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  • 301.
    Nilsson, Evalill
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Psychological factors related to physical, social,and mental dimensions of the SF-36: a populationbasedstudy of middle-aged women and men2010In: patient related outcome measures, Vol. 1, p. 153-162Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 302.
    Nilsson, Michael
    et al.
    Football Research Group, Linköping, Sweden and Ängelholm Hospital, Sweden .
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Head and Neck Injuries in Professional Soccer2013In: Clinical Journal of Sports Medicine, ISSN 1050-642X, E-ISSN 1536-3724, Vol. 23, no 4, p. 255-260Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the rate of and risk factors for head and neck injury in male soccer.

    Design: Prospective cohort study.

    Setting: Professional soccer.

    Participants: Twenty-six European teams between 2001/2002 and 2009/2010.

    Assessment of Risk Factors: Simple and multiple risk factor analyses were evaluated using Cox regression for player-related variables and logistic regression for match-related variables.

    Main Outcome Measures: Injury rate (number of time loss injuries per 1000 hours).

    Results: A total of 136 head and neck injuries were recorded (2.2% of all injuries). The head and neck injury rate was 0.17 (0.06 concussions) per 1000 hours. There was a 20-fold higher rate of head and neck injury during match play compared with training (rate ratio [RR], 20.2; 95% confidence interval [CI], 13.3-30.6) and a 78-fold higher rate of concussions (RR, 78.5; 95% CI, 24.4-252.5). Mean layoff for concussion was 10.5 days, but 27% of the concussed players returned to play within 5 days. Defender was the only significant player-related risk factor for head and neck injuries in the multiple analysis (RR, 1.8; 95% CI, 1.0-3.1), whereas no significant variables were identified for concussions.

    Conclusions: Head and neck injuries were relatively uncommon in professional soccer. Defender was the playing position most at risk. More than one-quarter of the concussed players returned to play before what is recommended in the consensus statements by the major sports governing bodies.

  • 303.
    Nordqvist, Cecilia
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hanberger, Lena
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Nordfeldt, Sam
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Health professionals' attitudes towards using a Web 2.0 portal for child and adolescent diabetes care: qualitative study.2009In: Journal of medical Internet research, ISSN 1438-8871, Vol. 11, no 2, p. e12-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Internet, created and maintained in part by third-party apomediation, has become a dynamic resource for living with a chronic disease. Modern management of type 1 diabetes requires continuous support and problem-based learning, but few pediatric clinics offer Web 2.0 resources to patients as part of routine diabetes care. OBJECTIVES: To explore pediatric practitioners' attitudes towards the introduction of a local Web portal for providing young type 1 diabetes patients with interactive pedagogic devices, social networking tools, and locally produced self-care and treatment information. Opportunities and barriers related to the introduction of such systems into clinical practice were sought. METHODS: Twenty clinicians (seven doctors, nine nurses, two dieticians, and two social welfare officers) from two pediatric diabetes teams participated in the user-centered design of a local Web 2.0 portal. After completion of the design, individual semi-structured interviews were performed and data were analyzed using phenomenological methods. RESULTS: The practitioners reported a range of positive attitudes towards the introduction of a local Web 2.0 portal to their clinical practice. Most interviewees were satisfied with how the portal turned out, and a sense of community emerged during the design process and development of the portal's contents. A complementary role was suggested for the portal within the context of health practice culture, where patients and their parents would be able to learn about the disease before, between, and after scheduled contacts with their health care team. Although some professionals expected that email communication with patients and online patient information would save time during routine care, others emphasized the importance of also maintaining face-to-face communication. Online peer-to-peer communication was regarded as a valuable function; however, most clinicians did not expect that the portal would be used extensively for social networking amongst their patients. There were no major differences in attitudes between different professions or clinics, but some differences appeared in relation to work tasks. CONCLUSIONS: Experienced clinical practitioners working in diabetes teams exhibited positive attitudes towards a Web 2.0 portal tailored for young patients with type 1 diabetes and their parents. The portal included provision of third-party information, as well as practical and social means of support. The practitioners' early and active participation provides a possible explanation for these positive attitudes. The findings encourage close collaboration with all user groups when implementing Web 2.0 systems for the care of young patients with chronic diseases, particularly type 1 diabetes. The study also highlights the need for efforts to educate clinical practitioners in the use of Web publishing, social networking, and other Web 2.0 resources. Investigations of attitudes towards implementing similar systems in the care of adults with chronic diseases are warranted.

  • 304.
    Nordqvist, Cecilia
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Holmqvist, Marika
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care.
    Intention to change heavy episodic drinking and actual change seen among emergency care patients2008In: Journal of Drug Addiction, Education and Eradication, ISSN 1546-6965, Vol. 3, no 3, p. 263-276Article in journal (Refereed)
  • 305.
    Nordqvist, Cecilia
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Holmqvist, Marika
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Usual drinking pattern and non‐fatal injury among patients seeking medical care2006In: Public Health, ISSN 0033-3506, Vol. 120, no 11, p. 1064-1073Article in journal (Refereed)
    Abstract [en]

    Objectives

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

    Study design

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

    Methods

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

    Results

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

    Conclusions

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

  • 306.
    Nordqvist, Cecilia
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Johansson, Kjell
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Routine screening for risky alcohol consumption at an emergency department using the AUDIT-C questionnaire2004In: Drug and Alcohol Dependence, ISSN 0376-8716, Vol. 74, no 1, p. 71-75Article in journal (Refereed)
    Abstract [en]

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

  • 307.
    Nordqvist, Cecilia
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Johansson, Kjell
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Alcohol prevention measures at an emergency department: physicians` perspectives. Short communication2005In: Public Health, ISSN 0033-3506, Vol. 119, no 9, p. 789-791Article in journal (Refereed)
  • 308.
    Nordqvist, Cecilia
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Johansson, Kjell
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Attitude changes among emergency department triage staff after conducting routine alcohol screening2006In: Addictive Behaviors, ISSN 0306-4603, Vol. 31, no 2, p. 191-202Article in journal (Refereed)
    Abstract [en]

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

  • 309.
    Nordqvist, Cecilia
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    What promotes sustainability in Safe Community programmes?2009In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 9, no 4Article in journal (Refereed)
    Abstract [en]

    Background: The theory and practice of safety promotion has traditionally focused on the safety of individuals. This study also includes systems, environments, and organizations. Safety promotion programmes are designed to support community health initiatives taking a bottom-up approach. This is a long-term and complex process. The aim of this study was to try to empirically identify factors that promote sustainability in the structures of programmes that are managed and coordinated by the local government.

    Methods: Four focus group sessions with local government politicians and administrators in designated Safe Communities were conducted and analyzed using qualitative content analysis.

    Results: Collaboration was found to be the basis for sustainability. Networks, enabling municipalities to exchange ideas, were reported to positively influence the programmes. Personal contacts rather than organizations themselves, determine whether collaboration is sustained. Participants reported an increase in cross-disciplinary collaboration among staff categories. Administrators and politicians were reported to collaborate well, which was perceived to speed up decision-making and thus to facilitate the programme work. Support from the politicians and the county council was seen as a prerequisite. Participants reported an increased willingness to share information between units, which, in their view, supports sustainability. A structure in which all local authorities offices were located in close proximity to one another was considered to support collaboration. Appointing a public health coordinator responsible for the programme was seen as a way to strengthen the relational resources of the programme.

    Conclusion: With a public health coordinator, the external negotiating power was concentrated in one person. Also, the internal programme strength increased when the coordination was based on a bureaucratic function rather than on one individual. Increased relational resources facilitated the transfer of information. A regular flow of information to policy-makers, residents, and staff was needed in order to integrate safety programmes into routines. Adopting a bottom-up approach requires that informal and ad hoc activities in information management be replaced by formalized, organizationally sanctioned routines. In contrast to injury prevention, which focuses on technical solutions, safety promotion tries to influence attitudes. Collaboration with the media was an area that could be improved.

  • 310.
    Nordqvist, Cecilia
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Wilhelm, Elisabeth
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Can screening and simple written advice reduce excessive alcohol consumption among emergency care patients?2005In: Alcohol & Alcoholism, ISSN 0735-0414 (print) 1464-3502 (online), Vol. 40, no 5, p. 401-408Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 311.
    Nordqvist, Cecilila
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Alcohol screening and simple advice in emergency care: staffs’ attitudes and injured patients’ drinking pattern2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

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

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

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

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

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

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

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

    Objectives

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

    Study design

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

    Methods

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

    Results

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

    Conclusions

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

    Keywords
    Usual alcohol drinking patterns; Non-fatal injury; Risky drinkers; Emergency care
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13760 (URN)10.1016/j.puhe.2006.06.007 (DOI)
    Available from: 2006-01-16 Created: 2006-01-16 Last updated: 2009-05-28
  • 312.
    Nyberg, Anders
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Gregersen, Nils Petter
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Practicing for and performance on driver’s license tests in relation to gender differences in crash involvement among novice drivers2007In: Journal of Safety Research, ISSN 0022-4375, E-ISSN 1879-1247, Vol. 38, no 1, p. 71-80Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 313.
    Nyberg, Anders
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Gregersen, Nils Petter
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nolén, Sixten
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Engström, Inger
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Safety halls: an evaluation2005In: Journal of Safety Research, ISSN 0022-4375, Vol. 36, no 5, p. 429-439Article in journal (Refereed)
    Abstract [en]

    Problem

    In most countries, drivers licensing systems usually include teaching some aspects of using safety equipment (e.g., airbags and seat belts). However, there is now evidence worldwide that such education is inadequate, as indicated by, for example, the overrepresentation of young drivers who do not use seat belts.

    Method

    A randomized controlled study was conducted in Sweden to evaluate the effects of visiting a facility known as a “safety hall” in combination with the mandatory skid training. The results were assessed to determine the effects of the knowledge and attitudes of learner drivers in the following subjects: airbags, securing loads, seat belts, sitting posture, speed, and tires. An experimental group and a control group comprising 658 and 668 learners, respectively, answered identical questionnaires on three different occasions (pretest, posttest 1, and posttest 2).

    Results

    The results show that, for most of the topics considered, knowledge and attitudes in both groups were better at posttest 2 than at the pretest, and in general, the best knowledge and attitudes were found in the experimental group. The combined safety/skid training seems to have had the greatest effect on seat belts and loads. The findings also indicate that the safety halls can be further improved to achieve an even better effect.

    Impact on Traffic Safety

    The use of safety halls has improved the knowledge and attitudes of learner drivers concerning several important areas related to traffic safety. Since knowledge and attitudes are important predictors of behavior, implementing safety halls can be expected to lead to improvements, especially regarding the use of safety belts and securing loads.

  • 314.
    Nyberg, Anders
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Gregersen, Nils Petter
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Wiklund, Mats
    Swedish National Road and Transport Research Institute (VTI), SE-581 95 Linköping, Sweden.
    Practicing in relation to the outcome of the driving test2007In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 39, no 1, p. 159-168Article in journal (Refereed)
    Abstract [en]

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

  • 315.
    Nyce, James M
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    The Reformist Triad and Institutional Forgetting of Culture: A Field Study into Twentieth-Century Swedish Social Medicine2012In: International Journal of Health Services, ISSN 0020-7314, E-ISSN 1541-4469, Vol. 42, no 1, p. 95-107Article in journal (Refereed)
    Abstract [en]

    Social medicine deals with the interplay between medicine and society. An awareness of how analytical categories have emerged historically can strengthen the role the discipline can play in the societal reinventions of health care now under way around the world. This study examines the categories that informed social medicine in Sweden during the 20th century. An anthropological field study was conducted over a 12-year period in a Swedish academic clinical setting. Historical documents were used to link local-level issues with macro-level (here, national and European) contexts. Social medicine, modernity, and social democracy were found to share a common history and a common vision of what society should be. As a result, concepts from politics, ideology, economy, and science tended to be conflated. As a clinician at the study site explained, "samhalle [community] is both society and state." The consequence for social medicine is that culture has become neglected as an analytical category. This institutional amnesia has strongly influenced how 21st century social medicine, in this region of the world, has defined itself and its interests. To return a cultural perspective to social medicine, a critical distance must be kept between the analyses the discipline undertakes and the prevailing societal ideologies.

  • 316.
    Nygren, Mikaela
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Öhrn, Annica
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Patient Safety.
    Rutberg, Hans
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Patient Safety.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Factors influencing patient safety in Sweden: perceptions of patient safety officers in the county councils2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 52Article in journal (Refereed)
    Abstract [en]

    Background

    National, regional and local activities to improve patient safety in Sweden have increased over the last decade. There are high ambitions for improved patient safety in Sweden. This study surveyed health care professionals who held key positions in their county council’s patient safety work to investigate their perceptions of the conditions for this work, factors they believe have been most important in reaching the current level of patient safety and factors they believe would be most important for achieving improved patient safety in the future.

    Methods

    The study population consisted of 218 health care professionals holding strategic positions in patient safety work in Swedish county councils. Using a questionnaire, the following topics were analysed in this study: profession/occupation; number of years involved in a designated task on patient safety issues; knowledge/overview of the county council’s patient safety work; ability to influence this work; conditions for this work; and the importance of various factors for current and future levels of patient safety.

    Results

    The response rate to the questionnaire was 79%. The conditions that had the highest number of responses in complete agreement were “patients’ involvement is important for patient safety” and “patient safety work has good support from the county council’s management”. Factors that were considered most important for achieving the current level of patient safety were root cause and risk analyses, incident reporting and the Swedish Patient Safety Law. An organizational culture that encourages reporting and avoids blame was considered most important for improved patient safety in the future, closely followed by improved communication between health care practitioners and patients.

    Conclusion

    Health care professionals with important positions in the Swedish county councils’ patient safety work believe that conditions for this work are somewhat constrained. They attribute the current levels of patient safety to a broad range of factors and believe that many different solutions can contribute to enhanced patient safety in the future, suggesting that this work must be multifactorial.

  • 317.
    Ockander, Marlene
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Long-term sickness absence: Women's opinions about health and rehabilitation2005In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 50, no 5, p. 508-517Article in journal (Refereed)
    Abstract [en]

    Aims. This paper reports a study to identify associations between ideas of health and rehabilitation in groups of women having first-hand experience of long-term sickness absence. Background. As a central part of their work, nurses have to be able to understand people in distress. When someone is unable to work because of illness, nurses are one of the central professional categories involved in their rehabilitation. Methods. Data were collected by Q-sort grid and biographical interviews from 82 women aged 30-49 years who had either been absent from work because of sickness for 60 days or more, or were receiving a disability pension. The data were first analysed by patterns and structures obtained from a modified factor analysis. The second phase of the analysis dealt with relocating the results from the statistical analyses to their social context. Results. Six opinions representing different conceptions of health, illness, and rehabilitation were identified. These ranged from reflecting high levels of trust in the health care system to reliance on 'nature's course' and emphasizing the meaning of 'feeling all right'. Conclusions. For women on long-term sick leave, it is reasonable to expect that their communication with rehabilitation professionals will be founded in a mutual understanding of basic concepts. However, the disparate opinions about health and rehabilitation identified in this study show that future studies need to investigate the prospective value of this categorization to see whether and how these conceptions affect rehabilitation practices. © 2005 Blackwell Publishing Ltd.

  • 318.
    Ockander, Marlene
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Nyce, J.M.
    School of Library and Information Management, Emporia, KS 66801, United States, Department of Radiology, Indiana University School of Medicine, Indianapolis, IN 46202, United States.
    How to avoid long-term sickness absence: The advice from women with personal experience2005In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 22, no 4, p. 394-398Article in journal (Refereed)
    Abstract [en]

    Objective. The aim of this study was to describe women's perceptions of what can be done to avoid extended sickness absence with following suffering and passivity. Methods. Qualitative interviews were conducted with 82 women who had been on sickness absence (60 days or more) or were receiving disability pensions. The data were analysed using phenomenological methods. Results. To be able to get back to work was found to be equivalent to breaking away from the prospect of isolation and loneliness. To support this, four parties were identified along with suggestions for their actions: the healthcare professionals, the woman who is on sick leave herself, the employer, and the social insurance official. Most interestingly, the family and close relatives were almost not mentioned at all. The results are connected to a theoretical model of distress in terms of enduring and suffering. Conclusions. It is necessary to look more carefully at how women on sickness absence use the resources in the world (like their families) to get well. More generally, the task is to understand why society deals insufficiently with women who need time off and cannot keep up with their duties because of illness. © The Author (2005). Published by Oxford University Press. All rights reserved.

  • 319.
    Olofsson, Niclas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Violence through the life cycle: A public health problem2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Violence has probably always been part of the human experience. Its impact can be seen, in various forms, in all parts of the world. In 1996, WHO:s Forty-Ninth World Health Assembly adopted a resolution , declaring violence a major and growing public health problem around the world. Public health work centers around health promotion and disease prevention activities in the population and public health is an expression of the health status of the population taking into account both the level and the distribution of health. Exposure to violence can have many aspects, differing throughout the life course — deprivation of autonomy, financial exploitation, psychological and physical neglect or abuse — but all types share common characteristics: the use of destructive force to control others by depriving them of safety, freedom, health and, in too many instances, life; the epidemic proportions of the problem, particularly among vulnerable groups; a devastating impact on individuals, families, neighborhoods, communities, and society.

    Methods: Three different data sources were used in the four articles, three cross-sectional studies (“Life and Health in Norrland” and “Health on Equal Terms 2004 and 2006”) and one longitudinal (“Level-of-Living Survey”).

    Results: We present an important picture of the strong association between exposure to violence and ill health through the life cycle. A population-based study showed an increased risk of poorer physical and psychological health among boys and girls aged 0-18, as reported by their mothers exposed to violence. Further, a strong association between those exposed to violence and physical and mental ill health was demonstrated in young adults aged 18-25, also after adjusting for possible confounders, specifically for women. Even in an elder group aged 65-84, representative results showed an extensive negative health outcome panorama caused by fear of crime and exposure to abuse both in elderly men and women. Lastly, in trying to provide additional empirical support for the association between exposure to violence and ill health the prospective study demonstrated that violence exposure in adolescence and young adulthood presented a negative association to severe illness burden in adulthood for women but not men.

    Conclusion: Exposure to violence among both men and women is an important risk factor for ill health and should receive greater attention in public health work. A strong association between violence and various health outcomes was demonstrated in different time periods through the life cycle.

    List of papers
    1. Physical and psychological symptoms and learning difficulties in children of women exposed and non-exposed to violence: a population-based study.
    Open this publication in new window or tab >>Physical and psychological symptoms and learning difficulties in children of women exposed and non-exposed to violence: a population-based study.
    Show others...
    2011 (English)In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 56, no 1, p. 89-96Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVES: To analyse the association between violence against mothers and the health of their children as reported by the mothers. METHODS: The data originate from a multistage sampling health-questionnaire survey, distributed to a representative sample of women in Sweden. The health of 283 children (aged 0-18 years), as reported by women who had been exposed to violence at home or outside home during the past 12 months, was compared with that of 4,664 children of non-exposed mothers. RESULTS: Odds ratios regarding most registered physical symptoms showed that children of violence-exposed mothers had a significant higher risk of ill health than children of non-exposed mothers. Regarding psychological symptoms and learning difficulties, the odds were raised for girls for most symptoms, but not for boys. A twofold increase in health-care utilisation and an overall general increase in the risk of pharmaceutical consumption were shown for both girls and boys of exposed mothers. CONCLUSIONS: This population-based study shows an increased risk of poorer health amongst boys and girls aged 0-18 years, as reported by mothers exposed to violence.

    Place, publisher, year, edition, pages
    Springer, 2011
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-62254 (URN)10.1007/s00038-010-0165-0 (DOI)000286944400012 ()20617453 (PubMedID)
    Available from: 2010-11-24 Created: 2010-11-24 Last updated: 2017-12-12Bibliographically approved
    2. Violence Against Young Men and Women: A Vital Health Issue
    Open this publication in new window or tab >>Violence Against Young Men and Women: A Vital Health Issue
    2009 (English)In: The Open Public Health Journal, ISSN 1874-9445, Vol. 2, p. 1-6Article in journal (Refereed) Published
    Abstract [en]

    Objectives: Violence is regarded as a major health issue in an increasing amount of literature and is known as an important factor in women's ill health. Little however is known about violence against young men and women and its impact on their health. The principal aim of this study was to analyze health outcomes and health care utilization as reported among men and women aged 18-25 exposed and not exposed to physical and/or emotional violence.

    Study design: A cross-sectional national health survey in Sweden.

    Methods: Postal questionnaires were sent to nearly 3,000 men and women. Three questions were used to ask about violence. Sociodemographic characteristics for those exposed to violence during the past 12 months were analyzed and compared to those not exposed. Crude and adjusted odds ratios were calculated for health outcomes and medical care utilization.

    Results: Increased odds ratios were found for most health outcomes, and health care utilization for those exposed to violence compared to non-exposed. After adjusting for socioeconomic factors, smoking, and use of alcohol and cannabis, most variables were principally unchanged for women but considerably lower for men. Socioeconomic factors, smoking, and the use of drugs were all correlated to victimization.

    Conclusions: A strong association between those exposed to violence and physical and mental ill health was demonstrated also after adjusting for possible confounders, specifically for women. It is time to include questions about violence in public health questionnaires aimed at young people, but also to start asking about it more frequently in health care settings.

    Keywords
    Young men, young women, health status, medical service, public health survey, violence
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-20894 (URN)10.2174/1874944500902010001 (DOI)
    Note
    Original Publication: Niclas Olofsson, Kent Lindqvist, Katja Gillander Gadin and Ingela Danielsson, Violence Against Young Men and Women: A Vital Health Issue, 2009, The Open Public Health Journal, (2), 1-6. http://dx.doi.org/10.2174/1874944500902010001Available from: 2009-09-24 Created: 2009-09-24 Last updated: 2012-05-03Bibliographically approved
    3. Fear of crime and psychological and physical abuse associated with ill health in a Swedish population aged 65-84 years
    Open this publication in new window or tab >>Fear of crime and psychological and physical abuse associated with ill health in a Swedish population aged 65-84 years
    2012 (English)In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 126, no 4, p. 358-364Article in journal (Refereed) Published
    Abstract [en]

    Objectives: To assess the association between fear of crime and/or psychological and/or physical abuse in relation to self-reported physical and psychological health, using a large representative sample of elderly women and men in Sweden. less thanbrgreater than less thanbrgreater thanStudy design: Cross-sectional national survey. less thanbrgreater than less thanbrgreater thanMethods: Data were taken from a nationwide representative public health survey (2006). Men and women between the ages of 65 and 84 years were selected for the present analyses (4386 men and 4974 women). The response rate for this age group was 59% for men and 70% for women. less thanbrgreater than less thanbrgreater thanResults: Psychological and physical abuse against elderly women and men led to higher odds ratios for negative health outcomes, independently of socio-economic status. Strong correlation was found between psychological abuse and negative health outcomes in both men and women, while the correlation was less strong for physical abuse, especially among women. The men had high odds ratios for suicidal thoughts and even for attempted suicide in connection with physical and psychological abuse and fear of crime. less thanbrgreater than less thanbrgreater thanConclusions: The study provides representative results addressing an extensive negative health outcome panorama caused by fear of crime and exposure to abuse.

    Place, publisher, year, edition, pages
    WB Saunders, 2012
    Keywords
    Elderly, Abuse, Ill health, Men, Women, Population study
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-76948 (URN)10.1016/j.puhe.2012.01.015 (DOI)000302121100016 ()
    Available from: 2012-05-02 Created: 2012-04-27 Last updated: 2017-12-07Bibliographically approved
    4. Long-term health consequences of violence exposure in adolescence: A 26–year prospective study
    Open this publication in new window or tab >>Long-term health consequences of violence exposure in adolescence: A 26–year prospective study
    2012 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, no 411Article in journal (Refereed) Published
    Abstract [en]

    Background: Violence victimization represents a serious risk factor for health related symptoms, for both men and women. The aim of this study was to evaluate the long-term effects of violence exposure in late adolescence and early adulthood on adult health, physical as well as mental, using a long-term prospective population-based study, with a follow up of 9, 19, and 26 years.

    Methods: The primary data source is a longitudinal panel from one of the longest running social science surveys in the world, the Swedish Level-of-Living surveys (LNU). We analyzed three cohorts, individuals aged 15-19 in 1974 and 1981, and individuals aged 18-19 in 1991 which were followed up 2000. Structured interviews on childhood, family relationships, life-events, living conditions, health history and status, working conditions, behavioral, psychosocial, and demographic variables were repeatedly used in all cohorts.

    Results: Multivariate models of violence exposures in adolescence in the 1974-91 cohorts as predictors of adult health in 2000 are reported for both men and women. Women exposed to violence had raised odds ratios for ill health, measured as heavy illness burden, and poor self rated health, after controlling for possible confounders. No such associations were found for men.

    Conclusions: This study’s findings provide additional empirical support for the importance of policies and practices to identify and prevent violence exposure in adolescence and young adulthood and to supply treatments for adolescence exposed to violence and above all the young women.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-77043 (URN)10.1186/1471-2458-12-411 (DOI)000307900500001 ()
    Available from: 2012-05-03 Created: 2012-05-03 Last updated: 2017-12-07Bibliographically approved
  • 320.
    Olofsson, Niclas
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Danielsson, I
    Vasternorrland County Council.
    Fear of crime and psychological and physical abuse associated with ill health in a Swedish population aged 65-84 years2012In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 126, no 4, p. 358-364Article in journal (Refereed)
    Abstract [en]

    Objectives: To assess the association between fear of crime and/or psychological and/or physical abuse in relation to self-reported physical and psychological health, using a large representative sample of elderly women and men in Sweden. less thanbrgreater than less thanbrgreater thanStudy design: Cross-sectional national survey. less thanbrgreater than less thanbrgreater thanMethods: Data were taken from a nationwide representative public health survey (2006). Men and women between the ages of 65 and 84 years were selected for the present analyses (4386 men and 4974 women). The response rate for this age group was 59% for men and 70% for women. less thanbrgreater than less thanbrgreater thanResults: Psychological and physical abuse against elderly women and men led to higher odds ratios for negative health outcomes, independently of socio-economic status. Strong correlation was found between psychological abuse and negative health outcomes in both men and women, while the correlation was less strong for physical abuse, especially among women. The men had high odds ratios for suicidal thoughts and even for attempted suicide in connection with physical and psychological abuse and fear of crime. less thanbrgreater than less thanbrgreater thanConclusions: The study provides representative results addressing an extensive negative health outcome panorama caused by fear of crime and exposure to abuse.

  • 321.
    Olofsson, Niclas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Gillander Gadin, Katja
    University Sundsvall.
    Danielsson, Ingela
    Sundsvall Hospital.
    Violence Against Young Men and Women: A Vital Health Issue2009In: The Open Public Health Journal, ISSN 1874-9445, Vol. 2, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Objectives: Violence is regarded as a major health issue in an increasing amount of literature and is known as an important factor in women's ill health. Little however is known about violence against young men and women and its impact on their health. The principal aim of this study was to analyze health outcomes and health care utilization as reported among men and women aged 18-25 exposed and not exposed to physical and/or emotional violence.

    Study design: A cross-sectional national health survey in Sweden.

    Methods: Postal questionnaires were sent to nearly 3,000 men and women. Three questions were used to ask about violence. Sociodemographic characteristics for those exposed to violence during the past 12 months were analyzed and compared to those not exposed. Crude and adjusted odds ratios were calculated for health outcomes and medical care utilization.

    Results: Increased odds ratios were found for most health outcomes, and health care utilization for those exposed to violence compared to non-exposed. After adjusting for socioeconomic factors, smoking, and use of alcohol and cannabis, most variables were principally unchanged for women but considerably lower for men. Socioeconomic factors, smoking, and the use of drugs were all correlated to victimization.

    Conclusions: A strong association between those exposed to violence and physical and mental ill health was demonstrated also after adjusting for possible confounders, specifically for women. It is time to include questions about violence in public health questionnaires aimed at young people, but also to start asking about it more frequently in health care settings.

  • 322.
    Olofsson, Niclas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Gådin, Katja Gillander
    Department of Health Sciences, Mid-Sweden University Sundsvall Sweden.
    Bråbäck, Lennart
    Pediatrik Umeå universitet.
    Danielsson, Ingela
    Obstetrics and Gynaecology, Umeå universitet.
    Physical and psychological symptoms and learning difficulties in children of women exposed and non-exposed to violence: a population-based study.2011In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 56, no 1, p. 89-96Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To analyse the association between violence against mothers and the health of their children as reported by the mothers. METHODS: The data originate from a multistage sampling health-questionnaire survey, distributed to a representative sample of women in Sweden. The health of 283 children (aged 0-18 years), as reported by women who had been exposed to violence at home or outside home during the past 12 months, was compared with that of 4,664 children of non-exposed mothers. RESULTS: Odds ratios regarding most registered physical symptoms showed that children of violence-exposed mothers had a significant higher risk of ill health than children of non-exposed mothers. Regarding psychological symptoms and learning difficulties, the odds were raised for girls for most symptoms, but not for boys. A twofold increase in health-care utilisation and an overall general increase in the risk of pharmaceutical consumption were shown for both girls and boys of exposed mothers. CONCLUSIONS: This population-based study shows an increased risk of poorer health amongst boys and girls aged 0-18 years, as reported by mothers exposed to violence.

  • 323.
    Olofsson, Niclas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Shaw, Benjamin A.
    Department of Health Policy, Management and Behavior, University at Albany, SUNY, Albany, NY, USA.
    Danielsson, Ingela
    Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå.
    Long-term health consequences of violence exposure in adolescence: A 26–year prospective study2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, no 411Article in journal (Refereed)
    Abstract [en]

    Background: Violence victimization represents a serious risk factor for health related symptoms, for both men and women. The aim of this study was to evaluate the long-term effects of violence exposure in late adolescence and early adulthood on adult health, physical as well as mental, using a long-term prospective population-based study, with a follow up of 9, 19, and 26 years.

    Methods: The primary data source is a longitudinal panel from one of the longest running social science surveys in the world, the Swedish Level-of-Living surveys (LNU). We analyzed three cohorts, individuals aged 15-19 in 1974 and 1981, and individuals aged 18-19 in 1991 which were followed up 2000. Structured interviews on childhood, family relationships, life-events, living conditions, health history and status, working conditions, behavioral, psychosocial, and demographic variables were repeatedly used in all cohorts.

    Results: Multivariate models of violence exposures in adolescence in the 1974-91 cohorts as predictors of adult health in 2000 are reported for both men and women. Women exposed to violence had raised odds ratios for ill health, measured as heavy illness burden, and poor self rated health, after controlling for possible confounders. No such associations were found for men.

    Conclusions: This study’s findings provide additional empirical support for the importance of policies and practices to identify and prevent violence exposure in adolescence and young adulthood and to supply treatments for adolescence exposed to violence and above all the young women.

  • 324.
    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
    Show others...
    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
    Show others...
    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
    Show others...
    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
    Show others...
    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
  • 325.
    Olsen Faresjö, Åshild
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Grodzinsky, Ewa
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Johansson, Saga
    University of Gothenburg.
    Wallander, Mari-Ann
    Uppsala University.
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Self-Reported Use of Pharmaceuticals Among Patients With Irritable Bowel Syndrome in Primary Care2008In: Journal of Managed Care Pharmacy, ISSN 1083-4087, Vol. 14, no 9, p. 870-877Article in journal (Refereed)
    Abstract [en]

    Background: Irritable bowel syndrome (IBS) has an estimated 10%-12% prevalence in industrial countries. Studies from the United States have shown that IBS causes notable financial losses for employers. Due to the lack of pathophysiological markers, only a fraction of the pharmacological management of IBS has focused on etiological mechanisms. We hypothesized that there is a high consumption of nonspecific drugs among patients with IBS in their attempts to manage symptoms.

    Objective: To analyze self-reported use of prescription and over-the-counter (OTC) drugs among patients with IBS in primary care compared with controls from the general population.

    Methods: A population-based case-control design was used for the study. IBS cases were identified from the electronic medical records of 3 Swedish primary health care centers from January 1, 1997, through December 31 2001. A questionnaire containing specific questions about prescription ad OTC drugs was mailed in 2003 to 5,015 working-age (18-64 years) individuals (IBS cases and controls) in the Linkoping IBS Population Study, a study of primary care patients with controls selected from the general population.

    Results: After 2 reminders, the overall response rate was 63% (3,074 respondents of 4,913 deliverable surveys); 71% responded for the IBS cases (347/486) and 57% (2,509/4,427) responded for the controls. 72.3% of the IBS respondents and 51.9% of the controls were female. Acid-suppressive agents were the most commonly cited drug category for abdominal complaints reported by IBS patients (13.3%) compared with controls (11.6%) (unadjusted odds ratio [OR] =9.20, 95% confidence interval [CI] = 5.94-14.25). Antidepressants were the most commonly cited drug category for nonabdominal complaints, reported by 13.3% of IBS patients versus 4.5% of controls (OR = 3.27, 95% CI = 2.27-4.70). An unadjusted univariate correlation analysis revealed that prescription acid-suppressive drugs, fiber and bulking laxatives, and antiflatulents and antidiarrhea drugs, as well as motility-regulating and antispasmodics drugs, were significantly more common among IBS cases compared with controls. In addition to the higher use of antidepressants, there were 3 other drug classes for nongastrointestinal complaints with a higher rate of use among IBS patients compared with controls: sedative hypnotics (OR = 2.49, CI = 1.444.29), analgesics (OR = 2.86, Cl = 1.88-4.33), and thyroid hormones (OR = 2.43, CI = 1.39-4.26).

    Conclusions: There was higher use of antidepressants among patients with IBS compared with controls from the general population. Even though they are not recommended for this patient category, the use of prescription and OTC acid-suppressive drugs is also common among IBS cases in primary care.

  • 326.
    Olsen Faresjö, Åshild
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Johansson, Saga
    Cardiovascular Institute, University of Gothenburg, Gothenburg, Sweden; and Department of Epidemiology, AstraZeneca R and D, Mölndal, Sweden.
    Wallander, Mari-Ann
    Department of Epidemiology, AstraZeneca R and D, Mölndal, Sweden; and Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Åkerlind, Ingemar
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.
    A population based case control study of work and psychosocial problems in patients with irritable bowel syndrome: women are more seriously affected than men2007In: American Journal of Gastroenterology, ISSN 0002-9270, E-ISSN 1572-0241, Vol. 102, no 2, p. 371-379Article in journal (Refereed)
    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.

  • 327.
    Olsen Faresjö, Åshild
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Johansson, Saga
    Cardiovascular Institute, University of Gothenburg, Gothenburg, Sweden.
    Wallander, Mari-Ann
    Department of Epidemiology, AstraZeneca R&D, Mölndal, Sweden; and Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Åkerlind, Ingermar
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Psychosocial factors at work and in everyday life are associated with irritable bowel syndrome2007In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 22, no 7, p. 473-480Article in journal (Refereed)
    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.

  • 328.
    Orwelius, Lotti
    et al.
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Department of Clinical and Experimental Medicine.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Health-related quality of life scores after intensive care are almost equal to those of the normal population: a multicenter observational study2013In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 17, no 5, p. R236-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    Health-related quality of life (HRQoL) in patients treated in intensive care has been reported to be lower compared with age- and sex-adjusted control groups. Our aim was to test whether stratifying for coexisting conditions would reduce observed differences in HRQoL between patients treated in the ICU and a control group from the normal population. We also wanted to characterize the ICU patients with the lowest HRQoL within these strata.

    METHODS:

    We did a cross-sectional comparison of scores of the short-form health survey (SF-36) questionnaire in a multicenter study of patients treated in the ICU (n = 780) and those from a local public health survey (n = 6,093). Analyses were in both groups adjusted for age and sex, and data stratified for coexisting conditions. Within each stratum, patients with low scores (below -2 SD of the control group) were identified and characterized.

    RESULTS:

    After adjustment, there were minor and insignificant differences in mean SF-36 scores between patients and controls. Eight (n = 18) and 22% (n = 51) of the patients had low scores (-2 SD of the control group) in the physical and mental dimensions of SF-36, respectively. Patients with low scores were usually male, single, on sick leave before admission to critical care, and survived a shorter time after being in ICU.

    CONCLUSIONS:

    After adjusting for age, sex, and coexisting conditions, mean HRQoL scores were almost equal in patients and controls. Up to 22% (n = 51) of the patients had, however, a poor quality of life as compared with the controls (-2 SD). This group, which more often consisted of single men, individuals who were on sick leave before admission to the ICU, had an increased mortality after ICU. This group should be a target for future support.

  • 329.
    Orwelius, Lotti
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Nordlund, Anders
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Edéll-Gustafsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Simonsson, Eva
    Department of Anaesthesia and Intensive Care, Ryhov Hospital, Jonkoping, Sweden.
    Nordlund, Peter
    Department of Anaesthesia and Intensive Care, Ryhov Hospital, Jonkoping, Sweden.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Unit . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Role of preexisting disease in patients' perceptions of health-related quality of life after intensive care.2005In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 33, no 7, p. 1557-1564Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To find out how patients perceive their health-related quality of life after they have been treated in an intensive care unit and whether preexisting disease influenced their perception.

    DESIGN:: Follow-up, quantitative, dual-site study.

    SETTING: Combined medical and surgical intensive care units of one university and one general hospital in Sweden.

    PATIENTS: Among the 1,938 patients admitted, 562 were considered eligible (>24 hrs in the intensive care unit, and age >18 yrs). The effect of preexisting disease was assessed by use of a large reference group, a random sample (n = 10,000) of the main intake area of the hospitals.

    INTERVENTIONS: None.

    MEASUREMENTS AND MAIN RESULTS: During 2000-2002, data were collected from the intensive care unit register and from a questionnaire mailed to the patients 6 months after their discharge from hospital. Subjects in the reference group were sent postal questionnaires during 1999. Of the patients in the intensive care unit group, 74% had preexisting diseases compared with 51% in the reference group. Six months after discharge, health-related quality of life was significantly lower among patients than in the reference group. When comparisons were restricted to the previously healthy people in both groups, the observed differences were about halved, and when we compared the patients in the intensive care unit who had preexisting diseases with subjects in the reference group who had similar diseases, we found little difference in perceived health-related quality of life. In some dimensions of health-related quality of life, we found no differences between patients in the intensive care unit and the subjects in the reference population.

    CONCLUSIONS: Preexisting diseases significantly affect the extent of the decline of health-related quality of life after critical care, and this effect may have been underestimated in the past. As most patients who are admitted to an intensive care unit have at least one preexisting disease, it is important to account for these effects when examining outcome.

  • 330.
    Per, Nilsen
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nordström (Avby), Gunilla
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Behavioural Sciences and Learning, Work and Working Life. Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Ellström, Per-Erik
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Behavioural Sciences and Learning, Work and Working Life. Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Integrating Research-based and Practice-based Knowledge through Workplace Reflection2011Conference paper (Refereed)
  • 331.
    Pilemalm, Sofie
    et al.
    Linköping University, Department of Computer and Information Science, MDA - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Hallberg, Niklas
    Linköping University, Department of Computer and Information Science, MDA - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    From 'the good work' to 'the good life': a Perspective on Labor Union Visions Regarding Information Technology1998In: Proceedings of the Participatory Design Conference, 1998, p. 137-145Conference paper (Refereed)
  • 332.
    Pilemalm, Sofie
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Hallberg, Niklas
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    From Utopia to DLK: Management of External Voices in Large Participatory Design Projects2000In: Proceedings of the Participatory Design Conference, 2000, p. 156-165Conference paper (Refereed)
    Abstract [en]

    There is a need to extend Participatory design in order to apply it in heterogeneous user groups and large projects of strategic importance for organizations. This study displays an approach to capturing and including relevant external design voices using data from the design of an information system aimed to support the day-to-day tasks of Swedish shop stewards. It was found that shop stewards often use an operative voice, middle level union ombudsmen an organizational voice, and union federation management an ideological one when relating to information technology. An Activity theory analysis showed that the union organization stands at a crossroads, and that the choice of information technology will directly influence the future direction to be taken. It is argued that all parties in a design process must therefore be heard, in order to arrive at system solutions that are actually implemented, used and administrated.

  • 333.
    Pilemalm, Sofie
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Hallberg, Niklas
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    How do Shop Stewards Perceive their Situation and Tasks?: Preconditions for Support of Union Work2001In: Economic and Industrial Democracy, ISSN 0143-831X, E-ISSN 1461-7099, Vol. 22, no 4, p. 569-599Article in journal (Refereed)
    Abstract [en]

    When unions worldwide confront a decline in density and power,pressure increases on shop stewards. They occupy a positiondesribed s demanding, which involves striking a balance betweenconciliation and tough negotiation, between ordinary work andunion work, and feelings of isolation from members. If shopstewards already experien a demanding work situation, and parallelto this the overall union conditions become aggravated, a nextstep would be to find out in what ways their situation can befacilitated. This article is based on data desribing recentexperiences of Swedish shop stewards, and it compares theirsituation to that desribed in the international research literature.It is found that the basic components of union work remain stable,in spite of rent labour relations changes and national differences.However, lees than half of the reported problems were relatedto direct contact with the employer. Shop stewards generalyexperience a situation characterized by inherent conflict andwide-ranging tasks, resulting in high demands on their skillsand in role overload. On the other hand, the results indicatedifferences with regard to the ulnion affilation, age, experienceand gender. En the eyes of union members the shop stew ardslargely emb ody the ui on organizati on. Therefore, they shouldreeive increased attention when dealing with the problems ofunions. Measures to facilitate their work can include training,supportive networks and access to adequate information technology,and can further be targeted with regard to age/experience andgender.

  • 334.
    Pilemalm, Sofie
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Hallberg, Niklas
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Organisational Policy and Shop-floor Requests in Design: Visualisation of the Argumentation Behind an Information System for the Swedish Trade Union Movement2001In: Scandinavian Journal of Information Systems, ISSN 0905-0167, E-ISSN 1901-0990, Vol. 13, p. 115-133Article in journal (Refereed)
    Abstract [en]

    Design Rationale is an approach to the design of information systems which highlights the underlying argumentative reasoning and documentation of design decisions. The Argumentative Design (ArD) method extends Design Rationale to address organisational problem identification and the formulation of needs to be supported by the system. In this study, ArD was further modified and then applied in the early phase of the design of an information system for shop stewards in the Swedish trade union movement. The application of ArD revealed that both similarities and significant discrepancies existed between top-management information technology strategies and shop-floor needs, and that the strategies involve fundamental power-relation issues in terms of centralisation versus decentralisation and individualism versus collectivism. It is suggested that ArD can be of general benefit in early design phases by eliciting fundamental organisational issues and by illustrating what impact chosen information technology solutions may have on organisations. The study is of value for other unions wishing to learn from the Swedish experience and the modified ArD approach can also be used in other contexts where several interest groups are to be satisfied by a system.

  • 335.
    Pilemalm, Sofie
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Anticipated and Actual Consequences of Implementing Information Technology in a Large Third Sector Organisation: the Case of a Trade Union Confederation2002Other (Other academic)
  • 336.
    Pilemalm, Sofie
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Third Generation Participatory Design - making particiption applicable to large-scale information system projects2004In: Proceedings of Participatory Design Conference 2004, 2004Conference paper (Refereed)
  • 337.
    Pilemalm, Sofie
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences. Linköping University, Faculty of Health Sciences.
    Third generation participatory design in health informatics--making user participation applicable to large-scale information system projects.2008In: Journal of biomedical informatics, ISSN 1532-0480, Vol. 41, no 2, p. 327-339Article in journal (Refereed)
    Abstract [en]

    Participatory Design (PD) methods in the field of health informatics have mainly been applied to the development of small-scale systems with homogeneous user groups in local settings. Meanwhile, health service organizations are becoming increasingly large and complex in character, making it necessary to extend the scope of the systems that are used for managing data, information and knowledge. This study reports participatory action research on the development of a PD framework for large-scale system design. The research was conducted in a public health informatics project aimed at developing a system for 175,000 users. A renewed PD framework was developed in response to six major limitations experienced to be associated with the existing methods. The resulting framework preserves the theoretical grounding, but extends the toolbox to suit applications in networked health service organizations. Future research should involve evaluations of the framework in other health service settings where comprehensive HISs are developed.

  • 338.
    Pilemalm, Sofie
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Using Activity Theory in system development for entire organisations: the case of the Swedish Trade Union Confederation2002In: International Journal of Human Resources Development and Management, ISSN 1465-6612, Vol. 2, no 3-4, p. 308-328Article in journal (Refereed)
    Abstract [en]

    Activity Theory has, in recent years, been criticised for not paying enough attention to the notion of individual versus collective subjects. It has also been pointed out that even though the Activity theoretical framework can beneficially be used in the development of information systems, actual attempts to apply it to concrete projects are only occasional. This study explores the use of Activity Theory in an organisational context where the subject is of marked collective nature, in an information systems development project for the Swedish National Trade Union Confederation (LO). Both implications of the study as regards the specific trade union application, and more general implications of applying Activity Theory to studies of entire organisations and for system development, are discussed.

  • 339.
    Pilemalm, Sofíe
    et al.
    Linköping University, Department of Computer and Information Science, MDA - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Anticipated and Actual Consequences of Implementing Information Technology in a Large Third Sector Organisation: the Case of a Trade Union Confederation2002In: 18th European Group for Organizational Studies Colloquium, Barcelona, 2002Conference paper (Refereed)
  • 340.
    Qvist, Ninni
    et al.
    Karolinska University Hospital.
    Bergström, Ingrid
    Karolinska University Hospital.
    Grahn Kronhed, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Rehabilitation in West County.
    Karlsson, Susanne
    Karolinska University Hospital.
    Forss, Anette
    Karolinska University Hospital.
    Empowering the fragile body: Experiences of a back muscle group training program in postmenopausal women with vertebral fractures. A qualitative interview study2011In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 13, no 2, p. 63-70Article in journal (Refereed)
    Abstract [en]

    This study was undertaken to explore the experiences of a professionally supervised back muscle exercise group training program (BMTP) in women with osteoporosis-related vertebral fractures and increased thoracic kyphosis. Method: A qualitative interview study was carried out with 11 women, aged 60–93 years (median age 68 years), participating in the BMTP for 4 months. Analysis of the open interviews was supported by qualitative content analysis. Findings: Two categories and four sub-categories were constructed from the analysis: Awareness and experiences of the body through back muscle exercise (sub-categories; Sense and awareness of straightening the back and The usefulness of increased bodily strength and mobility) and Social dimensions of group training (sub-categories: Affinity and support and Sense of trust and safety). The women experienced both bodily and social benefits from participation in the BMTP, including improved mobility, increased strength, physical activity, better sleep, reduced pain and uncertainty as well as positive experiences of training in a group under professional supervision. Conclusion: The study showed that professionally supervised specific back exercise training brought benefits to everyday life, increased well-being and quality of life, and provided an empowering complement to pharmacological therapy in this group of women.

  • 341.
    Rahimi, Bahlol
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Moberg, Anna
    Linköping University, Department of Computer and Information Science, EISLAB - Economic Information Systems. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Vimarlund, Vivian
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Implementing an integrated computerized patient record system: Towards an evidence-based information system implementation practice in healthcare2008In: AMIA 2008 Annual Symposium, Biomedical and Health Informatics:form foundations to applications to policy. Washington DC. 8-12 November 2008, 2008, p. 616-620Conference paper (Refereed)
    Abstract [en]

    A large number of health information system (HIS) implementations fail due to insufficient organizational harmonization. The aim of this study is to examine whether these problems remain when implementing technically integrated and more advanced generations of HIS. In a case study, data from observations, interviews, and organizational documents were analyzed using qualitative methods. We found that critical issues in the case study implementation process were the techniques employed to teach the staff to use the integrated system, involvement of the users in the implementation process, and the efficiency of the human computer interface. Comparisons with a literature review showed both recurrence of previously reported implementation problems and new issues specific to the integrated system context. The results indicate that the development of evidence-based implementation processes should be considered.

  • 342.
    Rahimi, Bahlol
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Moberg, Anna
    Vårdprocesscentrum Landstinget Östergötland.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Vimarlund, Vivian
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    The voices are the same2008In: Medical Informatics Association,2008, 2008Conference paper (Refereed)
    Abstract [en]

       

  • 343.
    Rahimi, Bahlol
    et al.
    Urmia University Med Science, Department Social Med, Orumiyeh, Iran Urmia University Med Science, Department Med Informat, Orumiyeh, Iran .
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Pharmacists views on integrated electronic prescribing systems: associations between usefulness, pharmacological safety, and barriers to technology use2011In: EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY, ISSN 0031-6970, Vol. 67, no 2, p. 179-184Article in journal (Refereed)
    Abstract [en]

    Purpose Integrated electronic prescribing systems (IEPSs) are expected to improve efficiency and safety in the management of pharmaceuticals throughout the healthcare sector. In Sweden (population 9 million), more than 25 million e-prescriptions each year are processed in the National IEPS. We set out to examine the introduction of an IEPS into pharmacists practice with regard to impact on work efficiency and pharmacological safety. Methods A questionnaire was distributed to all pharmacists (n=74) in a Swedish municipality (population 145,000), where an IEPS had recently been introduced. The response rate was 70%. Results The IEPS was in general perceived to have expedited the processing of prescriptions and reduced the risk for prescription errors as well as the handing over of erroneous medications to patients. We found that there was a positive correlation between usefulness of the IEPS system for work efficacy and pharmacological safety, respectively (r=0.524, pandlt;.001) and a negative correlation between the usefulness of the IEPS for work efficacy and perception of barriers to technology use (r=-0.010, pandgt;0.05). We also found that there was a negative correlation between IEPS usefulness for pharmacological safety and that barriers to IEPS technology use were experienced (r=0.031, pandgt;0.05). Conclusions The results indicate that reduction of system unavailability due to technical issues will increase the perceived usefulness of IEPSs for pharmacists with regard to both work efficacy and pharmacological safety. We conclude that the introduction of an IEPS was well received by pharmacists; however, barriers to full acceptance remained, in particular, system unavailability due to technical problems.

  • 344.
    Rahimi, Bahlol
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Vimarlund, Vivian
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Uppugunduri, Srinivas
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Chemistry.
    Svensson, Mikael
    Östergötland County Council, Drug and Therapeut Comm, Linkoping, Sweden .
    Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory2009In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 9, no 52Article in journal (Refereed)
    Abstract [en]

    Background: Computerized provider order entry (CPOE) systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care. Methods: The diffusion of innovation theory was used to understand physicians and nurses attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0%) and 176 from 741 physicians (23.8%). Data were analyzed using descriptive-analytical statistical methods. Results: More nurses (56.7%) than physicians (31.3%) stated that the CPOE system introduction had worked well in their clinical setting (P andlt; 0.001). Similarly, more physicians (73.9%) than nurses (50.7%) reported that they found the system not adapted to their specific professional practice (P = andlt; 0.001). Also more physicians (25.0%) than nurses (13.4%) stated that they did want to return to the previous system (P = 0.041). We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P andlt; 0.001) higher among nurses (39.6%) than physicians (16.5%). However, physicians agreements with the compatibility of the CPOE and with its complexity were significantly higher than the nurses (P andlt; 0.001). Conclusions: Qualifications for CPOE adoption as defined by three attributes of diffusion of innovation theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e. g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance, we emphasize that CPOE system designers and healthcare decision-makers should continually collect users feedback about the systems, while not forgetting that it also is necessary to inform the users about the potential benefits involved.

  • 345.
    Rahimi, Bahlol
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Vimarlund, Vivian
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Mokhtari, Rahman
    Hospital Pharmacy, University Hospital, Linköping.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Integrated electronic prescribing systems: pharmacists’ perceptions ofimpact on work performance and patient safety2009In: Proceedings of the 9th WSEAS International Conference on APPLIED INFORMATICS AND COMMUNICATIONS (AIC '09), 2009, p. 299-304Conference paper (Other academic)
    Abstract [en]

    Integrated electronic prescribing systems (IEPSs) are expected to improve efficiency and safety inthe management of pharmaceuticals throughout the healthcare sector. We examined the introduction of anIEPS into pharmacists’ work performance with regard to impact on efficiency and patient safety. Aquestionnaire was distributed to all pharmacists (n = 85) in a Swedish municipality (pop. 145,000) where anIEPS had recently been introduced. The response rate was 74%. We found that, in general, the IEPS wasperceived to have expedited the processing of prescriptions and reduced the risk for prescription errors, as wellas the handing over of erroneous medications to patients. Pharmacists were more cautious about the residualrisks for making mistakes than the pharmacist’s assistants. We conclude that the introduction of an IEPS waswell received by local-level pharmacy staff, but that an IEPS does not automatically reduce the need forqualified personnel in the management of pharmaceuticals.

  • 346.
    Rahimi, Bahlol
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Vimarlund, Vivian
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Health Information System Implementation: A Qualitative Meta-analysis2009In: Journal of medical systems, ISSN 0148-5598, E-ISSN 1573-689X, Vol. 33, no 5, p. 359-368Article in journal (Refereed)
    Abstract [en]

    Healthcare information systems (HISs) are often implemented to enhance the quality of care and the degree to which it is patient-centered, as well as to improve the efficiency and safety of services. However, the outcomes of HIS implementations have not met expectations. We set out to organize the knowledge gained in qualitative studies performed in association with HIS implementations and to use this knowledge to outline an updated structure for implementation planning. A multi-disciplinary team performed the analyses in order to cover as many aspects of the primary studies as possible. We found that merely implementing an HIS will not automatically increase organizational efficiency. Strategic, tactical, and operational actions have to be taken into consideration, including management involvement, integration in healthcare workflow, establishing compatibility between software and hardware and, most importantly, user involvement, education and training. The results should be interpreted as a high-order scheme, and not a predictive theory.

  • 347.
    Reigo, Tomas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Tropp, Hans
    Department of Orthopaedic Surgery, Norrköping Hospital, Sweden.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Absence of back disorders in adults and work-related predictive factors in a 5-year perspective2001In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 10, no 3, p. 215-220Article in journal (Refereed)
    Abstract [en]

    Factors important for avoiding back disorders in different age-groups have seldom been compared and studied over time. We therefore set out to study age-related differences in socio-economic and work-related factors associated with the absence of back disorders in a 5-year comparative cohort study using a mailed questionnaire. Two subgroups (aged 25-34 and 54-59 years) derived from a representative sample of the Swedish population were followed at baseline, 1 year and 5 years. Questions were asked about the duration of back pain episodes, relapses, work changes and work satisfaction. A work adaptability, partnership, growth, affection, resolve (APGAR) score was included in the final questionnaire. Multivariate logistic regression was used to identify factors predicting the absence of back disorders. Absence of physically heavy work predicted an absence of back disorders [odds ratio (OR), 2.86, 95% confidence interval (CI), 1.3-6.3] in the older group. In the younger age-group, the absence of stressful work predicted absence of back disorders (OR, 2.0, 95% CI, 1.1-3.6). Thirty-seven per cent of the younger age-group and 43% of the older age-group did not experience any back pain episodes during the study period. The exploratory work APGAR scores indicated that back disorders were only associated with lower work satisfaction in the older group. The analyses point out the importance of avoiding perceived psychological stress in the young and avoiding perceived physically heavy work in the older age-group for avoiding back disorders. The results suggest a need for different programmes at workplaces to avoid back disorders depending on the age of the employees concerned.

  • 348.
    Reigo, Tomas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Tropp, Hans
    Department of Orthopaedic Surgery, Norrköping Hospital, Sweden.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Clinical findings in a population with back pain: Relation to one-year outcome and long-term sick leave2000In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 18, no 4, p. 208-214Article in journal (Refereed)
    Abstract [en]

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

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

    Settings - Semi-rural Swedish county.

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

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

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

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

  • 349.
    Reinholdz, Hanna
    et al.
    University of Gothenburg, Sweden .
    Fornazar, Robin
    University of Gothenburg, Sweden .
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Spak, Fredrik
    University of Gothenburg, Sweden .
    Comparison of Systematic Versus Targeted Screening for Detection of Risky Drinking in Primary Care2013In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 48, no 2, p. 172-179Article in journal (Refereed)
    Abstract [en]

    Aim: To compare two identification methods for risky drinking in primary health care centres (PHCs). Methods: Sixteen PHCs from three Swedish counties were randomized into strands: consultation-based early identification (CEI) or systematic screening early identification (SS). Measurements took place at baseline and during two intervention periods. Patients filled in questionnaires including gender, age, if they had the issue of alcohol brought up during the consultation and the AUDIT-C (a three item screening tool). The intervention periods were preceded by training sessions for clinicians. The AUDIT-C was used for categorization of risky drinking with cut-offs for risky drinking set at andgt;= 5 for men and andgt;= 4 for women. In the SS strand, clinicians were supposed to give AUDIT-C to all patients for the identification of risky drinking. In the CEI strands, they were encouraged to use early clinical signs to identify risky drinking. Results: The proportions of patients having the issue of alcohol brought up are higher during the intervention periods than baseline. A higher proportion of all patients and of risk drinkers in SS, than in CEI, had the issue of alcohol brought up. A higher mean score of AUDIT-C was found among patients having the issue of alcohol brought up in CEI than in SS, and this was also true after adjusting for age and gender. Conclusions: More patients are asked about alcohol in the SS strand and thus have the possibility of receiving brief interventions. CEI identifies risk drinkers with higher AUDIT-C scores which might indicate more severe problems. No comparison of the effectiveness of a brief intervention following these alternative identification procedures is reported here.

  • 350.
    Reinholdz, Hanna K
    et al.
    University of Gothenburg.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Spak, Fredrik
    University of Gothenburg.
    Different Methods of Early Identification of Risky Drinking: A Review of Clinical Signs2011In: ALCOHOL AND ALCOHOLISM, ISSN 0735-0414, Vol. 46, no 3, p. 283-291Article, review/survey (Refereed)
    Abstract [en]

    Aims: To review the literature on detection of risky drinking to compare early identification based on everyday clinical encounters with systematic screening. We also reviewed specific clinical signs that have been suggested to be used as indicators of risky drinking. Methods: A literature review was performed in PubMed and CINAHL of articles up to November 2010. Results: Systematic screening and semi-systematic methods in various forms detected more risky drinkers than non-systematic identification during clinical encounter, but there was a lack of studies comparing the various means of identifying risky drinking. It may be too early to completely rule out the possibility of using non-systematic methods as an effective strategy to identify risky drinking. The earliest signs of risky drinking suggested in the literature are psychological distress and social problems. Conclusion: From a public health perspective, there is a lack of evidence that non-systematic or semi-systematic methods can substitute systematic screening in terms of numbers of risky drinkers detected. If early signs are going to be used to identify risky drinkers, or those to be screened for risky drinking, more focus should be on psychological and social signs because they appear earlier than somatic signs.

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