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  • 251.
    Müssener, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Linderoth, Catarina
    Försäkringskassan, Linköping.
    Kan jag få ett läkarintyg?: - Erfarenheter av telefonrådgivning i primärvården2009In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 86, no 6, p. 539-547Article in journal (Refereed)
    Abstract [en]

    Nurses’ knowledge on matters other than medical issues is limited although a growing number of the calls in the telephone services in primary health care deal with the need for a sickness certificate due to other problem than sickness/disease or injury. A two days course in insurance medicine was given to nurses with experiences of telephone advisory services. Data from focus-group interviews including 35 nurses were analysed. Outcomes of the practices of the course highlighted the value of this new knowledge to help nurses to: better understand the sickness insurance system, encounter their patients in a supportive way, getting their patients to be accountable for their own situation, and to improve the collaboration with colleagues.

  • 252.
    Müssener, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Persson, A.
    Alexandersson, A.
    A population-based questionnaire study of how people on sick leave perceive contacts with professionals in healthcare, occupational health services, and social insurance2007In: Article in journal (Refereed)
  • 253.
    Müssener, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences and Learning, Sociology. Linköping University, Faculty of Arts and Sciences.
    Söderberg, Elsy
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Vilken betydelse har positivt bemötande för återgång i arbete?2009In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 86, no 3, p. 238-244Article in journal (Refereed)
  • 254.
    Müssener, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Söderberg, Elsy
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences and Learning, Sociology. Linköping University, Faculty of Arts and Sciences.
    Alexandersson, Kristina
    Department of Clinical Neuroscience, Personal Injury Prevention, Stockholm, Sweden.
    Encouraging encounters: sick-listed persons’ experiences of interactions with rehabilitation professionals2007In: Social work in health care, ISSN 0098-1389, E-ISSN 1541-034X, Vol. 46, no 2, p. 71-87Article in journal (Refereed)
    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.

  • 255.
    Müssener, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Upmark, M.
    Borg, K.
    Alexandersson, A.
    Positive experiences of encounters with professionals among people on long-term sick leave2007In: Article in journal (Refereed)
  • 256.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    BRIEF ALCOHOL INTERVENTION RESEARCH AND PRACTICE-TOWARDS A BROADER PERSPECTIVE2010In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 105, no 6, p. 964-965Article in journal (Other academic)
  • 257.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Brief alcohol intervention to prevent drinking during pregnancy: an overview of research findings2009In: CURRENT OPINION IN OBSTETRICS and GYNECOLOGY, ISSN 1040-872X, Vol. 21, no 6, p. 496-500Article in journal (Refereed)
    Abstract [en]

    Purpose of review The aim is to describe the theory and practice of brief alcohol interventions and provide a summary of the current evidence base, including details about the four randomized controlled trials that have been conducted with pregnant women. Opportunities for providing alcohol interventions for pregnant women in antenatal care are also addressed. Recent findings Brief intervention has emerged as a promising approach to provide early intervention, before or soon after the onset of alcohol-related problems. There is convincing evidence for the efficacy and effectiveness of brief intervention in various healthcare settings. The findings from four randomized brief intervention trials that have been conducted with pregnant women are consistent with the broader literature on brief intervention. The interventions were effective in reducing alcohol consumption, but control group participants also reduced their consumption to the degree that statistically significant differences between the groups were difficult to detect. Summary Pregnant women are generally believed to be highly motivated to reduce their alcohol intake, and the contextual change provided by the pregnancy provides an opportunity to break habitual drinking behaviour. There is an empirical and theoretical support for providing brief intervention in antenatal care to achieve reduced or no alcohol consumption during pregnancy.

  • 258.
    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.
    Brief alcohol intervention-where to from here? Challenges remain for research and practice2010In: ADDICTION, ISSN 0965-2140, Vol. 105, no 6, p. 954-959Article in journal (Refereed)
    Abstract [en]

    Brief intervention (BI) is intended as an early intervention for non-treatment-seeking, non-alcohol-dependent, hazardous and harmful drinkers. This text provides a brief summary of key BI research findings from the last three decades and discusses a number of knowledge gaps that need to be addressed. Five areas are described: patient intervention efficacy and effectiveness; barriers to BI implementation by health professionals; individual-level factors that impact on BI implementation; organization-level factors that impact on BI implementation; and society-level factors that impact on BI implementation. BI research has focused largely upon the individual patient and health professional levels, with the main focus upon primary health care research, and studies are lacking in other settings. However, research must, to a larger degree, take into account the organizational and wider context in which BI occurs, as well as interaction between factors at different levels, in order to advance the understanding of how wider implementation of BI can be achieved in various settings and how different population groups can be reached. It is also important to expand BI research beyond its current parameters to investigate more ambitious long-term educational programmes and new organizational models. More widespread implementation of BI will require many different interventions (efforts, actions, initiatives, etc.) at different interlinked levels, from implementation interventions targeting individual health professionals knowledge, skills, attitudes and behaviours concerning alcohol issues, BI and behaviour change counselling to efforts at the organizational and societal levels that influence the conditions for delivering BI as part of routine health care.

  • 259.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    From "acts of God" to safety promotion: A brief history of injury research2007In: Strategies for health: An anthology / [ed] Per Nilsen, Linköping: Linköpings universitet , 2007, p. -83Chapter in book (Other academic)
    Abstract [sv]

    This anthology is comprised of six papers, introducing readers to at variety of topics relevant to the Strategies for Health arena. The papers are intended to reflect the breadth of research conducted in Strategies for Health. The aim is to contribute to a greater understanding of the concept of health and provide insight into some strategies for improvement of health and safety. The anthology was edited by Per Nilsen, in cooperation with Lennart Nordenfelt and Kerstin Ekberg, who served as an Editorial Committee.

  • 260.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Implementering: teori och tillämpning inom hälso- och sjukvård2010Collection (editor) (Other academic)
    Abstract [sv]

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

  • 261.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Inledning2010In: Implementering: Teori och tillämpning inom hälso- och sjukvård / [ed] Per Nilsen, Lund: Studentlitteratur , 2010, 1, p. 263-Chapter in book (Other academic)
    Abstract [sv]

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

  • 262.
    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
  • 263.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Praktikbaserad forskning kan ge forskningsbaserad praktik: Klyftan mellan forskningresultat och vårdnytta måste överbryggas2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 36, no 108, p. 1672-1673Article in journal (Refereed)
    Abstract [sv]

    Klyftan mellan produktion av forskningsresultat och vårdens nyttiggörande av dessa resultat har allt mer uppmärksammats som ett problem, såväl för samhället som för de individer som inte får bästa möjliga vård.

    Klyftan anses ofta bero på vårdens oförmåga att anamma ny kunskap. Det är dock viktigt att också se andra förklaringsgrunder.

    Mer praktikbaserad forskning skulle kunna möjliggöra en mer forskningsbaserad praktik.

  • 264.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Arts and Sciences.
    Praktiknära innovationer genom integration av praktik- och forskningsbaserad kunskap2010In: Implementering: Teori och tillämpning inom hälso- och sjukvård / [ed] Per Nilsen, Lund: Studentlitteratur , 2010, 1, p. 263-Chapter in book (Other academic)
    Abstract [sv]

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

  • 265.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Teoribaserad utvärdering av samhällsbaserat säkerhetsfrämjande arbete2007In: Skador och skadeprevention: en antologi / [ed] Ragnar Andersson,Sven Bremberg,Ingela Danielsson, Räddningsverket , 2007, , p. 8p. 66-73Chapter in book (Other academic)
    Abstract [sv]

    Med Falköpings skadeförebyggande arbete som förebild, utvecklades i Sverige under 1970-talet den samhällsbaserade modellen ("community-based") för säkerhetsfrämjande arbete. Inspiration kom från breda populationsbaserade program för prevention av hjärt- och kärlsjukdomsförekomst i flera samhällen i USA och Västeuropa. Samhällsbaserade (i Sverige används ofta termen ”kommunbaserade”) säkerhetsfrämjande program bygger på tvärsektoriellt samarbete mellan lokala organisationer och lokalt engagemang. Demokrati och delaktighet är viktiga inslag, eftersom skadeförekomst och bristande säkerhet är problem som delas av alla och som alla har ansvar för. Samhällsbaserade program möjliggör skadeprevention i hela lokalsamhället, vilket är angeläget då en stor andel av alla skador inträffar i hem och på fritiden, ”arenor” som inte kan regleras på samma sätt som trafiken eller arbetsplatser.

    Den samhällsbaserade ansatsen har vunnit bred acceptans och utgör idag grunden för flera internationella rörelser, bl.a. Världshälsoorganisationens (WHO) Safe Community och Safe Kids Worldwide, samt nationella rörelser som Canadian Safe Communities Foundation, Safe Communities Foundation of Australia samt Safe Communities Foundation of New Zealand. Trots modellens stora spridning, har resultaten dock varit tämligen skiftande. Många skäl har anförts till svårigheter att påvisa solid evidens för den samhällsbaserade modellens effektivitet, bl.a. otillräckliga resursinsatser i programmen, bristfälligt genomförda interventioner och dålig ”räckvidd” för programmen.

    Tyvärr är många utvärderingar av samhällsbaserade program behäftade med brister som gör det svårt eller omöjligt att förklara varför vissa program når goda resultat, medan andra inte alls lyckas. De flesta utvärderingar kan på sin höjd konstatera att programmet som helhet fungerat, utan att kunna identifiera vilka komponenter som varit mest framgångsrika. Med anledning av detta har många utvärderingar betecknats som ”svarta-lådan-utvärderingar”, vilket innebär att de innehåller begränsad analys av hur innehållet i den svarta lådan (”the black box”), såsom tillgängliga resurser, genomförda åtgärder och lokala förutsättningar, påverkat utfallet.

    Utvärderingar av samhällsbaserade program har i hög grad eftersträvat tillfredsställande inre validitet, att kunna påvisa att effekterna verkligen beror på programmet ifråga. Yttre validitet i form av generaliserbarhet, har däremot ägnats mindre uppmärksamhet. En följd av utvärderingar som fokuserar på utfall, med bristfällig eller avsaknad av analys av hur resultaten uppnåddes, är begränsad kunskapsuppbyggnad om den samhällsbaserade modellen. Somliga forskare hävdar att utvärderingar av dessa program har nått en ”avtagande avkastning”, i så motto att ytterligare utvärderingar av samma slag som tidigare tillför begränsad kunskap.

  • 266.
    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.
    The theory of community based health and safety programs: a critical examination.2006In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 12, no 3, p. 140-145Article in journal (Refereed)
    Abstract [en]

    This paper examines the theoretical underpinning of the community based approach to health and safety programs. Drawing upon the literature, a theory is constructed by elucidating assumptions of community based programs. The theory is then put to test by analyzing the extent to which the assumptions are supported by empirical evidence and the extent to which the assumptions have been applied in community based injury prevention practice. Seven principles representing key assumptions of the community based approach to health and safety programs are identified. The analysis suggests that some of the principles may have important shortcomings. Programs overwhelmingly define geographical or geopolitical units as communities, which is problematic considering that these entities can be heterogeneous and characterized by a weak sense of community. This may yield insufficient community mobilization and inadequate program reach. At the same time, none of the principles identified as most plausible appears to be widely or fully applied in program practice. The implication is that many community based health and safety programs do not function at an optimum level, which could explain some of the difficulties in demonstrating effectiveness seen with many of these programs.

  • 267.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    The theory of community-based health and safety programmes: A critical examination2007In: Strategies for health: An anthology / [ed] Per Nilsen, Linköpings universitet , 2007, p. 28-45Chapter in book (Other academic)
    Abstract [en]

    Community-based programmes have become an important strategy to enhance health and safety. These programmes have their roots in the North Karelia, Stanford Five City, Minnesota Heart Health, and Pawtucket Heart Health programmes, initiated in the 1970s and 1980s to reduce high community rates of cardiovascular disease. Since then, the belief that the community-based approach is beneficial appears to have become a deeply held conviction in public health. As noted by Cheadle and colleagues (1997, page 240), “It is almost an article of faith that locating programmes in the community and involving community members in planning, implementation, and evaluation can be an effective strategy for improving population health.”

    However, despite the wide application of community-based health andsafety programmes during the last 30 years, there is a paucity of evaluations from which to obtain evidence regarding effectiveness of community-based health and safety programs. The present evidence from both the health promotion and injury prevention field is inconsistent, with many programmes demonstrating modest or no effects at all (Nilsen, 2006). This weak evidence has been attributed to a number of reasons, including insufficient resources, poorly implemented programmes, lack of programme reach, methodological difficulties in study design and analysis that lead to problems in demonstrating convincing results, and unrealistically high expectations of what can be achieved through these programmes (Gielen & Collins, 1993; Fisher, 1995; Feinleib, 1996; Fishbein, 1996; Klassen et al., 2000; Merzel & D’Afflitti, 2003; Nilsen, 2004; Hoffmeister & Mensink, 2004; Nilsen, 2005).

    This paper examines whether there are shortcomings in the theoretical underpinning of the community-based approach that could explain the lack of strong evidence of the effectiveness of health and safety programmes. Drawing upon the literature, a theory is constructed by elucidating explicit and implicit assumptions of community-based programmes. The theory is then put to test by analysing the extent to which the assumptions are supported by empirical evidence and the extent to which the assumptions have been applied in community-based injury prevention practice.

  • 268.
    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.
    What makes community based injury prevention work?: In search of evidence of effectiveness2004In: Injury Prevention, ISSN 1353-8047, Vol. 10, no 5, p. 268-274Article in journal (Refereed)
    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.

  • 269.
    Nilsen, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Baird, J
    Mello, MJ
    Nirenberg, T
    Woolard, R
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Longabaugh, R
    A systematic review of emergency care brief alcohol interventions for injury patients2008In: Journal of Substance Abuse Treatment, ISSN 0740-5472, E-ISSN 1873-6483, Vol. 35, no 2, p. 184-201Article in journal (Refereed)
    Abstract [en]

    This article examines 14 studies that assessed the effectiveness of brief interventions (BIs) delivered to injury patients in emergency care settings. The aims were to review findings concerning the effectiveness of providing BI in these settings and to explore factors contributing to its effectiveness. Of the 12 studies that compared pre- and post-BI results, 11 observed a significant effect of BI on at least some of the outcomes: alcohol intake, risky drinking practices, alcohol-related negative consequences, and injury frequency. Two studies assessed only post-BI results. More intensive interventions tended to yield more favorable results. BI patients achieved greater reductions than control group patients, although there was a tendency for the control group(s) to also show improvements. Five studies failed to show significant differences between the compared treatment conditions. Variations in the study protocol, alcohol-related recruitment criteria, screening and assessment methods, and injury severity limit the specific conclusions that can be drawn. © 2008 Elsevier Inc. All rights reserved.

  • 270.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    McCambridge, Jim
    University of London London School Hyg and Trop Med, England .
    Karlsson, Nadine
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    When is it appropriate to address patients alcohol consumption in health care-national survey of views of the general population in Sweden2012In: Addictive Behaviours, ISSN 0306-4603, E-ISSN 1873-6327, Vol. 37, no 11, p. 1211-1216Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the Swedish populations beliefs and attitudes on when it is appropriate to address patients alcohol in health care services and to identify the characteristics of those who are most supportive of this alcohol-preventive work. A cross-sectional study of 5981 nationally representative individuals (18-64 years) was done using confidential mail questionnaires. Alcohol consumption was assessed with AUDIT-C and respondents were classified into four levels of drinking status. Sociodemographic data were also collected. Thirty-four percent completely agreed that health care providers should routinely ask patients about their alcohol habits and 33% completely agreed that providers should ask but only if patients have consulted them with alcohol-related symptoms. There was limited support for a statement that alcohol conversations should be premised on the patient bringing up the issue and even less support for the notion that alcohol habits are peoples own business and not something that health care providers should address. Thirty-four percent believed that people did not answer honestly when asked about their alcohol habits in health care. There appears to be considerable support in the general population for alcohol prevention in Swedish health care services that involves questions being asked routinely about alcohol. This should be helpful in ongoing efforts to improve the implementation of alcohol screening and brief interventions in Sweden. Further studies on the views of hazardous and excessive drinkers appear particularly important.

  • 271.
    Nilsen, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Bourne, M
    Verplanken, B
    Accounting for the role of habit in behavioural strategies for injury prevention.2008In: International journal of injury control and safety promotion, ISSN 1745-7300, Vol. 15, no 1, p. 33-40Article in journal (Refereed)
    Abstract [en]

    The limited success of behavioural strategies in injury prevention has been attributed to failure to properly apply behaviour change models to intervention design and the explanation of safety behaviours. However, this paper contends that many health behaviour change interventions do not succeed because they fail to take into account the habitual quality of most health and safety-related behaviour, a more complete model of behaviour change needs to be based on a better understanding of the role of habit. The overall aim is to contribute to better understanding of behavioural strategies for injury prevention. When habits are weak, attitudes and intentions predict behaviours, but as behaviours turn into habits, they become better predictors of future behaviour than attitudes or intentions. Furthermore, where habits are strong, individuals are less likely to act on new information, evaluating counter-habitual information negatively. Integrating the concepts of strong and weak habits with upstream and downstream strategies, a framework is presented for tailoring strategies to the habit strength of the target behaviour.

  • 272.
    Nilsen, Per
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bourne, Michael
    Department of Justice, Victoria, Australia.
    Coggan, Carolyn
    Safe Communities Foundation of New Zealand, Auckland, New Zealand.
    Using Local Injury Surveillance for Community-Based Injury Prevention: an Analysis of Scandinavian WHO Safe Community and Canadian Safe Community Foundation Programs2007In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, Vol. 14, no 1, p. 35-43Article in journal (Refereed)
    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.

  • 273.
    Nilsen, Per
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekman, Robert
    Karolinska Institute, Department of Public Health Science, Division of Social Medicine, Stockholm, Sweden.
    Stark Ekman, Diana
    Karolinska Institute, Department of Public Health Science, Division of Social Medicine, Stockholm, Sweden.
    Ryen, Linda
    Swedish Rescue Services Agency, National Centre for Learning from Incidents and Accidents (NCO), Karlskoga, Sweden.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Effectiveness of Community-Based Injury Prevention: Injury Rate Levels, Changes, and Trends for 14 Swedish WHO-Designated Safe Communities2007In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 39, no 2, p. 267-273Article in journal (Refereed)
    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.

  • 274.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Ellström, Per-Erik
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Behavioural Sciences and Learning, Work and Working Life. Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Fostering practice-based innovation through reflection at work2012In: Practice-based Innovation: Insights, Applications and Policy Implications / [ed] Helinä Melkas, Vesa Harmaakorpi, Heidelberg: Springer , 2012, p. 155-172Chapter in book (Other academic)
    Abstract [en]

    The book describes and analyses the new environment for innovation, it does this with an emphasis on yet uncharted regions within the field of practice-based innovation, coming up with guidelines for innovation policy measures needed in order to realise this. While it focuses on these policies it also takes into account multi-actor innovation processes, user-driven innovation, "related variety" and many other aspects; aspects such as, just to name a few: communicating creative processes and distributing practice-based innovation; then there is creativity itself, encompassing new fields of knowledge and expertise. The authors go on to describe value networks, showing how to make practice-based innovations, explaining innovation diffusion and absorptive capacity. The book presents new insights as well as the latest research related to the frequently used term "innovation". Definitions are put forward, giving, by way of examples, a detailed description of concepts we draw upon when using these. Innovation as a concept is constantly being subdivided into increasingly finer distinctions, which, in turn, determine the discourse. The book takes a close look at these, further taking into account the challenges as well as the opportunities inherent in developing practice-based innovation procedures and policies of global importance, never losing sight of advancing long-term   effectiveness.

  • 275.
    Nilsen, Per
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Festin, Karin
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Guldbrandsson, K.
    Karolinska Institutet.
    Carlfjord, Siw
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Holmqvist, Marika
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Implementation of a computerized alcohol advice concept in routine emergency care2009In: International Emergency Nursing, ISSN 1755-599X, Vol. 17, no 2, p. 113-121Article in journal (Refereed)
    Abstract [en]

    Background: There is a growing body of evidence for computer-generated advice for many health behaviours. This study evaluated the implementation of a computerized concept to provide tailored advice on alcohol in a Swedish emergency department (ED). Aim: The aim was to evaluate the usage of the concept over 12 months: participation rate among the ED population; representativeness of the participants; and participation development over time. Methods: The target population was defined as all patients aged 18-69 years given a card from ED triage staff with a request to conduct a computerized test about their alcohol use. After completing the 5-10-min programme, the patient received a printout, containing personalised alcohol habit feedback, as calculated by the computer from the patients answers. Data for this study were primarily obtained from the computer programme and ED logs. Results: Forty-one percent of the target population completed the computerized test and received tailored alcohol advice. The number of patients who used the concept showed a slight decreasing trend during the first half of the year, leveling off for the second half of the year. Conclusion: A computerized concept for provision of alcohol advice can be implemented in an ED without unrealistic demands on staff and with limited external support to attain sustainability.

  • 276.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis.
    Gardner, Benjamin
    UCL, England .
    Broström, Anders
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonköping University, Sweden .
    Editorial Material: Accounting for the role of habit in lifestyle intervention research2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 1, p. 5-6Article in journal (Refereed)
    Abstract [en]

    n/a

  • 277.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Holmqvist, M.
    National Board Health and Welfare, Stockholm, Sweden.
    Hermansson, U.
    Karolinska University Hospital.
    Alcohol prevention in Swedish occupational health care2011In: Occupational Medicine, ISSN 0962-7480, E-ISSN 1471-8405, Vol. 61, no 7, p. 472-U19Article in journal (Refereed)
    Abstract [en]

    Background Occupational health care (OHC) was part of the Swedish Risk Drinking Project, a government-supported continuing professional education (CPE) endeavour for health professionals, 2004-10. Aims To investigate OHC professionals perceived knowledge concerning patient counselling on alcohol, perceived efficiency in achieving patient changes, use of questionnaires and biomarkers, amount and content of their alcohol-related CPE, their reasons for participating in this CPE and improvements experienced in addressing alcohol issues in the last 3 years. Methods Baseline 2005 and follow-up 2008 data were collected by means of anonymous questionnaires to all physicians and nurses in OHC. Results Response rates ranged from 53 to 80%. The share of nurses and physicians who had taken part in greater than= 3 days training on risk drinking issues rose from 10 to 59% and from 7 to 59%, respectively. The OHC professionals perceived knowledge and efficiency concerning lifestyle counselling improved from 2005 to 2008, considerably more so for alcohol than the other lifestyle issues. The most competent nurses and physicians were more likely to have participated in training lasting greater than= 3 days. The most competent nurses and physicians had become better at initiating conversations about alcohol and at informing, providing advice and discussing alcohol with their clients. Conclusions There were major improvements in the OHC professionals perceived knowledge concerning alcohol counselling and efficiency in influencing patients alcohol habits after participation in a comprehensive CPE project. Overall, the nurses achieved more improvements than the physicians.

  • 278.
    Nilsen, Per
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Holmqvist, Marika
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Hultgren, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Cedergren, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Is Questionnaire-Based Alcohol Counseling More Effective for Pregnant Women Than Standard Maternity Care?2010In: JOURNAL OF WOMENS HEALTH, ISSN 1540-9996, Vol. 19, no 1, p. 161-167Article in journal (Refereed)
    Abstract [en]

    Objective: To compare current standard maternity care in Sweden concerning provision of alcohol advice with a more comprehensive questionnaire-based counseling model. Methods: The study population included pregnant women in Linkoping who were registered at a maternity care center during a 2-year period and whose pregnancies resulted in liveborn infants without birth defects, representing 93% of all pregnant women. Anonymous questionnaires were mailed to the women. The first cohort (registered April 2005 1, to March 31, 2006) received standard care according to a procedure that is common practice in Sweden. The second cohort (April 1, 2006 to March 31, 2007) received alcohol advice based on a comprehensive counseling model, incorporating the use of the three-item Alcohol Use Disorders Identification Test (AUDIT-C) questionnaire and tailored counseling based on the AUDIT-C score. Results: The response rate was 61% in the first cohort (standard care) and 70% in the second cohort (questionnaire-based counseling). The cohorts were similar in sociodemographic variables and prepregnancy drinking characteristics. The proportion of women who continued drinking alcohol during the pregnancy was 6.0% in cohort 1 and 5.8% in cohort 2. Women in cohort 2 were more favorable to the advice and, to a larger extent, perceived the main message to be abstinence from drinking during pregnancy. Conclusions: The questionnaire-based counseling model was more favorably perceived than the standard care model, but the new model was not more effective in terms of its impact on the proportion of women who abstained from drinking during pregnancy.

  • 279.
    Nilsen, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Holmqvist, Marika
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Hultgren, Eva
    Department of Clinical and Experimental Medicine Linlöping University.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Cedergren, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Alcohol use before and during pregnancy and factors influencing change among Swedish women2008In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 7, p. 768-774Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate alcohol intake during pregnancy among women, to assess health cares providers' advice to the women and the relative importance of different factors on changes in the women's drinking. Design. Questionnaire study. Setting. Linkoping, Sweden. Population. A total number of 1,533 women registered at a maternity health care center in Linkoping during a one-year period, from 1 April 2005 to 31 March 2006. Methods. Mailed anonymous questionnaire with a response rate of 61%. Main outcome measures. Drinking behavior and information sources. Results. During pregnancy, 94% (n=869) of the responding women abstained from alcohol, including 13% (n=117) who were already abstainers. Six percent (n=55) continued drinking during the pregnancy. Those who continued drinking during pregnancy were older, had more often given birth and drank more frequently before pregnancy than the women who abstained. Half of the respondents (n=428) believed that decreases in alcohol intake during pregnancy reported in previous studies could be due to inaccurate self-reporting. The main message from maternity health care providers was perceived to be complete abstinence from alcohol during pregnancy (85%, n=777), although 8% (n=76) claimed that they had not received any advice regarding this. Media attention concerning risks associated with drinking during pregnancy was seen as slightly more important to achieve reduced alcohol intake during pregnancy than advice from maternity health care providers. Conclusions. A majority of women in this study reported abstaining from alcohol during pregnancy. © 2008 Informa UK Ltd. (Informa Healthcare, Taylor & Francis AS).

  • 280.
    Nilsen, Per
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hudson, Diana
    Gabrielsson, Felicia
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Strategies and goals of community-based injury prevention programmes: a mixed-methods study of 25 Scandinavian WHO Safe Communities2006In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, Vol. 13, no 1, p. 27-33Article in journal (Refereed)
    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.

  • 281.
    Nilsen, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Hudson, D.S.
    Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Stockholm, Sweden.
    Kullberg, Agneta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Ekman, R.
    Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Stockholm, Sweden, Swedish Rescue Services Agency, Natl. Ctr. for Lrng. from Accidents, Skövde, Sweden.
    Lindqvist, Kent
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Making sense of safety2004In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 10, no 2, p. 71-73Other (Other academic)
    Abstract [en]

    [No abstract available]

  • 282.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Kaner, Eileeen
    Newcastle University, UK.
    Babor, Thomas F.
    University of Connecticut Health Center, USA.
    Brief intervention, three decades on: an overview of research findings and strategies for more widespread implementation2008In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 25, no 6, p. 453-468Article in journal (Refereed)
    Abstract [en]

    This paper provides an overview of brief intervention (BI) research to date and discusses future research needs as well as strategies for more widespread use of BI. Research has firmly established that significant reductions in drinking can be achieved by BI in a variety of health care settings. Despite convincing evidence, however, diffusion of BI in routine health care has been slow. Alcohol is a complex subject since it is often used moderately, without side-effects, and in a socially acceptable way. Although research on BI has accumulated rapidly during the last three decades, many important research challenges and development work remain before BI is widely implemented in routine health care.

  • 283.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekonomisk analys av säkerhetsfrämjande arbete2007Report (Other academic)
    Abstract [sv]

    Ekonomiska analyser av säkerhetsfrämjande arbete kan beskrivas som systematiska vägningar av kostnader och effekter av detta arbete. En vanlig fråga i dessa sammanhang är huruvida det är etiskt försvarbart att bry sig om ekonomiska aspekter när man diskuterar säkerhetsfrämjande arbete. Livet i sig är ju ovärderligt och det måste få kosta att rädda liv, förebygga skador och minska mänskligt lidande. Behöver man verkligen anlägga ett ekonomiskt perspektiv när det handlar om att främja hälsa och säkerhet? Frågor som dessa är inte ovanliga, men de bygger egentligen på ett antagande om att samhällets resurser är mer eller mindre obegränsade. I realiteten är resurser knappa och det finns alltid alternativ användning för dem. Därmed föreligger risken att begränsade resurser används suboptimalt, t.ex. genom att stora belopp satsas på områden där vinsterna vid prevention eller behandling är marginella. Samtidigt förnekas då andra grupper resurser där ett ökat resursutnyttjande kanske skulle bidra till markant förbättrad hälsa och säkerhet. Således är det snarare oetiskt att inte beakta ekonomiska aspekter på säkerhetsfrämjande arbete.

    Syftet med hälsoekonomiska analyser är att få förbättrade underlag för beslut och prioriteringar. Hälsoekonomisk forskning har expanderat kraftigt i takt med att man alltmer uppmärksammat att sjuk- och hälsovårdens resurser är begränsade. Världshälsoorganisationen (WHO) har genom sitt internationella Safe Community-nätverk förordat ökad användning av ekonomiska analyser av lokalt säkerhetsfrämjande arbete. Tanken är att ökad medvetenhet om ekonomiska konsekvenser av skador bättre kan förmå beslutsfattare att inse vidden av skadeproblemet. Ekonomiska analyser av säkerhetsfrämjande arbete på lokal nivå skulle kunna bidra till ökat gehör hos beslutsfattare och möjliggöra bättre beslut. Trots dessa användningsområden är det sällsynt med ekonomiska analyser inom området för säkerhetsfrämjande arbete. Ekonomiska analyser anses vara mycket komplexa och den ”språkbarriär” som skapats av ekonomisk terminologi försvårar för icke-ekonomer att ge sig i kast med hälsoekonomi.

    Frågan är emellertid om ekonomiska analyser av säkerhetsfrämjande arbete med nödvändighet måste vara så komplicerade. Enligt vårt förmenande finns det möjligheter att göra vissa förenklande antaganden, utan att för den skull ge avkall på ekonomiska principer eller analysens trovärdighet. Syftet med denna text är att kortfattat beskriva hur hälsoekonomiska analyser av lokalt säkerhetsfrämjande arbete kan genomföras med utgångspunkt från vissa förenklade antaganden.

  • 284.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    McCambridge, Jim
    London School of Hygiene and Tropical Medicine, London, UK.
    Karlsson, Nadine
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Brief interventions in routine health care: a population-based study of conversations about alcohol in Sweden.2011In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 106, no 10, p. 1748-1756Article in journal (Refereed)
    Abstract [en]

    Aims To investigate how brief alcohol interventions are delivered in routine practice in the Swedish health-care system. Design, setting and participants  A cross-sectional sample of 6000 individuals representative of the adult population aged 18-64 years registered in the Swedish total population register was drawn randomly. Data were collected in 2010 by means of a mail questionnaire. The response rate was 54%.

    Measurements The questionnaire consisted of 27 questions, of which 15 variables were extracted for use in this study. Whether alcohol had been discussed and the duration, contents, experiences and effects of any conversations about alcohol, as reported by patients themselves, were assessed.

    Findings Sixty-six per cent of the respondents had visited health-care services in the past 12 months and 20% of these had had one or more conversations about alcohol during these visits (13% of the population aged 18-64 years). The duration of the conversations was generally brief, with 94% taking less than 5 minutes, and were not experienced as problematic. The duration, contents, experiences and effects of these conversations generally varied between abstainers, moderate, hazardous and excessive drinkers. Twelve per cent of those having a conversation about alcohol reported that it led to reduced alcohol consumption. Reduced alcohol consumption was more likely when conversations lasted for 1-10 minutes rather than less than 1 minute and included advice on how to reduce consumption.

    Conclusions Population survey data in Sweden suggest that when health-care professionals give brief advice to reduce alcohol consumption, greater effects are observed when the advice is longer and includes advice on how to achieve it.

  • 285.
    Nilsen, Per
    et al.
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Nordström (Avby), Gunilla
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Behavioural Sciences and Learning, Work and Working Life. Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Ellström, Per-Erik
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Behavioural Sciences and Learning, Work and Working Life. Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Integrating research-based and practice-based knowledge through workplace reflection2012In: Journal of Workplace Learning, ISSN 1366-5626, E-ISSN 1758-7859, Vol. 24, no 6, p. 403-415Article in journal (Refereed)
    Abstract [en]

    Purpose – This paper seeks to present a theoretical framework with the aim of contributing to improved understanding of how reflection can provide a mechanism to integrate research-based knowledge with the pre-existing practice-based knowledge.

    Design/methodology/approach – The paper begins with an explanation of important concepts: research-based and practice-based knowledge, four levels of action and two modes of learning. Two mini cases concerning managers in the public sector in Sweden then provide an illustration of how research-based knowledge can be utilized to challenge practice-based knowledge. The concluding discussion addresses some of the challenges involved in achieving reflection in the workplace that utilizes research-based knowledge.

    Findings – The reflection programmes had several characteristics that facilitated their implementation: they achieved a balance between the workplace demands on the participating managers and time required for the reflection; the participants were specifically recruited, had full management support and were highly motivated to be part of the reflection groups; the facilitators played key roles in structuring the managers' discussions and linking their experiences to relevant research-based knowledge.

    Research limitations/implications – Methodological limitations of the cases constrain the conclusions to be drawn from these studies. However, it should be emphasized that the case studies were intended primarily as illustrations of how workplace reflection can be used to integrate research-based and practice-based knowledge. Obviously, there is a risk of social desirability bias because the interviewer was also involved in developing and implementing the reflection programmes. She also participated as a supervisor in mini case 2.

    Originality/value – The literature on reflection has largely focused on reflection in the context of education, training and preparing for work or a profession. The role of workplace reflection and learning for practitioners and managers in work has received far less attention. The emergence of the evidence-based practice (EBP) agenda has further highlighted the importance of workplace learning and reflection, as practitioners are increasingly expected to critically appraise research studies and integrate new findings into their practice. A more EBP requires reflecting practitioners who are able to synthesize research-based knowledge with their own practice-based knowledge acquired through experience. However, the process of integrating research-based and practice-based knowledge has not been the focus of much study.

  • 286.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis.
    Nygren, Mikaela
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Öhrn, Annica
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Patient Security.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    A new zero vision for Swedish patient safety - but how do we know that health care is becoming safer?2012Conference paper (Refereed)
  • 287.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Nygren, Mikaela
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Öhrn, Annica
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Health and Developmental Care, Patient Security.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Patientsäkerhet svårt att uppnå, svårt att värdera: Landstingens patientsäkerhetsberättelser granskas och diskuteras2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 20-21, p. 1028-1031Article in journal (Refereed)
    Abstract [sv]

    Ansträngningarna för ökad patientsäkerhet i Sverige intensifierades 2011 i och med den nya patientsäkerhetslagen och den satsning som regeringen och SKL gjorde på prestationsbaserad ersättning till landstingen.

    Förväntningarna på ökad patientsäkerhet i Sverige är stora, men frågan är hur vi kan veta att vården blir säkrare.

    Med avstamp i ett ramverk – en vidareutveckling av Donabedians triad – och genom tillägg av en kontextuell komponent och komplettering med en lärandedimension belyses svårigheterna och möjligheterna vid utvärdering av patientsäkerhet.

    Ramverkets olika komponenter diskuteras med hänvisning till vad som redovisas i de patientsäkerhetsberättelser som landstingen har sammanställt för att beskriva sitt arbete med patientsäkerhet.

  • 288.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Implementering, kunskap och lärande - en begreppsmässig plattform2010In: Implementering: Teori och tillämpning inom hälso- & sjukvård / [ed] Per Nilsen, Lund: Studentlitteratur AB , 2010, 1:1, p. 51-69Chapter in book (Other academic)
    Abstract [sv]

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

  • 289.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Broström, Anders
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ellström, Per-Erik
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Behavioural Sciences and Learning, Work and Working Life. Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Creatures of habit: accounting for the role of habit in implementation research on clinical behaviour change2012In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 7, no 53Article in journal (Refereed)
    Abstract [en]

    Background: Social cognitive theories on behaviour change are increasingly being used to understand and predict healthcare professionals intentions and clinical behaviours. Although these theories offer important insights into how new behaviours are initiated, they provide an incomplete account of how changes in clinical practice occur by failing to consider the role of cue-contingent habits. This article contributes to better understanding of the role of habits in clinical practice and how improved effectiveness of behavioural strategies in implementation research might be achieved. Discussion: Habit is behaviour that has been repeated until it has become more or less automatic, enacted without purposeful thinking, largely without any sense of awareness. The process of forming habits occurs through a gradual shift in cognitive control from intentional to automatic processes. As behaviour is repeated in the same context, the control of behaviour gradually shifts from being internally guided (e. g., beliefs, attitudes, and intention) to being triggered by situational or contextual cues. Much clinical practice occurs in stable healthcare contexts and can be assumed to be habitual. Empirical findings in various fields suggest that behaviours that are repeated in constant contexts are difficult to change. Hence, interventions that focus on changing the context that maintains those habits have a greater probability of success. Some sort of contextual disturbance provides a window of opportunity in which a behaviour is more likely to be deliberately considered. Forming desired habits requires behaviour to be carried out repeatedly in the presence of the same contextual cues. Summary: Social cognitive theories provide insight into how humans analytically process information and carefully plan actions, but their utility is more limited when it comes to explaining repeated behaviours that do not require such an ongoing contemplative decisional process. However, despite a growing interest in applying behavioural theory in interventions to change clinical practice, the potential importance of habit has not been explored in implementation research.

  • 290.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Garpenby, Peter
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Avslutande reflektioner2010In: Implementering: Teori och tillämpning inom hälso- & sjukvård / [ed] Per Nilsen, Lund: Studentlitteratur AB , 2010, 1:1, p. 259-263Chapter in book (Other academic)
    Abstract [sv]

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

  • 291.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Krevers, Barbro
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Förklaringsfaktorer för implementeringsutfall - ett ramverk2010In: Implementering: Teori och tillämpning inom hälso- & sjukvård / [ed] Per Nilsen, Lund: Studentlitteratur AB , 2010, 1:1, p. 71-89Chapter in book (Other academic)
    Abstract [sv]

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

  • 292.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Skagerström, Janna
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Hultgren, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Alcohol prevention in Swedish antenatal care: effectiveness and perceptions of the Risk Drinking project counseling model2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 6, p. 736-743Article in journal (Refereed)
    Abstract [en]

    Objective. To compare an earlier Swedish antenatal care counseling routine concerning alcohol consumption with an expanded model in terms of effectiveness in achieving abstinence in pregnancy. A further objective was to assess the womens perceptions of the alcohol counseling. Design. Cohort study. Setting. Antenatal care center in a provincial Swedish university town. Population. Women who received alcohol counseling; 1533 in cohort 1 (routine counseling) and 1476 in cohort 2 (expanded model). Approximately 93% of all pregnant women in Linkoping are registered at this center. Methods. Data were collected by means of an anonymous questionnaire. Thirteen questions in the questionnaire were analysed for this study. Main outcome measures. Replies from three questions concerning pre-pregnancy drinking and three questions on drinking during pregnancy. Results. The response rate was 60% for cohort 1 and 64% for cohort 2. Perceptions of the advice from the antenatal care center were generally favorable. Similar proportions of women, approximately 6%, in both cohorts drank at least once during the pregnancy (after pregnancy recognition). There were four predictors for drinking during pregnancy: older age; having previously given birth to a child; frequency of pre-pregnancy drinking; and perceiving the message from antenatal care as small amounts of alcohol during pregnancy dont matter.Conclusions. An expanded counseling model implemented in Swedish antenatal care did not reduce the proportion of women who continued drinking during pregnancy in comparison with a previous counseling model, although the advice provided in the new model was perceived more favorably.

  • 293.
    Nilsen, Per
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nordenfelt, Lennart
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Towards improved understanding of injury prevention program sustainability2005In: Safety Science, ISSN 0925-7535, Vol. 43, no 10, p. 815-833Article in journal (Refereed)
    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.

  • 294.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Wahlin, Sven
    Swedish National Institute of Public Health.
    Heather, Nick
    Northumbria University.
    Implementing Brief Interventions in Health Care: Lessons Learned from the Swedish Risk Drinking Project2011In: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, ISSN 1661-7827, Vol. 8, no 9, p. 3609-3627Article in journal (Refereed)
    Abstract [en]

    The Risk Drinking Project was a national implementation endeavour in Sweden, carried out from 200 4 to 2010, based on a government initiative to give alcohol issues a more prominent place in routine primary, child, maternity and occupational health care. The article describes and analyses the project. Critical factors that were important for the results are identified. The magnitude of the project contributed to its reach and impact in terms of providers awareness of the project goals and key messages. The timing of the project was appropriate. The increase in alcohol consumption in Sweden and diminished opportunities for primary prevention strategies since entry to the European Union in 1995 have led to increased expectations for health care providers to become more actively involved in alcohol prevention. This awareness provided favourable conditions for this project. A multifaceted approach was used in the project. Most educational courses were held in workshops and seminars to encourage learning-by-doing. Motivational interviewing was an integral aspect. The concept of risk drinking was promoted in all the activities. Subprojects were tailored to the specific conditions of each respective setting, building on the skills the providers already had to modify existing work practices. Nurses were afforded a key role in the project.

  • 295.
    Nilsing, Emma
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Söderberg, Elsy
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Primary Healthcare Professionals' Experiences of the Sick Leave Process: A Focus Group Study in Sweden2013In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 23, no 3, p. 450-461Article in journal (Refereed)
    Abstract [en]

    Purpose The aim of this study was to explore primary healthcare (PHC) professionals' experiences of the sick leave process. Methods This is an explorative study using data from four semi-structured focus group discussions with a purposeful sample of PHC professionals in A-stergotland County, Sweden. Content analysis with an inductive approach was used in the analysis. Results Four key themes emerged from the analysis; priority to the sick leave process, handling sickness certifications, collaboration within PHC and with other stakeholders, and work ability assessments. Patients' need for sick leave was handled from each professional group's perspective. Collaboration was considered important, but difficult to achieve and all the competencies available at the PHC centre were not used for work ability assessments. There was insufficient knowledge of patients' work demands and contact with an employer was rare, and the strained relationship with the social insurance officers affected the collaboration. Conclusions This study highlights the challenges physicians and other PHC professionals face when handling the need for sick leave, especially when encountering patients with symptom-based diagnoses, and the influence of non-medical factors. Hindrances to good practice were increased demands, collaboration, and role responsibility. The challenges in the sick leave process concerned both content and consequences related to poor collaboration within PHC and with representatives from various organizations, primarily employers and social insurance officers. Further research on how to develop a professional approach for handling the sick leave process is needed.

  • 296.
    Nilsing, Emma
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Söderberg, Elsy
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Normelli, Helena
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Description of functioning in sickness certificates2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 5, p. 508-516Article in journal (Refereed)
    Abstract [en]

    Aims: Sickness certificates are to provide information on a disease and its consequences on the patients functioning. This information has implications for the patients rights to sickness benefits and return-to-work measures. The objective of this study was to investigate the description of functioning in sickness certificates according to WHOs International Classification of Functioning, Disability, and Health (ICF), and to describe the influence of patients age, gender, diagnostic group, and affiliation of certifying physician. Method: A content analysis of written statements regarding how the disease limits the patients functioning with ICF as a framework was performed in 475 sickness certificates, consecutively collected in Ostergotland County, Sweden. Results: Musculoskeletal diseases (MSD) were the largest diagnostic group, followed by mental disorders (MD). Certificates were mainly issued from physicians at hospitals and in primary health care (PHC). ICF was applicable for classifying statements regarding functioning in 311 certificates (65%). The distribution of components was 58% body functions, 26% activity, and 7% participation. The descriptions were primarily restricted to the use of at least one component; namely, body functions. Subgroup analysis showed that descriptions of activity and participation were more common in certificates for MD and MSD, or those issued by PHC physicians. A multiple regression analysis with the activity component as dependent variable confirmed the results by showing that activity was related to both diagnosis and affiliation. Conclusions: In a consecutive sample of sickness certificates, it was shown that information on functioning is scarce. When functioning was described, it was mainly body oriented.

  • 297.
    Nilsing, Emma
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Söderberg, Elsy
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Sickness certificates in Sweden: did the new guidelines improve their quality?2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, no 907Article in journal (Refereed)
    Abstract [en]

    Background: Long-term sickness absence is high in many Western countries. In Sweden and many other countries, decisions on entitlement to sickness benefits and return to work measures are based on information provided by physicians in sickness certificates. The quality demands, as stressed by the Swedish sick leave guidelines from 2008, included accurate sickness certificates with assessment of functioning clearly documented. This study aims to compare quality of sickness certificates between 2007 and 2009 in Ostergotland County, Sweden. Quality is defined in terms of descriptions of functioning with the use of activity and participation according to WHOs International Classification of Functioning, Disability and Health (ICF), and in prescriptions of early rehabilitation. less thanbrgreater than less thanbrgreater thanMethods: During two weeks in 2007 and four weeks in 2009, all certificates had been collected upon arrival to the social insurance office in Ostergotland County, Sweden. Four hundred seventy-five new certificates were included in 2007 and 501 in 2009. Prolongations of sick leave were included until the last date of sick listing. Free text on functioning was analysed deductively using the ICF framework, and placed into categories (body functions/structures, activity, participation, no description) for statistical analysis. less thanbrgreater than less thanbrgreater thanResults: The majority of the certificates were issued for musculoskeletal diseases or mental disorders. Text on functioning could be classified into the components of ICF in 65% and 78% of sickness certificates issued in 2007 and 2009, respectively. Descriptions according to body components such as "sensations of pain" or "emotional functions" were given in 58% of the certificates from 2007 and in 65% from 2009. The activity component, for example "walking" or "handling stress", was more frequent in certificates issued in 2009 compared with 2007 (33% versus 26%). Prescriptions of early rehabilitation increased from 27% in 2007 to 35% in 2009, primarily due to more counseling. less thanbrgreater than less thanbrgreater thanConclusions: An improvement of the quality between certificates collected in 2007 and 2009 was demonstrated in Ostergotland County, Sweden. The certificates from 2009 provided more information linkable to ICF and incorporated an increased use of activity limitations when describing patients functioning. Still, activity limitations and prescriptions of early rehabilitation were only present in one-third of the sickness certificates.

  • 298.
    Nilsson, Evalill
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Aspects of health-related quality of life: Associations with psychological and biological factors, and use as patient reported outcome in routine health care2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background Health-related quality of life (HRQoL) is increasingly recognised as an important patient-reported outcome in health care research. However, the use is still restricted and several questions remain about the value and feasibility of using measures of HRQoL in routine health care. The general aims of the thesis were therefore to increase the understanding of these issues by studying 1) associations of HRQoL with psychological and biological factors, 2) comorbidity adjustments of HRQoL measurement results, and 3) the patient-perceived value and feasibility regarding the use of measures of HRQoL as patient-reported outcome in routine health care.

    Methods Three different data sets were used; baseline data (questionnaire, anthropometric, and biological) from the ongoing Life conditions, Stress, and Health Study (n=1007, papers I and II), data from a population survey from the County Council of Östergötland in combination with data from two national Swedish registries, the National Inpatient Register and the Causes of Death Register (n=6086, paper III), and data (questionnaire) from the multicentre Swedish Health Promoting Hospitals Network Health outcome assessment project (n=463, paper IV). The HRQoL measures used were the SF-36 and the EQ-5D. Statistical methods include variance, correlation and regression analyses.

    Results Psychological resources (Self-esteem, Sense of Coherence, and Perceived Control) as well as psychological risk factors (depressive mood) were found to relate independently to HRQoL (SF-36) in the expected directions (positive relations for resources and negative relations for risk factors), but with fewer sex differences than expected (Paper I). Low HRQoL (SF-36) was found to relate to higher levels of inflammatory biological factors (C-reactive protein, Interleukin-6, and MatrixMetalloProteinase-9), and, especially regarding Interleukin-6, many association remained significant, though attenuated, after adjustment for factors of known importance to HRQoL (age, sex, disease, lifestyle and psychological factors) (Paper II). A new comorbidity index, the Health-related Quality of Life Comorbidity Index (HRQL-CI), explicitly developed for use in HRQoL outcomes studies, showed higher explanatory power (higher R2 values) than the commonly used Charlson Comorbidity Index (CCI) regarding impact of comorbidity on HRQoL (SF-36 and EQ-5D). However, regarding mortality the CCI discriminated better between those who died within a year from answering the HRQoL questionnaires, died within ten years, or who were still alive after ten years. This result is in line with the CCI’s original purpose as a mortality predictor. Using morbidity data from mandatory, highly valid national health data bases was found to be useful in a large study of this kind, where using data from medical records might be impractical. (Paper III). Using measures of HRQoL as patient-reported outcome measures in routine health care was regarded as valuable by the majority of the patients in the Health outcome assessment project. A new concept was introduced, respondent satisfaction, and the respondent satisfaction summary score was in most cases equal, i.e. SF-36 and EQ-5D were found to be quite similar regarding the cognitive response process (understanding and responding to the items in the EQ-5D and the SF-36) and patient-perceived content validity (if EQ-5D and SF-36 gave patients the ability to describe their health in a comprehensive way) (Paper IV).

    Conclusions The four papers investigated different aspects of HRQoL that are important for the implementation of the use of measures of HRQoL within the health care system. In conclusion, 1) the use of measures of HRQoL to identify patients with low HRQoL for further health promoting interventions might be supported on a psychological (psychological resources are related to better HRQoL) and biological basis (low HRQoL being an important sign of increased biological vulnerability), 2) a comorbidity index specifically aimed to adjust for comorbidity in patient HRQoL outcomes studies was found to be valid in a normal population (that might serve as a reference population in future studies), and 3) patients perceived the use of measures of HRQoL to be valuable and feasible in routine health care, and questionnaire length and ease of response were not found to be crucial arguments in the choice between SF-36 and EQ-5D. Hence, in their own way, they all and together, contribute to removing obstacles in the implementation process of using patient-reported outcome measures in the health care system for quality improvement.

    List of papers
    1. Psychological factors related to physical, social,and mental dimensions of the SF-36: a populationbasedstudy of middle-aged women and men
    Open this publication in new window or tab >>Psychological factors related to physical, social,and mental dimensions of the SF-36: a populationbasedstudy of middle-aged women and men
    2010 (English)In: patient related outcome measures, Vol. 1, p. 153-162Article in journal (Refereed) Published
    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.

    Place, publisher, year, edition, pages
    Dove Medical Press Limited, 2010
    Keywords
    Health-related quality of life, patient-reported outcome measures, population
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-66496 (URN)10.2147/PROM.S13209 (DOI)
    Projects
    LSH-studien
    Available from: 2011-03-17 Created: 2011-03-17 Last updated: 2014-11-13Bibliographically approved
    2. Associations between SF-36 and inflammatory biomarkers CRP, CXCL8, IL-1β, IL-6, IL-10, and MMP-9 in a normal middle-aged Swedish population
    Open this publication in new window or tab >>Associations between SF-36 and inflammatory biomarkers CRP, CXCL8, IL-1β, IL-6, IL-10, and MMP-9 in a normal middle-aged Swedish population
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Objective: To evaluate associations between health-related quality of life, HRQoL, and inflammatory biomarkers in a normal population, and investigate whether associations could be explained by the presence of disease, lifestyle and/or psychological factors.

    Methods: A randomly selected sample of a middle-aged Swedish population (n=961; aged 45-70 years, 50% women) was investigated. Self-reported data on HRQoL (SF-36), presence of disease, lifestyle and psychological factors, and plasma levels of biomarkers of inflammation: C-reactive protein (CRP), CXCL8, interleukin (IL)-1β, 6, and 10, and matrix metalloproteinase-9, were analyzed using correlation and regression analyses.

    Results: After adjustment for sex and age, significant negative associations were seen for all scales of the SF-36 to plasma levels of IL-6 and CRP (except the Mental Health scale for CRP), and to a lesser extent to MMP-9, while only a few significant associations were noted for the other biomarkers. Associations with IL-6 were attenuated but generally remained significant after full adjustment (for age, sex, presence of disease, lifestyle and psychological factors) in regression analyses, while associations with CRP for many scales became nonsignificant after control for lifestyle factors.

    Conclusions: Poor HRQoL was related to low grade inflammation in a normal population. The results suggest a possible pathway for earlier observed effects of HRQoL on mortality risk and indicate that low HRQoL is a sign of increased biological vulnerability. The data further indicate that IL-6, CRP, and MMP-9 are more informative markers than CXCL8, IL-1β, and IL-10 for these relationships, but also that they may not convey exactly the same information.

    Keywords
    CRP; health-related quality of life; interleukin; MMP-9; population; SF-36
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-75137 (URN)
    Available from: 2012-02-17 Created: 2012-02-17 Last updated: 2012-02-17Bibliographically approved
    3. Impact of comorbidity on health-related quality of life: a population-based study using the Charlson Comorbidity Index and the new Health-Related Quality of Life Comorbidity Index, with data from the Swedish National Inpatient Register
    Open this publication in new window or tab >>Impact of comorbidity on health-related quality of life: a population-based study using the Charlson Comorbidity Index and the new Health-Related Quality of Life Comorbidity Index, with data from the Swedish National Inpatient Register
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: To investigate the impact of comorbidity on general health-related quality of life (HRQoL) in a Swedish normal population using the Charlson Comorbidity Index (CCI), designed for mortality outcomes, and the new Health-Related Quality of Life Comorbidity Index (HRQL-CI, with physical and psychosocial subindexes) designed for HRQoL outcomes, and comorbidity analyses based on data from the Swedish national inpatient register.

    Study design and setting:L In 1999, 6083 women (54%) and men aged 20-74 (mean 46, SD 15) responded to a public health survey in the county of Östergötland, Sweden, including measures of general HRQoL (the SF-36 and the EQ-5D).

    Results: During 1987-1999, 478 (15 %) and 664 (21 %)/418 (13 %) persons had been registered with ≥1 hospital admission ICD-code included in the CCI and the HRQL-CI physical/psychosocial dimensions, respectively. Both indices discriminated between persons with different degrees of comorbidity regarding their HRQoL. The HRQL-CI received somewhat higher R2 values (e.g. SF-36 scales Physical Functioning 0.161 vs 0.067 and Mental Health 0.026 vs 0.004).

    Conclusions: The new HRQL-CI, created on the basis of self-reports, proved to be a valid measure of comorbidity in a Swedish normal population using national register data.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-75138 (URN)
    Available from: 2012-02-17 Created: 2012-02-17 Last updated: 2012-02-17Bibliographically approved
    4. Respondent satisfaction regarding SF-36 and EQ-5D, and patients' perspectives concerning health outcome assessment within routine health care
    Open this publication in new window or tab >>Respondent satisfaction regarding SF-36 and EQ-5D, and patients' perspectives concerning health outcome assessment within routine health care
    2007 (English)In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 16, no 10, p. 1647-1654Article in journal (Refereed) Published
    Abstract [en]

    Objective: To investigate respondent satisfaction regarding SF-36 and EQ-5D and patients' perspectives concerning health outcome assessment within routine health care. Methods: Eighteen Swedish hospitals participated in the study which included 30 patient intervention groups (e.g. education groups for patients with ischemic heart disease or chronic obstructive pulmonary disease). Patients responded to SF-36 and EQ-5D before and after ordinary interventions (n = 463), and then completed an evaluation form. Results: Regarding respondent satisfaction, most patients found both questionnaires easy to understand (70% vs. 75% for SF-36 and EQ-5D respectively), easy to respond to (54% vs. 60%), and that they gave the ability of describing their health in a comprehensive way (68% for both). Health outcome assessment in routine health care was perceived as valuable by 57% of the patients, while 4% disapproved. Most patients (68%) considered both questionnaires equally suitable, 25% preferred SF-36 and 8% EQ-5D. Among those who were more satisfied with a short questionnaire (EQ-5D), several still preferred a longer and more comprehensive questionnaire (SF-36). Conclusion: Health outcome assessment within routine health care seems to be acceptable, and even appreciated, by patients. Questionnaire length and ease of response were not found to be crucial arguments in choosing between SF-36 and EQ-5D. © 2007 Springer Science+Business Media B.V.

    Keywords
    outcome assessment, SF-36, EQ-5D, patient perspective, respondent satisfaction
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-39617 (URN)10.1007/s11136-007-9263-8 (DOI)50285 (Local ID)50285 (Archive number)50285 (OAI)
    Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
  • 299.
    Nilsson, Evalill
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Borgstedt Risberg, Madeleine
    Public Health Centre, County Council of Östergötland, Linköping, Sweden.
    Orwelius, Lotti
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Unit . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Impact of comorbidity on health-related quality of life: a population-based study using the Charlson Comorbidity Index and the new Health-Related Quality of Life Comorbidity Index, with data from the Swedish National Inpatient RegisterManuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: To investigate the impact of comorbidity on general health-related quality of life (HRQoL) in a Swedish normal population using the Charlson Comorbidity Index (CCI), designed for mortality outcomes, and the new Health-Related Quality of Life Comorbidity Index (HRQL-CI, with physical and psychosocial subindexes) designed for HRQoL outcomes, and comorbidity analyses based on data from the Swedish national inpatient register.

    Study design and setting:L In 1999, 6083 women (54%) and men aged 20-74 (mean 46, SD 15) responded to a public health survey in the county of Östergötland, Sweden, including measures of general HRQoL (the SF-36 and the EQ-5D).

    Results: During 1987-1999, 478 (15 %) and 664 (21 %)/418 (13 %) persons had been registered with ≥1 hospital admission ICD-code included in the CCI and the HRQL-CI physical/psychosocial dimensions, respectively. Both indices discriminated between persons with different degrees of comorbidity regarding their HRQoL. The HRQL-CI received somewhat higher R2 values (e.g. SF-36 scales Physical Functioning 0.161 vs 0.067 and Mental Health 0.026 vs 0.004).

    Conclusions: The new HRQL-CI, created on the basis of self-reports, proved to be a valid measure of comorbidity in a Swedish normal population using national register data.

  • 300.
    Nilsson, Evalill
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Garvin, Peter
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Associations between SF-36 and inflammatory biomarkers CRP, CXCL8, IL-1β, IL-6, IL-10, and MMP-9 in a normal middle-aged Swedish populationManuscript (preprint) (Other academic)
    Abstract [en]

    Objective: To evaluate associations between health-related quality of life, HRQoL, and inflammatory biomarkers in a normal population, and investigate whether associations could be explained by the presence of disease, lifestyle and/or psychological factors.

    Methods: A randomly selected sample of a middle-aged Swedish population (n=961; aged 45-70 years, 50% women) was investigated. Self-reported data on HRQoL (SF-36), presence of disease, lifestyle and psychological factors, and plasma levels of biomarkers of inflammation: C-reactive protein (CRP), CXCL8, interleukin (IL)-1β, 6, and 10, and matrix metalloproteinase-9, were analyzed using correlation and regression analyses.

    Results: After adjustment for sex and age, significant negative associations were seen for all scales of the SF-36 to plasma levels of IL-6 and CRP (except the Mental Health scale for CRP), and to a lesser extent to MMP-9, while only a few significant associations were noted for the other biomarkers. Associations with IL-6 were attenuated but generally remained significant after full adjustment (for age, sex, presence of disease, lifestyle and psychological factors) in regression analyses, while associations with CRP for many scales became nonsignificant after control for lifestyle factors.

    Conclusions: Poor HRQoL was related to low grade inflammation in a normal population. The results suggest a possible pathway for earlier observed effects of HRQoL on mortality risk and indicate that low HRQoL is a sign of increased biological vulnerability. The data further indicate that IL-6, CRP, and MMP-9 are more informative markers than CXCL8, IL-1β, and IL-10 for these relationships, but also that they may not convey exactly the same information.

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