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  • 151.
    Nordenfelt, Lennart
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    The Concept of Work Ability2008Book (Refereed)
    Abstract [en]

    This book contains a systematic analysis of the notion of work ability. The analysis is particularly focused on the following three contexts: medical insurance, training for a vocation or a profession and evaluation of a job seeker. The first part of the book presents and briefly analyzes some methods and instruments designed for characterizing and assessing work ability. The second part gives a theoretical foundation for the analysis of work ability. Here the author presents an original taxonomy of competencies and other qualifications for work and proposes a new definition of work ability. The third part is devoted to the issue of work ability and its relation to medical conditions. In addition to a description of certain legislations in the medico-insurance field, this part of the book contains a substantial analysis of the notion of disease and an attempt to determine whether there is a viable notion of disease that can answer the demands of objectivity raised by offices of social insurance.

  • 152.
    Nordenfelt, Lennart
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    The Nature of Vital Goals: Comment on Andrew Bloodworths Review of Rationality and Compulsion in Health Care Analysis(ISSN 1065-3058), vol 17, issue 1, pp 92-942009In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 17, no 1, p. 92-94Article in journal (Refereed)
  • 153.
    Nordenfelt, Lennart
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    The opposition between naturalistic and holistic theories of health and disease2013In: Health, illness and disease: philosophical essays / [ed] Havi Carel and Rachel Cooper, Durham UK: Acumen Publishing, 2013, 1, p. 23-36Chapter in book (Other academic)
    Abstract [en]

    What counts as health or ill health? How do we deal with the fallibility of our own bodies? Should illness and disease be considered simply in biological terms, or should considerations of its emotional impact dictate our treatment of it?  Our understanding of health and illness had become increasingly more complex in the modern world, as we are able to use medicine not only to fight disease but to control other aspects of our bodies, whether mood, blood pressure, or cholesterol. This collection of essays foregrounds the concepts of health and illness and patient experience within the philosophy of medicine, reflecting on the relationship between the ill person and society. Mental illness is considered alongside physical disease, and the important ramifications of society's differentiation between the two are brought to light. Health, Illness and Disease is a significant contribution to shaping the parameters of the evolving field of philosophy of medicine and will be of interest to medical practitioners and policy-makers as well as philosophers of science and ethicists.

  • 154.
    Nordenfelt, Lennart
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medicine and Health Sciences, Health and Society.
    The varieties of dignity2004In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 12, no 2, p. 69-81Article in journal (Refereed)
    Abstract [en]

    As a part of a research project on Dignity and Older Europeans ( Fifth Framework (Quality of Life) Programme(3)) I explore in this paper a set of notions of human dignity. The general concept of dignity is introduced and characterized as a position on a value scale and it is further specified through its relations to the notions of right, respect and self-respect. I present four kinds of dignity and spell out their differences: the dignity of merit, the dignity of moral or existential stature, the dignity of identity and the universal human dignity (Menschenwurde). Menschenwurde pertains to all human beings to the same extent and cannot be lost as long as the persons exist. The dignity of merit depends on social rank and position. There are many species of this kind of dignity and it is very unevenly distributed among human beings. The dignity of merit exists in degrees and it can come and go. The dignity of moral stature is the result of the moral deeds of the subject, likewise it can be reduced or lost through his or her immoral deeds. This kind of dignity is tied to the idea of a dignified character and of dignity as a virtue. The dignity of moral stature is a dignity of degree and it is also unevenly distributed. The dignity of identity is tied to the integrity of the subject's body and mind, and in many instances, although not always, also dependent on the subject's self-image. This dignity can come and go as a result of the deeds of fellow human beings and also as a result of changes in the subject's body and mind.

  • 155.
    Nordenfelt, Lennart
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Värdighet i vården av äldre personer2010Collection (editor) (Other academic)
    Abstract [sv]

    I flera årtionden har livskvalitet varit ett vedertaget begrepp i den etiska diskussionen om hälso- och sjukvården och vården av äldre. På senare tid har dock begreppet värdighet kommit att ta en större plats i denna diskussion. Värdighet i vården av äldre personer belyser begreppet värdighet inom äldreomsorgen och fokuserar på vikten av teoretiska begrepp. Boken baseras till största delen på forskningsprojektet Dignity and older Europeans och den beskriver ingående begreppet värdighet samt relaterade begrepp som livskvalitet och autonomi. Begreppsundersökningen resulterar i en värdighetsmodell med fyra varianter av värdighet: meritvärdighet, den moraliska resningens värdighet, identitetsvärdighet och människovärdet (Menschenwürde, det specifikt mänskliga värdet). Av detta följer en diskussion om hur dessa varianter av värdighet kan tillämpas för att karaktärisera vården av äldre. Begreppen värdighet och värdig vård diskuteras, särskilt i samband med personer med demens och döende personer. Boken innehåller också ett kapitel om den döda personens värdighet. Genom dess internationella perspektiv ger Värdighet i vården av äldre personer ett högst aktuellt bidrag till den pågående diskussionen om vården av äldre. Boken vänder sig till blivande och redan yrkesverksamma sjuksköterskor samt personer inom den sociala omsorgen som arbetar med äldre.

  • 156.
    Nordenfelt, Lennart
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Edgar, Andrew
    Cardiff University, UK.
    The four notions of dignity2005In: Quality in Aging: Policy, Practice and Research (Quality in Ageing and Older Adults), ISSN 1471-7794, Vol. 6, no 1, p. 17-21Article in journal (Refereed)
    Abstract [en]

    This paper presents the theoretical model of dignity that has been created within the Dignity and Older Europeans (DOE) Project. The model consists of four kinds of dignity: the dignity of merit; the dignity of moral stature; the dignity of identity; and Menschenwurde.

    1) The dignity of merit depends on social rank and formal positions in life. There are many species of this kind of dignity and it is very unevenly distributed among human beings. The dignity of merit exists in degrees and it can come and go.

    2) The dignity of moral stature is the result of the moral deeds of the subject; likewise it can be reduced or lost through his or her immoral deeds. This kind of dignity is tied to the idea of a dignified character and of dignity as a virtue. The dignity of moral stature is a dignity of degree and it is also unevenly distributed among humans.

    3) The dignity of identity is tied to the integrity of the subject's body and mind, and in many instances, although not always, dependent on the subject's self-image. This dignity can come and go as a result of the deeds of fellow human beings and also as a result of changes in the subject's body and mind.

    4) Menschenwurde is the universal dignity that pertains to all human beings to the same extent and cannot be lost as long as the person exists.

  • 157.
    Nordin, Ingemar
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Animal Rights - a critical study2001Book (Other academic)
    Abstract [en]

    Do animals have rights similar to humans? In the philosophical debate concerning this question there have been two major ethical approaches. One of them is Peter Singer’s utilitarian theory, and the other is Tom Regan’s theory of animal rights. In this work these arguments for animal rights are extensively presented and discussed. Contrary to Singer and Regan, it is argued that there are ethically relevant biological distinctions between non-human animals and all humans. Although there are still good moral reasons for treating animals in a humane way, the main arguments for claiming that animals have rights equal to humans do not hold water. Militant animal rights activists have no moral ground for their actions.

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  • 158.
    Nordin, Ingemar
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medicine and Health Sciences, Health and Society.
    Complex causation and the virtue of pluralism2006In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 9, no 3, p. 321-323Article in journal (Refereed)
    Abstract [en]

    [No abstract available]

  • 159.
    Nordin, Ingemar
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Kritik och pseudovetenskap i klimatfrågan2009In: Folkvett, ISSN 0283-0795, Vol. 27, no 1, p. 31-37Article in journal (Refereed)
  • 160.
    Nordin, Ingemar
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Health and Society.
    Kunskapsanvändning och rationalitet i medicinen2010In: Implementering / [ed] Per Nilsen, Lund: Studentlitteratur , 2010, 1, p. 147-164Chapter in book (Other academic)
    Abstract [sv]

    Frågor kring implementering av forskningsbaserad kunskap i hälso- och sjukvårdens verksamhet får allt större uppmärksamhet. Det så kallade gapet mellan produktion av forskningsresultat och vad som nyttiggörs i vården diskuteras i dag som ett stort problem, såväl för samhället som för de individer som inte erbjuds bästa möjliga vård. Denna bok utgör en introduktion till teoribildning och forskningsrön inom flera kunskapsområden som har relevans för frågor kring implementering inom hälso- och sjukvården. Samtliga författare är verksamma som forskare vid den tvärvetenskapliga institutionen för medicin och hälsa vid Linköpings universitet. Boken vänder sig till studenter, lärare och forskare som intresserar sig för implementeringsfrågor samt till dem som arbetar praktiskt med implementerings- och förändringsarbete inom hälso- och sjukvård. Läs mer om redaktören Läs mer om doktorandkursen IMPLEMENTERING ht 2011 Linköpings Universitet

  • 161.
    Nordin, Ingemar
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Rationalitet utan tro2011In: Norsk Filosofisk Tidsskrift, ISSN 0029-1943, E-ISSN 1504-2901, Vol. 32, no 1, p. 31-43Article in journal (Refereed)
  • 162.
    Nordin, Ingemar
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Science fiction och filosofi2010In: Möjliga Världar: Tekniken, vetenskapet och science fiction / [ed] Michael Godhe och Jonas Ramsten, Stockholm: Carlssons , 2010, 1, , p. 15p. 101-115Chapter in book (Other academic)
    Abstract [sv]

    Vad har Harry Martinsons Aniara gemensamt med filmen Blade runner? Båda ingår i genren science fiction, en genre som har vuxit till en av vår tids mest vitala och populära uttrycksformer. Redan på 20-talet uppkom sf-klubbar inom vilka fans brevväxlade och även träffades på riktigt. det dröjde dock länge innan science fiction kom att uppmärksammas i den akademiska världen. Genren ansågs länge mestadels vara en oseriös och spekulativ verklighetsflykt. Sakta men säkert börjar nu science fiction bli accepterad som forskningsfält inom den akademiska världen. Den används bland annat för att illustrera filosofiska frågor, för att diskutera hur vetenskapliga teorier fungerar eller för att problematisera den teknovetenskapliga utvecklingens betydelse för samhälle och kultur. I den här antologin visar 12 forskare från skilda ämnesområden på hur rikt och fruktsamt science fiction är som forskningsfält. Boken är indelad i fyra delar: Vad är science fiction? De eviga frågorna, Nya perspektiv, och framtiden. Bokens redaktörer Mikael Godhe och Jonas Ramsten är båda verksamma vid Campus Norrköping, Linköpings universitet och undervisar vid Kultur, samhälle och mediegestaltning

  • 163.
    Nordin, Ingemar
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Sydenham och Locke2012In: Filosofi och medicin: från Platon till Foucault / [ed] Lennart Nordenfelt, Stockholm: Thales, 2012, p. 91-108Chapter in book (Other academic)
    Abstract [sv]

    Filosofi och medicin tar upp den medicinska ska filosofins centrala frågeställningar som de behandlas av några framträdande läkare, filosofer och andra tänkare från Platon till Foucault.

  • 164.
    Nordin, Ingemar
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Technology and Goodmans' Paradox2009In: Philosophy of science (East Lansing), ISSN 0031-8248, E-ISSN 1539-767X, Vol. 76, no 3, p. 345-354Article in journal (Refereed)
    Abstract [en]

    Goodmans paradox gives rise to a cluster of problems, problems that are in need of different answers. I will discuss some variants of the grue hypothesis applied to the technological context. One conclusion in this paper is that there is room for rational decisions, and that solutions to the paradoxes in technology can be found in the practical choice situation.

  • 165.
    Nordin, Ingemar
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Varför måste vi tro på något?2010In: Filosofisk Tidskrift, ISSN 0348-7482, Vol. 31, no 2, p. 35-40Article in journal (Refereed)
  • 166.
    Nordlund, Lars Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Pershagen, Göran
    Karolinska institutet, Stockholm.
    Are male and female smokers at equal risk of smoking-related cancer: evidence from a Swedish prospective study1999In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 27, no 1, p. 56-62Article in journal (Refereed)
    Abstract [en]

    This study examines sex differences in the relative risks of lung cancer and other smoking-related cancers (i.e. cancers of the upper respiratory tract, oesophagus, pancreas, bladder, and renal pelvis). Data on smoking habits in 1963 from a random sample of 56,000 men and women were linked with information on new cases of cancer for 1964-89. Compared with people who have never smoked, the relative risks of lung cancer at different levels of pack-years completed in 1963 (>5, 6-15, 16-25 and 25 + pack-years) were 1.6, 4.4, 14.2, and 17.9 for men, and 2.1, 6.3, 10.3, and 16.5 for women. The corresponding relative risks of other smoking-related cancers were 1.8, 3.0 5.4, and 6.4 for men, and 2.0, 3.1, 5.0, and 6.5 for women. These results suggest that men and women have similar relative risks of smoking-related cancers at different levels of smoking.

  • 167.
    Nordlund, Lars Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Pershagen, Göran
    Karolinska institutet, Stockholm.
    Cancer incidence in female smokers: a 26-year follow-up1997In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 73, no 5, p. 625-628Article in journal (Refereed)
    Abstract [en]

    A random sample of 26,000 Swedish women who were asked about their smoking habits in the early 1960s have now been followed for 26 years with respect to cancer incidence. Most findings regarding tobacco smoking and cancer from studies of men were confirmed also among the women. Elevated relative risk for current smokers compared with women who never smoked regularly were seen for cancers of the lung, upper aerodigestive sites, pancreas, bladder, cervix and all cancers combined, as well as a notably high relative risk for cancers of organs of the urinary tract other than kidney and bladder. Relative risk increased with dose, measured as grams of tobacco smoked per day, for cancers of the upper aerodigestive sites, lung, cervix, bladder, organs of the urinary tract other than kidney and bladder and all cancers combined. For cancers of the lung, bladder and cervix, there was an inverse relationship with age when starting to smoke tobacco. The reported inverse relationship between smoking and endometrial cancer could not be corroborated, nor was there any significant relationship between smoking and colorectal or breast cancer.

  • 168.
    Nygren, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Sepa, Anneli
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Adult attachment and parenting stress among parents of toddlers2012In: Journal of Reproductive and Infant Psychology, ISSN 0264-6838, E-ISSN 1469-672X, Vol. 30, no 3, p. 289-302Article in journal (Refereed)
    Abstract [en]

    Objective: The aim was to revise the dimensionality of the Relationship Scales Questionnaire (RSQ) assessing adult attachment and relate it to parenting stress within a large sample of parents of toddlers. Methods: As part of a longitudinal population-based study, 8122 parents (97% mothers) completed the 18-item version of RSQ and the Swedish Parenthood Stress Questionnaire (SPSQ) when their child was 2-3 years of age. Results: Exploratory factor analyses gave three uncorrelated RSQ factors named (1) Importance of Independence, (2) Relationship-related Anxiety, and (3) Discomfort with Closeness, with Cronbachs alpha andgt;= 0.65. In a linear regression Parenting Stress was most closely related to Relationship-related Anxiety (b = 0.20, t = 39.0), weaker associations were found with the attachment dimensions capturing avoidance: Importance of Independence (b = 0.07, t = 13.40) and Discomfort with Closeness (b = 0.07, t = 12.04). The SPSQ subscales Incompetence (R-2 = 17%) and Social Isolation (R-2 = 22%) showed stronger association with adult attachment than the remaining three. Conclusion: The agreement with previous findings in other study populations indicates that substantial and meaningful dimensions of attachment have been captured. Attachment anxiety and discomfort with closeness seem to have an important relationship with the perception of parenting stress, especially concerning feelings of incompetence and social isolation.

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  • 169. Order onlineBuy this publication >>
    Nygren, Victoria
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Mellan två samhällen: Inflyttat arbetsfolk i Linköping under det förindustriella 1800-talet2010Doctoral thesis, monograph (Other academic)
    Abstract [en]

    The purpose of the dissertation is to investigate the overall living situation for a selected group of individuals(one primary cohort of 19 men and one extended cohort of another 42 men, i.e. a total of 61 men) in a familycontext. This means, as far as the sources allow, trying to qualitatively understand and characterise socioeconomicconditions, family life and health, as it appears in the everyday life and in relation to the specifictime and the local urban environment. These individuals mainly belong to the lower social strata and havemoved to Linköping in the early 19th century before the regulations made it free to move into town. Possibilitiesand limitations, as well as events and acts are investigated in the intersection between individual and theenvironment, from a micro-historical point of view. In the purpose is thus also included to picture the localsociety in change and its relation to newcomers, as a foundation for further research regarding social change.Furthermore, the extended cohort is characterised from a micro-demographic perspective.

    The basic sources for this study are church books, i.e. records of catechetical meetings, records of births and deaths, records of weddings and migration. These sources are completed by several other sources like hospital records, records of fines, the chronicles of the county governor, records of the parish assembly and poor relief committee and the local newspapers, to get as rich a picture as possible. The individuals are followed throughout their life courses in town for several decades and are analysed in close connection to the local context. The latter also means that the local authorities are analysed in regard to their attitude and policy towards the migrants to town during the first half of the 19th century, i.e. before the 1847 legislation made migration free in the country.

    The town was not yet ready for these labourers who chose to stay there and start a family. They did thison their own responsibility, i.e. they settled outside the master´s household and risked being without thepatriarchal protection. The poor relief committee in town also rejected these families and tried to prevent theircoming into town. It is shown that the poor relief committee sometimes acted without legal support when ittried to make decisions regarding migration, based on estimated future incomes and the amount of children tofeed. Overall, the migration restriction was stricter in writing than it was in reality. Relatively few people weredenied access to the town and most who were tried individually got permission to move in on condition thatthey could show that they hade an employment and/or a personal guarantee. In this sense, the town was dividedin its attitude towards the servants and labourers in a manner typical of the situation. The burghersneeded the young, unmarried servants as labour force but were not interested in their staying in town to startfamilies. The men in the cohorts, and their families, on the other hand needed to find a new place to settlewhen the countryside ran out of opportunities. The life in the town became, for many of them, a life betweentwo societies. It was characterised by a constant struggle to support oneself, with a strain of a hidden economywhere for example begging was most likely important. This also meant a labourer´s life but with a meagresalary, sufficient only for one person, not for five or six. Many of the men in the cohorts were struck by the“urban penalty” with high mortality in late midlife. These labourers became a link between the crofter´s lifeand the labourer´s life. Many families were temporarily extended when they housed relatives and familymembers beyond the nuclear family and this is interpreted as a way of handling a tough situation. By their lifechoices these men and families contributed to an important social change.

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    Mellan två samhällenInflyttat arbetsfolk i Linköping under det förindustriella 1800-talet
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  • 170.
    Nygren, Victoria
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medicine and Health Sciences, Health and Society.
    Migrant men in misery: Result from a qualitative life history analysis on individuals and families concerning internal migration, health and life circumstances in early 19th century, Linköping, Sweden2007In: Hygiea Internationalis, ISSN 1403-8668, E-ISSN 1404-4013, Vol. 6, no 1, p. 107-144Article in journal (Refereed)
    Abstract [en]

    [No abstract available]

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  • 171.
    Omar, Faisal
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Just Waiting: Ethical Challenges in Priority Setting Posed by Organ Scarcity in Kidney Transplantation2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Over the last few decades kidney transplantation has transformed from an experimental treatment to the treatment of choice for end-stage renal disease. Unfortunately, however, the established organ donation models in many countries, relying chiefly on altruism, fail to motivate a sufficient number of donors. As a consequence, many lives which could be saved are lost, and others which can be improved are left to deteriorate.

    Dealing with the challenge of scarcity in kidney transplantation requires a dual approach. In the immediate term, we must ensure the fair distribution of kidney transplantation as a scarce medical resource. In the long term, we must find a policy level solution to mitigate the root issue of scarcity. The policy approach promoted in this thesis is the introduction of incentive based organ donation. Fair resource allocation, and incentive based donation are two themes which raise interesting normative questions, and ethical challenges. Each theme corresponds to two paperswhich form the basis for the thesis.

    Papers I &II, evaluate fairness in the priority setting processes underpinning access to kidney transplantation; this is done both within Sweden's four transplant centers and the Toronto General Hospital in Canada. The criteria, values, and procedures used in clinical decision-making are analyzed to identify barriers to fairness and how such barriers can be removed.

    Papers III and IV, propose incentive based living kidney donation and incentive based deceased donation, respectively, as policy solutions to the organ scarcity. The most frequently raised ethical objections against incentive based models are discussed in a bid to demonstrate the moral permissibility of incentive based organ donation.

    The discussion about fairness, and incentive based models, highlights that the ethical challenges raised by kidney scarcity are inherently difficult. While we may not find infallible solutions we certainly can work towards better solutions. We can create clinical priority setting processes, that while not perfect, move us closer towards increased fairness by removing clear obstacles to just distribution. We can create organ donation policies while not free of ethical challenges; do not shy away from all risk, or from asking the difficult questions.

    List of papers
    1. Priority setting in kidney transplantation: A qualitative study evaluating Swedish practices
    Open this publication in new window or tab >>Priority setting in kidney transplantation: A qualitative study evaluating Swedish practices
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    2013 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 41, no 2, p. 206-215Article in journal (Refereed) Published
    Abstract [en]

    Background: Kidney transplantation is the established treatment of choice for end-stage renal disease; it increases survival, and quality of life, while being more cost effective than dialysis. It is, however, limited by the scarcity of kidneys. The aim of this paper is to investigate the fairness of the priority setting process underpinning Swedish kidney transplantation in reference to the Accountability for Reasonableness (A4R) framework. To achieve this, two significant stages of the process influencing access to transplantation are examined: assessment for transplant candidacy, and allocation of kidneys from deceased donors.

    Methods: Semi-structured interviews were the main source of data collection. Fifteen Interviewees included transplant surgeons, nephrologists, and transplant coordinators representing centers nationwide. Thematic analysis was used to analyze interviews, with the Accountability for Reasonableness framework serving as an analytical lens.

    Results: Decision-making both in the assessment and allocation stages are based on clusters of factors that belong to one of three levels: patient, professional, and the institutional levels. The factors appeal to values such as maximizing benefit, priority to the worst off, and equal treatment which are traded off.

    Discussion and Conclusions: The factors described in this paper and the values on which they rest on the most part satisfy the relevance condition of the accountability for reasonableness framework. There are however two potential sources for unequal treatment which we have identified: clinical judgment and institutional policies relating both to assessment and allocation. The appeals mechanisms are well developed and supported nationally which help to offset differences between centers. There is room for improvement in the areas of publicity and enforcement. The development of explicit national guidelines for assessing transplant candidacy and the creation of a central kidney allocation system would contribute to standardize practices across centers; and in the process help to better meet the conditions of fairness in reference to the A4R. The benefits of these policy proposals in the Swedish kidney transplant system merit serious consideration.

    Place, publisher, year, edition, pages
    Sage Publications, 2013
    Keywords
    Ethics, fairness, kidney transplantation, priority setting, Sweden
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-71309 (URN)10.1177/1403494812470399 (DOI)000315233100014 ()
    Available from: 2011-10-11 Created: 2011-10-11 Last updated: 2017-12-08Bibliographically approved
    2. Priority Setting in the Assessment for Kidney Transplant Candidacy: a Canadian Case Study
    Open this publication in new window or tab >>Priority Setting in the Assessment for Kidney Transplant Candidacy: a Canadian Case Study
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    The benefits of kidney transplantation for treating kidney failure are well documented in terms of life expectancy, quality of life, and cost savings, making it the treatment of choice. It is however limited by the chronic shortage of kidneys. This study’s objective is to examine the fairness of the priority setting process underpinning the assessment for kidney transplant candidacy in one of Canada’s largest transplant programs at the Toronto General Hospital (TGH). This is done in reference to the Accountability for Reasonableness; a leading international framework in health care priority setting.

    The study relies on three sources for data collection: semi structured interviews, process observation, and review of relevant documents.

    The process underpinning the assessment for kidney transplantation is based on clusters of medical criteria reflecting the Canadian national consensus guidelines on eligibility for kidney transplantation. The process is permeated by ethical principles such as: maximizing benefit, equal treatment, and respect for autonomy; which are widely considered relevant in the distribution of scarce medical resources and in medical ethics generally. The criteria for assessment are well publicized and easily accessible while appeals through second opinions are well developed and supported. The process underpinning access to kidney transplantation at the TGH readily satisfies the conditions for fairness in references to the Accountability for Reasonableness framework.

    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-71311 (URN)
    Available from: 2011-10-11 Created: 2011-10-11 Last updated: 2011-10-11Bibliographically approved
    3. Compensated Living Kidney Donation: A Plea for Pragmatism
    Open this publication in new window or tab >>Compensated Living Kidney Donation: A Plea for Pragmatism
    2010 (English)In: HEALTH CARE ANALYSIS, ISSN 1065-3058, Vol. 18, no 1, p. 85-101Article in journal (Refereed) Published
    Abstract [en]

    Kidney transplantation is the most efficacious and cost-effective treatment for end-stage renal disease. However, the treatments accessibility is limited by a chronic shortage of transplantable kidneys, resulting in the death of numerous patients worldwide as they wait for a kidney to become available. Despite the implementation of various measures the disparity between supply and needs continues to grow. This paper begins with a look at the current treatment options, including various sources of transplantable kidneys, for end-stage renal disease. We propose, in accordance with others, the introduction of compensated kidney donation as a means of addressing the current shortage. We briefly outline some of the advantages of this proposal, and then turn to examine several of the ethical arguments usually marshaled against it in a bid to demonstrate that this proposal indeed passes the ethics test. Using available data of public opinions on compensated donation, we illustrate that public support for such a program would be adequate enough that we can realistically eliminate the transplant waiting list if compensation is introduced. We urge a pragmatic approach going forward; altruism in living kidney donation is important, but altruism only is an unsuccessful doctrine.

    Keywords
    End-stage renal disease, Dialysis, Transplantation, Compensated donation, Ethics, Cost-effectiveness, Public opinions
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-54072 (URN)10.1007/s10728-008-0110-z (DOI)000274334600005 ()
    Available from: 2010-02-22 Created: 2010-02-22 Last updated: 2011-10-11
    4. Incentivizing deceased organ donation: A Swedish priority-setting perspective.
    Open this publication in new window or tab >>Incentivizing deceased organ donation: A Swedish priority-setting perspective.
    2011 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 2, p. 156-163Article in journal (Refereed) Published
    Abstract [en]

    AIMS: The established deceased organ donation models in many countries, relying chiefly on altruism, have failed to motivate a sufficient number of donors. As a consequence organs that could save lives are routinely missed leading to a growing gap between demand and supply. The aim of this paper is twofold; firstly to develop a proposal for compensated deceased organ donation that could potentially address the organ shortage; secondly to examine the compatibility of the proposal with the ethical values of the Swedish healthcare system.

    METHODS: The proposal for compensating deceased donation is grounded in behavioural agency theory and combines extrinsic, intrinsic and signalling incentives in order to increase prosocial behaviour. Furthermore the compatibility of our proposal with the values of the Swedish healthcare system is evaluated in reference to the principles of human dignity, needs and solidarity, and cost effectiveness.

    RESULTS: Extrinsic incentives in the form of a €5,000 compensation towards funeral expenses paid to the estate of the deceased or family is proposed. Intrinsic and signalling incentives are incorporated by allowing all or part of the compensation to be diverted as a donation to a reputable charity. The decision for organ donation must not be against the explicit will of the donor.

    CONCLUSIONS: We find that our proposal for compensated deceased donation is compatible with the values of the Swedish healthcare system, and therefore merits serious consideration. It is however important to acknowledge issues relating to coercion, commodification and loss of public trust and the ethical challenges that they might pose.

    Place, publisher, year, edition, pages
    SAGE, 2011
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-65395 (URN)10.1177/1403494810391522 (DOI)000288065000006 ()21239479 (PubMedID)
    Available from: 2011-02-07 Created: 2011-02-07 Last updated: 2017-12-11Bibliographically approved
    Download (pdf)
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  • 172.
    Omar, Faisal
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Omnell-Persson, Marie
    Skane University Hospital.
    Welin, Stellan
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Priority Setting in Swedish Kidney Transplantation: Assessment for Transplant Candicacy and Allocation of Deceased Donor Kidneys in Transplant  International, vol 24, issue SI, pp 127-1272011In: TRANSPLANT INTERNATIONAL, Springer Verlag (Germany) / Wiley-Blackwell , 2011, Vol. 24, no SI, p. 127-127Conference paper (Refereed)
    Abstract [en]

    n/a

  • 173.
    Omar, Faisal
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Omnell Persson, Marie
    Department of Nephrology and Transplantation, Skåne University Hospital (Malmö), Lund University, Malmö, Sweden.
    Welin, Stellan
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Priority setting in kidney transplantation: A qualitative study evaluating Swedish practices2013In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 41, no 2, p. 206-215Article in journal (Refereed)
    Abstract [en]

    Background: Kidney transplantation is the established treatment of choice for end-stage renal disease; it increases survival, and quality of life, while being more cost effective than dialysis. It is, however, limited by the scarcity of kidneys. The aim of this paper is to investigate the fairness of the priority setting process underpinning Swedish kidney transplantation in reference to the Accountability for Reasonableness (A4R) framework. To achieve this, two significant stages of the process influencing access to transplantation are examined: assessment for transplant candidacy, and allocation of kidneys from deceased donors.

    Methods: Semi-structured interviews were the main source of data collection. Fifteen Interviewees included transplant surgeons, nephrologists, and transplant coordinators representing centers nationwide. Thematic analysis was used to analyze interviews, with the Accountability for Reasonableness framework serving as an analytical lens.

    Results: Decision-making both in the assessment and allocation stages are based on clusters of factors that belong to one of three levels: patient, professional, and the institutional levels. The factors appeal to values such as maximizing benefit, priority to the worst off, and equal treatment which are traded off.

    Discussion and Conclusions: The factors described in this paper and the values on which they rest on the most part satisfy the relevance condition of the accountability for reasonableness framework. There are however two potential sources for unequal treatment which we have identified: clinical judgment and institutional policies relating both to assessment and allocation. The appeals mechanisms are well developed and supported nationally which help to offset differences between centers. There is room for improvement in the areas of publicity and enforcement. The development of explicit national guidelines for assessing transplant candidacy and the creation of a central kidney allocation system would contribute to standardize practices across centers; and in the process help to better meet the conditions of fairness in reference to the A4R. The benefits of these policy proposals in the Swedish kidney transplant system merit serious consideration.

  • 174.
    Omar, Faisal
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Tinghög, Gustav
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Tinghög, Petter
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Attitudes towards priority-setting and rationing in healthcare - an exploratory survey of Swedish medical students2009In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 2, p. 122-130Article in journal (Refereed)
    Abstract [en]

    Background: Healthcare priority-setting is inextricably linked to the challenge of providing publicly funded healthcare within a limited budget, which may result in difficult and potentially controversial rationing decisions. Despite priority-settings increasing prominence in policy and academic discussion, it is still unclear what the level of understanding and acceptance of priority-setting is at different levels of health care. Aims: The aim of this study is threefold. First we wish to explore the level of familiarity with different aspects of priority-setting among graduating medical students. Secondly, to gauge their acceptance of both established and proposed Swedish priority-setting principles. Finally to elucidate their attitudes towards healthcare rationing and the role of different actors in decision making, with a particular interest in comparing the attitudes of medical students with data from the literature examining the attitudes among primary care patients in Sweden. Methods: A cross-sectional survey containing 14 multiple choice items about priority-setting in healthcare was distributed to the graduating medical class at Linkoping University. The response rate was 92% (43/47). Results: Less than half of respondents have encountered the notion of open priority-setting, and the majority believed it to be somewhat or very unclear. There is a high degree of awareness and agreement with the established ethical principles for priority-setting in Swedish health care; however respondents are inconsistent in their application of the cost-effectiveness principle. A larger proportion of respondents were more favourable to physicians and other health personnel being responsible for rationing decisions as opposed to politicians. Conclusions: Future discussion about priority-setting in medical education should be contextualized within an explicit and open process. There is a need to adequately clarify the role of the cost-effectiveness principle in priority-setting. Medical students seem to acknowledge the need for rationing in healthcare to a greater extent when compared with previous results from Swedish primary care patients.

  • 175.
    Omar, Faisal
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medicine and Health Sciences, Health and Society.
    Tinghög, Gustav
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Tinghög, Petter
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medicine and Health Sciences, Health and Society.
    Carlsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Diffusion of priority setting ethical principles in Swedish medical education (oral presentation)2008In: The 7th International Conference on Priorities in Health Care,2008, 2008Conference paper (Other academic)
    Abstract [en]

          

  • 176.
    Omar, Faisal
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Tinghög, Gustav
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Welin, Stellan
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Incentivizing deceased organ donation: A Swedish priority-setting perspective.2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 2, p. 156-163Article in journal (Refereed)
    Abstract [en]

    AIMS: The established deceased organ donation models in many countries, relying chiefly on altruism, have failed to motivate a sufficient number of donors. As a consequence organs that could save lives are routinely missed leading to a growing gap between demand and supply. The aim of this paper is twofold; firstly to develop a proposal for compensated deceased organ donation that could potentially address the organ shortage; secondly to examine the compatibility of the proposal with the ethical values of the Swedish healthcare system.

    METHODS: The proposal for compensating deceased donation is grounded in behavioural agency theory and combines extrinsic, intrinsic and signalling incentives in order to increase prosocial behaviour. Furthermore the compatibility of our proposal with the values of the Swedish healthcare system is evaluated in reference to the principles of human dignity, needs and solidarity, and cost effectiveness.

    RESULTS: Extrinsic incentives in the form of a €5,000 compensation towards funeral expenses paid to the estate of the deceased or family is proposed. Intrinsic and signalling incentives are incorporated by allowing all or part of the compensation to be diverted as a donation to a reputable charity. The decision for organ donation must not be against the explicit will of the donor.

    CONCLUSIONS: We find that our proposal for compensated deceased donation is compatible with the values of the Swedish healthcare system, and therefore merits serious consideration. It is however important to acknowledge issues relating to coercion, commodification and loss of public trust and the ethical challenges that they might pose.

  • 177.
    Omar, Faisal
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences.
    Tinghög, Gustav
    Linköping University. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Welin, Stellan
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Health and Society.
    Incentivizing organ donation: a Swedish priority setting perspective (oral presentation)2010Conference paper (Refereed)
  • 178.
    Omar, Faisal
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Tinghög, Petter
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Tinghög, Gustav
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Welin, Stellan
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Transplant tourism and compensated kidney donation: A survey of opinions amongst Swedish medical students2010In: International Journal of Health Promotion & Education, ISSN 1463-5240, Vol. 48, no 4, p. 106-112Article in journal (Refereed)
    Abstract [en]

    Objective: Transplant tourism and proposals for regulated compensated donation are reactions to the global scarcity in kidneys. These areas raise unique ethical challenges in medical education and clinical practice. We aimed to elucidate the opinions of soon-to-be physicians on transplant tourism, and compensated donation. We investigated how these opinions are formed, if they are interrelated, and their impact on encounters with patients.

    Design and Methods: a 14 item survey was developed using cognitive interviewing techniques, and distributed to the graduating class at Linköping Medical University. Spearman's correlation coefficient and Pearson's chi-square test were employed to investigate significant associations.

    Results: The response rate was 43/47 (92%). The majority were strongly (64%), or somewhat (29%) against transplant tourism. Those with strong negative positions on transplant tourism were significantly (p<0.05) more likely to dissuade patients from pursuing it. More students expressed support for regulated compensation from a clinical perspective (34%) as compared with support from an ethical perspective (15%).

    Conclusions: The opinions of young physicians on transplant tourism are a significant indicator for their clinical approach. Young physicians balance competing ethical responsibilities such as respect for autonomy against concerns for kidney vendors in the developing world. Clinical and policy scenarios, similar to those used in this survey are useful tools for students to explore challenging ethical issues within their medical education, to provide appropriate guidance for patients and empower them through health education.

     

  • 179.
    Omar, Faisal
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Tufveson, Gunnar
    Uppsala University.
    Welin, Stellan
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Compensated Living Kidney Donation: A Plea for Pragmatism2010In: HEALTH CARE ANALYSIS, ISSN 1065-3058, Vol. 18, no 1, p. 85-101Article in journal (Refereed)
    Abstract [en]

    Kidney transplantation is the most efficacious and cost-effective treatment for end-stage renal disease. However, the treatments accessibility is limited by a chronic shortage of transplantable kidneys, resulting in the death of numerous patients worldwide as they wait for a kidney to become available. Despite the implementation of various measures the disparity between supply and needs continues to grow. This paper begins with a look at the current treatment options, including various sources of transplantable kidneys, for end-stage renal disease. We propose, in accordance with others, the introduction of compensated kidney donation as a means of addressing the current shortage. We briefly outline some of the advantages of this proposal, and then turn to examine several of the ethical arguments usually marshaled against it in a bid to demonstrate that this proposal indeed passes the ethics test. Using available data of public opinions on compensated donation, we illustrate that public support for such a program would be adequate enough that we can realistically eliminate the transplant waiting list if compensation is introduced. We urge a pragmatic approach going forward; altruism in living kidney donation is important, but altruism only is an unsuccessful doctrine.

  • 180.
    Omar, Faisal
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Welin, Stellan
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Tufveson, Gunnar
    Uppsala University.
    Letter: Reply: Ethical Perspectives on Living Donor Organ Transplantation in Asia2010In: Liver transplantation, ISSN 1527-6465, E-ISSN 1527-6473, Vol. 16, no 7, p. 917-917Article in journal (Other academic)
    Abstract [en]

    n/a

  • 181.
    Omar, Faisal
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Wright, Linda
    Joint Center for Bioethics, Deptartment of Surgery, Faculty of Medicine, University of Toronto, Canada.
    Priority Setting in the Assessment for Kidney Transplant Candidacy: a Canadian Case StudyManuscript (preprint) (Other academic)
    Abstract [en]

    The benefits of kidney transplantation for treating kidney failure are well documented in terms of life expectancy, quality of life, and cost savings, making it the treatment of choice. It is however limited by the chronic shortage of kidneys. This study’s objective is to examine the fairness of the priority setting process underpinning the assessment for kidney transplant candidacy in one of Canada’s largest transplant programs at the Toronto General Hospital (TGH). This is done in reference to the Accountability for Reasonableness; a leading international framework in health care priority setting.

    The study relies on three sources for data collection: semi structured interviews, process observation, and review of relevant documents.

    The process underpinning the assessment for kidney transplantation is based on clusters of medical criteria reflecting the Canadian national consensus guidelines on eligibility for kidney transplantation. The process is permeated by ethical principles such as: maximizing benefit, equal treatment, and respect for autonomy; which are widely considered relevant in the distribution of scarce medical resources and in medical ethics generally. The criteria for assessment are well publicized and easily accessible while appeals through second opinions are well developed and supported. The process underpinning access to kidney transplantation at the TGH readily satisfies the conditions for fairness in references to the Accountability for Reasonableness framework.

  • 182.
    Persson, Anders
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, The Tema Institute, Technology and Social Change.
    Hamlin, Sven
    GRI Göteborgs universitet.
    Welin, Stellan
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medicine and Health Sciences, Health and Society.
    Profitable exchanges for scientists: The case of Swedish human embryonic stem cell research2007In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 15, no 4, p. 291-304Article in journal (Refereed)
    Abstract [en]

    In this article two inter-related issues concerning the ongoing commercialisation of biomedical research are analyzed. One aim is to explain how scientists and clinicians at Swedish public institutions can make profits, both commercially and scientifically, by controlling rare human biological material, like embryos and embryonic stem cell lines. This control in no way presupposes legal ownership or other property rights as an initial condition. We show how ethically sensitive material (embryos and stem cell lines) have been used in Sweden as a foundation for a commercial stem cell enterprise-despite all official Swedish strictures against commercialisation in this area. We also show how political decisions may amplify the value of controlling this kind of biological material. Another aim of the article is to analyze and discuss the meaning of this kind of academic commercial enterprise in a wider context of research funding strategies. A conclusion that is drawn is that the academic turn to commercial funding sources is dependent on the decline of public funding. © 2007 Springer Science+Business Media, LLC.

  • 183.
    Persson, Anders
    et al.
    Högskolan i väst.
    Welin, Stellan
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Health and Society.
    Contested technologies2008 (ed. 1)Book (Other academic)
    Abstract [en]

    Addressing the important perspectives on xenotransplantation and human embryonic stem cell research, this book explores both the enthusiastic proponents and vehement resistance to these new biomedical technologies. Investigating the political, social, and ethical forces behind this kind of research and development, as well as the commercial actors and strong financial incentives that are necessary, these stories of hope, fear, and hype are matched by stories of success, failure, and fraud, showing how these technologies have become truly polarizing.

  • 184.
    Priftakis, Peter
    et al.
    Karolinska institutet.
    Dalianis, Tina
    Karolinska institutet.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Oncology Centre.
    Samuelsson, Ulf
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Lewensohn-Fuchs, Ilona
    Karolinska institutet.
    Bogdanovic, Gordana
    Karolinska institutet.
    Winiarski, Jacek
    Karolinska institutet.
    Gustafsson, Britt
    Karolinska institutet.
    Human polyomavirus DNA is not detected in Guthrie cards (dried blood spots) from children who developed acute lymphoblastic leukemia2003In: Medical and Pediatric Oncology, ISSN 0098-1532, E-ISSN 1096-911X, Vol. 40, no 4, p. 219-223Article in journal (Refereed)
    Abstract [en]

    Background

    Epidemiological evidence has suggested that some childhood acute lymphoblastic leukemia (ALL) may be initiated in utero and may have an infectious etiology. The human polyomavirus JC virus (JCV) has been discussed as a candidate virus, but its presence has not been demonstrated in leukemia cells from children with ALL. The aim of this study was, therefore, to investigate if prenatal human polyomavirus infection could still indirectly be correlated to the development of childhood ALL.

    Procedure

    Fifty-four Guthrie cards (stored, dried blood spots filter papers, routinely collected from newborns for different screening analyses), collected at 3–5 days of age, from Swedish children who subsequently developed ALL, as well as from 37 healthy controls, were investigated by nested PCR for the presence of human polyomaviruses JCV and BK virus (BKV).

    Results

    JCV and BKV DNA were not detected in any of the Guthrie cards from ALL patients or from healthy controls, although all tested samples had amplifiable DNA as confirmed by an HLA DQ PCR.

    Conclusions

    JCV or BKV were not found in any of the dried blood spots of children who later developed ALL or in the healthy controls. These findings suggest that it is unlikely that childhood ALL is associated with an in utero infection with JCV or BKV, although it is not possible to exclude an association with an in utero infection that has become latent in the kidneys with very low levels of circulating virus at birth.

  • 185.
    Rosell, Johan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Regional Cancer Center South East Sweden.
    Nordenskjöld, Bo
    Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Bengtsson, Nils-Olof
    Umeå University Hospital, Sweden .
    Fornander, Tommy
    Karolinska University Hospital, Sweden .
    Hatschek, Thomas
    Karolinska University Hospital, Sweden .
    Lindman, Henrik
    University of Uppsala Hospital, Sweden .
    Malmstrom, Per-Olof
    Skåne University Hospital, Sweden .
    Wallgren, Arne
    Sahlgrens University Hospital, Sweden .
    Stål, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Effects of adjuvant tamoxifen therapy on cardiac disease: results from a randomized trial with long-term follow-up2013In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 138, no 2, p. 467-473Article in journal (Refereed)
    Abstract [en]

    Tamoxifen is associated with a reduced risk of coronary heart disease (CHD). However, there are few reports on long-term effects. Using data from a large Swedish randomized trial of 5 and 2 years of adjuvant tamoxifen in women with early breast cancer, we here present results on morbidity and mortality from cardiac diseases during treatment and long-term after treatment. A total of 4,150 patients were breast cancer recurrence-free after 2 years. Data from the Swedish National Hospital Discharge Registry combined with information from the Swedish Cause of Death Registry were used to define events of disease. Hazard ratios were estimated using Cox regression. Patients assigned to 5 years in comparison with 2 years of postoperative tamoxifen experienced a reduced incidence of CHD [hazard ratio (HR), 0.83; 95 % CI 0.70-1.00], especially apparent during the active treatment period (HR 0.65; 95 % CI 0.43-1.00). The mortality from CHD was significantly reduced (HR 0.72; 95 % CI 0.53-0.97). During the active treatment, the morbidity of other heart diseases was also significantly reduced (HR 0.40; 95 % CI 0.25-0.64) but not after treatment stopped (HR 1.06; 95 % CI 0.87-1.30). Similar results were seen for both heart failure and atrial fibrillation/flutter. As compared to 2 years of therapy, 5 years of postoperative tamoxifen therapy prevents CHD as well as other heart diseases. The risk reduction is most apparent during the active treatment period, and later tends to diminish.

  • 186.
    Rosell, Johan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Nordenskjöld, Bo
    Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Bengtsson, N-O
    Department of Oncolog, Umea University Hospital, Sweden.
    Fornander, T
    Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
    Hatschek, T
    Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
    Lindman, H
    Department of Oncology, Uppsala University Hospital, Uppsala, Sweden.
    Malmstrom, P-O
    Department of Oncology, Lund University Hospital, Lund, Sweden.
    Wallgren, A
    Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Stål, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Time dependent effects of adjuvant tamoxifen therapy on cerebrovascular disease: results from a randomised trial2011In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 104, no 6, p. 899-902Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Tamoxifen has been associated with an increased risk of stroke. There is, however, little information on the effect in the post-treatment period. Using data from the Swedish Breast Cancer Group adjuvant trial of 5 vs 2 years of tamoxifen treatment, we now report both short-term and long-term effects on morbidity as well as mortality because of cerebrovascular disease. METHODS: Data from the Swedish National Hospital Discharge Registry combined with information from the Swedish Cause of Death Registry was used to define events of disease. Hazard ratios (HRs) were estimated using Cox regression. RESULTS: Comparing patients randomised to 5 years of tamoxifen with patients randomised to 2 years of tamoxifen, the incidence of cerebrovascular diseases was increased (HR 1.70, 95% CI 1.05-2.75) during the active treatment phase and reduced after the active treatment period (HR 0.78, 95% CI 0.63-0.96), and the difference in HR between the two time-periods was significant (P 0.0033). The mortality from cerebrovascular diseases was increased during the treatment period (HR 3.18, 95% CI 1.03-9.87) and decreased during the post-treatment period (HR 0.60, 95% CI 0.40-0.90) with a significant difference in HR between the two periods of follow-up (P=0.0066). Similar results were seen for subgroups of cerebrovascular diseases, such as stroke and ischaemic stroke. CONCLUSION: In an adjuvant setting, tamoxifen was associated with an increased risk of cerebrovascular disease during treatment, but a decreased risk in the post-treatment period.

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  • 187.
    Samuelsson, Christina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Hydén, Lars-Christer
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Intonational Patterns of Nonverbal Vocalizations in People With Dementia2011In: American Journal of Alzheimer’s Disease and Other Dementia, ISSN 1533-3175, E-ISSN 1938-2731, Vol. 26, no 7, p. 563-572Article in journal (Refereed)
    Abstract [en]

    Nonverbal vocalizations in dementia are important clinically since they generally have been regarded as disruptive behavior that is disturbing. The aim of the present study is to describe the interactional pattern, including the prosodic package, of nonverbal vocalizations in a participant in a late stage of dementia. The acoustic analysis shows that the vocalizations do not differ significantly from the verbal utterances regarding mean fundamental frequency or pitch range. The mean fundamental frequency, F(0), of the utterances from Anna was significantly higher than the mean F(0) from the other elderly participants. The analysis demonstrates that there is a singing-like type of vocalizations that does not resemble the previously described patterns of nonverbal vocalizations. This pattern of the nonverbal vocalization does not resemble the intonation of Annas verbal utterances. The other participants perceive Annas vocalizations as potentially meaningful turns. Nonverbal vocalizations in clinical settings should be taken as communicative contributions.

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  • 188.
    Samuelsson, Ulf
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Space-time clustering at birth and at diagnosis of type 1 diabetes mellitus in relation to early clinical manifestation2003In: Journal of Pediatric Endocrinology & Metabolism (JPEM), ISSN 0334-018X, E-ISSN 2191-0251, Vol. 16, no 6, p. 859-867Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate whether space-time clustering at diagnosis of type 1 diabetes mellitus (DM1) is related to clinical manifestations and to see whether there is a time-space clustering at birth of children who later develop DM1. Patients: Using the method by Knox, clustering was analysed in all 1,144 children diagnosed between 1977 and 1994 in south-east Sweden. Results: The strongest significance was obtained for the cut-off value of 5 kin and 7 months (p <0.01). Using this cut-off, children with a short duration of symptoms before diagnosis had the same degree of clustering as children with a longer duration. Children diagnosed during autumn and winter tended to have a higher degree of clustering than children diagnosed during spring and summer. We found no significant clustering regarding birthplace and birth month. Conclusion: This study is consistent with the existence of space-time clustering at diagnosis. The most plausible explanation is that infections elicit several cases of DM1 in children in whom the disease process has already begun.

  • 189.
    Sarberg, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Restless legs syndrome during and after pregnancy and its relation to snoring2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 7, p. 850-855Article in journal (Refereed)
    Abstract [en]

    Objective. To study development of restless legs syndrome (RLS) during and after pregnancy, and whether RLS is related to snoring or other pregnancy-related symptoms. Design. Prospective study. Setting. Antenatal care clinics in the catchment area of Linkoping university hospital, Sweden. Population. Five hundred consecutively recruited pregnant women. Methods. Sleep disturbances, including symptoms of RLS and snoring, were assessed with questionnaires in each trimester. A complementary questionnaire was sent three years after delivery to women experiencing symptoms of RLS during pregnancy. Main outcome measures. Symptoms of RLS in relation to snoring in each trimester. Results. Symptoms of RLS were reported by 17.0% of the women in the first trimester, by 27.1% in the second trimester and by 29.6% in the third trimester. Snoring in the first trimester was correlated to increased prevalence of RLS in all three trimesters (p= 0.003, 0.017 and 0.044 in the first, second and third trimester, respectively). No correlation was found between RLS and anemia, parity or body mass index. Among the women who experienced RLS, 31% still had symptoms three years after delivery. Fifty-eight per cent of those whose symptoms had disappeared stated that this happened within one month after delivery. Conclusions. Symptoms of RLS progressed most between the first and second trimester. Women who snored in the first or second trimester of pregnancy had a higher prevalence of RLS in the third trimester, which indicates that snoring in early pregnancy might predict RLS later. Symptoms of RLS disappear quite soon after delivery, but about one-third of women with RLS during pregnancy may still have symptoms three years after childbirth.

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  • 190.
    Seing, Ida
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Nordenfelt, Lennart
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Bülow, Pia
    Avdelningen för beteendevetenskap och socialt arbete, Hälsohögskolan, Jönköping.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Avstämningsmötet som arena för förhandling om arbetsförmåga.2011In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 88, no 5, p. 408-417Article in journal (Refereed)
  • 191.
    Seing, Ida
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Nordenfelt, Lennart
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Bülow, Pia
    Avdelningen för beteendevetenskap och socialt arbete, Hälsohögskolan, Jönköping.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Policy and Practice of Work Ability: A Negotiation of Responsibility in Organizing Return to Work2012In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 22, no 4, p. 553-564Article in journal (Refereed)
    Abstract [en]

    Purpose In welfare policy and practical work it is unclear what the concept of work ability involves and assessments may be different among involved actors, partly due to a lack of theoretical research in relation to regulations and practice. Based on theoretical and legal aspects of work ability the aim of the study is to analyze stakeholders’ perspectives on work ability in local practice by studying multi-stakeholder meetings.

    Methods The material comprises nine digitally recorded multi-stakeholder meetings. Apart from the sick-listed individual, representatives from the public Social Insurance Agency, health care, employers, public employment service and the union participated in the meeting. The material was analyzed using qualitative content analysis.

    Results Three perspectives on work ability were identified: a medical perspective, a workplace perspective and a regulatory perspective. The meetings developed into negotiations of responsibility concerning workplace adjustments, rehabilitation efforts and financial support. Medical assessments served as objective expert statements to legitimize stakeholders’ perspectives on work ability and return to work.

    Conclusions Although the formal goal of the status meeting was to facilitate stakeholder collaboration, the results demonstrates an unequal distribution of power among cooperating actors where the employers had the “trump card” due to their possibilities to offer workplace adjustments. The employer perspective often determined whether or not persons could return to work and if they had work ability.

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  • 192.
    Sjöwall, Johanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Ledel, Anna
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Ekerfelt, Christina
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Forsberg, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Doxycycline-mediated effects on persistent symptoms and systemic cytokine responses post-neuroborreliosis: a randomized, prospective, cross-over study2012In: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 12, no 186, p. 1-12Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Persistent symptoms after treatment of neuroborreliosis (NB) are well-documented, although the causative mechanisms are mainly unknown. The effect of repeated antibiotic treatment has not been studied in detail. The aim of this study was to determine whether: (1) persistent symptoms improve with doxycycline treatment; (2) doxycycline has an influence on systemic cytokine responses, and; (3) improvement of symptoms could be due to doxycycline-mediated immunomodulation.

    METHODS/DESIGN:

    15 NB patients with persistent symptoms ≥6 months post-treatment were double-blindly randomized to receive 200 mg of doxycycline or a placebo for three weeks. After a six-week wash-out period, a cross-over with a three-week course of a placebo or doxycycline was conducted. The primary outcome measures were improvement of persistent symptoms assessed by neurological examinations, a symptom severity score and estimation of the quality of life. The secondary outcome measure was changes in systemic cytokine responses.

    RESULTS:

    All 15 patients finished the study. No doxycycline-mediated improvement of post-treatment symptoms or quality of life was observed. Nor could any doxycycline-mediated changes in systemic cytokine responses be detected. The study was completed without any serious adverse events.

    DISCUSSION:

    No doxycycline-mediated improvement of post-treatment symptoms or quality of life was observed. Nor could any doxycycline-mediated changes in systemic cytokine responses be detected. The study was completed without any serious adverse events. To conclude, in this pilot study, doxycycline-treatment did not lead to any improvement of either the persistent symptoms or quality of life in post-NB patients. Accordingly, doxycycline does not seem to be the optimal treatment of diverse persistent symptoms post-NB. However, the results need to be confirmed in larger studies.

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  • 193. Order onlineBuy this publication >>
    Skillnäs, Nicklas
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Livsplats, välbefinnande och kontrast: Väl- och illabefinnandets livsplatser, ur objekt-, subjekt- och processperspektiv2012Licentiate thesis, monograph (Other academic)
    Abstract [en]

    The purpose of this thesis is to develop a conceptual and theoretical understanding of place, with particular emphasis on places of wellbeing and illbeing, by taking account of life as a process. The thesis rests on empirical ground and takes off from the lack of conceptual and theoretical understanding and the neglected relationship between wellbeing, illbeing, place and lived lives in similar research.

    The theoretical framework deals with chosen views on the object of knowledge and the sources. It deals with the concepts of wellbeing, illbeing, place, place descriptions and life stories. In the light of Nordenfelt’s theory of quality of life and in contrast to space the merged object of knowledge, as places of wellbeing and illbeing, is defined as the positively and negatively experienced geographic, known and meaningful world, surrounding the body. Place descriptions and lifestories are understood as attempts to reconstruct past, present and expected place experiences and life experiences.

    The method is inspired by Charmaz version of Grounded Theory Method, although the theory is presented at the end of this thesis. Therefore it is called grounded analytical. The survey participants are seniors, for several reasons. They have been found via PRO, SPF, service houses and advertisements. The interviews were usually held at the home of the participants and have been interpreted as fusions of my understanding and the participants' understanding. The interviews focus on what the participants have said, not how, which in turn has decided how the place descriptions and the life stories have been transcribed. In order to get a grip of the transcribed material, it has been read through several times and then exposed to open coding, categorizing, focused coding and conceptual development, paralleled with memos. Conceptual categories that have survived critical tests have merged whereby theoretical contexts finally have been constructed. The chapter on theory and method ends with an ethical discussion about consent, information, confidentiality and use and a general discussion about used quality criteria’s.

    The empirical chapters are three. The first one deals with the properties of the places of wellbeing and illbeing, from an object perspective. Firstly the places of wellbeing and illbeing seem to be meaningful with positive and negative meanings. They are also spatial, in large and small scale. Some of them seem to shimmer. Most places of wellbeing and illbeing are stationary, but some are mobile. All of them are temporal, but some of them are invariant and others are changing. An overall property is that they all are bound in different ways: sex bound, age bound and class bound. Finally they all seem to be subordinate the thematic characteristics of nature, social aspects, culture, body and activity.

    The second empirical chapter deals with the opposite and attributed meanings of places of wellbeing and illbeing, from a subject perspective. They are found to be: vital and ill, natural and unnatural, aesthetic and unaesthetic, community and non community, harmonious and disharmonious, homelike and foreign and free and unfree meanings. Free and unfree meanings seem to permeate all of the above attributed meanings. Often there is a combination of the above meanings which together seem to make up for the overall experience of place. The attributed meanings are in their turn interpreted as nourishing and consuming meanings, as pleasing/uncomfortable in an emotional sense, like stimulating/repressive on the psyche and strengthening/weakening of the body. Places of wellbeing and illbeing as nourishing and consuming places are understood as places which have succeeded and failed to satisfy needs and desires, for the seven attributed reasons above.

    The third empirical chapter deals with the transformation of empirical data into theory, via a process perspective. The chapter starts with an analysis of properties and attributed meanings of places of wellbeing and illbeing found in a whole life story. As a result of the places being obvious in whole lives, the concept of place is interpreted and transformed into life place. Then the meaning of life place is related to the similar concept of life situation. The relationship can be compared to a sliding scale, where the meanings converge in geographical position, valuation in terms of well-being and illbeing and motivations and diverge in cases where life situation excludes geographical position. The concept of life place is then developed with the support of various phenomenological theories which correspond with the empirical data. The final sections offer an overall interpretive framework that shows how life places of wellbeing and illbeing appear in the light of lived lives. Results show that life places are held up as memorable, attracting and repulsive life places. Attracting life places are hunted and consumed of its nourishing ingredients, in other words positive attributed meanings, with the goal to satisfy needs and desires. Correspondingly repulsive life places have been abandoned because of their consuming ingredients, in other words negatively attributed meanings, which have been at odds with needs and desires and thus failed to satisfy them. In a final attempt to theorize on how life places of wellbeing and illbeing appear in the light of lived lives, as attracting and repulsive life places, they are moreover interpreted as valuable contrasts in life, in both physical and phenomenological sense. Consequently they are also called contrast life places.

    The last chapter deals with the results in relation to other place-oriented research, the scientific contribution of knowledge and the relevance of the knowledge in public health policy.

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  • 194.
    Sun, Xiao-Feng
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oncology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Zhang, Hong
    Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology . Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Jansson, Agneta
    Linköping University, Department of Clinical and Experimental Medicine, Oncology . Linköping University, Faculty of Health Sciences.
    Nordenskjöld, Bo
    Linköping University, Department of Clinical and Experimental Medicine, Oncology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Heat shock protein 72/73 in relation to cytoplasmic p53 expression and prognosis in colorectal adenocarcinomas1997In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 74, no 6, p. 600-604Article in journal (Refereed)
    Abstract [en]

    Heat shock proteins (hsp) are molecular chaperones that are increased by various environmental and patho-physiological stimuli. Hsp can bind to mutant/wild-type p53 in tumors and, consequently, could not only regulate p53 accumulation or localization but also modulate its biological effects on cells. However, there is little information available on the significance of hsp expression in colorectal cancer. The aim of our study was to investigate the relationship of hsp to p53 expression, clinico-pathological factors and prognosis in a series of 256 patients with colorectal adenocarcinomas, using immuno-histochemistry. Seventy-five cases exhibited hsp expression in the cytoplasm, with 11 presenting both cytoplasmic and nuclear staining. Hsp expression was related positively to cytoplasmic p53 expression but not to nuclear p53 expression. In the subgroup of rectal tumors, hsp over-expression appeared to predict unfavorable survival, though its prognostic value diminished using multivariate analysis. There were no significant relationships of hsp with patient sex or age, tumor site, Duke's stage, growth pattern or differentiation.

  • 195.
    Sundin, Jan
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medicine and Health Sciences, Health and Society.
    Health and wealth: Studies in history and policy2007In: Medical history, ISSN 0025-7273, E-ISSN 2048-8343, Vol. 51, no 3, p. 403-404Article, book review (Other academic)
  • 196.
    Sundin, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Willner, Sam
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Social Change and Health in Sweden: 250 Years of Politics and Practice2007Book (Other academic)
    Abstract [en]

    The impressive improvements in health for the Swedish population during the last two and a half centuries can be ascribed to many reasons. There has been a multifold of important public health measures including the regular collection of vital statistics from 1749 on a national level through the state church, which also played an important role in the early and widespread vaccination coverage against smallpox. Preventive mother and child care, access to health care free of charge, restrictive alcohol policy, accident prevention in several sectors and anti-tobacco campaigns have also been important. However, the increased living standard due to universal welfare policy strategies including social security, high educational standard, high degree of employment for women and men, regional and housing subsidies, appears to be equally or even more important.

    The Swedish National Institute of Public Health, SNIPH, has been responsible for supporting the implementation of the Swedish public health policy adopted by the Swedish Parliament, the Riksdag, in 2003, and for reporting on the implementation process as well as the results. The policy has been made available in English in a supplement to the Scandinavian Journal of Public Health (volume 32, supplement 64; eds. Hogstedt C, Lundgren B, Moberg H, Pettersson B and Ågren G) as well as in a summary of the first Public Health Policy Report published in 2005. SNIPH has also contributed to the evaluation of Swedish public health research in another supplement (no. 65) to the Scandinavian Journal of Public Health 2005.

    Today’s public health policies and results can to a large extent be explained by history and experiences from earlier decades and even centuries. Therefore, we were very pleased to publish a book in 2005 on the health of the Swedish people in a historical perspective (eds. Sundin J, Hogstedt C, Lindberg J and Moberg H) in Swedish in cooperation with Professor Jan Sundin and Associate Professor Sam Willner from Linköping University and others. We are now equally pleased to be able to publish a summarised and modified version in English by Professor Jan Sundin and Associate Professor Sam Willner focusing on the health development in relation to social changes over the last 250 years. Bernt Lundgren, Christer Hogstedt and Henrik Moberg from SNIPH were responsible for the discussions with the authors and the processing of the book.

    The new Swedish public health policy from 2003 has attracted much attention internationally due to its focus on structural determinants as well as lifestyle factors. The policy has been mentioned in the WHO Bangkok Charter on Health Promotion in a Globalized World and the WHO strategy for prevention and control of non-communicable diseases in the European Region, as well as by the Independent WHO Commission on Social Determinants. It is our hope that this publication shall contribute to the understanding of the background and context for this policy.

    Historical lessons from one country can not be transferred uncritically to another country or be used as a basis for future decisions. However, the likelihood of the effects of different policies could be indicated by comparing differences and similarities in the contexts. We hope that this book will prove useful for policy comparisons and in the training of public health policy-makers, researchers, administrators and field workers.

    Östersund, December 2007

    Gunnar Ågren

    Director General

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  • 197.
    Svenaeus, Fredrik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medicine and Health Sciences, Health and Society.
    Hermeneutics of clinical practice: The question of textuality2000In: Theoretical Medicine and Bioethics, ISSN 1386-7415, E-ISSN 1573-0980, Vol. 21, no 2, p. 171-189Article in journal (Refereed)
    Abstract [en]

    In this article I scrutinize the question whether clinical medicine, in order to be considered a hermeneutical enterprise, must be thought of as a reading of different "texts." Three different proposals for a definition of the concept of text in medicine, suggested by other hermeneuticians, are discussed. All three proposals are shown to be unsatisfying in various ways. Instead of attempting to find a fourth definition of the concept of text suitable to a hermeneutics of medicine, I then try to show that the assumption that one needs to operate with the concept of text in order to develop a hermeneutics of medicine is false. Clinical interpretation can be shown to essentially consist in a dialogical hermeneutics, the pattern of which can be found in the philosophy of Hans-Georg Gadamer. This kind of hermeneutics is not a methodology of text reading, but an ontological, phenomenological hermeneutics in which understanding is a necessary feature of the being-together of human beings in the world. This being-together in and through language takes on a peculiar form in the clinical encounter, since the medical meeting is typically characterized by an asymmetrical enstrangement and has a specific goal - health for the patient - absent in other forms of hermeneutics. Central issues of Gadamer's philosophy, e.g. "fusion of horizons," are shown to fit the structure of clinical practice.

  • 198.
    Svenaeus, Fredrik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medicine and Health Sciences, Health and Society.
    Hermeneutics of medicine in the wake of Gadamer: The issue of phronesis2003In: Theoretical Medicine and Bioethics, ISSN 1386-7415, E-ISSN 1573-0980, Vol. 24, no 5, p. 407-431Article in journal (Refereed)
    Abstract [en]

    The relevance of the Aristotelian concept of phronesis - practical wisdom for medicine and medical ethics has been much debated during the last two decades. This paper attempts to show how Aristotle's practical philosophy was of central importance to Hans-Georg Gadamer and to the development of his philosophical hermeneutics, and how, accordingly, the concept of phronesis will be central to a Gadamerian hermeneutics of medicine. If medical practice is conceived of as an interpretative meeting between doctor and patient with the aim of restoring the health of the latter, then phronesis is the mark of the good physician, who through interpretation comes to know the best thing to do for this particular patient at this particular time. The potential fruitfulness of this hermeneutical appropriation of phronesis for the field of medical ethics is also discussed. The concept can be ( and has been) used in critiques of the conceptualization of bioethics as the application of principle-based theory to clinical situations, since Aristotle's point is exactly that problems of praxis cannot be approached in this way. It can also point the way for alternative forms of medical ethics, such as virtue ethics or a phenomenological and hermeneutical ethics. The latter alternative would have to address the phenomena of health and the good life as issues for medical practice. It would also have to map out in detail the terrain of the medical meeting and the acts of interpretation through which phronesis is exercised.

  • 199.
    Tegern, Gunilla
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Flodmark, O
    Department of Clinical Neuroscience, Karolinska Institute; Dept of Neuroradiology, Karolinska Hospital, Stockholm, Sweden.
    Psychological, social and economic consequences of incidental discovery of aneurysm2003In: Rivista di neuroradiologia, ISSN 1120-9976, Vol. 16, no 5, p. 739-742Article in journal (Refereed)
  • 200.
    Theobald, Holger
    et al.
    Karolinska institutet, Stockholm.
    Bygren, Lars Olov
    Umeå universitet.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Engfeldt, Peter
    Karolinska institutet, Stockholm.
    Validity of two questions of alcohol use in a health survey questionnaire1999In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 27, no 1, p. 73-77Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate whether consumers of high and low levels of alcohol could be identified by two questions about alcohol use in a postal questionnaire survey. A sample of 2,300 persons aged 18 64 years from Stockholm county were sent a masked postal questionnaire comprising 30 questions about their health and functioning. Two questions concerned their alcohol consumption. One year later the subjects underwent a psychiatric health examination, which included an assessment of their alcohol use. The two questions about alcohol consumption identified high alcohol consumers with a relatively high sensitivity and specificity, of 64% and 87%, respectively, and thus are useful for identifying high alcohol consumers in health surveys using questionnaires.

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