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  • 251.
    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.

  • 252.
    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
  • 253.
    Malmström, Annika
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences.
    Studies for Better Treatment of Patients with Glioma2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In Sweden annually over 500 people will be diagnosed with the malignant brain tumor glioma. They are graded from I-IV. The majority are glioblastoma (grade IV) (GBM), these being the most aggressive type. Median survival for those treated with standard of care is expected to be around 15 months. This tumor will mainly affect those 60 years or older.

    The studies in this thesis focus on treatment of patients with malignant gliomas grade III and IV. The aim of the studies is to improve the care of glioma patients. Papers I and II explored different therapeutic options in randomized trials, to facilitate individualized treatment recommendations. Findings from studies I and II, together with additional trials, demonstrated the importance of analyzing the tumor marker O6-methylguanine DNA methyltransferase (MGMT) methylation status for survival of GBM patients treated with Temozolomide (TMZ). The third paper investigated how the analysis of this marker is implemented internationally.

    The first study (paper I, Nordic trial) investigated treatment options for patients 60 years or older with GBM. The trial compared standard radiotherapy (SRT) over 6 weeks versus hypofractionated radiotherapy (HRT) over 2 weeks versus single agent TMZ administered in up to six 4 weekly cycles. In all, 342 patients were included in the trial. This study demonstrated that those randomized to TMZ had superior survival as compared to SRT. In addition, quality of life (QoL) data also suggested a better QoL for TMZ treatment than for radiotherapy. The benefit of TMZ treatment seemed to be limited to those with the tumor molecular marker MGMT methylated (inactivated).

    The second trial (paper II, Neoadjuvant trial) studied whether integrating TMZ treatment with SRT for patients younger than 60 years with GBM (grade IV) and astrocytoma grade III would confer a survival benefit, if administered postoperatively, before the start of SRT (neoadjuvant). TMZ was provided for 2-3 four weekly cycles followed by SRT to patients randomized to neoadjuvant treatment and was compared to postoperative SRT alone. Although this trial could not illustrate any advantage of delaying the start of SRT while administering TMZ for the study cohort in general, for those included as astrocytoma grade III the median survival was found to be superior by 5 years when randomized to neoadjuvant TMZ. This trial also confirmed the importance of MGMT promoter methylation for the efficacy of TMZ.

    The third study (paper III) investigated international practices for analyzing tumor MGMT promoter methylation status. MGMT analysis can be conducted by various laboratory methods, which in some cases can provide opposing results regarding the MGMT methylation status of the patient´s tumor. This can lead to incorrect treatment recommendations. To establish which methods and cut-offs that are regularly used to determine tumor MGMT status in the clinic, an international survey was provided to those working in the field. We also inquired about opinions regarding an international consensus on how MGMT should be tested. The 152 respondents reported several methodologies and different cut-off levels also for the same method. A majority of respondents warrant international guidelines.

    In conclusion, the results of the 2 randomized trials contribute to individualized treatment recommendations for patients affected by GBM or astrocytoma grade III. The results of the survey regarding analyses of MGMT clarify the current problematic situation. The request of the respondents regarding international guidelines might contribute to their future development, so that personalized treatment recommendations can be improved.

    List of papers
    1. Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial
    Open this publication in new window or tab >>Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial
    Show others...
    2012 (English)In: The Lancet Oncology, ISSN 1470-2045, E-ISSN 1474-5488, Vol. 13, no 9, p. 916-926Article in journal (Refereed) Published
    Abstract [en]

    Background Most patients with glioblastoma are older than 60 years, but treatment guidelines are based on trials in patients aged only up to 70 years. We did a randomised trial to assess the optimum palliative treatment in patients aged 60 years and older with glioblastoma. less thanbrgreater than less thanbrgreater thanMethods Patients with newly diagnosed glioblastoma were recruited from Austria, Denmark, France, Norway, Sweden, Switzerland, and Turkey. They were assigned by a computer-generated randomisation schedule, stratified by centre, to receive temozolomide (200 mg/m(2) on days 1-5 of every 28 days for up to six cycles), hypofractionated radiotherapy (34.0 Gy administered in 3.4 Gy fractions over 2 weeks), or standard radiotherapy (60.0 Gy administered in 2.0 Gy fractions over 6 weeks). Patients and study staff were aware of treatment assignment. The primary endpoint was overall survival. Analyses were done by intention to treat. This trial is registered, number ISRCTN81470623. less thanbrgreater than less thanbrgreater thanFindings 342 patients were enrolled, of whom 291 were randomised across three treatment groups (temozolomide n=93, hypofractionated radiotherapy n=98, standard radiotherapy n=100) and 51 of whom were randomised across only two groups (temozolomide n=26, hypofractionated radiotherapy n=25). In the three-group randomisation, in comparison with standard radiotherapy, median overall survival was significantly longer with temozolomide (8.3 months [95% CI 7.1-9.5; n=93] vs 6.0 months [95% CI 5.1-6.8; n=100], hazard ratio [HR] 0.70; 95% CI 0.52-0.93, p=0.01), but not with hypofractionated radiotherapy (7.5 months [6.5-8.6; n=98], HR 0.85 [0.64-1.12], p=0.24). For all patients who received temozolomide or hypofractionated radiotherapy (n=242) overall survival was similar (8.4 months [7.3-9.4; n=119] vs 7.4 months [6.4-8.4; n=123]; HR 0.82, 95% CI 0.63-1.06; p=0.12). For age older than 70 years, survival was better with temozolomide and with hypofractionated radiotherapy than with standard radiotherapy (HR for temozolomide vs standard radiotherapy 0.35 [0.21-0.56], pandlt;0.0001; HR for hypofractionated vs standard radiotherapy 0.59 [95% CI 0.37-0.93], p=0.02). Patients treated with temozolomide who had tumour MGMT promoter methylation had significantly longer survival than those without MGMT promoter methylation (9.7 months [95% CI 8.0-11.4] vs 6.8 months [5.9-7.7]; HR 0.56 [95% CI 0.34-0.93], p=0.02), but no difference was noted between those with methylated and unmethylated MGMT promoter treated with radiotherapy (HR 0.97 [95% CI 0.69-1.38]; p=0.81). As expected, the most common grade 3-4 adverse events in the temozolomide group were neutropenia (n=12) and thrombocytopenia (n=18). Grade 3-5 infections in all randomisation groups were reported in 18 patients. Two patients had fatal infections (one in the temozolomide group and one in the standard radiotherapy group) and one in the temozolomide group with grade 2 thrombocytopenia died from complications after surgery for a gastrointestinal bleed. less thanbrgreater than less thanbrgreater thanInterpretation Standard radiotherapy was associated with poor outcomes, especially in patients older than 70 years. Both temozolomide and hypofractionated radiotherapy should be considered as standard treatment options in elderly patients with glioblastoma. MGMT promoter methylation status might be a useful predictive marker for benefit from temozolomide.

    Place, publisher, year, edition, pages
    Elsevier, 2012
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-84333 (URN)10.1016/S1470-2045(12)70265-6 (DOI)000308425600019 ()
    Note

    Funding Agencies|Merck||Lions Cancer Research Foundation||University of Umea||Swedish Cancer Society||Schering-Plough||University of Umea, Sweden||Cancer Fonden, Sweden||

    Available from: 2012-10-05 Created: 2012-10-05 Last updated: 2019-11-06
    2. Postoperative neoadjuvant temozolomide before radiotherapy versus standard radiotherapy in patients 60 years or younger with anaplastic astrocytoma or glioblastoma: a randomized trial
    Open this publication in new window or tab >>Postoperative neoadjuvant temozolomide before radiotherapy versus standard radiotherapy in patients 60 years or younger with anaplastic astrocytoma or glioblastoma: a randomized trial
    Show others...
    2017 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 56, no 12, p. 1776-1785Article in journal (Refereed) Published
    Abstract [en]

    Introduction: A pilot study of temozolomide (TMZ) given before radiotherapy (RT) for anaplastic astrocytoma (AA) and glioblastoma (GBM) resulted in prolonged survival compared to historical controls receiving RT alone. We therefore investigated neoadjuvant TMZ (NeoTMZ) in a randomized trial. During enrollment, concomitant and adjuvant radio-chemotherapy with TMZ became standard treatment. The trial was amended to include concurrent TMZ.Patients and methods: Patients, after surgery for GBM or AA, age 60 years and performance status (PS) 0-2, were randomized to either 2-3 cycles of TMZ, 200mg/m(2) days 1-5 every 28 days, followed by RT 60Gy in 30 fractions or RT only. Patients without progressive disease after two TMZ cycles, received the third cycle. From March 2005, TMZ 75mg/m(2) was administered daily concomitant with RT. TMZ was recommended first-line treatment at progression. Primary endpoint was overall survival and secondary safety.Results: The study closed prematurely after enrolling 144 patients, 103 with GBM and 41 with AA. Median age was 53 years (range 24-60) and 89 (62%) were male. PS was 0-1 for 133 (92%) patients, 53 (37%) had complete surgical resection and 18 (12%) biopsy. Ninety-two (64%) received TMZ concomitant with RT. Seventy-two (50%) were randomized to neoadjuvant treatment. For the overall study population survival was 20.3 months for RT and 17.7 months for NeoTMZ (p=.76), this not reaching the primary objective. For the preplanned subgroup analysis, we found that NeoTMZ AA patients had a median survival of 95.1 months compared to 35.2 months for RT (p=.022). For patients with GBM, no difference in survival was observed (p=.10). MGMT and IDH status affected outcome.Conclusions: No advantage of NeoTMZ was noted for the overall study population or subgroup of GBM, while NeoTMZ resulted in 5 years longer median survival for patients diagnosed as AA.

    Place, publisher, year, edition, pages
    TAYLOR & FRANCIS LTD, 2017
    National Category
    Surgery
    Identifiers
    urn:nbn:se:liu:diva-144005 (URN)10.1080/0284186X.2017.1332780 (DOI)000418118800016 ()28675067 (PubMedID)
    Note

    Funding Agencies|Merck; Linkoping University Hospital for Neuro-research; Lions Cancer Foundation; Cancer Foundation Norrland, Umea, Sweden; LIUCancer; South-East Sweden FORSS

    Available from: 2018-01-02 Created: 2018-01-02 Last updated: 2019-11-06
    3. Do we really know who has an MGMT methylated glioma?: Results of an international survey regarding use of MGMT analyses for glioma
    Open this publication in new window or tab >>Do we really know who has an MGMT methylated glioma?: Results of an international survey regarding use of MGMT analyses for glioma
    Show others...
    2019 (English)In: Neuro-Oncology Practice, ISSN 2054-2577, p. 1-9Article in journal (Refereed) Published
    Abstract [en]

    Glioma O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status informs clinical decision making. Worldwide different methods and cutoff levels are used, which can lead to discordant methylation results.We conducted an international survey to clarify which methods are regularly used and why. We also explored opinions regarding international consensus on methods and cutoff.The survey had 152 respondents from 25 countries. MGMT methylation status is determined for all glioblastomas in 37% of laboratories. The most common methods are methylation-specific polymerase chain reaction (msPCR) (37%) and pyrosequencing (34%). A method is selected for simplicity (56%), cost-effectiveness (50%), and reproducibility of results (52%). For sequencing, the number of CpG sites analyzed varies from 1–3 up to more than 16. For 50% of laboratories, the company producing the kit determines which CpG sites are examined, whereas 33% select the sites themselves. Selection of cutoff is equally distributed among a cutoff defined in the literature, by the local laboratory, or by the outside laboratory performing the analysis. This cutoff varies, reported from 1% to 30%, and in 1 laboratory tumor is determined as methylated in case of 1 methylated CpG site of 17 analyzed. Some report tumors as unmethylated or weakly vs highly methylated. An international consensus on MGMT methylation method and cutoff is warranted by 66% and 76% of respondents, respectively. The method preferred would be msPCR (45%) or pyrosequencing (42%), whereas 18% suggest next-generation sequencing.Although analysis of MGMT methylation status is routine, there is controversy regarding laboratory methods and cutoff level. Most respondents favor development of international consensus guidelines.

    Place, publisher, year, edition, pages
    Oxford: Oxford University Press, 2019
    National Category
    Medical Bioscience Clinical Laboratory Medicine
    Identifiers
    urn:nbn:se:liu:diva-160808 (URN)10.1093/nop/npz039 (DOI)
    Available from: 2019-10-09 Created: 2019-10-09 Last updated: 2019-11-06Bibliographically approved
  • 254.
    Manzoor, Mirfa
    et al.
    Department of Informatics, Jönköping International Business School, Jönköping University, Jönköping, Sweden.
    Vimarlund, Vivian
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering. Department of Informatics, Jönköping International Business School, Jönköping University, Jönköping, Sweden.
    Digital technologies for social inclusion of individuals with disabilities2018In: Health and Technology, ISSN 2190-7188, E-ISSN 2190-7196, Vol. 8, no 5, p. 377-390Article in journal (Refereed)
    Abstract [en]

    Information technology can be an important facilitator of social inclusion for people with disabilities into society. However, the goals specified in this area by organizations such as the European Commission have not yet been achieved in their totality. The aim of this paper is to explore which types of information communication technology-based applications and/or digital services have been suggested to facilitate the social integration of people who suffer from different types of disabilities. We performed a literature review that included studies published during a period of 6 years (2010-2016). The results show that, in the data we have had access to, no concrete patterns can be identified regarding the type of technology or technological trends that can be used to support the social integration of individuals with disabilities. This literature review is of relevance to the identification of further research areas and to the identification of issues which have to be considered in the context of the development and implementation of technological innovations that are aimed at promoting or facilitating social inclusion of individuals with disabilities.

  • 255.
    Marklund-Bau, Helén
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
    Spångberg, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
    Edéll-Gustafsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Sleep and partner-specific quality of life in partners of men with lower urinary tract symptoms compared with partners of men from the general population.2015In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 49, no 4, p. 321-328Article in journal (Refereed)
    Abstract [en]

    The aims of this study were to examine differences between partners of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) and partners of men from the population regarding sleep and two aspects of quality of life, partner-specific quality of life and health-related quality of life (HRQoL), and to identify factors related to the partner-specific quality of life and the parameter sleep efficiency. Materials and methods. The design was descriptive and comparative. The subjects were partners of men with LUTS suggestive of BPO (n = 126) and partners of randomly selected men from the general population (n = 131). Self-administered questionnaires about demography, comorbidity, sleep, sexuality, partner-specific quality of life and HRQoL were used. Results. Partners of men with LUTS suggestive of BPO were significantly more affected in all variables measuring partner-specific quality of life compared with partners from the population. The most impaired aspects were compassion and worry about an operation or cancer. In logistic regression, the only explanatory factors were having a partner belonging to the LUTS group for impaired partner-specific quality of life and having a bed partner for high sleep efficiency. There were no significant differences between the two groups regarding the quantity and quality of sleep or the HRQoL. Conclusions. The partner-specific quality of life was impaired in partners of men with LUTS suggestive of BPO. Sleep and HRQoL did not differ between partners of men with LUTS and partners from the population.

  • 256.
    McAuliffe, Tomomi
    et al.
    Curtin University, Australia.
    Cordier, Reinie
    Curtin University, Australia.
    Vaz, Sharmila
    Curtin University, Australia.
    Thomas, Yvonne
    University of Worcester, England.
    Falkmer, Torbjörn
    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. Curtin University, Australia; La Trobe University, Australia; Cooperat Research Centre Living Autism Spectrum Disorders, Australia.
    Quality of Life, Coping Styles, Stress Levels, and Time Use in Mothers of Children with Autism Spectrum Disorders: Comparing Single Versus Coupled Households2017In: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 47, no 10, p. 3189-3203Article in journal (Refereed)
    Abstract [en]

    This study aimed to examine the influence of differences in household status on the parental stress, coping, time use and quality of life (QoL) among mothers of children with autism spectrum disorders. Forty-three single and 164 coupled mothers completed the survey. Data were analysed using multivariate logistic regression. We found that single mothers were 1.05 times more likely to report lower levels of environmental QoL. Whilst they were 1.73 times more likely to use acceptance coping style, this association did not persist after adjusting for total number of children, household income and employment status. There was no difference in time use and stress between these mothers. Possible environmental issues for single mothers and implications for future research are discussed.

  • 257.
    Michel, Per-Olof
    Michel Mentor AB, Karlstad.
    Bergh Johannesson, Kerstin (Contributor)
    Uppsala Psykoterapimottagning.
    Nilsson, Doris (Contributor)
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Arnberg, Filip (Contributor)
    Kunskapscentrum för katastrofpsykiatri, Uppsala universitet.
    Psykotraumatologi2018 (ed. 3)Book (Other academic)
    Abstract [sv]

    Människosläktet har genom årtusenden exponerats för olyckor och naturkatastrofer. Transportolyckor och andra tekniska katastrofer, krig och flyktingtrauman, terrorhändelser liksom interpersonellt våld och traumatiska övergrepp under uppväxten kan utgöra påfrestningar under människors liv samt leda till svåra hälsoeffekter.

    Denna tredje upplaga av Psykotraumatologi riktar sitt fokus mot den utveckling som skett under senaste decenniet när det gäller forskningen inom området. Sålunda beskrivs hur människor reagerar på hot och på faktorer som både kan öka risken för och motverka utvecklingen av traumatisk stress. Komplicerade sorgereaktioner och traumarelaterade tillstånd beskrivs ingående både när det gäller barn och vuxna. Vidare är avsnitten om neurobiologi, krisstöd i akutfas och behandling uppdaterade.

    Syftet med Psykotraumatologi är att utgöra en samlad kunskapskälla för den som behöver det i sin utbildning och fortbildning. På så sätt kan alla som i sin profession kommer i kontakt med potentiellt traumatiserade individer, till exempel inom hälso- och sjukvården, skolväsendet samt inom kommunernas socialtjänst ha nytta av boken.

  • 258.
    Milovanovic, Micha
    et al.
    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 Internal Medicine in Norrköping.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Vikbolandet.
    Winblad, B
    NVS, Neurogeriatrics, Karolinska Institutet, Huddinge, Karolinska University Hospital, Geriatrics, Huddinge.
    Jelic, V
    NVS, Neurogeriatrics, Karolinska Institutet, Huddinge, Karolinska University Hospital, Geriatrics, Huddinge.
    Behbahani, H
    NVS, Neurogeriatrics, Karolinska Institutet.
    Shahnaz, T
    Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping. NVS, Neurogeriatrics, Karolinska Institutet, Huddinge .
    Oweling, M
    Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Järemo, Petter
    Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Inverse relationship between erythrocyte size and platelet reactivity in elderly.2017In: Platelets, ISSN 0953-7104, E-ISSN 1369-1635, Vol. 28, no 2, p. 182-186Article in journal (Refereed)
    Abstract [en]

    Previous work indicates that erythrocytes (RBCs) accumulate β-amyloid X-40 (Aβ40) in individuals with Alzheimer disease (AD) and to a lesser extent in healthy elderly. The toxin damages RBCs and increases their mean corpuscular volume (MCV). Furthermore, AD platelets demonstrate lower reactivity. This study investigated interactions between RBCs and platelets. Older individuals with moderate hypertension (n = 57) were classified into two groups, depending on MCV in whole blood: The MCV(high) group comprised individuals with higher MCV (n = 27; 97 ± 3(SD) fl) and MCV(low) group had relatively lower MCV (n = 30; 90 ± 3(SD) fl). Flow cytometry was used to determine platelet reactivity, i.e., the surface binding of fibrinogen after provocation. Adenosine diphosphate (ADP) and a thrombin receptor-activating protein (TRAP-6) were used as agonists. Subsequently, blood cells were divided according to density into 17 subfractions. Intra-RBC Aβ40 content was analyzed and in all platelet populations surface-bound fibrinogen was determined to estimate platelet in vivo activity. We found Aβ40 inside RBCs of approximately 50% of participants, but the toxin did not affect MCV and platelet reactivity. In contrast, MCV associated inversely with platelet reactivity as judged from surface-attached fibrinogen after ADP (1.7 μmol/L) (p < 0.05) and TRAP-6 provocation (57 μmol/L (p = 0.01) and 74 μmol/L (p < 0.05)). In several density fractions (nos. 3, 4, 8, 11-13 (p < 0.05) and nos. 5-7 (p < 0.01)) MCV linked inversely with platelet-attached fibrinogen. In our community-dwelling sample, enhanced MCV associated with decreased platelet reactivity and lower in vivo platelet activity. It resembles RBCs and platelet behavior in AD-type dementia.

  • 259.
    Modin, Bitte
    et al.
    Stockholm Univ, Sweden.
    Plenty, Stephanie
    Inst Futures Studies IFFS, Sweden; Swedish Inst Social Res, Sweden.
    Laftman, Sara B.
    Stockholm Univ, Sweden.
    Bergstrom, Malin
    Stockholm Univ, Sweden.
    Berlin, Marie
    Natl Board Hlth and Welf, Sweden; Stockholm Univ, Sweden.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. 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.
    Hjern, Anders
    Stockholm Univ, Sweden.
    School Contextual Features of Social Disorder and Mental Health ComplaintsA Multilevel Analysis of Swedish Sixth-Grade Students2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 1, article id 156Article in journal (Refereed)
    Abstract [en]

    This study addressed school-contextual features of social disorder in relation to sixth-grade students experiences of bullying victimization and mental health complaints. It investigated, firstly, whether the schools concentrations of behavioural problems were associated with individual students likelihood of being bullied, and secondly, whether the schools concentrations of behavioural problems and bullying victimization predicted students emotional and psychosomatic health complaints. The data were derived from the Swedish National Survey of Mental Health among Children and Young People, carried out among sixth-grade students (approximately 12-13 years old) in Sweden in 2009. The analyses were based on information from 59,510 students distributed across 1999 schools. The statistical method used was multilevel modelling. While students own behavioural problems were associated with an elevated risk of being bullied, attending a school with a higher concentration of students with behavioural problems also increased the likelihood of being bullied. Attending a school with higher levels of bullying victimization and behavioural problems predicted more emotional and psychosomatic complaints, even when adjusting for their individual level analogues. The findings indicate that school-level features of social disorder influence bullying victimization and mental health complaints among students.

  • 260.
    Molander, Peter
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    From Detection to Intervention Psychological Aspects of Online Hearing Rehabilitation2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Hearing problems are among the most common causes of disability worldwide for adults. It is currently classified as one of the top five causes of years lived with disability. Between the years 2005 and 2015 the global prevalence of hearing loss increased with about 26 %. The negative impact of hearing loss on those affected is not limited to communication problems, as a range of other negative effects can be present, such as increased levels of social isolation, problems in the work-place and psychological distress.

    The different studies of the thesis can be summarized in three overall research questions. The first question was if hearing loss can be detected through automated online screening procedures, and what are the characteristics of those who participate in online screening (Study I and II)? The second question focused on development and testing of a measure dealing with psychological acceptance of hearing loss (Study III). Finally, the third research question concerned if online administered guided self-help based on Acceptance and Commitment Therapy could help persons with hearing loss and psychological distress (Study IV)?

    In the screening studies (Study I and II) an online speech-in-noise hearing test was initially developed and later updated. Screening for hearing problems with this test was found to be feasible, and 16.7 (Study I) and 19% (Study II) of the participants were recommended to seek professional care for their potential hearing loss. These participants had more cognitive problems, were more likely to be of male gender, and had lower levels of education than those without measured hearing problems. Study III showed that it was possible to measure hearing-related acceptance with a new questionnaire and that this measure was a better predictor of disability than instruments measuring anxiety, depression, or measured hearing performance. In Study IV, people with hearing loss and comorbid psychological distress were offered an eight-week long internet-based therapist-guided self-help treatment inspired by ACT. After treatment ended, the intervention group had lower levels of perceived hearing disability, increased ratings of quality of life and reduced depressive symptoms in relation to the wait-list control group. This thesis suggests that the internet can be used to assist early detection, measuring acceptance of hearing loss and finally as a treatment modality for persons who experience distress in relation to their hearing loss.

    List of papers
    1. Internet-based hearing screening using speech-in-noise: validation and comparisons of self-reported hearing problems, quality of life and phonological representation
    Open this publication in new window or tab >>Internet-based hearing screening using speech-in-noise: validation and comparisons of self-reported hearing problems, quality of life and phonological representation
    Show others...
    2013 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 9, p. 3223-Article in journal (Refereed) Published
    Abstract [en]

    Objectives For the last decade a host of different projects have been launched to allow persons who are concerned about their hearing status to quickly and at a low cost test their hearing ability. Most often, this is carried out without collecting complementary information that could be correlated with hearing impairment. In this two-part study we first, present the development and validation of a novel Internet-based hearing test, and second, report on the associations between this test and phonological representation, quality of life and self-reported hearing difficulties.

    Design Cross-sectional study.

    Setting An opportunity sample of participants was recruited at the Stockholm central station for the first study. All parts of the second study were conducted via the Internet, with testing and self-report forms adapted for online use.

    Participants The first part of the study was carried out in direct contact with the participants, and participants from the second study were recruited by means of advertisements in newspapers and on webpages. The only exclusion criterion was that participants had to be over 18 years old. Most participants were between 60 and 69 years old. There were almost an equal number of men and women (total n=316).

    Outcome measures 48 participants failed the Internet-based hearing screening test. The group failing the test reported more problems on the Amsterdam Inventory of Auditory Disability. In addition, they were found to have diminished phonological representational skills. However, no difference in quality of life was found.

    Conclusions Almost one in five participants was in need of contacting their local hearing clinic. This group had more complaints regarding tinnitus and hyperacusis, rated their own hearing as worse than those who passed, and had a poorer capability of generating accurate phonological representations. This study suggests that it is feasible to screen for hearing status online, and obtain valid data.

    Place, publisher, year, edition, pages
    BMJ Open, 2013
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-100529 (URN)10.1136/bmjopen-2013-003223 (DOI)000330541900030 ()24041846 (PubMedID)
    Available from: 2013-11-08 Created: 2013-11-08 Last updated: 2019-01-15Bibliographically approved
    2. Internet-based acceptance and commitment therapy for psychological distress experienced by people with hearing problems: a pilot randomized controlled trial
    Open this publication in new window or tab >>Internet-based acceptance and commitment therapy for psychological distress experienced by people with hearing problems: a pilot randomized controlled trial
    Show others...
    2018 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 47, no 2, p. 169-184Article in journal (Refereed) Published
    Abstract [en]

    Psychological distress is common among people with hearing problems, but treatments that specifically target this aspect have been almost non-existent. In this pilot randomized controlled trial, an eight-week long Internet-based treatment, informed by Acceptance and Commitment Therapy, was administered to explore the feasibility and efficacy of such a treatment. Included participants were randomized to either treatment (n=31) or wait-list control (n=30) condition. All participants were measured prior to randomization and immediately after treatment ended using standardized self-report instruments measuring hearing-related emotional and social adjustment (Hearing Handicap Inventory for the Elderly - S, HHIE-S), quality of life (Quality of Life Inventory, QOLI), and symptoms of depression and anxiety (Patient health Questionnaire, PHQ-9 and Generalized Anxiety Disorder scale, GAD-7). Linear mixed effects regression analysis using the full intention-to-treat sample demonstrated that the treatment had superior outcomes on the main outcome measure as compared with the control group, Cohens d=0.93, 95% CI [0.24, 1.63]. The benefits of treatment over control were also evident in scores of depression, Cohens d=0.61, 95% CI [0.04, 1.19], and quality of life, Cohens d=0.88, 95% CI [0.14, 1.61]. The results provide preliminary support for Internet-delivered acceptance and commitment therapy as a potentially effective treatment of psychological symptoms associated with hearing problems.

    Place, publisher, year, edition, pages
    ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2018
    Keywords
    Hearing; distress; acceptance and commitment therapy; acceptance; randomized controlled trial
    National Category
    Applied Psychology
    Identifiers
    urn:nbn:se:liu:diva-145251 (URN)10.1080/16506073.2017.1365929 (DOI)000424157000006 ()28895787 (PubMedID)
    Note

    Funding Agencies|Swedish council for Working Life and Social Research [2009-0055]

    Available from: 2018-02-21 Created: 2018-02-21 Last updated: 2018-12-12
  • 261.
    Molarius, Anu
    et al.
    Reg Vastmanland, Sweden; Karlstad Univ, Sweden.
    Granström, Fredrik
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Educational differences in psychological distress? Results from a population-based sample of men and women in Sweden in 20122018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 4, article id e021007Article in journal (Refereed)
    Abstract [en]

    Background Mental health problems are more frequent in socially disadvantaged groups, but the results vary between different studies, different populations and different measures of mental health. This paper investigated the association between educational level, economic difficulties and psychological distress in men and women in Sweden. Methods The study population included 24 510 respondents aged 25-74 years who responded to a survey questionnaire in Mid-Sweden in 2012 (response rate 53%). Psychological distress was measured with the 12-item version of the General Health Questionnaire, and multivariate logistic regression models were used in statistical analyses, adjusting for age, employment status and social support. Results The prevalence of psychological distress was higher in women (16.4%) than in men (11.3%; pamp;lt;0.001). Persons with low and medium educational level had a lower risk of psychological distress than persons with high educational level after adjustment for confounders. Economic difficulties had a strong association with psychological distress (OR 2.80 (95% CI 2.39 to 3.27) and OR 2.40 (95% CI 2.12 to 3.71) in men and women, respectively) after adjustment for confounders. Conclusion We found a strong association between economic difficulties and psychological distress in this study, but no inverse association between educational level and psychological distress. On the contrary, persons with high education had more psychological distress than persons with low and medium education when age, employment status and social support were taken into account. The findings were similar in men and women.

  • 262.
    Molstad, Sigvard
    et al.
    Lund University, Sweden.
    Lofmark, Sonja
    Public Health Agency Sweden, Sweden.
    Carlin, Karin
    Public Health Agency Sweden, Sweden.
    Erntell, Mats
    County Halland, Sweden.
    Aspevall, Olov
    Public Health Agency Sweden, Sweden.
    Blad, Lars
    County Varmland, Sweden.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
    Hedin, Katarina
    Lund University, Sweden.
    Hellman, Jenny
    Public Health Agency Sweden, Sweden.
    Norman, Christer
    Public Health Agency Sweden, Sweden.
    Skoog, Gunilla
    Public Health Agency Sweden, Sweden.
    Stalsby-Lundborg, Cecilia
    Department Public Heatlh, Sweden.
    Tegmark Wisell, Karin
    Public Health Agency Sweden, Sweden.
    Ahren, Christina
    Sahlgrens Acad, Sweden.
    Cars, Otto
    Public Health Agency Sweden, Sweden.
    Lessons learnt during 20 years of the Swedish strategic programme against antibiotic resistance2017In: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 95, no 11, p. 764-773Article in journal (Refereed)
    Abstract [en]

    Increasing use of antibiotics and rising levels of bacterial resistance to antibiotics are a challenge to global health and development. Successful initiatives for containing the problem need to be communicated and disseminated. In Sweden, a rapid spread of resistant pneumococci in the southern part of the country triggered the formation of the Swedish strategic programme against antibiotic resistance, also known as Strama, in 1995. The creation of the programme was an important starting point for long-term coordinated efforts to tackle antibiotic resistance in the country. This paper describes the main strategies of the programme: committed work at the local and national levels; monitoring of antibiotic use for informed decision-making; a national target for antibiotic prescriptions; surveillance of antibiotic resistance for local, national and global action; tracking resistance trends; infection control to limit spread of resistance; and communication to raise awareness for action and behavioural change. A key element for achieving long-term changes has been the bottom-up approach, including working closely with prescribers at the local level. The work described here and the lessons learnt could inform countries implementing their own national action plans against antibiotic resistance.

  • 263.
    Moradi, Shahram
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Time is of the essence in speech perception!: Get it fast, or think about it2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The present thesis examined the extent to which background noise influences the isolation point (IP, the shortest time from the onset of speech stimulus required for correct identification of that speech stimulus) and accuracy in identification of different types of speech stimuli (consonants, words, and final words in high-predictable [HP] and low-predictable [LP] sentences). These speech stimuli were presented in different modalities of presentation (auditory, visual, and audiovisual) to young normal-hearing listeners (Papers 1, 2, and 5). In addition, the present thesis studied under what conditions cognitive resources were explicitly demanded in identification of different types of speech stimuli (Papers 1 and 2). Further, elderly hearing-aid (EHA) users and elderly normal-hearing (ENH) listeners were compared with regard to the IPs, accuracy, and under what conditions explicit cognitive resources were demanded in identification of auditory speech stimuli in silence (Paper 3). The results showed that background noise resulted in later IPs and reduced the accuracy for the identification of different types of speech stimuli in both modalities of speech presentation. Explicit cognitive resources were demanded in identification of speech stimuli in the auditory-only modality, under the noisy condition, and in the absence of a prior semantic context. In addition, audiovisual presentation of speech stimuli resulted in earlier IPs and more accurate identification of speech stimuli than auditory presentation. Furthermore, a pre-exposure to audiovisual speech stimuli resulted in better auditory speech-in-noise identification than an exposure to auditory-only speech stimuli (Papers 2 and 4). When comparing EHA users and ENH individuals, the EHA users showed inferior performance in the identification of consonants, words, and final words in LP sentences (in terms of IP). In terms of accuracy, the EHA users demonstrated inferior performance only in the identification of consonants and words. Only the identification of consonants and words demanded explicit cognitive resources in the EHA users. Theoretical predictions and clinical implications were discussed.

    List of papers
    1. Gated auditory speech perception: effects of listening conditions and cognitive capacity
    Open this publication in new window or tab >>Gated auditory speech perception: effects of listening conditions and cognitive capacity
    2014 (English)In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 5, no 531Article in journal (Refereed) Published
    Abstract [en]

    This study aimed to measure the initial portion of signal required for the correct identification of auditory speech stimuli (or isolation points, IPs) in silence and noise, and to investigate the relationships between auditory and cognitive functions in silence and noise. Twenty-one university students were presented with auditory stimuli in a gating paradigm for the identification of consonants, words, and final words in highly predictable and low predictable sentences. The Hearing in Noise Test (HINT), the reading span test, and the Paced Auditory Serial Attention Test were also administered to measure speech-in-noise ability, working memory and attentional capacities of the participants, respectively. The results showed that noise delayed the identification of consonants, words, and final words in highly predictable and low predictable sentences. HINT performance correlated with working memory and attentional capacities. In the noise condition, there were correlations between HINT performance, cognitive task performance, and the IPs of consonants and words. In the silent condition, there were no correlations between auditory and cognitive tasks. In conclusion, a combination of hearing-in-noise ability, working memory capacity, and attention capacity is needed for the early identification of consonants and words in noise.

    Place, publisher, year, edition, pages
    Frontiers Research Foundation, 2014
    Keywords
    Gating Paradigm, Auditory Perception, Consonant, Word, Final Word in Sentence, Silence, Noise
    National Category
    Psychology
    Identifiers
    urn:nbn:se:liu:diva-107008 (URN)10.3389/fpsyg.2014.00531 (DOI)000337545700001 ()
    Funder
    Swedish Research Council, 349-2007-8654
    Available from: 2014-06-02 Created: 2014-06-02 Last updated: 2017-12-05Bibliographically approved
    2. Gated audiovisual speech identification in silence vs. noise: effects on time and accuracy
    Open this publication in new window or tab >>Gated audiovisual speech identification in silence vs. noise: effects on time and accuracy
    2013 (English)In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 4, no 00359Article in journal (Refereed) Published
    Abstract [en]

    This study investigated the degree to which audiovisual presentation (compared to auditory-only presentation) affected isolation point (IPs, the amount of time required for the correct identification of speech stimuli using a gating paradigm) in silence and noise conditions. The study expanded on the findings of Moradi et al. (under revision), using the same stimuli, but presented in an audiovisual instead of an auditory-only manner. The results showed that noise impeded the identification of consonants and words (i.e., delayed IPs and lowered accuracy), but not the identification of final words in sentences. In comparison with the previous study by Moradi et al., it can be concluded that the provision of visual cues expedited IPs and increased the accuracy of speech stimuli identification in both silence and noise. The implication of the results is discussed in terms of models for speech understanding.

    Keywords
    audiovisual identification, gating paradigm, consonant, word, final word in sentences, silence, noise
    National Category
    Psychology
    Identifiers
    urn:nbn:se:liu:diva-94239 (URN)10.3389/fpsyg.2013.00359 (DOI)000331047800001 ()
    Funder
    Swedish Research Council, 349-2007-8654
    Available from: 2013-06-19 Created: 2013-06-19 Last updated: 2017-12-06
    3. Gated auditory speech perception in elderly hearing aid users and elderly normal-hearing individuals: effects of hearing impairment and cognitive capacity
    Open this publication in new window or tab >>Gated auditory speech perception in elderly hearing aid users and elderly normal-hearing individuals: effects of hearing impairment and cognitive capacity
    2014 (English)In: Trends in Hearing, ISSN 2331-2165, Vol. 18Article in journal (Refereed) Published
    Abstract [en]

    This study compared elderly hearing aid (EHA) users and elderly normal-hearing (ENH) individuals on identification of auditory speech stimuli (consonants, words, and final word in sentences) that were different when considering their linguistic properties. We measured the accuracy with which the target speech stimuli were identified, as well as the isolation points (IPs: the shortest duration, from onset, required to correctly identify the speech target). The relationships between working memory capacity, the IPs, and speech accuracy were also measured. Twenty-four EHA users (with mild to moderate hearing impairment) and 24 ENH individuals participated in the present study. Despite the use of their regular hearing aids, the EHA users had delayed IPs and were less accurate in identifying consonants and words compared with the ENH individuals. The EHA users also had delayed IPs for final word identification in sentences with lower predictability; however, no significant between-group difference in accuracy was observed. Finally, there were no significant between-group differences in terms of IPs or accuracy for final word identification in highly predictable sentences. Our results also showed that, among EHA users, greater working memory capacity was associated with earlier IPs and improved accuracy in consonant and word identification. Together, our findings demonstrate that the gated speech perception ability of EHA users was not at the level of ENH individuals, in terms of IPs and accuracy. In addition, gated speech perception was more cognitively demanding for EHA users than for ENH individuals in the absence of semantic context.

    Place, publisher, year, edition, pages
    Sage Publications, 2014
    Keywords
    hearing aid users, gating paradigm, speech perception, cognition
    National Category
    Otorhinolaryngology
    Identifiers
    urn:nbn:se:liu:diva-109067 (URN)10.1177/2331216514545406 (DOI)000343753700007 ()25085610 (PubMedID)
    Funder
    Swedish Research Council, 349-2007-8654
    Available from: 2014-08-04 Created: 2014-08-04 Last updated: 2015-08-12Bibliographically approved
    4. Audiovisual training is better than auditory-only training for auditory-only speech-in-noise identification
    Open this publication in new window or tab >>Audiovisual training is better than auditory-only training for auditory-only speech-in-noise identification
    2014 (English)In: Journal of the Acoustical Society of America, ISSN 0001-4966, E-ISSN 1520-8524, Vol. 136, no 2, p. EL142-EL147Article in journal (Refereed) Published
    Abstract [en]

    The effects of audiovisual versus auditory training for speech-in-noise identification were examined in 60 young participants. The training conditions were audiovisual training, auditory-only training, and no training (n = 20 each). In the training groups, gated consonants and words were presented at 0 dB signal-to-noise ratio; stimuli were either audiovisual or auditory-only. The no-training group watched a movie clip without performing a speech identification task. Speech-in-noise identification was measured before and after the training (or control activity). Results showed that only audiovisual training improved speech-in-noise identification, demonstrating superiority over auditory-only training.

    Place, publisher, year, edition, pages
    American Institute of Physics (AIP), 2014
    Keywords
    Audiovisual training, audio training, speech-in-noise identification
    National Category
    Applied Psychology
    Identifiers
    urn:nbn:se:liu:diva-108989 (URN)10.1121/1.4890200 (DOI)000341178100014 ()25096138 (PubMedID)
    Funder
    Swedish Research Council, 006-6917
    Available from: 2014-07-19 Created: 2014-07-19 Last updated: 2017-12-05Bibliographically approved
    5. Comparison of informational vs. energetic masking effects on speechreading performance
    Open this publication in new window or tab >>Comparison of informational vs. energetic masking effects on speechreading performance
    2014 (English)In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 5, no 639Article in journal (Refereed) Published
    Abstract [en]

    The effects of two types of auditory distracters (steady-state noise vs. four-talker babble) on visual-only speechreading accuracy were tested against a baseline (silence) in 23 participants with above-average speechreading ability. Their task was to speechread high frequency Swedish words. They were asked to rate their own performance and effort, and report how distracting each type of auditory distracter was. Only four-talker babble impeded speechreading accuracy. This suggests competition for phonological processing, since the four-talker babble demands phonological processing, which is also required for the speechreading task. Better accuracy was associated with lower self-rated effort in silence; no other correlations were found.

    Keywords
    speechperception, cognition, speechreading, informational masking, energetic masking
    National Category
    Psychology
    Identifiers
    urn:nbn:se:liu:diva-108990 (URN)10.3389/fpsyg.2014.00639 (DOI)000338723500001 ()
    Funder
    Swedish Research Council, 2006–6917
    Available from: 2014-07-19 Created: 2014-07-19 Last updated: 2017-12-05Bibliographically approved
  • 264.
    Morland, Jørg
    et al.
    Norwegian Institute of Public Health, Division of Forensic Toxicology and Drug Abuse, Nydalen, Oslo, Norway.
    Steentoft, Anni
    Department of Forensic Medicine, Section of Forensic Chemistry, Faculty of Health Sciences, University of Copenhagen, Denmark.
    Wiese Simonsen, Kirsten
    Department of Forensic Medicine, Section of Forensic Chemistry, Faculty of Health Sciences, University of Copenhagen, Denmark.
    Ojanperä, Ilkka
    Hjelt Institute, Department of Forensic Medicine, University of Helsinki, Finland.
    Vuori, Erkki
    Hjelt Institute, Department of Forensic Medicine, University of Helsinki, Finland.
    Magnusdottir, Kristin
    Department of Pharmacology and Toxicology, University of Iceland, Iceland.
    Kristinsson, Jakob
    Department of Pharmacology and Toxicology, University of Iceland, Iceland.
    Ceder, Gunnel
    Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
    Kronstrand, Robert
    Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
    Christophersen, Asbjørg
    Norwegian Institute of Public Health, Division of Forensic Toxicology and Drug Abuse, Nydalen, Oslo, Norway.
    Drugs related to motor vehicle crashes in northern European countries: A study of fatally injured drivers2011In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 43, no 6, p. 1920-1926Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to find which drugs and drug combinations were most common in drivers who died, in particular, in single vehicle crashes where the responsibility for the crash would be referred to the driver killed. The study included all available blood samples from drivers, who died within 24h of the accident, in the years 2001 and 2002 in the five Nordic countries (total population about 24 million inhabitants). The samples were analysed for more than 200 different drugs in addition to alcohol, using a similar analytical programme and cut-off limits in all countries. In three countries (Finland, Norway and Sweden) blood samples were available for more than 70% of the drivers, allowing representative prevalence data to be collected. 60% of the drivers in single vehicle crashes had alcohol and/or drug in their blood samples, compared with 30% of drivers killed in collisions with other vehicles. In single vehicle accidents, 66% of the drivers under 30 years of age had alcohol and/or drugs in their blood (alcohol only - 40%; drugs only - 12%; alcohol and drugs - 14%). The drugs found were mostly illicit drugs and psychoactive medicinal drugs with warning labels (in 57% and 58% respectively of the drivers under 30 with drugs present). Similar findings were obtained for drivers 30-49 years of age (63% with alcohol and/or drugs). In drivers aged 50 years and above, killed in single vehicle crashes (48% with alcohol and/or drugs) illicit drugs were found in only one case, and psychoactive medicinal drugs were detected less frequently than in younger age groups. In 75% of single vehicle crashes, the driver was under 50 years. Thus, the majority of accidents where the drivers must be considered responsible, occurred with drivers who had recently used alcohol, or drugs, alone or in combination. The drugs involved were often illicit and/or psychoactive drugs with warning labels. Therefore a large proportion of single vehicle accidents appear to be preventable, if more effective measures against driving after intake of alcohol and drugs can be implemented.

  • 265.
    Motel-Klingebiel, Andreas
    et al.
    German Centre of Gerontology (DZA), Manfred-von-Richthofen-Strasse 2, 12101, Berlin, Germany .
    Romeu Gordo, Laura
    German Centre of Gerontology (DZA), Manfred-von-Richthofen-Strasse 2, 12101, Berlin, Germany .
    Betzin, Jörg
    German Centre of Gerontology (DZA), Manfred-von-Richthofen-Strasse 2, 12101, Berlin, Germany .
    Welfare States and Quality of Later Life: Distributions and Predictions in a Comparative Perspective2009In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 6, no 2, p. 67-78Article in journal (Refereed)
    Abstract [en]

    Demographic transitions are a driver of social change and societal ageing influences the resources and chances in life of different age groups. As a contribution to the debate on (potential) results of the transformation of social security in ageing societies, the impact of social security systems on distributions of quality of life in later life is discussed. Quality of life is introduced as a helpful concept to answer the paper’s research questions: How are levels of quality of life in later life and the variability of objective and subjective quality of life indicators related to welfare state arrangements? What is the relevance of social structure indicators for this variability, how is it related to old age security, and what can be learned for the perspectives of current debates on equity and social security reforms? In a comparative perspective employing Esping-Andersen’s welfare regime typology, three basic hypotheses are thoroughly tested: the ‘hypothesis of (relative) levels’, the ‘distribution hypothesis’ and the ‘social structure hypothesis’. The analyses apply micro data from ten countries. While most of them are included in the first wave of the international comparative research project SHARE, data for England come from the English Longitudinal Study of Ageing. Descriptive analyses as well as multivariate models prove an interconnection between welfare state systems and quality of life indicators but not all three hypotheses can be fully confirmed. Social policy implications of these findings are discussed and a basis for extended future analyses is outlined.

  • 266.
    Motel-Klingebiel, Andreas
    et al.
    German Centre for Gerontology, Manfred-von-Richthofen-Strasse 2, 12101, Berlin, Germany.
    von Kondratowitz, Hans-Joachim
    German Centre for Gerontology, Manfred-von-Richthofen-Strasse 2, 12101, Berlin, Germany.
    Tesch-Römer, Clemens
    German Centre for Gerontology, Manfred-von-Richthofen-Strasse 2, 12101, Berlin, Germany.
    Social inequality in the later life: Cross-national comparison of quality of life2004In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 1, no 1, p. 6-14Article in journal (Refereed)
    Abstract [en]

    This paper analyses quality of life and inequality in old age in an international comparative and a life course perspective. Quality of life is seen as an outcome of unequal chances in life. We distinguish between overall and domain specific expressions of quality of life which allows us to analyse the determinants of overall quality of life and their development over the life course. The data presented come from the research project “OASIS - Old Age and Autonomy: The Role of Service Systems and Intergenerational Family Solidarity”. This data set is based on an age stratified random sample of the urban population (25–102 years) in Norway, England, Germany, Spain, and Israel (n=6,106). With advancing age, there are decreasing mean levels and increasing variation of quality of life. With age, the impact of physical health on overall quality of life increases, while the predictive power of other domains decreases. The results support the hypothesis of differentiation as well as the age-dependency hypothesis. For both these both aspects, international comparisons show similar results in different societies. These uniform age tendencies in modern European societies point to a limited importance of societal embeddedness and support the interpretation of age group differences as being life course effects.

  • 267.
    Murray, Elizabeth
    et al.
    UCL, England.
    Hekler, Eric B.
    Arizona State University, AZ USA.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Collins, Linda M.
    Penn State University, PA USA.
    Doherty, Aiden
    University of Oxford, England.
    Hollis, Chris
    University of Nottingham, England.
    Rivera, Daniel E.
    Arizona State University, AZ USA.
    West, Robert
    UCL, England.
    Wyatt, Jeremy C.
    University of Southampton, England.
    Evaluating Digital Health Interventions Key Questions and Approaches2016In: American Journal of Preventive Medicine, ISSN 0749-3797, E-ISSN 1873-2607, Vol. 51, no 5, p. 843-851Article in journal (Refereed)
    Abstract [en]

    Digital health interventions have enormous potential as scalable tools to improve health and healthcare delivery by improving effectiveness, efficiency, accessibility, safety, and personalization. Achieving these improvements requires a cumulative knowledge base to inform development and deployment of digital health interventions. However, evaluations of digital health interventions present special challenges. This paper aims to examine these challenges and outline an evaluation strategy in terms of the research questions needed to appraise such interventions. As they are at the intersection of biomedical, behavioral, computing, and engineering research, methods drawn from all of these disciplines are required. Relevant research questions include defining the problem and the likely benefit of the digital health intervention, which in turn requires establishing the likely reach and uptake of the intervention, the causal model describing how the intervention will achieve its intended benefit, key components, and how they interact with one another, and estimating overall benefit in terms of effectiveness, cost effectiveness, and harms. Although RCTs are important for evaluation of effectiveness and cost effectiveness, they are best undertaken only when: (1) the intervention and its delivery package are stable; (2) these can be implemented with high fidelity; and (3) there is a reasonable likelihood that the overall benefits will be clinically meaningful (improved outcomes or equivalent outcomes at lower cost). Broadening the portfolio of research questions and evaluation methods will help with developing the necessary knowledge base to inform decisions on policy, practice, and research. (C) 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  • 268.
    Månsson, Kristoffer N. T.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Restructuring the socially anxious brain: Using magnetic resonance imaging to advance our understanding of effective cognitive behaviour therapy for social anxiety disorder2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Social anxiety disorder (SAD) is a common psychiatric disorder associated with considerable suffering. Cognitive behaviour therapy (CBT) has been shown to be effective but a significant proportion does not respond or relapses, stressing the need of augmenting treatment. Using neuroimaging could elucidate the psychological and neurobiological interaction and may help to improve current therapeutics. To address this issue, functional and structural magnetic resonance imaging (MRI) were repeatedly conducted on individuals with SAD randomised to receive CBT or an active control condition. MRI was performed pre-, and post-treatment, as well as at one-year follow-up. Matched healthy controls were also scanned to be able to evaluate disorder-specific neural responsivity and structural morphology. This thesis aimed at answering three major questions. I) Does the brain’s fear circuitry (e.g., the amygdala) change, with regard to neural response and structural morphology, immediately after CBT? II) Are the immediate changes in the brain still present at long-term follow-up? III) Can neural responsivity in the fear circuitry predict long-term treatment outcome at the level of the individual? Thus, different analytic methods were performed. Firstly, multimodal neuroimaging addressed questions on concomitant changes in neural response and grey matter volume. Secondly, two different experimental functional MRI tasks captured both neural response to emotional faces and self-referential criticism. Thirdly, support vector machine learning (SVM) was used to evaluate neural predictors at the level of the individual.

    Amygdala responsivity to self-referential criticism was found to be elevated in individuals with SAD, as compared to matched healthy controls, and the neural response was attenuated after effective CBT. In individuals with SAD, amygdala grey matter volume was positively correlated with symptoms of anticipatory speech anxiety, and CBT-induced symptom reduction was associated with decreased grey matter volume of the amygdala. Also, CBT-induced reduction of amygdala grey matter volume was evident both at short- and long-term follow-up. In contrast, the amygdala neural response was weakened immediately after treatment, but not at one-year follow-up. In extension to treatment effects on the brain, pre-treatment connectivity between the amygdala and the dorsal anterior cingulate cortex (dACC) was stronger in long-term CBT non-responders, as compared to long-term CBT responders. Importantly, by use of an SVM algorithm, pre-treatment neural response to self-referential criticism in the dACC accurately predicted (>90%) the clinical response to CBT.

    In conclusion, modifying the amygdala is a likely mechanism of action in CBT, underlying the anxiolytic effects of this treatment, and the brain’s neural activity during self-referential criticism may be an accurate and clinically relevant predictor of the long-term response to CBT. Along these lines, neuroimaging is a vital tool in clinical psychiatry that could potentially improve clinical decision-making based on an individual’s neural characteristics.

    List of papers
    1. Altered neural correlates of affective processing after internet-delivered cognitive behavior therapy for social anxiety disorder
    Open this publication in new window or tab >>Altered neural correlates of affective processing after internet-delivered cognitive behavior therapy for social anxiety disorder
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    2013 (English)In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 214, no 3, p. 229-237Article in journal (Refereed) Published
    Abstract [en]

    Randomized controlled trials have yielded promising results for internet-delivered cognitive behavior therapy (iCBT) for patients with social anxiety disorder (SAD). The present study investigated anxiety-related neural changes after iCBT for SAD. The amygdala is a critical hub in the neural fear network, receptive to change using emotion regulation strategies and a putative target for iCBT. Twenty-two subjects were included in pre- and post-treatment functional magnetic resonance imaging at 3T assessing neural changes during an affective face processing task. Treatment outcome was assessed using social anxiety self-reports and the Clinical Global Impression-Improvement (CGI-I) scale. ICBT yielded better outcome than ABM (66% vs. 25% CGI-I responders). A significant differential activation of the left amygdala was found with relatively decreased reactivity after iCBT. Changes in the amygdala were related to a behavioral measure of social anxiety. Functional connectivity analysis in the iCBT group showed that the amygdala attenuation was associated with increased activity in the medial orbitofrontal cortex and decreased activity in the right ventrolateral and dorsolateral (dlPFC) cortices. Treatment-induced neural changes with iCBT were consistent with previously reported studies on regular CBT and emotion regulation in general.

    Place, publisher, year, edition, pages
    Elsevier, 2013
    Keywords
    Amygdala, Cognitive behavior therapy, dlPFC, fMRI, mOFC, vlPFC
    National Category
    Psychology
    Identifiers
    urn:nbn:se:liu:diva-102160 (URN)10.1016/j.pscychresns.2013.08.012 (DOI)000327531600008 ()24064198 (PubMedID)
    Available from: 2013-12-01 Created: 2013-12-01 Last updated: 2017-12-06Bibliographically approved
    2. Neuroplasticity in response to cognitive behavior therapy for social anxiety disorder
    Open this publication in new window or tab >>Neuroplasticity in response to cognitive behavior therapy for social anxiety disorder
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    2016 (English)In: Translational Psychiatry, ISSN 2158-3188, E-ISSN 2158-3188, Vol. 6, no e727Article in journal (Refereed) Published
    Abstract [en]

    Patients with anxiety disorders exhibit excessive neural reactivity in the amygdala, which can be normalized by effective treatment like cognitive behavior therapy (CBT). Mechanisms underlying the brains adaptation to anxiolytic treatments are likely related both to structural plasticity and functional response alterations, but multimodal neuroimaging studies addressing structure-function interactions are currently missing. Here, we examined treatment-related changes in brain structure (gray matter (GM) volume) and function (blood-oxygen level dependent, BOLD response to self-referential criticism) in 26 participants with social anxiety disorder randomly assigned either to CBT or an attention bias modification control treatment. Also, 26 matched healthy controls were included. Significant time x treatment interactions were found in the amygdala with decreases both in GM volume (family-wise error (FWE) corrected P-FWE = 0.02) and BOLD responsivity (P-FWE = 0.01) after successful CBT. Before treatment, amygdala GM volume correlated positively with anticipatory speech anxiety (P-FWE = 0.04), and CBT-induced reduction of amygdala GM volume (pre-post) correlated positively with reduced anticipatory anxiety after treatment (P-FWE &lt;= 0.05). In addition, we observed greater amygdala neural responsivity to self-referential criticism in socially anxious participants, as compared with controls (P-FWE = 0.029), before but not after CBT. Further analysis indicated that diminished amygdala GM volume mediated the relationship between decreased neural responsivity and reduced social anxiety after treatment (P = 0.007). Thus, our results suggest that improvement-related structural plasticity impacts neural responsiveness within the amygdala, which could be essential for achieving anxiety reduction with CBT.

    Place, publisher, year, edition, pages
    NATURE PUBLISHING GROUP, 2016
    National Category
    Basic Medicine
    Identifiers
    urn:nbn:se:liu:diva-127755 (URN)10.1038/tp.2015.218 (DOI)000373892200004 ()26836415 (PubMedID)
    Note

    Funding Agencies|Linkoping University; Swedish Research Council; Swedish Council for Working Life and Social Research; LJ Boethius Foundation; PRIMA Psychiatry Research Foundation

    Available from: 2016-05-12 Created: 2016-05-12 Last updated: 2018-01-10
    3. Structural but not functional neuroplasticity one year after effective cognitive behaviour therapy for social anxiety disorder
    Open this publication in new window or tab >>Structural but not functional neuroplasticity one year after effective cognitive behaviour therapy for social anxiety disorder
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    2017 (English)In: Behavioural Brain Research, ISSN 0166-4328, E-ISSN 1872-7549, Vol. 318, p. 45-51Article in journal (Refereed) Published
    Abstract [en]

    Abstract Effective psychiatric treatments ameliorate excessive anxiety and induce neuroplasticity immediately after the intervention, indicating that emotional components in the human brain are rapidly adaptable. Still, the interplay between structural and functional neuroplasticity is poorly understood, and studies of treatment-induced long-term neuroplasticity are rare. Functional and structural magnetic resonance imaging (using 3 T MRI) was performed in 13 subjects with social anxiety disorder on 3 occasions over 1 year. All subjects underwent 9 weeks of Internet-delivered cognitive behaviour therapy in a randomized cross-over design and independent assessors used the Clinically Global Impression-Improvement (CGI-I) scale to determine treatment response. Gray matter (GM) volume, assessed with voxel-based morphometry, and functional blood-oxygen level-dependent (BOLD) responsivity to self-referential criticism were compared between treatment responders and non-responders using 2 × 2 (group × time; pretreatment to follow-up) ANOVA. At 1-year follow-up, 7 (54%) subjects were classified as CGI-I responders. Left amygdala GM volume was more reduced in responders relative to non-responders from pretreatment to 1-year follow-up (Z = 3.67, Family-Wise Error corrected p = 0.02). In contrast to previous short-term effects, altered BOLD activations to self-referential criticism did not separate responder groups at follow-up. The structure and function of the amygdala changes immediately after effective psychological treatment of social anxiety disorder, but only reduced amygdala GM volume, and not functional activity, is associated with a clinical response 1 year after CBT.

    Place, publisher, year, edition, pages
    Elsevier, 2017
    Keywords
    Amygdala, Neuroplasticity, Long-term, Social anxiety disorder, Cognitive behavior therapy
    National Category
    Psychology
    Identifiers
    urn:nbn:se:liu:diva-132638 (URN)10.1016/j.bbr.2016.11.018 (DOI)000390725000007 ()27838341 (PubMedID)
    Note

    Funding agencies: Swedish Research Council; Linkoping University; Swedish Council for Working Life and Social Research; Capio Research Foundation; PRIMA Research Foundation

    Available from: 2016-11-18 Created: 2016-11-18 Last updated: 2017-11-29Bibliographically approved
    4. Predicting long-term outcome of Internet-delivered cognitive behavior therapy for social anxiety disorder using fMRI and support vector machine learning.
    Open this publication in new window or tab >>Predicting long-term outcome of Internet-delivered cognitive behavior therapy for social anxiety disorder using fMRI and support vector machine learning.
    Show others...
    2015 (English)In: Translational psychiatry, ISSN 2158-3188, Vol. 5, p. e530-Article in journal (Refereed) Published
    Abstract [en]

    Cognitive behavior therapy (CBT) is an effective treatment for social anxiety disorder (SAD), but many patients do not respond sufficiently and a substantial proportion relapse after treatment has ended. Predicting an individual's long-term clinical response therefore remains an important challenge. This study aimed at assessing neural predictors of long-term treatment outcome in participants with SAD 1 year after completion of Internet-delivered CBT (iCBT). Twenty-six participants diagnosed with SAD underwent iCBT including attention bias modification for a total of 13 weeks. Support vector machines (SVMs), a supervised pattern recognition method allowing predictions at the individual level, were trained to separate long-term treatment responders from nonresponders based on blood oxygen level-dependent (BOLD) responses to self-referential criticism. The Clinical Global Impression-Improvement scale was the main instrument to determine treatment response at the 1-year follow-up. Results showed that the proportion of long-term responders was 52% (12/23). From multivariate BOLD responses in the dorsal anterior cingulate cortex (dACC) together with the amygdala, we were able to predict long-term response rate of iCBT with an accuracy of 92% (confidence interval 95% 73.2-97.6). This activation pattern was, however, not predictive of improvement in the continuous Liebowitz Social Anxiety Scale-Self-report version. Follow-up psychophysiological interaction analyses revealed that lower dACC-amygdala coupling was associated with better long-term treatment response. Thus, BOLD response patterns in the fear-expressing dACC-amygdala regions were highly predictive of long-term treatment outcome of iCBT, and the initial coupling between these regions differentiated long-term responders from nonresponders. The SVM-neuroimaging approach could be of particular clinical value as it allows for accurate prediction of treatment outcome at the level of the individual.

    National Category
    Applied Psychology
    Identifiers
    urn:nbn:se:liu:diva-117119 (URN)10.1038/tp.2015.22 (DOI)000367654700004 ()25781229 (PubMedID)
    Note

    Funding agencies: Swedish Research Council; Linkoping University; Swedish Research Council for Health, Working Life and Welfare; PRIMA Psychiatry Research Foundation; Kings College London Centre of Excellence in Medical Engineering - Wellcome Trust; Engineering and Physica

    Available from: 2015-04-16 Created: 2015-04-16 Last updated: 2016-11-18
  • 269.
    Möller, Saffran
    et al.
    School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Hagberg, Kerstin
    Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden; dDepartment of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, SwedenAdvanced Reconstruction of Extremities, Sahlgrenska University Hospital, Gothenburg, Sweden .
    Samuelsson, Kersti
    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, Department of Rehabilitation Medicine.
    Ramstrand, Nerrolyn
    School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Perceived self-efficacy and specific self-reported outcomes in persons withlower-limb amputation using a non-microprocessor-controlled versus amicroprocessor-controlled prosthetic knee2018In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 13, no 3, p. 220-225Article in journal (Refereed)
    Abstract [en]

    Purpose: To measure self-efficacy in a group of individuals who have undergone a lower-limb amputationand investigate the relationship between self-efficacy and prosthetic-specific outcomes including prostheticuse, mobility, amputation-related problems and global health. A second purpose was to examine ifdifferences exist in outcomes based upon the type of prosthetic knee unit being used.Method: Cross-sectional study using the General Self-Efficacy (GSE) Scale and the Questionnaire forPersons with a Transfemoral Amputation (Q-TFA). Forty-two individuals participated in the study. Twentythreeused a non-microprocessor-controlled prosthetic knee joint (non-MPK) and 19 used a microprocessor-controlled prosthetic knee joint (MPK).Results: The study sample had quite high GSE scores (32/40). GSE scores were significantly correlated tothe Q-TFA prosthetic use, mobility and problem scores. High GSE scores were related to higher levels ofprosthetic use, mobility, global scores and negatively related to problem score. No significant differencewas observed between individuals using a non-MPK versus MPK joints.Conclusions: Individuals with high self-efficacy used their prosthesis to a higher degree and high self-efficacywas related to higher level of mobility, global scores and fewer problems related to the amputationin individuals who have undergone a lower-limb amputation and were using a non-MPK or MPK knee.

  • 270.
    Mörelius, Evalotte
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping. Linköping University, Department of Social and Welfare Studies, Division of Nursing Science.
    He, Hong-Gu
    National University of Singapore.
    Shorey, Shefaly
    National University of Singapore.
    Salivary Cortisol Reactivity in Preterm Infants in Neonatal Intensive Care: An Integrative Review2016In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, Vol. 13, no 3, p. E337-Article, review/survey (Refereed)
    Abstract [en]

    Recently, more and more researchers have been using salivary cortisol reactivity to evaluate stress in preterm infants in the neonatal intensive care unit (NICU). The aim of this integrative literature review was to summarize the evidence of interventions leading to a change in salivary cortisol from the baseline in preterm infants in the NICU. The electronic databases of PubMed, CINAHL, Web of Science, and Scopus were searched for relevant studies. The inclusion criteria were studies with preterm infants exposed to an intervention evaluated by salivary cortisol reactivity before discharge from the NICU, which were published in English. In total, 16 studies were included. Eye-screening examination and heel lance provoked an increase in the salivary cortisol level. Music, prone position, and co-bedding among twins decreased the salivary cortisol level. Several studies reported a low rate of successful saliva sampling or did not use control groups. Future studies need to focus on non-painful interventions in order to learn more about salivary cortisol regulation in preterm infants. Moreover, these studies should use study designs comprising homogenous gestational and postnatal age groups, control groups, and reliable analysis methods that are able to detect cortisol in small amounts of saliva.                  

  • 271.
    Müssener, Ulrika
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Encouraging Encounters: Experiences of People on Sick Leave in Their Meetings with Professionals2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The recent increase in long-term sickness absence both in Sweden and many other countries has been met with various attempts to intensify the use of rehabilitation measures in order to prevent people from remaining long-term sickness absent. Several actors, among them professionals in healthcare, occupational health services, and social insurance are involved in handling issues related to the sick leave of an individual, and in providing measures to promote return to work (RTW). Identification of the factors that are related to RTW of the individual is a multifaceted task; therefore to meet the individual in this process is an essential challenge for many actors involved. Knowledge is needed about factors that might promote RTW in order to facilitate future research aimed at designing effective rehabilitation programs. Such information is of great importance to improve the work situations of the professionals, to decrease the cost for society, and to improve the situations for people on sick leave by facilitating RTW.

    Objectives: The overall aim of the work underlying this thesis was to ascertain whether contacts between professionals and sickness absentees might a factor that can promote RTW, and also to identify different aspects of how such positive encounters are experienced by those who are sick listed.

    Material and methods: Five investigations were conducted using different study designs, data, and methods of data analyses. The first two (papers I and II) concerned interviews with people on sick leave about positive experiences of their encounters with professionals. The third study (paper III) was based on four questions about encounters, which were included in a questionnaire that was administrated to people who were on sick leave. The fourth study (paper IV) used a broad questionnaire to examine experiences of positive encounters, and the final study (paper V) proposed a model of possible effects of the encounters on RTW.

    Results: In paper I and II different aspects of sick-listed person’s experiences of positive encounters were identified. For example, it seemed that important qualities included being treated with respect, feeling supported, establishing a personal relationship, and participating in decisions regarding RTW measures. Several of the interviewees stated that RTW might be promoted by positive encounters. Paper III showed that perceptions of interactions varied with the type of professionals, as well as with demographics. The respondents perceived their encounters with professionals within healthcare as most positive, followed by social insurance, and lastly occupational health services. In general, females, people born in Sweden, and those who were older, or had a higher education rated their encounters with professionals as more positive. The main finding reported in paper IV was that the majority of the participants had experienced being positive encountered by professionals. Three aspects of such encounters were stressed, namely being treated with ”competence”, ”personal attention”, and ”competence and trust”. The results related in paper V indicated that theories about empowerment and on social emotions could be successfully applied in this area, after they were specifically adapted to some unique features of the contacts between sickness absentees and rehabilitation professionals.

    Conclusions: This thesis emphasizes that being positively encountered by professionals can have a beneficial impact on RTW after a period of sickness absence. More research is required to elucidate the interaction between sick-listed persons and professionals who are involved in their cases. Further studies should focus on how methods for professionals can be provided to increase sick-listed persons’ own ability to mobilize and develop their resources. Moreover, additional knowledge is needed to extend professional treatment strategies that enhance self-confidence and empowerment of individuals during sickness absence.

    List of papers
    1. Positive encounters with rehabilitation professionals reported by persons with experience of sickness absence
    Open this publication in new window or tab >>Positive encounters with rehabilitation professionals reported by persons with experience of sickness absence
    2004 (English)In: Work: A Journal of Prevention, Assessment & Rehabilitation, ISSN 1051-9815, Vol. 22, no 3, p. 247-254Article in journal (Refereed) Published
    Abstract [en]

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

    Keywords
    sickness absence, sick leave, rehabilitation, encounter, return to work
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14286 (URN)
    Available from: 2007-02-13 Created: 2007-02-13 Last updated: 2015-06-02
    2. Encouraging encounters: sick-listed persons’ experiences of interactions with rehabilitation professionals
    Open this publication in new window or tab >>Encouraging encounters: sick-listed persons’ experiences of interactions with rehabilitation professionals
    2007 (English)In: Social work in health care, ISSN 0098-1389, E-ISSN 1541-034X, Vol. 46, no 2, p. 71-87Article in journal (Refereed) Published
    Abstract [en]

    Long-term sickness-absence has increased in many countries and more knowledge is warranted on factors that can promote return-to-work (RTW). Interactions with professionals might be one such factor and especially experiences of positive encounters. The purpose of the study was to identify and analyze sick-listed persons' experiences of positive encounters with professionals within social insurance and healthcare. An inductive and descriptive qualitative approach was used to analyze ttanscripts from 11 semi-structured interviews with persons with experience of long-term sickness absence.

    The following five categories of qualities of encounters were found to be of importance: being treated with respect, feeling supported, establishing a personal relationship, perceiving demands as well-balanced, and participating in decisions regarding rehabilitation measures. Several interviewees expressed the opinion that positive encounters with professionals can promote RTW.

    Further research is needed to elucidate the aspects of interactions that enhance empowerment and self-confidence in persons on sick leave, in order to develop professional treatment strategies that facilitate RTW.

    Keywords
    Sickness-absence, sick leave, encounter, return-to-work, professionals
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14287 (URN)10.1300/J010v46n02_05 (DOI)
    Available from: 2007-02-13 Created: 2007-02-13 Last updated: 2017-12-13
    3. A population-based questionnaire study of how people on sick leave perceive contacts with professionals in healthcare, occupational health services, and social insurance
    Open this publication in new window or tab >>A population-based questionnaire study of how people on sick leave perceive contacts with professionals in healthcare, occupational health services, and social insurance
    2007 (English)In: Article in journal (Refereed) Submitted
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14288 (URN)
    Available from: 2007-02-13 Created: 2007-02-13 Last updated: 2015-06-02
    4. Positive experiences of encounters with professionals among people on long-term sick leave
    Open this publication in new window or tab >>Positive experiences of encounters with professionals among people on long-term sick leave
    2007 (English)In: Article in journal (Refereed) Submitted
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14289 (URN)
    Available from: 2007-02-13 Created: 2007-02-13 Last updated: 2015-06-02
    5. Pride, empowerment and return to work: On the significance of positive social emotions in the rehabilitation of sickness absentees
    Open this publication in new window or tab >>Pride, empowerment and return to work: On the significance of positive social emotions in the rehabilitation of sickness absentees
    2006 (English)In: Work: A Journal of Prevention, Assessment & Rehabilitation, ISSN 1051-9815, Vol. 27, no 1, p. 57-65Article in journal (Refereed) Published
    Abstract [en]

    Sickness absence is a great public health problem and there is a lack of knowledge concerning the hows and whys of success or failure in promoting return to work of sick-listed persons. Discussions of and research into social and psychological aspects of this problem area are in need of theoretical contextualisation. In this paper it is suggested that theories of social emotions may be useful, and that the concept of empowerment can be applied provided that it is reasonably well defined. The notions of pride/shame and empowerment are elucidated and discussed, and it is shown that they can be related in the context of research into emotional dimensions of sickness absentees' experiences of the rehabilitation process in a way that may help to guide empirical studies. A simple model of hypothetical relations between pride/shame, empowerment/disempowerment, work ability, health, and return to work is sketched.

    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-14290 (URN)
    Available from: 2007-02-13 Created: 2007-02-13 Last updated: 2015-06-02
  • 272.
    Müssener, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Andersson, E Kristin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Linderoth, Catharina
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Leijon, Matti E.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Business support and Development, Department of Health and Care Development.
    Bendtsen, Marcus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    A Text Message-Based Intervention Targeting Alcohol Consumption Among University Students: User Satisfaction and Acceptability Study.2018In: JMIR Human Factors, E-ISSN 2292-9495, Vol. 5, no 3, article id e23Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Heavy consumption of alcohol among university students is a global problem, with excessive drinking being the social norm. Students can be a difficult target group to reach, and only a minority seek alcohol-related support. It is important to develop interventions that can reach university students in a way that does not further stretch the resources of the health services. Text messaging (short message service, SMS)-based interventions can enable continuous, real-time, cost-effective, brief support in a real-world setting, but there is a limited amount of evidence for effective interventions on alcohol consumption among young people based on text messaging. To address this, a text messaging-based alcohol consumption intervention, the Amadeus 3 intervention, was developed.

    OBJECTIVE: This study explored self-reported changes in drinking habits in an intervention group and a control group. Additionally, user satisfaction among the intervention group and the experience of being allocated to a control group were explored.

    METHODS: Students allocated to the intervention group (n=460) were asked about their drinking habits and offered the opportunity to give their opinion on the structure and content of the intervention. Students in the control group (n=436) were asked about their drinking habits and their experience in being allocated to the control group. Participants received an email containing an electronic link to a short questionnaire. Descriptive analyses of the distribution of the responses to the 12 questions for the intervention group and 5 questions for the control group were performed.

    RESULTS: The response rate for the user feedback questionnaire of the intervention group was 38% (176/460) and of the control group was 30% (129/436). The variation in the content of the text messages from facts to motivational and practical advice was appreciated by 77% (135/176) participants, and 55% (97/176) found the number of messages per week to be adequate. Overall, 81% (142/176) participants stated that they had read all or nearly all the messages, and 52% (91/176) participants stated that they were drinking less, and increased awareness regarding negative consequences was expressed as the main reason for reduced alcohol consumption. Among the participants in the control group, 40% (52/129) stated that it did not matter that they had to wait for access to the intervention. Regarding actions taken while waiting for access, 48% (62/129) participants claimed that they continued to drink as before, whereas 35% (45/129) tried to reduce their consumption without any support.

    CONCLUSIONS: Although the main randomized controlled trial was not able to detect a statistically significant effect of the intervention, most participants in this qualitative follow-up study stated that participation in the study helped them reflect upon their consumption, leading to altered drinking habits and reduced alcohol consumption.

    TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number ISRCTN95054707; http://www.isrctn.com/ISRCTN95054707 (Archived by WebCite at http://www.webcitation.org/705putNZT).

  • 273.
    Müssener, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Bendtsen, Marcus
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, The Institute of Technology.
    Karlsson, Nadine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    White, Ian R.
    Cambridge Institute of Public Health.
    McCambridge, Jim
    University of York.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    SMS-based smoking cessation intervention among university students: study protocol for a randomised controlled trial (NEXit trial)2015In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 16, article id 140Article in journal (Refereed)
    Abstract [en]

    Background: Most smoking efforts targeting young people have so far been focused on prevention of initiation, whereas smoking cessation interventions have largely been targeted towards adult populations. Thus, there is limited evidence for effective smoking cessation interventions in young people, even though many young people want to quit smoking. Mobile communication technology has the potential to reach large numbers of young people and recent text-based smoking cessation interventions using phones have shown promising results. Methods/design: The study aims to evaluate a newly developed text-based smoking cessation intervention for students in colleges and universities in Sweden. The design is a randomised controlled trial (RCT) with a delayed/waiting list intervention control condition. The trial will be performed simultaneously in all colleges and universities served by 25 student health care centres in Sweden. Outcomes will be evaluated after 4 months, with 2 cessation primary outcomes and 4 secondary outcomes. After outcome evaluation the control group will be given access to the intervention. Discussion: The study will examine the effectiveness of a stand-alone SMS text-based intervention. The intervention starts with a motivational phase in which the participants are given an opportunity to set a quit date within 4 weeks of randomisation. This first phase and the subsequent core intervention phase of 12 weeks are totally automated in order to easily integrate the intervention into the daily routines of student and other health care settings. As well as providing data for the effectiveness of the intervention, the study will also provide data for methodological analyses addressing a number issues commonly challenging in Internet-based RCTs. For example, an extensive follow-up strategy will be used in order to evaluate the use of repeated attempts in the analysis, and in particular to explore the validity of a possible missing not at random assumption that the odds ratio between the primary outcome and response is the same at every attempt.

  • 274.
    Neher, Margit
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Learning Challenges Associated with Evidence-Based Practice in Rheumatology2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Rheumatology is a field of practice that is undergoing many changes, leading to growing demand for rheumatology practitioners to keep up-to-date about the research developments in their field and to implement new findings and recommendations into clinical practice. Research within implementation science has shown that there are numerous barriers to the clinical use of research-based knowledge in health care. Implementation of evidencebased practice (EBP) requires a great deal of learning on the part of practitioners. It is likely that practitioners in rheumatology face similar challenges to those in other clinical fields, but there is a paucity of research concerning the implementation of EBP in rheumatology and the learning required.

    Aims: The overall aim of the research project was to generate knowledge concerning the learning challenges associated with evidence-based practice in rheumatology.

    Methods: Qualitative methods were used to explore the use of knowledge sources in rheumatology nursing and the learning opportunities in clinical rheumatology for participants belonging to five professional groups. Quantitative methods sought to examine to what extent evidence-based practice was implemented in clinical rheumatology practice and which individual and organizational factors affected research use. A theory-based study analysed the learning processes associated with achieving an evidence-based practice.

    Results: Four sources of knowledge were identified for rheumatology nursing practice: interaction with other people in the workplace (peers in particular) and previous knowledge and experience were perceived as preferred sources of knowledge, while written materials and contacts outside the workplace were less privileged. Learning opportunities occurring during daily practice were perceived by participants of all professional groups to consist predominantly of interactions with professional peers in the workplace. Participants perceived a lack of recognized learning opportunities such as continuing professional education and regular participation in rheumatology-specific courses and conferences. Participants also expressed that time for reflection and up-dating knowledge was short in everyday clinical work. The quantitative data showed that while the general interest for EBP was high in rheumatology practice, individual interest and professional self-efficacy related to EBP varied. A longer work-experience in rheumatology, better self-efficacy concerning the use research-based knowledge and more experience from research activities were positively associated with the use of research in practice. The theoretical analysis showed that challenges of implementing evidence-based practice concern not only the acquisition of research-based knowledge and the integration of this knowledge in practice, but also the abandonment of outdated practices.

    Conclusions: In this thesis, implementation of EBP in rheumatology has been shown to be a complex issue. Social, contextual and individual aspects were found to be involved in the learning processes, the use of knowledge sources and learning opportunities, as well as in the EBP-relevant behaviours that are enacted in clinical rheumatology. The thesis hopes to contribute to a better understanding of the learning challenges in connection with the implementation of EBP in rheumatology practice.

    List of papers
    1. Knowledge Sources for Evidence-Based Practice in Rheumatology Nursing.
    Open this publication in new window or tab >>Knowledge Sources for Evidence-Based Practice in Rheumatology Nursing.
    2015 (English)In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 24, no 6, p. 661-679Article in journal (Refereed) Published
    Abstract [en]

    As rheumatology nursing develops and extends, knowledge about current use of knowledge in rheumatology nursing practice may guide discussions about future knowledge needs. To explore what perceptions rheumatology nurses have about their knowledge sources and about what knowledge they use in their practice, 12 nurses working in specialist rheumatology were interviewed using a semi-structured interview guide. The data were analyzed using conventional qualitative content analysis. The analysis yielded four types of knowledge sources in clinical practice: interaction with others in the workplace, contacts outside the workplace, written materials, and previous knowledge and experience. Colleagues, and physicians in particular, were important for informal learning in daily rheumatology practice. Evidence from the medical arena was accessed through medical specialists, while nursing research was used less. Facilitating informal learning and continuing formal education is proposed as a way toward a more evidence-based practice in extended roles.

    Place, publisher, year, edition, pages
    Sage Publications, 2015
    Keywords
    extended roles, health care, informal learning, workplace learning, qualitative
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-118283 (URN)10.1177/1054773814543355 (DOI)000364723000006 ()25059719 (PubMedID)
    Available from: 2015-05-25 Created: 2015-05-25 Last updated: 2017-12-04
    2. Learning opportunities in rheumatology practice: a qualitative study
    Open this publication in new window or tab >>Learning opportunities in rheumatology practice: a qualitative study
    2015 (English)In: Journal of Workplace Learning, ISSN 1366-5626, E-ISSN 1758-7859, Vol. 27, no 4, p. 282-297Article in journal (Refereed) Published
    Abstract [en]

    Purpose

    – This paper aims to explore what opportunities for learning practitioners in rheumatology perceive of in their daily practice, using a typology of workplace learning to categorize these opportunities.

    Design/methodology/approach

    – Thirty-six practitioners from different professions in rheumatology were interviewed. Data were analyzed using conventional qualitative content analysis with a directed approach, and were categorized according to a typology of formal and informal learning.

    Findings

    – The typology was adjusted to fit the categories resulting from the analysis. Further analysis showed that work processes with learning as a by-product in general, and relationships with other people in the workplace in particular, were perceived as important for learning in the workplace. The use of many recognized learning opportunities was lower. Barriers for learning were a perceived low leadership awareness of learning opportunities and factors relating to workload and the organization of work.

    Research limitations/implications

    – The generalizability of results from all qualitative inquiries is limited by nature, and the issue of transferability to other contexts is for the reader to decide. Further studies will need to confirm the results of the study, as well as the proposed enhancement of the typology with which the results were categorized.

    Practical implications

    – The study highlights the importance of relationships in the workplace for informal learning in rheumatology practice. In the clinical context, locally adapted strategies at organizational and individual levels are needed to maximize opportunities for both professional and interprofessional informal learning, taking the importance of personal relationships into account. The findings also suggest a need for increased continuing professional education in the specialty.

    Originality/value

    – The workplace learning typology that was used in the study showed good applicability to empirical health-care study data, but may need further development. The study confirmed that informal workplace learning is an important part of learning in rheumatology. Further studies are needed to clarify how informal and formal learning in the rheumatology clinic may be supported in workplaces with different characteristics.

    Place, publisher, year, edition, pages
    Emerald Group Publishing Limited, 2015
    Keywords
    Health care, Continuing professional development, Workplace learning, Collaborative relationships
    National Category
    Chemical Sciences
    Identifiers
    urn:nbn:se:liu:diva-127494 (URN)10.1108/JWL-07-2014-0054 (DOI)
    Available from: 2016-04-28 Created: 2016-04-28 Last updated: 2017-11-30Bibliographically approved
  • 275.
    Neher, Margit
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. 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.
    Ellström, Per-Erik
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Knowledge Sources for Evidence-Based Practice in Rheumatology Nursing.2015In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 24, no 6, p. 661-679Article in journal (Refereed)
    Abstract [en]

    As rheumatology nursing develops and extends, knowledge about current use of knowledge in rheumatology nursing practice may guide discussions about future knowledge needs. To explore what perceptions rheumatology nurses have about their knowledge sources and about what knowledge they use in their practice, 12 nurses working in specialist rheumatology were interviewed using a semi-structured interview guide. The data were analyzed using conventional qualitative content analysis. The analysis yielded four types of knowledge sources in clinical practice: interaction with others in the workplace, contacts outside the workplace, written materials, and previous knowledge and experience. Colleagues, and physicians in particular, were important for informal learning in daily rheumatology practice. Evidence from the medical arena was accessed through medical specialists, while nursing research was used less. Facilitating informal learning and continuing formal education is proposed as a way toward a more evidence-based practice in extended roles.

  • 276.
    Neher, Margit
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. 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.
    Festin, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Implementation of Evidence-Based Practice in Rheumatology: What Sociodemographic, Social Cognitive and Contextual Factors Influence Health Professionals’ Use of Research in Practice?2016In: Journal of rheumatic diseases and treatment, ISSN 2469-5726, Vol. 2, no 3, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Abstract

    Objective: Research on the use of research in rheumatology practice is largely lacking. This study attempts to fill this knowledge gap by exploring the degree to which evidence-based practice (EBP) is implemented in clinical rheumatology practice and identifying individual and organizational factors that may potentially affect research use in the clinical environment.

    Methods: A web-based questionnaire was distributed to members of health professional groups in clinical rheumatology by way of publicly available e-mail addresses. Data were collected on sociodemographic, social cognitive, and contextual factors deemed to potentially influence the use of research in practice. The outcome measure was the EBP Implementation Scale.

    Results: A complex range of factors was found to influence the outcome. The factors that were most clearly associated with research use were the perception of personal ability to use research knowledge, years of experience in clinical rheumatology, and experience of research activities.

    Conclusions: Our study results suggest a large variation in levels of implementation of EBP across work units and individuals, and although a low general standard is indicated (even if a gold standard does not exist), there was also a great interest in working according to EBP principles. Potential for change is apparent, but it seems necessary to examine the use of research evidence in rheumatology practice at the individual and work unit levels to accommodate local and individual needs and resources. Future studies are needed to examine the influence of contextual influences by other methods.

  • 277.
    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.
    Opening the Black Box of Community-Based Injury Prevention Programmes: Towards Improved Understanding of Factors that Influence Programme Effectiveness2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Despite wide application of community-based programmes to prevent injuries and promote health over the last 25 years, there is a paucity of evaluations from which to obtain evidence regarding the effectiveness and critical factors contributing to achieving effectiveness of these programmes. Research on community-based injury prevention programmes thus far has been driven by the question “does it work?” However, merely establishing whether a programme works or not provides insufficient information to generate new knowledge about these programmes. Many programme evaluations have been characterised as “black box” evaluations, with inadequate information about the intervening and contextual factors that mediate the relationship between the programme and its effects. Opening the black box is essential to developing the best evidence in relation to community-based programmes.

    Keeping the question “does it work?” in mind as a departure point, the seven studies of this thesis address different aspects of the questions “why does it work?” and “how does it work?” The aim is to aid in the understanding of factors that influence the operation and effectiveness of community-based injury prevention programmes.

    The findings from the studies support a number of conclusions with regard to the three research questions posed. There is limited evidence for the effectiveness of communitybased injury prevention programmes. Some of the problems of providing convincing evidence are due to the methodological difficulties of evaluating these programs.

    Contextual conditions and the amount of financial resources available to a programme are key factors associated with the effectiveness of community-based injury prevention programmes. There is inconclusive evidence regarding the importance of some of the socalled success factors described in the scientific literature for achieving effectiveness. While many programmes have access to locally collected injury data, they devote limited time to the analysis of this ssembled data. When selecting interventions, many programmes rely upon tuitive and subjective methods, e.g. discussions in networks, feedback from the general public, and experiences gained in their own work. This style of decision making is “experience-based” rather than evidence-based.

    The theoretical underpinning of the community-based approach has certain shortcomings, which could explain some of the difficulties in demonstrating effectiveness seen with many of these programmes. Programmes overwhelmingly define geographical units as communities. However, these entities can be highly heterogeneous and characterised by a weak sense of community, which can yield insufficient community member participation and intersectoral collaboration, as well as inadequate reach for many programmes. At the same time, none of the most plausible assumptions of the community-based approach appears to be fully or widely applied in programme practice. The implication is that many community-based programmes do not function at an optimum level.

    List of papers
    1. What makes community based injury prevention work?: In search of evidence of effectiveness
    Open this publication in new window or tab >>What makes community based injury prevention work?: In search of evidence of effectiveness
    2004 (English)In: Injury Prevention, ISSN 1353-8047, Vol. 10, no 5, p. 268-274Article in journal (Refereed) Published
    Abstract [en]

    Community based injury prevention work has become a widely accepted strategy among safety promotion specialists. Hundreds of community based injury prevention programs have been implemented since the mid-1970s, but relatively few have been evaluated rigorously, resulting in a lack of consensus regarding the effectiveness of this approach. This study sought to identify key components that contribute to the effectiveness of these programs. The objective was to gain a better understanding of the community based model for injury prevention. The study was performed as a structured review of existing evaluations of injury prevention programs that employed multiple strategies to target different age groups, environments, and situations.

    The results of this study suggested that there are complex relationships between the outcome and the context, structure, and process of community-wide injury prevention programs. The interconnectedness of these variables made it difficult to provide solid evidence to prioritise in terms of program effectiveness. The evaluations of multifaceted community oriented injury prevention programs were found to have many shortcomings. Meagre descriptions of community characteristics and conditions, insufficient assessment of structural program components, and failure to establish process-outcome relationships contributed to the difficulty of identifying key success factors of the programs.

    Keywords
    community based injury prevention, evidence of effectiveness
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13873 (URN)10.1136/ip.2004.005744 (DOI)
    Available from: 2006-06-26 Created: 2006-06-26 Last updated: 2009-05-28
    2. Effectiveness of Community-Based Injury Prevention: Injury Rate Levels, Changes, and Trends for 14 Swedish WHO-Designated Safe Communities
    Open this publication in new window or tab >>Effectiveness of Community-Based Injury Prevention: Injury Rate Levels, Changes, and Trends for 14 Swedish WHO-Designated Safe Communities
    Show others...
    2007 (English)In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 39, no 2, p. 267-273Article in journal (Refereed) Published
    Abstract [en]

    This study investigates the injury rate levels, changes, and trends between 1987 and 2002 for the 14 Swedish municipalities designated as WHO Safe Communities. The injury rate was defined as the number of injured patients discharged from hospital per 1000 persons. Injury rates were age standardised. Each municipality was compared with its respective municipality group, according to a classification of Sweden's 288 municipalities into nine groups based on numerous structural parameters.

    The average injury rate levels for the 14 WHO-designated Safe Community municipalities ranged from 11.54 to 19.09 per 1000 population during the study period, which was defined as the time period during which a municipality's injury prevention program has been operational. Eleven of 14 municipalities had higher levels than their corresponding municipality groups. Five of the 14 municipalities “outperformed” their respective municipality groups and achieved a greater relative injury rate decrease during the study period. The trends for the 14 municipalities in relation to their municipality groups showed an inconsistent pattern, with only four municipalities exhibiting overall favourable trends for the study period.

    Keywords
    Intervention effectiveness, Community-based, Injury prevention, WHO Safe Community
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13874 (URN)10.1016/j.aap.2006.07.007 (DOI)
    Available from: 2006-06-26 Created: 2006-06-26 Last updated: 2017-12-13
    3. Towards improved understanding of injury prevention program sustainability
    Open this publication in new window or tab >>Towards improved understanding of injury prevention program sustainability
    2005 (English)In: Safety Science, ISSN 0925-7535, Vol. 43, no 10, p. 815-833Article in journal (Refereed) Published
    Abstract [en]

    As policy makers and funders have become more concerned with allocating scarce resources effectively, attention to the sustainability of health intervention programs has increased. However, the empirical knowledge base about factors facilitating or working against sustainability remains at an early stage. The aim of this study was to contribute to improved understanding of the conditions under which community-based injury prevention programs are most likely to attain sustainability. Ten Swedish community-based injury prevention programs were analysed with respect to factors that contribute to or detract from program sustainability. All the programs are integrated within existing municipality structures. Data were collected by means of semi-structured telephone interviews with key informants.

    The results suggested that different factors are interrelated, with no one factor being either primary or by itself sufficient for program sustainability. Financial, human, and relational resources lay the groundwork for the long-term operation of a program. The “integrated” program model appears to facilitate sustainability, but program intensity is vulnerable to changes in the financial status of the municipality and the priority-setting by municipality political decision makers. Sustainability may be compromised if a program becomes too dependent on a few key individuals. In contrast to financial, human, and relational resources, structural resources (e.g., injury surveillance and goals) appeared to have limited influence on sustainability. The programs were sustained with little evidence of effectiveness, resulting in limited feedback about how to improve a program in order to achieve and maintain long-term effectiveness.

    Keywords
    Sustainability; Resources; Activities; Effects; Context
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13875 (URN)10.1016/j.ssci.2005.08.015 (DOI)
    Available from: 2006-06-26 Created: 2006-06-26 Last updated: 2013-09-05
    4. Strategies and goals of community-based injury prevention programmes: a mixed-methods study of 25 Scandinavian WHO Safe Communities
    Open this publication in new window or tab >>Strategies and goals of community-based injury prevention programmes: a mixed-methods study of 25 Scandinavian WHO Safe Communities
    2006 (English)In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, Vol. 13, no 1, p. 27-33Article in journal (Refereed) Published
    Abstract [en]

    Documentation and analysis of prevention goals and interventions employed by community-based injury prevention programmes is vital to advance the knowledge and understanding of synergistic multi-strategy injury prevention programmes. This study examined the goals and interventions of 25 Scandinavian community-based injury prevention programmes in WHO-designated Safe Communities. Collection and analysis of quantitative data from survey questionnaires to the programme coordinators was followed by collection and analysis of qualitative data from structured interviews with programme coordinators from eight of the programmes. The results demonstrated that the programmes under study predominantly relied on 'intuitive' and subjective methods for selecting interventions. The programmes largely failed to transform injury surveillance data into information and knowledge that could prioritize community safety strategies and measures, due to insufficient time and personnel resources. The results demonstrated the importance of combining passive approaches with active interventions. Educational efforts were considered essential to the programmes. The programmes preferred to rely on broadly stated goals rather than specific objectives.

    Keywords
    Strategies; Measures; Goals; Objectives
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13876 (URN)10.1080/15660970500077352 (DOI)
    Available from: 2006-06-26 Created: 2006-06-26
    5. Using Local Injury Surveillance for Community-Based Injury Prevention: an Analysis of Scandinavian WHO Safe Community and Canadian Safe Community Foundation Programs
    Open this publication in new window or tab >>Using Local Injury Surveillance for Community-Based Injury Prevention: an Analysis of Scandinavian WHO Safe Community and Canadian Safe Community Foundation Programs
    2007 (English)In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, Vol. 14, no 1, p. 35-43Article in journal (Refereed) Published
    Abstract [en]

    Injury surveillance is widely recognized as a critical prerequisite for effective injury prevention, yet few studies have investigated its use by community-based injury prevention programmes. This study examined the extent to which local injury data were collected, documented, analysed, linked to injury prevention action and used for evaluation among WHO Safe Communities in Scandinavia (25 programmes) and the Canadian Safe Community Foundation (SCF) network (16 programmes). For each programme, a key informant with relevant local knowledge was selected to respond to an emailed questionnaire. The study demonstrates that community-based injury prevention programmes experience difficulties accessing and effectively utilizing local injury surveillance data. The findings suggest that the responding SCF programmes approach injury prevention more scientifically than the Scandinavian WHO-designated Safe Community programmes, by making greater use of injury surveillance for assessment, integration into prevention strategies and measures, and evaluation. Despite study limitations, such as the low response rate among Canadian programmes and a large number of non-responses to two questions, the results highlight the importance of, and need for, greater use of local injury surveillance.

    Keywords
    wounds & injuries, prevention, community organization, questionnaires, response rates, Scandinavia, Canada, community-based injury surveillance
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13877 (URN)10.1080/17457300600864447 (DOI)
    Available from: 2006-06-26 Created: 2006-06-26 Last updated: 2009-05-08
  • 278.
    Nilsson, Evalill
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Psychological factors related to physical, social,and mental dimensions of the SF-36: a populationbasedstudy of middle-aged women and men2010In: patient related outcome measures, Vol. 1, p. 153-162Article in journal (Refereed)
    Abstract [en]

    Background: Measures of health-related quality of life (HRQoL) are increasingly used as patient-reported outcome measures in routine health care. Research on determinants and correlates of HRQoL has, therefore, grown in importance. Earlier studies have generally been patient-based and few of them have examined differences between women and men. The aim of this study was to explore the relationship between psychological factors and physical, social, and mental dimensions of HRQoL, as measured by the Medical Outcome Study Short Form-36 Health Survey (SF-36), in a normal population and to see if observed relations were the same for women and men.

    Methods: Relations between scale scores for the eight scales of SF-36 and scale scores for Self-esteem, Sense of Coherence, Perceived Control, Depressed Mood (CES-D), and Cynicism were assessed through partial correlation and multiple linear regression analyses on a sample of 505 women and 502 men (aged 45–69 years), stratified for sex and adjusted for effects of age, presence of disease, back pain, lifestyle, and social support.

    Results: All psychological factors tested, except Cynicism, were significantly correlated to all scales of the SF-36 for women and men (Pearson product-moment partial correlation coefficient, |r| = 0.11–0.63 and |r| = 0.11–0.60, respectively). The addition of psychological factors into regression models resulted in significant total explained variance (R2) changes in all scales of the SF-36 for both sexes. Any discrepancies between women and men pertained more to the strength of relationships rather than the significance of different psychological factors.

    Conclusion: In this population-based study, psychological factors showed significant correlation, for women and men alike, with the physical and social scales of SF-36, as well as the mental scales. These findings suggest that assessments of HRQoL are not merely a measure of absolute function but are also dependent on people’s perception of their ability.

  • 279.
    Nilsson, Staffan
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, HELIX Vinn Excellence Centre.
    Samarbete kring och utredning av långtidssjukskrivna2001Report (Other academic)
  • 280.
    Nilsson, Staffan
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Yrke, Cancer och Alkohol: En studie av alkoholrelaterad cancer i olika yrken1999Report (Other academic)
    Abstract [en]

    The association between alcohol and e.g. liver cirrhosis, alcohol psychosis, alcohol poisoning, violence, accidents etc is well established . The connection between alcohol and cancer is less well known, however. Every third Swede will fall ill with cancer during their lifetime. Alcohol is considered to be the second most important risk factor of cancer, preceded by tobacco. Earlier studies on alcohol consumption in different occupations is scarce. There is however a well-established association between alcohol consumption and socio-economic group.

    The aim of this study is to examine the risks of alcohol-related cancer in men by different occupations. For this purpose the 1970 Census population was followed up for the period 1971-1984 by means of the Swedish Cancer-Environment Registry. Previous research have shown a strong association between alcohol and cancer in the oral cavity, oesophagus, larynx, and pharynx and a slightly weaker association with cancer of the liver. More than half of the incidence of aerodigestive cancer is caused by alcohol. There is a strong synergistic effect between alcohol and cancer in the aetiology of the aerodigestive cancers and more than 80% of these cancers is caused by alcohol in combination with smoking. Smoking is not a risk factor of cancer in the liver, though. The aetiology of cancer is very complex and factors and this complicates the discussion about causality. Lung cancer is largely caused by smoking and by observing the lung cancer incidence in a group the proportion of smokers can be roughly estimated. This is helpful in the estimation of impact of alcohol respectively smoking in the results. In occupational groups which display statistically significantly elevated standardised morbidity rates (SMR) of alcohol related cancer and lung cancer there is reason to take smoking into account in the discussion of the aetiology of aerodigestive cancer. This is a descriptive study is intended to be a base for further etiological or analytical studies. The aim is to establish hypotheses about the possible impact of alcohol in the aetiology of cancer at the aerodigestive sites and cancer of the liver in different occupational groups.

    The results implies a need for further research on alcohol consumption and cancer among literary and artistic workers, printing workers, housekeepers and related service workers, secretaries, typists and related workers, legal workers, travelling agents, waiters and waitresses, ship officers, post workers and other messengers, and finally packers, dockers and freight handlers, store and warehouse workers. It is difficult to draw any general conclusions from these results, but in several of these occupational groups there are several established risk factors of a higher alcohol consumption to be found, such as inadequate social contacts, low control, high demands resulting in high tension, among others. Whether the cancer, examined in this study, is caused by alcohol or some other risk factors it is important in a pubic health perspective to study these occupational groups and work environments in further detail to order to enable future prevention.

  • 281.
    Nilsson, Staffan
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    John, Carstensen
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Mortality among male and female smokers in Sweden2000In: Norweigian Journal of Epidemiology, ISSN 0803-4206, Vol. 10, no 2, p. 78-78Article in journal (Refereed)
    Abstract [en]

    n/a

  • 282.
    Nilsson, Staffan
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    John, Carstensen
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Pershagen, Göran
    Karolinska Institute.
    Mortality among male and female smokers in Sweden: A 33 year follow up2001In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 55, no 11, p. 825-830Article in journal (Refereed)
    Abstract [en]

    Study objective - It is still unclear if men and women are equally susceptible to the hazards of tobacco smoking. The objective of this study was to examine smoking-related mortality among men and women.

    Design - In 1963 a questionnaire concerning tobacco smoking habits was sent out to a random sample from the 1960 Swedish census population. Date and cause of death have been collected for the deceased in the cohort through 1996.

    Setting - Sweden

    Participants - The survey included a total of 27 841 men and 28 089 women, aged 18-69 years. The response rate was 93.1% among the men and 95.4% among the women.

    Main results - After adjustment for age and place of residence positive associations were found between cigarette smoking and mortality from ischaemic heart disease, aortic aneurysm, bronchitis and emphysema, cancer of the lung, upper aerodigestive sites, bladder, pancreas in both men and women, but not from cerebrovascular disease. When the effect of amount of the cigarette consumption was considered, female smokers displayed e.g. slightly higher relative death rates from ischaemic heart disease. However, no statistically significant gender differential in relative mortality rates was observed for any of the studied diseases.

    Conclusions - Women and men in this Swedish cohort seem equally susceptible to the hazards of smoking, when the gender differential in smoking characteristics is accounted for. Although the cohort under study is large, there were few female smokers in the high consuming categories and the relative risk estimates are therefore accompanied by wide confidence intervals in these categories.

  • 283.
    Nilsson, Staffan
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Department of Behavioural Sciences and Learning, Work and Working Life. Linköping University, Department of Behavioural Sciences and Learning, Learning in Working Life and Educational Settings. Linköping University, HELIX Vinn Excellence Centre.
    Persson, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences. Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, HELIX Vinn Excellence Centre.
    Ekberg, Kerstin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences. Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, HELIX Vinn Excellence Centre.
    Arbetsförmåga och anställningsbarhet efter långvarig sjukskrivning2009Report (Other academic)
  • 284.
    Nodenfelt, Lennart
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Begreppet arbetsförmåga2009In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 86, no 3, p. 220-228Article in journal (Refereed)
    Abstract [en]

    There are several causes and reasons to why a person lack the ability to take a job or to perform his or her tasks at the work place. Even though nearly all these causes and reasons are well-known, we lack a way of systematicly analysing them. There is a need to understand how they are empirically and logically related to each other. As a reslut of such an analysis we can classify the conditions of work ability and thereby more easily distinguish between different types of reduced work ability. This article is an attempt to contribute to such an analysis.

  • 285.
    Nordanskog, Pia
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Hultén, Martin
    Psychiatric Neuromodulation Unit (PNU), Dept of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.
    Landén, Mikael
    Psychiatric Neuromodulation Unit (PNU), Dept of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.
    Lundberg, Johan
    Department of Clinical Neuroscience, Karolinska Institutet and Section for Affective Disorders, Northern Stockholm Psychiatry, Stockholm, Sweden.
    von Knorring, Lars
    Department of Neuroscience, Psychiatry, Uppsala university, Uppsala, Sweden.
    Nordenskjöld, Axel
    Department of Psychiatry, Faculty ofMedicine and Health, Örebro University, Örebro, Sweden.
    Electroconvulsive Therapy in Sweden 2013: Data From the National Quality Register for ECT2015In: The Journal of ECT, ISSN 1095-0680, Vol. 31, no 4, p. 263-267Article in journal (Refereed)
    Abstract [en]

    Objectives: The use of electroconvulsive therapy (ECT) varies across countries. The aim of this study was to describe and explore the use of ECT in Sweden in 2013.

    Methods: The Swedish mandatory patient register of the National Board of Health and Welfare includes information on diagnoses and treatments, including ECT. All 56 hospitals that provide ECT in Sweden also report to the nonmandatory national quality register for ECT, which contains information on patient and treatment characteristics. In this study, we combined data from both registers. In addition, all hospitals responded to a survey concerning equipment and organization of ECT.

    Results: We identified 3972 unique patients who received ECT in Sweden in 2013. This translates into 41 ECT-treated individuals per 100,000 inhabitants. Of these patients, 85% opted to participate in the quality register. The median age was 55 years (range, 15-94 years), and 63% were women. The indication was depression in 78% of the treatment series. Of 4 711 hospitalized patients with severe depression, 38% received ECT. The median number of treatments per index series was 7. Unilateral treatment was used in 86% of the series.

    Conclusions: In Sweden, ECT is used at a relatively high rate as compared with other western countries, and the rate was unchanged from the last survey in 1975. However, there is room for improvement in the specificity of use and availability of ECT for disorders where ECT is considered a first-line treatment.

  • 286.
    Nordanskog, Pia
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Knutsson, Linda
    Department of Medical Radiation Physics, Lund University, Lund, Sweden.
    Larsson, Elna-Marie
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.
    Johanson, Aki
    Department of Psychiatry, Lund University, Lund, Sweden.
    Relative decrease of frontal blood flow after electroconvulsive therapy in depression distinguishes remission: a perfusion MRI studyManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Understanding electroconvulsive therapy (ECT) is of importance not only for optimizing treatment, but could also provide important information about key features of the healing process in depression. Enhanced inhibition (the anticonvulsant hypothesis) is one of several suggested mechanisms of action of ECT. Earlier studies on cerebral blood flow during ECT have given diverging results. Our aim was to study changes in cerebral blood flow in depression treated with ECT and their relation to treatment outcome.

    Methods: We obtained MRI scans in 14 depressed subjects referred for ECT. Cerebral blood flow (CBF) was measured using dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) within 1 week before and 2 weeks after a course of ECT. The relative CBF was calculated from mean values in predefined regions of interest in relation to the mean value in the whole brain.

    Results: A significant relative CBF increase in the occipital region (p < 0.05) and a significant relative decrease in the right lateral temporal lobe (p < 0.05) were found in the entire study group. A significant decrease in the right frontal lobe, with a significant anteriorposterior and right-left gradient shift in relative CBF, was a distinguishing feature in patients with ECT-induced remission (n = 8).

    Limitations: This observational study is limited by the risk of random bias and its low number of participants.

    Conclusions: Our results suggest that a decreased relative blood flow in frontal regions may be a hallmark of treatment efficacy in depression treated with ECT.

  • 287.
    Nordenfelt, Lennart
    Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, Faculty of Arts and Sciences.
    Disability, Action Theory and the ICF2003In: Newsletter on the WHO-FIC, ISSN 1388-5138, Vol. 1, no 1, p. 13-15Article in journal (Other academic)
  • 288.
    Nordenfelt, Patrik
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hereditary Angioedema in Sweden: a National Project2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Hereditary angioedema (HAE) due to C1-inhibitor deficiency, type I and II, is a rare disease with an estimated prevalence of 1/50,000. Angioedema in the larynx can be life threatening and angioedema in the abdomen and skin can give severe and disabling pain. Data on patients with HAE in Sweden were scarce before our study.

    Aim: To study the prevalence of HAE, and to investigate clinical manifestations, treatments, and Health-Related Quality of Life (HR-QoL) in adults and children in Sweden.

    Method: In studies, I and II, all patients received a written questionnaire followed by a phone interview with questions about clinical manifestations, medication, sick leave and QoL. In study III the patients completed EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) questionnaires for both the attack-free state (EQ5D today), and the last HAE attack (EQ5D attack). Questions were also asked about sick-leave. In study IV all adults received questionnaires with EQ-5D-5L and RAND-36, Angioedema Quality of Life instrument (AE-QoL), and Angioedema Activity Score (AAS) form, and questionnaires on sick leave and prophylactic medication.

    Results: We identified 146 patients, 110 adults and 36 children with HAE, type I (n=136) or II (n=10), giving a minimal HAE prevalence of 1.54/100,000. For adults, the median age at onset of symptoms was 12 years and median age at diagnosis was 22 years. Median age at onset of symptoms for children was 4 years and at diagnosis 3 years. During the previous year, 47% of adults experienced at least 12 attacks, 21% 4-11 attacks, 11% 1-3 attacks, while 22% were asymptomatic. For children, the corresponding figures were about the same. The median number of attacks in those having attacks was 14 in adults and 6 in children last year. Adult females reported on average 19 attacks the previous year versus nine for males. Irrespective of location nine out of 10 reported pain. Trigger factors were experienced in 95 % of adults and 74 % of children. Plasma-derived C1-inhibitor concentrate (pdC1INH) had a very good effect on acute attacks. Long-term prophylaxis with androgens and pdC1INH reduced the annual attack frequency by more than 50 %. Of the children’s parents, 73% had been on parental leave to care for the child due to HAE symptoms. Health and QoL were generally rated as good. In study III 103 of 139 responded and reported an EQ5D today score that was significantly higher than the EQ5D attack score. Attack frequency had a negative effect on EQ5D today. Children had significantly higher EQ-5D-5L than adults. Forty four percent had been absent from work or school during the latest attack. In study IV 64 of 133 adults responded. The most affected HR-QoL dimensions in EQ-5D-5L were pain/discomfort and anxiety/depression, in RAND-36 energy/fatigue, general health, health transition, pain, and in AE-QoL fears/shame and fatigue/mood. Females had significantly lower HR-QoL in RAND-36 for general health and energy/fatigue. There was an association between AAS and EQ-5D-5L/RAND-36 (except physical function) /AEQoL. There was no significant difference in HR-QoL in patients with and without prophylactic medication.

    Conclusion: The minimal prevalence of HAE type I and II in Sweden is 1.54/100,000. Median age at onset was 12 years. Adult females had twice as many attacks as males, adults had also twice as many attacks as children. For acute treatment, pdC1INH had a very good effect. For long term prophylaxis, androgens and pdC1INH had good effect. The most affected HR-QoL dimensions in EQ-5D-5L were pain/discomfort and anxiety/ depression, in RAND-36 energy/fatigue, general health, health transition and pain, and in AE-QoL fears/shame and fatigue/mood. Children reported better HR-QoL than adults. AE-QoL is more disease-specific in HAE than the generic instruments EQ-5D-5L and RAND-36. However, the latter highlights the pain aspect, whereas AE-QoL does not. Patients with high disease activity should thus be considered for more intensive treatment to improve their HR-QoL.

    List of papers
    1. Hereditary Angioedema in Swedish Adults: Report From the National Cohort
    Open this publication in new window or tab >>Hereditary Angioedema in Swedish Adults: Report From the National Cohort
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    2016 (English)In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 96, no 4, p. 540-545Article in journal (Refereed) Published
    Abstract [en]

    Hereditary angioedema (HAE) is rare, disabling and sometimes life-threatening. The aim of this study is to describe its prevalence, symptomatology and treatment in Sweden. A total of 146 patients were identified; 110 adults and 36 children with HAE type I (n = 136) or II (n = 10), giving a minimum HAE prevalence of 1.54/100,000. All patients received a written questionnaire followed by a structured telephone interview. This report focuses on the 102 adults who responded. Females reported 19 attacks in the previous year vs. 9 for males (p &lt; 0.01), and females reported 10 days of sick leave vs. 4 days for males (p &lt; 0.05). For all treated acute attacks, plasma-derived Cl-inhibitor concentrate (pdClINH) (used in 27% of patients) had a good effect. For maintenance treatment, 43% used attenuated androgens and 8% used pdClINH, which reduced their attack rate by more than 50%. In conclusion, the minimum HAE prevalence in Sweden was 1.54/100,000. HAE affected females more severely. Attenuated androgens and pdClINH had a good effect on preventing attacks.

    Place, publisher, year, edition, pages
    ACTA DERMATO-VENEREOLOGICA, 2016
    Keywords
    Clinhibitor deficiency; census; clinical manifestations; epidemiology; hereditary angioedema; prevalence; Sweden
    National Category
    Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-128976 (URN)10.2340/00015555-2274 (DOI)000375741300022 ()26540175 (PubMedID)
    Note

    Funding Agencies|Futurum the Academy for Healthcare; Jonkoping County Council; Linkoping University; Karolinska Institutet

    Available from: 2016-06-09 Created: 2016-06-07 Last updated: 2018-03-19
    2. Swedish children with hereditary angioedema report good overall health and quality of life despite symptoms
    Open this publication in new window or tab >>Swedish children with hereditary angioedema report good overall health and quality of life despite symptoms
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    2016 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 5, p. 529-534Article in journal (Refereed) Published
    Abstract [en]

    AimFew studies have been published on children with hereditary angioedema (HAE), an autosomal dominant disease caused by mutations on chromosome 11. This study explored various aspects of the disease in the Swedish paediatric population. MethodsA retrospective questionnaire was sent to all 36 Swedish children known to have HAE, and a physician carried out follow-up telephone interviews. ResultsMost of the questionnaires were completed by the parents of 31 (86%) children with HAE, with or without their input, at a median age of nine years (range 1-17), and the physician also interviewed 29. HAE symptoms were experienced by 23 children, including abdominal attacks (96%), skin swelling (78%) and swelling in the mouth and/or upper airways (52%). Psychological stress was the most common trigger for abdominal attacks and trauma and sports triggered skin swelling. The majority (n = 19) had access to complement-1 esterase inhibitor concentrate at home. Current health and quality of life were generally rated as good, independent of whether the child had experienced HAE symptoms or not. ConclusionMost children with HAE had experienced abdominal attacks and skin swelling, but their overall health and quality of life were generally perceived to be good.

    Place, publisher, year, edition, pages
    WILEY-BLACKWELL, 2016
    Keywords
    Children; Complement-1 esterase inhibitor defects; Epidemiology; Hereditary angioedema; Symptoms
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-127743 (URN)10.1111/apa.13345 (DOI)000373921200028 ()26821285 (PubMedID)
    Note

    Funding Agencies|Futurum - the Academy for Health and Care; Region Jonkoping County; Linkoping University; Karolinska Institutet

    Available from: 2016-05-12 Created: 2016-05-12 Last updated: 2017-11-30
    3. Quantifying the burden of disease and perceived health state in patients with hereditary angioedema in Sweden
    Open this publication in new window or tab >>Quantifying the burden of disease and perceived health state in patients with hereditary angioedema in Sweden
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    2014 (English)In: Allergy and Asthma Proceedings, ISSN 1088-5412, E-ISSN 1539-6304, Vol. 35, no 2, p. 185-190Article in journal (Refereed) Published
    Abstract [en]

    Hereditary angioedema (HAE) due to C1 inhibitor deficiency is a rare disease characterized by attacks of edema, known to impact quality of life (QoL). This study investigates the burden of HAE in Swedish patients, both children and adults. We used a retrospective registry study of Swedish patients with HAE, captured by the Sweha-Reg census. Data were collected using a paper-based survey. Patients completed EuroQoL 5 Dimensions 5 Levels (EQ5D-5L) questionnaires for both the attack-free state (EQ5D today), and the last HAE attack (EQ5D attack). Questions related to patients age and sex and other variables, such as attack location and severity, were included to better understand the burden of HAE. EQ5D-5L values were estimated for the two HAE disease states. Patient-reported sick leave was also analyzed. A total of 103 responses were analyzed from 139 surveys (74% response rate). One hundred one reported an EQ5D today score (mean, 0.825) and 78 reported an EQ5D attack score (mean, 0.512) with significant differences between the two states (p less than 0.0001). This difference was observed for both mild (p less than 0.05), moderate (p less than 0.0001), and severe attacks (p less than 0.0001). Attack frequency had a negative effect on EQ5D today. Patients with greater than30 attacks a year had a significantly lower EQ5D today score than those with less frequent attacks. Of 74 participants, 33 (44.6%) had been absent from work or school during the latest attack and, of those with a severe attack, 81% had been absent. HAE has a significant impact on QoL both during and between attacks and on absenteeism during attacks.

    Place, publisher, year, edition, pages
    OceanSide Publications; 1999, 2014
    National Category
    Engineering and Technology
    Identifiers
    urn:nbn:se:liu:diva-106024 (URN)10.2500/aap.2014.35.3738 (DOI)000333071700015 ()
    Available from: 2014-04-17 Created: 2014-04-17 Last updated: 2017-12-05
    4. Health-related quality of life in relation to disease activity in adults with hereditary angioedema in Sweden
    Open this publication in new window or tab >>Health-related quality of life in relation to disease activity in adults with hereditary angioedema in Sweden
    Show others...
    2017 (English)In: Allergy and Asthma Proceedings, ISSN 1088-5412, E-ISSN 1539-6304, Vol. 38, no 6, p. 447-455Article in journal (Refereed) Published
    Abstract [en]

    Background: Health-related quality of life (HR-QoL) is impaired in patients with hereditary angioedema (HAE) but has not yet been satisfactorily described.

    Objective: To study HR-QoL in patients with HAE by combining different HR-QoL instruments with disease activity assessment. Methods: All adults in the Swedish HAE registry were invited to take part in this questionnaire study, which used the generic HR-QoL instruments, EuroQol 5 Dimensions 5 Level (EQ-5D-5L) and the RAND Corporation Short Form 36 (RAND-36), the disease-specific Angioedema Quality of Life instrument (AE-QoL), the recently introduced Angioedema Activity Score (AAS) form, and questionnaires on sick leave and prophylactic medication.

    Results: Sixty-four of 133 adults (26 men, 38 women) between 18 and 91 years old responded. The most affected HR-QoL dimensions in the EQ-5D-5L were pain/discomfort and anxiety/depression; in the RAND-36, energy/fatigue, general health, pain; and, in the AE-QoL, fears/shame and fatigue/mood. Women had lower HR-QoL in the RAND-36 for general health and energy/fatigue (p < 0.05). Patients who reported any AAS of >0 had significantly impaired HR-QoL. There were significant associations (p < 0.05) between the AAS and EQ-5D-5L, between the AAS and all dimensions of the RAND-36 except physical function, and between the AAS and AE-QoL in all dimensions. Nine of 36 patients who reported sick leave during the previous 4 weeks had significantly impaired HR-QoL in all the instruments (p < 0.05). There was no significant difference in HR-QoL in the patients with and the patients without prophylactic medication, except for the nutrition dimension of the AE-QoL (p < 0.05).

    Conclusion: Comprehensive information is obtained by combining different HR-QoL instruments. Pain, anxiety/depression, and fatigue/mood are important aspects of HAE but the AE-QoL disregards pain. HR-QoL was not significantly affected by prophylaxis. Increased disease activity was associated with impaired HR-QoL, which justifies more active disease management.

    Place, publisher, year, edition, pages
    OceanSide Publications, 2017
    Keywords
    AAS; AE-QoL; C1-inhibitor deficiency; EQ-5D-5L; HAE; HR-QoL; RAND-36; Sweden; disease activity; prophylaxis; sex differences; sick leave; the Svensson method
    National Category
    Neurology Public Health, Global Health, Social Medicine and Epidemiology Geriatrics
    Identifiers
    urn:nbn:se:liu:diva-142205 (URN)10.2500/aap.2017.38.4087 (DOI)000415839200009 ()28855002 (PubMedID)
    Note

    Funding agencies: Karolinska Institutet; Stockholm County Council, Stockholm; Futurum; Jonkoping County Council, Jonkoping; Linkoping University, Linkoping, Sweden; CSL Behring; Shire; Galderma; Novartis

    Available from: 2017-10-23 Created: 2017-10-23 Last updated: 2018-03-28Bibliographically approved
  • 289.
    Nordenfelt, Patrik
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.
    Nilsson, Mats
    Futurum, Academy for Health and Care, Jönköping County Council, Jönköping, Sweden.
    Lindfors, Anders
    Department of Pediatrics, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Wahlgren, Carl-Fredrik
    Dermatology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden / Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden.
    Björkander, Jan Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Futurum, Academy for Health and Care, Jönköping County Council, Jönköping, Sweden,.
    Health-related quality of life in relation to disease activity in adults with hereditary angioedema in Sweden2017In: Allergy and Asthma Proceedings, ISSN 1088-5412, E-ISSN 1539-6304, Vol. 38, no 6, p. 447-455Article in journal (Refereed)
    Abstract [en]

    Background: Health-related quality of life (HR-QoL) is impaired in patients with hereditary angioedema (HAE) but has not yet been satisfactorily described.

    Objective: To study HR-QoL in patients with HAE by combining different HR-QoL instruments with disease activity assessment. Methods: All adults in the Swedish HAE registry were invited to take part in this questionnaire study, which used the generic HR-QoL instruments, EuroQol 5 Dimensions 5 Level (EQ-5D-5L) and the RAND Corporation Short Form 36 (RAND-36), the disease-specific Angioedema Quality of Life instrument (AE-QoL), the recently introduced Angioedema Activity Score (AAS) form, and questionnaires on sick leave and prophylactic medication.

    Results: Sixty-four of 133 adults (26 men, 38 women) between 18 and 91 years old responded. The most affected HR-QoL dimensions in the EQ-5D-5L were pain/discomfort and anxiety/depression; in the RAND-36, energy/fatigue, general health, pain; and, in the AE-QoL, fears/shame and fatigue/mood. Women had lower HR-QoL in the RAND-36 for general health and energy/fatigue (p < 0.05). Patients who reported any AAS of >0 had significantly impaired HR-QoL. There were significant associations (p < 0.05) between the AAS and EQ-5D-5L, between the AAS and all dimensions of the RAND-36 except physical function, and between the AAS and AE-QoL in all dimensions. Nine of 36 patients who reported sick leave during the previous 4 weeks had significantly impaired HR-QoL in all the instruments (p < 0.05). There was no significant difference in HR-QoL in the patients with and the patients without prophylactic medication, except for the nutrition dimension of the AE-QoL (p < 0.05).

    Conclusion: Comprehensive information is obtained by combining different HR-QoL instruments. Pain, anxiety/depression, and fatigue/mood are important aspects of HAE but the AE-QoL disregards pain. HR-QoL was not significantly affected by prophylaxis. Increased disease activity was associated with impaired HR-QoL, which justifies more active disease management.

  • 290.
    Nordlund, Lars Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Pershagen, Göran
    Karolinska institutet, Stockholm.
    Are male and female smokers at equal risk of smoking-related cancer: evidence from a Swedish prospective study1999In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 27, no 1, p. 56-62Article in journal (Refereed)
    Abstract [en]

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

  • 291.
    Nordlund, Lars Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Pershagen, Göran
    Karolinska institutet, Stockholm.
    Cancer incidence in female smokers: a 26-year follow-up1997In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 73, no 5, p. 625-628Article in journal (Refereed)
    Abstract [en]

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

  • 292.
    Nordqvist, Cecilila
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Alcohol screening and simple advice in emergency care: staffs’ attitudes and injured patients’ drinking pattern2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: About 800,000 people are risky drinkers in Sweden and the alcohol consumption has increased around 30% during the last 6 years. In order to counteract the negative effects of drinking there is a need to implement preventive measures at various levels in society. One place where risky drinkers could be identified is the healthcare setting. More than 10% of the visits at emergency departments and 20% of the injuries have been found to be alcohol‐related. So far, very few risky drinkers attending emergency departments receive advice about sensible drinking although there is good research evidence of the efficacy of such advice. Aim: The main aim was to explore the effects of a simple alcohol preventive routine in emergency care on staffs´ attitudes towards alcohol prevention and injury patients´ drinking pattern. Material and methods: A screening and simple advice routine was introduced at the emergency department of Motala County hospital. The staffs´ attitudes were explored by interviews with 12 staff members before the introduction and in 6 follow‐up interviews after a year. All the triage staffs´ attitudes were also measured by a questionnaire before the start of the routine and after 6 months. During the first 6 months of the routine 878 injury patients between 16 and 70 completed an alcohol screening questionnaire. During the next 6 months 647 patients received written advice about sensible drinking after having completed the screening questionnaire. A total of 619 patients included in the 12 months study period were followed‐up by telephone interview and changes in drinking pattern were analyzed. After a further 6 months of intervention a total of 2151 patients had been completing the questionnaire during the total study period of 18 months. The association between drinking pattern and different injury variables was analyzed in order to identify special risk groups and situations. Results: The staff was generally positive to alcohol prevention before the routine started and it was completed as intended. After 6 months of screening the staffs´ role legitimacy and perceived skills had increased. Despite of a further positive change in attitudes towards alcohol prevention the staff was uncertain after the study period whether emergency departments are appropriate settings for alcohol prevention. A total of 9% of the women and 31% of the men attending the emergency department for an injury were defined as risky drinkers. One single item in the questionnaire, concerning frequency of heavy episodic drinking, identified the majority of risky drinkers. In the cohort of patients,who was only screened, 34% was no longer engaged in heavy episodic drinking after 6 months and in the cohort that received written advice in addition to the screening the proportion was 25%. The latter group also increased readiness to change by 14%. The proportion of risky drinkers was higher among injury patients, 21% compared to 15% in the general population in the cathment area. This was mostly explained by a higher proportion of young men in the study group. When drinking pattern was compared, both risky and non‐risky drinkers proved to be significantly more likely than abstainers to be injured in amusement locations, parks, lakes or seas and during play or other recreational activities, when controlling for age and sex. Nine percent of the injury patients reported that they believed that their injury was related to alcohol. Half of this group was non risky‐drinkers. Conclusions: The triage staff performed the intervention as agreed, and in some aspects, which could facilitate further development of alcohol preventive measures, their attitudes changed positively. However, it appears difficult to expect alcohol preventive measures to involve more of the staff’s time than the routine tried, and other practical solutions have to be evaluated. A question about frequency of heavy episodic drinking identified the majority of risky drinkers and could be used as a single screening question. There was a reasonable reduction in heavy episodic drinking among the injury patients. The lack of a control group makes it difficult to fully explain whether this change is a result of the injury per se, the screening and the written advice procedure or a natural fluctuation in the patients´ drinking pattern. More studies are needed in order to establish the minimal levels of intervention in routine care that is accepted by the staff, and has a reasonable effect on risky drinkers’ alcohol consumption.

    List of papers
    1. Alcohol prevention measures at an emergency department: physicians` perspectives. Short communication
    Open this publication in new window or tab >>Alcohol prevention measures at an emergency department: physicians` perspectives. Short communication
    2005 (English)In: Public Health, ISSN 0033-3506, Vol. 119, no 9, p. 789-791Article in journal (Refereed) Published
    Keywords
    Physicians' attitudes; Routine alcohol screening; Prevention of alcohol problems; Emergency department
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13756 (URN)10.1016/j.puhe.2004.10.008 (DOI)
    Available from: 2006-01-16 Created: 2006-01-16
    2. Attitude changes among emergency department triage staff after conducting routine alcohol screening
    Open this publication in new window or tab >>Attitude changes among emergency department triage staff after conducting routine alcohol screening
    2006 (English)In: Addictive Behaviors, ISSN 0306-4603, Vol. 31, no 2, p. 191-202Article in journal (Refereed) Published
    Abstract [en]

    Excessive alcohol consumption is common among injury patients, but routine alcohol interventions seem to be difficult to implement in emergency departments. An obstacle seen in previous studies is the limited time available in a real-world setting for staff to participate in routine alcohol screening and interventions. In the present study, ordinary staff participated in a simple alcohol screening procedure. The aim of the study was to evaluate the feasibility of this procedure and if there was any change in attitudes and practices among triage staff after the implementation. We analyzed interviews with six staff members and questionnaires completed by 29 nurses and medical secretaries before and after a period of systematic routine screening. The staff reported that the routine worked well and that few patients reacted negatively. A positive change was seen in attitudes towards alcohol preventive measures in general. However, this seems not to be sufficient for the staff to spontaneously engage more actively. In fact, more of the staff were uncertain after the study period whether the emergency department is an appropriate place for alcohol screening and intervention despite an increased role legitimacy and perceived competence. There is a need for further development of alcohol prevention models that are acceptable for the staff to implement as part of the daily routine.

    Keywords
    Nurses; Medical secretaries; Attitude change; Emergency department; Obstacles to screening; Role legitimacy; Routine screening
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13757 (URN)10.1016/j.addbeh.2005.04.021 (DOI)
    Available from: 2006-01-16 Created: 2006-01-16
    3. Routine screening for risky alcohol consumption at an emergency department using the AUDIT-C questionnaire
    Open this publication in new window or tab >>Routine screening for risky alcohol consumption at an emergency department using the AUDIT-C questionnaire
    2004 (English)In: Drug and Alcohol Dependence, ISSN 0376-8716, Vol. 74, no 1, p. 71-75Article in journal (Refereed) Published
    Abstract [en]

    A questionnaire including the three AUDIT-C items was used to screen for alcohol use among trauma patients. The aim was to display, in a pragmatic way, how the AUDIT-C scores can be converted into different levels and kind of risky drinking. Using AUDIT-C scores with a cut-off score of 4 points for women and 5 for men indicated that 28% of the women and 40% of the men were risky drinkers. When calculating weekly alcohol consumption from the answers in AUDIT-C, 3% of the women and 7% of the men were hazardous and/or harmful drinkers. Regarding heavy episodic drinking 7% of the women and 30% of the men was drinking 72 g alcohol or more at on at least one occasion a month. These results indicate that the AUDIT-C score as such give little information about the pattern of alcohol consumption and that evaluation of risky drinking must be calculated from the three items in order to differentiate between risky drinking in terms of alcohol consumed per week and heavy episodic drinking.

    Keywords
    AUDIT-C, Increased-risk drinking, Screening, Emergency department, Alcohol consumption
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13758 (URN)10.1016/j.drugalcdep.2003.11.010 (DOI)
    Available from: 2006-01-16 Created: 2006-01-16
    4. Can screening and simple written advice reduce excessive alcohol consumption among emergency care patients?
    Open this publication in new window or tab >>Can screening and simple written advice reduce excessive alcohol consumption among emergency care patients?
    2005 (English)In: Alcohol & Alcoholism, ISSN 0735-0414 (print) 1464-3502 (online), Vol. 40, no 5, p. 401-408Article in journal (Refereed) Published
    Abstract [en]

    Aims: Emergency care patients have an overrepresentation of risky drinkers. Despite the evidence on the effectiveness of a short feedback on screening or self-help material, most studies performed so far have required considerable time from staff and thus been difficult to implement in the real world. The present study evaluates the effect of the screening and whether simple written advice has any additional effect on risky drinking.

    Methods: An alcohol screening routine was implemented among injury patients in a Swedish emergency care department. Over 12 months, two cohorts were invited to answer an alcohol screening questionnaire in the waiting room. In the first 6 months, 771 patients were screened without any written advice (cohort A) and in the following 6 months, 563 were screened and in addition received simple written advice about sensible drinking (cohort B). None of the patients received one-to-one feedback. Six months after the screening, a follow-up interview by telephone explored the changes in drinking.

    Results: In cohort A 182 (24%) of the patients were defined as risky drinkers and in cohort B 125 (22%). Reached at follow-up after 6 months were 81 (44%) risky and 278 (47%) non-risky drinkers in cohort A, and 40 (32%) risky and 220 (50%) non-risky drinkers in cohort B. The number of patients with heavy episodic drinking decreased significantly in cohort A from 76 (94% of the risky drinkers) to 49 (59%). In cohort B a similar change was seen from 37 (92%) to 27 (68%). Only in cohort B, was a significant increase in readiness to change drinking habits seen [from 3 (8%) to 9 (23%)]. The reduction in heavy episodic drinking was comparable with previous reports from more extensive interventions. However, at the time of follow-up, drinking among non-risky drinkers at baseline had increased. When considering the greater numbers of non-risky drinkers, the total consumption in the study group increased during the study period.

    Conclusions: Owing to the reported difficulties of integrating more time-consuming alcohol interventions in emergency departments, it is suggested that at least screening for drinking should be implemented as routine in emergency departments. More research is needed in order to establish the optimal balance between effective alcohol intervention, and acceptable time and effort requirement from staff.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13759 (URN)10.1093/alcalc/agh175 (DOI)
    Available from: 2006-01-16 Created: 2006-01-16 Last updated: 2009-05-28
    5. Usual drinking pattern and non‐fatal injury among patients seeking medical care
    Open this publication in new window or tab >>Usual drinking pattern and non‐fatal injury among patients seeking medical care
    Show others...
    2006 (English)In: Public Health, ISSN 0033-3506, Vol. 120, no 11, p. 1064-1073Article in journal (Refereed) Published
    Abstract [en]

    Objectives

    To explore the association between drinking patterns, irrespective of whether alcohol was consumed in the event of the injury or not, and different injury variables; and to identify settings and situations in which risky drinkers have an increased likelihood of injury.

    Study design

    The study population consisted of all patients aged 18–70 years registered for an injury according to ICD-10 at a Swedish emergency department during an 18-month period. After informed consent, the injury patients were screened for drinking habits by the AUDIT-C questionnaire. The gender, age and drinking pattern of injury patients were compared with the general population.

    Methods

    A total of 2782 patients aged 18–70 years were registered for an injury during the study period. The number of drop-outs was 631. Drop-outs include those who did not consent to participate, were severely injured, too intoxicated or did not fill out the questionnaire satisfactory. Thus, 77.3% of the target group were included for further analysis (1944 drinkers and 207 abstainers). The patients were categorized into three drinking categories: abstainers, non-risky and risky drinkers. Risky drinkers were defined according to usual weekly consumption of 80 g or more of alcohol for women and 110 g or more for men and/or heavy episodic drinking (i.e. having six glasses or more one glass=12 g alcohol), or both, on one occasion at least once a month, valid for both women and men. To estimate the relationship between drinking patterns and the injury variables (environment, cause of injury, activity and diagnosis), odds ratios (OR) were calculated by logistic regression. Multiple logistic regression was used in order to control for age and sex differences between the various drinking and injury categories.

    Results

    The proportion of risky drinkers was higher in the study population compared with the general population in the same area. When controlling for age and sex, risky drinkers (OR 6.4adj Confidence interval CI 1.9–21.2) and non-risky drinkers (OR .4.5adj CI 1.4–14.5) displayed an increased risk for injury compared with abstainers, in amusement locations, parks, by or on lakes or seas, especially while engaged in play, hobby or other leisure activities (risky drinkers: OR 2.8adj CI 1.3–5.6; non-risky drinkers: OR 2.4adj CI 1.2–4.6). All differences between drinking patterns in external cause of injury disappeared when age and sex were considered. During rest, meals and attending to personal hygiene, the non-risky drinkers had a lower probability of injury compared with abstainers (OR 0.3adj CI 0.1–0.8). Non-risky drinkers had a higher probability than abstainers of suffering luxation (dislocation) or distortion (OR 1.6adj CI 1.1–2.5). Nine per cent of the study population reported that they believed that their injury was related to intake of alcohol. Half of this group were non-risky drinkers (CI for the 13.7% difference was 9.7–17.6).

    Conclusions

    Few significant associations between drinking pattern and injury remained when age and sex were controlled for.

    Keywords
    Usual alcohol drinking patterns; Non-fatal injury; Risky drinkers; Emergency care
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13760 (URN)10.1016/j.puhe.2006.06.007 (DOI)
    Available from: 2006-01-16 Created: 2006-01-16 Last updated: 2009-05-28
  • 293.
    Norlin, Anna-Karin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Olsen Faresjö, Åshild
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Falk, Magnus
    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.
    Jones, Michael P.
    Macquarie Univ, Australia.
    Walter, Susanna
    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, Department of Gastroentorology. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Primary healthcare utilisation and self-rated health among patients with Irritable Bowel Syndrome: What are the impacts of comorbidities, gastrointestinal symptom burden, sense of coherence and stress?2019In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 119Article in journal (Refereed)
    Abstract [en]

    Objectives: Irritable Bowel Syndrome (IBS) is a chronic gastrointestinal disease associated with impaired quality of life and an increased use of healthcare services. Self-ratings of health have proven a powerful predictor of health outcomes. The aim of this study was to evaluate the unique impacts of comorbidities, gastrointestinal symptoms, perceived stress and sense of coherence on the number of healthcare contacts and self-rated health of IBS patients in Swedish primary care. Methods: In this cross-sectional study, 186 primary-care IBS patients and 360 non-IBS patients (as a reference group) were administrated a test battery of validated questionnaires. Data on comorbidities and healthcare-seeking frequency were obtained from a registry. Results: In the reduced multivariable logistic regression model, average days of abdominal pain/week (OR = 0.83, 95% CI = 0.72-0.96), age (OR = 0.95, 95% CI = 0.92-0.97) and sense of coherence (OR = 1.07, 95% CI = 1.03-1.11) remained independent, statistically significant predictors of IBS (and non-IBS) patients reporting good health. Only the number of comorbidities in general (OR = 1.22, 95% CI = 1.14-1.32) and sleep disorders in particular (OR = 5.40, 95% CI = 1.85-15.76) independently predicted high levels of primary healthcare utilisation among IBS patients. Conclusion: Lack of gastrointestinal symptoms, a high sense of coherence and younger age were associated with better self-rated health in both IBS and non-IBS patients. The number of comorbidities in general and sleep disorders in particular were associated with frequent PHC contacts in IBS patients. The association between frequent primary-care contacts and sleep disorders was not seen in the control group, indicating a unique association with IBS patients.

  • 294.
    Numerato, Dino
    et al.
    Bocconi University, Italy.
    Fattore, Giovanni
    Bocconi University, Italy.
    Tediosi, Fabrizio
    Bocconi University, Italy.
    Zanini, Rinaldo
    Osped A Manzoni, Italy.
    Peltola, Mikko
    National Institute Health and Welf, Finland.
    Banks, Helen
    Bocconi University, Italy.
    Mihalicza, Peter
    Semmelweis University, Hungary.
    Lehtonen, Liisa
    Turku University Hospital, Finland; Turku University, Finland.
    Svereus, Sofia
    Karolinska Institute, Sweden.
    Heijink, Richard
    National Institute Public Health and Environm, Netherlands.
    Toksvig Klitkou, Soren
    University of Oslo, Norway.
    Fletcher, Eilidh
    NHS Lothian, Scotland.
    van der Heijden, Amber
    Vrije University of Amsterdam Medical Centre, Netherlands.
    Lundberg, Fredrik
    Region Östergötland, Heart and Medicine Center, Department of Nephrology.
    Over, Eelco
    National Institute Public Health and Environm, Netherlands.
    Hakkinen, Unto
    National Institute Health and Welf, Finland.
    Seppala, Timo T.
    National Institute Health and Welf, Finland.
    Mortality and Length of Stay of Very Low Birth Weight and Very Preterm Infants: A EuroHOPE Study2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 6, article id e0131685Article in journal (Refereed)
    Abstract [en]

    The objective of this paper was to compare health outcomes and hospital care use of very low birth weight (VLBW), and very preterm (VLGA) infants in seven European countries. Analysis was performed on linkable patient-level registry data from seven European countries between 2006 and 2008 (Finland, Hungary, Italy (the Province of Rome), the Netherlands, Norway, Scotland, and Sweden). Mortality and length of stay (LoS) were adjusted for differences in gestational age (GA), sex, intrauterine growth, Apgar score at five minutes, parity and multiple births. The analysis included 16,087 infants. Both the 30-day and one-year adjusted mortality rates were lowest in the Nordic countries (Finland, Sweden and Norway) and Scotland and highest in Hungary and the Netherlands. For survivors, the adjusted average LoS during the first year of life ranged from 56 days in the Netherlands and Scotland to 81 days in Hungary. There were large differences between European countries in mortality rates and LoS in VLBW and VLGA infants. Substantial data linkage problems were observed in most countries due to inadequate identification procedures at birth, which limit data validity and should be addressed by policy makers across Europe.

  • 295.
    Nyberg, Anders
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    The Potential of Driver Education to Reduce Traffic Crashes Involving Young Drivers2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Traffic fatalities and injuries among young drivers as a result of road crashes constitute a serious public health problem. The ultimate goal of traffic safety work in Sweden has been formulated in Vision Zero, which includes an image of a future in which no one will be killed or seriously injured in traffic crashes. Therefore, it is unacceptable that young learner and novice drivers are involved in road crashes that result in fatalities or severe injuries. Driver education is an important tool to increase the probability that young drivers actually take their share of the responsibility for Vision Zero by obeying traffic rules and driving as safely as possible.

    The general aim of the work underlying this thesis was to determine the potential of driver education to reduce road traffic crashes involving young drivers, particularly in Sweden. Paper I examined the relationship between the way in which the education is carried out and the outcome of the driving test. Paper II explored whether there are any gender‐related differences regarding driving practicing, the outcome of the license tests, and involvement in crashes during the first year of licensure. Paper III evaluated the reform that made it possible for learner drivers to start practicing from 16 years of age in terms of its effects on crashes involving young novice drivers. In paper IV, the focus was on investigating crashes during practice and comparing the results with the corresponding situation for novice divers during their first two years of licensure. Paper V assessed an insight‐based educational approach aimed at inducing young drivers to make better use of vehicle‐related safety equipment.

    The findings of two of the studies (papers III and IV) showed that, in Sweden, taking advantage of the possibility to start practicing behind the wheel from the age of 16 years had a beneficial effect seen as reduced crash involvement among those young drivers. In paper V, it was revealed that using an insight‐based educational approach can have a positive influence on learner drivers’ knowledge of and attitudes towards the use of car safety equipment (e.g., safety belts). In paper I, it was found that it is difficult to explain why 18–24‐year‐olds pass or fail the driving test on the basis of background variables and information concerning how they had practiced driving. Paper II showed that, for females, training pursued in a more structured manner did not seem to be beneficial for the outcome of the license tests, and that males aged 18–24 were involved in 1.9 more injury crashes per 1,000 drivers than females during their first year of licensed driving. Suggestions are given that can be used to develop the Swedish licensing system in a way that will increase the potential of driver education to reduce traffic crashes among young drivers. These ideas comprise aspects such as the following: persuading the youngest learner driver population to start practicing as early and as much as possible; the learning period should be better organized, which includes improved agreement between the goals of the national curriculum, the content/process of driver education, and the design of the license tests; professional instruction of learners in both the theory and the practice of driving should be a more prominent component of driver education; and parts of the Swedish licensing system should be made mandatory to help solve the problems of young drivers and to fulfil he goals of the national curriculum.

    List of papers
    1. Practicing in relation to the outcome of the driving test
    Open this publication in new window or tab >>Practicing in relation to the outcome of the driving test
    2007 (English)In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 39, no 1, p. 159-168Article in journal (Refereed) Published
    Abstract [en]

    In Sweden, a written and a driving test must be passed for licensure, and these two examinations are the only means of verifying that learner drivers have acquired the competencies stipulated in the national curriculum. The present study investigated 18–24-year olds regarding the effects of personal background and mode of driver education instruction on the outcome of the driving test. This was done by analysing the following for individual subjects: data on practicing obtained using a questionnaire, and test results of license tests. The results suggest that among the candidates under study, there are equal opportunities in the context of obtaining a driver's license independent of a person's background. The rate of passing was higher for those who started behind-the-wheel training at 16 and applied to take the driving test via a driving school, than for those who started the training at an older age and applied to take the test in person. It was also found that the probability of passing the test was greater if there is successful cooperation between learner and driving school instructor, and if a large proportion of the training been devoted to the task speed adaptation.

    Keywords
    Driver education, Driving test, Questionnairem, Learner drivers
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14310 (URN)10.1016/j.aap.2006.06.015 (DOI)
    Available from: 2007-02-27 Created: 2007-02-27 Last updated: 2017-12-13
    2. Practicing for and performance on driver’s license tests in relation to gender differences in crash involvement among novice drivers
    Open this publication in new window or tab >>Practicing for and performance on driver’s license tests in relation to gender differences in crash involvement among novice drivers
    2007 (English)In: Journal of Safety Research, ISSN 0022-4375, E-ISSN 1879-1247, Vol. 38, no 1, p. 71-80Article in journal (Refereed) Published
    Abstract [en]

    Background: Young male novice drivers are overrepresented in injury motor-vehicle crashes compared to females in the same category. This difference in crash involvement is often assumed to include factors such as overestimation, risk acceptance, and sensation seeking, but it can also be related to acquisition of knowledge, skills, insight, and driving experience. Therefore, this study explored possible gender differences among 18–24-year-olds in Sweden regarding practicing as learners, outcome of the driver's tests, and crash involvement during the first year after licensure.

    Method: Data for 2005 from different sources (e.g., questionnaires, license test, and crash statistics) were examined. It was not possible to follow individual subjects through all stages or in all analyses. Nevertheless, the study design did enable scrutinization and discussion of gender differences between younger inexperienced drivers with respect to education and training, license test results, and initial period of licensure.

    Results: Males and females assimilated tuition in different ways. Females studied more theory, pursued training in a more structured manner, practiced more elements of driving in several different environments, and participated more extensively in driving school instruction. National statistics showed that females did better on the written test but not on the driving test. Males were involved in 1.9 more injury crashes per 1,000 drivers than females during their first year of licensed driving. The proportional distribution of crash types was the same for both sexes during the first period as novice drivers, but the circumstances surrounding the accidents varied (e.g., males were involved in more night crashes).

    Impact on traffic safety: More structured training while learning appears to be one of the reasons why females initially do better than males as novice drivers. Therefore, in the future, driver education should focus not only on matters such as the amount of time spent on training and preconditioning, but also on the importance of the organization and content of the learning process.

    Keywords
    Driver education, Drivers license tests, Gender, Novice drivers, Crashes
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14311 (URN)10.1016/j.jsr.2007.01.001 (DOI)
    Available from: 2007-02-27 Created: 2007-02-27 Last updated: 2017-12-13
    3. Sixteen years age limit for learner drivers in Sweden: an evaluation of safety effects
    Open this publication in new window or tab >>Sixteen years age limit for learner drivers in Sweden: an evaluation of safety effects
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    2000 (English)In: Accident Analysis and Prevention, ISSN 0001-4575, Vol. 32, no 1, p. 25-35Article in journal (Refereed) Published
    Abstract [en]

    Through a reform implemented in Sweden, September 1993, the age limit for practising car driving was lowered from 17½ to 16 years while the licensing age remained 18. The purpose of lowering the age limit was to give the learner drivers an opportunity to acquire more experience as drivers before being allowed to drive on their own. The primary aim of this study was to evaluate the effect of the reform in terms of accident involvement and data were therefore obtained from the national register of police reported accidents. The results show that after the reform there was a general reduction in the accident risk (accidents per 10 million km) of novice drivers with approximately 15%. Additional analyses show that the reduction of accident risk in the group who utilised