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  • 201.
    Kullberg, Agneta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    My Home is my Castle: Residential Well being and Perceived Safety in Different Types of Housing Areas in Sweden2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Safety in the housing environment is a basic human need and may be a prerequisite for health but studies from the perspective of the residents are limited in the literature. Although historically public health research has recognized the housing environment as an important determinant of health, there is a need for more research on how housing conditions influence residential well-being.

    Aim: The overall aim of this thesis was to examine factors and conditions associated with residential well-being and perceived safety in different types of housing areas and to compare safety promotion intervention designs based on residents self-expressed safety needs with corresponding designs developed by local government professionals.

    Materials and methods: A postal survey (response rate 56%, n=2476) and 11 focus groups (57 participants) were conducted among the residents in 3 small-scale housing areas with detached houses and 3 housing areas with blocks of flats in a Swedish municipality. The areas were geographically contiguous as each of the small-scale areas bordered on an area with blocks of flats. The study municipality is a designated member of WHO Safe Community network that have signed up to work in line with the indicators developed by WHO Collaborating Centre on Community Safety Promotion. Narrative data from a postal questionnaire were used to analyze the lay perspective and identify features perceived to be necessary to feel safe by residents in areas with blocks of flats and small-scale housing areas. Quantitative data were used to examine correlates of local safety-related concerns through a factor analysis. Logistic regression analysis examined associations between high-level scores of the safetyrelated dimensions found and area-level crime rate and being a victim of crime, area reputation, gender, age, education, country of birth, household civil status and type of housing. To examine how self-assessed area reputation is associated with social trust and residential well-being, a multilevel logistic regression analysis was performed using quantitative data, controlling for the random effect of neighbourhood- and individual-level socio-demographic factors. Data from focus group interviews were analyzed to identify mechanisms of how neighbourhood reputation was established. The quality function deployment (QFD) technique was used in a case study to integrate residents’ demands into the design of safety promotion interventions in housing areas. The resulting design was then compared with the safety intervention programme designed by professionals at the municipality administrative office. The results from this comparison were then investigated to identify improvements for the indicators for Safe Homes in the Safe Community programme.

    Results: The residents’ narratives showed that a stable social structure in the housing area was perceived to be the central factor in a safety-supportive residential environment. Whereas maintenance of good and reassuring relations was emphasized in small-scale housing areas, support for management of poor or even fear-provoking neighbour relations was requested from areas with blocks of flats. The crime rates were lower and safety-related concerns were less in small-scale housing areas. Three composite dimensions (CD) of perceived residential safety were identified: structural indicators of social disorder (CD 1); contact with disorderly behaviour (CD 2); and existential insecurity (CD 3). Area-level crime rates and individual-level variables were associated with dimensions (CD 1) and (CD 3), but only individuallevel variables were associated with dimension (CD 2). The level of residential well-being and social trust was higher in small-scale areas. The housing area reputation was found to be strongly associated with safety-related concerns, residential well-being and social trust. The area reputation also seemed to be a determinant of position in the local social structure; residents were found to position themselves in a rank order. The QFD analysis showed that the initiation and maintenance of social integrative processes in housing areas were the most highly prioritized interventions among the residents, but the analysis did not highlight the safety needs of several vulnerable groups. The Safe Community programme designed by professionals did not address the social integrative processes, but did cover the vulnerable groups.

    Conclusions: Area reputation is an important and probably underestimated dimension in the development of residential well-being and perceived safety. The QFD technique can be added to the methodological toolbox for residential safety promotion. The technique is particular suitable for providing a quality orientation from the lay perspective on safety promotion in local residential areas. The current Safe Homes concept in the Safe Community programme would benefit from being widened to Safe Housing.

    List of papers
    1. Residents’ perspectives on safety support needs in different types of housing areas
    Open this publication in new window or tab >>Residents’ perspectives on safety support needs in different types of housing areas
    2011 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 6, p. 590-597Article in journal (Refereed) Published
    Abstract [en]

    Background: Knowledge about conditions that are understood to support safety is important for planning residential safety promotion in interactions with residents. How residents themselves perceive and reason about their own safety needs has seldom been investigated in Scandinavia. Aim: To identify factors perceived to be necessary to feel safe by residents in areas with blocks of flats and detached houses.

    Methods: Residents in a Swedish municipality were asked an open-ended question on the research topic by a mail survey; 787 residents provided narrative data that were fed into a summative qualitative and quantitative content analysis.

    Results: A stable social structure in the housing area was perceived to be the central factor in a safety-supportive residential environment. Whereas maintenance of good and reassuring relations was emphasized in detached housing areas, support for management of poor or even fear-provoking neighbour relations was requested from areas with blocks of flats. This finding emphasizes the need to reduce the differential exposure to safety-related factors in the living environment.

    Conclusions: The results of our study encourage the continued use of a setting-orientated safety promotion approach in which residents and other stakeholders are involved. The policy recommendation that can be drawn from the study is that both the subjective and objective dimensions of safety should be identified and considered when developing local safety promotion interventions in community contexts.

    Place, publisher, year, edition, pages
    Sage, 2011
    Keywords
    Safety promotion; resident perspective; housing; neighbourhoods; safety inequalities, content analysis
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-60158 (URN)10.1177/1403494810395988 (DOI)000293249400005 ()
    Available from: 2010-10-07 Created: 2010-10-07 Last updated: 2017-12-12Bibliographically approved
    2. Correlates of local safety-related concerns in a Swedish Community: a cross-sectional study
    Open this publication in new window or tab >>Correlates of local safety-related concerns in a Swedish Community: a cross-sectional study
    2009 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, no 221Article in journal (Refereed) Published
    Abstract [en]

    Background: Crime in a neighbourhood has been recognized as a key stressor in the residential environment. Fear of crime is related to risk assessment, which depends on the concentration of objective risk in time and space, and on the presence of subjective perceived early signs of imminent hazard. The aim of the study was to examine environmental, socio-demographic, and personal correlates of safety-related concerns at the local level in urban communities. The specific aim was to investigate such correlates in contiguous neighbourhoods in a Swedish urban municipality. Methods: A cross-sectional study design was used to investigate three neighbourhood settings with two pair-wise conterminous but socially contrasting areas within each setting. Crime data were retrieved from police records. Study data were collected through a postal questionnaire distributed to adult residents (n = 2476) (response rate 56%). Composite dimensions of perceived residential safety were derived through a factor analysis. Logistic regression analysis was used to examine associations between high-level scores of the three safety-related dimensions and area-level crime rate, being a victim of crime, area reputation, gender, age, education, country of birth, household civil status and type of housing. Results: Three composite dimensions of perceived residential safety were identified: (I) structural indicators of social disorder; (II) contact with disorderly behavior; and (III) existential insecurity. We found that area-level crime rates and individual-level variables were associated with the dimensions structural indicators of social disorder and existential insecurity, but only individual-level variables were associated with the dimension contact with disorderly behavior. Self-assessed less favorable area reputation was found to be strongly associated with all three factors. Being female accorded existential insecurity more than being a victim of crime. Conclusion: We have identified environmental, socio-demographic, and personal correlates of safety-related concerns in contiguous neighbourhoods in a Swedish community. The results of this study suggest that residents self-assessed area reputation is an important underlying mechanism of perceived safety. We also found a difference in crime rates and safety-related concerns between areas with blocks of flats compared with small-scale areas although the neighbourhoods were close geographically.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-20757 (URN)10.1186/1471-2458-9-221 (DOI)
    Note
    Original Publication: Agneta Kullberg, Nadine Karlsson, Toomas Timpka and Kent Lindqvist, Correlates of local safety-related concerns in a Swedish Community: a cross-sectional study, 2009, BMC PUBLIC HEALTH, (9), 221. http://dx.doi.org/10.1186/1471-2458-9-221 Licensee: BioMed Central http://www.biomedcentral.com/ Available from: 2009-09-19 Created: 2009-09-18 Last updated: 2017-12-13
    3. Does the perceived neighborhood reputation contribute to neighborhood differences in social trust and residential wellbeing?
    Open this publication in new window or tab >>Does the perceived neighborhood reputation contribute to neighborhood differences in social trust and residential wellbeing?
    Show others...
    2010 (English)In: Journal of community psychology (Print), ISSN 0090-4392, E-ISSN 1520-6629, Vol. 38, no 5, p. 591-606Article in journal (Refereed) Published
    Abstract [en]

    The authors used a mixed methods approach to examine if the reputation of a housing area has bearing on residential wellbeing and social trust in three pairs of socioeconomically contrasting neighborhoods in a Swedish urban municipality. Multilevel logistic regression analyses were performed to examine associations between area reputation and residential wellbeing and social trust, controlling for the random effect of neighborhood and individual level sociodemographic factors. Qualitative data were analyzed to identify mechanisms of how neighborhood reputations were established. The housing area reputation was found to be strongly associated with wellbeing and social trust. The area reputation also seemed to be a determinant of position in the local social structure; residents were found to position themselves in a rank order The results suggest that area reputation is an important and probably underestimated dimension in the development of residential wellbeing and social trust in housing.

    Place, publisher, year, edition, pages
    John Wiley and Sons, Ltd, 2010
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-58346 (URN)10.1002/jcop.20383 (DOI)000278776400004 ()
    Available from: 2010-08-13 Created: 2010-08-11 Last updated: 2017-12-12
    4. Integrating residents’ demands into the design of safety promotion interventions in housing areas: a case study application of quality function deployment in a Safe Community program
    Open this publication in new window or tab >>Integrating residents’ demands into the design of safety promotion interventions in housing areas: a case study application of quality function deployment in a Safe Community program
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: The needs and demands of the residents are rarely considered in community-based design of safety services and planning in housing areas. We therefore set out to compare safety promotion intervention design based on residents’ self-expressed safety needs with interventions designed by local government professionals. A secondary aim was to use the results to suggest improvements for the safety promotion indicators targeting Safe Homes within the Safe Community movement.

    Methods: Case study research methods based on a nested single-case design were used for the study. Data collected from 787 residents in a case study community were analyzed using the quality function deployment (QFD) technique. Quantitative and qualitative data on residents’ self-expressed safety needs were transformed into an intervention design. The resulting design was then compared with the safety intervention program designed by professionals at the municipality administrative office. The results from this comparison were then investigated to identify improvements for the indicators for Safe Homes in the Safe Community program.

    Results: The QFD analysis showed that the initiation and maintenance of social integrative processes in housing areas were the most highly prioritized interventions among the residents, but the analysis did not highlight the safety needs of several vulnerable groups (e.g. the old elderly, infants, and persons with disabilities). The Safe Community program designed by professionals did not address the social integrative processes, but did cover the vulnerable groups. Our results indicate that the current Safe Homes concept in the Safe Community program would benefit from being widened to Safe Housing.

    Conclusions: The QFD technique can be added to the methodological toolbox for residential safety promotion. The technique is particularly suitable for providing a quality orientation from the lay perspective of residents. Residents and professionals can contribute with different perspectives on safety promotion and injury prevention in local residential areas. In developing safe housing, these different views should be identified and considered. Socio-economic differences and social inequalities in safety-related housing conditions between areas also need to be considered in the programs.

    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-60159 (URN)
    Available from: 2010-10-07 Created: 2010-10-07 Last updated: 2013-09-05
  • 202.
    Kullberg, Agneta
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nordqvist, Cecilia
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Integrating residents’ demands into the design of safety promotion interventions in housing areas: a case study application of quality function deployment in a Safe Community programManuscript (preprint) (Other academic)
    Abstract [en]

    Background: The needs and demands of the residents are rarely considered in community-based design of safety services and planning in housing areas. We therefore set out to compare safety promotion intervention design based on residents’ self-expressed safety needs with interventions designed by local government professionals. A secondary aim was to use the results to suggest improvements for the safety promotion indicators targeting Safe Homes within the Safe Community movement.

    Methods: Case study research methods based on a nested single-case design were used for the study. Data collected from 787 residents in a case study community were analyzed using the quality function deployment (QFD) technique. Quantitative and qualitative data on residents’ self-expressed safety needs were transformed into an intervention design. The resulting design was then compared with the safety intervention program designed by professionals at the municipality administrative office. The results from this comparison were then investigated to identify improvements for the indicators for Safe Homes in the Safe Community program.

    Results: The QFD analysis showed that the initiation and maintenance of social integrative processes in housing areas were the most highly prioritized interventions among the residents, but the analysis did not highlight the safety needs of several vulnerable groups (e.g. the old elderly, infants, and persons with disabilities). The Safe Community program designed by professionals did not address the social integrative processes, but did cover the vulnerable groups. Our results indicate that the current Safe Homes concept in the Safe Community program would benefit from being widened to Safe Housing.

    Conclusions: The QFD technique can be added to the methodological toolbox for residential safety promotion. The technique is particularly suitable for providing a quality orientation from the lay perspective of residents. Residents and professionals can contribute with different perspectives on safety promotion and injury prevention in local residential areas. In developing safe housing, these different views should be identified and considered. Socio-economic differences and social inequalities in safety-related housing conditions between areas also need to be considered in the programs.

  • 203.
    Kullberg, Agneta
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nordqvist, Cecilia
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Residents’ perspectives on safety support needs in different types of housing areas2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 6, p. 590-597Article in journal (Refereed)
    Abstract [en]

    Background: Knowledge about conditions that are understood to support safety is important for planning residential safety promotion in interactions with residents. How residents themselves perceive and reason about their own safety needs has seldom been investigated in Scandinavia. Aim: To identify factors perceived to be necessary to feel safe by residents in areas with blocks of flats and detached houses.

    Methods: Residents in a Swedish municipality were asked an open-ended question on the research topic by a mail survey; 787 residents provided narrative data that were fed into a summative qualitative and quantitative content analysis.

    Results: A stable social structure in the housing area was perceived to be the central factor in a safety-supportive residential environment. Whereas maintenance of good and reassuring relations was emphasized in detached housing areas, support for management of poor or even fear-provoking neighbour relations was requested from areas with blocks of flats. This finding emphasizes the need to reduce the differential exposure to safety-related factors in the living environment.

    Conclusions: The results of our study encourage the continued use of a setting-orientated safety promotion approach in which residents and other stakeholders are involved. The policy recommendation that can be drawn from the study is that both the subjective and objective dimensions of safety should be identified and considered when developing local safety promotion interventions in community contexts.

  • 204.
    Kvarnström, Susanne
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Interprofessionella team i vården: En studie om samarbete mellan hälsoprofessioner2007Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    There are great expectations that collaboration among professions and various sectors will further develop health care and thus lead to improved public health. In the World Health Organization’s declaration “Health 21” the designated goal for health professions in the member nations in Europe by the year 2010 is to have developed health promotional competence, including teamwork and cooperation based on mutual respect for the expertise of various professions. The challenges faced by the interprofessional teams are, however, multifaceted, and these challenges place demands upon society, which, in turn, determines the fundamental conditions for collaboration among the health professions within the health care organizations.

    This licentiate dissertation contains discourse and content analyses of interprofessional teamwork in health care. The major objective of this dissertation is to study and describe how the team members construct and create the content and significance of teams and teamwork among health professions. One specific goal has been to study how the members of a multi-professional health care team refer to their team, especially the discursive patterns that emerge and the function that these patterns has (I). The second specific goal has been to identify and describe the difficulties that the health professionals have experienced within their interprofessional teamwork. One purpose has been to enable discussions of the implications for interprofessional learning (II).

    Focused group interviews with team members (n=32) from six teams were studied using discursive social psychological research approach. The analysis concentrated on the use of the pronouns “I”, “we” and “them”. The results were then analyzed in relation to theories on discursive membership and discursive communities (I). Individual semi-structured interviews with team members (n=18) from four of the six teams were carried out using critical incident techniques. The interviews were analysed via latent qualitative content analysis and the results were interpreted in the light of theories on sociology of professions and learning at work (II).

    The findings showed that two discursive patterns emerged in the team members’ constructions of “we the team”. These patterns were designated knowledge synergy and trustful support (I). The following three themes that touched upon the difficulties of interprofessional teamwork were identified in the personal interviews: (A) difficulties concerning the teams’ dynamics that arose when the team members acted as representatives for their respective professions; (B) difficulties when the various contributions of knowledge interacted in the team; and (C) difficulties that were related to the surrounding organisation’s influence on the team (II).

    The conclusion was reached that the discursive pattern provided rhetorical resources for the team members, both in order to reaffirm membership in the team and to promote their views with other care providers, but also to deal with difficulties regarding, for example, lack of unity in outlook. The conclusion was also drawn that, in addition to the individual consequences, one outcome of the perceived difficulties was that they caused limitations of the use of collaborative resources to arrive at a holistic view of the patient’s problems. Thus the patients could not be met in the desired manner.

    The practical implications of the research project concern the development of teams in which various forms of interprofessional learning can influence the continued development of the team and the management of health care in regard to the importance of implementation processes and organisational learning.

    List of papers
    1. Discursive patterns in multiprofessional healthcare teams
    Open this publication in new window or tab >>Discursive patterns in multiprofessional healthcare teams
    2006 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 53, no 2, p. 244-252Article in journal (Refereed) Published
    Abstract [en]

    Aim. The aim of this paper is to report a study exploring how members of multiprofessional healthcare teams talk about their team. Specifically, the team members' talk was analysed to explore the discursive patterns that emerged and their functions.

    Background. Over recent decades there has been an increasing demand in Western countries to change care organizations and to coordinate resources and professional competencies to meet the needs of patients/service users better. Because society promotes this kind of work, it may be valuable to explore the self-presentations of a multiprofessional healthcare team.

    Methods. A discourse analysis was carried out on existing empirical data from focus group interviews with a member-identified category sample comprising 32 healthcare professionals in six authentic multiprofessional teams in south-east Sweden. The analysis focused on the participants' discursive constructions of multiprofessional teamwork, on the way they talked about their group, and, in particular, on their use of the pronouns we, they and I.

    Findings. The constructions of 'we' by multiprofessional healthcare teams showed discursive patterns that are here referred to as knowledge synergy and trusting support, which included factors such as cross-learning and personal chemistry. The pronoun we was also used as a flexible resource to manage expertise, power and leadership within the teams, and it might also function to ease the pressure for consensus.

    Conclusion. These discursive patterns provided powerful rhetorical resources for team members, both to affirm their choice of membership and to claim superiority in relations with the surrounding community (the others) by linking to a societal discourse that promotes collaboration.

    Keywords
    discourse analysis, inter-professional practice, membership, nursing, self-presentations, teamwork
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14668 (URN)10.1111/j.1365-2648.2006.03719.x (DOI)
    Available from: 2007-10-12 Created: 2007-10-12 Last updated: 2015-01-19
    2. Difficulties in collaboration: a critical incident study of interprofessional healthcare teamwork
    Open this publication in new window or tab >>Difficulties in collaboration: a critical incident study of interprofessional healthcare teamwork
    2008 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 22, no 2, p. 191-203Article in journal (Refereed) Published
    Abstract [en]

    The challenge for members of interprofessional teams is to manage the team processes that occur in all teamwork while simultaneously managing their individual professional identities. The aim of this study was to identify and describe difficulties perceived by health professionals in interprofessional teamwork. Utterances on verbal actions and resolutions were also explored to enable a discussion of the implications for interprofessional learning. Individual interviews using a Critical Incident Technique were performed with 18 Swedish professionals working in healthcare teams, and examined with qualitative content analysis. The main findings show difficulties related to the team dynamic that arose when team members acted towards one another as representatives of their professions, difficulties that occurred when the members' various knowledge contributions interacted in the team, and difficulties related to the influence of the surrounding organization. The perceived consequences of the difficulties, beyond individual consequences, were restrictions on the use of collaborative resources to arrive at a holistic view of the patient's problem, and barriers to providing patient care and service in the desired manner. This paper also discusses how experiences of managing difficulties entailed various forms of interprofessional learning situations.

    Keywords
    Critical incident technique; interdisciplinary health team; interprofessional learning; interprofessional relations; sociology of professions
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14669 (URN)10.1080/13561820701760600 (DOI)
    Available from: 2007-10-12 Created: 2007-10-12 Last updated: 2017-12-13
  • 205.
    Kvist Lindholm, Sofia
    Linköping University, The Tema Institute, Department of Child Studies. Linköping University, Faculty of Arts and Sciences.
    Social and Emotional Programmes at School: Manuals and Practice2015Manuscript (preprint) (Other academic)
  • 206.
    Kvist Lindholm, Sofia
    Linköping University, Department of Thematic Studies, Department of Child Studies. Linköping University, Faculty of Arts and Sciences.
    Students’ Reproduction and Transformation of Norms Incorporated into a Programme for Social and Emotional Learning2017In: Ethnography and Education, ISSN 1745-7823, E-ISSN 1745-7831, Vol. 12, no 3, p. 294-310Article in journal (Other academic)
    Abstract [en]

    The present ethnographic study aims to explore how students reproduce and make use of a programme for social and emotional learning to create their own moral orders and routines for interaction in their local school context. The study demonstrates that the students made use of routines and norms conveyed by the programme to negatively position and exclude peers as well as to reproduce discourses of ‘blaming the victim’. The results highlight the inappropriateness of implementing a programme that strips emotions and behaviours of their meaning and that fails to situate emotions within students’ actual social and cultural contexts. The study demonstrates how such an approach relocates the responsibility for dealing with socially and culturally situated problems to the individual and denies teachers the opportunity to respond to problematic situations that give rise to emotions of anger and that emerge in social and cultural contexts at school.

  • 207.
    Kvist Lindholm, Sofia
    Linköping University, Department of Thematic Studies, Department of Child Studies. Linköping University, Faculty of Arts and Sciences.
    The Paradoxes of Socio-Emotional Programmes in School: Young people’s perspectives and public health discourses2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Over the past decades socio-emotional programmes have been implemented in schools worldwide. Depression in Swedish Adolescents (DISA) and Social and Emotional Training (SET) are two socio-emotional programmes being practised in Swedish schools. The aim of the present dissertation is to explore students’ perspectives on DISA and SET, as well as the programmes’ intentions and strategies. The empirical material consists of interviews with students taking part in DISA and SET, participant observations conducted in an elementary school practising SET, participant observations of DISA and SET instructor courses, and a broad range of textual material concerning the programmes. Article I reports on an inherent contradiction in DISA, where techniques designed as treatment are practised as universal prevention for girls as a group. The girls’ accounts of DISA demonstrate why this contradiction is problematic – it was not up to the girls as course participants to define what problems they were having, but the problems were instead defined for them by the course. Taking part in DISA and SET involves exercises in which the students are expected to selfdisclose in front of their classmates. Article II reports on how this task of self-disclosure had a potential for strengthening students’ peer relations, while it at the same time entailed a risk of triggering already on-going destructive interactions, such as bullying and harassment. Article III demonstrates that the potential of self-disclosure is not equally distributed across the students, but depends on their social status within their peer group. Article III also shows that the norm conveyed by the SET programme – that showing anger is an inappropriate behaviour –functioned locally as a way to justify exclusion and negative positioning of peers who showed anger in response to ill treatment. Article IV provides an in-depth analysis of exchanges in a SET lesson concerning how students should deal with exposure to the negative actions of peers. It demonstrates how the types of questions a teacher is instructed to pose to maintain a neutral attitude in practice involve using more implicit forms of authority to construct ideals concerning desirable behaviours. These ideals were formed by discussing fictive examples, which meant stripping students’ actions of meaning and detaching them from the social and cultural context to which they belong. The present dissertation concludes by giving recommendations for policy practice.

    List of papers
    1. "Apparently I've Got Low Self-Esteem": Schoolgirls' perspectives On a School-Based Public Health Intervention
    Open this publication in new window or tab >>"Apparently I've Got Low Self-Esteem": Schoolgirls' perspectives On a School-Based Public Health Intervention
    2015 (English)In: Children & society, ISSN 0951-0605, E-ISSN 1099-0860, Vol. 29, no 5, p. 473-483Article in journal (Refereed) Published
    Abstract [en]

    This article focuses on a psycho-educational programme, DISA, currently practised in the Swedish schools to prevent girls from developing depressive symptoms. We draw on group interviews with schoolgirls to explore how they describe DISA and how an understanding of the programme is constructed through their arguments. We demonstrate how the girls’ version of DISA highlights a contradiction in the intervention that is traceable to the theoretical underpinnings of the programme and the mix of traditions — treatment and prevention — that constitute the intervention. We discuss problematic aspects of DISA and outline implications for policy practice.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2015
    Keywords
    children's perspectives; interviews; mental health; psycho-educational course; school-based intervention
    National Category
    Sociology Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-113544 (URN)10.1111/chso.12083 (DOI)000359323300013 ()
    Note

    Funders: Swedish National Institute of Public Health [HFAngstrom 2008/213]

    Available from: 2015-01-22 Created: 2015-01-22 Last updated: 2017-12-05Bibliographically approved
    2. Schoolgirls’ perspectives on self-disclosure in a group-based mentalhealth intervention at school: acquiring friends or risking harassment?
    Open this publication in new window or tab >>Schoolgirls’ perspectives on self-disclosure in a group-based mentalhealth intervention at school: acquiring friends or risking harassment?
    2015 (English)In: Advances in School Mental Health Promotion, ISSN 1754-730X, E-ISSN 2049-8535, Vol. 8, no 3, p. 141-155Article in journal (Refereed) Published
    Abstract [en]

    The article draws on interviews with participants in a psychotherapeutic education programme, called Depression in Swedish Adolescents, which has seen wide distribution within Swedish schools. We demonstrate how, in their accounts, self-disclosure in front of classmates is made into a central and both positive and problematic aspect of the programme. Sharing private matters in a group setting consisting of classmates might strengthen their interpersonal relations; but at the same time, it carries the risk of triggering already ongoing destructive interactions such as bullying and harassment. Voluntary participation, group composition and paying attention to how members respond to one another and make use of the private information shared stand out as important criteria to consider. However, in order to meet these criteria, an intervention involving self-disclosure in front of classmates needs to challenge the tradition in school of practising mandatory participation, as well as the class structures with their predefined group composition.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2015
    Keywords
    student's perspectives, self-disclosure, psycho-education, school-based intervention, therapeutic culture
    National Category
    Sociology Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-122454 (URN)10.1080/1754730X.2015.1044253 (DOI)
    Available from: 2015-11-02 Created: 2015-11-02 Last updated: 2017-12-01Bibliographically approved
    3. Students’ Reproduction and Transformation of Norms Incorporated into a Programme for Social and Emotional Learning
    Open this publication in new window or tab >>Students’ Reproduction and Transformation of Norms Incorporated into a Programme for Social and Emotional Learning
    2017 (English)In: Ethnography and Education, ISSN 1745-7823, E-ISSN 1745-7831, Vol. 12, no 3, p. 294-310Article in journal (Other academic) Published
    Abstract [en]

    The present ethnographic study aims to explore how students reproduce and make use of a programme for social and emotional learning to create their own moral orders and routines for interaction in their local school context. The study demonstrates that the students made use of routines and norms conveyed by the programme to negatively position and exclude peers as well as to reproduce discourses of ‘blaming the victim’. The results highlight the inappropriateness of implementing a programme that strips emotions and behaviours of their meaning and that fails to situate emotions within students’ actual social and cultural contexts. The study demonstrates how such an approach relocates the responsibility for dealing with socially and culturally situated problems to the individual and denies teachers the opportunity to respond to problematic situations that give rise to emotions of anger and that emerge in social and cultural contexts at school.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2017
    Keywords
    SEL, school-based intervention, mental health, school bullying, children’s perspectives
    National Category
    Sociology Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-122455 (URN)10.1080/17457823.2016.1232622 (DOI)000403214100003 ()2-s2.0-84988416819 (Scopus ID)
    Note

    The previous status of this article was Manuscript.

    Available from: 2015-11-02 Created: 2015-11-02 Last updated: 2018-02-09Bibliographically approved
    4. Social and Emotional Programmes at School: Manuals and Practice
    Open this publication in new window or tab >>Social and Emotional Programmes at School: Manuals and Practice
    2015 (English)Manuscript (preprint) (Other academic)
    Keywords
    Social and Emotional Learning; SET; SEL; SEAL; Manual-based Programmes in Practice; Bullying Prevention
    National Category
    Sociology Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-122456 (URN)
    Available from: 2015-11-02 Created: 2015-11-02 Last updated: 2015-11-06Bibliographically approved
  • 208.
    Kvist Lindholm, Sofia
    et al.
    Linköping University, The Tema Institute, Department of Child Studies. Linköping University, Faculty of Arts and Sciences.
    Zetterqvist Nelson, Karin
    Linköping University, The Tema Institute, Department of Child Studies. Linköping University, Faculty of Arts and Sciences.
    "Apparently I've Got Low Self-Esteem": Schoolgirls' perspectives On a School-Based Public Health Intervention2015In: Children & society, ISSN 0951-0605, E-ISSN 1099-0860, Vol. 29, no 5, p. 473-483Article in journal (Refereed)
    Abstract [en]

    This article focuses on a psycho-educational programme, DISA, currently practised in the Swedish schools to prevent girls from developing depressive symptoms. We draw on group interviews with schoolgirls to explore how they describe DISA and how an understanding of the programme is constructed through their arguments. We demonstrate how the girls’ version of DISA highlights a contradiction in the intervention that is traceable to the theoretical underpinnings of the programme and the mix of traditions — treatment and prevention — that constitute the intervention. We discuss problematic aspects of DISA and outline implications for policy practice.

  • 209.
    Kvist Lindholm, Sofia
    et al.
    Linköping University, The Tema Institute, Department of Child Studies. Linköping University, Faculty of Arts and Sciences.
    Zetterqvist Nelson, Karin
    Linköping University, The Tema Institute, Department of Child Studies. Linköping University, Faculty of Arts and Sciences.
    Schoolgirls’ perspectives on self-disclosure in a group-based mentalhealth intervention at school: acquiring friends or risking harassment?2015In: Advances in School Mental Health Promotion, ISSN 1754-730X, E-ISSN 2049-8535, Vol. 8, no 3, p. 141-155Article in journal (Refereed)
    Abstract [en]

    The article draws on interviews with participants in a psychotherapeutic education programme, called Depression in Swedish Adolescents, which has seen wide distribution within Swedish schools. We demonstrate how, in their accounts, self-disclosure in front of classmates is made into a central and both positive and problematic aspect of the programme. Sharing private matters in a group setting consisting of classmates might strengthen their interpersonal relations; but at the same time, it carries the risk of triggering already ongoing destructive interactions such as bullying and harassment. Voluntary participation, group composition and paying attention to how members respond to one another and make use of the private information shared stand out as important criteria to consider. However, in order to meet these criteria, an intervention involving self-disclosure in front of classmates needs to challenge the tradition in school of practising mandatory participation, as well as the class structures with their predefined group composition.

  • 210.
    Künemund, Harald
    et al.
    Research Group on Aging and the Life Course (FALL), Institute of Sociology, Free University of Berlin, Germany.
    Motel-Klingebiel, Andreas
    German Centre of Gerontology (DZA), Berlin, Germany.
    Kohli, Martin
    Research Group on Aging and the Life Course (FALL), Institute of Sociology, Free University of Berlin, Germany.
    Do private intergenerational transfers from elderly parents increase social inequality among their middle-aged children? Evidence from the German Ageing Survey2005In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 60B, no 1, p. S30-S36Article in journal (Refereed)
    Abstract [en]

    Objectives. This study examines the consequences of private intergenerational transfers from elderly parents to their middle-aged children with respect to social inequality within the children's generation.

    Methods. With use of the nationally representative cross-sectional sample of the German Aging Survey, descriptive analyses as well as multivariate logistic regressions are used to identify the effects of three different types of private intergenerational transfers in the middle-age group (40–54 year olds, n = 1,719 for inter vivos and n = 1,446 for mortis causa transfers).

    Results. Transfers from parents or parents-in-law during the last 12 months—many of them smaller ones—are not significantly related to children's income. Separated and divorced children have significantly higher probabilities of receiving such transfers, indicating a need-directed family transfer process. Larger transfers before the last 12 months are need directed as well and moreover positively related to income position. Bequests, finally, are positively related to income position while having no need component at the time of observation.

    Discussion. Whereas larger monetary transfers and bequests may increase social inequality in the children's generation, a substantial part of the regular monetary flow from elderly parents to their adult children buffers situations of need. Public policy should take into account these different effects. Reducing the general level of public pensions would weaken regular transfer giving and thus lead to more inequality in the children's generation. Higher taxation of very large transfers and bequests would have the opposite effect.

  • 211.
    Landberg, Åsa
    et al.
    Stiftelsen Allmänna Barnhuset, Stockholm.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Priebe, Gisela
    Lunds universitet.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Jonsson, Linda
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Fredlund, Cecilia
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Det gäller en av fem: fakta om barn, sexuella övergrepp och sexuell exploatering i Sverige 20142014Report (Other academic)
    Abstract [sv]

    Det här är den tredje stora undersökningen som gjorts om av samma forskargrupp. De tidigare undersökningarna genomfördes 2004 och 2009. Det gör att vi kan jämföra svaren och se utveckling över tid. Undersökningen har genomförts av forskare från Linköpings och Lunds universitet på uppdrag av Stiftelsen Allmänna Barnhuset och har finansierats av regeringen. Den här skriften sammanfattar delar av undersökningen från 2014. Den som är intresserad av att läsa mer om resultaten eller om hur undersökningen är upplagd, kan ta del av den fullständiga rapporten, Unga, sex och internet - i en föränderlig värld, via Stiftelsen Allmänna Barnhusets hemsida www.allmannabarnhuset.se eller via Linköpings universitet www.barnafrid.se.

    Statistiska Centralbyrån har gjort ett urval av skolor som är representativt. Några av de utvalda skolorna föll bort för att de lagt ned, inte ville delta eller inte svarade. Det var frivilligt att delta, och det fanns elever som valde att avstå, eller helt enkelt inte var i skolan den dag som undersökningen genomfördes.

    Sammanlagt medverkade 5 873 elever från 171 skolor. Eleverna besvarade enkäten under lektionstid, med en av skolan utvald, ansvarig person i klassrummet. Elever, ansvariga lärare och rektor fick information om studien i form av ett informationsbrev. Där fanns också uppgifter om vart eleverna kunde vända sig för att få stöd och hjälp.

    Vi ställde frågor på en rad olika områden. Det gör att vi vet mycket om de elever som svarade. Frågorna handlade om sociodemografi (bakgrundsfaktorer som till exempel ålder, kön, födelseland, ekonomi eller föräldrarnas utbildningsnivå), sport/idrottsutövande, sexualitet, erfarenhet av frivilligt sex, alkohol och droganvändning, antisocialt beteende, fysiska, psykiska och sexuella övergrepp, erfarenheter av vård för psykiatriska besvär, självskadebeteende, självskada genom sex, sälja sex, människohandel, kontakt med socialtjänsten, mobbning samt användande av internet, mobiler och pornografi.

    Enkäten innefattade även ett antal standardiserade mätinstrument som mäter hur eleverna uppfattar relationen till sina föräldrar, deras självkänsla, symtom på posttraumatisk stress och självskadebeteende. De ungdomar som svarat gick tredje året på gymnasiet 2014. Åldern varierade mellan 16 och 23 år med en medelålder på knappt 18 år. Något fler tjejer än killar deltog och en grupp på 0,9 procent tyckte inte att indelningen kille/tjej passade dem. Vad den grupp som inte tycker att könsindelningen passar dem har svarat på frågorna redovisas på några områden.

  • 212.
    Landén Ludvigsson, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Rehabilitation in Motala.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Peterson, Gunnel
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Neck-specific exercise program2015Report (Other academic)
    Abstract [en]

    Description of neck specific exercise program as used by Maria Landén Ludvigsson, Anneli Peolsson, Gunnel Peterson in a randomized study comparing exercise approaches in chronic whiplash “Effects of neck-specific exercise with or without a behavioural approach in addition to prescribed physical activity for individuals with chronic whiplash-associated disorders: a prospective randomised study”

  • 213.
    Larsen, Robert
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Risk-Adjustment for Swedish In-Hospital Trauma Mortality using International Classification of disease Injury Severity Score (ICISS): issues with description and methods2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction

    Different methods have been used to describe the epidemiology of trauma with varying results. Crude mortality outcome data differ significantly from risk-adjusted information. A previous standard method for risk-adjustment in trauma was the Injury Severity Score (ISS), although it has several shortcomings. In this thesis I examine Swedish injury statistics from an epidemiological perspective using crude and risk-adjusted mortality, and to adjust for injury I used the International Classification of disease Injury Severity Score (ICISS). The groups of most lethal injuries (fall, traffic, and assault) were examined separately using an ICISS mortality prediction model that focused particularly on the effects on the prediction of mortality by adding coexisting conditions (comorbidity) to it. Differences in mortality between the sexes and changes over time were tested separately.

    Material and Methods

    Data from all patients with ICD-10 based diagnoses of injury (ICD-10: V01 to Y36) in the Swedish National Patient Registry and Cause of Death Registry were collected from 1999 to 2012 and used for assessment of mortality and comorbidity. A subgroup (patients in hospital) from 2001-2011 were selected as the study group. Their injuries were in the subgroups of falls, traffic, and assaults, and are the focus of this thesis. Mortality within 30 days of injury was used as the endpoint. The severity of injury was adjusted for using the ICISS, which was first described by Osler et al. The model was also adjusted for age, sex, and comorbidities.

    Results

    The study group comprised 815 846 patients (of whom 17 721 died). There was a decrease over time in injuries caused by falls and traffic (coefficient -4.71, p=0.047 and coefficient -5.37, p<0.001), whereas there was no change in assault-related injuries/100 000 inhabitants. The risk-adjusted 30-day mortality showed a decrease in injuries related to traffic and assault (OR 0.95, p<0.001 and OR 0.93, p=0.022) whereas for falls it remained unchanged. There was also a risk-adjusted survival benefit for women, which increased with increasing age. Adjusting for comorbidities made the prediction of 30-day mortality by the ICISS model better (accuracy, calibration, and discrimination). However, most of this effect was found to be the result of the other characteristics of the fall related injury group (they were older, and had more coexisting conditions).

    Conclusion

    During a 10-year period, there has been a significant overall decrease in crude as well as risk-adjusted mortality for these three injury groups combined. Within these groups there is a clear, risk-adjusted, female survival advantage. The ICISS model for the prediction of mortality improves when comorbidities are added, but this effect is minor and seen mainly among the injuries caused by falls, where comorbidity is significant. The ICISS method was a valuable adjunct in the investigation of data on Swedish mortality after injury that has been gathered from health care registry data.

    List of papers
    1. Deaths caused by injury among people of working age (18-64) are decreasing, while those among older people (64+) are increasing
    Open this publication in new window or tab >>Deaths caused by injury among people of working age (18-64) are decreasing, while those among older people (64+) are increasing
    Show others...
    2018 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 44, no 4, p. 589-596Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Injury is an important cause of death in all age groups worldwide, and contributes to many losses of human and economic resources. Currently, we know a few data about mortality from injury, particularly among the working population. The aim of the present study was to examine death from injury over a period of 14 years (1999-2012) using the Swedish Cause of Death Registry (CDR) and the National Patient Registry, which have complete national coverage.

    METHOD: CDR was used to identify injury-related deaths among adults (18 years or over) during the years 1999-2012. ICD-10 diagnoses from V01 to X39 were included. The significance of changes over time was analyzed by linear regression.

    RESULTS: The incidence of prehospital death decreased significantly (coefficient -0.22, r (2) = 0.30; p = 0.041) during the study period, while that of deaths in hospital increased significantly (coefficient 0.20, r (2) = 0.75; p < 0.001). Mortality/100,000 person-years in the working age group (18-64 years) decreased significantly (coefficient -0.40, r (2) = 0.37; p = 0.020), mainly as a result of decrease in traffic-related deaths (coefficient -0.34, r (2) = 0.85; p < 0.001). The incidence of deaths from injury among elderly (65 years and older) patients increased because of the increase in falls (coefficient 1.71, r (2) = 0.84; p < 0.001) and poisoning (coefficient 0.13, r (2) = 0.69; p < 0.001).

    CONCLUSION: The epidemiology of injury in Sweden has changed during recent years in that mortality from injury has declined in the working age group and increased among those people 64 years old and over.

    Place, publisher, year, edition, pages
    Springer, 2018
    Keywords
    Elderly, Injury, Mortality, Prehospital, Trauma, Working age
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-142763 (URN)10.1007/s00068-017-0827-1 (DOI)000440981100014 ()28825159 (PubMedID)2-s2.0-85027836250 (Scopus ID)
    Available from: 2017-11-02 Created: 2017-11-02 Last updated: 2019-04-30Bibliographically approved
    2. Decreased risk adjusted 30-day mortality for hospital admitted injuries: a multi-centre longitudinal study
    Open this publication in new window or tab >>Decreased risk adjusted 30-day mortality for hospital admitted injuries: a multi-centre longitudinal study
    Show others...
    2018 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, no 1, article id 24Article in journal (Refereed) Published
    Abstract [en]

    Background: The interpretation of changes in injury-related mortality over time requires an understanding of changes in the incidence of the various types of injury, and adjustment for their severity. Our aim was to investigate changes over time in incidence of hospital admission for injuries caused by falls, traffic incidents, or assaults, and to assess the risk-adjusted short-term mortality for these patients.less thanbr /greater thanMethods: All patients admitted to hospital with injuries caused by falls, traffic incidents, or assaults during the years 2001-11 in Sweden were identified from the nationwide population-based Patient Registry. The trend in mortality over time for each cause of injury was adjusted for age, sex, comorbidity and severity of injury as classified from the International Classification of diseases, version 10 Injury Severity Score (ICISS).less thanbr /greater thanResults: Both the incidence of fall (689 to 636/100000 inhabitants: p = 0.047, coefficient - 4.71) and traffic related injuries (169 to 123/100000 inhabitants: p less than 0.0001, coefficient - 5.37) decreased over time while incidence of assault related injuries remained essentially unchanged during the study period. There was an overall decrease in risk-adjusted 30-day mortality in all three groups (OR 1.00; CI95% 0.99-1.00). Decreases in traffic (OR 0.95; 95% CI 0.93 to 0.97) and assault (OR 0.93; 95% CI 0.87 to 0.99) related injuries was significant whereas falls were not during this 11-year period.less thanbr /greater thanDiscussion: Risk-adjustment is a good way to use big materials to find epidemiological changes. However after adjusting for age, year, sex and risk we find that a possible factor is left in the pre- and/or in-hospital care.less thanbr /greater thanConclusions: The decrease in risk-adjusted mortality may suggest changes over time in pre- and/or in-hospital care. A non-significantdecrease in risk-adjusted mortality was registered for falls, which may indicate that low-energy trauma has not benefited for the increased survivability as much as high-energy trauma, ie traffic- and assault related injuries.

    National Category
    Surgery
    Identifiers
    urn:nbn:se:liu:diva-146965 (URN)10.1186/s13049-018-0485-2 (DOI)000429285700002 ()29615089 (PubMedID)
    Available from: 2018-04-09 Created: 2018-04-09 Last updated: 2019-02-11
    3. Female risk-adjusted survival advantage after injuries caused by falls, traffic or assault: a nationwide 11-year study
    Open this publication in new window or tab >>Female risk-adjusted survival advantage after injuries caused by falls, traffic or assault: a nationwide 11-year study
    Show others...
    2019 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 27, no 1, article id 24Article in journal (Refereed) Published
    Abstract [en]

    Background: A female survival advantage after injury has been observed, and animal models of trauma have suggested either hormonal or genetic mechanisms as component causes. Our aim was to compare age and riskadjusted sex-related mortality in hospital for the three most common mechanisms of injury in relation to hormonal effects as seen by age.

    Methods: All hospital admissions for injury in Sweden during the period 2001–2011 were retrieved from the National Patient Registry and linked to the Cause of Death Registry. The International Classification of Diseases Injury Severity Score (ICISS) was used to adjust for injury severity, and the Charlson Comorbidity Index to adjust for comorbidity. Age categories (0–14, 15–50, and ≥ 51 years) were used to represent pre-menarche, reproductive and post- menopausal women.

    Results: Women had overall a survival benefit (OR 0.51; 95% CI 0.50 to 0.53) after adjustment for injury severity and comorbidity. A similar pattern was seen across the age categories (0–14 years OR 0.56 (95% CI 0.25 to 1.25), 15–50 years OR 0.70 (95% CI 0.57 to 0.87), and ≥ 51 years OR 0.49 (95% CI 0.48 to 0.51)).

    Conclusion: In this 11-year population-based study we found no support for an oestrogen-related mechanism to explain the survival advantage for females compared to males following hospitalisation for injury.

    Place, publisher, year, edition, pages
    BioMed Central, 2019
    Keywords
    Risk-adjusted mortality; ICISS; Trauma; injury; Nationwide; Epidemiological
    National Category
    Surgery
    Identifiers
    urn:nbn:se:liu:diva-155087 (URN)10.1186/s13049-019-0597-3 (DOI)000461309000001 ()30871611 (PubMedID)
    Note

    Funding agencies: Linkoping University, Linkoping, Sweden; Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns

    Available from: 2019-03-15 Created: 2019-03-15 Last updated: 2019-04-17Bibliographically approved
  • 214.
    Larsson, Anders
    et al.
    Uppsala Univ, Sweden.
    Hagstrom, Emil
    Uppsala Univ, Sweden; Uppsala Clin Res Ctr, Sweden.
    Nilsson, Lennart
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Svensson, Maria K.
    Uppsala Univ, Sweden.
    Treatment target re-classification of subjects comparing estimation of low-density lipoprotein cholesterol by the Friedewald equation and direct measurement of LDL-cholesterol2018In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, no 2, p. 94-99Article in journal (Refereed)
    Abstract [en]

    Aims: To compare low-density lipoprotein cholesterol (LDL-C) values calculated by the Friedewald equation with direct LDL-C in patient samples and assess the possible impact on re-classification of LDL-C target values for primary prevention or high cardiovascular disease (CVD) risk (amp;lt;2.5 mmol/L) and secondary prevention or very high CVD risk (amp;lt;1.8mmol/L). LDL-C is an important CVD risk factor. Over the last decade, there has been a change in laboratory methodology from indirectly calculated LDL-C with the Friedewald equation to direct LDL-C measurements (dLDL-C). Methods: Reported results for plasma triglycerides, total cholesterol, high-density lipoprotein-cholesterol, and dLDL-C from 34,981 samples analyzed in year 2014 were extracted from the laboratory information system, Uppsala University Hospital, Uppsala, Sweden. Results: dLDL-C was approximately 10% lower than the corresponding LDL-C results calculated by the Friedewald equation in both men and women. In subjects with triglyceride concentrations above 4 mmol/L (n = 1250) the same discordant pattern was seen as for the entire study population. Altogether 5469 out of 18,051 men (30.3%) and 4604 out of 16,928 women (27.2%) were down-classified at least one CVD risk category. A very small number of subject was up-classified, in total 37 out of 18,051 men (0.2%) and 28 out of 16,928 women (0.2%). Conclusions: The two LDL-C methods had a high concordance, but the direct LDL-C measurement consistently gave approx. 10% lower values, and this caused one-third of subjects to be re-classified as having a lower cardiovascular disease risk in relation to recommended LDL-C target values and decision limits.

  • 215.
    Larsson, Britt
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dragioti, Elena
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bjork, Jonas
    Lund Univ, Sweden; Skane Univ Hosp Lund, Sweden.
    Positive psychological well-being predicts lower severe pain in the general population: a 2-year follow-up study of the SwePain cohort2019In: Annals of General Psychiatry, ISSN 1744-859X, E-ISSN 1744-859X, Vol. 18, article id 8Article in journal (Refereed)
    Abstract [en]

    BackgroundPositive psychology indicators like well-being and life satisfaction may play a pivotal role in pain-related outcomes. In this study, we aimed to examine the prospective associations of positive well-being and life satisfaction with pain severity.Methods and SubjectsThis longitudinal study, with a follow-up of 2years, included 9361 participants (4266 males, 5095 females; mean age: 52.5years; SD: 17.5) without and with chronic pain (CP) at baseline. All analyses were stratified by the two sub-cohortsparticipants without CP (sub-cohort 1) and participants with CP (sub-cohort 2) at baseline. The predictive associations, assessed using ordinal regression in a Generalized Linear Model, were adjusted for baseline potential confounders and reported as odds ratios (ORs) with corresponding 95% confidence intervals (CIs).ResultsAfter adjustments, in sub-cohort 1 positive well-being at baseline was associated with lower severe pain at follow-up compared to participants with severe distress (OR: 0.64; 95% CI 0.49-0.84; pamp;lt;0.001). In sub-cohort 2, both positive well-being and life satisfaction at baseline were associated with lower severe pain at follow-up compared to participants with severe distress and not satisfied with life (OR: 0.80; 95% CI 0.65-0.98; p=0.031 and OR: 0.82; 95% CI 0.69-0.96; p=0.014, respectively).ConclusionsPositive well-being is predictive of lower pain severity both among participants without and with CP at baseline, whereas life satisfaction was found predictive of lower pain severity only for subjects with CP. Future research should emphasize implementing treatments associated with promoting and maintaining positive well-being and life satisfaction in patients who suffer from chronic pain and in risk populations.

  • 216.
    Larsson, Britt
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Dragioti, Elena
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Distinctive subgroups derived by cluster analysis based on pain and psychological symptoms in Swedish older adults with chronic pain - a population study (PainS65+)2017In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 200Article in journal (Refereed)
    Abstract [en]

    Background: Improved knowledge based on clinical features of chronic pain in older adults would be valuable in terms of patient-orientated approaches and would provide support for health care systems in optimizing health care resources. This study identifies subgroups based on pain and psychological symptoms among Swedish older adults in the general population and compares derived subgroups with respect to socio-demographics, health aspects, and health care costs. Methods: This cross-sectional study uses data collected from four registers and one survey. The total sample comprised 2415 individuals amp;gt;= 65 years old. A two-step cluster analysis was performed. Data on pain intensity, number of pain sites, anxiety, depression, and pain catastrophizing were used as classification variables. Differences in socio-demographics, quality of life, general health, insomnia, and health care costs among the clusters were investigated. Association of the clusters with the above parameters was further evaluated using multinomial logistic regression. Results: Four major clusters were identified: Subgroup 1 (n = 325; 15%) - moderate pain and high psychological symptoms; Subgroup 2 (n = 516; 22%) - high pain and moderate psychological symptoms; Subgroup 3 (n = 686; 30%) - low pain and moderate psychological symptoms; and Subgroup 4 (n = 767; 33%) - low pain and low psychological symptoms. Significant differences were found between the four clusters with regard to age, sex, educational level, family status, quality of life, general health, insomnia, and health care costs. The multinomial logistic regression analysis revealed that Subgroups 1 and 2, compared to Subgroup 4, were significantly associated with decreased quality of life, decreased general health, and increased insomnia. Subgroup 3, compared to Subgroup 4, was associated with decreased general health and increased insomnia. In addition, compared to Subgroup 4, Subgroups 1 and 2 were significantly associated with higher health care costs. Conclusions: Two high risk clusters of older adults suffering from chronic pain; one mainly based on psychological symptoms and one mainly on pain intensity and pain spread, associated with decreased quality of life and health and increased health care costs were identified. Our findings indicate that subgroup-specific treatment will improve pain management and reduce health care costs.

  • 217.
    Lasrado, Reena
    et al.
    Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, United Kingdom.
    Bielsten, Therese
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Hann, Mark
    Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, United Kingdom.
    Davies, Linda
    Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, United Kingdom.
    Schumm, James
    IT Services, The University of Manchester, Manchester, United Kingdom.
    Reilly, Siobhan
    Division of Health Research, Lancaster University, Lancaster, United Kingdom.
    Swarbrick, Caroline
    Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, United Kingdom.
    Keady, John
    Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, United Kingdom.
    Hellström, Ingrid
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland. Department of Health Care Science, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
    Designing and Implementing a Home-Based Couple Management Guide for Couples Where One Partner has Dementia (DemPower): Protocol for a Nonrandomized Feasibility Trial2018In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 7, no 8, article id e171Article in journal (Refereed)
    Abstract [en]

    The increasing rate of dementia and high health and social care costs call for effective measures to improve public health and enhance the wellbeing of people living with dementia and their relational networks. Most postdiagnostic services focus on the condition and the person with dementia with limited attention to the caring spouse or partner. The key focus of the study is to develop a guide for couples where one partner has a diagnosis of dementia. This couple management guide is delivered in the form of an app, DemPower.

  • 218.
    Lauppe, Rosa
    et al.
    Quantify Res, Sweden.
    Akesson, Kristina E.
    Lund Univ, Sweden; Lund Univ, Sweden.
    Ljunggren, Osten
    Uppsala Univ, Sweden.
    Spångeus, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology.
    Ortsater, Gustaf
    Quantify Res, Sweden.
    Feudjo-Tepie, Maurille
    Amgen Ltd, England.
    Strom, Oskar
    Quantify Res, Sweden; Karolinska Inst, Sweden.
    Differing impact of clinical factors on the risk of fracture in younger and older women in the general population and an osteoporosis clinic population2019In: ARCHIVES OF OSTEOPOROSIS, ISSN 1862-3522, Vol. 14, no 1, article id 45Article in journal (Refereed)
    Abstract [en]

    This study assesses the impact of risk factors for fracture in women aged 80+ and 60-79. The results suggest that risk assessment which fits younger women may not be suited for the 80+ strata as many common risk factors are less predictive in the older compared to the younger cohort. Purpose This study assesses whether the impact of classical risk factors for fracture due to osteoporosis is different in women aged 80+ and women aged 60-79. Since most prior research on the contribution of risk factors is based on patients below 80years of age, this study aims to fill this knowledge gap to increase the accuracy of risk assessment in the oldest old. Methods Retrospective, observational cohort study using Swedish national health register data and BMD data from osteoporosis clinics. Women aged at least 60 were identified from a random sample of the general population and from the BMD databases and allocated to two populations representing patients at different stages of risk assessment. The relative impact of risk factors on fracture risk was assessed using multivariate competing risk regression with fracture as outcome and death as competing event. Results A total of 163,329 women were included from the general population (52,499 aged 80+) and 22,378 from the BMD databases (4563 aged 80+). The clinical risk factors with relatively highest effect on fracture risk in the older patients were prior fracture and hip T-score below -2.5 SD. Other included risk factors showed lower impact in the older compared to the younger strata. Conclusions This study confirms our understanding of the key risk factors for fracture: age, prior fracture, and a low T-score. Regarding remaining risk factors, risk assessment which fits younger women may not be suited for the 80+ strata as many common risk factors are less predictive in the older compared to the younger cohort.

  • 219.
    Leandersson, Per
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Krapi, Blerim
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    High levels of isocyanic acid in smoke generated during hot iron cauterization2019In: Archives of Environmental & Occupational Health, ISSN 1933-8244, E-ISSN 2154-4700Article in journal (Refereed)
    Abstract [en]

    Pyrolysis of nitrogen containing biofuels generates isocyanic acid (ICA) and we here studied if ICA also is present in cauterization smoke. Air sampling was performed when animal technicians that had developed airway symptoms worked with dehorning. Tissue heated in a laboratory model was used to mimic cauterization. ICA in air at the workplace exceeded 10 times the national exposure limit. In the laboratory, the ICA generated per mg tissue from heated hair, horn and nail was 13.9 +/- 7.8, 24.0 +/- 4.1 and 32.0 +/- 2.9 mu g, respectively. Three workers were medically examined and two were diagnosed with asthma and a third had severe airway problem that resembled asthma. The study shows that high levels of ICA are generated during cauterization of nitrogen-containing tissue. If this could trigger airway symptoms deserves to be investigated further.

  • 220.
    Lear, Jonathan
    Linköping University, Department of Culture and Communication, Centre for Applied Ethics.
    Intersex: Problems of theory become problems in practice2007Independent thesis Advanced level (degree of Magister), 20 points / 30 hpStudent thesis
    Abstract [en]

    This paper discusses the medical treatment of intersex infants: children born with ambiguous genitalia, chromosomes, or hormones. The central thesis is that unnecessary surgery, defined as surgery that is not necessary to preserve the life or physical health of the infant, is unethical when performed on infants and should be postponed until the patient is able to participate in, and contribute to, the decision. Three lines of argument are presented: One based on the lack of clinical evidence supporting unnecessary surgery; one based on how unnecessary surgery limits the child’s future choices; and one based on how problematic notions of gender have resulted in problems in practice. Together and separately, the three arguments lead to the conclusion that performing unnecessary surgery on intersex infants is unethical, and wherever possible surgery should be delayed until the patient can participate in the decision.

  • 221.
    Leijon, Matti
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Stark Ekman, Diana
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Walter, Lars
    Landstinget i Östergötland; Centre for Public Health Sciences; Folkhälsovetenskapligt centrum.
    Ståhle, Agneta
    Department of Neurobiology, Health Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Is there a demand for physical activity interventions from health care providers?: Findings from a population survey2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, no 34Article in journal (Refereed)
    Abstract [en]

    Background: Health care providers in many countries have delivered interventions to improve physical activity levels among their patients. Thus far, less is known about the population's interest to increase their physical activity levels and their opinion about the health care provider's role in physical activity promotion. The aims of this paper were to investigate the self-reported physical activity levels of the population and intention to increase physical activity levels, self-perceived need for support, and opinions about the responsibilities of both individuals and health care providers to promote physical activity.

    Methods: A regional public health survey was mailed to 13 440 adults (aged 18-84 years) living in Östergötland County (Sweden) in 2006. The survey was part of the regular effort by the regional Health Authorities.

    Results: About 25% of the population was categorised as physically active, 38% as moderately active, 27% as somewhat active, and 11% as low active. More than one-third (37%) had no intentions to increase their physical activity levels, 36% had thought about change, while 27% were determined to change. Lower intention to change was mainly associated with increased age and lower education levels. 28% answered that physical activity was the most important health-related behaviour to change "right now" and 15% of those answered that they wanted or needed support to make this change. Of respondents who might be assumed to be in greatest need of increased activity (i.e. respondents reporting poor general health, BMI>30, and inactivity) more than one-quarter wanted support to make improvements to their health. About half of the respondents who wanted support to increase their physical activity levels listed health care providers as a primary source for support.

    Conclusion: These findings suggest that there is considerable need for physical activity interventions in this population. Adults feel great responsibility for their own physical activity levels, but also attribute responsibility for promoting increased physical activity to health care practitioners.

  • 222.
    Lemming, Dag
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Börsbo, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Sjörs, Anna
    Linköping University, Department of Medical and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Single-point but not tonic cuff pressure pain sensitivity is associated with level of physical fitness: a study of non-athletic healthy subjects2015Data set
    Abstract [en]

    Exercise is often used for pain rehabilitation but the link between physical activity level and pain sensitivity is still not fully understood. Pressure pain sensitivity to cuff algometry and conditioned pain modulation (CPM) were evaluated in highly active men (n=22), normally active men (n=26), highly active women (n=27) and normally active women (n=23) based on the Godin Leisure-Time Exercise Questionnaire. Cuff pressure pain sensitivity was assessed at the arm and lower leg. The subjects scored the pain intensity on an electronic Visual Analogue Scale (VAS) during ten minutes with 25 kPa constant cuff pressure and two minutes with zero pressure. The maximal VAS score and area under the VAS-curve were extracted. Pressure pain thresholds (PPT) were recorded by manual pressure algometry on the ipsilateral tibialis anterior muscle before, during and after the tonic arm stimulation.

    Tonic cuff stimulation of the arm and leg resulted in higher VAS peak scores in women compared with men (p<0.04). In all groups the PPTs were reduced during and after the cuff stimulation compared with baseline (p=0.001). PPT were higher in men compared with women (p=0.03) and higher in highly physical active compared with normal active (p=0.048). 

    Besides the well-known gender difference in pressure pain sensitivity this study demonstrates  that a high physical fitness degree in non-athletic subjects is associated with increased pressure pain thresholds but does not affect cuff pressure pain sensitivity in healthy people.

  • 223.
    Lemming, Dag
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Börsbo, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Sjörs, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Lind, Eva-Britt
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Arendt-Nielsen, Lars
    Center for Sensory-Motor Interaction (SMI), Laboratory for Experimental Pain Research, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
    Graven-Nielsen, Thomas
    Center for Sensory-Motor Interaction (SMI), Laboratory for Experimental Pain Research, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Single-point but not tonic cuff pressure pain sensitivity is associated with level of physical fitness: a study of non-athletic healthy subjects2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0125432Article in journal (Refereed)
    Abstract [en]

    Exercise is often used for pain rehabilitation but the link between physical activity level and pain sensitivity is still not fully understood. Pressure pain sensitivity to cuff algometry and conditioned pain modulation (CPM) were evaluated in highly active men (n=22), normally active men (n=26), highly active women (n=27) and normally active women (n=23) based on the Godin Leisure-Time Exercise Questionnaire. Cuff pressure pain sensitivity was assessed at the arm and lower leg. The subjects scored the pain intensity on an electronic Visual Analogue Scale (VAS) during ten minutes with 25 kPa constant cuff pressure and two minutes with zero pressure. The maximal VAS score and area under the VAS-curve were extracted. Pressure pain thresholds (PPT) were recorded by manual pressure algometry on the ipsilateral tibialis anterior muscle before, during and after the tonic arm stimulation.

    Tonic cuff stimulation of the arm and leg resulted in higher VAS peak scores in women compared with men (p<0.04). In all groups the PPTs were reduced during and after the cuff stimulation compared with baseline (p=0.001). PPT were higher in men compared with women (p=0.03) and higher in highly physical active compared with normal active (p=0.048). 

    Besides the well-known gender difference in pressure pain sensitivity this study demonstrates  that a high physical fitness degree in non-athletic subjects is associated with increased pressure pain thresholds but does not affect cuff pressure pain sensitivity in healthy people.

  • 224.
    Levi, Richard
    et al.
    Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Hultling, C
    Solberga SCI Research Project, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Seiger, A
    Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    The Stockholm spinal cord injury study: 4. Psychosocial and financial issues of the Swedish annual level-of-living survey in SCI subjects and controls.1996In: Paraplegia, ISSN 0031-1758, Vol. 34, no 3, p. 152-157Article in journal (Refereed)
    Abstract [en]

    In a series of articles from the Stockholm Spinal Cord Injury Study (SSCIS), the health status of a near-total regional SCI population comprising 353 subjects has been investigated. The present study describes the psycho-social and financial consequences of SCI in this group. It is based on a level-of-living survey that has been used annually on 8000-14,000 Swedes since 1974. The health-focused version of this survey was used for data collection in the subset of 326 subjects in the SSCIS that were residents of the Greater Stockholm area. The normative material consisted of 1978 interviews of residents of the same area, provided by the Swedish Bureau of Statistics. The results show that SCI subjects, although provided with basic material commodities up to par with the general population, have less financial reserves and more frequently express worry about their finances. Less than half of the subjects are gainfully employed, when part-time jobs are also included. Social activities are more restricted, and more centered on the core social network. Several items in the survey point to a preoccupation with personal rather than public matters. We feel that these factors, at least to some degree, are consequential to separation from the workplace, with resulting disadvantageous financial and social effects. Intensified vocational rehabilitation efforts might thus be justified from both an economic and a psycho-social point of view.

  • 225.
    Lewis, Kate Marie
    et al.
    UCL, England.
    Ruiz, Milagros
    UCL, England.
    Goldblatt, Peter
    UCL, England.
    Morrison, Joana
    UCL, England.
    Porta, Daniela
    Lazio Regional Health Syst, Italy.
    Forastiere, Francesco
    Lazio Regional Health Syst, Italy.
    Hryhorczuk, Daniel
    University of Illinois, IL USA.
    Zvinchuk, Oleksandr
    National Academic Medical Science Ukraine, Ukraine.
    Saurel-Cubizolles, Marie-Josephe
    Paris Descartes University, France.
    Lioret, Sandrine
    Paris Descartes University, France.
    Annesi-Maesano, Isabella
    Pierre Louis Institute Epidemiol and Public Health iPLESP, France.
    Vrijheid, Martine
    ISGlobal, Spain; UPF, Spain; Spanish Consortium Research Epidemiol and Public Health CIBE, Spain.
    Torrent, Maties
    Spanish Consortium Research Epidemiol and Public Health CIBE, Spain; IB Salut Menorca Health Area, Spain.
    Iniguez, Carmen
    Spanish Consortium Research Epidemiol and Public Health CIBE, Spain; University of Valencia, Spain.
    Larranaga, Isabel
    Public Health Department Gipuzkoa, Spain; BIODONOSTIA Health Research Institute, Spain.
    Harskamp-van Ginkel, Margreet W.
    University of Amsterdam, Netherlands.
    Vrijkotte, Tanja G. M.
    University of Amsterdam, Netherlands.
    Klanova, Jana
    Masaryk University, Czech Republic; Masaryk University, Czech Republic.
    Svancara, Jan
    Masaryk University, Czech Republic.
    Barross, Henrique
    University of Porto, Portugal; University of Porto, Portugal.
    Correia, Sofia
    University of Porto, Portugal; University of Porto, Portugal.
    Jarvelin, Marjo-Riitta
    Imperial Coll London, England; University of Oulu, Finland; Oulu University Hospital, Finland; University of Oulu, Finland.
    Taanila, Anja
    University of Oulu, Finland.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Marmot, Michael
    UCL, England.
    Pikhart, Hynek
    UCL, England.
    Mothers education and offspring asthma risk in 10 European cohort studies2017In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 32, no 9, p. 797-805Article in journal (Refereed)
    Abstract [en]

    Highly prevalent and typically beginning in childhood, asthma is a burdensome disease, yet the risk factors for this condition are not clarified. To enhance understanding, this study assessed the cohort-specific and pooled risk of maternal education on asthma in children aged 3-8 across 10 European countries. Data on 47,099 children were obtained from prospective birth cohort studies across 10 European countries. We calculated cohort-specific prevalence difference in asthma outcomes using the relative index of inequality (RII) and slope index of inequality (SII). Results from all countries were pooled using random-effects meta-analysis procedures to obtain mean RII and SII scores at the European level. Final models were adjusted for child sex, smoking during pregnancy, parity, mothers age and ethnicity. The higher the score the greater the magnitude of relative (RII, reference 1) and absolute (SII, reference 0) inequity. The pooled RII estimate for asthma risk across all cohorts was 1.46 (95% CI 1.26, 1.71) and the pooled SII estimate was 1.90 (95% CI 0.26, 3.54). Of the countries examined, France, the United Kingdom and the Netherlands had the highest prevalences of childhood asthma and the largest inequity in asthma risk. Smaller inverse associations were noted for all other countries except Italy, which presented contradictory scores, but with small effect sizes. Tests for heterogeneity yielded significant results for SII scores. Overall, offspring of mothers with a low level of education had an increased relative and absolute risk of asthma compared to offspring of high-educated mothers.

  • 226.
    Liljegren, Mats
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.
    Health at Work: The Relationship between Organizational Justice, Behavioral Responses, and Health2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Employee health, individual behaviors in an organizational context and perceived organizational justice are theoretically united. The empirical relationship, especially between behavioral responses and organizational justice and between behavioral responses, and especially job mobility, and health are not previously studied in any apparent

    extent.

    Aim: The main aim with the present dissertation was to study the relationship between organizational justice, behavioral responses, and health.

    Methods: The present study was designed as a longitudinal, three-wave, panel study. A questionnaire was mailed to all employees in three regional organizations of the Swedish National Labour Market Administration (AMV) at 2001 (N=1010, response rate: 78%), 2002 (N=1078, response rate: 75%) and 2003 (N=1122, response rate: 74%).

    In study I, a cross-sectional and longitudinal validation study, was analyses of variance, multi-trait/multiitem analyses, logistic regression analyses and different forms of factor analyses used to validate and evaluate the Hagedoorn et al. EVLN instrument. In study II, a longitudinal panel study, correlation and Structural Equation Modeling (SEM) analyses were used to elucidate the reciprocal relationship between behavioral responses and health. In study III, a longitudinal panel study, factor, correlation and SEM analyses were used to investigate the association between organizational justice, health and burnout. In study IV, a longitudinal panel study, was variance and General Linear Modeling (GLM) repeated measures analyses used to examine the relationship between turnover intentions, job mobility and health and burnout. In study V, a longitudinal panel study, variance, correlation, and SEM analyses were used to shed light upon the reciprocal relationship between health, burnout and job mobility with turnover intentions, organizational justice and age as affecting factors.

    Results: Study I showed that the Hagedoorn et al. EVLN instrument was a valid instrument with the exception for the aggressive voice subscale that presents some obvious and distinct deficiencies. The results of study II indicate that the relation between behavioural responses versus health is mainly one-sided: behavioural responses predict psychosocial health. The behavioural response ‘exit’ at baseline was associated with worse psychosocial health at the two-year follow-up, while ‘considerate voice’ predicted good psychosocial health at the two-year follow-up. Good baseline physical health predicted a high degree of ‘exit’ behaviour after two years. Study III showed that organizational justice is cross-sectionally and longitudinally associated with physical, psychosocial health, and burnout. The two approaches to study organizational justice, as a global or threefold construct, should be regarded as complementary rather than exclusive. The results of study IV showed that external mobility had a positive effect on personal and work-related burnout compared with non-mobility and that the combined effects of turnover intentions and job mobility are additive rather than interactive. Finally, the results of study V showed that job mobility is a more distinct predictor of health and burnout than health and burnout is of job mobility. Turnover intentions, but not organizational justice, proved to have an effect on job mobility.

    Conclusion: The present dissertation has elucidated the social-psychological relationship between organizational justice, behavioral responses and health. The results show that perceived organizational justice predicted good health and low degree of burnout. The results also show that active behavioural responses predict psychosocial health: pro-organizational behaviour, (considerate voice), was associated with high psychosocial health and a contra-organizational behaviour (exit) was associated with low psychosocial health. External job mobility showed a positive effect on burnout and is a more distinct predictor of health and burnout than health and burnout is of job mobility.

    List of papers
    1. Personality and Social Sciences: Psychometric evaluation and further validation of the Hagedoorn et al. modified EVLN measure
    Open this publication in new window or tab >>Personality and Social Sciences: Psychometric evaluation and further validation of the Hagedoorn et al. modified EVLN measure
    2008 (English)In: Scandinavian Journal of Psychology, ISSN 0036-5564, Vol. 49, no 2, p. 169-177Article in journal (Refereed) Published
    Abstract [en]

    The aim of the present study was to evaluate and further validate a modified Exit, Voice, Loyalty and Neglect (EVLN) instrument (Hagedoorn, Van Yperen, Van de Vliert & Buunk, 1999), in a Swedish sample (n= 792). To test the underlying scaling assumptions, the convergent and divergent validity, a multitrait/multi-item analysis was conducted and factor analyses were used to evaluate the factor structure. The concurrent validity was tested by using the modified EVLN instrument as predictor and three different forms of justice as criteria in the analysis. The criterion-related validity was tested and an association between exit behavioral response and actual exit behavior was found (predictive validity). The results showed that the instrument may be considered to be a valid measure with the exception of the aggressive voice scale.

    Keywords
    Psychometric evaluation • validation • EVLN • behavioral responses
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-13223 (URN)10.1111/j.1467-9450.2007.00620.x (DOI)
    Available from: 2008-04-28 Created: 2008-04-28 Last updated: 2013-09-03
    2. The relationship between self-rated health and employee behavioural responses: a two-year follow-up study
    Open this publication in new window or tab >>The relationship between self-rated health and employee behavioural responses: a two-year follow-up study
    2008 (English)Article in journal (Refereed) Submitted
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13224 (URN)
    Available from: 2008-04-28 Created: 2008-04-28 Last updated: 2013-09-03
    3. The Associations between Perceived Distributive, Procedural, and Interactional Organizational Justice, Self-rated Health and Burnout
    Open this publication in new window or tab >>The Associations between Perceived Distributive, Procedural, and Interactional Organizational Justice, Self-rated Health and Burnout
    2009 (English)In: Work - Journal of Prevention Assessment and Rehabilitation, ISSN 1051-9815, Vol. 33, no 1, p. 43-51Article in journal (Refereed) Published
    Abstract [en]

    Aim: The aim of the present study was to examine the cross-sectional and 2-year longitudinal associations between perceived organizational justice, self-rated health and burnout. Metods: The study used questionnaire data from 428 Swedish employment officers and the data was analyzed with Structural Equation Modeling, SEM. Two different models were tested: a global organizational justice model (with and without correlated measurement errors) and a differentiated (distributive, procedural and interactional organizational justice) justice model (with and without correlated measurement errors). Results: The global justice model with autocorrelations had the most satisfactory goodness-of-fit indices. Global justice showed statistically significant (p andlt; 0.01) cross-sectional (0.80 andlt;= mle andlt;= 0.84) and longitudinal positive associations (0.76 andlt;= mle andlt;= 0.82) between organizational justice and self-rated health, and significant (p andlt; 0.01) negative associations between organizational justice and burnout (cross-sectional: mle = -0.85, longitudinal -0.83 andgt;= mle andgt;= -0.84). Conclusion: The global justice construct showed better goodness-of-fit indices than the threefold justice construct but a differentiated organizational justice concept could give valuable information about health related risk factors: if they are structural (distributive justice), procedural (procedural justice) or inter-personal (interactional justice). The two approaches to study organizational justice should therefore be regarded as complementary rather than exclusive.

    Keywords
    Organizational justice, self-rated health, burnout
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13225 (URN)
    Note

    DOI does not work: 10.3233/WOR-2009-0842

    Available from: 2008-04-28 Created: 2008-04-28 Last updated: 2018-03-06
    4. Job mobility as predictor of health and burnout
    Open this publication in new window or tab >>Job mobility as predictor of health and burnout
    2009 (English)In: Journal of Occupational and Organizational Psychology, ISSN 0963-1798, Vol. 82, no 2, p. 317-329Article in journal (Refereed) Published
    Abstract [en]

    A few earlier studies have shown that employee's turnover intentions and job mobility simultaneously could affect health and burnout. The present study investigated the cross-sectional, 2-year longitudinal and possible interactional or additive effects of turnover intentions and job mobility (internal and external mobility) on health (SF-36) and burnout (CBI). The study used questionnaire data from 662 Swedish civil servants, 73% remained at the same workplace, 13% were internally mobile, and 14% left the organization (externally mobile) during the 2-year follow-up period. The results showed that high turnover intentions were cross-sectionally associated with worse mental health (MH) and higher degree of burnout. The externally mobile group had, after the change of workplace, less degree of personal and work-related burnout compared to the non-mobile group. The effect of internal mobility on burnout and health was negligible compared to the effects of external mobility. The results also indicated that the relationship between turnover intentions and actual job mobility are additive rather than interactive. One practical implication of the present findings is that external mobility, if it is in concordance with the individual intentions, could be a powerful health promoting factor.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13226 (URN)10.1348/096317908X332919 (DOI)
    Available from: 2008-04-28 Created: 2008-04-28 Last updated: 2013-09-03
    5. The longitudinal relationship between job mobility, perceived organizational justice, and health
    Open this publication in new window or tab >>The longitudinal relationship between job mobility, perceived organizational justice, and health
    2008 (English)In: BMC Public Health, ISSN 1471-2458, Vol. 8, no 164Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: The main purpose of the present study was to examine the 2-year longitudinal and reciprocal relationship between job mobility and health and burnout. A second aim was to elucidate the effects of perceived organizational justice and turnover intentions on the relationship between job mobility (non-, internally and externally mobile), and health (SF-36) and burnout (CBI). METHODS: The study used questionnaire data from 662 Swedish civil servants and the data were analysed with Structural Equation Modeling statistical methods. RESULTS: The results showed that job mobility was a better predictor of health and burnout, than health and burnout were as predictors of job mobility. The predictive effects were most obvious for psychosocial health and burnout, but negligible as far as physical health was concerned. Organizational justice was found to have a direct impact on health, but not on job mobility; whereas turnover intentions had a direct effect on job mobility. CONCLUSION: The predictive relationship between job mobility and health has practical implications for health promotive actions in different organizations.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13227 (URN)10.1186/1471-2458-8-164 (DOI)
    Available from: 2009-02-22 Created: 2009-02-22 Last updated: 2013-09-03Bibliographically approved
  • 227. Lilliecreutz Huitema, Eva
    et al.
    Samuelsson, Kersti
    Linköping University, Department of Medical and Health Sciences, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Andersson, Gunnar
    Lifestyle changes with help from Health Profile Assessment in combination with support in individual interventions for persons with aquired brain injury - a pilot study2014In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 16, no 3, p. 151-158Article in journal (Refereed)
    Abstract [en]

    Little is known about how to support a lifestyle change for persons with acquired brain injury (ABI), who have poor health compared with the rest of the population. This study investigates whether the Health Profile Assessment (HPA) combined with individual support in individually adjusted interventions could affect the lifestyle of persons with ABI. This longitudinal prospective and quasi-experimental study has a before and after design. HPA aims to improve health habits, perceived health and physiological measurements. In addition, this study includes interventions based on individual goals and actions decided on by the participants. The intervention process was supported through various communication methods such as Motivational Interviewing (MI) and Transactional Analyses (TA). The studied group (n = 25) included persons with cognitive impairments due to ABI who were considered for outpatient rehabilitation at a specialized facility at a university hospital in south-eastern Sweden. Results at follow-up showed significant improvements in physical activity, perceived health and diet. Significant improvements were also shown in sagittal abdominal diameter, waist circumference, body mass index (BMI) and physical fitness. Consequently, this study describes a method that successfully supported lifestyle changes in persons with ABI.Read

  • 228.
    Linderholm, Marit
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Medicine and Health Sciences. Primary Hlth Care Ctr Valdemarsvik, Sweden.
    Törnvall, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Yngman Uhlin, Pia
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Operations management Region Östergötland, Research and Development Unit.
    Hjelm, Katarina
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Self-rated health, lifestyle habits and risk assessment in 75-year-old persons attending preventive clinic visits with a nurse in primary health care: a cross-sectional study2019In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 20, article id UNSP e88Article in journal (Refereed)
    Abstract [en]

    Aim:

    To describe self-rated health in relation to lifestyle and illnesses and to identify risk factors for ill health such as pressure ulcers, falls and malnutrition among 75-year-old participants in a new clinical routine involving health assessment followed by tailored one-to-one health promotion at preventive clinic visits to a nurse at primary health care centres (PHCC).

    Background:

    There is a rapidly growing ageing population worldwide. It is central to health policy to promote active and healthy ageing. Preventive clinic visits to a nurse in primary health care were introduced as a new clinical intervention in a region in Sweden to improve the quality of health for the older adults.

    Design:

    A quantitative cross-sectional population-based study.

    Methods:

    The sample consisted of 306 individuals in six primary health care centres in Sweden aged 75 years who attended preventive clinic visits to a nurse. Data were collected from March 2014 to May 2015 during structured conversations with a nurse based on self-administered questionnaires, clinical examinations, risk assessments and after the clinic visit existing register data were collected by the researcher.

    Findings:

    Participants experienced good self-rated health despite being overweight and having chronic illnesses. Daily exercise such as walking and housework was more common than aerobic physical training. The majority had no problems with mobility but reported anxiety, pain and discomfort and had increased risk of falls.

    Conclusion:

    It is important to encourage the older adults to live actively and independently for as long as possible. The healthy older adults may benefit from the clinical intervention described here to support the individual’s ability to maintain control over their health. Such supportive assessments might help the healthy older adult to achieve active ageing, reducing morbidity and preventing functional decline.

  • 229.
    Lindh Falk, Annika
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Interprofessional Collaboration in Health Care: Education and Practice2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Interprofessional collaboration is of global interest for addressing to the complex health care needs and improving patient safety in health care. Professionals have to develop collaborative skills and the ability to share knowledge. Interprofessional education describes learning activities where students learn with, from and about each other to improve collaboration. The dimension of interprofessional collaboration is complex and includes different collaborative competencies to bring about the best for the patients. To  become a  professional, often understood as someone exerting expertise within a specific field of practice, involves a learning process that challenges the boundaries of the professions. Boundaries are not only barriers, but also places that increase learning. There is a complexity to studying the phenomenon of interprofessional collaboration and learning regarding how it occurs in education and health care practice. By using a sociomaterial perspective on practice, it is possible to more robustly explore the collaborative context.

    Aim: The overarching aim of the thesis has been to explore interprofessional collaboration and learning in health care education and in interprofessional health care practice. More specifically, the research questions in the thesis were answered in two studies regarding how professional knowledge is developed and shared in interprofessional undergraduate health care education and in interprofessional health care practice.

    Methods: A questionnaire was distributed to students from a medicine, nursing, physiotherapy and occupational therapy programme who participated in a two-week period of practice at an Interprofessional Training Ward in Linköping. The data was analysed quantitatively to explore how female and male students experienced their professional identity formation. The open-ended responses were analysed using a sociomaterial perspective on practice.

    An ethnographic study was conducted in a hospital setting during a period of one year, during which two interprofessional teams were observed. A theory-driven analysis was made using a sociomaterial perspective on practice, and this provided a lens through which the nature of interprofessional collaboration and knowledge sharing could be observed.

    Findings: The main findings from the questionnaire showed that the practice architectures of the Interprofessional Training Ward, prefigured practices where different professional responsibilities were enacted in ways that were reproducing expected and unexpected roles in a traditional health care practice. That disrupted the students´ practical and general understandings of professional responsibilities and the nature of professional work including their professional identity formation.

    The findings from the ethnographic study showed different patterns of how knowledge was shared among professionals in their daily work practice as it unfolded, like chains of actions. The patterns arose through activities where collaboration between professionals was planned beforehand, and at other times it arose in more spontaneous or responsive ways. Due to the way the activities were arranged, the nursing assistants were totally or partially excluded from the collaborative practices.

    Conclusions: The way that educational and health care practices were arranged had an influence on the patterns of interactions between the students as well as the professionals. The arrangement at the Interprofessional Training Ward enabled and constrained the possibilities for students to learn professional and interprofessional competencies. Professional practices in health care hung together through chains of actions that influenced interprofessional collaboration and learning. The relations between human actors, material objects and artifacts are of importance for understanding interprofessional practices.

    List of papers
    1. One site fits all? A student ward as a learning practice for interprofessional development
    Open this publication in new window or tab >>One site fits all? A student ward as a learning practice for interprofessional development
    Show others...
    2013 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 27, no 6, p. 476-481Article in journal (Refereed) Published
    Abstract [en]

    Interprofessional training wards (IPTWs), aiming to enhance interprofessional collaboration, have been implemented in medical education and evaluated over the last decade. The Faculty of Health Sciences, Linkoping University has, in collaboration with the local health provider, arranged such training wards since 1996, involving students from the medical, nursing, physiotherapy, and occupational therapy programs. Working together across professional boundaries is seen as a necessity in the future to achieve sustainable and safe healthcare. Therefore, educators need to arrange learning contexts which enhance students interprofessional learning. This article shows aspects of how the arrangement of an IPTW can influence the students collaboration and learning. Data from open-ended questions from a questionnaire survey, during autumn term 2010 and spring term 2011 at an IPTW, was analyzed qualitatively using a theoretical framework of practice theory. The theoretical lens gave a picture of how architectures of the IPTW create a clash between the "expected" professional responsibilities and the "unexpected" responsibilities of caring work. Also revealed was how the proximity between students opens up contexts for negotiations and boundary work. The value of using a theoretical framework of professional learning in practice within the frames of healthcare education is discussed.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2013
    Keywords
    Collaboration, interprofessional education, interprofessional training ward, practice theory, professional boundaries, qualitative method
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-102721 (URN)10.3109/13561820.2013.807224 (DOI)000327284700006 ()
    Available from: 2013-12-19 Created: 2013-12-19 Last updated: 2017-12-06
    2. Does gender matter?: Differences between students at an interprofessional training ward
    Open this publication in new window or tab >>Does gender matter?: Differences between students at an interprofessional training ward
    2015 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 29, no 6, p. 616-621Article in journal (Refereed) Published
    Abstract [en]

    Studies on graduates’ transitions from education into clinical work highlight inequalities concerning how women and men experience their professional learning and development. This study explores how female and male students from different programs within the health care education system, i.e. medicine, nursing, occupational therapy and physiotherapy programmes, experience an IPTW as a part of their professional identity formation.

    Students from the medicine, nursing, physiotherapy, and occupational therapy programmes collaborate in teams during two weeks at one of three IPTWs at the medical school, Linköping University. They together take the responsibility for diagnosis, treatment and rehabilitation of the patients, albeit with professional supervisors as support. During 2010 to 2011 454 (93%) of the 488 students who practiced at the IPTWs answered a questionnaire on their experiences of the IPTW. The students stated that the IPTW had positively influenced their professional development. The female and male medical students were significantly less positive than other female and male students, respectively, concerning the value of IPTW. The male students from all programmes were slightly, but significantly, less positive than all the female students. These findings show that students “do gender” as an integral part of the educational practice. It is important to scrutinize the IPTW as an educational practice, influencing students’ preparation for future work. Gender should be discussed during the IPTW rotation but also in general during the curriculum for all healthcare programmes.

     

    Place, publisher, year, edition, pages
    Taylor & Francis, 2015
    Keywords
    IPTW, professional development, gender, questionnaire
    National Category
    Pedagogical Work
    Identifiers
    urn:nbn:se:liu:diva-121056 (URN)10.3109/13561820.2015.1047491 (DOI)000366450200017 ()
    Available from: 2015-09-04 Created: 2015-09-04 Last updated: 2017-12-04
  • 230.
    Lindhe Söderlund, Lena
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Challenges of learning and practicing motivational interviewing2009Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The past three decades have seen a growth in health promotion research and practice, stimulated by the epidemiologic transition of the leading causes of death from infectious to chronic diseases. An estimated 50% of mortality from the 10 leading causes of death is due to behaviour, which suggests individuals can make important contributions to their own health by adopting some health-related behaviours and avoiding others. Motivational interviewing (MI) has emerged as a brief counselling approach for behavioural modification that builds on a patient empowerment perspective by supporting self-esteem and self-efficacy. MI has become increasingly popular in a variety of health care settings as well as non-health care settings.

    Aims: The overall aim of this thesis is to contribute to improved understanding of the different factors that impact on the learning and practice of MI. The aim of study I was to identify barriers and facilitators to use MI with overweight and obese children in child welfare and school health services. The aim of study II was to identify barriers, facilitators and modifiers to use MI with pharmacy clients in community pharmacies.

    Methods: Participants in study I were five child welfare centre nurses from the county council and six municipally-employed school health service nurses, all from Östergötland, Sweden. Participants in study II were 15 community pharmacy pharmacists in Östergötland Sweden. Data for both studies were obtained through focus group interviews with the participants, using interview guides containing open-ended questions related to the aims of the studies. Study II also included five individual interviews. Interview data were interpreted from a phenomenological perspective.

    Results: In study I, important barriers were nurses’ lack of recognition that overweight and obesity among children constitutes a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything, and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem, and working with obese children rather than those who were overweight. In study II, pharmacists who had previously participated in education that included elements similar to MI felt this facilitated their use of MI. The opportunity to decide on appropriate clients and/or healthrelated behaviours for counselling was also an important facilitator. The pharmacists believed the physical environment of the pharmacies was favourable for MI use, but they experienced time limitations when there were many clients on the premises. They also experienced many difficulties associated with the practical application of MI, including initiating and concluding client conversations.

    Conclusions: Learning and practicing MI effectively is difficult for many practitioners as it requires a new way of thinking and acting. Practitioners’ use of MI is not effective unless there is recognition that there is an important health-related problem to be solved. Practitioners feel more confident using MI with clients who have health-compromising behaviours and/or risks in which the practitioners feel they have expertise. Possessing considerable MI counselling skills does not compensate for insufficient knowledge about a targeted health-related behaviour and/or risk. Feedback from clients plays an important role for the quality and quantity of practitioners’ MI use.

    List of papers
    1. Feasibility of using motivational interviewing in a Swedish pharmacy setting
    Open this publication in new window or tab >>Feasibility of using motivational interviewing in a Swedish pharmacy setting
    2009 (English)In: International Journal of Pharmacy Practice, ISSN 0961-7671, E-ISSN 2042-7174, Vol. 17, no 3, p. 143-149Article in journal (Refereed) Published
    Abstract [en]

    Aims: Motivational interviewing (MI) is widely established as an effective counselling approach for many lifestyle issues, but is largely untested in pharmacy settings. The aim of this study was to identify factors that impact on the feasibility of using MI with pharmacy clients in routine community pharmacy work in Sweden.

    Methods: Interviews were conducted with 15 pharmacists at two pharmacies after they had participated in a manualbased MI skills training and used MI with clients for 6 months. The pharmacists were offered hands-on training from “pilot pharmacists” who had received more MI training and were involved in assembling the manual that adapted MI for use in pharmacies. Three focus groups with the pharmacists and five individual interviews with pharmacists in leading positions were conducted. Data were interpreted from a phenomenological perspective.

    Results/conclusions: Pharmacists who had previously participated in education that included elements similar to MI felt this facilitated their use of MI. Pharmacists experienced many difficulties associated with the practical application of MI, including initiating and concluding client conversations. The opportunity to decide on appropriate clients and/or health-related behaviours for counselling was an important facilitator. The pharmacists believed the physical environment of the pharmacies was favourable for MI use, but they experienced time limitations when there were many clients on the premises. The organizational context in which MI was applied affected the pharmacists’ attitudes to using MI.

    Keywords
    Counselling; Health promotion; Pharmacist
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-17314 (URN)10.1211/ijpp/17.03.0004 (DOI)
    Available from: 2009-03-19 Created: 2009-03-17 Last updated: 2017-12-13Bibliographically approved
    2. Applying motivational interviewing to counselling overweight and obese children
    Open this publication in new window or tab >>Applying motivational interviewing to counselling overweight and obese children
    2009 (English)In: Health Education Research, ISSN 0268-1153, E-ISSN 1465-3648, Vol. 24, no 3, p. 442-449Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to identify barriers and facilitators to nurses’ application of motivational interviewing (MI) to counselling overweight and obese children aged 5 and 7 years, accompanied by their parents. Ten welfare centre and school health service nurses trained and practiced MI for 6 months, then participated in focus group interviews concerning their experiences with applying MI to counselling overweight and obese children. Important barriers were nurses’ lack of recognition that overweight and obesity among children constitute a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem and working with obese children rather than those who were overweight.

    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-17312 (URN)10.1093/her/cyn039 (DOI)
    Available from: 2009-03-19 Created: 2009-03-17 Last updated: 2017-12-13Bibliographically approved
  • 231.
    Lindhe Söderlund, Lena
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Feasibility of using motivational interviewing in a Swedish pharmacy setting2009In: International Journal of Pharmacy Practice, ISSN 0961-7671, E-ISSN 2042-7174, Vol. 17, no 3, p. 143-149Article in journal (Refereed)
    Abstract [en]

    Aims: Motivational interviewing (MI) is widely established as an effective counselling approach for many lifestyle issues, but is largely untested in pharmacy settings. The aim of this study was to identify factors that impact on the feasibility of using MI with pharmacy clients in routine community pharmacy work in Sweden.

    Methods: Interviews were conducted with 15 pharmacists at two pharmacies after they had participated in a manualbased MI skills training and used MI with clients for 6 months. The pharmacists were offered hands-on training from “pilot pharmacists” who had received more MI training and were involved in assembling the manual that adapted MI for use in pharmacies. Three focus groups with the pharmacists and five individual interviews with pharmacists in leading positions were conducted. Data were interpreted from a phenomenological perspective.

    Results/conclusions: Pharmacists who had previously participated in education that included elements similar to MI felt this facilitated their use of MI. Pharmacists experienced many difficulties associated with the practical application of MI, including initiating and concluding client conversations. The opportunity to decide on appropriate clients and/or health-related behaviours for counselling was an important facilitator. The pharmacists believed the physical environment of the pharmacies was favourable for MI use, but they experienced time limitations when there were many clients on the premises. The organizational context in which MI was applied affected the pharmacists’ attitudes to using MI.

  • 232.
    Lindhe Söderlund, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nordqvist, Cecilia
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Angbratt, Marianne
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Applying motivational interviewing to counselling overweight and obese children2009In: Health Education Research, ISSN 0268-1153, E-ISSN 1465-3648, Vol. 24, no 3, p. 442-449Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to identify barriers and facilitators to nurses’ application of motivational interviewing (MI) to counselling overweight and obese children aged 5 and 7 years, accompanied by their parents. Ten welfare centre and school health service nurses trained and practiced MI for 6 months, then participated in focus group interviews concerning their experiences with applying MI to counselling overweight and obese children. Important barriers were nurses’ lack of recognition that overweight and obesity among children constitute a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem and working with obese children rather than those who were overweight.

  • 233.
    Lindqvist, Kent
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Dalal, Koustuv
    School of Health & Medical Sciences, Department of Public Health Science, Örebro University, Örebro, Sweden.
    Impact of social standing on traffic injury prevention in a WHO safe community2012In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 4, no 4, p. 216-221Article in journal (Other academic)
    Abstract [en]

    The objective of the current study was to evalu- ate outcomes of a program to prevent traffic injuries among the different social strata under WHO Safe Community Program. A quasi-experi- mental design was used, with pre- and post- implementation registrations in the program im- plementation area (population 41,000) and in a neighbouring control municipality (population 26,000) in Östergötland County, Sweden. The traffic injury rate in the not vocationally active households was twice than employed or self- employed households in the intervention area. In the employed and not vocationally active households, males showed higher injury rates than females in both areas. In the self-employed households females exhibited higher injury rates than males in the intervention area. Males from not vocationally active households displayed the highest post-intervention injury rate in both the intervention and control areas. After 6 years of Safe Community program activity, the injury rates for males in employed category, injury rates for females in self-employed category, and males/females in non- vocationally active cate- gory displayed a decreasing trend in the inter- vention area. However, in the control area injury rate decreased only for males of employed households. The study indicated that there was almost no change in injury rates in the control area. Reduction of traffic injuries in the inter- vention area between 1983 and 1989 was likely to be attributable to the success of safety pro- motion program. Therefore, the current study concludes that Safe Community program seems to be successful for reducing traffic injuries in different social strata.

  • 234.
    Lindqvist, Kent
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    The impact of child safety promotion on different social strata in a WHO Safe Community2012In: Journal of Injury and Violence Research, ISSN 2008-2053, E-ISSN 2008-4072, Vol. 4, no 1, p. 20-25Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The objective of the current study was to evaluate outcomes of a program to prevent severe and less severe unintentional child injuries among the different social strata under WHO Safe Community program. Specifically, the aim was to study effectiveness of Safe Community program for reducing child injury.

    METHODS: A quasi-experimental design was used, with pre- and post-implementation registrations covering the children (0 -15 years) in the program implementation area (population 41,000) and in a neighboring control municipality (population 26,000) in Ostergotland County, Sweden.

    RESULTS: Boys from not vocationally active households displayed the highest pre-intervention injury rate in both the control and intervention areas. Also in households in which the vocationally significant member was employed, boys showed higher injury rates than girls. Households in which the vocationally significant member was self-employed, girls exhibited higher injury rates than boys in the intervention area. After 6 years of program activity, the injury rates for boys and girls in employed category and injury rates for girls in self-employed category displayed a decreasing trend in the intervention area. However, in the control area injury rate decreased only for boys of employed families.

    CONCLUSIONS: The study indicated that almost no changes in injury rates in the control area suggested that the reduction of child injuries in the intervention area between 1983 and 1989 was likely to be attributable to the safety promotion program. Therefore, the current study indicates that Safe Community program seems to be successful for reducing child injuries.

  • 235.
    Lindroos, Anna Karin
    et al.
    Swedish Natl Food Agcy, Sweden; Univ Gothenburg, Sweden.
    Sipinen, Jessica Petrelius
    Swedish Natl Food Agcy, Sweden.
    Axelsson, Cecilia
    Swedish Natl Food Agcy, Sweden.
    Nyberg, Gisela
    Karolinska Inst, Sweden.
    Landberg, Rikard
    Chalmers Univ Technol, Sweden.
    Leandersson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Amemo, Marianne
    Swedish Natl Food Agcy, Sweden.
    Lemming, Eva Warensjo
    Swedish Natl Food Agcy, Sweden.
    Use of a Web-Based Dietary Assessment Tool (RiksmatenFlex) in Swedish Adolescents: Comparison and Validation Study2019In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 21, no 10, article id e12572Article in journal (Refereed)
    Abstract [en]

    Background: A Web-based dietary assessment tool-RiksmatenFlex-was developed for the national dietary survey of adolescents in Sweden. Objective: This study aimed to describe the Web based method RiksmatenFlex and to test the validity of the reported dietary intake by comparing dietary intake with 24-hour dietary recalls (recall interviews), estimated energy expenditure, and biomarkers. Methods: Adolescents aged 11-12, 14-15, and 17-18 years were recruited through schools. In total, 78 students had complete dietary information and were included in the study. Diet was reported a few weeks apart with either RiksmatenFlexDiet (the day before and a random later day) or recall interviews (face-to-face, a random day later by phone) in a cross-over, randomized design. At a school visit, weight and height were measured and blood samples were drawn for biomarker analyses. Students wore an accelerometer for 7 days for physical activity measurements. Dietary intake captured by both dietary methods was compared, and energy intake captured by both methods was compared with the accelerometer-estimated energy expenditure (EEest). Intake of whole grain wheat and rye and fruit and vegetables by both methods was compared with alkylresorcinol and carotenoid concentrations in plasma, respectively. Results: The mean of the reported energy intake was 8.92 (SD 2.77) MJ by RiksmatenFlexDiet and 8.04 (SD 2.67) MJ by the recall interviews (P=.01) Intake of fruit and vegetables was 224 (169) g and 227 (150) g, and whole grain wheat and rye intake was 12.4 (SD 13.2) g and 12.0 (SD 13.1) g, respectively; the intakes of fruit and vegetables as well as whole grain wheat and iye did not differ between methods. Intraclass correlation coefficients ranged from 0.57 for protein and carbohydrates to 0.23 for vegetables. Energy intake by RiksmatenFlexDiet was overreported by 8% (P=.03) but not by the recall interviews (P=.53) compared with EEest. The Spearman correlation coefficient between reported energy intake and EEest was 0.34 (P=.008) for RiksmatenFlexDiet and 0.16 (P=.21) for the recall interviews. Spearman correlation coefficient between whole grain wheat and rye and plasma total alkylresorcinol homologs was 0.36 (P=.002) for RiksmatenFlexDiet and 0.29 (P=.02) for the recall interviews. Spearman correlations between intake of fruit and vegetables and plasma carotenoids were weak for both dietary tools. The strongest correlations were observed between fruit and vegetable intake and lutein/zeaxanthin for RiksmatenFlexDiet (0.46; Pamp;lt;.001) and for recall interviews (0.28; P=.02). Conclusions: RiksmatenFlexDiet provides information on energy, fruit, vegetables, and whole grain wheat and rye intake, which is comparable with intake obtained from recall interviews in Swedish adolescents. The results are promising for cost-effective dietary data collection in upcoming national dietary surveys and other studies in Sweden. Future research should focus on how, and if, new technological solutions could reduce dietary reporting biases.

  • 236.
    Lingfors, Hans
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Futurum, Sweden.
    Persson, Lars-Göran
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Futurum, Sweden.
    All-cause mortality among young men 24-26 years after a lifestyle health dialogue in a Swedish primary care setting: a longitudinal follow-up register study2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 1, article id e022474Article in journal (Refereed)
    Abstract [en]

    Objectives To compare mortality and socioeconomic status among men invited to a health dialogue with men from all of Sweden approximately 24 years after the start of the study, and to analyse the associations between lifestyle and all-cause mortality, incidence of cardiovascular disease (CVD) and cancer. Design Longitudinal follow-up register study of men 33-42 years old at baseline. Setting Primary care in a community in Sweden. Subjects All 757 men aged 33-42 years old in a community in southern Sweden, and 652 of these men who participated in a health examination between 1985 and 1987. Interventions Health examination, lifestyle-directed health dialogue and group activities in primary care in cooperation with local associations. Primary and secondary outcome measures All-cause mortality, income and educational level, and associations between lifestyle at baseline and all-cause mortality, incidence of CVD and cancer. Results At follow-up, all-cause mortality was 29% lower (OR= 0.71, 95% CI 0.53 to 0.95) among all men invited to the health dialogue compared with all men from the same age cohort in all of Sweden (intention-to-treat) and 43% lower (OR= 0.57, 95% CI 0.40 to 0.81) among participating men (on-treatment). A healthy lifestyle was associated with lower mortality (OR= 0.16, 95% CI 0.07 to 0.36), with the strongest association for no smoking (OR= 0.38, 95% CI 0.21 to 0.68) and a healthy diet (OR= 0.37, 95% CI 0.20 to 0.68). A healthy lifestyle was also associated with a decreased incidence of CVD and cancer. There was a significantly higher proportion with short education among invited men compared with men from the same age cohort in all of Sweden. Conclusions This study indicates that a combination of low-risk and high-risk strategies, combining a health examination with a lifestyle-directed health dialogue conducted in an ordinary primary care setting in cooperation with local associations, may have contributed to reduced premature mortality. However, we cannot exclude that there may be other factors explaining the lower mortality.

  • 237.
    Ljungcrantz, Desireé
    Linköping University, Department of Thematic Studies, The Department of Gender Studies. Linköping University, Faculty of Arts and Sciences.
    Skrubbsår: Berättelser om ur hiv föreställs och erfars i samtida Sverige2017Doctoral thesis, monograph (Other academic)
    Abstract [en]

    This thesis is a transdisciplinary cultural study on the imaginaries and experiences of HIV as a chronic illness in Sweden between 2005 and 2014. HIV narratives are analyzed through a theoretical merging of a queer, vulnerable illness phenomenology and the construction of the feminist figurations: the HIV threshold, abrasion, bandages and sharp small stones. The material is in-depth interviews, auto-fiction, and popular culture representations. In in-depth interviews with people living with HIV and in auto-fictive texts, the thesis explores when and how HIV is becoming palpable in everyday life. An analysis of the ways in which HIV and protagonist with HIV are portrayed in popular culture is undertaken through the reading of HIV narratives: How could she?, Ophelia's journey, My Positive Life and Positive. It is analyzed how the dramaturgic curve and hero narratives are built and how normalization narratives of HIV in these stories risk the (re) construction of normative lines. Normative lines touch repeatedly upon respectability, the desire to be conceived as happy and successful, but also to live a liveable life. The HIV narratives unfolds trough emotions of fear, shame and mononormative melancholia that are like abrasions made from the relational becoming with HIV - generated in the encounter with other people, institutions and cultural imaginaries. These imaginaries, as sharp small stones, rub against ourselves and our bodies. Bandages, as individual strategies, of exposure and distance to the external gaze, are made of and co-constructed with emotions such as relief, pride and anger. Abrasiom offers and discusses performativities of HIV in the everyday life; how we are becoming HIV-positive together with not only other people and institutions, but also in interaction with societal dimensions of shame and control; and how emotions are co-constructing the phenomena of HIV. This thesis also builds on a poetic writing inspired by literary narratology: in particular, the poetic writing style is used in scenes with fictive characters, shaped against the background of interpretations of interviews, as well as in the auto fictive alter-ego narrator Desideria. This thesis closely portrays the relational becoming with HIV.

  • 238.
    Lundeborg Hammarström, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences.
    Manual till LINUS 2.0: LINköpingsUnderSökningen 2.0: Ett fonologiskt bedömningsmaterial för barn från 3 år2019Report (Other academic)
    Abstract [sv]

    När ett barn med misstänkta tal- och språkavvikelser kommer till logoped för bedömning är det viktigt att samtliga aspekter av tal och språk beaktas. Under de år som svensk logopedi har vuxit fram, har ett flertal instrument för bedömning av barns tal- och språk tagits fram. Ett av dessa, Stora fonemtestet, som skapades i mitten av 1980-talet, har länge varit det enda vitt spridda testet av barns fonologi i landet. Testet fanns under flera år inte att beställa på förlag, vilket var ett av motiven till arbetet med att ta fram ett nytt fonologiskt bedömningsmaterial. Ett annat var att Enheten för logopedi vid Linköpings universitet sedan 2010 ingår i en större multicenterstudie med syftet att jämföra fonologiska avvikelser hos barn i olika länder. Inom ramen för detta projekt och genom några magisterarbeten i logopedi färdigställdes LINUS 2014. Som en direkt följd av det fortsatta internationella forskningssamarbetet och av feed-back från kollegor som använt materialet i sin kliniska vardag, kommer nu en ny version av materialet, LINUS 2.0. och finns för gratis nedladdning på http://phonodevelopment.sites.olt.ubc.ca/practice-units/swedish/. Vi hoppas att det även fortsatt skall komma till användning vid utredning av tal- och språkförmåga hos barn.

    Linköpings universitet, 2019

    Inger Lundeborg Hammarström

  • 239.
    Lundell, Marie
    et al.
    Radiumhemmet, Karolinska Hospital, Stockholm.
    Mattsson, Anders
    Radiumhemmet, Karolinska Hospital, Stockholm.
    Karlsson, Per
    Sahlgrenska University Hospital, Gothenburg.
    Holmberg, Erik
    Sahlgrenska University Hospital, Gothenburg.
    Gustafsson, Agnetha
    Sahlgrenska University Hospital, Gothenburg.
    Holm, Lars-Erik
    Swedish Radiation Protection Institute, Solna.
    Breast cancer risk after radiotherapy in infancy: a pooled analysis of two Swedish cohorts of 17,202 infants1999In: Radiation Research, ISSN 0033-7587, E-ISSN 1938-5404, Vol. 151, no 5, p. 626-632Article in journal (Refereed)
    Abstract [en]

    The incidence of breast cancer was studied in a cohort of 17,202 women irradiated for skin hemangioma in infancy at the Radiumhemmet, Stockholm, or the Sahlgrenska University Hospital, Gothenburg. A major part of the cohort had been treated with radium-226 applicators, and the mean absorbed dose to the breasts was 0.29 Gy (range <0.01-35.8 Gy). Two hundred forty-five breast cancers were diagnosed in the cohort during the period 1958-1993, and the standardized incidence ratio (SIR) was 1.20 (95% CI 1.06-1.36). Different dose-response models were tested, and a linear model gave the best fit. Neither age at exposure, breast dose rate, ovarian dose nor time since exposure had any statistically significant modifying effect, and breast dose was the only determinant of risk. The excess relative risk per gray (ERR/Gy) was 0.35 (95% CI 0.18-0.59), which is lower than in most other studies.

  • 240.
    Lundmark, Åse
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Företagshälsovård mot sjukskrivning?: Företagshälsovårdstjänster i förebyggande och rehabiliterande syften i Norrköpings kommun2019Report (Other academic)
    Abstract [sv]

    Denna rapport beskriver resultat från en studie där Norrköpings kommuns användning av företagshälsovårdens tjänster för sjuk- och friskanmälan undersökts. Syftet med rapporten är att beskriva sjukskrivnas erfarenheter av sjukskrivnings- och rehabiliteringsprocessen, med särskilt fokus på av användningen av företagshälsovård och hur detta hänger samman med kontakten med övriga aktörer. Studien bygger på intervjuer med femton deltagare som arbetar inom vård- och omsorgssektorn i Norrköpings kommun som har analyserats genom kvalitativ innehållsanalys.

    Kontakten med företagshälsovården upplevs generellt som positiv, både i relation till sjuk- och friskanmälan och till olika åtgärder som initierats. Deltagarna uppskattar särskilt att kunna prata med en tredje part. Utformningen av avtal med företagshälsovården tycks dock ha betydelse för vilken typ av insatser som kan sättas in. Några problem med tjänsten för sjuk- och friskanmälan lyftes, exempelvis missvisande rubriceringar av sjukfrånvaroorsak, och upplevelser av onödig kontroll.

    Betydelsen av chefens stöd lyfts av samtliga deltagare. En optimal kontakt med chefen karaktäriseras av en aktiv chef som sätter den sjukskrivne medarbetaren i fokus och i samråd med medarbetaren planerar och lägger upp återgången i arbete. Den ambivalenta chefen initierar anpassningar och åtgärder, men detta sker ibland utan involvering av medarbetaren. För sjukskrivna med en mera passiv chef är kontakt med

    företagshälsovården ibland det enda stöd som initierats för att främja återgång till arbete. Resultatet pekar på att chefens roll och stöd vid sjukskrivning och återgång i arbete inte är utbytbart mot insatser från andra aktörer, såsom företagshälsovården. Kontakten med arbetsplatsen är viktig, och sjukskrivna betonar framför allt betydelsen av chefens kontakt, närvaro, och att denne anpassar kontakten utifrån sjukskrivningsorsak. Dialog mellan chef och medarbetare behövs kring hur kontakten med arbetsplatsen på lämpligast sätt bör läggas upp och på så vis anpassas efter den individuella situationen.

    Företagshälsovården kan användas för att stödja arbetsgivaren i arbetet med att förebygga och hantera sjukfrånvaro, och de insatser som erbjuds upplevs ofta som uppskattade och effektiva. Insatserna från företagshälsovården och arbetsgivaren bör dock initieras i samråd med den sjukskrivne för att öka möjligheterna att insatserna upplevs som hjälpsamma och rättvisa.

  • 241.
    Lundqvist, Daniel
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Fogelberg Eriksson, Anna
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Arts and Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Exploring the relationship between managers’ leadership and their health.2012In: WORK: A journal of Prevention, Assessment & Rehabilitation, ISSN 1051-9815, Vol. 42, no 3, p. 419-427Article in journal (Refereed)
    Abstract [en]

    Objective: To explore the relationship between managers' leadership and their health, by investigating what psychosocial conditions in the workplace managers experience as being important to their health, and how their health influences their leadership.

    Participants and methods: Semi-structured interviews with forty-two managers at different managerial levels in a large Swedish industrial production company.

    Results: Most managers felt their health was good, but many perceived their work as stressful. They said it was important to their health that they did a good job and achieved results as expected, that conditions in the workplace enabled this achievement, and that their performance was acknowledged. In comparison to the other managerial levels, the first-line managers' work and health were especially dependent on such enabling conditions. The results also showed that the managers' health influenced their leadership, the quality of their work and the quality of their relationship with subordinates.

    Conclusion: Managers' leadership, health and their work conditions are reciprocally related to each other. A productive and healthy workplace is facilitated by focusing on managers' conditions for leadership, their health and their work conditions.

  • 242.
    Lundqvist, Daniel
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Fogelberg Eriksson, Anna
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Arts and Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    First-line managers’ work conditions as antecedents of transformational leadership2013Manuscript (preprint) (Other academic)
    Abstract [en]

    Transformational leadership is one of the most researched leadership styles of today; nevertheless, surprisingly little attention has been paid to its antecedents. In this study, questionnaire data from 322 first-line managers and 3001 of their subordinates were used to investigate the association between first-line managers’ self-rated work conditions and their displayed transformational leadership, as rated by their subordinates; also, whether superiors’ leadership is associated with first-line managers’ displayed transformational leadership. The results showed that performance feedback, skill discretion, and social capital were positively associated with first-line managers’ transformational leadership, whereas role conflict and span of control were negatively associated with transformational leadership. No  association was found between superiors’ leadership and transformational leadership. These results suggest that changes in leaders’ work situation might facilitate an increased display of transformational leadership behaviours.

  • 243.
    Lundqvist, Daniel
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Fogelberg Eriksson, Anna
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Arts and Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Managers’ Social Support may both Reinforce and Undermine their Legitimacy2013Manuscript (preprint) (Other academic)
    Abstract [en]

    This study investigates managers’ social support, and whether managers perceive that receiving social support affects their managerial legitimacy. The material consists of 62 interviews with managers in two organizations. The results show that in order to preserve their legitimacy, managers seek support from different people, and in various distinct arenas, based on the types of support these sources provide. Work-related support, which strengthens the managers’ legitimacy, was sought from sources within the workplace. Sensitive and personal support, where there is a risk of jeopardizing their legitimacy, was sought from sources outside the workplace. The results also show that participation in various arenas in order to receive support meant that demands were placed on the managers, and this could increase their stress and strain. Social support has the potential to both reinforce and undermine managers’ perceived legitimacy.

  • 244.
    Lundqvist, Johan
    et al.
    SLU, Uppsala.
    Andersson, Anna
    Linköping University, Department of Thematic Studies, Tema Environmental Change. Linköping University, Faculty of Arts and Sciences.
    Johannisson, Anders
    SLU, Uppsala, Sweden.
    Lavonen, Elin
    Norrvatten, Solna.
    Mandava, Geeta
    SLU, Uppsala.
    Kylin, Henrik
    Linköping University, Department of Thematic Studies, Tema Environmental Change. Linköping University, Faculty of Arts and Sciences.
    Bastviken, David
    Linköping University, Department of Thematic Studies, Tema Environmental Change. Linköping University, Faculty of Arts and Sciences.
    Oskarsson, Agneta
    SLU, Uppsala.
    Innovative drinking water treatment techniques reduce the disinfection-induced oxidative stress and genotoxic activity2019In: Water Research, ISSN 0043-1354, E-ISSN 1879-2448, Vol. 5, p. 182-192Article in journal (Refereed)
    Abstract [en]

    Disinfection of drinking water using chlorine can lead to the formation of genotoxic by-products whenchlorine reacts with natural organic matter (NOM). A vast number of such disinfection by-products(DBPs) have been identified, making it almost impossible to routinely monitor all DBPs with chemicalanalysis. In this study, a bioanalytical approach was used, measuring oxidative stress (Nrf2 activity),genotoxicity (micronucleus test), and aryl hydrocarbon receptor (AhR) activation to evaluate an innovativewater treatment process, including suspended ion exchange, ozonation, in-line coagulation,ceramic microfiltration, and granular activated carbon. Chlorination was performed in laboratory scaleafter each step in the treatment process in order to investigate the effect of each treatment process to theformation of DBPs. Suspended ion exchange had a high capacity to remove dissolved organic carbon(DOC) and to decrease UV absorbance and Nrf2 activity in non-chlorinated water. High-dose chlorination(10 mg Cl2 L-1) of raw water caused a drastic induction of Nrf2 activity, which was decreased by 70% inwater chlorinated after suspended ion exchange. Further reduction of Nrf2 activity following chlorinationwas achieved by ozonation and the concomitant treatment steps. The ozonation treatment resulted indecreased Nrf2 activity in spite of unchanged DOC levels. However, a strong correlation was found betweenUV absorbing compounds and Nrf2 activity, demonstrating that Nrf2 inducing DBPs were formedfrom pre-cursors of a specific NOM fraction, constituted of mainly aromatic compounds. Moreover, highdosechlorination of raw water induced genotoxicity. In similarity to the DOC levels, UV absorbance andNrf2 activity, the disinfection-induced genotoxicity was also reduced by each treatment step of theinnovative water treatment technique. AhR activity was observed in the water produced by the conventionalprocess and in the raw water, but the activity was clearly decreased by the ozonation step inthe innovative water treatment process.

  • 245.
    Lundström, Catrin
    Uppsala universitet, Sociologiska institutionen.
    Hur lyckas man med mångkulturellt folkhälsoarbete?: Hälso- och sjukvård för invandrare: Erfarenheter från ett EU-samarbete2003In: Folkhälsostämman, Stockholm, 2003Conference paper (Other academic)
  • 246.
    Lundåsen, Susanne
    Enheten för forskning om det civila samhället, Ersta Sköndal högskola, Stockholm, Sweden.
    Frivilliga insatser och hälsa2005Book (Other academic)
    Abstract [sv]

    I den genomförda undersökningen har samband mellan hälsa och frivilligt arbete kunnat konstateras. Det är dock, som alltid, svårt att utröna riktningen på sambanden med tvärsnittsstudier. Den teoretiska förklaringen till sambandet mellan frivilliga insatser och hälsa skulle i detta fall gå via det sociala kapitalet som antas vara större hos dem som arbetar frivilligt eller har tillgång till andra typer av informella ideellt baserade nätverk, och att det sociala kapitalet i sin tur påverkar hälsan positivt. De som är frivilligt aktiva har i den genomförda studien i genomsnitt bättre hälsa än de som inte är frivilligt aktiva. Skillnaderna i självskattad hälsa mellan frivilligt aktiva och icke aktiva kan inte förklaras enbart med socioekonomiska skillnader, eftersom frivilligt arbete kvarstår som signifikant i en regressionsmodell där även socioekonomiska faktorer ingår. Andra faktorer som kan kopplas till socialt kapital (såsom tillit) har också en statistiskt signifikant och positiv effekt på den självskattade hälsan. Men bilden av skillnaderna mellan frivilligt aktiva och icke frivilligt aktiva blir något mer komplex om man delar upp dem i mindre grupper.

    Inom gruppen frivilligt aktiva finns det skillnader, där bland andra äldre aktiva har större positiva skillnader i självskattad hälsa än vad yngre har. Bland de yngre finns det inga statistiskt signifikanta skillnader i självskattad hälsa mellan aktiva och icke aktiva. Det finns större hälsoskillnader mellan frivilligt arbetande och icke frivilligt arbetande kvinnor än mellan frivilligt arbetande och icke frivilligt arbetande män. De frivilligt aktiva kvinnorna har i genomsnitt mindre värk i axlar, nacke, rygg, händer, armbågar, ben och knän, medan de frivilligt aktiva männen i vissa fall har mer besvär än vad de icke frivilligt aktiva männen har. En stor del av den generella hälsoskillnaden mellan dem som arbetar frivilligt och dem som inte gör det skulle kunna härledas till de frivilligt arbetande kvinnornas bättre hälsa. Dessa kvinnor har en markant högre utbildningsnivå än de kvinnor som inte arbetar frivilligt, och den är även markant högre än vad genomsnittet bland de frivilligt arbetande männen är. Den högre utbildningsnivån skulle delvis kunna förklara hälsoskillnaderna mellan de frivilligt arbetande kvinnorna och de frivilligt arbetande männen.

    De som är frivilligt aktiva är ofta även aktiva på andra plan, exempelvis genom informella hjälpinsatser för vänner och släktingar som är mer eller mindre omfattande. Även här finns det könsskillnader – kvinnor lägger i genomsnitt ned betydligt mer tid på informellt hjälparbete än vad männen gör. Det finns dock undantag: bland dem som gör betydande informella hjälpinsatser är det vissa som har en sämre hälsa än de övriga aktiva. De som gör de allra största informella hjälpinsatserna, i detta fall för personer med särskilda omsorgsbehov i det egna hushållet, har en i genomsnitt väsentligt sämre självskattad hälsa än de övriga. Denna grupp har antagligen också en mer begränsad möjlighet att engagera sig i aktiviteter utanför det egna hushållet.

    Studien har även berört deltagandet i ideellt baserade nätverk och finner att den självskattade hälsan och den psykiska hälsan i genomsnitt är bättre hos dem som deltar i flertalet ideellt baserade nätverk.

    Teorierna om det sociala kapitalets betydelse finner delvis stöd i denna studie då sambanden mellan de olika formerna av frivilliga insatser och hälsan generellt sett är positiva, vilket var det som hypotetiskt kunde förväntas. Orsakerna till att människor står utanför det organiserade frivilliga arbetet och andra typer av ideella nätverk är antagligen många och de olika faktorernas betydelse för hälsan torde kunna utgöra föremål för en annan studie.

  • 247.
    Lyth, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Regional Cancer Center South East Sweden.
    Clinical-epidemiological studies on cutaneous malignant melanoma: A register approach2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The incidence of cutaneous malignant melanoma (CMM) is steadily increasing. Most of the patients have thin CMM with a good prognosis and a 5-year survival of about 90%. The prognosis is highly related to tumour thickness and clinical stage at diagnosis. Effective systemic treatment for patients with metastatic disease has only recently been available. This thesis aims to increase knowledge of trends in tumour thickness, prognostic factors, socioeconomic differences and medical costs in patients with CMM.

    The population-based Swedish melanoma register is the main source of data in all papers in the thesis. Papers I-III include patients from all of Sweden while paper IV is delimited to the County of Östergötland. Cox regression and logistic regression are the main multivariable methods used. Paper IV is focused on stage-specific costs of CMM by comparing direct healthcare costs to a general population.

    For men, there has been a shift over time towards thinner tumours at diagnosis accompanied by an improved survival. Women are still diagnosed with considerably thinner tumours and they experience a better survival than men. Tumour ulceration, tumour thickness and Clark’s level of invasion all showed significant independent long-term prognostic information in T1 CMMs. By combining these factors, three distinct prognostic subgroups were identified. Lower level of education was associated with reduced CMM-specific survival, which may at least partially be attributed to a more advanced stage at diagnosis. The direct healthcare costs for CMM patients were significantly higher than for the general population, independent of clinical stage. CMM patients diagnosed in clinical stage III-IV were associated with particularly high costs.

    Even though the survival among Swedish patients with CMM is among the highest in the world and still seems to improve, the results of this thesis emphasise the need of improved early detection strategies. This may be of particular concern in men, older women, and groups with a low level of education. The results also imply that the costs for the management of CMM patients may be reduced if early detection efforts are successful and lead to a more favourable stage distribution. The finding of a better risk stratification of thin CMMs may help to improve the management of this large patient group.

    List of papers
    1. Trends in cutaneous malignant melanoma in Sweden 1997-2011: Thinner tumours and improved survival among men
    Open this publication in new window or tab >>Trends in cutaneous malignant melanoma in Sweden 1997-2011: Thinner tumours and improved survival among men
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    2015 (English)In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 172, no 3, p. 700-706Article in journal (Refereed) Published
    Abstract [en]

    Background: Both patient survival and the proportion of patients diagnosed with thin cutaneous malignant melanoma (CMM) have been steadily rising in Sweden as in most western countries, though the rate of improvement in survival appears to have declined in Sweden at the end of last millennium.

    Objectives: To analyse the most recent trends in the distribution of tumour thickness (T-category) as well as CMM-specific survival in Swedish patients diagnosed 1997-2011.

    Methods: This nationwide population-based study included 30 590 patients registered in the Swedish Melanoma Register (SMR) and diagnosed with a first primary invasive CMM 1997-2011. The patients were followed through 2012 in the national Cause-of-Death Register.

    Results: Logistic and Cox regression analyses adjusting for age at diagnosis, tumour site, and health care region were carried out. The odds ratio for being diagnosed with thicker tumours was significantly reduced (P = 0·0008) and the CMM-specific survival significantly improved in men diagnosed 2007-2011 compared to men diagnosed 1997-2001 (hazard ratio=0·81; 95% CI 0·72-0·91, P = 0·0009) while the corresponding differences for women were not significant. Women were diagnosed with significantly thicker tumours during 2002-2006 and a tendency towards decreased survival was observed compared to those diagnosed earlier 1997-2001 and later 2007-2011.

    Conclusion: In Sweden, the CMMs of men are detected earlier over time and this seems to be followed by an improved CMM-specific survival for men. Women are still diagnosed with considerably thinner tumours and they experience a better survival than men.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2015
    Keywords
    malignant melanoma, time trend, survival, tumour thickness, population based
    National Category
    Dermatology and Venereal Diseases
    Identifiers
    urn:nbn:se:liu:diva-113143 (URN)10.1111/bjd.13483 (DOI)000351400500029 ()25323770 (PubMedID)
    Available from: 2015-01-12 Created: 2015-01-12 Last updated: 2017-12-05Bibliographically approved
    2. Prognostic subclassifications of T1 cutaneous melanomas based on ulceration, tumour thickness and Clark’s level of invasion: results of a population-based study from the Swedish Melanoma Register
    Open this publication in new window or tab >>Prognostic subclassifications of T1 cutaneous melanomas based on ulceration, tumour thickness and Clark’s level of invasion: results of a population-based study from the Swedish Melanoma Register
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    2013 (English)In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 168, no 4, p. 779-786Article in journal (Refereed) Published
    Abstract [en]

    Background  Survival and prognostic factors for thin melanomas have been studied relatively little in population-based settings. This patient group accounts for the majority of melanomas diagnosed in western countries today, and better prognostic information is needed.

    Objectives  The aim of this study was to use established prognostic factors such as ulceration, tumour thickness and Clark’s level of invasion for risk stratification of T1 cutaneous melanoma.

    Methods  From 1990 to 2008, the Swedish Melanoma Register included 97% of all melanomas diagnosed in Sweden. Altogether, 13 026 patients with T1 melanomas in clinical stage I were used for estimating melanoma-specific 10- and 15-year mortality rates. The Cox regression model was used for further survival analysis on 11 165 patients with complete data.

    Results  Ulceration, tumour thickness and Clark’s level of invasion all showed significant, independent, long-term prognostic information. By combining these factors the patients could be subdivided into three risk groups: a low-risk group (67·9% of T1 cases) with a 10-year melanoma-specific mortality rate of 1·5% (1·2–1·9%); an intermediate-risk group (28·6% of T1 cases) with a 10-year mortality rate of 6·1% (5·0–7·3%); and a high-risk group (3·5% of T1 cases) with a 10-year mortality rate of 15·6% (11·2–21·4%). The high- and intermediate-risk groups accounted for 66% of melanoma deaths within T1.

    Conclusions  Using a population-based melanoma register, and combining ulceration, tumour thickness and Clark’s level of invasion, three distinct prognostic subgroups were identified.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2013
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-92611 (URN)10.1111/bjd.12095 (DOI)000317016100030 ()23066913 (PubMedID)
    Note

    Funding Agencies|regional cancer centre Southeast in Linkoping||

    Available from: 2013-05-16 Created: 2013-05-14 Last updated: 2017-12-06
    3. Low level of education is associated with later stage at diagnosis and reduced survival in cutaneous malignant melanoma: A nationwide population-based study in Sweden
    Open this publication in new window or tab >>Low level of education is associated with later stage at diagnosis and reduced survival in cutaneous malignant melanoma: A nationwide population-based study in Sweden
    Show others...
    2013 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 49, no 12, p. 2705-2716Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND:

    A worse outcome has been reported for cutaneous malignant melanoma (CMM) patients with low socioeconomic status. We have investigated the association between level of education, clinical stage at diagnosis (stage at diagnosis) and CMM-specific survival in Sweden.

    METHODS:

    We identified 27,235 patients from the Swedish Melanoma Register diagnosed with a primary invasive CMM between 1990 and 2007 and linked data to nationwide, population-based, health and census registers with a follow-up to 2010.

    RESULTS:

    The odds ratio (OR) of higher disease stage at diagnosis was significantly increased in lower education groups (OR stage II versus I=1.6; 95% confidence interval (CI)=1.5-1.7. OR stage III-IV versus I=2.3; 95% CI=1.8-2.9). The risk of dying of CMM, was significantly increased in patients with low (hazard ratio (HR) low versus high=2.02; 95% CI=1.80-2.26; p<0.0001) and intermediate (HR intermediate versus high=1.35; 95% CI=1.20-1.51; p<0.0001) level of education. After adjustment for age, gender, stage at diagnosis and other known prognostic factors, the HRs remained significant for low versus high (HR=1.13; 95% CI=1.01-1.27; p=0.04) but not for intermediate versus high (HR=1.11; 95% CI=0.99-1.24; p=0.08) education. The HR associated with low level of education was significantly higher among female patients, patients <55years, patients with truncal tumours and during the first 5years after diagnosis.

    CONCLUSION:

    Lower level of education is associated with reduced CMM-specific survival, which may at least partially be attributed to a more advanced stage at diagnosis. These results emphasise the need for improved early detection strategies.

    Place, publisher, year, edition, pages
    Elsevier, 2013
    Keywords
    Melanoma, Survival, Socioeconomic status, Level of education, Stage at diagnosis, Population-based
    National Category
    Medical and Health Sciences Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-95938 (URN)10.1016/j.ejca.2013.03.013 (DOI)000321336800010 ()23583439 (PubMedID)
    Note

    Funding Agencies|Swedish Cancer Society||Radiumhemmet Research Funds||Sigurd and Elsa Goljes Memorial Foundation||Stockholm County Council||

    Available from: 2013-08-19 Created: 2013-08-12 Last updated: 2017-12-06Bibliographically approved
    4. Stage-specific direct healthcare costs in patients with cutaneous malignant melanoma
    Open this publication in new window or tab >>Stage-specific direct healthcare costs in patients with cutaneous malignant melanoma
    2016 (English)In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 30, no 5, p. 789-793Article in journal (Refereed) Published
    Abstract [en]

    Background Clinical stage at diagnosis is a strong prognostic factor for death in cutaneous malignant melanoma (CMM), with worse prognosis at higher stages. However, few studies have investigated how direct healthcare cost per patient varies with clinical stage.

    Objective The aim of this study was to determine the stage-specific direct healthcare costs for CMM patients compared to the healthcare costs in the general population in the County of Östergötland, Sweden.

    Methods CMM patients in the County of Östergötland diagnosed 2005-2012 were identified from the Swedish cancer registry. Information on clinical stage was collected from the Swedish Melanoma Register (SMR) and cost data from the Cost per Patient database (CPP) for 1 075 CMM patients in Östergötland. CPP contains costs associated with all healthcare contacts per patient including inpatient, outpatient, and primary care. The CMM-related costs were defined as the difference in mean healthcare costs between CMM patients and general population.

    Results The first year after CMM diagnosis, the average healthcare costs for CMM patients was 2.8 times higher than in the general population. The healthcare cost ratio varied from 2.0 (stage I) to 10.1 (stage IV) and the CMM-related costs per patient-year varied from €2 670 (stage I) to €29 291 (stage IV). The mean healthcare costs decreased over time but remained significantly higher than in the general population for all clinical stages. During the first year after diagnosis, patients in clinical stage III-IV (7% of CMM patients) accounted for 27% of the total CMM-related healthcare costs.

    Conclusions The direct healthcare costs for CMM patients were significantly higher than in the general population independent of clinical stage. CMM patients diagnosed in clinical stage III-IV were associated with particularly high costs and the healthcare system may save resources by finding CMM patients in earlier stages.

    National Category
    Dermatology and Venereal Diseases
    Identifiers
    urn:nbn:se:liu:diva-113144 (URN)10.1111/jdv.13110 (DOI)000374554200007 ()
    Note

    Funding agencies:Regional cancer center South East in Linkoping

    Vid tiden för disputation förelåg publikationen som manuskript

    Available from: 2015-01-12 Created: 2015-01-12 Last updated: 2017-05-03
  • 248.
    Mahrs Träff, Annsofie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Cedersund, Elisabet
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Abramsson, Marianne
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Fysisk aktivitet för äldre på särskilda boenden: Om inställningar och handlande i svensk äldreomsorg2018In: Journal of Care Research, ISSN 2387-5976, E-ISSN 2387-5984, Vol. 4, no 2, p. 165-176Article in journal (Refereed)
    Abstract [en]

    Physical activity is described in the literature as positive and important, and has come into focus in recent years. An activity-based theoretical approach dominates in Swedish eldercare, and there are also international recommendations on physical activity for older people. Nevertheless, few studies have explored how the need for physical activity is satisfied at assisted living facilities.

    The aim of this study was to investigate how professionals working in eldercare think about and act to promote physical activities for elderly people. The empirical data consists of observations and interviews conducted at four assisted living facilities in two different Swedish municipalities.

    The results show how cultures and norms are important for how professionals think and act regarding physical activity. There is a contradiction between how professionals discuss elderly people’s need for support for physical activity and how they act in their day-to-day work. There seems to be an acceptance that elderly people’s individual needs cannot be met if professionals have other tasks to perform.

  • 249.
    Mahrs Träff, Annsofie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Cedersund, Elisabet
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Larsson, Ann-Christine
    The Research and Development Unit for Eastern Östergötland, Norrköping, Sweden.
    Abramsson, Marianne
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Approaches to physical activity at assisted living facilities: from the perspective of older people and physiotherapists2018In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Aim: Physical activity has been described as important for the well-being of all individuals, including the very old. The aim of this study was to investigate how physical activity is performed at assisted living facilities, the situations in which older people were and wanted to be physically active and the role of the physiotherapist at each facility.

    Methods: To achieve this aim, an ethnographic study including observations and interviews was conducted at four assisted living facilities.

    Results: The results show that physical activity neither was an issue in focus at any of the assisted living facilities, nor were recommendations on physical activity followed. Individuals that were able to exercise themselves could do so, whereas those in need of assistance had but limited possibilities to be physically active. There was a need for physical activity that the staff do not necessarily and sufficiently identify.

    Conclusion: The study illustrated that there were major variations in how older people engaged in physical activity and how physical activities were part of everyday life. Physiotherapists played no clear role at the facilities, especially with regard to preventive exercise. Older individuals were not involved in determining which activities should be made available to the residents.

  • 250.
    Mahrs-Träff, Annsofie
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    ”Fysisk aktivitet –att röra sig och må väl.” Villkor och dilemman för äldres fysiskaaktivitet: En observations- och intervjustudie2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Physical activity is described as being positive for both physical and mental health and for people of all ages. A daily level and amount of physical activity has been recommended for older people. There are also specific recommendations for people living in assisted living facilities.

    The purpose of this dissertation is to illustrate different aspects of physical activity in assisted living facilities in relation to the people living, and the people working, in assisted living facilities. Previous research shows the importance of being physically active and the risk of passivity when people move to assisted living facilities. It is therefore important to examine the conditions of physical activity in the particular environment that the assisted living facilities consist of.

    An ethnographic method has been used for which observations, interviews and information brochures constitute the empirical material.

    The results show that older people and staff do not always define the concept of physical activity in the same way, and what is meant by the term is perceived differently. The cultures and norms for how staff think about physical activity is of great importance. There is an acceptance that the older person’s individual wishes cannot be met. Physiotherapists appear to have no clear role in the assisted living facilities, in particular in regard to preventive physical activity. The national recommendations for physical activity are rarely used and are not achieved. The physical environment is important and can promote or prevent physical activity. There are a number of factors that can be perceived as promoting or limiting the individual’s ability to be physically active. In some cases, the physical factors can influence a limiting factor to change and to become a promoting factor. There is a difference between the extent of physical activity in assisted living facilities which have dedicated premises for this purpose, compared to facilities where such premises are lacking.

    List of papers
    1. Perceptions of physical activity among elderly residents and professionals in assisted living facilities
    Open this publication in new window or tab >>Perceptions of physical activity among elderly residents and professionals in assisted living facilities
    2017 (English)In: European Review of Aging and Physical Activity, ISSN 1813-7253, E-ISSN 1861-6909, Vol. 14, article id 2Article in journal (Refereed) Published
    Abstract [en]

    Physical activity is often described as being important for people of all ages, but what different people mean when they talk about physical activity is unclear. A phenomenographic method was used to analyze how 13 older people and 17 professionals answer the question, "If I say physical activity, what does the concept mean to you?" as part of semi-structured interviews conducted in four assisted living facilities in two different municipalities. We identified a number of different perceptions of physical activity, with the older people and professionals having different responses. Elderly and professionals alike, define physical activity as a requirement for life and as an opportunity to maintain the body although they define the concepts in different ways. Elderly define the concept as a way to create meaning and the professionals have the attitude that the concept means everyday activities. The concept of physical activity may be defined in many different ways. This study has shown that elderly and professionals do not define physical activity in the same way. Therefore, professionals need to be aware of these differences when talking with elderly about individual needs in everyday life.

    Place, publisher, year, edition, pages
    SPRINGER HEIDELBERG, 2017
    Keywords
    Older people; Residential care; Qualitative interviews; Phenomenography; Variation of perceptions; Descriptive categories
    National Category
    Social Work
    Identifiers
    urn:nbn:se:liu:diva-135717 (URN)10.1186/s11556-017-0171-9 (DOI)000394341900001 ()28203305 (PubMedID)
    Available from: 2017-03-17 Created: 2017-03-17 Last updated: 2018-09-11
    2. Approaches to physical activity at assisted living facilities: from the perspective of older people and physiotherapists
    Open this publication in new window or tab >>Approaches to physical activity at assisted living facilities: from the perspective of older people and physiotherapists
    2018 (English)In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, p. 1-8Article in journal (Refereed) Epub ahead of print
    Abstract [en]

    Aim: Physical activity has been described as important for the well-being of all individuals, including the very old. The aim of this study was to investigate how physical activity is performed at assisted living facilities, the situations in which older people were and wanted to be physically active and the role of the physiotherapist at each facility.

    Methods: To achieve this aim, an ethnographic study including observations and interviews was conducted at four assisted living facilities.

    Results: The results show that physical activity neither was an issue in focus at any of the assisted living facilities, nor were recommendations on physical activity followed. Individuals that were able to exercise themselves could do so, whereas those in need of assistance had but limited possibilities to be physically active. There was a need for physical activity that the staff do not necessarily and sufficiently identify.

    Conclusion: The study illustrated that there were major variations in how older people engaged in physical activity and how physical activities were part of everyday life. Physiotherapists played no clear role at the facilities, especially with regard to preventive exercise. Older individuals were not involved in determining which activities should be made available to the residents.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2018
    Keywords
    Physiotherapy, participation, elderly care, ethnography, observations, interviews
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Physiotherapy Social Sciences Interdisciplinary
    Identifiers
    urn:nbn:se:liu:diva-151021 (URN)10.1080/21679169.2018.1465120 (DOI)2-s2.0-85046025809 (Scopus ID)
    Available from: 2018-09-11 Created: 2018-09-11 Last updated: 2018-09-13Bibliographically approved
    3. Fysisk aktivitet för äldre på särskilda boenden: Om inställningar och handlande i svensk äldreomsorg
    Open this publication in new window or tab >>Fysisk aktivitet för äldre på särskilda boenden: Om inställningar och handlande i svensk äldreomsorg
    2018 (Swedish)In: Journal of Care Research, ISSN 2387-5976, E-ISSN 2387-5984, Vol. 4, no 2, p. 165-176Article in journal (Refereed) Published
    Abstract [sv]

    Fysisk aktivitet för äldre beskrivs i litteraturen som något positivt och viktigt och har kommit i fokus under senare år. I svensk äldreomsorg dominerar ett aktivitetsteoretiskt synsätt och det finns även internationella rekommendationer om fysisk aktivitet för äldre. Få studier har dock undersökt hur behovet av fysisk aktivitet tillfredsställs i det särskilda boendet.

    Syftet med denna studie var att undersöka hur äldreomsorgens personal tänker och agerar när det gäller fysisk aktivitet för äldre. Det empiriska materialet består av observationer och intervjuer på fyra särskilda boenden i två olika svenska kommuner.

    Resultaten visar betydelsen av rådande kulturer och normer för hur personalen tänker och agerar kring fysisk aktivitet. Det finns en motsättning mellan hur personalen diskuterar äldres önskemål om stöd för fysisk aktivitet och hur hänsyn tas till fysisk aktivitet i det dagliga arbetet. Denna motsättning visar sig genom att personalen beskriver vikten av fysisk aktivitet för de äldre personerna samtidigt som denna prioriteras bort till förmån för andra arbetsuppgifter. Det förefaller ha skapats en acceptans för att äldres individuella önskemål inte kan tillgodoses om personalen har andra uppgifter att utföra.

    Abstract [en]

    Physical activity is described in the literature as positive and important, and has come into focus in recent years. An activity-based theoretical approach dominates in Swedish eldercare, and there are also international recommendations on physical activity for older people. Nevertheless, few studies have explored how the need for physical activity is satisfied at assisted living facilities.

    The aim of this study was to investigate how professionals working in eldercare think about and act to promote physical activities for elderly people. The empirical data consists of observations and interviews conducted at four assisted living facilities in two different Swedish municipalities.

    The results show how cultures and norms are important for how professionals think and act regarding physical activity. There is a contradiction between how professionals discuss elderly people’s need for support for physical activity and how they act in their day-to-day work. There seems to be an acceptance that elderly people’s individual needs cannot be met if professionals have other tasks to perform.

    Place, publisher, year, edition, pages
    Universitetsforlaget, 2018
    Keywords
    Professional role, older people’s requests, routines, norms, Professional role, older people’s requests, routines, norms, Personalens roll, äldres önskemål, rutiner, normsystem
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Social Sciences Interdisciplinary
    Identifiers
    urn:nbn:se:liu:diva-151022 (URN)10.18261/issn.2387-5984-2018-02-12 (DOI)
    Available from: 2018-09-11 Created: 2018-09-11 Last updated: 2018-09-14Bibliographically approved
2345678 201 - 250 of 446
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