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  • 301.
    Näsström, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Luttik, Marie Louise
    Hanze University of Applied Sciences Groningen, Research Group Nursing Diagnostics, Groningen, the Netherlands.
    Idvall, Ewa
    Department of Care Science, Malmö University, and Department of Intensive Care and Perioperative Medicine, Skåne University Hospital, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Exploring partners’ perspectives on participation in heart failure home-care: A mixed method design2017In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 5, p. 1208-1219Article in journal (Refereed)
    Abstract [en]

    Previous research has shown that partners are involved in the care of patients with heart failure. The aim of this study was to gain a better understanding of the partners ‘perspectives on participation in the care for patients with heart failure receiving structured home-care. A parallel convergent mixed method design with data from interviews analyzed with content analysis and questionnaires statistically analyzed (n=15). Results were analyzed with regard to whether they were comparable and convergent, expanded the understanding, or were inconsistent. Partners scored that they were satisfied with most aspects of participation, information and contact. Qualitative findings revealed four different aspects of participation; adapting to the caring needs and illness trajectory, mastering caregiving demands, interacting with health care providers, and gaining knowledge to comprehend the health situation. Results showed confirmatory results that were convergent and expanded knowledge that gave a broader understanding of partner participation in this context.

  • 302.
    Näsström, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Mårtensson, Jan
    Department of Nursing, School of Health Sciences, Jönköping, Sweden.
    Idvall, Ewa
    Department of Care Science, Malmö University, and Department of Intensive Care and Perioperative Medicine, Skåne University Hospital, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Participation in the Care Encounter among Patients with Heart Failure Receiving Home-care2013Manuscript (preprint) (Other academic)
    Abstract [en]

    Background Heart failure is a chronic condition that affects patients’ life situation. Living with heart failure puts high demands on self-care and patient participation. Patients often need advanced care due to deterioration of their heart failure symptoms, and one option is homecare. Prerequisites for participation may differ when receiving home-care.

    Objective The aim of this study was to identify and describe participation in care encounters during home visits in heart failure home-care.

    Participants and setting Seventeen patients diagnosed with heart failure, aged 63-95 years, and ten registered nurses participated. The patients received home-care from three different home-care providers in Sweden.

    Methods Data from nineteen home visits was collected through observations and documented by video-recordings. The verbal communication in these video-recordings was transcribed verbatim and complemented with non-verbal communication. Data was analysed using qualitative content analysis, and the video-recordings and transcribed material were analysed in parallel.

    Results We identified two themes with three and four categories respectively; (a) Participation in the care encounter is made possible by interaction, including exchange of care-related information, care-related reasoning, and collaboration, and (b) Participation in the care encounter is made possible by an enabling approach, including the patient expresses their own wishes and shows an active interest, and the nurse is committed and invites to a dialogue.

    Conclusion Our findings underline that patient participation is multifaceted and that the home-care context shows good potential for patient participation as the care encounters were categorised by interaction and an enabling approach.

  • 303.
    Odzakovic, Elzana
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Hyden, Lars-Christer
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Medicine and Health Sciences.
    Festin, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Kullberg, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    People diagnosed with dementia in Sweden: What type of home care services and housing are they granted? A cross-sectional study2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 2, p. 229-239Article in journal (Refereed)
    Abstract [en]

    AIMS: This study aims to examine what types of home care services and housing are granted to people with a dementia diagnosis and how these types are associated with socio-demographic factors (sex, age, marital status, native or foreign born, and regional area).

    METHODS: A cross-sectional study of all people diagnosed with dementia in three Swedish counties was conducted from the medical records in 2012. Logistic regression analysis was carried out to investigate associations between home care services and housing and socio-demographic variables.

    RESULTS: In total, 17,405 people had a dementia diagnosis, and the majority were women, aged 80+ years, and unmarried. Some 72% were living in ordinary housing and 28% lived in special housing. Of those who lived in ordinary housing, 50% did not receive any home care service. Not receiving any type of home care services was less common for older people and was also associated with being married and living in rural municipalities. The most common home care services granted were home help and personal care. Special housing was more common for older people, unmarried persons, and those living in rural municipalities.

    CONCLUSIONS: Most people with a dementia diagnosis were living in ordinary housing, and, surprisingly, half of those did not receive any type of home care service. This knowledge is essential for making the living conditions and needs of people living with dementia more visible and to provide good home care services for people with dementia and their families.

  • 304.
    Odzakovic, Elzana
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology in Linköping.
    Kullberg, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hellström, Ingrid
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland.
    Andrew, Clark
    School of Health and Society, University of Salford, Salford, UK.
    Sarah, Campbell
    Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
    Kainde, Manji
    Faculty of Social Science, University of Stirling, Stirling, UK.
    Kirstein, Rummery
    Faculty of Social Science, University of Stirling, Stirling, UK.
    John, Keady
    Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
    Richard, Ward
    Faculty of Social Science, University of Stirling, Stirling, UK.
    ‘It's our pleasure, we count cars here’: an exploration of the ‘neighbourhood-based connections’ for people living alone with dementia2019In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 9, p. 1-26Article in journal (Refereed)
    Abstract [en]

    The extent of social isolation experienced by people living with dementia who reside in the community has been well acknowledged, yet little is known about how people living alone with dementia maintain neighbourhood-based connections. The purpose of this study is to examine the experiences of people with dementia who live alone, focusing upon how they establish social networks and relationships in a neighbourhood context, and how they are supported to maintain this social context within everyday life. Multiple data collection methods were used including, semi-structured interviews, walking interviews, guided home tours and social network mapping, which were conducted with 14 community-dwelling people living alone with dementia (11 women and three men) situated across the three international study sites in England, Scotland and Sweden. Data were analysed using thematic analysis. The analysis revealed four main themes: (a) making the effort to stay connected; (b) befriending by organisations and facilitated friendships; (c) the quiet neighbourhood atmosphere; and (d) changing social connections. The analysis suggests that people with dementia who live alone were active agents who took control to find and maintain relationships and social networks in the neighbourhood. Our findings indicate the need to raise awareness about this specific group in both policy and practice, and to find creative ways to help people connect through everyday activities and by spontaneous encounters in the neighbourhood.

  • 305.
    Oldin, Carin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Reg Jonkoping Cty, Sweden.
    Golsäter, Marie
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Reg Jonkoping Cty, Sweden; Jonkoping Univ, Sweden.
    Ask, Lina Schollin
    South Gen Hosp, Sweden; Karolinska Inst, Sweden.
    Fredriksson, Sara
    Norrahammar Primary Hlth Care Ctr, Sweden.
    Stenmarker, Margaretha
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Reg Jonkoping Cty, Sweden; Univ Gothenburg, Sweden.
    Introduction of rotavirus vaccination in a Swedish region: assessing parental decision-making, obtained vaccination coverage and resulting hospital admissions2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 7, p. 1329-1337Article in journal (Refereed)
    Abstract [en]

    Aim This study evaluated the introduction of rotavirus vaccination in Jonkoping County, Sweden, starting in 2014. This project explored the parental factors that influenced the decision to vaccinate and studied the obtained vaccination coverage and its potential influence on hospital admissions due to acute gastroenteritis. Methods This was a descriptive, cross-sectional study based on a study-specific questionnaire (n = 356) and regional statistical data on vaccination coverage and hospital admissions in Jonkoping County, Sweden. Results Central aspects when deciding on vaccination were vaccine efficacy and safety, that the vaccine was offered to all children, and recommended by healthcare professionals. One in five parents expressed uncertainty about whether they had sufficient information to make a decision. However, the rotavirus vaccination coverage was elevated from 76.1% to 81.0% and the hospital admissions due to acute gastroenteritis decreased by approximately 60%. Conclusion The results highlight the necessity for Child Health Services to have solid knowledge regarding vaccinations, to understand individual parental issues and to support uncertain parents. The high vaccination coverage achieved is an indication of the trust in healthcare professionals and is considered to be a major contributing factor to the substantial reduction of hospital admissions due to acute gastroenteritis.

  • 306.
    Olsen Faresjö, Åshild
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Irritable bowel syndrome diagnosed in primary care: Occurrence, treatment and impact on everyday life2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: IBS is the most common functional gastrointestinal disorders and affects approximately 10-20 % of the general population and is widespread in all societies and socio-economic groups. Although the disorder does not have a life-threatening course, it still seriously affects the patients in their everyday life.

    Aim: The general aims of this thesis were to estimate the occurrence of irritable bowel syndrome in the general population and to achieve a better understanding of present treatment of this disorder and impact on every-day life in those suffering from IBS.

    Material and methods: The LIPS study comprises two parts. Part I was a retrospective register study where the data collection was based on computerised medical records at three selected Primary Health Care centres in a defined region. Part II was a population based case-control study. The identified IBS cases from part I constitute the cases, while their control groups were randomly selected from the population census register in the same area as the cases. Data in part II were collected by means of a postal questionnaire to cases and controls. The study was conducted in Linköping, a city located in the south-east of Sweden with 135 000 inhabitants.

    Results: The female IBS patients reported lower influence on planning their work and working hours as well as fewer opportunities to learn new things at their work compared to their controls, even after adjustments in multiple logistic regressions for potential confounders like; mood, sleeping problems and perceived health. The female IBS patients had considerably lower HRQOL in all dimensions compared to their controls, even when compared to male patients. Younger female IBS cases (18-44 years) reported lower mental health on the SF-36 scale than the older IBS female cases (p=0.015). In the multivariate analysis these variables, lack of influence on planning the work, family history of IBS, anxiety and sleeping disturbance displayed an association with being diagnosed with IBS in women. In men, lack of influence on working pace, family history of IBS was associated with an IBS diagnosis.The consultation incidence of IBS in part I was 3.4 (95% CI 3.20-3.70) per 1000 person-years for all IBS cases, among females; the incidence rate was 4.6 per 1000 person-years (95% CI 4.16-4.97) and males; 2.3 per 1000 person-years (95% CI 2.01-2.59). The dominating pharmacological treatment prescribed for abdominal complaints were fibre and bulking laxatives agents as well as acid suppressive drugs. These variables had an independent impact on the probability of a follow-up consultation; diagnosed co-morbidity besides the IBS diagnosis, rectoscopy ordered and laboratory tests ordered.

    Conclusions: IBS patients identified in primary care are significantly affected in their working-life compared to individuals in the general population. Especially female IBS-patients report lower decision latitude at work and they also appear to have a particularly impaired psychosocial functioning in their every day life and impaired HRQOL. Factors associated with IBS diagnosis among females are anxiety as well as family history of IBS and lack of co-determination at work.

    The incidence rate of IBS was 3.4 per 1000 person-years which increased with age and with an overrepresentation of females. IBS patients did not appear to be heavy utilisers of primary care and those who attended were treated by their GP without further consultation. The strongest predictors for having a follow-up consultation were diagnosed co-morbidity, rectoscopy and laboratory tests ordered

    List of papers
    1. Patients with irritable bowel syndrome in Swedish primary care
    Open this publication in new window or tab >>Patients with irritable bowel syndrome in Swedish primary care
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    2006 (English)In: European Journal of General Practice, ISSN 1381-4788, Vol. 12, no 2, p. 88-90Article in journal (Refereed) Published
    Keywords
    Consultation; consulting incidence; IBS; primary health care; stress
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13965 (URN)10.1080/13814780600872937 (DOI)
    Available from: 2006-09-19 Created: 2006-09-19 Last updated: 2013-09-05
    2. Patients with irritable bowel syndrome in primary care appear not to be heavy health care utilisers
    Open this publication in new window or tab >>Patients with irritable bowel syndrome in primary care appear not to be heavy health care utilisers
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    2006 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 23, no 6, p. 807-814Article in journal (Refereed) Published
    Abstract [en]

    Background

    Irritable bowel syndrome is a frequently diagnosed gastrointestinal condition in general practice. Managing this chronic condition requires a co-ordinated effort between patient and doctor.

    Aim

    To explore the patterns of treatment and healthcare utilization of irritable bowel syndrome cases in a Swedish primary care setting.

    Methods

    All cases with a registered diagnosis of irritable bowel syndrome were identified retrospectively for a 5-year period through computerized medical records at three primary healthcare centres in Sweden. Documentation of diagnosis, healthcare visits, treatments, investigations, medications, referrals, laboratory tests, mental and demographic data were retrieved from the records.

    Results

    Of all 723 irritable bowel syndrome patients identified, only 37% had a follow-up appointment to their General Practitioner during the study period. For 80%, the General Practitioner initiated some treatment during the initial consultation and 75% were prescribed medication. Fibre and bulking laxatives and acid-suppressive drugs were the most common medication. Almost a quarter was referred for complementary investigations at hospital, only 8.9% of the irritable bowel syndrome patients were referred to a specialist investigation. Laboratory investigations varied and were ordered more frequently (P = 0.05) for men.

    Conclusions

    Irritable bowel syndrome patients appear not to be heavy utilizers of primary care and, of those who attend, the majority are managed by their General Practitioner.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13966 (URN)10.1111/j.1365-2036.2006.02815.x (DOI)
    Available from: 2006-09-19 Created: 2006-09-19 Last updated: 2017-12-13
    3. A population based case control study of work and psychosocial problems in patients with irritable bowel syndrome: women are more seriously affected than men
    Open this publication in new window or tab >>A population based case control study of work and psychosocial problems in patients with irritable bowel syndrome: women are more seriously affected than men
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    2007 (English)In: American Journal of Gastroenterology, ISSN 0002-9270, E-ISSN 1572-0241, Vol. 102, no 2, p. 371-379Article in journal (Refereed) Published
    Abstract [en]

    Objective: Everyday psychosocial functioning and quality of life are known to be reduced for patients with irritable bowel syndrome (IBS), but few previous studies have analyzed associations with functioning in working life. Accordingly, we examined perceptions of working conditions, functioning in the workplace, quality of life, and psychological complaints among IBS patients compared with age- and sex-matched controls.

    Methods: A case–control study design was used based on 347 IBS patients from Swedish general practice who were compared with age- and sex-matched controls (N = 1,041) randomly selected from the general population. A survey was performed including validated questions concerning job strain, quality of life (SF-36 [Short Form 36]), absence because of illness, depression, anxiety, and sleeping habits.

    Results: The IBS patients reported considerably more often that their daily performance in working life was affected by their gastrointestinal problems (OR [odds ratio] 7.14, 95% CI 5.45–9.36). Male IBS cases only reported less authority regarding decisions on their working pace (OR 5.44, 95% CI 1.28–23.18), while female IBS patients reported less decision authority regarding planning their work (OR 2.29, 95% CI 1.13–4.64), fewer learning opportunities at work (OR 2.12, 95% CI 1.26–3.57), and more long-term sick leave than their controls (OR 3.70, 95% CI 1.94–7.07). The female IBS cases also reported lower quality of life in all dimensions than their controls.

    Conclusion: In particular, female IBS patients reported lower authority over decisions at work and problems in their daily functioning in the workplace. These associations persisted after adjustments for possible confounders such as mood, sleeping problems, and perceived health.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13967 (URN)10.1111/j.1572-0241.2006.01012.x (DOI)
    Available from: 2006-09-19 Created: 2006-09-19 Last updated: 2017-12-13
    4. Psychosocial factors at work and in everyday life are associated with irritable bowel syndrome
    Open this publication in new window or tab >>Psychosocial factors at work and in everyday life are associated with irritable bowel syndrome
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    2007 (English)In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 22, no 7, p. 473-480Article in journal (Refereed) Published
    Abstract [en]

    The etiology of irritable bowel syndrome (IBS) tends to be complex and multi-factorial and there is still a lack of understanding of how different psychosocial factors are associated with the syndrome. Our aim was to examine the occurrence of psychosocial and behavioural factors among patients diagnosed with IBS in primary care. The study had an epidemiological population-based case–control design comparing 347 IBS cases to 1041 age and sex matched controls from the general population. A survey was directed to cases and controls based on validated questions asking for mood status, job strain, family history of IBS, and sleeping habits as well as education, nutritional and exercise habits and medication. In multivariate analyses, independent associations were found between IBS and lack of influence on work planning, a family history of IBS, anxiety, and sleeping disturbances. Important factors associated with IBS diagnosis among females were anxiety as well as family history of IBS and lack of co-determination at work. For males, only lack of influence on working pace and family history of IBS remained independently associated with an IBS diagnosis. The causal associations of the complex risk factor panorama for IBS warrants further study. This study indicates that there should be a special focus on investigating the psychosocial working conditions and their associations to IBS.

    Keywords
    Case–control study, Irritable bowel syndrome, Family history, Psychosocial factors, Risk factors
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13968 (URN)10.1007/s10654-007-9133-2 (DOI)
    Available from: 2006-09-19 Created: 2006-09-19 Last updated: 2017-12-13
    5. Health related quality of life of irritable bowel syndrome patients in different cultural settings
    Open this publication in new window or tab >>Health related quality of life of irritable bowel syndrome patients in different cultural settings
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    2006 (English)In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 4, no 21, p. 4-21Article in journal (Refereed) Published
    Abstract [en]

    Background

    Persons with Irritable bowel syndrome (IBS) are seriously affected in their everyday life. The effect across different cultural settings of IBS on their quality of life has been little studied. The aim was to compare health-related quality of life (HRQOL) of individuals suffering from IBS in two different cultural settings; Crete, Greece and Linköping, Sweden.

    Methods

    This study is a sex and age-matched case-control study, with n = 30 Cretan IBS cases and n = 90 Swedish IBS cases and a Swedish control group (n = 300) randomly selected from the general population. Health-related quality of life, measured by SF-36 and demographics, life style indicators and co-morbidity, was measured.

    Results

    Cretan IBS cases reported lower HRQOL on most dimensions of SF-36 in comparison to the Swedish IBS cases. Significant differences were found for the dimensions mental health (p < 0.0001) and general health (p = 0.05) even after adjustments for educational level and co-morbidity. Women from Crete with IBS scored especially low on the dimensions general health (p = 0.009) and mental health (p < 0.0001) in comparison with Swedish women with IBS. The IBS cases, from both sites, reported significantly lower scores on all HRQOL dimensions in comparison with the Swedish control group.

    Conclusion

    The results from this study tentatively support that the claim that similar individuals having the same disease, e.g. IBS, but living in different cultural environments could perceive their disease differently and that the disease might affect their everyday life and quality of life in a different way. The Cretan population, and especially women, are more seriously affected mentally by their disease than Swedish IBS cases. Coping with IBS in everyday life might be more problematic in the Cretan environment than in the Swedish setting.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13969 (URN)10.1186/1477-7525-4-21 (DOI)
    Available from: 2006-09-19 Created: 2006-09-19 Last updated: 2017-12-13
  • 307.
    Olsson, Yvonne
    et al.
    Lund University, Sweden.
    Claren, Lena
    Lund University, Sweden.
    Alvariza, Anette
    Ersta Skondal University of Coll, Sweden; Capio Palliat Care Unit, Sweden.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Ersta Skondal University of Coll, Sweden; Linnaeus University, Sweden.
    Hagell, Peter
    Kristianstad University, Sweden.
    Health and Social Service Access Among Family Caregivers of People with Parkinsons Disease2016In: Journal of Parkinson's Disease, ISSN 1877-7171, E-ISSN 1877-718X, Vol. 6, no 3, p. 581-587Article in journal (Refereed)
    Abstract [en]

    Background: Being a family caregiver for a person with Parkinsons disease (PD) can negatively impact health and wellbeing, but it appears less clear to what extent caregivers health/social service needs are met. Objective: We explored the extent to which PD family caregivers experience sufficient access to health/social services, as compared to age-matched controls; and the associations between this and demographic and health-related variables. Methods: A cross-sectional survey of 66 PD family caregivers and 79 age-matched control subjects including the SF-36 health survey, the Nottingham Health Profile Sleep section (NHP-Sleep), and questions regarding contacts with various health/social related services and whether these were perceived as sufficient. Results: People reporting insufficient access (n = 29) were more often PD family caregivers than controls (83% vs. 37%), did more often have a disease of their own (79% vs. 46%), and reported poorer health according to the SF-36 and the NHP-Sleep. Being a PD family caregiver (OR, 8.90), reporting more pain (OR, 1.02) and having an own disease (OR, 3.46) were independently associated with insufficient health/social service access. Conclusions: Our results imply that those in greatest need for health/social services (i.e., those with poorer health, an own disease, and who are PD family caregivers) are those whose health/social service needs are least met. Larger studies are needed for firmer conclusions and regarding how unmet health/social service needs impacts caregiver health and wellbeing. Health/social service providers should not only focus on patients but also consider their family members needs.

  • 308.
    Ouermi, D.
    et al.
    Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA)/LABIOGENE, Université Ouaga I Professeur Joseph KI-ZERBO, 01 B.P. 364, 01 Ouagadougou, Ouagadougou, Burkina Faso, West Africa.
    Soubeiga, D.
    Institut de Formation et de Recherche Interdisciplinaires en Santé (IFRIS), Ouagadougou, Burkina Faso.
    Nadembega, W. M. C.
    Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA)/LABIOGENE, Université Ouaga I Professeur Joseph KI-ZERBO, 01 B.P. 364, 01 Ouagadougou, Ouagadougou, Burkina Faso, West Africa.
    Sawadogo, P. M.
    Institut de Formation et de Recherche Interdisciplinaires en Santé (IFRIS), Ouagadougou, Burkina Faso.
    Zohoncon, T. M.
    Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA)/LABIOGENE, Université Ouaga I Professeur Joseph KI-ZERBO, 01 B.P. 364, 01 Ouagadougou, Ouagadougou, Burkina Faso, West Africa.
    Obiri-Yeboah, D.
    Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Ghana.
    Djigma, F. W.
    Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA)/LABIOGENE, Université Ouaga I Professeur Joseph KI-ZERBO, 01 B.P. 364, 01 Ouagadougou, Ouagadougou, Burkina Faso, West Africa.
    Nordgren, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Simpore, J.
    University Saint Thomas dAquin, USTA, Ouagadougou, Burkina Faso.
    Molecular Epidemiology of Rotavirus in Children under Five in Africa (2006-2016): A Systematic Review2017In: Pakistan Journal of Biological Sciences, ISSN 1028-8880, E-ISSN 1812-5735, Vol. 20, no 2, p. 59-69Article, review/survey (Refereed)
    Abstract [en]

    Group A human rotaviruses (RVA) are the most common causes of severe viral gastroenteritis in infants and young children worldwide. The available vaccines, while effective in Europe and North America have shown a reduced efficacy in Africa. One issue raised is the genetic variability of RVA. The objective of this study was to perform a literature review of molecular epidemiology to determine the prevalence of RVA genotypes circulating in Africa so as to establish a mapping of reliable data on these various genotypes. The search for articles was done from the National Institutes of Health (PUBMED) using three set of keywords. Articles were selected with inclusion criteria such as the date of publication, the age of the children, the sample size and the diagnostic techniques (standardized laboratory techniques). The data were imported into STATA SE version 11 software. Specific prevalence was estimated with Confidence Intervals (CI) of 95%. A total of 326 published studies were initially retrieved, out of which 27 studies were finally selected for the systematic review. The selected studies cover 20 African countries. The most encountered genotypes in Africa during this period were G1 (32.72%), followed by G2 (17.17%), G3 (9.88%), G9 (8.61%) and G12 (7.56%) among the G-types. The most common P-types were P[8] (48.71%) followed by P[6] (22.60%) and P[4] (11.58%) and the G1P[8] combination (22.64%) was the most encountered followed by G2P[4] (8.29%), G9P[8] (6.95%) and G2P[6] (5.00%). North Africa presented the highest prevalence of the P[8] genotype (65.70%). This review provides a comprehensive view of the current circulating rotavirus strains in Africa, which can be important in light of the new rotavirus vaccinations. Indeed, in Africa, the pursuit of national and continental studies for epidemiological surveillance of circulating rotavirus strains is vital for the promotion of future successful vaccines.

  • 309.
    Owuor, John O. A.
    et al.
    Linköping University, Department of Social and Welfare Studies, REMESO - Institute for Research on Migration, Ethnicity and Society. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden; University of Huddersfield, England.
    Locke, Abigail
    University of Huddersfield, England.
    Heyman, Bob
    University of Huddersfield, England.
    Clifton, Andrew
    University of Huddersfield, England.
    Concealment, communication and stigma: The perspectives of HIV-positive immigrant Black African men and their partners living in the United Kingdom2016In: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 21, no 12, p. 3079-3091Article in journal (Refereed)
    Abstract [en]

    This study explored the perspectives of Black men, originally from East Africa, living in the United Kingdom and their partners on what it means to live with diagnosed HIV. This article reports on concealment of HIV-positive status as a strategy adopted by the affected participants to manage the flow of information about their HIV-positive status. Analysis of the data, collected using in-depth interviews involving 23 participants, found widespread selective concealment of HIV-positive status. However, a few respondents had come out publicly about their condition. HIV prevention initiatives should recognise concealment as a vital strategy in managing communication about ones HIV-positive status.

  • 310.
    Palm, Anna
    et al.
    Uppsala University, Sweden; Sundsvall Hospital, Sweden.
    Danielsson, Ingela
    Umeå University, Sweden.
    Skalkidou, Alkistis
    Uppsala University, Sweden.
    Olofsson, Niclas
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Högberg, Ulf
    Uppsala University, Sweden.
    Violence victimisation-a watershed for young womens mental and physical health2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 5, p. 861-867Article in journal (Refereed)
    Abstract [en]

    Purpose: The association between victimisation and adverse health in children is well established but few studies have addressed the effect of victimisation, especially multiple victimisations, in older adolescents and young adults. The aim of this study was to assess self-reported health in young women (15-22 years) victimised to one or more types of violence, compared with non-victimised.aEuro integral Methods: Young women visiting youth health centres in Sweden answered a questionnaire constructed from standardised instruments addressing violence victimisation (emotional, physical, sexual and family violence), socio-demographics, substance use and physical and mental health. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and attributable risk (AR) were assessed.aEuro integral Results: Of 1051 women (73% of eligible women), 25% were lifetime victims of one type of violence and 31% of two or more types of violence. Sexual-minority young women were more victimised than heterosexual women. Violence victimisation increased the risk for adverse health outcomes, especially evident for those multiply victimised. Victims of two or more types of violence had AOR 11.8 (CI 6.9-20.1) for post-traumatic stress symptoms, 6.3 (CI 3.9-10.2) for anxiety symptoms and 10.8 (CI 5.2-22.5) for suicide ideation. The AR of victimisation accounted for 41% of post-traumatic stress symptoms, 30% of anxiety symptoms and 27% of suicide ideation. Stratified analyses showed that lower economic resources did not influence health negatively for non-victimised, whereas it multiplicatively reinforced ill-health when combined with violence victimisation.aEuro integral Conclusion: Violence victimisation, and particularly multiple victimisations, was strongly associated with mental ill-health in young women, especially evident in those with low economic resources.

  • 311.
    Papola, D.
    et al.
    Univ Verona, Italy.
    Ostuzzi, G.
    Univ Verona, Italy.
    Gastaldon, C.
    Univ Verona, Italy.
    Morgano, G. P.
    McMaster Univ, Canada.
    Dragioti, Elena
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Carvalho, A. F.
    Univ Toronto, Canada; CAMH, Canada.
    Fusar-Poli, P.
    Kings Coll London, England; South London and Maudsley NHS Fdn Trust, England; Univ Pavia, Italy; South London and Maudsley NHS Fdn Trust, England.
    Correll, C. U.
    Zucker Hillside Hosp, NY USA; Hofstra Northwell, NY USA; Feinstein Inst Med Res, NY USA; Charite Univ Med Berlin, Germany.
    Solmi, M.
    Kings Coll London, England; Univ Padua, Italy; Univ Padua, Italy.
    Barhui, C.
    Univ Verona, Italy.
    Antipsychotic use and risk of life-threatening medical events: umbrella review of observational studies2019In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447Article, review/survey (Refereed)
    Abstract [en]

    Objective To quantify the risk of hip fracture, thromboembolism, stroke, myocardial infarction, pneumonia and sudden cardiac death associated with exposure to antipsychotics. Methods Systematic searches were conducted in Medline, Embase and PsycINFO from inception until 30/07/2018 for systematic reviews of observational studies. AMSTAR-2 was used for the quality assessment of systematic reviews, while the strength of associations was measured using GRADE and quantitative umbrella review criteria (URC). Results Sixty-eight observational studies from six systematic reviews were included. The association between antipsychotic exposure and pneumonia was the strongest [URC = class I; GRADE = low quality; odds ratio (OR) = 1.84, 95% confidence interval (CI) = 1.62-2.09; participants = 28 726; age = 76.2 +/- 12.3 years], followed by the association with hip fracture (URC = class II; GRADE = low quality; OR = 1.57, 95% CI = 1.42-1.74; participants = 5 288 118; age = 55.4 +/- 12.5 years), and thromboembolism (URC = class II; GRADE = very low quality; OR = 1.55, 95% CI = 1.31-1.83; participants = 31 417 175; age = 55.5 +/- 3.2 years). The association was weak for stroke (URC = class III; GRADE = very low quality; OR = 1.45, 95% CI = 1.24-1.70; participants = 65 700; age = 68.7 +/- 13.8 years), sudden cardiac death (URC = class III; GRADE = very low quality; OR = 2.24, 95% CI = 1.45-3.46; participants = 77 488; age = 52.2 +/- 6.2 years) and myocardial infarction (URC = class III; GRADE = very low quality; OR = 2.21, 95% CI = 1.41-3.46; participants = 399 868; age = 74.1 +/- 9.3 years). Conclusion The most robust results were found for the risk of pneumonia, followed by the risk of hip fracture and thromboembolism. For stroke, sudden cardiac death and myocardial infarction, the strength of association was weak. The observational nature of the primary studies may represent a source of bias.

  • 312.
    Patil, Indrajeet
    et al.
    Scuola Int Super Studi Avanzati, Italy; Harvard Univ, MA 02138 USA.
    Zanon, Marco
    Univ Bologna, Italy.
    Novembre, Giovanni
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Zangrando, Nicola
    Univ Udine, Italy.
    Chittaro, Luca
    Univ Udine, Italy.
    Silani, Giorgia
    Univ Vienna, Austria.
    Neuroanatomical basis of concern-based altruism in virtual environment2018In: Neuropsychologia, ISSN 0028-3932, E-ISSN 1873-3514, Vol. 116, p. 34-43Article in journal (Refereed)
    Abstract [en]

    Costly altruism entails helping others at a cost to the self and prior work shows that empathic concern (EC) for the well-being of distressed and vulnerable individuals is one of the primary motivators of such behavior. However, extant work has investigated costly altruism with paradigms that did not feature self-relevant and severe costs for the altruist and have solely focused on neurofunctional, and not neuroanatomical, correlates. In the current study, we used a contextually-rich virtual reality environment to study costly altruism and found that individuals who risked their own lives in the virtual world to try to save someone in danger had enlarged right anterior insula and exhibited greater empathic concern than those who did not. These findings add to the growing literature showing the role of caring motivation in promoting altruism and prosociality and its neural correlates in the right anterior insula.

  • 313.
    Perera, Nirmala
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Federat Univ Australia, Australia; Univ Oxford, England; Ctr Sport Exercise and Osteoarthrit Res Versus Arth, England; La Trobe Univ, Australia.
    Kemp, Joanne L.
    Federat Univ Australia, Australia; La Trobe Univ, Australia.
    Joseph, Corey
    Monash Hlth, Australia.
    Finch, Caroline F.
    Edith Cowan Univ, Australia.
    Epidemiology of hospital-treated cricket injuries sustained by women from 2002-2003 to 2013-2014 in Victoria, Australia2019In: Journal of Science and Medicine in Sport, ISSN 1440-2440, E-ISSN 1878-1861, Vol. 22, no 11, p. 1213-1218Article in journal (Refereed)
    Abstract [en]

    Objectives: To present the first comprehensive epidemiological profile of hospital-treated injuries sustained by female cricketers from 2002-2003 to 2013-2014 in Victoria, Australia. Design: Analysis of routinely collected hospital data (detailed case-series). Methods: A retrospective analysis of hospital-treatment data associated with cricket injuries sustained by women between 1 July 2002 and 30 June 2014, inclusive were extracted from databases held by the Victorian Injury Surveillance Unit in Australia. Results: Over the 12-year period, 668 cases were treated in Victoria. Of these, 547 were emergency department (ED)-presentations. There were 121 hospital-admissions, of which, the length of stay was amp;lt;2 days for 78.5% cases. All cases were treated and released, and no fatalities were reported. The 10-14 year age group most frequently presented to ED (19.9%) and were most commonly admitted to hospital (16.5% of the total admissions). Fractures were the most common cause of hospital-admissions (47.1%) but only accounted for 17.2% of the ED-presentations. Dislocations, sprains and strains, were the most common (36.4%) cause of ED-presentations. The head was the most commonly injured anatomical location (27.8% of ED-presentations and 28.1% of hospital-admissions), followed by the wrist and hand (27.8% ED-presentations and 17.4% hospital-admissions). Conclusions: These findings provide the first overview of the nature of injuries requiring hospital attendance in female cricketers, and a foundation to inform the development of targeted injury prevention programs for female cricketers. (C) 2019 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  • 314.
    Persson Asplund, Robert
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Dagöö, Jesper
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Fjellström, Ida
    Karolinska Inst, Sweden.
    Niemi, Linnea
    Karolinska Inst, Sweden.
    Hansson, Katja
    Uppsala Univ, Sweden.
    Zeraati, Forough
    Uppsala Univ, Sweden.
    Ziuzina, Masha
    Uppsala Univ, Sweden.
    Geraedts, Anna
    Vrije Univ Amsterdam, Netherlands.
    Ljotsson, Brjann
    Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholms Univ, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Internet-based stress management for distressed managers: results from a randomised controlled trial2018In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 75, no 2, p. 105-113Article in journal (Refereed)
    Abstract [en]

    Objective The aim of this randomised controlled trial (RCT) was to evaluate the efficacy of a guided internet-based stress management intervention (iSMI) among distressed managers compared with a attention control group (AC) with full access to treatment-as-usual. Method A total sample of 117 distressed managers, mainly employed in the healthcare, IT, communication and educational sector, were randomised to either iSMI (n=59) or an AC group (n=58). The iSMI consisted of eight modules including cognitive behavioural stress management and positive management techniques. Participants received a minimal and weekly guidance from a psychologist or master-level psychology student focusing on support, feedback and adherence to the intervention. Self-report data were assessed at pre, post and 6 months after the intervention. The primary outcome was perceived stress (Perceived Stress Scale-14). The secondary outcomes included mental and work-related health outcomes. Results Participants in the iSMI intervention reported significantly less symptoms of perceived stress (d=0.74, 95% CI 0.30 to 1.19) and burnout (d=0.95, 95% CI 0.53 to 1.37) compared with controls, at postassessment. Significant medium-to-large effect sizes were also found for depression, insomnia and job satisfaction. Longterm effects (6 months) were seen on the mental health outcomes. Conclusion This is one of the first studies showing that iSMIs can be an effective, accessible and potentially time-effective approach of reducing stress and other mental-related and work-related health symptoms among distressed managers. Future studies are needed addressing distressed managers and the potential of indirect effects on employee stress and satisfaction at work.

  • 315.
    Persson, Mats
    et al.
    Karolinska Institute, Sweden.
    Belfrage, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Vadstena Forens Psychiat Hospital, Sweden.
    Kristiansson, Marianne
    Karolinska Institute, Sweden; National Board Forens Med, Sweden.
    Violent victimization and health service utilization in a forensic psychiatric context: a comparison between offenders with mental disorders and matched controls2017In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, article id 91Article in journal (Refereed)
    Abstract [en]

    Background: Offenders with mental disorders constitute a particularly exposed group in society, with high rates of morbidity, mortality, and social deprivation. Often thought of primarily as perpetrators, these individuals may also be subjected to violence. Previous research indicates that violent victimization during lifespan is a risk factor for violent perpetration among psychiatric patients, but victimization studies on the group of offenders with mental disorders are scarce. Health services are pivotal to this group, but although most individuals do utilize these services, their vulnerability seems to remain. This study aimed at exploring the rates of victimization and health service utilization, including perceptions of unmet health care needs, among offenders with mental disorders. Methods: Two hundred detainees undergoing a forensic psychiatric evaluation in Stockholm were asked about violent victimization and health service utilization. Each detainee was compared with three controls from the general population, matched regarding age, sex, and occupation. Results: Victimization during the past year was reported by 52.3% of the detainees and 11.1% of the controls, with a corresponding risk ratio of 8.2. Health service utilization during the past three months was reported by 47.7 and 23.7%, respectively (risk ratio 2.0); and unmet health care needs by 42.2 and 16.7%, respectively (risk ratio 3.4). There was no distinct association between victimization and health service utilization among detainees. Conclusions: Offenders with mental disorders are at great risk of being victimized, and they experience impediments to receiving requisite health care. A possible way to reduce victimization and improve health service utilization may be to establish interdisciplinary yet specialized health centers with outreach teams but without complicated referral procedures.

  • 316.
    Persson, Mats
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Clinical Department of Operation and Intensive Care, Pain Unit, County Hospital Ryhov, Jönköping.
    Sörensen, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Chronic Whiplash Associated Disorders (WAD): Responses to Nerve Blocks of Cervical Zygapophyseal Joints.2016In: Pain medicine (Malden, Mass.), ISSN 1526-2375, E-ISSN 1526-4637, Vol. 17, no 12, p. 2162-2175Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study explores the prevalence of facet joint pain in chronic Whiplash Associated Disorder (WAD).

    DESIGN: Forty-seven patients with chronic WAD were scheduled for medial branch blocks of the cervical spine.

    METHODS: The patient's localization of the pain together with established pain maps guided to the first level of zygapophyseal joint to be tested. The joint was anesthetized by injecting bupivacaine (0.5 ml; 5 mg/ml) to the medial branches of the cervical dorsal rami above and below the joint. If a positive response was noted, the schedule continued with a double-blinded sequence with a placebo (saline) and bupivacaine. If a negative response was noted, other joint levels were anesthetized until all joints from C2 to C7 were tested. The responses were assessed using a visual analog scale (VAS) in a predefined protocol.The study was carried through with a definition of a positive response to a diagnostic block as a VAS decrease ≥50% compared with baseline during a minimum of 3 hours after the block. All other responses were regarded as negative. The data were also analyzed using a definition of a positive response as a VAS decrease ≥80%, and figures from this analysis are presented as the main result of the study.

    RESULTS: The study yielded 29% true positive responders, 60% non-responders, and 11% placebo responders.

    CONCLUSIONS: A substantial amount of patients with chronic WAD have their persistent pain emanating from cervical zygapophyseal joints.

  • 317.
    Petersen, Eline Borch
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Eriksholm Research Centre.
    Neural and Cognitive Effects of Hearing Loss on Speech Processing2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Understanding speech in the presence of noise can be difficult, especially when suffering from a hearing loss. This thesis examined behavioural and electrophysiological measures of speech processing with the aim of establishing how they were influenced by hearing loss (internal degradation) and listening condition (external degradation). The hypothesis that more internal and external degradation of a speech signal would result in higher working memory (WM) involvement was investigated in four studies. The behavioural measure of speech recognition consistently decreased with worse hearing, whereas lower WM capacity only resulted in poorer speech recognition when sound were spatially co-located. Electrophysiological data (EEG) recorded during speech processing, revealed that worse hearing was associated with an increase in inhibitory alpha activity (~10 Hz). This indicates that listeners with worse hearing experienced a higher degree of WM involvement during the listening task. When increasing the level of background noise, listeners with poorer hearing exhibited a breakdown in alpha activity, suggesting that these listeners reached a ceiling at which no more WM resources could be released through neural inhibition. Worse hearing was also associated with a reduced ability to selectively attend to one of two simultaneous talkers, brought on by a reduced neural inhibition of the to-be-ignored speech. Increasing the level of background noise reduced the ability to neurally track the to-be-attended speech. That internal and external degradation affected the tracking of ignored and attended speech, respectively, indicates that the two speech streams were neurally processed as independent objects. This thesis demonstrates for the first time that hearing loss causes changes in the induced neural activity during speech processing. In the last paper of the thesis, it is tentatively suggested that neural activity can be utilized from electrodes positioned in the ear canal (EarEEG) for adapting hearing-aid processing to suite the individual listeners and situation.

    List of papers
    1. Danish Reading Span data from 283 hearing-aid users, including a sub-group analysis of their relationship to speech-in-noise performance
    Open this publication in new window or tab >>Danish Reading Span data from 283 hearing-aid users, including a sub-group analysis of their relationship to speech-in-noise performance
    2016 (English)In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 55, no 4, p. 254-261Article in journal (Refereed) Published
    Abstract [en]

    Objective: This study provides descriptive statistics of the Danish reading span (RS) test for hearing-impaired adults. The combined effect of hearing loss, RS score, and age on speech-in-noise performance in different spatial settings was evaluated in a subset of participants. Design: Data from published and unpublished studies were re-analysed. Data regarding speech-in-noise performance with co-located or spatially separated sound sources were available for a subset of participants. Study sample: RS scores from 283 hearing-impaired participants were extracted from past studies, and 239 of these participants had completed a speech-in-noise test. Results: RS scores (mean = 41.91%, standard deviation = 11.29%) were related to age (p <0.01), but not pure-tone average (PTA) (p = 0.29). Speech-in-noise performance for co-located sound sources was related to PTA and RS score (both p < 0.01, adjusted R-squared = 0.226). Performance for spatially separated sounds was related to PTA (p < 0.01, adjusted R-squared = 0.10) but not RS score (p = 0.484). We found no differences between the standardized coefficients of the two regression models. Conclusions: The distribution of RS scores indicated a high test difficulty. We found that age should be controlled when RS scores are compared across populations. The experimental setup of the speech-in-noise test may influence the relationship between performance and RS score.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2016
    Keywords
    Reading span; hearing impairment; spatially distributed vs. co-located sound sources; speech-in-noise; working memory
    National Category
    Otorhinolaryngology
    Identifiers
    urn:nbn:se:liu:diva-126496 (URN)10.3109/14992027.2015.1125533 (DOI)000371744400008 ()26836955 (PubMedID)
    Available from: 2016-03-29 Created: 2016-03-29 Last updated: 2017-11-30Bibliographically approved
    2. Hearing loss impacts neural alpha oscillations under adverse listening conditions
    Open this publication in new window or tab >>Hearing loss impacts neural alpha oscillations under adverse listening conditions
    Show others...
    2015 (English)In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 6, no 177Article in journal (Refereed) Published
    Abstract [en]

    Degradations in external, acoustic stimulation have long been suspected to increase the load on working memory (WM). One neural signature of WM load is enhanced power of alpha oscillations (6–12 Hz). However, it is unknown to what extent common internal, auditory degradation, that is, hearing impairment, affects the neural mechanisms of WM when audibility has been ensured via amplification. Using an adapted auditory Sternberg paradigm, we varied the orthogonal factors memory load and background noise level, while the electroencephalogram was recorded. In each trial, participants were presented with 2, 4, or 6 spoken digits embedded in one of three different levels of background noise. After a stimulus-free delay interval, participants indicated whether a probe digit had appeared in the sequence of digits. Participants were healthy older adults (62–86 years), with normal to moderately impaired hearing. Importantly, the background noise levels were individually adjusted and participants were wearing hearing aids to equalize audibility across participants. Irrespective of hearing loss (HL), behavioral performance improved with lower memory load and also with lower levels of background noise. Interestingly, the alpha power in the stimulus-free delay interval was dependent on the interplay between task demands (memory load and noise level) and HL; while alpha power increased with HL during low and intermediate levels of memory load and background noise, it dropped for participants with the relatively most severe HL under the highest memory load and background noise level. These findings suggest that adaptive neural mechanisms for coping with adverse listening conditions break down for higher degrees of HL, even when adequate hearing aid amplification is in place.

    Keywords
    alpha oscillations, hearing loss, hearing aid, cognition, working memory
    National Category
    Other Electrical Engineering, Electronic Engineering, Information Engineering
    Identifiers
    urn:nbn:se:liu:diva-114641 (URN)10.3389/fpsyg.2015.00177 (DOI)000349597100001 ()25745410 (PubMedID)
    Available from: 2015-03-02 Created: 2015-03-02 Last updated: 2017-12-04
    3. Neural tracking of attended versus ignored speech is differentially affected by hearing loss
    Open this publication in new window or tab >>Neural tracking of attended versus ignored speech is differentially affected by hearing loss
    2017 (English)In: Journal of Neurophysiology, ISSN 0022-3077, E-ISSN 1522-1598, Vol. 117, no 1, p. 18-27Article in journal (Refereed) Published
    Abstract [en]

    Hearing loss manifests as a reduced ability to understand speech, particularly in multitalker situations. In these situations, younger normal-hearing listeners' brains are known to track attended speech through phase-locking of neural activity to the slow-varying envelope of the speech. This study investigates how hearing loss, compensated by hearing aids, affects the neural tracking of the speech-onset envelope in elderly participants with varying degree of hearing loss (n = 27, 62–86 yr; hearing thresholds 11–73 dB hearing level). In an active listening task, a to-be-attended audiobook (signal) was presented either in quiet or against a competing to-be-ignored audiobook (noise) presented at three individualized signal-to-noise ratios (SNRs). The neural tracking of the to-be-attended and to-be-ignored speech was quantified through the cross-correlation of the electroencephalogram (EEG) and the temporal envelope of speech. We primarily investigated the effects of hearing loss and SNR on the neural envelope tracking. First, we found that elderly hearing-impaired listeners' neural responses reliably track the envelope of to-be-attended speech more than to-be-ignored speech. Second, hearing loss relates to the neural tracking of to-be-ignored speech, resulting in a weaker differential neural tracking of to-be-attended vs. to-be-ignored speech in listeners with worse hearing. Third, neural tracking of to-be-attended speech increased with decreasing background noise. Critically, the beneficial effect of reduced noise on neural speech tracking decreased with stronger hearing loss. In sum, our results show that a common sensorineural processing deficit, i.e., hearing loss, interacts with central attention mechanisms and reduces the differential tracking of attended and ignored speech.

    Keywords
    hearing loss, neural tracking, attention, speech-onset envelope, electroencephalography, cross-correlation
    National Category
    Neurosciences
    Identifiers
    urn:nbn:se:liu:diva-133644 (URN)10.1152/jn.00527.2016 (DOI)000393860400003 ()
    Note

    Funding agencies: European Research Council (ERC) Consolidator Grant; Volkswagen foundation

    Available from: 2017-01-05 Created: 2017-01-05 Last updated: 2018-05-05
    4. Cognitive Hearing Aids? - Insights and Possibilities
    Open this publication in new window or tab >>Cognitive Hearing Aids? - Insights and Possibilities
    2015 (English)Conference paper, Published paper (Refereed)
    Abstract [en]

    The working memory plays an important role in successfully overcoming adverse listening conditions and should consequently be considered when designing and testing hearing aids. A number of studies have established the relationship between hearing in noise and working memory involvement, but with the Sentence-final Word Identification and Recall (SWIRL) test, it is possible to show that working memory is also involved in listening under favorable conditions and that noise reduction has a positive influence in situation with very little noise. Although the capacity of the working memory is a finite individual size, its involvement can differ with fatigue and other factors and individualization of hearing aids should take this into account to obtain the best performance. A way of individually adapting hearing aids is based on changes in the electrical activity of the brain (EEG). Here we present the possibilities that arise from using EEG and show that ear-mounted electrodes is able to record useful EEG that can be explored for individualization of hearing aids. Such an adaptation could be done based on changes in the electrical activity of the brain (EEG). Here we present the possibilities that arise from using EEG and show that ear-mounted electrodes is able to record useful EEG that can be explored for individualization of hearing aids.

    Place, publisher, year, edition, pages
    American Institute of Physics (AIP), 2015
    Series
    AIP Conference Proceedings, ISSN 0094-243X
    National Category
    Otorhinolaryngology
    Identifiers
    urn:nbn:se:liu:diva-126560 (URN)10.1063/1.4939399 (DOI)000372065400086 ()978-0-7354-1350-4 (ISBN)
    Conference
    12th international workshop in Mechanics of Hearing, Cape Sounio, Greece, 23-29 May 2014
    Available from: 2016-03-30 Created: 2016-03-30 Last updated: 2018-03-22
  • 318.
    Poli, Arianna
    et al.
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Kelfve, Susanne
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden; Stockholm Univ, Sweden.
    Motel-Klingebiel, Andreas
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    A research tool for measuring non-participation of older people in research on digital health2019In: BMC PUBLIC HEALTH, Vol. 19, no 1, article id 1487Article in journal (Refereed)
    Abstract [en]

    BackgroundHealthcare services are being increasingly digitalised in European countries. However, in studies evaluating digital health technology, some people are less likely to participate than others, e.g. those who are older, those with a lower level of education and those with poorer digital skills. Such non-participation in research - deriving from the processes of non-recruitment of targeted individuals and self-selection - can be a driver of old-age exclusion from new digital health technologies. We aim to introduce, discuss and test an instrument to measure non-participation in digital health studies, in particular, the process of self-selection.MethodsBased on a review of the relevant literature, we designed an instrument - the NPART survey questionnaire - for the analysis of self-selection, covering five thematic areas: socioeconomic factors, self-rated health and subjective overall quality of life, social participation, time resources, and digital skills and use of technology. The instrument was piloted on 70 older study persons in Sweden, approached during the recruitment process for a trial study.ResultsResults indicated that participants, as compared to decliners, were on average slightly younger and more educated, and reported better memory, higher social participation, and higher familiarity with and greater use of digital technologies. Overall, the survey questionnaire was able to discriminate between participants and decliners on the key aspects investigated, along the lines of the relevant literature.ConclusionsThe NPART survey questionnaire can be applied to characterise non-participation in digital health research, in particular, the process of self-selection. It helps to identify underrepresented groups and their needs. Data generated from such an investigation, combined with hospital registry data on non-recruitment, allows for the implementation of improved sampling strategies, e.g. focused recruitment of underrepresented groups, and for the post hoc adjustment of results generated from biased samples, e.g. weighting procedures.

  • 319.
    Priftakis, Peter
    et al.
    Karolinska institutet.
    Dalianis, Tina
    Karolinska institutet.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Oncology Centre.
    Samuelsson, Ulf
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Lewensohn-Fuchs, Ilona
    Karolinska institutet.
    Bogdanovic, Gordana
    Karolinska institutet.
    Winiarski, Jacek
    Karolinska institutet.
    Gustafsson, Britt
    Karolinska institutet.
    Human polyomavirus DNA is not detected in Guthrie cards (dried blood spots) from children who developed acute lymphoblastic leukemia2003In: Medical and Pediatric Oncology, ISSN 0098-1532, E-ISSN 1096-911X, Vol. 40, no 4, p. 219-223Article in journal (Refereed)
    Abstract [en]

    Background

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

    Procedure

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

    Results

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

    Conclusions

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

  • 320.
    Qvarsell, Roger
    Linköping University, Department for Studies of Social Change and Culture, Department of Culture Studies – Tema Q. Linköping University, Faculty of Arts and Sciences.
    Att bli gammal utan att vara det2017In: Det goda åldrandet: Vad du behöver veta om din kropp och hälsa / [ed] John Bagger-Sjögren, Stockholm: Carlsson Bokförlag, 2017, 2, p. 329-343Chapter in book (Other academic)
  • 321.
    Rahman, Laila
    et al.
    Univ Toronto, Canada.
    Du Mont, Janice
    Univ Toronto, Canada; Womens Coll Hosp, Canada.
    OCampo, Patricia
    Univ Toronto, Canada; St Michaels Hosp, Canada; St Michaels Hosp, Canada.
    Einstein, Gillian
    Linköping University, Department of Thematic Studies, The Department of Gender Studies. Linköping University, Faculty of Arts and Sciences. Univ Toronto, Canada; Womens Coll Hosp, Canada; Univ Toronto, Canada.
    Currently married womens present experiences of male intimate partner physical violence in Bangladesh: An intercategorical intersectional approach2019In: Global Public Health, ISSN 1744-1692, E-ISSN 1744-1706Article in journal (Refereed)
    Abstract [en]

    In Bangladesh, one in five currently married women (CMW) presently experience male intimate partner physical violence (MIPPV). While previous studies analysed womens individual-level multiple locations-younger age, lower education, income, and poverty in an additive manner, we took an intersectional approach to look at the effects of their multiple intersectional locations on MIPPV. Using McCalls intercategorical intersectional approach, we examine how womens intersectional locations are associated with their odds of experiencing MIPPV. Our sample from a 2015 nationally representative survey comprised 14,557 CMW living with their spouses. Thirty-four percent of CMW are young, 49% below primary educated, 19% income earning, 23% poor, and 25% experience MIPPV. We found that CMW in their dual disadvantaged younger age-lower education and single disadvantaged higher education-poor locations have 13.57% (95% CI, 9.25, 17.89) and 12.02% (95% CI, 6.87, 17.17) (respectively) higher probabilities of experiencing MIPPV than their counterparts in the corresponding dual privileged older age-higher education and higher education-nonpoor locations. Consistent with intersectionality theory, instead of prioritising a few groups over others (i.e. Oppression Olympics), we recommend building intersectional solidarity with women, men and communities to disrupt the underlying socio-economic-educational-legal-political structures and processes that have sustained these marginalised locations.

  • 322.
    Rahmqvist, Mikael
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Gjessing, Kristian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Influenca-like illness among children: Young children suffer, primary care takes the strain, society bears the cost2016Conference paper (Refereed)
    Abstract [en]

    Conclusions

    Our results demonstrated a significant increase in the burden of disease during the peak influenza season with increased direct medical costs, especially in primary care. The largest impact of ILI was identified among the youngest children (2-4 years). Increased absence from work due to parents' care of ill children correlates strongly with the ILI encounters in health care. This loss of productivity represents a large indirect cost for society.

  • 323.
    Rahmqvist, Mikael
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Gjessing, Kristian
    Linköping University, Department of Medical and Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Influenza-like illness: Young children, working parents and primary care take the strain2015Conference paper (Refereed)
  • 324.
    Rahmqvist, Mikael
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Effekter av sjukvårdsrådgivning per telefon: En analys av rådgivningsverksamheten 1177 i Östergötland och Jämtland2009Report (Other academic)
    Abstract [en]

    Background: In 2001, Sweden’s Ministry of Health and Social Affairs and the organizationthen known as the Federation of Swedish County Councils explored thefeasibility of a nationally coordinated health care hotline and in 2003 publishedtheir findings in a report titled “Vårdråd direkt – Sjukvårdsrådgivningar isamverkan” [Health care hotline – collaborative effort for medical advice].Jämtland has had a health care hotline unit since 2001 while ÖstergötlandCounty Council launched theirs in late 2003. By 2008, Östergötland andJämtland were two of the six county councils in the national health care hotlinenetwork that used the telephone number 1177. In 2009 the national hotlineadvisory service will essentially be complete, involving 16 health careauthorities and their affiliated units.

    National coordination offers several advantages. Neighbouring units can helpeach other in cases of overload, units with specialized expertise can provideadvisory services to others, and a common data and medical recordsmanagement system provides a good overview with efficiency gains. The nurseshave access to a computer-based decision support system to assist them in theiradvisory capacity. The 1177 telephone hotline service gives patients increased,round-the-clock access which provides professional, documented advice withthe aim to direct the patients to the most suitable care option, as well as givingappropriate advice on self-care.

    In cases where advisory services lead to a level of care that differs from the levelpatients initially expected, resources can be freed for other purposes. The“Vårdråd direkt” report refers to a potential for efficiency gains with suchpatient flow management, estimated at SEK 3 billion, or SEK 300 per inhabitantfor a fully established national advisory service. A few units have carried outhealth economics studies since 2001 which have shown a successfulredistribution of patient flow via the health care hotline. However, these studieshave had certain limitations in method and selection, which would justify furtherstudies of the effects of the advisory service.

    Method: The present study uses three independent data sources to study patient flow inÖstergötland, based on calls registered during 1 week in October 2008 and thenotes entered in each patient’s chart. All patients who called the hotline duringthat week have been checked against the health care data warehouse 1 weekbefore and 1 week after the call. A total of 660 of these patients were selected toparticipate in a questionnaire study including questions such as what level of care they expected before making the call, how they felt about the treatment theymet with, and the quality of the advice. The study also includes all patients inJämtland who called the hotline that same week in October; 670 patients fromthis patient population were selected for inclusion in the questionnaire study. Wedid not match patient data before and after the call for the Jämtland patients. Thenet response rate was the same in Östergötland and Jämtland, about 49 per cent,and the response rate varied from 30 to 60 per cent in the different age groupswhere older patients had a higher response rate than younger.

    Results and conclusions: In Östergötland the health care advisory hotline had about 200 000 calls where ajournal was recorded to a cost of SEK 20 million. The health care advisoryhotline determines level of care in 42 per cent of all documented cases(confidence interval, CI 38–46 per cent). In about 20 per cent of cases theadvisory service resulted in a less urgent level of care than the patient expectedwhile in 13 per cent of cases the patient was advised to obtain medical care at ahigher level than they had expected. Calculations in terms of number of doctorvisits were carried out in these two groups while the other 9 percent resulted in avisit in primary health care without any particular savings. In Östergötland,callers were advised to exercise self-care and/or schedule a visit to a nurse orpublic health nurse, rather than visit the doctor as they had planned, in 15 percent of cases, corresponding to a savings of 24,000 doctor visits annually.

    According to our assumptions about the cost of different types of medical visits,the gross effect in Östergötland was SEK 240 per capita per annum equal to 97million per annum. Based on these figures, calculated for the entire country (i.e.about 92 per cent of the population, since not everyone will be affiliated with thenational advisory service) the gross effect will be SEK 2 billion to a cost of SEK425 million. This is about half of the savings estimated in 2003.

    It can be difficult for a health care authority to demonstrate visible effects of anadvisory hotline in terms of savings in number of doctor visits. The effectsshould be most apparent the first years after the telephone advisory hotline isimplemented; once the hotline has been in operation for a number of years, thehealth care services would be adapted and optimized to the resource gainsprovided by the advisory services and the savings fully achieved. Someindications suggest that the health care hotline in Östergötland had an effect onthe statistics for doctor visits in 2004, when it began on a full scale. There was arelatively large decline in the total number of doctor visits in 2004 and asrecently as 2007, the total number of visits had not yet returned to the 2003 leveldespite an population increase that motivates another 25 000 visits.

    Our conclusion is that the health care hotline influences patient flow in a largenumber of cases, positively affecting resource utilization. Return on investmentfor the advisory service is good in terms of fewer health care encounters and anincrease in the percentage of encounters at the appropriate level of care, as wellas relevant self-care advice.

    Nevertheless, other parts of the health care system have not experienced anynotable relief from the health care hotline, as noted in discussions with referencegroup members that have experience of many parts of the health care system.For example, in Östergötland the patient calls to primary care centres hasincreased a bit the last year, despite a substantial increase in the number of callsto 1177. We hope that future studies will be able to provide an explanation forthis finding.

  • 325.
    Rajan, Gita
    et al.
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Ljunggren, Gunnar
    Stockholm County Council, Sweden; Karolinska Institute, Sweden.
    Wandell, Per
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Wahlstrom, Lars
    Karolinska Institute, Sweden.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Carlsson, Axel C.
    Karolinska Institute, Sweden; Uppsala University, Sweden.
    Diagnoses of sexual abuse and their common registered comorbidities in the total population of Stockholm2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 6, p. 592-598Article in journal (Refereed)
    Abstract [en]

    Background Prior research based on self-reports has proven sexual abuse to be a risk factor for pain and psychiatric disorders. However, less is known about how this is reflected within the healthcare system. The aim of this study was to study the 2-year prevalence of diagnosis of sexual abuse and concomitant conditions. Methods Using data from VAL, the study population included all living persons in Stockholm County, Sweden, between 1 January 2008 and 31 December 2014 (N=2 549 496). Diagnoses of sexual abuse were identified during 2013-2014, with information on the concomitant conditions somatic pain, depression, anxiety, psychotic disorders and bipolar disorders, stress disorders and alcohol and substance abuse. All diagnoses were prospectively registered. Age and neighbourhood socioeconomic status-adjusted ORs with 95% CIs for individuals with a diagnosis of sexual abuse, using individuals without sexual abuse as referents, were calculated. Results Girls at the ages 13-17 years had the highest 2-year prevalence (0.69%) of sexual abuse followed by girls 5-12 years (0.11%), and girls 0-4 years (0.04%). For women 45 years and older the 2-year prevalence rates were substantially lower (0.008-0.004%). The highest 2-year prevalence of sexual abuse in men was seen in boys 5-12 (0.03%) years. The total 2-year prevalence of diagnoses of sexual abuse among the population in the material was 0.04%. The highest ORs of comorbidities for girls (ages 017 years) with sexual abuse versus those without sexual abuse were: Stress disorder; 15.7 (13.1 to 18.9), drug abuse; 10.0 (7.7 to 13.0), and alcohol abuse; 9.7(7.8 to 12.0). For boys (ages 0-17 years), the highest ORs of comorbidities were: Stress disorder 12.4 (6.0 to 25.7), anxiety disorders; 5.5 (2.6 to 11.5), and alcohol abuse; 3.9 (1.4 to 11.3). The highest ORs of comorbidities for women (18-) with sexual abuse versus those without sexual abuse were: alcohol abuse; 19.3 (12.6 to 29.6), drug abuse; 16.7 (10.7 to 26.1) and psychotic disorders; 15.3 (8.0 to 29.4). For men (18-) the highest ORs of comorbidities were: alcohol abuse; 25.8 (15.2 to 43.9), anxiety disorders; 14.3 (8.5 to 24.2) stress disorder; 12.9 (7.5 to 22.1) and drug abuse; 12.9 (6.9 to 24.1). Conclusions Diagnoses of drug and alcohol abuse, psychotic, bipolar, stress anxiety disorders, depression and somatic pain are more common among individuals with a diagnosis of sexual abuse than among individuals without a diagnosis of sexual abuse.

  • 326.
    Reichenpfader, Ursula
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Noack, Horst
    Developing an analytical framework for categorising the knowledge base of European public health: content analysis of selected presentations at the "EUPHA 2005 Conference"2006In: Promoting The Public's Health: EUPHA 2005 Conference Book / [ed] Noack, Horst; Kahr-Gottlieb, Dorothea;, Gamburg, Germany: Verlag fuer Gesundheitsförderung , 2006, p. 203-220Chapter in book (Other academic)
  • 327.
    Reichenpfader, Ursula
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Wickström, Anette
    Linköping University, Department of Thematic Studies, Department of Child Studies. Linköping University, Faculty of Arts and Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Embedding hospital-based medication review: The conflictual and developmental potential of a practice2019In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 33, no 3, p. 339-352Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper is to explore the embedding of hospital-based medication review attending to the conflictual and developmental nature of practice. Specifically, this paper examines manifestations of contradictions and how they play out in professional practices and local embedding processes.

    Design/methodology/approach: Using ethnographic methods, this paper employs the activity-theoretic notion of contradictions for analyzing the embedding of medication review. Data from participant observation (in total 290?h over 48 different workdays) and 31 semi-structured interviews with different healthcare professionals in two Swedish hospital-based settings (emergency department, department of surgery) are utilized.

    Findings: The conflictual and developmental potential related to three interrelated characteristics (contested, fragmented and distributed) of the activity object is shown. The contested nature is illustrated showing different conceptualizations, interests and positions both within and across different professional groups. The fragmented character of medication review is shown by tensions related to the appraisal of the utility of the newly introduced practice. Finally, the distributed character is exemplified through tensions between individual and collective responsibility when engaging in multi-site work. Overall, the need for ongoing ᅵrepairᅵ work is demonstrated.

    Originality/value: By using a practice-theoretical approach and ethnographic methods, this paper presents a novel perspective for studying local embedding processes. Following the day-to-day work of frontline clinicians captures the ongoing processes of embedding medication review and highlights the opportunities to learn from contradictions inherent in routine work practices.

  • 328.
    Rendek, Zlatica
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Region Östergötland, Local Health Care Services in Central Östergötland, Primary Health Care in Central County. Linköping University, Faculty of Medicine and Health Sciences.
    Falk, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. National Board Forens Med, Linkoping, Sweden.
    Wahlin, Karl
    Linköping University, Department of Computer and Information Science, Statistics. Linköping University, Faculty of Arts and Sciences.
    Kechagias, Stergios
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Gastroentorology.
    Svernlöv, Rikard
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Gastroentorology.
    Hjortswang, Henrik
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Gastroentorology.
    Effect of oral diclofenac intake on faecal calprotectin2016In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 51, no 1, p. 28-32Article in journal (Refereed)
    Abstract [en]

    Background. NSAIDs are a known source of increased faecal calprotectin (FC) levels. Currently, there is a lack of knowledge about how long it takes for an increased FC level to return to normal after NSAID intake. Objective. The aim was to investigate how oral diclofenac intake affects FC levels and assess how long it takes for an increased FC level to return to normal after oral diclofenac intake. Material and methods. Thirty healthy volunteers received diclofenac 50 mg three times daily for 14 days. Participants provided a stool sample on Days 0, 2, 4, 7, 14 during intake and Days 17, 21, 28 after discontinuation. FC levels were then followed at 7-day intervals until normalization. Results. During diclofenac intake, eight participants (27%) had FC levels exceeding the upper limit of normal (median, 76 mu g/g; range, 60-958 mu g/g), corresponding to 8.3% of measurements. FC was not constantly increased and became normal in most participants during diclofenac intake. FC levels were on average significantly higher during intake (M = 9.5, interquartile range (IQR) = 13.4) than on baseline (M = 7.5, IQR = 0.0), p = 0.003. After discontinuation, two participants had increased FC on Days 17 and 21, respectively. No significant differences in FC levels were found between baseline and measurements after discontinuation. Two weeks after discontinuation, all participants had normal FC levels. Conclusions. Short-term oral diclofenac intake is associated with increased FC levels. However, the likelihood of an increased test result is low. Our results suggest that 2 weeks of diclofenac withdrawal is sufficient to get an uninfluenced FC test result.

  • 329.
    Ridelberg, Mikaela
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Using surveillance data to reduce healthcare–associated infection: a qualitative study in Sweden2015In: Journal of Infection Prevention, ISSN 1757-1774, Vol. 16, no 5, p. 208-214Article in journal (Refereed)
    Abstract [en]

    Introduction: Healthcare-associated infection (HAI) surveillance data can be used to estimate the scope, spread and location of infections, monitor trends, evaluate preventive efforts, and improve practices, policy and facility planning. In Sweden, national point prevalence surveys (PPS) have been conducted twice yearly in all county councils since 2008.

    Aim: The aim of this study was to identify key obstacles concerning the HAI surveillance process.

    Methods: Twenty-two infection control practitioners (ICPs) from all county councils in Sweden were interviewed, using semi-structured interview guides. Data were analysed using qualitative content analysis.

    Results: Sixteen types of obstacles pertaining to four surveillance stages were identified. Most obstacles were associated with the first two stages, which meant that the latter stages of this process, i.e. the use of the results to reduce HAI, were underdeveloped. The ICPs observed scepticism towards both the PPS methodology itself and the quality of the HAI data collected in the PPS, which hinders HAI surveillance realising its full potential in Swedish healthcare.

  • 330.
    Ring Jacobsson, Lisa
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Perspectives on living with coeliac disease in remission: Daily life experiences, symptoms and well-being2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and aims: Despite living with a gluten-free diet (GFD) Swedish women with coeliac disease (CD) report a lower level of well-being than women without the disease and men with the disease. The all-embracing aim of the thesis was to study experiences of living with coeliac disease in remission and to discover whether a patient education intervention can influence the perceived health and daily life of women with coeliac disease.

    Methods: Studies I-IV were based on the same sample, a total population of 106 women, > 20 years old, with confirmed CD, who had been treated with a GFD for a minimum of five years. From the total population of 106, 15 and 14 purposefully selected women were included in studies I and IV respectively, which had a phenomenological approach by which data was collected through recorded personal narrative interviews. The participants in studies II & III, comprising the total sample of 106 women, were randomized to one of two groups: either to the intervention group (n=54) that underwent a ten-session patient education (PE) program with problem based learning (PBL), or to a control group (n=52) that received information regarding CD, which was sent to their home on a regular basis. Data was collected by self-administered questionnaires. Study V included 22 purposefully selected people (11 women and 11 men) with confirmed CD that had experienced any kind of residual discomfort despite treatment for at least five years with a GFD. Data was collected by recorded semistructured interviews.

    Well-being (II-III) was assessed at baseline and after 10 weeks in all patients and after six months in the intervention group using the Psychological General Well-Being index and the Gastrointestinal Symptom Rating Scale. The interviews (I & IV), which were carried out before the start of the PE (I) and within two weeks of completion of the PE program and about three months after the first interview (IV), were analysed with descriptive phenomenology. The data from study V was analysed by content analysis.

    Results: In the results, the experience of living with CD in remission was described by participants as a constant quest for a normal life (I, V). Three constituents representing conditions necessary to achieve a normalised lifeworld were described (I) as: being secure, being in control, and being seen and included. The balance of thoughts in relation to these constituents proved to be crucial for the individual woman’s ability to experience a normal life, despite the disease. Participants described (V) conditions facilitating the opportunities to live a normal life, but also various barriers to reaching this goal.

    The results from the PE based on PBL (II-III) showed that the PE improved psychological well-being (II) and GI (III) in women with CD to some extent, but not sufficiently as the improvement reached normative values for women only at 10 weeks regarding PGWB mean total index, and at no point in time regarding GSRS mean total index. The effect had waned at the follow-up six months after the intervention was completed as regards the women’s psychological well-being. In coping with CD, it seems essential for women to interact with others with the same disease (IV). The interaction made women feel individually strengthened, and provided them with a broader perspective on life with CD. As a result, this strengthened their sense of self in relation to the disease. Knowledge given by other participants and experts could result in both relief and anxiety.

    The results from the PE based on PBL (II-III) showed that the PE improved psychological well-being (II) and GI (III) in women with CD to some extent, but not sufficiently as the improvement reached normative values for women only at 10 weeks regarding PGWB mean total index, and at no point in time regarding GSRS mean total index. The effect had waned at the follow-up six months after the intervention was completed as regards the women’s psychological well-being. In coping with CD, it seems essential for women to interact with others with the same disease (IV). The interaction made women feel individually strengthened, and provided them with a broader perspective on life with CD. As a result, this strengthened their sense of self in relation to the disease. Knowledge given by other participants and experts could result in both relief and anxiety.

    List of papers
    1. Coeliac disease: Women’s experiences in everyday life
    Open this publication in new window or tab >>Coeliac disease: Women’s experiences in everyday life
    2012 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 23-24, p. 3442-3450Article in journal (Refereed) Published
    Abstract [en]

    Aim. This paper is a report of a descriptive study on what life is like as a woman living with coeliac disease (CD).

    Background. The therapy for CD is a gluten-free diet (GFD), and if sufferers keep strictly to this it is suggested that they will stay well. However, previous studies point out that people who are treated for CD, particularly women, experience various kinds of inconvenience in relation to having CD and to being treated with GFD.

    Methods. A phenomenological approach as devised by Giorgi was used. Taperecorded qualitative interviews with a total of 15 women who were being treated for CD were conducted in 2008 in Sweden.

    Results. The results demonstrated that CD can influence women’s lives in different ways. The general structure of being a woman with coeliac disease was described as a striving towards a normalised lifeworld. Three  conditions necessary to achieve a normalised life were described, namely being secure, being in control and being seen and included.

    Conclusion. The results of this study can help caregivers, and others, to understand and develop support for women with this condition.

    Place, publisher, year, edition, pages
    Blackwell Publishing, 2012
    Keywords
    Chronic disease, illness experience, phenomenology research, nursing
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-72451 (URN)10.1111/j.1365-2702.2012.04279.x (DOI)000310978000013 ()
    Note

    funding agencies|Medical Research Council of Southeast Sweden FORSS||Ostergotland County Council||

    Available from: 2011-11-28 Created: 2011-11-28 Last updated: 2019-11-15
    2. Does a Coeliac School increase psychological well-being in women suffering from coeliac disease, living on a gluten-free diet?
    Open this publication in new window or tab >>Does a Coeliac School increase psychological well-being in women suffering from coeliac disease, living on a gluten-free diet?
    2012 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 5-6, p. 766-775Article in journal (Refereed) Published
    Abstract [en]

    Aim and objective.  To assess the effects of an active method of patient education on the psychological well-being of women with coeliac disease in remission.

    Background.  Despite remission with a gluten-free diet, adults with coeliac disease and especially women experience a subjective poor health. Self-management education seems to be promising tool to help patients suffering from coeliac disease to cope with their disorder.

    Design.  A randomised controlled trial. Methods.  A total of 106 women, ≥20 years, with confirmed coeliac disease, who had been on a gluten-free diet for a minimum of five years. The intervention group (n = 54) underwent a 10-session educational programme, 'Coeliac School', based on problem-based learning. The controls (n = 52) received information regarding coeliac disease sent home on a regular basis. The primary outcomes were psychological general well-being measured with a validated questionnaire.

    Results.  Participants in the Coeliac School reported a significant improvement in psychological well-being at 10 weeks, whereas the controls given usual care reported a worsening in psychological well-being. After six months, a significant improvement remained for the index of vitality.

    Conclusions.  Patient education increased psychological well-being in women with coeliac disease. There is a need to refine the methods of patient education to make the effects of well-being more pronounced over time.

    Relevance to clinical practice. Patient education using problem-based learning promotes self-management in coeliac disease by improving the well-being of patients who have been struggling with the gluten-free diet for years.

    Place, publisher, year, edition, pages
    Blackwell Publishing, 2012
    Keywords
    Disease, Coeliac School, gluten-free diet, patient education, problem-based learning, randomised controlled trial
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-72452 (URN)10.1111/j.1365-2702.2011.03953.x (DOI)000300504000019 ()22039932 (PubMedID)
    Available from: 2011-11-28 Created: 2011-11-28 Last updated: 2019-11-15Bibliographically approved
    3. Impact of an Active Patient Education Programme on GastrointestinalSymptoms in Women with Celiac Disease Following a Gluten-free Diet: Randomized Controlled Trial
    Open this publication in new window or tab >>Impact of an Active Patient Education Programme on GastrointestinalSymptoms in Women with Celiac Disease Following a Gluten-free Diet: Randomized Controlled Trial
    2012 (English)In: Gastroenterology Nursing, ISSN 1042-895X, E-ISSN 1538-9766, Vol. 35, no 3, p. 200-206Article in journal (Refereed) Published
    Abstract [en]

    Despite living with a gluten-free diet Swedish women with celiac disease report a higher rate of gastrointestinal symptoms than women without the disease. This study was designed to assess the impact of active patient education on gastrointestinal symptoms in women with a gluten-free diet. A total of 106 Swedish women, > 20 years, with celiac disease on a gluten free diet for minimum five years took part in a randomized, controlled trial. The intervention group (n=54) underwent a ten-session educational program “Celiac School”, based on problem-based learning. Controls (n=52) were sent information regarding celiac disease at home. Outcome measure was gastrointestinal symptoms at ten weeks and six months after intervention, assessed with the Gastrointestinal Symptom Rating Scale. After ten weeks “Celiac school” (p=0.013) the participating women reported significant improvements that remained six months later (p=0.029). The controls did not improve significantly. A comparison of the development of scores, from baseline to 10 weeks, could not demonstrate a significant difference in the overall index between the two groups but showed a significant improvement concerning one of its components, namely the index reflecting Abdominal Pain (p= 0.007). Intervention methods should be refined in order to reach an even more pronounced effect.

    Place, publisher, year, edition, pages
    United States: Lippincott Williams & Wilkins, 2012
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-72453 (URN)10.1097/SGA.0b013e318255fe3a (DOI)000304758000005 ()
    Note

    On the day of the defence day the status of this article was: Manuscript

    Available from: 2011-11-28 Created: 2011-11-28 Last updated: 2019-11-15Bibliographically approved
    4. Gaining perspective on own illness - The lived experiences of a patient education program for women with treated coeliac disease.
    Open this publication in new window or tab >>Gaining perspective on own illness - The lived experiences of a patient education program for women with treated coeliac disease.
    2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 9-10, p. 1229-1237Article in journal (Refereed) Published
    Abstract [en]

    Aims and Objectives

    To explore the lived experiences of women with coeliac disease after attending a patient education programme, to gain a broader perspective of its influence.

    Background

    Adults, particularly women, with coeliac disease report suffering from poor well-being and reduced quality of life in terms of health. Patient education programmes might support and encourage them in the search for possible improvements in lifestyle and in their approach to the disease.

    Design

    A qualitative phenomenological study.

    Methods

    Personal narrative interviews with 14 women suffering from coeliac disease who had participated in an educational programme. Data analysis in accordance with Giorgi was performed.

    Results

    The essential structure of women's lived experiences following their participation in the patient education programme was found to be an interaction with others with the same disease, which left the women feeling individually strengthened. The interaction enabled the participants to acquire a broader view of their life with coeliac disease. As a result, this realigned their sense of self in relation to their own disease.

    Conclusion

    In coping with coeliac disease, it seems that women need interaction with others with the disease to experience togetherness within a group, get the opportunity to compare themselves with others and to exchange knowledge. The interaction appears to result in that women acquire an overview of life with the disease, develop a greater confidence and dare to try new things in life.

    Relevance to clinical practice

    When designing a patient education programme it seems important to consider the needs of persons to meet others with the same disease, and to ask them about their need for knowledge, rather than simply assuming that health care professionals know what they need.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2016
    Keywords
    Chronic disease ;coeliac disease;nursing;patient education;phenomenology;women′s health
    National Category
    Nursing
    Identifiers
    urn:nbn:se:liu:diva-123585 (URN)10.1111/jocn.13123 (DOI)000374506500006 ()26814834 (PubMedID)
    Note

    At the time of the thesis presentation was the publication in the status Manuscript

    Available from: 2015-12-29 Created: 2015-12-29 Last updated: 2019-11-15Bibliographically approved
    5. Experiences, Own Management and Beliefs regarding Residual Symptoms among People with Coeliac Disease
    Open this publication in new window or tab >>Experiences, Own Management and Beliefs regarding Residual Symptoms among People with Coeliac Disease
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Objective: To explore experiences and beliefs concerning residual symptoms despite a gluten-free diet in women and men with coeliac disease, with a focus on causes and management.

    Background: Between 7% and 30% of people with coeliac disease suffer from residual symptoms, despite following a long-term gluten-free diet, and it has been proposed that women in particular, continue to experience such inconveniences. There is a lack of knowledge about own beliefs concerning the underlying causes of persistent symptoms among people with coeliac disease and their own management of these symptoms.

    Methods: A qualitative explorative design with semi-structured interviews with 22 adults, 11 females and 11 males, with coeliac disease in Sweden. Data were analyzed using qualitative content analysis.

    Results: The disease was continuing to have a substantial impact on the informants’ lives even after several years’ treatment. The interviews revealed residual symptoms of both a gastrointestinal and extra-intestinal nature, which were considered to influence their personality. The management of persistent symptoms resembled thorough detective work, and both efforts to find the missing puzzle piece and strategies to prevent problems were used. Beliefs about the underlying causes of these symptoms were bodily convictions and that it was impossible to live completely gluten-free.

    Conclusion: People with treated coeliac disease, irrespective of gender, may experience residual symptoms of both a physical and psychological nature, causing major negative impacts on their lives in different ways. In the light of this, healthcare staff should change their practices regarding the follow-up of these people, and in addition to medical care should  provide guidance on management strategies to facilitate the daily life of these people. Furthermore, information to people who have just been diagnosed should make them aware of the possibility that they may come to experience continued symptoms, despite treatment.

    Keywords
    Coeliac disease, chronic disease, content analysis, symptom experiences
    National Category
    Gastroenterology and Hepatology Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-122380 (URN)
    Available from: 2015-10-30 Created: 2015-10-30 Last updated: 2019-11-15Bibliographically approved
  • 331.
    Robinson, Stephen Cory
    Linköping University, Department of Science and Technology, Media and Information Technology. Linköping University, Faculty of Science & Engineering.
    No exchange, same pain, no gain: Risk–reward of wearable healthcare disclosure of health personally identifiable information for enhanced pain treatment2019In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 25, no 4, p. 1675-1691Article in journal (Refereed)
    Abstract [en]

    Wearable technologies have created fascinating opportunities for patients to treat chronic pain in a discreet, mobile fashion. However, many of these health wearables require patients to disclose sensitive information, including health information (e.g., heart rate, glucose levels) and personal information (location, email, name, etc.). Individuals using wearables for treatment of chronic pain may sacrifice social health elements, including their privacy, in exchange for better physical and mental health. Utilizing communication privacy management, a popular disclosure theory, this article explores the policy and ethical ramifications of patients disclosing sensitive health information in exchange for better health treatment and relief of chronic pain. The article identifies scenarios where a user must disclose information, and what factors motivate or dissuade disclosure, and ultimately the use of a health wearable. Practical implications of this conceptual article include an improved understanding of how and why consumers may disclose personal data to health wearables, and potential impacts for public policy and ethics regarding how wearables and their manufacturers entice disclosure of private health information.

  • 332.
    Rosander, Michael
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Blomberg, Stefan
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    The WHOLE picture: Measurement of Psychosocial Work Environment2018Report (Other academic)
    Abstract [en]

    This report is the first official description of PSYWEQ (Psychosocial Work Environment Questionnaire). PSYWEQ is a measurement instrument focussing on both individual work experience and organisational factors. It was developed by Blomberg and Rosander beginning in 2012.

    The main focus of the report was to clarify the factor structure behind PSYWEQ as well as describing the additional instruments included in PSYWEQ – NAQ-22R (Einarsen, Hoel & Notelaers, 2009), SHIS (Bringsén, Andersson & Ejlertsson, 2009) and HAD (Zigmond & Snaith, 1983). The report also includes descriptive statistics based on the first wave of data from a governmental organization, two municipalities and a private organisation.

  • 333.
    Rosell, Johan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Regional Cancer Center South East Sweden.
    Nordenskjöld, Bo
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Bengtsson, Nils-Olof
    Umeå University Hospital, Sweden .
    Fornander, Tommy
    Karolinska University Hospital, Sweden .
    Hatschek, Thomas
    Karolinska University Hospital, Sweden .
    Lindman, Henrik
    University of Uppsala Hospital, Sweden .
    Malmstrom, Per-Olof
    Skåne University Hospital, Sweden .
    Wallgren, Arne
    Sahlgrens University Hospital, Sweden .
    Stål, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Effects of adjuvant tamoxifen therapy on the incidence of secondary cancer: results from a randomized trial with long term follow-up2014Manuscript (preprint) (Other academic)
    Abstract [en]

    BACKGROUND

    Tamoxifen is a well-established endocrine treatment for breast cancer. We here present results with respect to second primary cancer from a large randomized trial of 5 and 2 years of adjuvant tamoxifen. Breast cancer distant recurrence and mortality are also reported.

    METHODS

    Our study included 4128 postmenopausal patients with early stage breast cancer who were alive and free of breast cancer recurrence after 2 years of tamoxifen therapy. They were randomized to receive three more years of therapy or stop tamoxifen. In the comparison of 5 years versus 2 years of postoperative tamoxifen treatment hazard ratios were estimated using Cox regression for different follow-up periods defined as: During treatment (2-5 years) and after treatment (5-10 years, 10-15 years, > 5 years, > 10 years and > 15 years).

    RESULTS

    In the five years group the incidence of lung cancer was halved (hazard ratio [HR], 0.45, 95% confidence interval [95% CI], 0.27-0.77 [P = .0038]), and lung cancer mortality was decreased. An increased risk was observed for endometrial cancer (HR, 1.83; 95% CI, 1.19-2.81 [P = .0059]), but this risk appeared to decrease over time. The risk of contralateral breast cancer was decreased (HR, 0.73; 95% CI, 0.56-0.96 [P = .022]), also in the period after treatment stopped. In the five years group, the risk of distant recurrence was decreased, and statistically significant reductions were observed both during treatment and in the five year period after treatment stopped. The breast cancer mortality was reduced, especially during the post-treatment phase.

    CONCLUSIONS

    In this randomized study, tamoxifen substantially reduces the risk of new cancer both in contralateral breast and in lung up to 10 years after treatment stopped.

  • 334.
    Rådholm, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Cardiovascular risk factors in elderly: With special emphasis on atrial fibrillation, hypertension and diabetes2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    The part of the population that belongs to the oldest-old (ages 80 years or older) increases rapidly, worldwide. Cardiovascular disease (CVD) is the leading cause of death and disease burden globally. Multimorbidity is common in old age and stroke, diabetes mellitus (DM) and atrial fibrillation (AF) are strongly associated with age. Cardiovascular risk factors are well studied and documented in younger and middle ages, but not as well in old and frail individuals. Therefore, preventive treatment choices are mostly based on evidence for younger patients. The aim of this thesis was to explore age and other aspects of cardiovascular risk factors; AF, hypertension and DM, in relation to comorbidity, cardiovascular outcome and mortality.

    Methods

    This thesis was based on four different studies:

    • The ELSA85 study of 85 years old in Linköping, Sweden
    • The international, multicentre, randomised controlled INTERACT2 trial of spontaneous intracranial haemorrhage (ICH), mean age 64 years.
    • The prospective SHADES study of nursing home residents, mean age 85 years.
    • The prospective, national SWE-diadep study of dispensed antidiabetics, antidepressantsand prevalent myocardial infarction (MI) in 45-84 years old.

    Data was obtained from questionnaires (ELSA85, INTERACT2), medical records and medical examination (ELSA85, INTERACT2, SHADES), and national registers (SWE-Diadep).

    Results

    The ELSA85 study showed that 16% (n=53) had an ECG showing AF. There was an increased hazard ratio (HR) for all-cause mortality in participants with AF at baseline, at 90 years of age (HR 1.59, 95% [Confidence Interval] CI 1.04-2.44) adjusted for sex. This increase in HR did not persist when adjusted for congestive heart failure (CHF). In the INTERACT2 study, increasing age was associated with increasing frequency of death or dependency (odds ratio [OR] 4.36, 95% [CI] 3.12-6.08 for >75 years vs <52 years, p value for trend <0.001). The SHADES study showed that participants with Systolic blood pressure (SBP) <120 mmHg had an increased HR for mortality (1.56, 95% CI, 1.08–2.27; p=0.019) but there were no differences between SBP groups 140–159 mmHg and ≥160 mmHg compared with the reference group SBP 120–139 mmHg. SBP decreased during the prospective study period. In the SWE-diadep study, individuals with antidiabetics and antidepressants combined had a greater HR for MI compared to the reference of no antidiabetics or antidepressants, mostly so in women aged 45-64 years (HR 7.4, 95% CI: 6.3-8.6).

    Conclusion

    Risk factors for CVDs in elderly differ from cardiovascular risk factors in middle aged individuals an

    List of papers
    1. Atrial fibrillation (AF) and co-morbidity in elderly. A population based survey of 85 years old subjects.
    Open this publication in new window or tab >>Atrial fibrillation (AF) and co-morbidity in elderly. A population based survey of 85 years old subjects.
    Show others...
    2011 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 52, no 3, p. e170-e175Article in journal (Refereed) Published
    Abstract [en]

    The occurrence of AF increases sharply with age. The aim of this study was to explore and compare prevalent co-morbidity and self-estimated health-related quality of life (HRQoL) in subjects with AF versus subjects with sinus rhythm or pacemaker in 85 years old subjects. We analyzed data from a population of 336 eighty-five years old subjects participating in the Elderly in Linköping Screening Assessment (ELSA-85) study. Medical history was obtained from postal questionnaire, medical records and during medical examination that included a physical examination, cognitive tests, non-fasting venous blood samples and electrocardiographic (ECG) examination. 19% had an ECG showing AF. There were very few significant differences regarding medical history, self-estimated quality of life (QoL), laboratory- and examination findings and use of public health care between the AF group and the non-AF group. The study showed that the population of 85 years old subjects with AF was surprisingly healthy in terms of prevalent co-existing medical conditions, healthcare contacts and overall HRQoL. We conclude that elderly patients with AF do not in general have increased co-morbidity than subjects without AF.

    Place, publisher, year, edition, pages
    Elsevier, 2011
    Keywords
    Atrial fibrillation; Co-morbidities of elderly; CHADS2 score; Oral anticoagulation; Health-related quality of life
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-67143 (URN)10.1016/j.archger.2010.10.024 (DOI)000288989400015 ()
    Note

    Original Publication: Karin Rådholm, Carl Johan Östgren, Urban Alehagen, Magnus Falk, Eva Wressle, Jan Marcusson and Katarina Nägga, Atrial fibrillation (AF) and co-morbidity in elderly. A population based survey of 85 years old subjects., 2011, Archives of gerontology and geriatrics (Print), (52), 3, e170-e175. http://dx.doi.org/10.1016/j.archger.2010.10.024 Copyright: Elsevier Science B.V., Amsterdam. http://www.elsevier.com/

    Available from: 2011-03-31 Created: 2011-03-31 Last updated: 2019-06-27
    2. Older age is a strong predictor for poor outcome in intracerebral haemorrhage: the INTERACT2 study
    Open this publication in new window or tab >>Older age is a strong predictor for poor outcome in intracerebral haemorrhage: the INTERACT2 study
    Show others...
    2015 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, no 3, p. 422-427Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND AND PURPOSE:: Global ageing contributes greatly to the burden of stroke. We investigated the influence of age on the baseline profile and on outcomes in acute intracerebral haemorrhage (ICH) among participants of the INTERACT2 study.

    METHODS:: INTERACT2 was an international, randomised controlled trial in 2839 patients with spontaneous ICH within 6 h of onset and elevated systolic blood pressure (SBP; 150-220 mmHg) who were allocated to receive intensive (target SBP <140 mmHg within 1 h) or guideline-recommended (target SBP <180 mmHg) blood pressure lowering treatment. Stroke severity was assessed with the National Institutes of Health Stroke Scale. Poor outcome was defined as death or major disability ('dependency', modified Rankin Scale scores 3-6) at 90 days. Health-related quality of life (HRQoL) was assessed with the European Quality of Life-5 Dimensions (EQ-5D) questionnaire. Associations between age and outcomes were analysed in multivariable logistic regression models.

    RESULTS:: Stroke severity increased in categories of older age (P-trend 0.002). Stroke patients over 75 years old were four times more likely to die or be disabled at 90 days than those <52 years when other confounders were accounted for (odds ratio 4.36, 95% confidence interval 3.12-6.08). Older age was also associated with decreasing HRQoL, across mobility, self-care, usual activities and depression (all P-trend <0.001), and pain or discomfort (P-trend 0.022).

    CONCLUSION:: In the INTERACT2 cohort, older people had more severe ICH and worse outcomes (death, major disability and HRQoL). These data will help guide clinicians manage older people with haemorrhagic stroke. Clinical Trial Registration: http://www.clinicaltrials.gov (NCT00716079).

    Place, publisher, year, edition, pages
    Oxford University Press, 2015
    National Category
    General Practice
    Identifiers
    urn:nbn:se:liu:diva-115371 (URN)10.1093/ageing/afu198 (DOI)000355623100014 ()25497513 (PubMedID)
    Available from: 2015-03-13 Created: 2015-03-13 Last updated: 2018-01-11
    3. Blood pressure and all-cause mortality: a prospective study of nursing home residents
    Open this publication in new window or tab >>Blood pressure and all-cause mortality: a prospective study of nursing home residents
    Show others...
    2016 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 45, no 6, p. 826-832Article in journal (Refereed) Published
    Abstract [en]

    Aim: To explore the natural course of blood pressure development and its relation to mortality in a nursing home cohort.

    Methods: A cohort of 406 nursing home residents in south east Sweden was followed prospectively for 30 months. Participants were divided into four groups based on systolic blood pressure (SBP) at baseline. Data were analysed using a Cox regression model with all-cause mortality as the outcome measurement; paired Student t-tests were used to evaluate blood pressure development over time.

    Results: During follow-up, 174 (43%) people died. Participants with SBP <120 mmHg had a hazard ratio for mortality of 1.56 (95% confidence interval, 1.08–2.27) compared with those with SBP 120–139 mmHg, adjusted for age and sex. Risk of malnutrition or present malnutrition was most common in participants with SBP <120 mmHg; risk of malnutrition or present malnutrition estimated using the Mini Nutritional Assessment was found in 78 (71%). The levels of SBP decreased over time independent of changes in anti-hypertensive medication.

    Conclusions: In this cohort of nursing home residents, low SBP was associated with increased all-cause mortality. SBP decreased over time; this was not associated with altered anti-hypertensive treatment. The clinical implication from this study is that there is a need for systematic drug reviews in elderly persons in nursing homes, paying special attention to those with low SBP.

    Place, publisher, year, edition, pages
    Oxford University Press, 2016
    Keywords
    older people, prospective study, nursing home, hypertension, hypotension, all-cause mortality
    National Category
    General Practice Other Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-121283 (URN)10.1093/ageing/afw122 (DOI)000392702200018 ()
    Note

    Funding agencies| Health Research Council in south east Sweden (FORSS-8888, FORSS-11636 and FORSS-31811); the County of Östergötland (LIO-11877, LIO-31321 and LIO-79951); the Family Janne Elgqvist Foundation; King Gustaf V and Queen Victoria Freemason Foundation.

    At the time for thesis presentation publication was in status: Manuscript

    Available from: 2015-09-11 Created: 2015-09-11 Last updated: 2018-01-11Bibliographically approved
    4. Use of antidiabetic and antidepressant drugs is associated with increased risk of myocardial infarction: a nationwide register study
    Open this publication in new window or tab >>Use of antidiabetic and antidepressant drugs is associated with increased risk of myocardial infarction: a nationwide register study
    2016 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, no 2, p. 218-223Article in journal (Refereed) Published
    Abstract [en]

    Aims

    To explore the gender- and age-specific risk of developing a first myocardial infarction in people treated with antidiabetic and/or antidepressant drugs compared with people with no pharmaceutical treatment for diabetes or depression.

    Methods

    A cohort of all Swedish residents aged 45–84 years (n = 4 083 719) was followed for a period of 3 years. Data were derived from three nationwide registers. The prescription and dispensing of antidiabetic and antidepressant drugs were used as markers of disease. All study subjects were reallocated according to treatment and the treatment categories were updated every year. Data were analysed using a Cox regression model with a time-dependent variable. The outcome of interest was first fatal or non-fatal myocardial infarction.

    Results

    During follow-up, 42 840 people had a first myocardial infarction, 3511 of which were fatal. Women aged 45–64 years, receiving both antidiabetic and antidepressant drugs had a hazard ratio for myocardial infarction of 7.4 (95% CI 6.3–8.6) compared with women receiving neither. The corresponding hazard ratio for men was 3.1 (95% CI 2.8–3.6).

    Conclusions

    The combined use of antidiabetic and antidepressant drugs was associated with a higher risk of myocardial infarction compared with use of either group of drugs alone. The increase in relative risk was greater in middle-aged women than in middle-aged men.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2016
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Other Health Sciences General Practice
    Identifiers
    urn:nbn:se:liu:diva-121285 (URN)10.1111/dme.12822 (DOI)000370161800011 ()26036276 (PubMedID)
    Note

    Funding agencies: King Gustaf V and Queen Victoria Freemason Foundation

    Available from: 2015-09-11 Created: 2015-09-11 Last updated: 2018-01-11Bibliographically approved
  • 335.
    Rådholm, Karin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Wiréhn, Ann-Britt
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis.
    Chalmers, J.
    The George Institute for Global Health, University of Sydney, NSW, Australia.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, "Primary Health Care in Motala".
    Use of antidiabetic and antidepressant drugs is associated with increased risk of myocardial infarction: a nationwide register study2016In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, no 2, p. 218-223Article in journal (Refereed)
    Abstract [en]

    Aims

    To explore the gender- and age-specific risk of developing a first myocardial infarction in people treated with antidiabetic and/or antidepressant drugs compared with people with no pharmaceutical treatment for diabetes or depression.

    Methods

    A cohort of all Swedish residents aged 45–84 years (n = 4 083 719) was followed for a period of 3 years. Data were derived from three nationwide registers. The prescription and dispensing of antidiabetic and antidepressant drugs were used as markers of disease. All study subjects were reallocated according to treatment and the treatment categories were updated every year. Data were analysed using a Cox regression model with a time-dependent variable. The outcome of interest was first fatal or non-fatal myocardial infarction.

    Results

    During follow-up, 42 840 people had a first myocardial infarction, 3511 of which were fatal. Women aged 45–64 years, receiving both antidiabetic and antidepressant drugs had a hazard ratio for myocardial infarction of 7.4 (95% CI 6.3–8.6) compared with women receiving neither. The corresponding hazard ratio for men was 3.1 (95% CI 2.8–3.6).

    Conclusions

    The combined use of antidiabetic and antidepressant drugs was associated with a higher risk of myocardial infarction compared with use of either group of drugs alone. The increase in relative risk was greater in middle-aged women than in middle-aged men.

  • 336.
    Samuelsson, Christina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ekström, Anna
    Linköping University, Department of Social and Welfare Studies. Linköping University, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Majlesi, Ali Reza
    Linköping University, Department of Social and Welfare Studies. Linköping University, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Plejert, Charlotta
    Linköping University, Department of Culture and Communication, Language and Culture. Linköping University, Faculty of Arts and Sciences.
    Kommunikation vid demenssjukdom2016In: Att leva med demens / [ed] Ingrid Hellström & Lars-Christer Hydén, Gleerups Utbildning AB, 2016, 1, p. 63-70Chapter in book (Other academic)
  • 337.
    Samuelsson, Kersti
    et al.
    Linköping University, Department of Medical and Health Sciences, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Tropp, Maria
    Lundqvist, Anna
    Vocational rehabilitation after aquired brain injury: a pilot study on benefits and costs.2014In: Open journal of therapy and rehabilitation, no 2, p. 133-145Article in journal (Refereed)
    Abstract [en]

    Purpose: To examine the benefits from a vocational rehabilitation program for patients suffering from Acquired Brain Injury (ABI) in terms of quality of life, and overall health. In addition, to examine the direct societal costs of healthcare interventions related to vocational rehabilitation and indirect societal costs related to production loss. Method: Identified interventions in 45 patients with ABI who were discharged from a vocational rehabilitation program between 2010 and 2011 were documented, classified and translated into costs. Expenses associated with production loss were calculated by comparing sick leave production loss at first contact with the team, with sick leave production loss at discharge. Health related QoL and overall health, was measured at first contact and at discharge by using the EQ5D. Results: For vocational rehabilitation interventions, mean costs were €6303/individual/month. At first contact with the team, mean production loss was estimated to be €4409/individual/month compared; at discharge to be €2446. QoL-ratings increased from first contact to discharge, although estimated health did not change. At discharge, significant correlations were found between QoL ratings and estimated health and the extent of production loss (p < 0.05). Conclusion: Healthcare interventions that help ABI patients resume work are cost effective for society as well as for patients.

  • 338.
    Sandberg, Camilla
    et al.
    Umeå University, Sweden; Umeå University, Sweden; Umeå University, Sweden.
    Rinnstrom, Daniel
    Umeå University, Sweden; Umeå University, Sweden.
    Dellborg, Mikael
    University of Gothenburg, Sweden.
    Thilen, Ulf
    Lund University, Sweden.
    Sorensson, Peder
    Karolinska Institute, Sweden.
    Nielsen, Niels Erik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Christersson, Christina
    Uppsala University, Sweden.
    Wadell, Karin
    Umeå University, Sweden.
    Johansson, Bengt
    Umeå University, Sweden; Umeå University, Sweden.
    Height, weight and body mass index in adults with congenital heart disease2015In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 187, p. 219-226Article in journal (Refereed)
    Abstract [en]

    Background: High BMI is a risk factor for cardiovascular disease and, in contrast, low BMI is associated with worse prognosis in heart failure. The knowledge on BMI and the distribution in different BMI-classes in adults with congenital heart disease (CHD) are limited. Methods and results: Data on 2424 adult patients was extracted from the Swedish Registry on Congenital Heart Disease and compared to a reference population (n = 4605). The prevalence of overweight/obesity (BMI greater than= 25) was lower in men with variants of the Fontan procedure, pulmonary atresia (PA)/double outlet right ventricle (DORV) and aortic valve disease (AVD) (Fontan 22.0% and PA/DORV 15.1% vs. 43.0%, p = 0.048 and p less than 0.001) (AVD 37.5% vs. 49.3%, p less than 0.001). Overt obesity (BMI greater than= 30) was only more common in women with AVD (12.8% vs. 9.0%, p = 0.005). Underweight (BMI less than 18.5) was generally more common in men with CHD (complex lesions 4.9% vs. 0.9%, p less than 0.001 and simple lesions 3.2% vs. 0.6%, less than0.001). Men with complex lesions were shorter than controls in contrast to females that in general did not differ from controls. Conclusion: Higher prevalence of underweight in men with CHD combined with a lower prevalence of over-weight/obesity in men with some complex lesions indicates that men with CHD in general has lower BMI compared to controls. In women, only limited differences between those with CHD and the controls were found. The complexity of the CHD had larger impact on height in men. The cause of these gender differences as well as possible significance for prognosis is unknown. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

  • 339.
    Sandberg, Johanna
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Institutionally Shaped Response to the Introduction of National Guidelines: Case Studies in the Swedish Regional Health Policy Arena2018Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    The purpose of this thesis is to explore the institutionally shaped response to the introduction of the national guidelines on the Swedish regional health policy arena. The thesis consists of two case studies. Adapting a qualitative approach, the data is based on individual interviews and these were analysed thematically. The first paper explores the response by four Swedish regional health authorities to the introduction of the National Guidelines for Cardiac Care, while the second paper aims to broaden the understanding of how the national guidelines are used for strategic purposes among politicians.

    As illustrated in this thesis, organizations will respond, adjust and react to external pressure according to conditions shaped by the institutional context. Key findings here are that the national guidelines are a complex policy instrument that, beyond being able to be used in an instrumental fashion by the medical managment, can also serve a legitimizing function for political decision-makers.

    The goals of the national guidelines, i.e. equal and efficient care, and the uncertainty about who, among multiple stakeholders, is responsible for the guidelines in the regional health authority, is a source of ambiguity and potential conflict. Those who are potentially responsible represent different rationales – a political rationale and a scientific rationale. The dominating scientific rationale of the national guidelines can create instability, when pushing towards the use of explicit priority-setting.

    Priority-setting in the institutional setting of a regional health authority has strong elements of becoming “wicked problems” since the dilemma of prioritization remains regardless of ambitions to apply a “technocratic fix”. A wicked problem is characterized by high complexity and being persistently hard to solve (Williams et al. 2012). A recurring dilemma is that priority-setting still contains many wicked problems, as social values and political considerations remain important parts of the policy process. One weakness of the national guidelines, identified in this thesis, is that the guidelines discuss each service area separately, and thereby reinforce a silo mentality in the Swedish health policy arena.

    To sum up, the national guidelines create a multifaceted and complex response in the Swedish health policy arena where different rationalities collide, and where conflicts appear and are dealt with within the regional health authorities.

    List of papers
    1. Management by Knowledge in Practice: Implementation of National Healthcare Guidelines in Sweden
    Open this publication in new window or tab >>Management by Knowledge in Practice: Implementation of National Healthcare Guidelines in Sweden
    2015 (English)In: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515, Vol. 49, no 7, p. 911-927Article in journal (Refereed) Published
    Abstract [en]

    In the last ten years, the concept of management by knowledge has gained growing attention inSwedish healthcare, as well as internationally. In Sweden, the most prominent example ofmanagement by knowledge is the National Guidelines, aimed at influencing both clinical andpolitical decision-making in the health sector. The objective of this article is to explore the response among four Swedish county councils to the National Guidelines for Cardiac Care (NGCC). Empirical material was collected through 155 expert interviews with the target groups of the NGCC, politicians, administrators and clinical managers. Analysis of the responses to this multifaceted policy instrument was addressed by drawing on implementation theory (Matland 1995) and institutional theory (Oliver 1991). The NGCC are primarily based on the voluntary diffusion of norms. The county councils are a long way from having adapted all the means suggested by the National Board of Health and Welfare (NBHW): explicit prioritization, healthcare programmes and dialogue between the various actor groups. The high degree of ambiguity in the content of the NGCC, the inherent conflict and the multiplicity and uncertainty in the context of the county councils, have often resulted in avoidance and compromise. The strategic responses we observe can be viewed as an attempt to balance multiple constituents and achieve the various internal organizational goals. The ambiguity and conflict inherent in the policy of the NGCC influence the strategic responses made by the organization. The question remains how far management by knowledge can be applied in a political context.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2015
    Keywords
    Policy implementation; Institutional pressure; Strategic responses; Swedish National Guidelines
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-113304 (URN)10.1111/spol.12102 (DOI)000368267400006 ()
    Available from: 2015-01-15 Created: 2015-01-15 Last updated: 2018-11-09Bibliographically approved
    2. The dilemma of knowledge use in political decision-making: National Guidelines in a Swedish priority-setting context
    Open this publication in new window or tab >>The dilemma of knowledge use in political decision-making: National Guidelines in a Swedish priority-setting context
    2019 (English)In: Health Economics, Policy and Law, ISSN 1744-1331, E-ISSN 1744-134X, Vol. 14, no 4, p. 425-442Article in journal (Refereed) Published
    Abstract [en]

    There is a growing recognition of the importance of evidence to support allocative policy decisions in health care. This study is based on interviews with politicians in four regional health authorities in Sweden. Drawing on theories of strategic use of knowledge, the article analyses how politicians perceive and make use of expert knowledge represented by the National Guidelines, embracing both a scientific and a political rationale. As health care is an organisation with a dual basis for legitimacy – at the same time a political and an action organisation – it affects knowledge use. We investigate how the context of health care priority setting influences the conditions for knowledge use among regional politicians. Our findings illustrate the dilemma of political decision-makers and how they prefer to use expert knowledge. The politicians use this policy instrument in a legitimising fashion, as it will fit into the current political debate on more equal care. As an instrument for resource allocation the politicians noted that ‘facts’ per se could not provide them with a sufficient basis for legitimising their governing of health care. The dualistic organisational context makes knowledge important as a political weapon in negotiations with the medical profession.

    Place, publisher, year, edition, pages
    Cambridge University Press, 2019
    Keywords
    Expert knowledge, Policy making, Health policy, knowledge utilization
    National Category
    Social Sciences Interdisciplinary
    Identifiers
    urn:nbn:se:liu:diva-149919 (URN)10.1017/S1744133118000233 (DOI)000482431400001 ()29986792 (PubMedID)2-s2.0-85049867288 (Scopus ID)
    Available from: 2018-08-06 Created: 2018-08-06 Last updated: 2019-09-09Bibliographically approved
  • 340.
    Sarberg, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Sleep disorders during pregnancy2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Sleep disorders are known to increase in prevalence during pregnancy, and associations between disturbed sleep during pregnancy and adverse outcomes for mother and child have been reported in a number of studies. However, most of these studies were retrospective and too small to satisfactorily demonstrate the association.

    Aims

    • To prospectively investigate the development of snoring during pregnancy and assess if there is an association between snoring and sleepiness or adverse pregnancy outcomes.
    • To study the development of restless legs syndrome during and after pregnancy, and whether it is associated with snoring or other pregnancy-related symptoms.
    • To investigate the possible association between depressive symptoms in the postpartum period and sleep related problems during pregnancy, using screening instruments.
    • To objectively evaluate sleep disordered breathing in pregnant women compared to non-pregnant controls and to evaluate differences in Epworth Sleepiness Scale scores between the two groups.

    Methods

    Questionnaires containing subjective rating of snoring, Epworth Sleepiness Scale and symptoms of restless legs were used in all studies. Information from the medical records of the pregnant women was also utilized. For objective evaluation of sleep disordered breathing, nocturnal respiratory recordings were used. In the research for the first three papers the same cohort of 500 pregnant women was followed on three occasions during pregnancy and also after delivery, and for the last paper, 100 other pregnant women were compared to 80 nonpregnant controls.

    Results and conclusions

    Both snoring and restless legs syndrome increase during pregnancy, but this had no convincing impact on obstetric outcome. Sleep recordings could not verify an increased prevalence of obstructive sleep apnea among pregnant women. Restless legs syndrome was associated with snoring and could persist after delivery. Women who had high scores on the Epworth Sleepiness Scale in the last trimester of pregnancy showed more depressive symptoms in the postpartum period. No difference in item scoring of the Epworth Sleepiness Scale was found between pregnant women and controls.

    List of papers
    1. Snoring during pregnancy and its relation to sleepiness and pregnancy outcome - a prospective study
    Open this publication in new window or tab >>Snoring during pregnancy and its relation to sleepiness and pregnancy outcome - a prospective study
    2014 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, no 15Article in journal (Refereed) Published
    Abstract [en]

    Background: The incidence of snoring and sleepiness is known to increase during pregnancy, and this might impact maternal health and obstetric outcome. However, the association between snoring and sleepiness during pregnancy is not fully understood. This study was aimed at investigating the development of snoring during pregnancy and prospectively assessing if there is an association between snoring and sleepiness or adverse pregnancy outcomes, such as preeclampsia, mode of delivery, and fetal complications. Methods: Consecutively recruited pregnant women (n = 500) received a questionnaire concerning snoring and sleep at the 1st and 3rd trimester of pregnancy. The women who had rated their frequency of snoring at both occasions (n = 340) were divided into subgroups according to the development of snoring they reported and included in the subsequent analyses. Additional medical data were collected from the medical records. Results: The frequency of snoring was 7.9% in the 1st trimester and increased to 21.2% in the 3rd trimester of pregnancy. The women who snored already in early pregnancy had significantly higher baseline BMI (p = 0.001) than the women who never snored, but snoring was not associated with the magnitude of weight gain during pregnancy. Snoring women were more likely to experience edema in late pregnancy than the non-snorers. Women who started to snore during pregnancy had higher Epworth Sleepiness Scores than the non snorers in both early and late pregnancy. No significant association between obstetric outcome and snoring was found. Conclusion: Snoring does increase during pregnancy, and this increase is associated with sleepiness, higher BMI at the start of pregnancy and higher prevalence of edema, but not with weight gain.

    Place, publisher, year, edition, pages
    BioMed Central, 2014
    Keywords
    Pregnancy; Snoring; Sleepiness; Epworth sleepiness score; Body mass index; Edema; Pregnancy outcome
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-105253 (URN)10.1186/1471-2393-14-15 (DOI)000331215600004 ()
    Available from: 2014-03-14 Created: 2014-03-14 Last updated: 2019-06-28
    2. Restless legs syndrome during and after pregnancy and its relation to snoring
    Open this publication in new window or tab >>Restless legs syndrome during and after pregnancy and its relation to snoring
    2012 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 7, p. 850-855Article in journal (Refereed) Published
    Abstract [en]

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

    Place, publisher, year, edition, pages
    Informa Healthcare / Wiley-Blackwell, 2012
    Keywords
    Restless legs syndrome; pregnancy; snoring; sleep; sleep disturbance
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-79784 (URN)10.1111/j.1600-0412.2012.01404.x (DOI)000305328000013 ()
    Available from: 2012-08-17 Created: 2012-08-14 Last updated: 2019-06-28
    3. Postpartum depressive symptoms and its association to daytime sleepiness and restless legs during pregnancy
    Open this publication in new window or tab >>Postpartum depressive symptoms and its association to daytime sleepiness and restless legs during pregnancy
    2016 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, article id 137Article in journal (Refereed) Published
    Abstract [en]

    Purpose: To investigate the possible association between depressive symptoms in the postpartum period and sleep related problems during pregnancy, using screening instruments.

    Methods: In a prospective study 293 women in the last trimester of pregnancy answered a questionnaire about sleep related problems in terms of symptoms of restless legs, snoring and daytime sleepiness. They also completed the Epworth Sleepiness Scale (ESS). The same women were screened for depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) four to ten weeks after giving birth. Additional information about social data, pregnancy and delivery was received from the medical charts.

    Results: Women with postpartum depressive symptoms had higher prevalence of sleep related problems including excessive daytime sleepiness defined as ESS score ≥10 (OR 3.84, CI 1.57-9.39), and restless legs syndrome (OR 2.837 CI 1.18-6.84) in last trimester of pregnancy, when adjusted for sociodemographic factors and obstetric risk factors.

    Conclusions: Depressive symptoms after childbirth are preceded by disturbed sleep already during pregnancy. The results from Epworth Sleepiness Scale completed during pregnancy might be used for detecting women at risk, enabling preventive interventions.

    Place, publisher, year, edition, pages
    BioMed Central, 2016
    Keywords
    Postnatal depression, sleep, restless legs syndrome, pregnancy, Epworth Sleepiness Scale
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-117867 (URN)10.1186/s12884-016-0917-9 (DOI)000377160400001 ()
    Note

    Funding agencies: This investigation was supported by grants from The Regional Council of Ostergotland, Sweden.

    Vid tiden för disputationen förelåg publikationen endast som manuskript

    Available from: 2015-05-12 Created: 2015-05-12 Last updated: 2019-06-28Bibliographically approved
    4. Sleepiness and sleep disordered breathing during pregnancy
    Open this publication in new window or tab >>Sleepiness and sleep disordered breathing during pregnancy
    2016 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 20, no 4, p. 1231-1237Article in journal (Refereed) Published
    Abstract [en]

    Study objectives: To investigate if sleep recordings show differences in prevalence of sleep-disturbed breathing among pregnant women compared to non-pregnant controls. To compare the Epworth sleepiness scale (ESS) scores between the two groups. To evaluate obstetric outcomes.

    Setting: At one antenatal care center at an outpatient unit in Linköping, Sweden.

    Participants: One hundred pregnant women (gestational week 24-34) and 80 non-pregnant women age- and body mass index-matched as controls.

    Interventions: Whole-night respiratory recordings were performed in the homes of all participants, who also answered the same questionnaire, including the Epworth Sleepiness Scale.

    Measurements and results: Objectively recorded snoring was more common among the pregnant women (median value 10% of total estimated sleep time) than among the non-pregnant controls (2.5% of total sleep time, p<0.001). The prevalence of obstructive events was low and similar in pregnant and non-pregnant women (1% vs. 3% had obstructive apnea-hypopnea index ≥5). The total ESS score was higher among pregnant women than controls (median 9 vs. 7, p<0.001) but no significant differences were found between the two groups in the scores for the separate items of the ESS. Sleep-disturbed breathing and snoring showed no impact on obstetric outcome. There were no significant associations between either subjectively reported or objectively recorded snoring and ESS scores.

    Conclusion: Snoring increases during pregnancy, but sleep recordings could not verify an increased prevalence of obstructive sleep apnea among pregnant women. Development of obstructive sleep apnea is not a likely explanation for the increased daytime sleepiness seen in pregnant women.

    Place, publisher, year, edition, pages
    Springer Publishing Company, 2016
    Keywords
    Pregnancy, snoring, sleep recordings, sleep disordered breathing, obstructive sleep apnea, Epworth Sleepiness Scale
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-117868 (URN)10.1007/s11325-016-1345-9 (DOI)
    Note

    The previous status of this publication was manuscript, and the working title was: "Snoring, sleepiness and sleep-disordered breathing during pregnancy"

    Available from: 2015-05-12 Created: 2015-05-12 Last updated: 2019-06-28Bibliographically approved
  • 341.
    Sarberg, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Sleepiness and sleep disordered breathing during pregnancy2016In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 20, no 4, p. 1231-1237Article in journal (Refereed)
    Abstract [en]

    Study objectives: To investigate if sleep recordings show differences in prevalence of sleep-disturbed breathing among pregnant women compared to non-pregnant controls. To compare the Epworth sleepiness scale (ESS) scores between the two groups. To evaluate obstetric outcomes.

    Setting: At one antenatal care center at an outpatient unit in Linköping, Sweden.

    Participants: One hundred pregnant women (gestational week 24-34) and 80 non-pregnant women age- and body mass index-matched as controls.

    Interventions: Whole-night respiratory recordings were performed in the homes of all participants, who also answered the same questionnaire, including the Epworth Sleepiness Scale.

    Measurements and results: Objectively recorded snoring was more common among the pregnant women (median value 10% of total estimated sleep time) than among the non-pregnant controls (2.5% of total sleep time, p<0.001). The prevalence of obstructive events was low and similar in pregnant and non-pregnant women (1% vs. 3% had obstructive apnea-hypopnea index ≥5). The total ESS score was higher among pregnant women than controls (median 9 vs. 7, p<0.001) but no significant differences were found between the two groups in the scores for the separate items of the ESS. Sleep-disturbed breathing and snoring showed no impact on obstetric outcome. There were no significant associations between either subjectively reported or objectively recorded snoring and ESS scores.

    Conclusion: Snoring increases during pregnancy, but sleep recordings could not verify an increased prevalence of obstructive sleep apnea among pregnant women. Development of obstructive sleep apnea is not a likely explanation for the increased daytime sleepiness seen in pregnant women.

  • 342.
    Sarberg, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Postpartum depressive symptoms and its association to daytime sleepiness and restless legs during pregnancy2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, article id 137Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate the possible association between depressive symptoms in the postpartum period and sleep related problems during pregnancy, using screening instruments.

    Methods: In a prospective study 293 women in the last trimester of pregnancy answered a questionnaire about sleep related problems in terms of symptoms of restless legs, snoring and daytime sleepiness. They also completed the Epworth Sleepiness Scale (ESS). The same women were screened for depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) four to ten weeks after giving birth. Additional information about social data, pregnancy and delivery was received from the medical charts.

    Results: Women with postpartum depressive symptoms had higher prevalence of sleep related problems including excessive daytime sleepiness defined as ESS score ≥10 (OR 3.84, CI 1.57-9.39), and restless legs syndrome (OR 2.837 CI 1.18-6.84) in last trimester of pregnancy, when adjusted for sociodemographic factors and obstetric risk factors.

    Conclusions: Depressive symptoms after childbirth are preceded by disturbed sleep already during pregnancy. The results from Epworth Sleepiness Scale completed during pregnancy might be used for detecting women at risk, enabling preventive interventions.

  • 343.
    Schuster, Raphael
    et al.
    Univ Salzburg, Austria.
    Pokorny, Raffaela
    Univ Vienna, Austria.
    Berger, Thomas
    Univ Bern, Switzerland.
    Topooco, Naira
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Laireiter, Anton-Rupert
    Univ Salzburg, Austria; Univ Vienna, Austria.
    The Advantages and Disadvantages of Online and Blended Therapy: Survey Study Amongst Licensed Psychotherapists in Austria2018In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, no 12, article id e11007Article in journal (Refereed)
    Abstract [en]

    Background: Web-based and blended (face-to-face plus Web-based) interventions for mental health disorders are gaining significance. However, many licensed psychotherapists still have guarded attitudes toward computer-assisted therapy, hindering dissemination efforts. Objective: The objective of this study was to provide a therapist-oriented evaluation of Web-based and blended therapies and identify commonalities and differences in attitudes toward both formats. Furthermore, it aimed to test the impact of an information clip on expressed attitudes. Methods: In total, 95 Austrian psychotherapists were contacted and surveyed via their listed occupational email address. An 8-minute information video was shown to half of the therapists before 19 advantages and 13 disadvantages had to be rated on a 6-point Likert scale. Results: The sample resembled all assessed properties of Austrian psychotherapists (age, theoretical orientation, and region). Therapists did not hold a uniform overall preference. Instead, perceived advantages of both interventions were rated as neutral (t(94)=1.89, P=. 06; d=0.11), whereas Web-based interventions were associated with more disadvantages and risks (t(94)=9.86, Pamp;lt;. 001; d=0.81). The information clip did not excerpt any detectable effect on therapists attitudes (r(95)=-. 109, P=. 30). The application of modern technologies in the own therapeutic practice and cognitive behavioral orientation were positively related to the given ratings. Conclusions: This study is the first to directly compare therapists attitudes toward Web-based and blended therapies. Positive attitudes play a pivotal role in the dissemination of new technologies, but unexperienced therapists seem to lack knowledge on how to benefit from technology-aided treatments. To speed up implementation, these aspects need to be addressed in the development of new interventions. Furthermore, the preference of blended treatments over Web-based interventions seems to relate to avoidance of risks. Although this study is likely to represent therapists attitudes in countries with less advanced electronic health services, therapists attitudes in more advanced countries might present differently.

  • 344.
    Seing, Ida
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Activating the Sick-Listed: Policy and Practice of Return to Work in Swedish Sickness Insurance and Working Life2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    A critical task of social policy in most Western welfare states during recent decades has consisted of reducing the economic burden on society due to sick leave, by stimulating participation in the labour market. Many jurisdictions have introduced activation policies, based on the premise that work “per se” has a therapeutic effect on sick-listed workers. People are expected to be “active”, rather than “passive”, recipients of financial benefits. However, there is limited knowledge of how activation policies focusing on return to work (RTW) are carried out in local practice. Against this background, the overall aim of this thesis is to study the local practice of activation policies by analysing how they are received, implemented and experienced by welfare state organizations, employers and sick-listed workers. The analysis has been influenced by theories concerning organization fields, individualization, street-level bureaucracy and organizational governance.

    In this thesis, the overall aim is investigated in four interrelated papers. In Paper I, the aim is to analyse the perspectives of stakeholders (i.e. welfare state actors and employers) on work ability by studying multistakeholder meetings. Paper II sheds light on activation policy, focusing on early RTW in the context of modern working conditions; the aim is to analyse RTW practice in local workplace contexts, in relation to Swedish early-RTW policy. The third paper focuses on employers, with the aim of analysing their role and activities regarding RTW, in local workplace practice. In Paper IV, the aim is to analyse sick-listed workers’ experiences of the sickness insurance system in their contact with the Swedish Social Insurance Agency (SSIA) and their front-line staff.

    The empirical material comprises two empirical studies: 1) audio-recorded multi-stakeholder meetings from regular practice (n=9) and 2) semi-structured interviews with sick-listed workers and their supervisors in 18 workplaces (n=36). The analyses of the material have been performed in accordance with the principles of qualitative content analysis.

    Main findings of the papers reflect strong organizational boundaries in the implementation process of activation policies. Welfare state actors and employers appear to be governed by their own organizational logics and interests, so the actors involved fail to take a holistic view of sick-listed workers and do not share a common social responsibility for individuals’ RTW. This thesis illustrates how current activation policies focusing on RTW are based on a rather idealized image of the standard workplace. There is an explicit or implicit assumption that employers and work organizations are able to welcome sick-listed workers back to work in a healthy way. However, the intensity of modern working life leaves limited room for accommodating people with reduced work ability, who are not considered to have a business value to the workplace. In several cases, findings indicate that the SSIA’s focus on activation and early RTW clashes with the financially oriented perspective of employers. Economic considerations regarding their business take precedence over legal and ethical considerations, and employers have difficulty taking social responsibility for RTW. Sick-listed workers are encouraged to adjust to new workplace settings and environments to meet the demands of the workplace, and, if RTW is not possible, to the demands of the labour market. The findings also show that sick-listed workers experience that contacts with the SSIA are ‘standardized’; i.e., they perceive that the officials are loyal  to demands in their organizations rather than being involved actors who support workers’ individual needs. Sick-listed workers clearly experience that measures in Swedish activation policies have a strong focus on demanding aspects (financial work incentives) and less on enabling aspects (investments in skills).

    Overall, this thesis illustrates an emerging social climate where sick-listed workers are positioned as active agents who must take responsibility for their sick leave and their RTW process. In a Swedish context, RTW is a matter of activating the sick-listed rather than activating the workplace.

    List of papers
    1. Policy and Practice of Work Ability: A Negotiation of Responsibility in Organizing Return to Work
    Open this publication in new window or tab >>Policy and Practice of Work Ability: A Negotiation of Responsibility in Organizing Return to Work
    Show others...
    2012 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 22, no 4, p. 553-564Article in journal (Refereed) Published
    Abstract [en]

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

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

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

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

    Place, publisher, year, edition, pages
    Springer, 2012
    National Category
    Occupational Therapy Work Sciences Public Health, Global Health, Social Medicine and Epidemiology Political Science Sociology
    Identifiers
    urn:nbn:se:liu:diva-73888 (URN)10.1007/s10926-012-9371-3 (DOI)000310472400012 ()
    Available from: 2012-01-16 Created: 2012-01-16 Last updated: 2017-12-08
    2. Early-Return-to-Work in the Context of an Intensification of Working Life and Changing Employment Relationships
    Open this publication in new window or tab >>Early-Return-to-Work in the Context of an Intensification of Working Life and Changing Employment Relationships
    2015 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, no 1, p. 74-85Article in journal (Refereed) Published
    Abstract [en]

    Purpose Many Western welfare states have introduced early-return-to-work policies, in which getting sick-listed people back to work before they have fully recovered is presented as a rather unproblematic approach. This reflects a belief in the ability of employers and the labour market to solve sickness absence. Against this background, the aim of this study was to analyse return-to-work practice in local workplace contexts, in relation to Swedish early-return-to-work policy.

    Methods Semi-structured interviews were conducted with 18 matched pairs of workers and managers. The material, comprising a total of 36 interviews, was analysed using qualitative content analysis.

    Results Three main themes were identified: (1) intensive workplaces and work conditions (2) employer support—a function of worker value and (3) work attachment and resistance to job transition. The results reflected the intensity of modern working life, which challenged return-to-work processes. Managers had different approaches to workers’ return-to-work, depending on how they valued the worker. While managers used the discourse of ‘new opportunities’ and ‘healthy change’ to describe the transition process (e.g. relocation, unemployment and retirement), workers regularly experienced transitions as difficult and unjust.

    Conclusions In the context of early-return-to-work policy and the intensity of modern working life, a great deal of responsibility was placed on workers to be adaptable to workplace demands in order to be able to return and stay at work. Overall, this study illustrates an emerging social climate where sick-listed workers are positioned as active agents who must take responsibility for sick leave and return-to-work process.

    Place, publisher, year, edition, pages
    Springer, 2015
    Keywords
    Social policy; Return-to-work; Sick leave; Work place; Career mobility
    National Category
    Occupational Therapy Public Health, Global Health, Social Medicine and Epidemiology Sociology Political Science Work Sciences
    Identifiers
    urn:nbn:se:liu:diva-112396 (URN)10.1007/s10926-014-9526-5 (DOI)000349971100008 ()24920449 (PubMedID)
    Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2017-12-05Bibliographically approved
    3. Return to work or job transition?: Employer dilemmas in taking social responsibility for return to work in local workplace practice
    Open this publication in new window or tab >>Return to work or job transition?: Employer dilemmas in taking social responsibility for return to work in local workplace practice
    2015 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 18-19, p. 1760-1769Article in journal (Refereed) Published
    Abstract [en]

    Purpose: The aim was to analyze the role and activities of employers with regard to return to work (RTW), in local workplace practice.

    Method: Semi-structured interviews were conducted with sick-listed workers and their supervisors in 18 workplaces (n  = 36). The analytical approach to study the role of employers in RTW was based on the three-domain model of social corporate responsibility. The model illustrates the linkage between corporations and their social environment, and consists of three areas of corporate responsibility: economic, legal and ethical.

    Results: Employers had difficulties in taking social responsibility for RTW, in that economic considerations regarding their business took precedence over legal and ethical considerations. Employers engaged in either “RTW activities” or “transition activities” that were applied differently depending on how valued sick-listed workers were considered to be to their business, and on the nature of the job (e.g. availability of suitable work adjustments).

    Conclusions: This study suggests that Swedish legislation and policies does not always adequately prompt employers to engage in RTW. There is a need for further attention to the organizational conditions for employers to take social responsibility for RTW in the context of business pressure and work intensification.

    Implications for Rehabilitation

    • Employers may have difficulties in taking social responsibility for RTW when economic considerations regarding their business take precedence over legal and ethical considerations.
    • Rehabilitation professionals should be aware of that outcomes of an RTW process can be influenced by the worker’s value to the employer and the nature of the job (e.g. availability of suitable work adjustments). “Low-value” workers at workplaces with limited possibilities to offer workplace adjustments may run a high risk of dismissal.
    • Swedish legislation and policies may need reforms to put more pressure on employers to promote RTW.
    Place, publisher, year, edition, pages
    Informa Healthcare, 2015
    Keywords
    Activation policy, employers, sick leave, work accommodation, workplace
    National Category
    Occupational Therapy Public Health, Global Health, Social Medicine and Epidemiology Political Science Sociology Work Sciences
    Identifiers
    urn:nbn:se:liu:diva-112397 (URN)10.3109/09638288.2014.978509 (DOI)000359878700020 ()25355548 (PubMedID)
    Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2017-12-05Bibliographically approved
    4. Activation Policies and Sick-Listed Workers’ Experiences and Trust in the Sickness Insurance System in Local Practice
    Open this publication in new window or tab >>Activation Policies and Sick-Listed Workers’ Experiences and Trust in the Sickness Insurance System in Local Practice
    2014 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    In recent welfare and labour market reforms in Europe and North America, there is a general trend towards activation, in that people (e.g. those who are sick-listed, unemployed and recipients of social welfare) are expected to be “active”, rather than “passive”, recipients of financial benefits. Meanwhile, street-level bureaucracy in many welfare state organizations has been fundamentally reformed in recent years with the implementation of New Public Management Principles which have come to influence the day-to-day work of front-line staff. The aim of this paper is to analyse sick-listed workers’ experiences of the sickness insurance system in their contact with the SSIA and their front-line staff. The data consists of semistructured interviews with 18 sick-listed workers in Sweden. The material was analysed using qualitative content analysis. The findings illustrate that sick-listed workers experienced contacts with the Social Insurance Agency (SSIA) as “standardized”; that is, they perceived that the officials were loyal to demands in their organizations rather than involved actors that supported workers’ individual needs. The SSIA was described as having a mainly administrative and controlling function during their sick leave, resulting in a distant relationship. It was also clear that sick-listed individuals experienced the activation policy as demanding, and their sick leave was characterized by insecurity and uncertainty. Overall, this paper suggests that activation policies with regulations emphasizing time limits, and enforcement of standardized work processes at the SSIA, challenge sick-listed workers’ trust in the sickness insurance system.

    National Category
    Occupational Therapy Public Health, Global Health, Social Medicine and Epidemiology Work Sciences Political Science Sociology
    Identifiers
    urn:nbn:se:liu:diva-112398 (URN)
    Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2014-11-26
  • 345.
    Seing, Ida
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Avstämningsmötet: en arena för förhandling omarbetsförmåga och rehabiliteringsansvar2011Report (Other academic)
    Abstract [sv]

    I juli 2003 infördes ett krav i lagstiftningen att Försäkringskassan vid behov ska använda sig av ett så kallat avstämningsmöte vid bedömningen av individers rätt till ersättning och rehabiliterande insatser från sjukförsäkringen. På policynivå har avstämningsmötet presenterats som ett effektivt verktyg i lösningen på problemen med långa sjukskrivningar och hög sjukfrånvaro. Genom att samla involverade aktörer ”runt ett bord” (Försäkringskassan, den sjukskrivne, sjukvården, arbetsgivare och Arbetsförmedlingen) förväntas parterna hitta gemensamma lösningar som ska underlätta den sjukskrivnes väg tillbaka i arbetslivet.

    Huvudsyftet med föreliggande studie har varit att analysera på vilka grunder involverade parter bedömer individers arbetsförmåga och möjligheter för återgång i arbete. En central frågeställning var att studera vilka aspekter av arbetsförmåga som under mötet belystes. Fokus riktades mot involverade aktörers resonemang om arbetsförmåga och hur parterna såg på sin egen och övriga aktörers roll i verksamhetsprocessen. Rapporten baseras på nio inspelade avstämningsmöten under år 2007 och 2008 i Östergötland. Det empiriska materialet har kompletterats med metodstöd från Försäkringskassan och offentliga rapporter. En innehållsanalytisk metod har använts i analysen av det empiriska materialet.

    Studiens resultat visar hur välfärdspolitikens fokus på arbetslinjen och aktiva insatser ställer krav på de organisationer som har till uppgift att återföra sjukskrivna i arbetslivet. Avstämningsmötet äger rum i skärningspunkten mellan organisationer med skilda regler och rutiner. Mötena utmärktes av en förhandling om arbetsförmåga och vilka aktörer som hade rehabiliteringsansvaret för individerna i fråga. Tre perspektiv på arbetsförmåga blev framträdande: det medicinska, regelverkets och arbetslivets perspektiv. Försäkringskassan argumenterade ofta utifrån sjukförsäkringens regelverk, och sjukvården betonade främst medicinska hinder för individens arbetsoförmåga, medan arbetsgivare framhöll individens fysiska nedsättningar i relation till arbetes krav. Samtidigt som perspektiven kunde knytas till specifik aktör kunde parterna växla mellan olika perspektiv på arbetsförmåga beroende på situation. I förhandlingen om den sjukskrivnes arbetsförmåga utgjorde den medicinska expertisen en ”neutral expertfunktion” som skapade legitimitet för parternas ståndpunkter. I rapporten visas hur Försäkringskassans regelverk med fokus på tidig återgång i arbete och aktiva insatser kom på kollisionskurs med arbetsgivarnas svårigheter att anpassa arbetsplatsen. Sjukskrivnas arbetsförmåga och möjligheter att återgå i arbete berodde därför inte enbart beror på den strikt medicinska bedömningen av funktionsnedsättning. I praktiken grundades bedömningen av arbetsförmåga istället på relationen mellan individens förmåga och arbetets förutsättningar. Studien aktualiserar avslutningsvis frågor om vilka förutsättningar den arbetslivsinriktade rehabiliteringen har när arbetsmarknaden idag tenderar att lämna begränsat utrymme för människor som inte anses leva upp till arbetslivets krav.

  • 346.
    Seing, Ida
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    MacEachen, Ellen
    Department of Public Health and Health Systems, Faculty of Applied Public Health, University of Waterloo, Ontario, Canada.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Activation Policies and Sick-Listed Workers’ Experiences and Trust in the Sickness Insurance System in Local Practice2014Manuscript (preprint) (Other academic)
    Abstract [en]

    In recent welfare and labour market reforms in Europe and North America, there is a general trend towards activation, in that people (e.g. those who are sick-listed, unemployed and recipients of social welfare) are expected to be “active”, rather than “passive”, recipients of financial benefits. Meanwhile, street-level bureaucracy in many welfare state organizations has been fundamentally reformed in recent years with the implementation of New Public Management Principles which have come to influence the day-to-day work of front-line staff. The aim of this paper is to analyse sick-listed workers’ experiences of the sickness insurance system in their contact with the SSIA and their front-line staff. The data consists of semistructured interviews with 18 sick-listed workers in Sweden. The material was analysed using qualitative content analysis. The findings illustrate that sick-listed workers experienced contacts with the Social Insurance Agency (SSIA) as “standardized”; that is, they perceived that the officials were loyal to demands in their organizations rather than involved actors that supported workers’ individual needs. The SSIA was described as having a mainly administrative and controlling function during their sick leave, resulting in a distant relationship. It was also clear that sick-listed individuals experienced the activation policy as demanding, and their sick leave was characterized by insecurity and uncertainty. Overall, this paper suggests that activation policies with regulations emphasizing time limits, and enforcement of standardized work processes at the SSIA, challenge sick-listed workers’ trust in the sickness insurance system.

  • 347.
    Seing, Ida
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    MacEachen, Ellen
    Department of Public Health and Health Systems, Faculty of Applied Public Health, University of Waterloo, Ontario, Canada.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Return to work or job transition?: Employer dilemmas in taking social responsibility for return to work in local workplace practice2015In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 18-19, p. 1760-1769Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim was to analyze the role and activities of employers with regard to return to work (RTW), in local workplace practice.

    Method: Semi-structured interviews were conducted with sick-listed workers and their supervisors in 18 workplaces (n  = 36). The analytical approach to study the role of employers in RTW was based on the three-domain model of social corporate responsibility. The model illustrates the linkage between corporations and their social environment, and consists of three areas of corporate responsibility: economic, legal and ethical.

    Results: Employers had difficulties in taking social responsibility for RTW, in that economic considerations regarding their business took precedence over legal and ethical considerations. Employers engaged in either “RTW activities” or “transition activities” that were applied differently depending on how valued sick-listed workers were considered to be to their business, and on the nature of the job (e.g. availability of suitable work adjustments).

    Conclusions: This study suggests that Swedish legislation and policies does not always adequately prompt employers to engage in RTW. There is a need for further attention to the organizational conditions for employers to take social responsibility for RTW in the context of business pressure and work intensification.

    Implications for Rehabilitation

    • Employers may have difficulties in taking social responsibility for RTW when economic considerations regarding their business take precedence over legal and ethical considerations.
    • Rehabilitation professionals should be aware of that outcomes of an RTW process can be influenced by the worker’s value to the employer and the nature of the job (e.g. availability of suitable work adjustments). “Low-value” workers at workplaces with limited possibilities to offer workplace adjustments may run a high risk of dismissal.
    • Swedish legislation and policies may need reforms to put more pressure on employers to promote RTW.
  • 348.
    Seing, Ida
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    MacEachen, Ellen
    School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Canada.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Early-Return-to-Work in the Context of an Intensification of Working Life and Changing Employment Relationships2015In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, no 1, p. 74-85Article in journal (Refereed)
    Abstract [en]

    Purpose Many Western welfare states have introduced early-return-to-work policies, in which getting sick-listed people back to work before they have fully recovered is presented as a rather unproblematic approach. This reflects a belief in the ability of employers and the labour market to solve sickness absence. Against this background, the aim of this study was to analyse return-to-work practice in local workplace contexts, in relation to Swedish early-return-to-work policy.

    Methods Semi-structured interviews were conducted with 18 matched pairs of workers and managers. The material, comprising a total of 36 interviews, was analysed using qualitative content analysis.

    Results Three main themes were identified: (1) intensive workplaces and work conditions (2) employer support—a function of worker value and (3) work attachment and resistance to job transition. The results reflected the intensity of modern working life, which challenged return-to-work processes. Managers had different approaches to workers’ return-to-work, depending on how they valued the worker. While managers used the discourse of ‘new opportunities’ and ‘healthy change’ to describe the transition process (e.g. relocation, unemployment and retirement), workers regularly experienced transitions as difficult and unjust.

    Conclusions In the context of early-return-to-work policy and the intensity of modern working life, a great deal of responsibility was placed on workers to be adaptable to workplace demands in order to be able to return and stay at work. Overall, this study illustrates an emerging social climate where sick-listed workers are positioned as active agents who must take responsibility for sick leave and return-to-work process.

  • 349.
    Seing, Ida
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Nordenfelt, Lennart
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Bülow, Pia
    Avdelningen för beteendevetenskap och socialt arbete, Hälsohögskolan, Jönköping.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Avstämningsmötet som arena för förhandling om arbetsförmåga.2011In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 88, no 5, p. 408-417Article in journal (Refereed)
  • 350.
    Seing, Ida
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Nordenfelt, Lennart
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Bülow, Pia
    Avdelningen för beteendevetenskap och socialt arbete, Hälsohögskolan, Jönköping.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Policy and Practice of Work Ability: A Negotiation of Responsibility in Organizing Return to Work2012In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 22, no 4, p. 553-564Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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