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  • 151.
    Reigo, Tomas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Tropp, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    The epidemiology of back pain in vocational age groups1999In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 17, no 1, p. 17-21Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the prevalence of back pain in a general population aged between 20 and 59 years.

    POPULATION: A representative sample of 2000 individuals from Ostergotland County, Sweden (population 400,000).

    STUDY DESIGN: Cross-sectional study using a questionnaire including the pain drawing.

    RESULTS: The observed point prevalence was 28% (95% confidence interval 26-31%). The adjusted prevalence taking into account the non-responders was 23% (21-25%). Lumbar pain with radiation was reported by 40%, while 4% had only cervical pain with radiation. Twelve per cent were on sick-leave due to back pain. Activity of daily life was affected mainly in the group of men aged 40-59 and only in household tasks. The back problems did not affect social activity.

    CONCLUSIONS: The prevalence of back problems in the vocational ages was found to be 23%. Only small parts of a pain population are on sick-leave or have changed working tasks because of back problems. The distribution of pain in most cases is combined with radiation to extremities and not isolated to a single region. The combination of different localisations shows the pain problem to be more than just a "low back" problem.

  • 152.
    Reigo, Tomas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Tropp, Hans
    Department of Orthopaedic Surgery, Norrköping Hospital, Sweden.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Clinical findings in a population with back pain: Relation to one-year outcome and long-term sick leave2000In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 18, no 4, p. 208-214Article in journal (Refereed)
    Abstract [en]

    Objective - To investigate whether physical examination findings can be used in predicting recovery from back pain and new episodes of sick leave.

    Design - One-year prospective study of a single cohort.

    Settings - Semi-rural Swedish county.

    Population - A cross-section of a general population with back pain (207 women, 176 men) between 20 and 59 years of age.

    Main outcome measures - Cumulative incidence of sick leave due to back pain, cumulative incidence of sick leave due to back pain > 30 days, incidence of recovery from back pain.

    Results - For recovery from pain, the absence of tenderness in the trapezius muscle (OR 0.33, CI 0.1-0.5) was predictive. New sick leave was predicted by tenderness in the trapezius muscle (OR 2.67, CI 1.5-4.9), and had a tendency to be associated with a flattened lumbar lordosis and a restricted cervical range of motion. For long-term sick leave, the same findings and also observation of scoliosis (OR 3.44, CI 1.1-10.5) were predictive.

    Conclusion - There are subgroups with back pain predisposed to development of more persistent symptoms and a higher risk for sick-listing.

  • 153.
    Richt, Bengt
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Nordqvist, Cecilia
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Ett krympande liv2005In: Sjukdomsvärldar.: Människors erfarenheter av kroppslig ohälsa / [ed] Bengt Richt, Gunilla Tegern, Lund: Studentlitteratur , 2005, 1, p. 231-256Chapter in book (Other academic)
    Abstract [sv]

        

    En stor andel av befolkningen i de västerländska samhällena och en växande andel världen över lever med långvarig kroppslig ohälsa. Den utbredda förekomsten har en djupgående påverkan på sättet att leva, både bland de redan sjuka och bland dem som är friska. Kunskap om den kroppsliga ohälsans personliga, sociala och kulturella dimensioner är därför av grundläggande betydelse för förståelsen av tendenser och processer i samtiden.

    Boken bygger på berättelser från personer som själva lever med olika former av långvarig och ibland svår kroppslig ohälsa. Några kapitel är rättframt rapporterande, medan andra ansluter till sådana förståelseramar som fenomenologi, symbolisk interaktionism och analytisk filosofi. Texten ansluter sig till den internationella vetenskapliga tradition som under senare tid har försökt ge den levda erfarenheten av ohälsa ett språk och en röst, i opposition mot eller som komplement till ett rent biomedicinskt perspektiv. Den är utpräglat tvärvetenskaplig och skriven av personer med olika ämnesbakgrund, alltifrån omvårdnadsvetenskap, filosofi, sociologi och pedagogik till sjukgymnastik och arbetsterapi.

    Sjukdomsvärldar vänder sig till alla med intresse för vad det kan innebära att leva med kroppslig ohälsa i vardagslivet och för hur de möjliga innebörderna formas av mer övergripande sociala och kulturella omständigheter. Den tvärvetenskapliga inriktningen gör boken väl användbar på såväl olika vårdutbildningar som kurser i både samhällsvetenskap och humaniora.

  • 154.
    Ringsberg, K
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Clinical health education for patients with asthma-like symptoms but negative asthma tests2001In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 56, no 11, p. 1049-1054Article in journal (Refereed)
    Abstract [en]

    Background: Patients with asthma-like symptoms but negative asthma tests often state that they lack strategies to cope with their symptoms. The aim of the study was to determine whether a problem-based health education program had a beneficial effect on the participants' experience of symptoms and subjective health. Methods: Thirty-eight patients, consecutively drawn from an outpatient clinic for asthma and allergy, were randomly allocated to an intervention group (I group, n = 18) and a control group (C group, n = 20). The I group, divided into three subgroups, met on seven occasions over 5 months. The program had a multidisciplinary approach, used exercises inspired by cognitive behavioral therapy, and was performed according to the principles of problem-based learning. All patients answered the Nijmegen Symptom Questionnaire (NQ) and the SF-36 health survey before and 2 months after the training was terminated. Results: Before the program, there were no significant differences between the groups in their earlier experience of symptoms. After it, the I group scored significantly lower on shortness of breath (P = 0.001) and central tetany (P = 0.05) than the C group. On both test occasions, the asthma-like patients scored lower on all variables of the SF-36 than the reference groups of asthmatics and healthy subjects. No significant differences were seen between the I group and the C group except for vitality, in which the C group scored lower before the intervention. Conclusions: Patients with asthma-like symptoms but negative asthma tests benefit from taking part in a problem-based health education program. It mainly reduces the frequency of symptoms.

  • 155.
    Ringsberg, K
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Åkerlind, I
    FoU enheten Norrköping.
    Presence of hyperventilation in patients with asthma-like symptoms but negative asthma test responses: Provocation with voluntary hyperventilation and mental stress. 1999In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 103, p. 601-608Article in journal (Refereed)
  • 156.
    Ringsberg, Karin
    Linköping University, Department of health and environment. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Arts and Sciences.
    Patients with asthma-like symptoms but negative asthma tests and patients with bronchial asthma1997Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Patients with asthma-like symptoms but with negative results in asthma tests have recently been identified. The symptoms are mainly triggered by strong odours, physical exercise and mental stress. These patients are often misdiagnosed and mistreated. They mostly have to find coping strategies by themselves. Patients with diagnosed bronchial asthma sometimes are 'educated in their own disease' by health care professionals in order to increase their compliance and to help them to find coping strategies.

    The overall aim of this thesis was to identify and describe patients with asthma-like symptoms but negative asthma tests and to find diagnostic instruments to differentiate these patients from patients with bronchial asthma and healthy subjects and to investigate some possible mechanisms behind the disorder. A further aim was to describe the effects of a cognitive and affective treatment of patients with diagnosed bronchial asthma and to discuss if this model might also be applicable to patients with asthma-like symptoms but negative asthma tests.

    Altogether 24 patients with asthma-like symptoms but negative asthma: tests, 28 patients with bronchial asthma and 10 healthy controls participated in four studies. Only women aged 18-60 years were included. They were investigated with psychological tests, questionnaires and provocation with physical exercise, voluntary hyperventilation and mental stress. In-depth interviews were also performed. In a fifth study, the effects of a cognitive and affective model for treating patients with bronchial asthma, an "asthma school'', were studied by means of different questionnaires and lung function testo;, Althogether 38 patients with bronchial asthma, women and men aged· 18-70 yrs, participated.

    The results showed that the patients with asthma-like symptoms suffered more frequently from a greater variety of symptoms compared to the patients with asthma and healthy contJ:ols. They were more depressed, less hedonic, more hypochondriac and had lower trust in others than the patients of the astluna group. They had a higher health care consumption compared to the patients with asthma The physical exercise test did not provoke any bronchoconstriction in the patients with asthma-like symptoms. Neither could the symptoms be explained by physical unfitness. The provocations with voluntary hyperventilation and mental stress revealed that hyperventilation might be present in these patients and that mental stress might be one trigger factor. In a qualitative study, the patients stated that they felt dejected, confused and non confirmed by health care professionals, family and friends. Their subjective hyperreactivity limited them socially. They lacked adequate coping strategies. The findings were characterised by numerous self-reinforcing vicious circles where the circles comprised subjective hyperreactivity, social limitations and non confinnation. Patients with bronchial asthma benefit from being treated in an "asthma-school''. After having attended an "asthma-school", the patients increased their knowledge of the disease slightly more than a control group. They also increased their quality of life and decreased their health care conswnption.

    In summary, no evidence was found for the diagnosis of asthma in the patients with asthmalike symptoms but negative asthma tests. It is possible to separate them from patients with bronchial asthma by using different lung function tests, and different provocation tests. Patients with bronchial asthma benefit from taking part in an "asthma school". A similar treatment, with both a cognitive and an affective approach, might also be applicable in patients with asthma-like symptoms but negative asthma tests. A multidisciplinary approach and confirmation of these patients is important.

  • 157.
    Ringsberg, K.C.
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bjarneman, P.
    Bjärneman, P., Asthma and Allergy Centre Sahlgrenska University Hospital, 413 45 Göteborg, Sweden.
    Lowhagen, O.
    Löwhagen, O., Asthma and Allergy Centre Sahlgrenska University Hospital, 413 45 Göteborg, Sweden.
    Oden, A.
    Odén, A., Consultant Statistician, Valler, 442 92 Romelanda, Sweden.
    Toren, K.
    Torén, K., Occupational and Environmental Medicine, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden.
    Differences in trigger factors and symptoms between patients with asthma-like symptoms and patients with asthma: Development of a basis for a questionnaire2002In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 96, no 5, p. 305-311Article in journal (Refereed)
    Abstract [en]

    Patients with asthma-like symptoms but with negative asthma tests are often misdiagnosed as having asthma and treated as asthmatics. They describe their trigger factors and symptoms very similar to those of patients with asthma. The aim of the study was to analyze differences in symptoms and trigger factors between asthma-like patients and asthmatics in order to elaborate a basis for a questionnaire for epidemiological and clinical use. A questionnaire with 54 questions about trigger factors and 137 questions about symptoms was sent to 40 patients with asthma-like symptoms and 40 with asthma, all consecutively selected from patients referred to an out-patient clinic for asthma and allergy for investigation of suspected asthma. Data were analyzed statistically in two steps using multiple logistic regression analysis. Significant differences were seen in several trigger factors and symptoms after the first analysis. After the second analysis, seven out of the 54 trigger factors and 22 out of the 137 symptoms emerged as those that most significantly discriminated between the two patient groups. These trigger factors and symptoms can be the basis of a new questionnaire with high discriminating power. Before using it, it is important to evaluate the best combination of variables, add some demographic variables and to test the reliability and validity of this new questionnaire. © 2002 Elsevier Science Ltd.

  • 158.
    Ringsberg, KC
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lepp, M
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Finnstrom, B
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Experiences by patients with asthma-like symptoms of a problem-based learning health education programme2002In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 19, no 3, p. 290-293Article in journal (Refereed)
    Abstract [en]

    Background. Eighteen patients with asthma-like symptoms but negative asthma tests, randomly selected, participated in a problem-based learning health education programme. The programme had a multidisciplinary approach and included exercises inspired by cognitive behavioural therapy. Objective. The aim of this study was to describe how the patients experienced the programme. Methods. After termination of the programme, semi-structured interviews with a phenomenographic approach were conducted with 15 of the participants. Results. Two categories emerged, with three sub-categories each. In these, the informants described how they felt solidarity with the group, received confirmation from the other participants and had increased their self-confidence. They had started to look upon themselves and the disorder from a different perspective, they could describe the disorder in words and they had started to use new, conscious coping strategies. Conclusions. Patients with asthma-like symptoms benefit from taking part in a problem-based learning health education programme. It helps them to reflect upon themselves and the disorder and to use new strategies to cope with it.

  • 159.
    Risto, Olof
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Towards safe environments for youth sports: impact of a fair play programme on injury rates in youth bandy.2007In: International journal of injury control and safety promotion, ISSN 1745-7300, Vol. 14, no 3, p. 189-191Article in journal (Refereed)
    Abstract [en]

    [No abstract available]

  • 160. Savikko, A
    et al.
    Hensing, G
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Do mental health problems increase sickness absence due to other diseases?2001In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 36, p. 310-316Article in journal (Refereed)
  • 161.
    Sjögren, Elaine
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Psychosocial factors in adult life - in relation to gender, biological markers of stress and self-rated health2005Doctoral thesis, comprehensive summary (Other academic)
  • 162.
    Sjögren, Elaine
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Leanderson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Östergötlands Läns Landsting, Pain and Occupational Centre, Occupational and Environmental Medicine Centre.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Diurnal saliva cortisol levels and relations to psychosocial factors in a population sample of middle-aged Swedish men and women2006In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 13, no 3, p. 193-200Article in journal (Refereed)
    Abstract [en]

    Whereas psychosocial risk factors increase the risk for disease, psychosocial resources reduce this risk. To examine a possible pathway for these effects, the relations between saliva cortisol levels and psychosocial factors were studied in a random sample of 257 men and women aged 30 to 64 years. Saliva samples were collected at home on waking, 30 min after waking, and in the evening. A flatter diurnal rhythm of cortisol, that is, lower deviations between awakening and evening cortisol levels, was related to high levels of psychosocial risk factors (cynicism, depression, and vital exhaustion), whereas a steeper diurnal rhythm was related to psychosocial resources (social support and coping), general health, and well-being (all p < .05). Our results support earlier suggestions that the capacity of the hypothalamic-pituitary- adrenal-axis to dynamically respond to stress is 1 pathway for observed effects of psychosocial factors regarding risk for disease development. Copyright © 2006 by Lawrence Erlbaum Associates, Inc.

  • 163.
    Sjögren, Elaine
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Leanderson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Östergötlands Läns Landsting, Pain and Occupational Centre, Occupational and Environmental Medicine Centre.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Ernerudh, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Interleukin-6 levels in relation to psychosocial factors: Studies on serum, saliva, and in vitro production by blood mononuclear cells2006In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 20, no 3, p. 270-278Article in journal (Refereed)
    Abstract [en]

    Psychosocial factors and interleukin-6 (IL-6) levels are both related to risk of morbidity and mortality. The aim of this study was to investigate how a broad range of psychosocial factors related to levels of IL-6 in different media. Fifty-nine men and women aged 30-65 were recruited from a larger study and selected to cover a broad range of psychosocial status. IL-6 levels were analyzed in serum, in saliva collected at home at three different time points during a day, and in the supernatant of cell cultures stimulated in vitro with lipopolysaccharide. After adjustments for age, gender, self-reported health problems, and lifestyle factors, IL-6-levels in serum were negatively correlated with coping and self-esteem, and positively correlated with cynicism, hostile affect, hopelessness, depression, and vital exhaustion. In saliva samples, at all time points, IL-6 levels were positively correlated to cynicism, and IL-6 levels 30 min after awakening were also positively correlated with hopelessness, depression, and vital exhaustion. After adjustment for age and gender, cynicism, depression, and vital exhaustion were negatively correlated to IL-6 levels in the supernatant of cell cultures stimulated in vitro with lipopolysaccharide, but this effect was lost after control for self-reported health problems and lifestyle factors. In conclusion, we found that IL-6 levels in serum and saliva were negatively related to psychosocial resources and positively related to psychosocial risk factors. These data strengthen the argument that IL-6 is involved in mediating the risk for disease development that has been associated with psychosocial factors. © 2005 Elsevier Inc. All rights reserved.

  • 164.
    Sjögren, Elaine
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Leandersson, Per
    Linköping University, Department of Molecular and Clinical Medicine.
    Ernerudh, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Interleukin 6 levels in serum, saliva and in vitro production by blood mononuclear cells and their relations to psychosocial factors2004In: Eighth International Congress of Behavioral Medicine,2004, London: Lawrence erlbaum associates publishers London , 2004, p. 353-Conference paper (Refereed)
  • 165.
    Sjögren, Elaine
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Leandersson, Per
    Linköping University, Department of Molecular and Clinical Medicine.
    Ernerudh, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Psycholsocial factors and biological mechanisms in stress2004In: The 26th World Congress of the International Federation of Biomedical Laboratory Science IFBLS,2004, Stockholm: ABCD Swedish Association of health professionals , 2004, p. 74-Conference paper (Refereed)
  • 166.
    Sjögren, Elaine
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Sjögren, Elaine
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Tondel, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Östergötlands Läns Landsting, Pain and Occupational Centre, Occupational and Environmental Medicine Centre.
    Ståhlbom, Bengt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Östergötlands Läns Landsting, Pain and Occupational Centre, Occupational and Environmental Medicine Centre.
    Can gender differences in psychosocial factors be explained by socioeconomic status?2006In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 34, p. 59-68Article in journal (Refereed)
  • 167.
    Svensson, Tommy
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Karlsson, A
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Nordqvist, Cecilia
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Shame-inducing encounters. Negative emotional aspects of sickness-absentees' interactions with rehabilitation professionals2003In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 13, no 3, p. 183-195Article in journal (Refereed)
    Abstract [en]

    There is little knowledge on how sickness absentees experience encounters with rehabilitation professionals. This paper explores and describes negative emotions ("shame " in a broad sense) experienced by individuals on sick leave in their interactions with rehabilitation professionals. We performed a qualitative analysis of data from five focus-group interviews. The participants had experience of sickness absence with back diagnoses and discussed factors that facilitate or impede return to work. Reports of demeaning experiences in encounters with rehabilitation workers were frequent and could be divided into two major categories: 1) subjects perceived the behavior of rehabilitation professionals as distanced in a negative way, and felt that they were treated in an indifferent and nonchalant manner or fairly routinely, 2) subjects felt that they were disqualified, which included being discredited or belittled. This explorative study indicates the need for further, more directed investigations of emotional aspects of interactions between sickness absentees and rehabilitation professionals.

  • 168.
    Sydsjö, Adam
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Sydsjö, Gunilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Influence of pregnancy-related diagnoses on sick-leave data in women aged 16-442001In: Journal of Womens Health & Gender-Based Medicine, ISSN 1524-6094, E-ISSN 2168-7722, Vol. 10, no 7, p. 707-714Article in journal (Refereed)
    Abstract [en]

    Data on sickness absence frequently are used as a measure of morbidity and its social consequences in the employed population. The effects of sickness absence, as well as any possible differences in diagnoses among pregnant women as compared the sick leave data among the total population of women in fertile age have so far not been studied. The aim of this study was to investigate the relative contribution of pregnant women to the level of sickness absence, in general and in different diagnostic groups, as well as the extent to which sick-listed pregnant women can be identified through diagnoses on sickness certificates. In a cross-sectional study of all sick leave insured women aged 16-44 years (n=24,481) in Link÷ping, Sweden (117,000 inhabitants), data from two population-based research registers were used, one of sickness absence for the whole population, one of sickness absence among pregnant women in the same population and year. Pregnant women (5%) had a significantly higher cumulative incidence of sickness absence (0.64) compared with all women (0.18) and accounted for 20% of the women listed as absent because of sickness. The duration of the sickness absence was also significantly longer among pregnant women, 44.8 days compared with 9.7 days among all women. Practically all diagnoses among pregnant women were related to pregnancy or back pain (93%). When using diagnoses on the sickness certificates, only 46% of all sick-listed pregnant women could be identified, suggesting methodological difficulties in studies on sickness absence. Studies on sickness absence among women of fertile age should also contain information on the proportion of sick-listed pregnant women, as a small proportion of pregnant women may have a deep impact on the results and conclusions among all women.

  • 169.
    Söderberg, Elsy
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Sickness benefits and measures promoting return to work2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Decisions concerning entitlement to sickness benefits have a substantial impact on the lives of individuals and on society. In most countries, such decisions are made by professionals working in public organisations, and there is much debate about the work performed by those experts, hence more knowledge is needed on this subject.

    Objectives: The overall aim of the research underlying this thesis was to study, from different perspectives, the practices of actors involved in making decisions regarding the right to both sickness benefits and measures aimed at promoting return to work (RTW).

    Materials and methods: Five separate studies were performed using different investigative designs, data, and data analyses. The first two studies (papers I and II) scrutinised scientific publications concerning the sickness certification practices of physicians and the routines of social insurance officers, respectively. The third investigation (paper III) assessed the quality of physician's sickness certificates as a basis for social insurance officers' decisions about sickness benefits. The fourth study (paper IV) examined the experiences of inter-organisational cooperation between public servants working at social insurance and employment offices. The last study (Paper V) analysed the experiences of patients regarding encounters with health care professionals and social insurance officers in this context.

    Results: The twenty-six studies of physicians' sickness certification practices that were reviewed (paper I) focused on physicians, and occasionally on physicians and patients, but never on the interaction between them. Most of the studies emanated from Norway and Sweden, and were conducted by researchers in medical science, mainly physicians. Questionnaires were used to collect data in 80% of the studies. It was found that different physicians varied greatly in regard to the length of sickness absence they certified for similar patients.

    All but two of the sixteen studies scrutinised in paper 11 were conducted by behavioural scientists using social science theory. In the majority of those investigations, data were obtained through interviews. The studies were done in Norway and Sweden, and dealt with different dimensions of managing clients, although only two of the investigations considered the actual granting of sickness benefits. The majority of the studies focused on coordination of RTW measures, and some of those indicated that gender bias affected the decisions that were made.

    In the study presented in paper III, it was found that many of the analysed sickness certificates (n = 2,249) did not contain enough information to allow social insurance officers to determine eligibility for sickness benefits. General practitioners and physicians in training provided more essential data than did other categories of physicians, for example concerning the patients' occupational tasks. Statements about rehabilitation measures aimed at promoting RTW were not included on 60% of the certificates for women, compared to 36% of those issued for men.

    As described in paper IV, analyses of fourteen interviews with public servants working together on the same cases in inter-organisational projects identified important areas of the experiences. The daily collaboration on cases enabled development of good relationships and improved what was referred to as cooperative competence. The collaborative nature of the project made it possible to include only those clients who were perceived as being motivated to participate in RTW measures. Close and more frequent interaction with clients proved to be beneficial in that it facilitated mobilisation of the clients. The discrepancy between the rules and regulations of the social insurance, and the unemployment authorities was an obstacle to cooperation.

    In the study reported in paper V, eleven sickness benefit recipients were interviewed about how they experienced encounters with rehabilitation professionals. The experiences were assigned to five major categories: being treated with respect, feeling supported, establishing a personal relationship, perceiving demands as well-balanced, and participating in decisions regarding rehabilitation. Several interviewees believed that RTW might be promoted by positive encounters and hindered by negative interactions.

    Conclusions: The overall conclusion that can be drawn from the current results is that there is insufficient knowledge concerning the sickness certification practices of physicians and the practices of social insurance officers regarding granting of sickness benefits. Closely related to the granting of sickness benefits, particulary given the work-line strategy in Sweden is the assessment of work capacity, which has, from the perspective of social insurance standards, been studied from a very limited viewpoint. The theoretical framework of research in this area need to be developed to provide better understanding of the mentioned practices and the interactions between the different professionals and between professsionals and clients, from the perspectives of both gender and ethnicity.

    List of papers
    1. Sickness certification practices of physicians: a review of the literature
    Open this publication in new window or tab >>Sickness certification practices of physicians: a review of the literature
    2003 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 31, no 6, p. 460-474Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: In most Western countries the responsibilities of physicians include assessing work ability and issuing certificates for sickness absence and disability pension. These tasks often have a substantial impact on the lives of patients and constitute a financial burden on employers, insurance companies, and communities.

    AIM: The aim was to review scientific studies on sickness certification practices of physicians published in English, Danish, Norwegian, or Swedish.

    METHOD: Analyses were carried out of studies searched for through literature databases, reference lists, and personal contacts.

    RESULTS: Twenty-six publications fulfilled the inclusion criteria. Most of these were published in the last decade. The studies focused on physicians, and occasionally on physicians and patients, but never on interaction between them. Data had generally been collected using questionnaires, some including case vignettes. There was a large variation in how long different physicians sickness-certified similar patients. Three comprehensive categories of studies were identified dealing with the following: (1). how physicians certify sickness; (2). factors that might affect the certification process; (i.e. elements related to the patient, to the physician, or to restrictions in insurance legislation); and (3). studies concerning attitudes. No studies were found that took into account the work conditions of the hospital or health-care organization in which the physician works.

    CONCLUSIONS: The research problems were seldom medical in nature but were instead carried out within the realm of behavioural science and should preferably be conducted using theories from behavioural, social, and public health scientific theories. Furthermore, factors such as gender, ethnicity, and power should be taken into consideration in studies on this complex phenomenon.

    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-26249 (URN)10.1080/14034940310005367 (DOI)14675938 (PubMedID)10753 (Local ID)10753 (Archive number)10753 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    2. Gatekeepers in sickness insurance: a systematic review of the literature on practices of social insurance officers
    Open this publication in new window or tab >>Gatekeepers in sickness insurance: a systematic review of the literature on practices of social insurance officers
    2005 (English)In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 13, no 3, p. 211-223Article in journal (Refereed) Published
    Abstract [en]

    Decisions concerning entitlement to sickness benefits have a substantial impact on the lives of individuals and on society. In most countries, such decisions are made by staff of private or public insurance organisations. The work performed by these professionals is debated, hence more knowledge is needed on this subject. The aim of the present study was to review scientific studies of the practices of social insurance officers (SIOs) published in English, Danish, Norwegian and Swedish. Studies were searched for in literature databases, in reference lists, and through personal contacts. Analyses were made of type of study, areas investigated, research questions, theories used, and the results. Sixteen studies were included. SIOs and several other actors are responsible for applying measures to minimise sick-leave and promote return to work (RTW). The studies focusing on coordination of such measures revealed that SIOs felt unsure about how to handle their contacts with clients and other actors. One study indicated that the SIOs, partly due to lack of time, accepted the recommendations of physicians instead of making their own judgments about granting sickness benefits. While all SIOs must make decisions concerning entitlement to sickness benefits on a daily basis, few of the reviewed studies scrutinised the actual granting of sickness compensation. The studies were also deficient in that they investigated the decision latitude of the SIOs from a very limited perspective, mainly on an individual level and often primarily in relation to colleagues and/or clients rather than to the laws and regulations of the sickness insurance. The concepts and framework in this area of research need to be developed to facilitate elucidation of the interaction between different actors in local spheres, professionals in different disciplines, and between welfare staff and individual citizens.

    Keywords
    Client, Cooperation, Return to work, Sick-leave, Sickness benefit, Social insurance officer
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-45458 (URN)10.1111/j.1365-2524.2005.00551.x (DOI)
    Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
    3. Sickness certificates as a basis for decisions regarding entitlement to sickness insurance benefits
    Open this publication in new window or tab >>Sickness certificates as a basis for decisions regarding entitlement to sickness insurance benefits
    2005 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 33, no 4, p. 314-320Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND:

    The sickness certificate is a major instrument for establishing contact and conveying information between two authorities that have a substantial impact on the life situation and work situation of the patients, as well as on the economic costs of the society.

    AIM:

    A study was undertaken to assess the quality of physicians' sickness certificates as a basis for social insurance officers' decisions regarding entitlement to sickness benefits.

    METHOD:

    Information on all 2,449 sickness certificates for sick-leave periods exceeding 28 days' sick leave period received at the social insurance offices in one Swedish county during one week in 2002 was coded and analysed.

    RESULTS:

    Information provided in the certificates was often not sufficient to allow social insurance officers to determine eligibility for sickness benefits. Qualitative analyses of certificates from general practitioners (GPs) revealed that 21% contained ambiguous statements about the medical disorder, 30% were unclear regarding the assessment of functional capacity, and 22% required additional information on both those aspects. Sickness certificates issued by GPs and physicians under specialist training, as compared with other categories of physicians, more often provided essential data, for example concerning the patient's occupational tasks and type of employment.

    CONCLUSIONS:

    Physicians often fail to contribute required information concerning functional capacity and other important aspects when issuing sickness certificates. This limits the use of these documents as a basis for decisions regarding sickness insurance benefits. The practical consequences of incomplete certificates might be delayed payment of benefits and delayed initiation of return to work measures.

    Keywords
    Sick leave, Sickness benefit, Sickness certificate, Sickness insurances
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-50273 (URN)10.1080/14034940510005798 (DOI)
    Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12Bibliographically approved
    4. Experiences of professionals participating in inter-organisational cooperation aimed at promoting clients' return to work
    Open this publication in new window or tab >>Experiences of professionals participating in inter-organisational cooperation aimed at promoting clients' return to work
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Over the past decade, sickness absence has increased in Sweden and other Western European countries, with regard to both the number of people claiming sickness benefits and the length of the sick-leave spells. In Sweden, the activities initiated to promote RTW are performed in parallel by four different public organisations: the health services, the social services, the employment and the social insurance authorities. The present study focused on cooperation between professionals affiliated to the employment and social insurance authorities.

    Aim: To gain deeper understanding on the experiences of professionals involved in cooperative projects aimed at promoting RTW among unemployed sickness benefit recipients.

    Method: Qualitative analyses were performed of transcribed data from interviews of professionals participating in cooperative projects.

    Result: The analyses identified four impmtant areas of the experiences of such cooperation. First, the daily collaboration on the same cases enabled development of good relationships and cooperative competence, which improved the contact with clients. Second, the cooperative projects made it possible to include only clients perceived motivated for RTW measures. Third, the closer and more frequent interaction with clients proved to be constmctive in that it facilitated recognition and mobilisation of the strengths and abilities of the clients in the RTW process. Fotnih, the differences in rules and regulations between the social insurance and the unemployment insurance standards was often mentioned, and were perceived to induce problems, for example, on how to assess the work capacity of clients.

    Conclusion: The direct cooperation between the professionals from two different authorities was found to improve the application of RTW measures. The assessments of work capacity represent both important and complex tasks that professionals must perfonn without having access to either scientific knowledge or consensus agreement on which to base their decisions. Finally, it is important to gain further knowledge on how to create, develop, and maintain the 'cooperative competence' developed in the projects.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-81942 (URN)
    Available from: 2012-09-26 Created: 2012-09-26 Last updated: 2012-09-26Bibliographically approved
    5. Sickness absentees' experiences of positive encounters by healthcare and sickness insurance professionals: an interview study
    Open this publication in new window or tab >>Sickness absentees' experiences of positive encounters by healthcare and sickness insurance professionals: an interview study
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    We need more knowledge on factors that can promote retum to work (RTW) grounded on peoples' own views. One such factor of importance is the way absentees themselves experience their interactions with professionals. The purpose of the study was to identify and analyse sick-listed persons' experiences of positive encounters with professionals.

    An inductive and descriptive-qualitative approach was used to analyse transcripts from 11 semi-structured interviews with persons after or during long-term sickness absence. Being treated with respect, feeling supported, establishing a personal relationship, perceiving demands as well-balanced, and patiicipating in decisions regarding rehabilitation appeared as important qualities. Several interviewees believed that positive encounters might promote RTW.

    Further research is needed to elucidate the aspects of such interactions that enhance empowerment and self-confidence in persons on sick leave, in order to develop professional treatment strategies that facilitates for rehabilitation, and to favour collaborative work between and within group of professionals.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-81943 (URN)
    Available from: 2012-09-26 Created: 2012-09-26 Last updated: 2015-06-02Bibliographically approved
  • 170.
    Söderberg, Elsy
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Alexanderson, Kristina
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Sickness certification practices of physicians: a review of the literature2003In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 31, no 6, p. 460-474Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In most Western countries the responsibilities of physicians include assessing work ability and issuing certificates for sickness absence and disability pension. These tasks often have a substantial impact on the lives of patients and constitute a financial burden on employers, insurance companies, and communities.

    AIM: The aim was to review scientific studies on sickness certification practices of physicians published in English, Danish, Norwegian, or Swedish.

    METHOD: Analyses were carried out of studies searched for through literature databases, reference lists, and personal contacts.

    RESULTS: Twenty-six publications fulfilled the inclusion criteria. Most of these were published in the last decade. The studies focused on physicians, and occasionally on physicians and patients, but never on interaction between them. Data had generally been collected using questionnaires, some including case vignettes. There was a large variation in how long different physicians sickness-certified similar patients. Three comprehensive categories of studies were identified dealing with the following: (1). how physicians certify sickness; (2). factors that might affect the certification process; (i.e. elements related to the patient, to the physician, or to restrictions in insurance legislation); and (3). studies concerning attitudes. No studies were found that took into account the work conditions of the hospital or health-care organization in which the physician works.

    CONCLUSIONS: The research problems were seldom medical in nature but were instead carried out within the realm of behavioural science and should preferably be conducted using theories from behavioural, social, and public health scientific theories. Furthermore, factors such as gender, ethnicity, and power should be taken into consideration in studies on this complex phenomenon.

  • 171.
    Söderberg, Elsy
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Vimarlund, Vivian
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Alexanderson, Kristina
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Experiences of professionals participating in inter-organisational cooperation aimed at promoting clients' return to workManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Over the past decade, sickness absence has increased in Sweden and other Western European countries, with regard to both the number of people claiming sickness benefits and the length of the sick-leave spells. In Sweden, the activities initiated to promote RTW are performed in parallel by four different public organisations: the health services, the social services, the employment and the social insurance authorities. The present study focused on cooperation between professionals affiliated to the employment and social insurance authorities.

    Aim: To gain deeper understanding on the experiences of professionals involved in cooperative projects aimed at promoting RTW among unemployed sickness benefit recipients.

    Method: Qualitative analyses were performed of transcribed data from interviews of professionals participating in cooperative projects.

    Result: The analyses identified four impmtant areas of the experiences of such cooperation. First, the daily collaboration on the same cases enabled development of good relationships and cooperative competence, which improved the contact with clients. Second, the cooperative projects made it possible to include only clients perceived motivated for RTW measures. Third, the closer and more frequent interaction with clients proved to be constmctive in that it facilitated recognition and mobilisation of the strengths and abilities of the clients in the RTW process. Fotnih, the differences in rules and regulations between the social insurance and the unemployment insurance standards was often mentioned, and were perceived to induce problems, for example, on how to assess the work capacity of clients.

    Conclusion: The direct cooperation between the professionals from two different authorities was found to improve the application of RTW measures. The assessments of work capacity represent both important and complex tasks that professionals must perfonn without having access to either scientific knowledge or consensus agreement on which to base their decisions. Finally, it is important to gain further knowledge on how to create, develop, and maintain the 'cooperative competence' developed in the projects.

  • 172.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Professional ethics for system developers in health care.1999In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 38, p. 144-147Article in journal (Refereed)
  • 173.
    Timpka, Toomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Angbratt, Marianne
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Hermansson, Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Bolme, P
    Häger, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Valter, L
    A high-precision protocol for identification of preschool children at risk for persisting obesity2007In: PLoS ONE, ISSN 1932-6203, Vol. 2, no 6Article in journal (Refereed)
    Abstract [en]

    Background: Recent studies suggest that adolescent adiposity is established already in preadolescence. Earlier studies have confirmed a strong tracking of obesity from adolescence to adulthood. Our aim was to examine the diagnostic accuracy of a population-derived protocol for identification of preschool children at risk for obesity in preadolescence. Methodology/Principal Findings: We analysed data obtained for child health surveillance up to age 5 from 5778 children born in a swedish county in 1991. The basic data set included age, sex, and weight and height measurements from the regular checkups between ages 1.5 and 5. Data not routinely collected in the child health centre setting were disregarded. The children were at age 10 randomly assigned to protocol derivation and validation cohorts and assessed for obesity according to IOTF criteria. The accuracy of predicting obesity in the validation cohort was measured using decision precision, specificity, and sensitivity. The decision protocol selected 1.4% of preschool children as being at obesity risk. The precision of the protocol at age 10 was 82% for girls and 80% for boys, and the specificity was 100% for both boys and girls, The sensitivity was higher for girls (41 %) than for boys (21%). The relative risk for obesity at age 10 estimated by the odds ratio for individuals selected by the protocol compared to non-selected peers was 212.6 (95% confidence interval 56.6 to 798.4) for girls and 120.3 (95% Cl 24.5 to 589.91for boys. Conclusion/Significance: A simple and inexpensive decision protocol based on BMI values proved to have high precision and specificity for identification of preschool children at risk for obesity persisting into adolescence, while the sersitivity was low especially for boys. Implementation and further evaluations of the protocol in chlid health centre settings are warranted. © 2007 Timpka et al.

  • 174.
    Timpka, Toomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Hassling, Linda
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Nordfeldt, Sam
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics.
    Eriksson, Henrik
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Towards integration of computer games in interactive health education environments: understanding gameplay challenge, narrative and spectacle.2004In: MedInfo, IOS Publishing , 2004, Vol. 11, no Pt 2, p. 941-945Conference paper (Refereed)
    Abstract [en]

    CONTEXT: There is an alarming progress in the health status of the young in western countries, and new methods and tools for behavioural health interventions are urgently called for. OBJECTIVE: To explore how computer game designs can be integrated in the development of Interactive Health Education Environments. DESIGN: Qualitative analyses of adolescents' experiences of playing an action-adventure computer game, using data from in-depth interviews. RESULTS: A model is presented, where the gameplaying experience is connected to four components of computer games. Playing computer games was found to mainly be motivated by the challenges and competition represented in the gameplay scripts. CONCLUSIONS: Interactive health education environments can be improved by implementing challenging gameplay scripts, spectacular technical features and narratives.

  • 175.
    Timpka, Toomas
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Leijon, Margareta
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Karlsson, Göran
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Svensson, Lilian
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bjurulf, Per
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Long-term economic effects of team-based clinical case management of patients with chronic minor disease and long-term absence from working life1997In: Scandinavian Journal of Social Medicine, ISSN 0300-8037, Vol. 25, no 4, p. 229-237Article in journal (Refereed)
    Abstract [en]

    Objectives: To examine the socio-economic effects of team-based clinical case management of patients with chronic minor disease bound for early retirement.

    Design: Marginal analysis of programme costs and benefits to society compared with no-programme baseline of costs occurring in society due to productivity loss. Prospective patient data collection on admission, discharge, and at one year and five years after discharge to determine programme effectiveness.

    Setting: Out-patient clinic at the department of social medicine in tertiary care hospital.

    Subjects: 239 patients with minor disease and long-term vocational absence consecutively admitted to the study. At the one-year evaluation, 17 patients had been readmitted to the team, 7 could not be found, 6 declined the interview and 2 were deceased. At the five-year evaluation of 49 patients who were active after one year, one was deceased and 10 were unable to be found.

    Main outcome measures: Vocational activity. Programme costs. Benefits to society measured by decrease in indirect costs.

    Results: The one-year vocational rehabilitation rate from the program was 20.5% and the five-year rehabilitation rate was 11.3%. The total discounted cost for case management of the 239 patients was 7.6 MSEK (£600,000). The decrease in the indirect costs to society from the 28 patients found active after five years was 35.1 MSEK (£2,500,000). The net present value of the programme at the 1991 price level was 27.5 MSEK (£2,365,000).

    Conclusions: Tertiary care level team-based clinical case management for vocational rehabilitation of patients with chronic minor disease has a positive cost-benefit ratio. A cross-boundary awareness at a health policy level is needed of the societal costs involved for this group of patients who fall between the traditional services in health care and social work.

  • 176.
    Timpka, Toomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Lindqvist, Kent
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Evidence based prevention of acute injuries during physical exercise in a WHO safe community2001In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 35, no 1, p. 20-27Article in journal (Refereed)
    Abstract [en]

    Objective - To evaluate a community based programme for evidence based prevention of injuries during physical exercise. Design - Quasi-experimental evaluation using an intervention population and a non-random control population. Participants - Study municipality (population 41 000) and control municipality (population 26 000) in Sweden. Main outcome measures - Morbidity rate for sports related injuries treated in the health care system, severity classification according to the abbreviated injury scale (AIS). Results - The total morbidity rate for sports related injuries in the study area decreased by 14% from 21 to 18 injuries per 1000 population years (odds ratio 0.87, 95% confidence interval (CI) 0.79 to 0.96). No tendency towards a decrease was observed in people over 40. The rate of moderately severe injury (AIS 2) decreased to almost half (odds ratio 0.58, 95% CI 0.50 to 0.68), whereas the rate of minor injuries (AIS 1) increased (odds ratio 1.22, 95% CI 1.06 to 1.40). The risk of severe injuries (AIS 3-6) remained constant. The rate of total sports injury in the control area did not change (odds ratio 0.93, 95% CI 0.81 to 1.07), and the trends in the study and control areas were not statistically significantly different. Conclusion - An evidence based prevention programme based on local safety rules and educational programmes can reduce the burden of injuries related to physical exercise in a community. Future studies need to look at adjusting the programme to benefit all age groups.

  • 177.
    Timpka, Toomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Lindqvist, Kent
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Ekstrand, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Karlsson, Nadine
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Impact of social standing on sports injury prevention in a WHO safe community: intervention outcome by household employment contract and type of sports.2005In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 39, no 7, p. 453-457Article in journal (Refereed)
  • 178.
    Timpka, Toomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Lindqvist, Kent
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Schelp, L
    Åhlgren, M
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Community-based injury prevention: effects on health care utilization.2000In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 28, p. 502-508Article in journal (Refereed)
  • 179.
    Timpka, Toomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Morin, Magnus
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, ASLAB - Application Systems Laboratory.
    Jenvald, Johan
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, ASLAB - Application Systems Laboratory.
    Eriksson, Henrik
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Gursky, Elin
    ANSER.
    Towards a simulation environment for modeling of local influenza outbreaks2005In: AIMA 2005 Annual Symposium,2005, 2005Conference paper (Refereed)
  • 180.
    Timpka, Toomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Morin, Magnus
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, ASLAB - Application Systems Laboratory.
    Jenvald, Johan
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, ASLAB - Application Systems Laboratory.
    Gursky, Elin
    Eriksson, Henrik
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Dealing with ecological fallacy in preparations for influenza pandemics: Use of a flexible environment for adaptation of simulations to household structures in local contexts2007In: MedINFO 2007,2007, 2007Conference paper (Refereed)
    Abstract [en]

      

  • 181.
    Timpka, Toomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Nilsen, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Lindqvist, Kent
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    The impact of home safety promotion on different social strata in a WHO safe community.2006In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 120, p. 427-433Article in journal (Refereed)
    Abstract [en]

      

  • 182.
    Timpka, Toomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Risto, Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Borg, K
    Johansson, J
    Injury incidence in a men's elite bandy league: An epidemiological study of a full regular season2007In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 17, no 6, p. 636-640Article in journal (Refereed)
    Abstract [en]

    Bandy is a popular European winter team-sport. The best bandy teams participate in semi-professional leagues, where the play-off games attract more than 10 000 spectators. Injury patterns in elite bandy have not been investigated previously. The aim of this study is to examine the incidence and types of injuries sustained during elite bandy games for men. Twelve of the 16 teams in the Swedish elite bandy league during the 2002 season participated in the study. In total, 36 injuries were recorded, corresponding to 7.3 injuries/1000 player game hours and 5.7 injuries/1000 athlete exposures. Collision was the most common injury cause (47%), while contusion was the most common injury type (25%), followed by fracture (22%) and ligament rupture (19%). The study showed that the injury incidence in elite bandy is low, but also that the injuries that are still sustained are relatively severe. This pattern can be explained by the fact that even though bandy rules do not allow body checks, collisions between skaters moving at high speeds still cause the majority of injuries. Further studies of the injury rehabilitation practices, and the implementation and evaluation of safety programs in elite bandy are warranted. © 2007 Blackwell Munksgaard.

  • 183.
    Timpka, Toomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Risto, Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Lindqvist, Kent
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Injuries in competitive youth bandy: An epidemiological study of a league season2002In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 34, no 6, p. 993-997Article in journal (Refereed)
    Abstract [en]

    Purpose: Bandy, with a century-long tradition in northern Europe, is a winter team-sport similar to ice hockey. To investigate the occurrence of injuries during competitive youth bandy games, injury incidence, injury types, and age-related risks were analyzed for one youth league season. Methods: The National Athletic Injury/Illness Reporting System (NAIRS) definition of sports injury was used for the injury registration. All 416 games during the 1999-2000 season in the Swedish southeastern youth bandy league were included in the study. Primary data was collected by a questionnaire and completed by the team coaches after each game. At the end of the season, physician interviews with each team coach were performed to assure that no injuries had been missed as well as to ascertain whether there was any remaining disability. Results: In total, 2.0 injuries (95% confidence interval 1.2-2.9 injuries) per 1000 player game hours were recorded. Sixty-eight percent of the injuries caused the injured player to be absent from bandy play for more than a week. Collision was the most common cause of injury (36%), and contusion was the most common injury type (41%). The injury incidence in the leagues for older players (Youth 14 - Youth 16) was slightly higher than in the leagues for the younger players (Youth 12 - Youth 13), while participation by under-aged players in games organized for older players led to an almost four-fold increase of injury risk. For severe injuries, the mean rehabilitation time away from bandy practice or competition was 27 d (range 8-56 d). Conclusion: The overall injury incidence during youth bandy games is low, but the injuries that occur cause extensive absences from the only four months long bandy season. From a public health perspective, bandy can be recommended for consideration when physical exercise is to be promoted among school-age children in countries with a winter climate.

  • 184.
    Trygg, Tomas
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lundberg, Gunnar
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Rosenlund, Elisabeth
    Department of Psychology, Lund University, Sweden.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre. Linköping University, Faculty of Health Sciences.
    Personality characteristics of women with fibromyalgia and of women with chronic neck, shoulder, or low back complaints in terms of Minnesota Multiphasic Personality Inventory and defense mechanism technique modified2002In: Journal of Musculoskeletal Pain, ISSN 1058-2452, E-ISSN 1540-7012, Vol. 10, no 3, p. 33-55Article in journal (Refereed)
    Abstract [en]

    Objectives: To compare personality features of fibro-myalgia patients with those of a disease control group with regional pain.

    Methods: A group of 33 women with fibromyalgia [FMS-group] was compared on the Minnesota Multiphasic Personality Inventory [MMPI] and the Defense Mechanism Technique modified [DMTm] with 31 women [C-group] without this diagnosis who had localized chronic pain in their neck, shoulder, and/or low back areas and were very similar in chronological age, intelligence, and basic personality patterns.

    Results: As hypothesized the FMS-group scored higher than the C-group on the MMPI-scales of Hypochondriasis, Depression, and Hysteria. They also scored higher on Admission of symptoms, Psych-asthenia, Anxiety, Schizophrenia, Social introversion, and a number of nonclinical subscales. The differences were not found to be due to differences in pain intensity. The only statistically significant difference in DMTm between the groups was that of FMS patients more often reporting the projected self to be positive and/or to be afraid, suggesting them to be more vulnerable than the comparison group to threatening experiences. Significant relationships between the disability level and the number of tender points, group membership, pain intensity, and various of the MMPI scales were found.

    Conclusions: There were no signs on the MMPI of serious psychological disturbances in either group, and at the “deeper” psychological level, assessed in DMTm, there were no marked differences between the two groups, a proneness to somaticize psychological pain being found in both groups. Both the MMPI and the DMTm results were interpreted as suggesting that a cognitive coping strategy program be considered for rehabilitation. The fact that both different symptoms and signs had importance when regressing disability might indicate that univariate approaches is not sufficient when investigating factors of importance for disability.

  • 185. Unell, L
    et al.
    Söderfledt, B
    Halling, A
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Birked, D
    Explanatory models for indicators of periodontal disease in an adult population.2000In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 27, p. 22-29Article in journal (Refereed)
  • 186.
    Vaez, Marjan
    et al.
    Socialmedicin Karolinska institutet.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Laflamme, Lucie
    Socialmedicin Karolinska institutet.
    Perceived quality of life and self-rated health among first-year university students2004In: Social Indicators Research, ISSN 0303-8300, E-ISSN 1573-0921, Vol. 68, no 2, p. 221-234Article in journal (Refereed)
    Abstract [en]

    This study compares health status and quality of life assessments of first-year university students with those of their same-age working counterparts. Subjects and materials for each group were gathered in 1999 from two cross-sectional data sets from the Swedish region of Östergötland, covering males and females aged 20-34 years. Subjects' perceived quality of life (QoL) and self-rated health (SRH) were assessed on a 10-point scale (Ladder scale) and a five-point scale, respectively. Gender-based comparison revealed that, for both males and females, first-year university students' average perceived QoL was lower than that of their working counterparts (p < 0.0001 in all instances). A higher proportion of students than expected rated their health as "average" or as "low" (p < 0.0001). Perceived QoL was significantly correlated with SRH in both groups. Differences in perceived QoL and SRH exist between students and their full-time working peers, and the determinants of these differences deserves greater attention. Knowledge of the determinants of SRH and perceived QoL among university students might then be translated into sound and effective public-health practice and intervention programs.

  • 187.
    Vimarlund, Vivian
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Sjöberg, Cecilia
    Swedish Agency for Innovation Systems, Stockholm, Sweden.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    A theory for classification of health care organizations in the new economy2003In: Journal of medical systems, ISSN 0148-5598, E-ISSN 1573-689X, Vol. 27, no 5, p. 465-473Article in journal (Refereed)
  • 188.
    Vimarlund, Vivian
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, EISLAB - Economic Information Systems.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Changes in the roll of IT in primary healthcare2004In: Journal of the American Medical Informatics Association, ISSN 0195-4210Article in journal (Refereed)
    Abstract [en]

    Proceeding of 11th Conference on Medical Informatics, Medinfo-San Francisco, Cal. (Eds) Edward Shortliffe et.al .Amsterdam: IOS. Press, 2004

  • 189.
    Vimarlund, Vivian
    et al.
    Linköping University, Department of Computer and Information Science, EISLAB - Economic Information Systems. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Socialmed FHVC.
    Design participation as an insurance: Risk-management and end-user participation in the development of information systems in healthcare organizations2002In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 41, no 1, p. 76-80Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this paper is to build a theoretical framework for analysis of when decision-makers should use end-user participation as a form of insurance for unforeseen consequences of implementing information systems in healthcare organizations. Method: Data were collected in a case study of an information system development project in a small clinical setting. During the initial phase, the future end-users of the system were allowed to actively influence the system design and test every new tool that was considered for implementation. Results: The results of the case study suggest that when time and effort are invested in allowing healthcare staff to participate in information system development processes, the benefits can well exceed the costs throughout the life cycle of the project. Risk-averse decision-makers fearing negative secondary consequences of a HIS, with regard to clinical work flow, will always adopt measures to prevent future failures, if they can find a possibility of shifting these risks. Therefore, they calculate the present discounted value of the effects accrued over time to the unit and predict the amount of resources they are willing to pay to acquire an insurance (such as design participation) that will protect the organization from future losses. Conclusions: End-user participation in the design process can be the key positive influence on the quality of the service and, thereby, organizational effectiveness. Investments in broad design participation can, consequently, be a productive activity that transforms potential current income into future benefits.

  • 190.
    Vimarlund, Vivian
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Hallberg, Niklas
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Healthcare professional's demand for knowledge in informatics. 1999In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 53, p. 107-114Article in journal (Refereed)
  • 191.
    Wigertz, Ove
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Lundquist, Per-Gotthard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Teaching health informatics at Linköping University. A New design for the medical student curriculum1996In: HTE96 European Conference on Health Telematics Education,1996, 1996Conference paper (Refereed)
  • 192.
    Wilhelmsson, Susan
    et al.
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Foldevi, Mats
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Åkerlind, Ingemar
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Unfavourable Working Conditions for Female GPs: A Comparison between Swedish General Practitioners and District NursesManuscript (preprint) (Other academic)
    Abstract [en]

    Objective: The aim of this study was to investigate gender and occupational differences in the psychosocial work environment among general practitioners (GPs) and district nurses (DNs) in Sweden.

    Design: A stratified random sample of general practitioners (n = 566) and district nurses (n= 554) from four county councils in Sweden was selected. The overall participation rate was 83%. A mailed questionnaire including ten items of demographic and work sites characteristics, and 36 items of psychosocial working conditions was used. The questionnaire had been tested concerning validity and reliability. A factor analysis gave five factors: strains and symptoms, professional content, social support at work, workload, and job control.

    Results: In total, professional content was the most positively experienced aspect whereas workload was the most negatively. The GPs perceived a higher workload and fewer opportunities to social support at work compared with the DNs. The female GPs scored significantly more unfavourable than both male GPs and female DNs did in four out of the five factors. The female GPs reported a high workload, low job control and fewer opportunities to social support at work. The female DNs also reported a high workload, relatively low job control but a rather strong social support at work.

    Conclusion: Female GPs perceive more unfavourable psychosocial working conditions compared with both male GPs and female DNs in the same organisational setting.

  • 193.
    Åkerlind, Ingemar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, National Centre for Work and Rehabilitation.
    Johansson, Kjell
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Beroendekliniken IHS. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Dependency.
    How often are patients receiving advice about alcohol and other lifestyle habits in primary care in Sweden?2002In: Eur J Public Health,2002, 2002, p. 35-36Conference paper (Refereed)
  • 194.
    Östlund, G
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Cedersund, E
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Hensing, Gunnel
    It was really nice to have someone: Lay people with musculoskeletal disorders request supportive relationships in rehabilitation2001In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 29, no 4, p. 285-291Article in journal (Refereed)
    Abstract [en]

    Aims : To explore the lay person's perspective on the rehabilitation process. Methods : A total of 20 interviews were conducted with women and men who had recent or more distant experience of sickness absence with musculoskeletal diagnoses. Grounded theory was used, which includes an inductive approach and theoretical sampling. The interviews focused on the individuals' own stories and experiences of factors that promoted or hindered the rehabilitation process. Results : The interviewees emphasized how and by whom they had been treated rather than what type of rehabilitation programmes they had attended. They focused on the importance of supportive relationships from the private, occupational, and health care arenas. The relationship with rehabilitation agents (professionals who implemented rehabilitation) was described as having either supportive or non-supportive qualities. Based on the interviewees' descriptions, a model was developed on the socioemotional qualities of the rehabilitation agent. The most promoting factor in the rehabilitation process was to have a professional mentor that is a rehabilitation agent who combines a supportive approach with individually chosen rehabilitation measures and goals. Conclusions : The lay person's perspective gave additional knowledge regarding rehabilitation and recovery from musculoskeletal disorders. The socioemotional qualities of the rehabilitation agents were emphasized by the interviewees and a model regarding these qualities was developed. This model needs to be tested further. A clinical implication of the present study is the need for rehabilitation agents to develop their communication skills further.

  • 195.
    Östlund, Gunnel
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Promoting return to work: lay experiences after sickness absence with musculoskeletal diagnoses2002Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Musculoskeletal disorders constitute the greatest cause of sickness absence from work. Despite research and efforts at rehabilitation, sickness absence due to these disorders has not decreased, but has instead increased, particularly in women. Clients’ perceptions of care and rehabilitation, i.e. knowledge generated from a lay perspective, is a neglected area of research. This thesis deals with lay experiences of rehabilitation following sickness absence due to back, neck or shoulder problems, termed musculoskeletal disorders (MSD).

    Aim: The overall aim was to examine hindering and promoting processes in rehabilitation after sickness absence due to MSD from a lay perspective. Specific aims were to study how lay persons experience rehabilitation agents and rehabilitation activities (paper I), how they describe themselves and their experience in relation to work (paper II), the significance of the private arena regarding return to work (paper III), and how clients who have experienced sickness absence due to MSD perceive contact with rehabilitation agents (paper IV).

    Method: The study population in the four papers is part of a cohort of persons living in the same municipality and who in 1985 were aged 25-34 years and were sick-listed due to back, neck or shoulder diagnoses for 28 days or  more, n=213. During 1995, 148 persons in the cohort responded to a questionnaire, and in 1997-1998, 20 of these persons were interviewed concerning their experiences with rehabilitation. In papers I, II and III the qualitative method of Grounded Theory was used with a focus on creating an empirically-based theory concerning the area under study. Data collection was strategic and analysis of the tape-recorded interviews was done on a continual basis. How previously sick-listed persons experienced contact with professional rehabilitation agents in t he health care sector and social insurance office was investigated in paper IV. Factor analysis and multiple regression analysis were used to analyse the data in this study.

    Results: The interview study shed light on lay persons’ experiences with medical, social and work-related measures in rehabilitation, their perceptions of rehabilitation actors and family members in relation to rehabilitation, and their self-presentations. The descriptions of lay persons concerned three arenas, the health care arena, the occupational arena, and the private arena. Dilemmas and difficulties in these arenas were described, such as handling the duty to work, experiencing domestic strain, and the experience of lacking socioemotional support from significant persons during the rehabilitation process. In paper I some ideal types of rehabilitation agents emerged from the interviewees’ descriptions concerning the health care arena, and we called these the routine bureaucrat, the empathic administrator, the distant technician, and the professional mentor. The latter agent was requested and was described as a person who could provide socioemotional support, who had professional competence, and who could function as a unifying link during the rehabilitation process. The results from paper II showed that in their self-presentations, the interviewees expressed having a duty to work and that there were differences in how they handled this sense of duty. The selfpresentations contained descriptions of work as a part of personal identity and could be summarised in the following ideal types: the work manic, the workhorse, the workaholic and the relaxed worker. The latter used a strategy that can be considered to promote rehabilitation in that the individual himself/herself had control over his/her work and worked in accordance with his/her own needs rather than those of others. Paper III focused on the private arena. Different patterns were found in the experiences of men and women. Women related that their responsibility for the home and domestic work seldom left any time for themselves, including any time for rehabilitation. Men more often reported having time for themselves that could be used for leisure activities and rehabilitation. Some of the women said that they lacked socioemotional support from their partner and that they had a great deal of responsibility for housework, which seemed to be a hindrance in returning to work after sickness absence. Furthermore, these women, like most of the men, had little education, which could make finding other work alternatives more difficult. Based on the interviews, a hypothesis was developed regarding domestic strain that is related to the distribution of domestic work, the distribution of responsibility for the home, and the quality of the marital relationship. Paper IV dealt with clients’ perceptions of contact with rehabilitation agents in health care and the social insurance office. Three latent dimensions were found in the respondents’ ratings of these contacts: supportive treatment, distant treatment, and empowering treatment. Sex, disability pension status, mental health and diagnostic group were significantly related to how these dimensionswere rated. Women perceived the treatment from both types of rehabilitation agents as more supportive than men. Contact with the social insurance offices were rated higher by persons with disability pensions than by those who had returned to work. Men rated their contact with rehabilitation agents at social insurance offices high on the dimension of distant treatment. Respondents with mental health problems rated the contact as distant for both types of rehabilitation agents, but contact with health care was also scored low on the supportive dimension. Finally, respondents with neck/shoulder diagnoses rated contact with rehabilitation agents in health care as more empowering than was done by persons with back diagnoses.

    Conclusions: From a lay perspective rehabilitation following sickness absence due to MSD occured in three arenas, the health care arena, the occupational arena and the private arena, where the quality of relationships both with rehabilitation agents, persons at work and in one’s private life was described as important regarding the rehabilitation process. This thesis also showed that both sex and health were important factors regarding how lay persons’ perceived contacts with rehabilitation agents during the rehabilitation process following sickness absence due to MSD.

    List of papers
    1. It was really nice to have someone: Lay people with musculoskeletal disorders request supportive relationships in rehabilitation
    Open this publication in new window or tab >>It was really nice to have someone: Lay people with musculoskeletal disorders request supportive relationships in rehabilitation
    2001 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 29, no 4, p. 285-291Article in journal (Refereed) Published
    Abstract [en]

    Aims : To explore the lay person's perspective on the rehabilitation process. Methods : A total of 20 interviews were conducted with women and men who had recent or more distant experience of sickness absence with musculoskeletal diagnoses. Grounded theory was used, which includes an inductive approach and theoretical sampling. The interviews focused on the individuals' own stories and experiences of factors that promoted or hindered the rehabilitation process. Results : The interviewees emphasized how and by whom they had been treated rather than what type of rehabilitation programmes they had attended. They focused on the importance of supportive relationships from the private, occupational, and health care arenas. The relationship with rehabilitation agents (professionals who implemented rehabilitation) was described as having either supportive or non-supportive qualities. Based on the interviewees' descriptions, a model was developed on the socioemotional qualities of the rehabilitation agent. The most promoting factor in the rehabilitation process was to have a professional mentor that is a rehabilitation agent who combines a supportive approach with individually chosen rehabilitation measures and goals. Conclusions : The lay person's perspective gave additional knowledge regarding rehabilitation and recovery from musculoskeletal disorders. The socioemotional qualities of the rehabilitation agents were emphasized by the interviewees and a model regarding these qualities was developed. This model needs to be tested further. A clinical implication of the present study is the need for rehabilitation agents to develop their communication skills further.

    Keywords
    Lay; Experiences; Neck; Qualitative; Interviews; Rehabilitation; Shoulder; And; Low; Back; Pain
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25751 (URN)10.1080/140349401317115240 (DOI)10184 (Local ID)10184 (Archive number)10184 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13
    2. Developing a typology of the 'duty to work', as experienced by lay persons with musculoskeletal disorders
    Open this publication in new window or tab >>Developing a typology of the 'duty to work', as experienced by lay persons with musculoskeletal disorders
    2002 (English)In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 11, no 2, p. 150-158Article in journal (Refereed) Published
    Abstract [en]

    Musculoskeletal diagnoses account for the majority of cases of reduced work capacity. This article investigates lay persons' strategies in relation to work and musculoskeletal disorders. Twenty interviews were conducted and analysed using grounded theory. A typology of self-presentations was developed. The interviewees' self-presentations revealed a strong sense of a 'duty to work'. This sense of duty took four different forms, leading us to categorise persons expressing particular forms as workaholics, work manics, workhorses or relaxed workers. Relaxed workers seem to have the best prognosis for recovery as they had a confident self-agency and worked to fulfil their own needs rather than those of others. This was in contrast to work manics, with an uncertain self-agency and driven to work by others' needs. In conclusion, awareness of such linguistic forms as self-attributions and idiomatic phrases provides an opportunity to identify and talk about individual's self-agency and driving forces in the recovery process.

    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-26250 (URN)10754 (Local ID)10754 (Archive number)10754 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13
    3. Domestic strain: A hindrance in rehabilitation?
    Open this publication in new window or tab >>Domestic strain: A hindrance in rehabilitation?
    2004 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 18, no 1, p. 49-56Article in journal (Refereed) Published
    Abstract [en]

    Long-term sick leave due to musculoskeletal disorders has increased, especially for women. The aim of this paper was to explore women's and men's descriptions of the private arena in relation to rehabilitation and sickness absence. This study is part of a larger project focusing on consequences of sick leave. Individual interviews were conducted in 1997 and 1998 with 20 women and men who had been long-term sick-listed in 1985 with musculo-skeletal diagnoses. The data were analysed using Grounded theory in combination with gender analysis, which involved separately comparing men's and women's statements in order to find similarities and differences. According to the interviewees, factors in the private arena were closely associated with the rehabilitation process. Women described themselves as being responsible for the domestic work while men more often 'helped out' when asked to do so. Women and men described similar strategies to facilitate domestic work. Three dimensions of domestic life were identified, comprising division of domestic work and division of responsibility for domestic life and the amount of socio-emotional support or isolation at home. Using these dimensions, a 'domestic strain model' was developed. Our study indicates that long-term sicklisted women experiencing domestic strain would rather stay at home than return to work. Domestic strain involves inequities in the division of work and responsibilities and a lack of socio-emotional support at home. However, the model of domestic strain needs further empirical testing.

    Keywords
    gender, sick leave, sickness absence, back, neck or shoulder pain, qualitative interview, musculoskeletal diagnoses.
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-22066 (URN)10.1111/j.1471-6712.2004.00254.x (DOI)1143 (Local ID)1143 (Archive number)1143 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
    4. Client’s perceptions of contacts with professionals within health care and social insurance offices
    Open this publication in new window or tab >>Client’s perceptions of contacts with professionals within health care and social insurance offices
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    2003 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 31, no 4, p. 275-282Article in journal (Refereed) Published
    Abstract [en]

    Aims: An increasing number of people interact with professionals within healthcare and social insurance offices during periods of sick leave due to musculoskeletal disorders. Knowledge of clients' perceptions of such contact is scarce. This study analysed clients' perceptions of their contact with professionals within healthcare and social insurance offices.

    Methods: A cohort study was conducted in the municipality of Linköping, Sweden. Participants were all citizens who in 1985 were aged 25 - 34 years and had at least one new sick-leave spell due to back, neck, or shoulder diagnoses exceeding 28 days (n=213). In 1996, 11 years after inclusion, a questionnaire about perception of contact with professionals, self-perceived health, and mental health was administered. Register data on sickness absence and disability pension from 1985 - 96 were also obtained.

    Results: Factor analysis indicated the existence of three dimensions of contact with professionals: supportive treatment, distant treatment, and empowering treatment. Women perceived their contact with both social insurance officers and healthcare professionals as more supportive than did the men. Respondents with disability pensions perceived their contact with social insurance officers as more supportive and empowering than persons without disability pensions. Respondents with mental health problems perceived their contact with both types of professionals as more distant. Respondents with neck/shoulder diagnoses perceived their contact with healthcare professionals as more empowering than respondents with low back diagnoses.

    Conclusion: There was a relationship between clients' perceptions of contact with professionals and the sex, disability pension, diagnosis, and mental health of clients.

    Keywords
    clients' perspective of treatment, musculoskeletal diagnoses, sick leave
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13676 (URN)10.1080/14034940210165037 (DOI)
    Available from: 2006-01-18 Created: 2006-01-18 Last updated: 2017-12-13
  • 196.
    Östlund, Gunnel
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Borg, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Wide, P
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Hensing, G
    Göteborgs universitet.
    Alexandersson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Client´s perceptions of their contacts with rehabilitation agents - reports from persons with exeriences of back, neck, or shoulder disorders2002In: Seventh International Congress of behavioral Medicine 28-31 Augusti 2002,2002, 2002, p. 304-304Conference paper (Refereed)
  • 197.
    Östlund, Gunnel
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Cedersund, Elisabet
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV).
    Hensing, G
    Göteborg.
    Alexandersson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Developing a typology of the 'duty to work', as experienced by lay persons with musculoskeletal disorders2002In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 11, no 2, p. 150-158Article in journal (Refereed)
    Abstract [en]

    Musculoskeletal diagnoses account for the majority of cases of reduced work capacity. This article investigates lay persons' strategies in relation to work and musculoskeletal disorders. Twenty interviews were conducted and analysed using grounded theory. A typology of self-presentations was developed. The interviewees' self-presentations revealed a strong sense of a 'duty to work'. This sense of duty took four different forms, leading us to categorise persons expressing particular forms as workaholics, work manics, workhorses or relaxed workers. Relaxed workers seem to have the best prognosis for recovery as they had a confident self-agency and worked to fulfil their own needs rather than those of others. This was in contrast to work manics, with an uncertain self-agency and driven to work by others' needs. In conclusion, awareness of such linguistic forms as self-attributions and idiomatic phrases provides an opportunity to identify and talk about individual's self-agency and driving forces in the recovery process.

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