth and adult athletics athletes ranked in the top 10 in Sweden (n=292).

    Results: One-hundred ninety-nine (68%) athletes reported an injury during the study season. The median time to first injury was 101 days (95% confidence interval (CI) 75–127). Univariate log-rank tests revealed risk differences with regard to athlete category (P=0.046), serious injury (>3 weeks time loss) during the previous season (P=0.039) and training load rank index (TLRI) (P=0.019). Multivariate Cox proportional hazards regression analyses showed that athletes in the third (hazard ratio (HR) 1.79; 95% CI 1.54–2.78) and fourth TLRI quartile (HR 1.79; 95% CI 1.16–2.74) had almost a twofold increased risk of injury compared with their peers in the first quartile and interaction effects between athlete category and previous injury; youth male athletes with a previous serious injury had more than a fourfold increased risk of injury (HR=4.39; 95% CI 2.20–8.77) compared with youth females with no previous injury.

    Conclusions: A training load index combing hours and intensity and a history of severe injury the previous year are predictors for injury risk among elite athletic athletes. Future studies on measures to quantify training content and protocols for safe return to athletics are warranted.

  • 178.
    Jacobsson, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Kowalski, Jan
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsson, Sverker
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekberg, Joakim
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Renström, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Prevalence of Musculoskeletal Injuries in Swedish Elite Track and Field Athletes2012In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 40, no 1, p. 163-169Article in journal (Refereed)
    Abstract [en]

    Background: Little is known of injury patterns in track and field (athletics). Injury prevalence has been proposed as the most appropriate measure of the injury rate in sports where athletes are at risk for overuse problems. less thanbrgreater than less thanbrgreater thanPurpose: To ascertain 1-year retrospective and current prevalence of injury in elite track and field athletes to help plan injury prevention programs for this sport. less thanbrgreater than less thanbrgreater thanStudy Design: Descriptive epidemiology study. less thanbrgreater than less thanbrgreater thanMethods: Two hundred seventy-eight youth (16 years old) and adult athletes from an eligible study population of 321 athletes were included. less thanbrgreater than less thanbrgreater thanResults: The 1-year retrospective injury prevalence was 42.8% (95% confidence interval [CI], 36.9%-49.0%); the point prevalence was 35.4% (95% CI, 29.7%-41.4%). The diagnosis group displaying the highest injury prevalence was inflammation and pain in the gradual onset category (1-year prevalence, 20.9%; 95% CI, 16.2%-26.2%; and point prevalence, 23.2%; 95% CI, 18.4%-28.7%). A strong tendency for higher 1-year prevalence of 16.5% (95% CI, 12.2%-21.4%) than point prevalence of 8.5% (95% CI, 5.5%-12.5%) was recorded for sudden onset injuries in the diagnosis group sprain, strain, and rupture. The body region showing the highest injury prevalence was the knee and lower leg with 15.0% (95% CI, 11.0%-19.8%) 1-year prevalence and 13.7% (95% CI, 9.8%-18.3%) point prevalence, followed by the Achilles tendon, ankle, and foot/toe with 11.7% (95% CI, 8.2%-16.1%) 1-year prevalence and 11.4% (95% CI, 7.9%-15.8%) point prevalence. less thanbrgreater than less thanbrgreater thanConclusion: The injury prevalence is high among Swedish elite track and field athletes. Most of the injuries affect the lower extremities and are associated with a gradual onset. Although it is associated with a potential recall bias, the 1-year retrospective prevalence measure captured more sudden onset injuries than the point prevalence measure. Future prospective studies in track and field are needed to identify groups of athletes at increased risk.

  • 179.
    Jorgensen, U.
    et al.
    Jørgensen, U., Department of Orthopedic Surgery, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark.
    Bak, K.
    Department of Orthopedic Surgery, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark.
    Ekstrand, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Scavenius, M.
    Department of Orthopedic Surgery, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark.
    Reconstruction of the anterior cruciate ligament with the iliotibial band autograft in patients with chronic knee instability2001In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 9, no 3, p. 137-145Article in journal (Refereed)
    Abstract [en]

    We performed combined internal and external anterior cruciate ligament (ACL) reconstruction with the iliotibial band autograft in 169 consecutive patients with chronic ACL insufficiency who were followed up for 24-61 months. Of these, 155 (91%) agreed to an additional independent observer follow-up after 24-92 months. Eight patients (5%) had sustained a rerupture/elongation of the graft and were operated on again, nine (6%) had sustained a tear of the contralateral ACL. Knee function and activity increased after the reconstruction. Lysholm scores improved from median 81 preoperatively to 99 at follow-up and Tegner scores from median 4 to 7. At follow-up 97 (71%) were active at the same level as prior to injury. In 17 of the 40 patients (12%) dropping to a lower activity level this was due to knee problems. The side-to-side difference in anterior-posterior knee laxity was more than 3 mm in 18 knees (13%) and more than 5 mm in 3 knees (2%). Including eight reruptures, this results in a "stability" failure rate of 8.8%. The overall IKCD rating showed normal knee function in 88 (73%) and nearly normal knee function in 30 (25%). Anterior knee pain was present in 14 (10%) of the patients at follow-up. Patients with isolated ACL injury had higher Lysholm scores and Tegner scores than patients with associated injuries. No clinical signs of varus knee development were seen. Of the 155 patients 94% would have the procedure repeated if necessary with the knowledge that they have today. The combined internal and external iliotibial band procedure can restore knee stability and function in the majority of chronic ACL-insufficient knees.

  • 180.
    Kallings, L.V.
    et al.
    Karolinska Institute.
    Leijon, Matti E.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Kowalski, J.
    Biostatistics, Stockholm.
    Hellenius, M.-L.
    Karolinska Institute.
    Stahle, A.
    Karolinska Institute.
    Self-reported adherence: A method for evaluating prescribed physical activity in primary health care patients2009In: Journal of Physical Activity and Health, ISSN 1543-3080, Vol. 6, no 4, p. 483-492Article in journal (Refereed)
    Abstract [en]

    Physical activity on prescription, as a method for increasing physical activity, has attracted attention in recent years. However, few studies have examined adherence as a primary outcome variable. The aim of this article was to examine self-reported adherence to individualized prescribed physical activity in a routine primary health care setting. Methods: Patients receiving an individualized physical activity on prescription (FaR) for prevention or treatment of disease were recruited from 13 Swedish primary health care units. Self-reported adherence, physical activity level, readiness to change to a more physically active lifestyle, and well-being were measured with questions at baseline and after 6 months in 240 patients (mean age 51, range 12 to 80, 75% women). Results: At the 6-month follow-up a majority (65%) of the patients reported adherence to the prescription. Partial adherence was reported by 19% and nonadher- ence by 16%. There was a relationship between adherence and well-being and stages of action or maintenance. Conclusions: The results demonstrate that adherence to physical activity on prescription is as good as adherence to other treatments for chronic diseases. This is significant because even a small increase in physical activity is important both on an individual level and for public health.

  • 181.
    Karlsson, David
    et al.
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, The Institute of Technology.
    Ekberg, Joakim
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Spreco, Armin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Eriksson, Henrik
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Center for Public Health.
    Visualization of infectious disease outbreaks in routine practice2013In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 192, p. 697-701Article in journal (Refereed)
    Abstract [en]

    Throughout the history of epidemiology, visualizations have been used as the interface between public-health professionals and epidemiological data. The aim of this study was to examine the impact of the level of abstraction when using visualizations on routine infectious disease control. We developed three interactive visualization prototypes at increasing levels of abstraction to communicate subsets of influenza outbreak surveillance information. The visualizations were assessed through workshops in an exploratory evaluation with infectious disease epidemiologists. The results show that despite the potential of processed, abstract, and information-dense representations, increased levels of abstraction decreased epidemiologists understanding and confidence in visualizations. Highly abstract representations were deemed not applicable in routine practice without training. Infectious disease epidemiologists work routines and decision-making need to be further studied in order to develop visualizations that meet both the quality requirements imposed by policy-makers and the contextual nature of work practice.

  • 182.
    Karlsson, Nadine
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Borg, Karin
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medicine and Health Sciences, Health and Society.
    Hensing, Gunnel
    Department of Social Medicine, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
    Alexanderson, Kristina
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Risk of disability pension in relation to gender and age in a Swedish county: A 12-year population based, prospective cohort study2006In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 27, no 2, p. 173-179Article in journal (Refereed)
    Abstract [en]

    Residents of the county of Östergötland, Sweden, who were 16-64 years of age in December 1984 and not pensioned (n=229,864), were followed in a prospective, cohort, study of data collected between 1985 and 1996. Using survival methods as the method of analysis, the likelihood of being granted a disability pension was 14% for women, 11% for men, and increased with age. Women less than 54 years of age were at higher risk than men (P<0.001), 69% of disability pensions granted were full-time and 31% were part-time, more women received part-time pensions (P<0.001). Whether the differences observed are due to gender bias in social insurance practices, to disease patterns, to occupational and work-related factors, or to a cohort effect has yet to be determined.

  • 183.
    Karlsson, Nadine
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Borg, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, Faculty of Health Sciences.
    Hensing, Gunnel
    Department of Social Medicine, Sahlgrenska Academy, University of Göteborg, Göteborg, Sweden.
    Alexanderson, Kristina
    Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Risk of disability pension in relation to sex and age in a Swedish county 1985-1996; A 12-year prospective cohort study.2004Conference paper (Other academic)
    Abstract [en]

    Background

    Number of persons on disability pension is increasing in many countries. So far the nowledge on risk for disability pension in a population over time is very limited.

    Aim

    To estimate the cumulative probability of disability pension among women and men in different age groups over a 12-year period.

    Methods

    A population-based prospective longitudinal cohort study. All the 229,864 sick-insured individuals, aged 16–64 years in the Swedish County of Östergötland in 1984 who then had no disability or old age pension were followed to 1996. The following data was obtained for each of the 12 years for all the individuals: disability pension status, old-age retirement status, and date of death. The probability of being granted disability pension over the study period was estimated using life tables. The risk for disability pension was modelled as a function of sex and age using a Cox's proportional hazards model. 95% confidence intervals were calculated.

    Results

    The cumulative estimates of the probability (in %) of being granted disability pension over 5 years adjusted for mortality and age retirement were, respectively 0.3, 0.9, 1.8, 6.3, and 22.8 for men and 0.4, 1.4, 3.2, 9.2, and 21.5 for women in the age groups 16–24, 25–34, 35–44, 45–54, and 55–64 years. The probabilities increased much over the years, more so for the women. The hazard ratios of disability pension for women vs. men were 1.6 (1.4–1.8), 1.9 (1.7–2.0), 1.7 (1.6–1.8), 1.2 (1.2–1.3), and 0.9 (0.9–0.9) in the same five age groups.

    Conclusions

    There were significant both age and sex differences in the risk of being granted disability pension. The former was expected but that the later was so large and differed with ages was not expected. Except for the age group 55–64 years, women had a higher risk of disability pension than men. More knowledge is needed on factors affecting this.

  • 184.
    Karlsson, Nadine
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Carstensen, John
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Gjesdal, Sturla
    Personskadeprevention Karolinska Institutet.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Mortality in relation to disability pension: findings from a 12-year prospective population-based cohort study in Sweden.2007In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 35, no 4, p. 341-347Article in journal (Refereed)
  • 185.
    Karlsson, Nadine
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Carstensen, John
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medicine and Health Sciences, Health and Society.
    Gjesdal, Sturla
    Socialmedicin Bergen Norge.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Risk factors for disability pension in a population-based cohort of men and women on long-term sick leave in Sweden2008In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 18, no 3, p. 224-231Article in journal (Refereed)
    Abstract [en]

    Background: Knowledge on predictors of disability pension is very limited. The aim was to assess the importance of sick-leave diagnosis and socio-demographic variables as risk factors for disability pension among individuals on long-term sickness absence and to compare these factors by gender and over time. Methods: A prospective population-based cohort study in Östergötland County, Sweden, included 19 379 individuals who, in 1985-87, were aged 16-60 years and had a new spell of long-term sickness absence lasting <56 days. Follow-up was done in two time frames: 0-5 and 6-10 years after inclusion. The risk of disability pension in relation to sick-leave diagnosis and socio-demographic factors was assessed by Cox proportional hazard regression analysis. Results: In 5 years, after inclusion, 28% of the cohort had been granted disability pension. Those with higher age, low income, previous sick leave, no employment and non-Swedish origin had higher risk of disability pension, while those with young children had lower risk. Considering the inclusion diagnosis, the pattern differed between men and women (P < 0.001). Among men, those with mental disorders had the highest risk and among women those with musculoskeletal disorders. Except for income, the effect of which was reversed over time, the overall pattern of disability pension predictors remained 6-10 years after inclusion but was attenuated. Conclusion: Besides socio-demographic risk factors, the sick-leave diagnoses constitute an important both medium and long-term predictor of disability pension among both men and women on long-term sickness absence. © 2008. The Author(s).

  • 186.
    Karlsson, Nadine
    et al.
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Skargren, Elisabeth
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Emotional support predicts more sickness absence and poorer self assessed work ability: a two-year prospective cohort study2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, no 1, p. 648-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: While back pain and stressful work environment are shown to be important causes of sickness absence the effect of psychosocial resources on sickness absence, and on self assessed work ability, is less commonly investigated. The aim of this study was to assess these associations in a two-year follow-up study.

    METHODS: 341 working people aged 45 to 64, randomly drawn from the population, responded to a questionnaire at baseline and at a two-year follow-up. Poisson regression was used to analyse the association of psychosocial factors (psychosocial instruments on work environment, emotional support and psychological resources) and previous back pain (low back and/or neck) at baseline with sickness absence (spells and days) at follow-up, controlling for effects of age, sex, BMI, smoking, alcohol, occupation, disease and previous sickness absence. Logistic regression was used to study the associations of psychosocial factors and previous back pain at baseline with self assessed prognosis of poor work ability six months from follow-up. Finally, a multivariate analysis tested the independent effects of previous back pain and 3 psychosocial factors derived in a factor analysis: 1. work environment; 2. emotional support; 3. psychological resources, on work ability and absence days and spells.

    RESULTS: 80% of the sickness absence spells within the last 12 months before follow-up were short-term (<= 14 days). In the final model, high emotional support predicted more sickness absence spells (RR 1.36; 1.11-1.67) and days (RR 1.68, 1.22-2.31). Previous back pain (OR 2.56; 1.13-5.81), high emotional support (OR 1.58; 1.02-2.46), and low psychological resources (OR 0.62; 0.44-0.89) were related to poorer self assessed prognosis of work ability at follow up.

    CONCLUSIONS: In a general middle aged working population high emotional support was related to more sickness absence and also poorer self assessed prognosis of work ability. Our findings suggest that both sickness absence and self assessed work ability are dependent of life outside work and can be affected by a person's close community.

  • 187.
    Karlén, Jerker
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Lowert, Yvonne
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Chatziarsenis, KM
    Clinic of Social and Family Medicine, School of Medicine, University of Crete, Greece.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Fälth-Magnusson, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Are children from Crete abandoning a Mediterranean diet?2008In: Rural and remote health, ISSN 1445-6354, Vol. 8, no 4, p. 1034-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    Mediterranean countries such as Greece have experienced rapid social change in the last decade. These community changes affect nutritional habits and there is a tendency for the traditional healthy Mediterranean diet to be abandoned.

    METHODS:

    The parents of children from one rural Greek village on Crete (Neapolis), and one rural village in Sweden (Kisa) were invited to their primary health care centers for an interview and to fill in a validated nutrition questionnaire, KidMed.

    RESULTS:

    There were no differences (p = 0.48) in total KidMed score between the Cretan and Swedish children, adjusted for gender and age. However, there were some significant differences in scores on certain KidMed questions. Parents of the Cretan children reported significantly higher daily use of olive oil at home and more regular nut consumption, but also more commercially baked goods or pastries for breakfast. The parents of Swedish children reported significantly higher use of cereals, grains or bread for breakfast. The mean BMIs were similar for the Cretan (Neapolis mean 16.8, 95% CI 13.5-23.0) and for the Swedish children (Kisa mean 17.4, 95% CI 13.7-25.5)

    CONCLUSION:

    The results suggest the possibility of changing nutritional habits, measurable among young children in rural areas. The study raises the question of whether Cretan children may have abandoned some aspects of the traditional Mediterranean diet. It may also be that Swedish children have changed their diet in favor of a more Mediterranean food choice. The major limitation of the study is the small sample size, and further, larger studies are warranted.

  • 188.
    Kerkhoffs, Gino M M J
    et al.
    University of Amsterdam, Netherlands .
    van Es, Nick
    University of Amsterdam, Netherlands .
    Wieldraaijer, Thijs
    University of Amsterdam, Netherlands .
    Sierevelt, Inger N.
    University of Amsterdam, Netherlands .
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Niek van Dijk, C
    University of Amsterdam, Netherlands .
    Diagnosis and prognosis of acute hamstring injuries in athletes2013In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 21, no 2, p. 500-509Article in journal (Refereed)
    Abstract [en]

    Identification of the most relevant diagnostic and prognostic factors of physical examination and imaging of hamstring injuries in (elite) athletes. less thanbrgreater than less thanbrgreater thanA literature search was conducted in MEDLINE and EMBASE for articles between 1950 and April 2011. A survey was distributed among the members of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy, which focused on physical examination, prognosis, imaging and laboratory tests of hamstring injuries in (elite) athletes. less thanbrgreater than less thanbrgreater thanMedical history, inspection and palpation of the muscle bellies and imaging are most valuable at the initial assessment according to the literature. Experts considered medical history, posture and gait inspection, inspection and palpation of muscle bellies, range of motion tests, manual muscle testing, referred pain tests and imaging to be most important in the initial assessment of hamstring injuries. Magnetic resonance imaging (MRI) is preferred over ultrasonography and should take place within 3 days post-trauma. Important prognostic factors are injury grade, length of the muscle tear on MR images, MRI-negative injuries and trauma mechanism. less thanbrgreater than less thanbrgreater thanPosture and gait inspection, inspection and palpation of muscle bellies, range of motion tests, manual muscle testing and referred pain tests within 2 days post-trauma were identified as the most relevant diagnostic factors. less thanbrgreater than less thanbrgreater thanLiterature review and expert opinion, Level V.

  • 189.
    Keurhorst, Myrna N.
    et al.
    Radboud University of Nijmegen, Netherlands.
    Anderson, Peter
    Newcastle University, United Kingdom.
    Spak, Fredrik
    University of Gothenburg, Sweden.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Segura, Lidia
    Government of Catalonia, Barcelona, Spain.
    Colom, Joan
    Government of Catalonia, Barcelona, Spain.
    Reynolds, Jillian
    Hospital Clin Barcelona, Spain.
    Drummond, Colin
    Kings Coll London, England.
    Deluca, Paolo
    Kings Coll London, England.
    van Steenkiste, Ben
    Maastricht University, Netherlands.
    Mierzecki, Artur
    Pomeranian Medical University, Poland.
    Kloda, Karolina
    Pomeranian Medical University, Poland.
    Wallace, Paul
    UCL, England.
    Newbury-Birch, Dorothy
    Fac Med, England.
    Kaner, Eileen
    Fac Med, England.
    Gual, Toni
    Hospital Clin Barcelona, Spain.
    Laurant, Miranda G H.
    Radboud University of Nijmegen, Netherlands.
    Implementing training and support, financial reimbursement, and referral to an internet-based brief advice program to improve the early identification of hazardous and harmful alcohol consumption in primary care (ODHIN): study protocol for a cluster randomized factorial trial2013In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 8Article in journal (Refereed)
    Abstract [en]

    Background

    The European level of alcohol consumption, and the subsequent burden of disease, is high compared to the rest of the world. While screening and brief interventions in primary healthcare are cost-effective, in most countries they have hardly been implemented in routine primary healthcare. In this study, we aim to examine the effectiveness and efficiency of three implementation interventions that have been chosen to address key barriers for improvement: training and support to address lack of knowledge and motivation in healthcare providers; financial reimbursement to compensate the time investment; and internet-based counselling to reduce workload for primary care providers.

    Methods/design

    In a cluster randomized factorial trial, data from Catalan, English, Netherlands, Polish, and Swedish primary healthcare units will be collected on screening and brief advice rates for hazardous and harmful alcohol consumption. The three implementation strategies will be provided separately and in combination in a total of seven intervention groups and compared with a treatment as usual control group. Screening and brief intervention activities will be measured at baseline, during 12 weeks and after six months. Process measures include health professionals’ role security and therapeutic commitment of the participating providers (SAAPPQ questionnaire). A total of 120 primary healthcare units will be included, equally distributed over the five countries. Both intention to treat and per protocol analyses are planned to determine intervention effectiveness, using random coefficient regression modelling.

    Discussion

    Effective interventions to implement screening and brief interventions for hazardous alcohol use are urgently required. This international multi-centre trial will provide evidence to guide decision makers.

  • 190.
    Kivimaki, M.
    et al.
    Kivimäki, M., Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom, International Institute for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, London, United Kingdom, Finnish Institute of Occupational Health, Helsinki, Finland.
    Ferrie, J.E.
    International Institute for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, London, United Kingdom.
    Hagberg, J.
    Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Head, J.
    International Institute for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, London, United Kingdom.
    Westerlund, H.
    National Institute for Psychosocial Medicine, Stockholm, Sweden.
    Vahtera, J.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Diagnosis-specific sick leave as a risk marker for disability pension in a Swedish population2007In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 61, no 10, p. 915-920Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate diagnosis-specific sick leave as a risk marker for subsequent disability pension. Design: A prospective population based cohort study. Exposure to a new medically certified sick leave episode of more than seven days by diagnosis during 1985 was examined in relation to incident cause-specific disability pension through 1996. Participants: The total non-retired population of one Swedish county aged 16 to 49 years, alive and not in receipt of a disability pension at the end of 1985 (176 629 persons, 51% men). Main results: To eliminate confounding by sick leaves that translate into a disability pension, the follow up period for disability pension was started five years after the assessment of sick leave. After adjustment for demographic characteristics, the risk of disability pension from mental disorders was 14.1 times higher (95% confidence interval (CI), 12.1 to 16.4) for those with sick leave for mental disorders than for those with no sick leave. The corresponding hazard ratio for sick leave and disability pension within diagnostic category was 5.7 (95% CI, 5.3 to 6.2) for musculoskeletal diseases and 13.0 (7.7 to 21.8) for gastrointestinal diseases. Irrespective of diagnoses, the hazard ratio for sick leave and disability pension was 3.0 (2.9 to 3.1). Conclusions: Sick leave may provide an important risk marker for identifying groups at high risk of a disability pension, especially for psychiatric diagnoses.

  • 191.
    Klanghed Müssener, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences and Learning, Sociology. Linköping University, Faculty of Arts and Sciences.
    Alexandersson, Kristina
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Positive encounters with rehabilitation professionals reported by persons with experience of sickness absence2004In: Work: A Journal of Prevention, Assessment & Rehabilitation, ISSN 1051-9815, Vol. 22, no 3, p. 247-254Article in journal (Refereed)
    Abstract [en]

    More knowledge is needed on different factors that can promote return to work among sick-listed persons. One such factor might be by their interactions with the rehabilitation professionals they encounter. The aim of the present study was to identify and analyze statements about positive encounters with rehabilitation staff, reported by persons who had been absent from work with back, neck, or shoulder diagnoses. A descriptive and explorative qualitative approach was used to analyze data from five focus-group interviews. There were few statements on positive encounters, and they were frequently attributed to sheer luck. Experiences of positive encounters were assigned to two major categories: respectful treatment and supportive treatment. Receiving adequate medical examination or treatment was also mentioned as being positive. Further efforts are needed to study and develop methods for investigating interactions with rehabilitation professionals that laypersons experience as positive and that may contribute to empowerment and influence return to work when sickness absent.

  • 192.
    Kragh, Annika M
    et al.
    Hassleholm Hospital.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Apelqvist, Anna
    Hassleholm Hospital.
    Wagner, Philippe
    Lund University.
    Atroshi, Isam
    Hassleholm Hospital.
    Bleeding and first-year mortality following hip fracture surgery and preoperative use of low-dose acetylsalicylic acid: an observational cohort study2011In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 12, no 254Article in journal (Refereed)
    Abstract [en]

    Background: Hip fracture is associated with high mortality. Cardiovascular disease and other comorbidities requiring long-term anticoagulant medication are common in these mostly elderly patients. The objective of our observational cohort study of patients undergoing surgery for hip fracture was to study the association between preoperative use of low-dose acetylsalicylic acid (LdAA) and intraoperative blood loss, blood transfusion and first-year all-cause mortality. less thanbrgreater than less thanbrgreater thanMethods: An observational cohort study was conducted on patients with hip fracture (cervical requiring hemiarthroplasty or pertrochanteric or subtrochanteric requiring internal fixation) participating in a randomized trial that found lack of efficacy of a compression bandage in reducing postoperative bleeding. The participants were 255 patients (andgt;= 50 years) of whom 118 (46%) were using LdAA (defined as andlt;= 320 mg daily) preoperatively. Bleeding variables in patients with and without LdAA treatment at time of fracture were measured and blood transfusions given were compared using logistic regression. The association between first-year mortality and preoperative use of LdAA was analyzed with Cox regression adjusting for age, sex, type of fracture, baseline renal dysfunction and baseline cardiovascular and/or cerebrovascular disease. less thanbrgreater than less thanbrgreater thanResults: Blood transfusions were given postoperatively to 74 (62.7%) LdAA-treated and 76 (54%) non-treated patients; the adjusted odds ratio was 1.8 (95% CI 1.04 to 3.3). First-year mortality was significantly higher in LdAA-treated patients; the adjusted hazard ratio (HR) was 2.35 (95% CI 1.23 to 4.49). The mortality was also higher with baseline cardiovascular and/or cerebrovascular disease, adjusted HR 2.78 (95% CI 1.31 to 5.88). Patients treated with LdAA preoperatively were significantly more likely to suffer thromboembolic events (5.7% vs. 0.7%, P = 0.03). less thanbrgreater than less thanbrgreater thanConclusions: In patients with hip fracture (cervical treated with hemiarthroplasty or pertrochanteric or subtrochanteric treated with internal fixation) preoperative use of low-dose acetylsalicylic acid was associated with significantly increased need for postoperative blood transfusions and significantly higher all-cause mortality during one year after surgery.

  • 193.
    Kristenson, Karolina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Bjørneboe, John
    Norwegian School Sport Science, Norway.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Andersen, Thor Einar
    Norwegian School Sport Science, Norway.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    The Nordic Football Injury Audit: higher injury rates for professional football clubs with third-generation artificial turf at their home venue2013In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 12, p. 775-781Article in journal (Refereed)
    Abstract [en]

    Background Previously, no difference in acute injury rate has been found when playing football on artificial turf (AT) compared with natural grass (NG).

    Aim To compare acute injury rates in professional football played on AT and NG at the individual player level; and to compare, at club level, acute and overuse injury rates between clubs that have AT at their home venue (AT clubs) and clubs that have NG (NG clubs).

    Methods 32 clubs (AT, n=11; NG, n=21) in the male Swedish and Norwegian premier leagues were followed prospectively during the 2010 and 2011 seasons. Injury rate was expressed as the number of time loss injuries/1000 h and compared with rate ratio (RR) and 99% CI.

    Results No statistically significant differences were found in acute injury rates on AT compared with NG during match play (RR 0.98, 99% CI 0.79 to 1.22) or training (RR 1.14, 99% CI 0.86 to 1.50) when analysing at the individual player level. When analysing at the club level, however, AT clubs had a significantly higher acute training injury rate (RR 1.31, 99% CI 1.04 to 1.63) and overuse injury rate (RR 1.38, 99% CI 1.14 to 1.65) compared with NG clubs.

    Conclusions At the individual player level, no significant differences were found in acute injury rates when playing on AT compared with NG. However, clubs with AT at their home venue had higher rates of acute training injuries and overuse injuries compared with clubs that played home matches on NG.

  • 194.
    Kristenson, Karolina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Lower Injury Rates for Newcomers to Professional Soccer: a Prospective Cohort Study over Nine Consecutive Seasons2013In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 41, no 6, p. 1419-1425Article in journal (Refereed)
    Abstract [en]

    Background: No study has investigated whether newcomers to professional soccer have a different injury rate than established players.                     

    Purpose: The primary objective was to investigate whether being a newcomer to professional soccer influences injury rates. The secondary objective was to evaluate whether playing position and player age influence injury rates.                     

    Study Design: Cohort study; Level of evidence, 2.                     

    Methods: Twenty-six soccer clubs, with 1401 players, were followed prospectively over 9 consecutive seasons between 2001 and 2010. Club medical staff recorded time-loss injuries and soccer exposure on an individual level. Cox regression analyses were used to evaluate associations between time-loss injuries and time in professional soccer, playing position, and age.                     

    Results: In total, 6140 injuries and 797,389 hours of exposure were registered. A decreased general injury rate was observed for newcomers (n = 116) compared with established players (n = 3091) (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.61-0.99). In contrast, newcomers had a higher rate of fractures (rate ratio [RR], 1.77; 95% CI, 1.05-2.97), especially stress-related bone injuries (RR, 2.68; 95% CI, 1.08-6.69). Using goalkeepers as a reference, all outfield playing positions had significantly higher adjusted injury rates: defenders with an HR of 1.91 (95% CI, 1.64-2.24), midfielders with an HR of 1.78 (95% CI, 1.53-2.07), and forwards with an HR of 1.82 (95% CI, 1.55-2.14). Using players aged ≤21 years as a reference, the overall adjusted injury rate increased with age, with a peak injury rate among players aged 29 to 30 years (HR, 1.44; 95% CI, 1.24-1.68).                     

    Conclusion: Newcomers to professional soccer had a lower general injury rate than established players but a higher rate of stress-related bone injuries. Being a goalkeeper was associated with lower injury rates than all outfield playing positions. Injury rates increased with age, a pattern that persisted after adjusting for playing position and match exposure.

  • 195.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Impact of socioeconomic determinants on psychosocial factors and lifestyle - implications for health service: The Swedish experience2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 74, no 5, p. 661-664Article in journal (Refereed)
    Abstract [en]

    n/a

  • 196.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    LEVELS OF SALIVA CORTISOL AS PREDICTOR FOR SOMATIC OUTCOMES in INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, vol 17, issue , pp 207-2072010In: INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, Springer Science Business Media , 2010, Vol. 17, p. 207-207Conference paper (Refereed)
    Abstract [en]

    n/a

  • 197.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Rethinking health promotion: a global approach.2001In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 11, no 3, p. 354-354Article, book review (Other academic)
  • 198.
    Kristenson, Margareta
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Lindfors, Petra
    Stockholm University.
    Lundberg, Ulf
    Stockholm University.
    Harris, Anette
    University of Bergen.
    Hansen, Ase M
    University of Copenhagen.
    Garvin, Peter
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ursin, Holger
    University of Bergen.
    THE ROLE OF SALIVA CORTISOL MEASUREMENTS IN HEALTH AND DISEASE - A MATTER OF THEORY AND METHODOLOGY in INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, vol 17, issue , pp 206-2062010In: INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, Springer Science Business Media , 2010, Vol. 17, p. 206-206Conference paper (Refereed)
    Abstract [en]

    n/a

  • 199.
    Kristenson, Margareta
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lundberg, Johanna
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Garvin, Peter
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Socioeconomic differences in outpatient healthcare utilisation are mainly seen for musculoskeletal problems in groups with poor self-rated health2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 8, p. 805-812Article in journal (Refereed)
    Abstract [en]

    Aim: To assess whether there are socioeconomic (SES) differences in outpatient visits within groups of comparable morbidity (medical disease and self-rated health) and whether psychosocial factors can explain these differences. Methods: Baseline data for SES, presence of disease, self-rated health (SRH), and psychosocial factors were collected during 2003-04 from 923 men and women aged 45-69 years in southeast Sweden. Outcome data were all registered outpatient healthcare visits to physicians during 2004-08. Cumulative incidences and standardised rate ratios (SSR) were calculated for strata of comparable morbidity for all visits, for visits due to cardiovascular disorders (CVD)/diabetes and for musculoskeletal problems. Results: Low SES was associated with more outpatient visits due to musculoskeletal problems (SRR for education 1.52, 95% CI 1.35-1.73; for occupation 1.40, 95% CI 1.26-1.56) and accentuated in groups with poor SRH. The SES effect was significant for visits to primary care and to hospitals, for men and women, and independent of present disease, SRH, and psychosocial factors. Low SES was significantly associated with more total outpatient visits at primary healthcare centres. In contrast, for outpatient visits due to CVD/diabetes, high SES was related to more visits to hospitals among people with good SRH at baseline. Conclusions: We found a consistent pattern for outpatient visits related to musculoskeletal problems where people with low SES counted more visits and this was most prominent in groups of poor SRH. The results demonstrate the need to apply different morbidity measures when studying inequalities in healthcare utilisation.

  • 200.
    Kullberg, Agneta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Area crime and resident worry of crime -:  a comparative study in a Swedish urban community2008In: 9th World Conference on injury prevention and safety promotion March 15-18 2008, 2008, p. 286-286Conference paper (Refereed)
1234567 151 - 200 of 438
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