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  • 351.
    Rosell, Johan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Regional Cancer Center South East Sweden.
    Nordenskjöld, Bo
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Bengtsson, Nils-Olof
    Umeå University Hospital, Sweden .
    Fornander, Tommy
    Karolinska University Hospital, Sweden .
    Hatschek, Thomas
    Karolinska University Hospital, Sweden .
    Lindman, Henrik
    University of Uppsala Hospital, Sweden .
    Malmstrom, Per-Olof
    Skåne University Hospital, Sweden .
    Wallgren, Arne
    Sahlgrens University Hospital, Sweden .
    Stål, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Effects of adjuvant tamoxifen therapy on the incidence of secondary cancer: results from a randomized trial with long term follow-up2014Manuscript (preprint) (Other academic)
    Abstract [en]

    BACKGROUND

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

    METHODS

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

    RESULTS

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

    CONCLUSIONS

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

  • 352.
    Rådholm, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Cardiovascular risk factors in elderly: With special emphasis on atrial fibrillation, hypertension and diabetes2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

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

    Methods

    This thesis was based on four different studies:

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

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

    Results

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

    Conclusion

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Aims

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

    Methods

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

    Results

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

    Conclusions

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

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

    Funding agencies: King Gustaf V and Queen Victoria Freemason Foundation

    Available from: 2015-09-11 Created: 2015-09-11 Last updated: 2018-01-11Bibliographically approved
  • 353.
    Rådholm, Karin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Wiréhn, Ann-Britt
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis.
    Chalmers, J.
    The George Institute for Global Health, University of Sydney, NSW, Australia.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, "Primary Health Care in Motala".
    Use of antidiabetic and antidepressant drugs is associated with increased risk of myocardial infarction: a nationwide register study2016In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, no 2, p. 218-223Article in journal (Refereed)
    Abstract [en]

    Aims

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

    Methods

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

    Results

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

    Conclusions

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

  • 354.
    Samuelsson, Christina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ekström, Anna
    Linköping University, Department of Social and Welfare Studies. Linköping University, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Majlesi, Ali Reza
    Linköping University, Department of Social and Welfare Studies. Linköping University, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Plejert, Charlotta
    Linköping University, Department of Culture and Communication, Language and Culture. Linköping University, Faculty of Arts and Sciences.
    Kommunikation vid demenssjukdom2016In: Att leva med demens / [ed] Ingrid Hellström & Lars-Christer Hydén, Gleerups Utbildning AB, 2016, 1, p. 63-70Chapter in book (Other academic)
  • 355.
    Samuelsson, Kersti
    et al.
    Linköping University, Department of Medical and Health Sciences, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Tropp, Maria
    Lundqvist, Anna
    Vocational rehabilitation after aquired brain injury: a pilot study on benefits and costs.2014In: Open journal of therapy and rehabilitation, no 2, p. 133-145Article in journal (Refereed)
    Abstract [en]

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

  • 356.
    Sandberg, Camilla
    et al.
    Umeå University, Sweden; Umeå University, Sweden; Umeå University, Sweden.
    Rinnstrom, Daniel
    Umeå University, Sweden; Umeå University, Sweden.
    Dellborg, Mikael
    University of Gothenburg, Sweden.
    Thilen, Ulf
    Lund University, Sweden.
    Sorensson, Peder
    Karolinska Institute, Sweden.
    Nielsen, Niels Erik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Christersson, Christina
    Uppsala University, Sweden.
    Wadell, Karin
    Umeå University, Sweden.
    Johansson, Bengt
    Umeå University, Sweden; Umeå University, Sweden.
    Height, weight and body mass index in adults with congenital heart disease2015In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 187, p. 219-226Article in journal (Refereed)
    Abstract [en]

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

  • 357.
    Sandberg, Johanna
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Institutionally Shaped Response to the Introduction of National Guidelines: Case Studies in the Swedish Regional Health Policy Arena2018Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

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

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

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

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

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

    Place, publisher, year, edition, pages
    Cambridge University Press, 2019
    Keywords
    Expert knowledge, Policy making, Health policy, knowledge utilization
    National Category
    Social Sciences Interdisciplinary
    Identifiers
    urn:nbn:se:liu:diva-149919 (URN)10.1017/S1744133118000233 (DOI)000482431400001 ()29986792 (PubMedID)2-s2.0-85049867288 (Scopus ID)
    Available from: 2018-08-06 Created: 2018-08-06 Last updated: 2019-09-09Bibliographically approved
  • 358.
    Sarberg, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Sleep disorders during pregnancy2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

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

    Aims

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

    Methods

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

    Results and conclusions

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

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

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

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

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

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

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

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

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

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

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

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

    Vid tiden för disputationen förelåg publikationen endast som manuskript

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

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

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

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

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

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

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

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

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

    Available from: 2015-05-12 Created: 2015-05-12 Last updated: 2019-06-28Bibliographically approved
  • 359.
    Sarberg, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Sleepiness and sleep disordered breathing during pregnancy2016In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 20, no 4, p. 1231-1237Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

  • 360.
    Sarberg, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Postpartum depressive symptoms and its association to daytime sleepiness and restless legs during pregnancy2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, article id 137Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 361.
    Schuster, Raphael
    et al.
    Univ Salzburg, Austria.
    Pokorny, Raffaela
    Univ Vienna, Austria.
    Berger, Thomas
    Univ Bern, Switzerland.
    Topooco, Naira
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Laireiter, Anton-Rupert
    Univ Salzburg, Austria; Univ Vienna, Austria.
    The Advantages and Disadvantages of Online and Blended Therapy: Survey Study Amongst Licensed Psychotherapists in Austria2018In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, no 12, article id e11007Article in journal (Refereed)
    Abstract [en]

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

  • 362.
    Seing, Ida
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Activating the Sick-Listed: Policy and Practice of Return to Work in Swedish Sickness Insurance and Working Life2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Implications for Rehabilitation

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

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

    National Category
    Occupational Therapy Public Health, Global Health, Social Medicine and Epidemiology Work Sciences Political Science Sociology
    Identifiers
    urn:nbn:se:liu:diva-112398 (URN)
    Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2014-11-26
  • 363.
    Seing, Ida
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Avstämningsmötet: en arena för förhandling omarbetsförmåga och rehabiliteringsansvar2011Report (Other academic)
    Abstract [sv]

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

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

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

  • 364.
    Seing, Ida
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    MacEachen, Ellen
    Department of Public Health and Health Systems, Faculty of Applied Public Health, University of Waterloo, Ontario, Canada.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Activation Policies and Sick-Listed Workers’ Experiences and Trust in the Sickness Insurance System in Local Practice2014Manuscript (preprint) (Other academic)
    Abstract [en]

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

  • 365.
    Seing, Ida
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    MacEachen, Ellen
    Department of Public Health and Health Systems, Faculty of Applied Public Health, University of Waterloo, Ontario, Canada.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Return to work or job transition?: Employer dilemmas in taking social responsibility for return to work in local workplace practice2015In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 18-19, p. 1760-1769Article in journal (Refereed)
    Abstract [en]

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

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

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

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

    Implications for Rehabilitation

    • Employers may have difficulties in taking social responsibility for RTW when economic considerations regarding their business take precedence over legal and ethical considerations.
    • Rehabilitation professionals should be aware of that outcomes of an RTW process can be influenced by the worker’s value to the employer and the nature of the job (e.g. availability of suitable work adjustments). “Low-value” workers at workplaces with limited possibilities to offer workplace adjustments may run a high risk of dismissal.
    • Swedish legislation and policies may need reforms to put more pressure on employers to promote RTW.
  • 366.
    Seing, Ida
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    MacEachen, Ellen
    School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Canada.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Early-Return-to-Work in the Context of an Intensification of Working Life and Changing Employment Relationships2015In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, no 1, p. 74-85Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 367.
    Seing, Ida
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Nordenfelt, Lennart
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Bülow, Pia
    Avdelningen för beteendevetenskap och socialt arbete, Hälsohögskolan, Jönköping.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Avstämningsmötet som arena för förhandling om arbetsförmåga.2011In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 88, no 5, p. 408-417Article in journal (Refereed)
  • 368.
    Seing, Ida
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Nordenfelt, Lennart
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Bülow, Pia
    Avdelningen för beteendevetenskap och socialt arbete, Hälsohögskolan, Jönköping.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Policy and Practice of Work Ability: A Negotiation of Responsibility in Organizing Return to Work2012In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 22, no 4, p. 553-564Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 369.
    Shedrawy, Jad
    et al.
    Karolinska Inst, Sweden.
    Henriksson, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Hergens, Maria-Pia
    Karolinska Inst, Sweden; Dept Communicable Dis Control and Prevent, Sweden.
    Askling, H. Helena
    Karolinska Inst, Sweden; Dept Communicable Dis Control and Prevent, Sweden.
    Estimating costs and health outcomes of publicly funded tick-born encephalitis vaccination: A cost-effectiveness analysis2018In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 36, no 50, p. 7659-7665Article in journal (Refereed)
    Abstract [en]

    Background: The number of notified cases of Tick-Borne Encephalitis (TBE) in Sweden has been increasing the past years despite the increased use of TBE-vaccine not subsidized by the healthcare system. Stockholm County is a high endemic area and an earlier study has shown that low-income households have lower vaccination coverage even when they are at high risk. This paper aims to determine the cost-effectiveness of a publicly funded TBE vaccination program in Stockholm. Methods: In three different cohorts with individuals aged 3, 40 or 50 years, long-term costs and health outcomes of an out-of-pocket strategy (53% of the cohort is vaccinated on their own expenses) and a structured vaccination program (full cohort is vaccinated covered by the publicly funded health care system), were estimated using a Markov model. The Markov model predicts the costs and effects in term of Quality-adjusted Life Years (QALYs) over a lifetime horizon using a third-party healthcare payer perspective. The primary results are presented as an incremental cost effectiveness ratio (ICER) indicating the additional cost required to achieve one additional QALY with the structured vaccination program. Results: The results show that the structured vaccination program is associated with a gain in QALYs and increased costs compared with an out-of-pocket strategy. The calculated ICERs were 27 761, 99 527 and 160 827 SEK/QALY in cohorts of age 3, 40 and 50, respectively. The sensitivity analyses showed that the results are robust when varying different parameters. Conclusion: Given the setting of Stockholm county, this analysis shows a cost per QALY of a free vaccinations program, especially for children of 3 years old, below generally acceptable cost-effectiveness thresholds in Sweden. 

  • 370.
    Shoeb, Mohammad
    et al.
    University of Dhaka, Bangladesh.
    Mondal, Prithu
    University of Dhaka, Bangladesh.
    Kylin, Henrik
    Linköping University, Department of Thematic Studies, Tema Environmental Change. Linköping University, Faculty of Arts and Sciences.
    Nahar, Nilufar
    University of Dhaka, Bangladesh.
    Chemical and biological activity of mushrooms naturally occurring in Bangladesh2017In: Asian Journal of Pharmacognosy, E-ISSN 0128-1119, Vol. 1, no 3, p. 42-51Article in journal (Refereed)
    Abstract [en]

    Five freeze-dried mushroom species namely Agaricus bisporus, Coprinus micaceus, Pleurotus ostreatus, Termitomyces clypeatus and T. heimii were extracted separately with dichloromethane:methanol followed by partitioned using hexane, dichloromethane and methanol. Silica gel column chromatography of hexane extract of T. heimii and dichloromethane extract of P. ostreatus afforded 2,4-di-hydroxy-9-octadecenoic acid and 2-hydroxy-9-octadecenoic acid, respectively. The n-hexane extracts of mushrooms were analyzed for the presence of n-alkanes and fatty acid compositions. n-Alkanes were found in T. heimii only. Different extracts of mushrooms were evaluated for antimicrobial activity against a wide range of Gram-positive and Gram-negative bacteria and fungi, general toxicity and antioxidant activity.

  • 371.
    Shrestha, D. P.
    et al.
    Kathmandu Medical College, Nepal.
    Gurung, D.
    Kathmandu Medical College, Nepal.
    Rosdahl, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Dermatology and Venerology.
    Prevalence of skin diseases and impact on quality of life in hilly region of Nepal2012In: Institute of Medicine. Journal, ISSN 1993-2979, Vol. 34, no 3, p. 44-49Article in journal (Refereed)
    Abstract [en]

    Introduction: Skin diseases (SDs) are one of the most common health problems in Nepal. The objectives of this study are to determine the prevalence of SDs and impact on quality of life (QoL) in a rural community in Nepal.

    Methods: A house-to-house survey was conducted in a community with 3,207 inhabitants, to obtain socio-demographic data and identify individuals with SDs. Free examination and treatment was offered at 4 health camps. Individuals with long-standing SDs were interviewed using the Dermatology Life Quality Index (DLQI).

    Results: Of 735 individuals attending the health camps, 645 (mean age 24.9 years, range 0.5-90) had one or more SDs. The overall prevalence of SDs was 20.1% (males 18.1%, females 22.5% and children 28.2%). The most common SD categories were eczemas (12.2%), pigment disorders (4.1%), acne (2.7%), urticaria (2.4%) and moles and lumps (1.6%). In the Nepalese culture, the DLQI question on sexuality was too direct so only 9/10 questions were used. In the 75 patients who were interviewed, the mean DLQI score was 10.7 (range 7-19), indicating a large impact on QoL.

    Conclusions: This population-based study shows that SDs were very common in a rural community in Nepal. The five most common SD categories comprise 77% of all SDs. Targeted training should enable health-care workers to prevent, accurately diagnose and manage these problems on site. An appropriate instrument to measure QoL adjusted to the socio-cultural norms of Nepal has to be developed.

  • 372.
    Silvén Hagström, Anneli
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Breaking the silence: parentally suicide-bereaved youths’ self-disclosure on the internet and the social responses of others related to stigma2017In: Journal of Youth Studies, ISSN 1367-6261, E-ISSN 1469-9680, Vol. 20, no 8, p. 1077-1092Article in journal (Refereed)
    Abstract [en]

    Suicide stigma’ contributes to the silencing of parental suicide within family and social networks. This article departs from a narrative theoretical framework on grief and identity to analyse suicide-bereaved youths ‘breaking the silence’ through self-disclosure in self-initiated chat threads on the Internet, which is their way of actively seeking social support, telling of their experiences and opening up space for a renegotiation of the meanings around suicide. The article investigates which narrative frameworks for the interpretation of suicide are operating in these contexts, and whether and, if so, how stigma is reproduced or counteracted. Two frameworks are identified: ‘Who is to blame for suicide?’; and ‘What caused the suicide?’. The former is utilized by the newly bereaved chat-initiators, who attribute blame for suicide to the parent and/or themselves in accordance with stigmatizing discourses. These are reproduced in the responses first and foremost of the non-suicide-bereaved, who construct a dichotomy between the deceased parent as ‘perpetrator’ and the child as ‘victim’ in order to relieve blame. A lack of contact with other suicide-bereaved youths can reinforce feelings of otherness. Identities, however, can potentially be de-stigmatized by the meanings drawn from the latter framework.

  • 373.
    Simmons, Johanna
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Toward an integrated approach in research on interpersonal violence: Conceptual and methodological challenges2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: There is a growing understanding that different kinds of interpersonal violence are interrelated. Many victims report experiences of cumulative violence, i.e., being subjected to more than one kind of violent behaviour (sexual, physical, emotional) and/or violence from more than one kind of perpetrator (family members, partners, acquaintances/strangers). To gain a more comprehensive understanding of what violence entails for victims, how victims can be helped and how violence can be prevented, there is a need to learn more about the co-occurrence of violence. Also, despite strong associations repeatedly being found between exposure to violence and the reporting of different kinds of ill-health, only a minority of victims have told health care professionals about their victimization. Less is known about the process of disclosing victimization to health care professionals for men than for women.

    Main aims: 1) Investigate the prevalence and co-occurrence of self-reported lifetime experiences of different kinds of interpersonal violence among male and female clinical and random population samples in Sweden (Study I-II). 2) Investigate whether cumulative violence is more strongly associated with       self-reported symptoms off psychological ill-health than with any kind of victimization alone (Study III).   3) Develop a theoretical model concerning male victims’ process of disclosing experiences of victimization to health care professionals in Sweden (Study IV).  

    Method: The self-reported prevalence of interpersonal violence as well as self-reported symptoms of psychological ill-health were estimated by means of secondary analyses of data collected with the NorVold Abuse Questionnaire (NorAQ). Both sexes were represented in clinical (women n=2439 men n=1767) and random population samples (women n=1168 men n=2924). Descriptive statistics as well as binary logistic regression and ordinal regression analyses were used (Study I-III). In study IV, constructivist grounded theory was used, and 12 men were interviewed concerning their experience of disclosing victimization to health care professionals.

    Results: A large proportion of victims (women: 47-48%, men: 29-31%) reported experiences of more than one kind of violent behaviour. Many also reported being subjected to violence by more than one kind of perpetrator (women: 33-37%, men: 22-23%). Reporting cumulative violence had a stronger association with symptoms of psychological ill-health than reporting only one kind of victimization. In study IV, the interviewed men’s own perceptions and considerations beforehand (e.g., perceived need for help and feelings of shame), as well as the dynamics during the actual health care encounter (e.g., patient-provider relationship and time constraints), were essential for understanding the process of disclosure. Also, the men’s own conformity to hegemonic constructions of masculinity and professionals’ adherence to gender norms had a strong negative influence on the men’s process of disclosure.

    Discussion: Experiences of cumulative violence were common. Prevalence rates of experiences of different kinds of interpersonal violence were compared to previous studies on interpersonal violence in Sweden. Large discrepancies were found between all studies, which is a symptom of methodological and conceptual difficulties within the research field. Violence is a gendered phenomenon. Differences were seen in the kind of violence men and women reported. In addition to this, the results in study IV indicate that gender affects how violence is perceived and how victims are treated by health care professionals.

    Conclusion: Integrated approaches in research on interpersonal violence, as well as in clinical work, are needed. If the co-occurrence of violence is ignored, it may hamper our understanding of the experiences and consequences of interpersonal violence for victims. More research is needed into what produces the differences found in prevalence rates between studies to improve the methodology.

    List of papers
    1. Men's experiences of emotional, physical, and sexual abuse and abuse in health care: A cross-sectional study of a Swedish random male population sample
    Open this publication in new window or tab >>Men's experiences of emotional, physical, and sexual abuse and abuse in health care: A cross-sectional study of a Swedish random male population sample
    2012 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 2, p. 191-202Article in journal (Refereed) Published
    Abstract [en]

    Aims: This article addresses the under-researched area ofmen’s experiences of abuse. The aims were to estimate prevalence ofemotional, physical, and sexual abuse and abuse in health care in a random sample of Swedish adult men, to compare these estimates with previously collected prevalence rates in a male clinical sample to see if prevalence rates were dependant on response rate and sampling method. We also wanted to contribute to a more general analysis of men’s experiences ofvictimisation.

    Methods: Cross-sectional study design. The NorVold Abuse Questionnaire that measures the prevalence of four kinds of abuse was sent to 6000 men selected at random from the population of Östergötland, Sweden.

    Results: The responserate was 50% (n=2924). Lifetime experiences of emotional abuse were reported by 16.7%, physical abuse by 48.9%, sexualabuse by 4.5%, and abuse in health care by 7.3%. The proportion ofmen who currently suffered fromabusive experiences washighest for emotional abuse and abuse in health care. No difference in prevalence was seen between the random populationsample and the clinical sample despite significant differences regarding response rate and background characteristics.

    Conclusions: Abuse against men is prevalent and men are victimised as patients in health care. Response rateand sampling method did not influence prevalence rates of abuse. Men’s victimisation from emotional abuseand abuse in health care was associated with low income and being born outside of the Nordic countries and hence needs to be analysed in the intersections of gender, class, and ethnicity.

    Keywords
    Abuse, male victimisation, masculinity, violence
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-75588 (URN)10.1177/1403494811425711 (DOI)000301192100012 ()
    Funder
    Swedish Research Council, 2007-3011
    Note

    funding agencies|Swedish Research Council| 2007-3011 |

    Available from: 2012-03-09 Created: 2012-03-09 Last updated: 2018-11-15
    2. Associations and Experiences Observed for Family and Nonfamily Forms of Violent Behavior in Different Relational Contexts Among Swedish Men and Women
    Open this publication in new window or tab >>Associations and Experiences Observed for Family and Nonfamily Forms of Violent Behavior in Different Relational Contexts Among Swedish Men and Women
    2014 (English)In: Violence and Victims, ISSN 0886-6708, E-ISSN 1945-7073, Vol. 29, no 1, p. 152-170Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to examine how lifetime experiences of different types of violent behavior as well as violence by different kinds of perpetrators overlap, and to investigate the co-occurrence of experiences of violent behavior by kind of perpetrator. This was done among both sexes in both a random sample from a county population (women n = 1,168, men n = 2,924) and a clinical sample (women n = 2,439, men, n = 1,767) in Sweden. More than 1 kind of perpetrator was reported by 33%-37% of female and 22%-23% of male victims of some kind of violence, whereas 47%-48% of female and 29%-31% of male victims reported more than 1 kind of violence. The reporting of 2 or 3 kinds of perpetrators was associated with the reporting of experiences of more than 1 kind of violent behavior. Health care providers must be trained to recognize the overlap of violent victimization and help prevent further victimization of those who already have such experiences.

    Place, publisher, year, edition, pages
    Springer Publishing Co, 2014
    Keywords
    revictimization; gender; cumulative violence; perpetrator; multiple victimization
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-105043 (URN)10.1891/0886-6708.VV-D-12-00084 (DOI)000330514100010 ()2-s2.0-84899457345 (Scopus ID)
    Available from: 2014-03-06 Created: 2014-03-06 Last updated: 2018-11-15
    3. Lifetime co-occurrence of violence victimisation and symptoms of psychological ill health: a cross-sectional study of Swedish male and female clinical and population samples
    Open this publication in new window or tab >>Lifetime co-occurrence of violence victimisation and symptoms of psychological ill health: a cross-sectional study of Swedish male and female clinical and population samples
    2015 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 979Article in journal (Refereed) Published
    Abstract [en]

    Background

    Lifetime co-occurrence of violence victimisation is common. A large proportion of victims report being exposed to multiple forms of violence (physical, sexual, emotional violence) and/or violence by multiple kinds of perpetrators (family members, intimate partners, acquaintances/strangers). Yet much research focuses on only one kind of victimisation. The aim of this study was to investigate the association between symptoms of psychological ill health, and A) exposure to multiple forms of violence, and B) violence by multiple perpetrators.

    Method

    Secondary analysis of cross-sectional data previously collected for prevalence studies on interpersonal violence in Sweden was used. Respondents were recruited at hospital clinics (women n = 2439, men n = 1767) and at random from the general population (women n = 1168, men n  = 2924). Multinomial regression analysis was used to estimate associations between exposure to violence and symptoms of psychological ill health.

    Results

    Among both men and women and in both clinical and population samples, exposure to multiple forms of violence as well as violence by multiple perpetrators were more strongly associated with symptoms of psychological ill health than reporting one form of violence or violence by one perpetrator. For example, in the female population sample, victims reporting all three forms of violence were four times more likely to report many symptoms of psychological ill health compared to those reporting only one form of violence (adj OR: 3.8, 95 % CI 1.6–8.8). In the male clinical sample, victims reporting two or three kind of perpetrators were three times more likely to report many symptoms of psychological ill health than those reporting violence by one perpetrator (adj OR 3.3 95 % CI 1.9–5.9).

    Discussion

    The strong association found between lifetime co-occurrence of violence victimisation and symptoms of psychological ill-health is important to consider in both research and clinic work. If only the effect of one form of violence or violence by one kind of perpetrator is considered this may lead to a misinterpretation of the association between violence and psychological ill health. When the effect of unmeasured traumata is ignored, the full burden of violence experienced by victims may be underestimated.

    Conclusion

    Different kinds of victimisation can work interactively, making exposure to multiple forms of violence as well as violence by multiple perpetrators more strongly associated with symptoms of psychological ill health than any one kind of victimisation alone.

    Place, publisher, year, edition, pages
    BioMed Central, 2015
    Keywords
    Abuse, Mental health, Stress, Intimate Partner Violence, Revictimization, polyvictimization
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-114676 (URN)10.1186/s12889-015-2311-3 (DOI)000361795600010 ()
    Note

    On the day of the defence date the status of this article was Manuscript and the original title was Cumulative violence and symptoms of psychological ill-health : importance of the interplay between exposure to different kinds of interpersonal violence in Swedish male and female clinical and population samples.Funding: Nordic Council of Ministers

    Available from: 2015-03-02 Created: 2015-03-02 Last updated: 2018-11-15Bibliographically approved
    4. Disclosing victimisation to healthcare professionals in Sweden: a constructivist grounded theory study of experiences among men exposed to interpersonal violence
    Open this publication in new window or tab >>Disclosing victimisation to healthcare professionals in Sweden: a constructivist grounded theory study of experiences among men exposed to interpersonal violence
    2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 6, article id e010847Article in journal (Refereed) Published
    Abstract [en]

    Despite associations between being subjected to violence and ill-health being well known, most victims have never told health care professionals about their victimisation. Although both experiences of victimisation and help-seeking behaviour are gendered, male victims’ encounters with the health care system are under-researched. The aim of this study was to develop a theoretical model concerning male victims’ processes of disclosing experiences of being subjected to violence to health care professionals in Sweden. Constructivist grounded theory was used. Twelve men who had reported experiences of emotional, sexual, and/or physical violence by any type of perpetrator in an earlier quantitative study were interviewed. Conflicting thoughts within the men affected their likelihood of disclosing their victimisation. For example, a sense of urgency to seek help increased their likelihood, whereas shame and fear of negative consequences decreased their likelihood. Conformity to hegemonic masculinity had a strong negative influence, and was tipping the men towards a low likelihood of disclosing victimisation. Health care professionals strongly influence the disclosing process. For example, a good patient-provider relationship would help the men disclose, whereas a strong factor hindering disclosure was professionals’ adherence to gender norms, thus neither validating men’s experiences of violence nor acknowledging their psychological suffering.

    Place, publisher, year, edition, pages
    BMJ Publishing Group Ltd, 2016
    Keywords
    Sweden; Violence; Abuse; Help-seeking; Screening; Gender; Masculinity; Constructivist Grounded Theory
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-114678 (URN)10.1136/bmjopen-2015-010847 (DOI)000380237100066 ()
    Note

    The status of this article was previous manuscript.

    Funding agencies: Region Ostergotland, Sweden [LIO-340221, LIO-514621]

    Available from: 2015-03-02 Created: 2015-03-02 Last updated: 2018-11-15Bibliographically approved
  • 374.
    Simmons, Johanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Brüggemann, Adrianus Jelmer
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden .
    Disclosing victimisation to healthcare professionals in Sweden: a constructivist grounded theory study of experiences among men exposed to interpersonal violence2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 6, article id e010847Article in journal (Refereed)
    Abstract [en]

    Despite associations between being subjected to violence and ill-health being well known, most victims have never told health care professionals about their victimisation. Although both experiences of victimisation and help-seeking behaviour are gendered, male victims’ encounters with the health care system are under-researched. The aim of this study was to develop a theoretical model concerning male victims’ processes of disclosing experiences of being subjected to violence to health care professionals in Sweden. Constructivist grounded theory was used. Twelve men who had reported experiences of emotional, sexual, and/or physical violence by any type of perpetrator in an earlier quantitative study were interviewed. Conflicting thoughts within the men affected their likelihood of disclosing their victimisation. For example, a sense of urgency to seek help increased their likelihood, whereas shame and fear of negative consequences decreased their likelihood. Conformity to hegemonic masculinity had a strong negative influence, and was tipping the men towards a low likelihood of disclosing victimisation. Health care professionals strongly influence the disclosing process. For example, a good patient-provider relationship would help the men disclose, whereas a strong factor hindering disclosure was professionals’ adherence to gender norms, thus neither validating men’s experiences of violence nor acknowledging their psychological suffering.

  • 375.
    Simmons, Johanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Lifetime co-occurrence of violence victimisation and symptoms of psychological ill health: a cross-sectional study of Swedish male and female clinical and population samples2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 979Article in journal (Refereed)
    Abstract [en]

    Background

    Lifetime co-occurrence of violence victimisation is common. A large proportion of victims report being exposed to multiple forms of violence (physical, sexual, emotional violence) and/or violence by multiple kinds of perpetrators (family members, intimate partners, acquaintances/strangers). Yet much research focuses on only one kind of victimisation. The aim of this study was to investigate the association between symptoms of psychological ill health, and A) exposure to multiple forms of violence, and B) violence by multiple perpetrators.

    Method

    Secondary analysis of cross-sectional data previously collected for prevalence studies on interpersonal violence in Sweden was used. Respondents were recruited at hospital clinics (women n = 2439, men n = 1767) and at random from the general population (women n = 1168, men n  = 2924). Multinomial regression analysis was used to estimate associations between exposure to violence and symptoms of psychological ill health.

    Results

    Among both men and women and in both clinical and population samples, exposure to multiple forms of violence as well as violence by multiple perpetrators were more strongly associated with symptoms of psychological ill health than reporting one form of violence or violence by one perpetrator. For example, in the female population sample, victims reporting all three forms of violence were four times more likely to report many symptoms of psychological ill health compared to those reporting only one form of violence (adj OR: 3.8, 95 % CI 1.6–8.8). In the male clinical sample, victims reporting two or three kind of perpetrators were three times more likely to report many symptoms of psychological ill health than those reporting violence by one perpetrator (adj OR 3.3 95 % CI 1.9–5.9).

    Discussion

    The strong association found between lifetime co-occurrence of violence victimisation and symptoms of psychological ill-health is important to consider in both research and clinic work. If only the effect of one form of violence or violence by one kind of perpetrator is considered this may lead to a misinterpretation of the association between violence and psychological ill health. When the effect of unmeasured traumata is ignored, the full burden of violence experienced by victims may be underestimated.

    Conclusion

    Different kinds of victimisation can work interactively, making exposure to multiple forms of violence as well as violence by multiple perpetrators more strongly associated with symptoms of psychological ill health than any one kind of victimisation alone.

  • 376.
    Skagerström, Janna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Alcohol consumption during pregnancy: Prevalence, predictors and prevention2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    It is well established that fetal alcohol exposure can disturb the development of the fetus and cause a range of effects for the affected child. However, research on the effects of exposure to lower levels is inconclusive and the subject is debated. Based on the precautionary principle women in many countries, Sweden included, are advised to maintain total abstinence throughout pregnancy. Regardless, studies have shown that a significant proportion of women consume alcohol around conception and throughout pregnancy. The overall aim of this thesis was to generate knowledge about the prevalence, predictors and prevention of alcohol consumption among women before and during pregnancy.

    The aim was addressed in five studies using several datasets and methods. A systematic review of the international literature was undertaken to identify predictors of alcohol consumption during pregnancy (Study I). Questionnaires to midwives were used to investigate the alcohol-preventive work in antenatal care in Sweden (Study II). Questionnaires were also used to gather data on alcohol consumption before and during pregnancy from pregnant women across Sweden and from women who had given birth to a child in one area of Sweden (Study III and IV). Focus group interviews were used to assess non-pregnant women’s voices on alcohol consumption and pregnancy in Sweden (Study V).

    The results from the studies showed that alcohol consumption was common among women of childbearing age in Sweden (Study III-V) and that there were social expectations for women to drink (Study V). During pregnancy, the expectation was the opposite, as pregnant women were expected to abstain from all alcohol consumption (Study V), which is in line with the total abstinence recommendation from antenatal care. The national “Risk Drinking” project led to revised alcohol-preventive routines in Swedish antenatal care, including screening of all pregnant women for hazardous alcohol use in the year preceding pregnancy, an important predictor of drinking during pregnancy (Study II). A great majority of pregnant women and new mothers reported abstinence from alcohol after pregnancy recognition (Study III and IV), yet the level of reported alcohol consumption during pregnancy appeared to be affected by formulation of the question (Study IV). Factors associated with more drinking during pregnancy in Sweden were: living in a major city, older maternal age, tobacco use, low social support, stronger pre-pregnancy drinking habits and stronger social drinking motives (Study III). In the international research, pre-pregnancy drinking habits, exposure to abuse or violence, high income or social class and positive screen for dependence were the factors most consistently reported to be associated with more drinking during pregnancy (Study I). Women of childbearing age were uncertain about the potential effects of drinking in the period around conception and the social expectations to abstain did not seem to be as strong in this period as after pregnancy  recognition (Study V). A majority of women reported having reduced their alcohol consumption only after they became aware that they are pregnant, meaning that they could have been dinking for several weeks in early pregnancy (Study III).

    List of papers
    1. Predictors of Drinking During Pregnancy: A Systematic Review
    Open this publication in new window or tab >>Predictors of Drinking During Pregnancy: A Systematic Review
    2011 (English)In: Journal of Women's Health, ISSN 1540-9996, E-ISSN 1931-843X, Vol. 20, no 6, p. 901-913Article, review/survey (Refereed) Published
    Abstract [en]

    Background: Many pregnant women continue to drink alcohol despite clinical recommendations and public health campaigns about the risks associated with alcohol use during pregnancy. This review examines the predictors of prenatal alcohol use, with the long-term goal of developing more effective preventive efforts. Methods: A literature search of several databases for relevant articles was undertaken. Studies were included if they occurred in the context of antenatal care, collected data during the womans pregnancy (between 1999 and 2009), investigated predictors of any drinking, had a population-based orientation (e. g., did not focus only on high-risk drinkers), and were published in English in a scientific peer-reviewed journal between 1999 and 2009. Results: Fourteen studies published between 2002 and 2009 fulfilled the inclusion criteria (United States, 4; Europe, 4; Australia and New Zealand, 3; Japan, 2; and Uganda, 1). The predictors of prenatal alcohol use most consistently identified were prepregnancy alcohol consumption and having been abused or exposed to violence. Less consistent predictors of drinking during pregnancy were high income/social class and positive dependence screen. Unemployment, marital status, and education level were examined in many studies but found to be predictive only infrequently. Conclusions: Womens prepregnancy alcohol consumption (i.e., quantity and frequency of typical drinking) and exposure to abuse or violence were consistently associated with drinking during pregnancy. Antenatal care providers should assess these factors for improved detection of women at risk for alcohol-exposed pregnancies.

    Place, publisher, year, edition, pages
    Mary Ann Liebert, Inc., 2011
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-69901 (URN)10.1089/jwh.2010.2216 (DOI)000291590700010 ()
    Note

    Original Publication: Janna Skagerstrom, Grace Chang and Per Nilsen, Predictors of Drinking During Pregnancy: A Systematic Review, 2011, Journal of Women's Health, (20), 6, 901-913. http://dx.doi.org/10.1089/jwh.2010.2216 Copyright: Mary Ann Liebert, Inc. http://www.liebertpub.com/

    Available from: 2011-08-09 Created: 2011-08-08 Last updated: 2017-12-08
    2. Towards improved alcohol prevention in Swedish antenatal care?
    Open this publication in new window or tab >>Towards improved alcohol prevention in Swedish antenatal care?
    Show others...
    2012 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 3, p. 314-320Article in journal (Refereed) Published
    Abstract [en]

    Objective: to evaluate an education effort and revised alcohol-preventive routine in Swedish antenatal care; to generate more knowledge for further development of alcohol issues in antenatal care. less thanbrgreater than less thanbrgreater thanDesign: two national cross-sectional surveys of Swedish midwives were conducted. Baseline data were collected in 2006 and follow-up data in 2009. less thanbrgreater than less thanbrgreater thanSetting: antenatal care centres in Sweden. less thanbrgreater than less thanbrgreater thanParticipants: 974 midwives in 2006 and 1108 midwives in 2009. less thanbrgreater than less thanbrgreater thanMeasurement: amount and content of continuing professional education, work with alcohol-related issues, identification of women with risky consumption of alcohol, and action after identifying women with risky consumption. less thanbrgreater than less thanbrgreater thanFindings: the amount of continuing professional education undertaken by midwives on handling risky drinking increased significantly between 2006 and 2009. The routine to detect risky drinking changed between the baseline and follow-up data collection, as nearly all midwives reported the use of an alcohol screening questionnaire in 2009. The most confident midwives in 2009 had taken part in more days of education, more often stated it was their own initiative to participate, and had more often taken part in education regarding MI, provision of advice and information on the health risks associated with alcohol and, screening. less thanbrgreater than less thanbrgreater thanKey conclusions: our results indicate that a broad, national education effort can be successful in enhancing knowledge and changing antenatal care practice. However, generalisation to other countries or cultures may be limited because the usage of new routines is affected by many organisational and contextual factors.

    Place, publisher, year, edition, pages
    Elsevier, 2012
    Keywords
    Antenatal care, Alcohol, Education
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-78573 (URN)10.1016/j.midw.2011.04.008 (DOI)000304441400006 ()
    Note

    Funding Agencies|Swedish National Institute of Public health||

    Available from: 2012-06-15 Created: 2012-06-15 Last updated: 2017-12-07
    3. Prevalence of alcohol use before and during pregnancy and predictors of drinking during pregnancy: a cross sectional study in Sweden
    Open this publication in new window or tab >>Prevalence of alcohol use before and during pregnancy and predictors of drinking during pregnancy: a cross sectional study in Sweden
    Show others...
    2013 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, no 780Article in journal (Refereed) Published
    Abstract [en]

    Background

    There is a paucity of research on predictors for drinking during pregnancy among women in Sweden and reported prevalence rates differ considerably between studies conducted at different antenatal care centres. Since this knowledge is relevant for preventive work the aim of this study was to investigate these issues using a multicenter approach.

    Methods

    The study was conducted at 30 antenatal care centers across Sweden from November 2009 to December 2010. All women in pregnancy week 18 or more with a scheduled visit were asked to participate in the study. The questionnaire included questions on sociodemographic data, alcohol consumption prior to and during the pregnancy, tobacco use before and during pregnancy, and social support.

    Results

    Questionnaires from 1594 women were included in the study. A majority, 84%, of the women reported alcohol consumption the year prior to pregnancy; about 14% were categorized as having hazardous consumption, here defined as a weekly consumption of > 9 standard drinks containing 12 grams of pure alcohol or drinking more than 4 standard drinks at the same occasion. Approximately 6% of the women consumed alcohol at least once after pregnancy recognition, of which 92% never drank more than 1 standard drink at a time. Of the women who were hazardous drinkers before pregnancy, 19% reduced their alcohol consumption when planning their pregnancy compared with 33% of the women with moderate alcohol consumption prior to pregnancy. Factors predicting alcohol consumption during pregnancy were older age, living in a large city, using tobacco during pregnancy, lower score for social support, stronger alcohol habit before pregnancy and higher score for social drinking motives.

    Conclusions

    The prevalence of drinking during pregnancy is relatively low in Sweden. However, 84% of the women report drinking in the year preceding pregnancy and most of these women continue to drink until pregnancy recognition, which means that they might have consumed alcohol in early pregnancy. Six factors were found to predict alcohol consumption during pregnancy. These factors should be addressed in the work to prevent alcohol-exposed pregnancies.

    Place, publisher, year, edition, pages
    BioMed Central, 2013
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-97660 (URN)10.1186/1471-2458-13-780 (DOI)000323754500003 ()
    Note

    Funding Agencies|Swedish National Institute of Public Health||

    Available from: 2013-09-19 Created: 2013-09-19 Last updated: 2017-12-06
    4. Asking about alcohol consumption during pregnancy: how prevalence rate is affected by the formulation of the question
    Open this publication in new window or tab >>Asking about alcohol consumption during pregnancy: how prevalence rate is affected by the formulation of the question
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Studies of alcohol consumption during pregnancy in Sweden have reported prevalence rates from 6% to 30%. The reason for these differences is unknown. The aim of this study was to compare how alcohol consumption is reported by pregnant women when asked explicitly to report drinking after pregnancy recognition compared with asking about drinking during pregnancy without stating if the time before pregnancy recognition should be included. Data were collected from two groups of women. The women in group A were asked to estimate their alcohol consumption during pregnancy and the women in group B were asked to estimate their alcohol consumption during pregnancy, after pregnancy recognition. There was a significant difference in the reported prevalence rate between the cohorts: 9.3% in cohort A (n=1041) and 6.8% in cohort B (n=933). The results from this study may explain some of the variations in previously reported prevalence rates. To be able to compare different studies, it is important to be clear about the methodological aspects.

    Keywords
    Prevalence rate, alcohol consumption, pregnancy
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:liu:diva-122373 (URN)
    Available from: 2015-10-30 Created: 2015-10-30 Last updated: 2015-10-30Bibliographically approved
    5. The voice of non-pregnant women on alcohol consumption during pregnancy: a focus group study among women in Sweden
    Open this publication in new window or tab >>The voice of non-pregnant women on alcohol consumption during pregnancy: a focus group study among women in Sweden
    2015 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 1193Article in journal (Refereed) Published
    Abstract [en]

    Background: Consensus is that fetal exposure to alcohol is harmful. Abstinence while trying to conceive and throughout pregnancy is recommended. Despite this, there are many women who consume alcohol around conception and until pregnancy recognition. The aim of this study was to explore the voice of non-pregnant women concerning alcohol consumption and its relation to pregnancy.

    Methods: Data were collected through seven focus groups interviews with 34 women of fertile age, who were neither pregnant nor mothers. Semi-structured interviews were undertaken, recorded and transcribed verbatim and then analysed using thematic analysis.

    Results: Three main themes were identified in the analysis: an issue that cannot be ignored; awareness and uncertainty concerning alcohol and pregnancy; and transition to parenthood. Alcohol was an integral part of the women’s lives. A societal expectation to drink alcohol was prevalent and the women used different strategies to handle this expectation. Most women agreed not to drink alcohol during pregnancy although their knowledge on the specific consequences was scanty and they expressed a need for more information. Most of the participants found drinking alcohol during pregnancy to be irresponsible and saw pregnancy as a start of a new way of life.

    Conclusions: Social expectations concerning women’s alcohol use change with pregnancy when women are suddenly expected to abstain. Although most study participants shared an opinion for zero tolerance during pregnancy, their knowledge regarding consequences of drinking during pregnancy were sparse. In order for prospective mothers to make informed choices, there is a need for public health initiatives providing information on the relationship between alcohol consumption and reproduction.

    Place, publisher, year, edition, pages
    BioMed Central, 2015
    Keywords
    Alcohol consumption, Pregnancy, Fertile age, Pregnancy planning, Health education, Focus group
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:liu:diva-122374 (URN)10.1186/s12889-015-2519-2 (DOI)000365477300002 ()
    Note

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

    Funding agencies: Systembolaget Alcohol Research Council (Systembolagets alkoholforskningsrad)

    Available from: 2015-10-30 Created: 2015-10-30 Last updated: 2017-12-01Bibliographically approved
  • 377.
    Skagerström, Janna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Festin, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Asking about alcohol consumption during pregnancy: how prevalence rate is affected by the formulation of the questionManuscript (preprint) (Other academic)
    Abstract [en]

    Studies of alcohol consumption during pregnancy in Sweden have reported prevalence rates from 6% to 30%. The reason for these differences is unknown. The aim of this study was to compare how alcohol consumption is reported by pregnant women when asked explicitly to report drinking after pregnancy recognition compared with asking about drinking during pregnancy without stating if the time before pregnancy recognition should be included. Data were collected from two groups of women. The women in group A were asked to estimate their alcohol consumption during pregnancy and the women in group B were asked to estimate their alcohol consumption during pregnancy, after pregnancy recognition. There was a significant difference in the reported prevalence rate between the cohorts: 9.3% in cohort A (n=1041) and 6.8% in cohort B (n=933). The results from this study may explain some of the variations in previously reported prevalence rates. To be able to compare different studies, it is important to be clear about the methodological aspects.

  • 378.
    Skagerström, Janna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Häggström-Nordin, Elisabet
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden / School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    The voice of non-pregnant women on alcohol consumption during pregnancy: a focus group study among women in Sweden2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 1193Article in journal (Refereed)
    Abstract [en]

    Background: Consensus is that fetal exposure to alcohol is harmful. Abstinence while trying to conceive and throughout pregnancy is recommended. Despite this, there are many women who consume alcohol around conception and until pregnancy recognition. The aim of this study was to explore the voice of non-pregnant women concerning alcohol consumption and its relation to pregnancy.

    Methods: Data were collected through seven focus groups interviews with 34 women of fertile age, who were neither pregnant nor mothers. Semi-structured interviews were undertaken, recorded and transcribed verbatim and then analysed using thematic analysis.

    Results: Three main themes were identified in the analysis: an issue that cannot be ignored; awareness and uncertainty concerning alcohol and pregnancy; and transition to parenthood. Alcohol was an integral part of the women’s lives. A societal expectation to drink alcohol was prevalent and the women used different strategies to handle this expectation. Most women agreed not to drink alcohol during pregnancy although their knowledge on the specific consequences was scanty and they expressed a need for more information. Most of the participants found drinking alcohol during pregnancy to be irresponsible and saw pregnancy as a start of a new way of life.

    Conclusions: Social expectations concerning women’s alcohol use change with pregnancy when women are suddenly expected to abstain. Although most study participants shared an opinion for zero tolerance during pregnancy, their knowledge regarding consequences of drinking during pregnancy were sparse. In order for prospective mothers to make informed choices, there is a need for public health initiatives providing information on the relationship between alcohol consumption and reproduction.

  • 379.
    Skansén Nyberg, Helena
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Hur hälsa, kön, individuell socioekonomisk status och boendeform påverkar självkänslan2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction Health has improved for the entire world population. Economic and social conditions, such as socioeconomic status, influence the possibility of good health. Self-esteem is also associated with good health, as well as housing tenure and socioeconomic status. 

    Purpose To investigate whether, and to what extent, self-esteem is influenced by self-rated health, housing tenure, education (objective socioeconomic status) and self-rated economic status (subjective socioeconomic status), and if there is such an association, whether there is a difference between sexes. 

    Method This study was quantitative, with cross-sectional design, using results from the LSH-study questionnaires 2012/13 in Östergötland. The relationship between self-esteem and independent variables was analysed using logistic regressions. 

    Results High self-esteem demonstrates a strong correlation with self-rated health, as well as with self-rated economic status and sex. Being a man, or indicating good economic status increases the probability of high self-esteem. Owning one’s own housing also has a positive association with high self-esteem.

    Conclusion Being a man who owns his own housing increases the possibilities for high self-esteem. The same variables also covariate with health. Likewise, subjective socioeconomic status has a stronger relationship with health as well as self-esteem than objective socioeconomic status does.

  • 380.
    Skogar, Ö
    et al.
    Ryhov Hospital, Jönköping, Sweden.
    Fall, Per-Arne
    Linköping University, Department of Clinical and Experimental Medicine, Geriatric. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
    Hallgren, G
    Skaraborg Hospital, Skövde, Sweden.
    Lökk, J
    Karolinska University Hospital, Stockholm, Sweden.
    Bringer, B
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
    Carlsson, M
    Ryhov Hospital, Jönköping, Sweden.
    Lennartsson, U
    Skaraborg Hospital, Skövde, Sweden.
    Sandbjörk, H
    Skaraborg Hospital, Skövde, Sweden.
    Törnhage, C-J
    Skaraborg Hospital, Skövde, Sweden.
    Diurnal salivary cortisol concentrations in Parkinson’s disease: increased total secretion and morning cortisol concentrations2011In: International Journal of General Medicine, ISSN 1178-7074, E-ISSN 1178-7074, Vol. 4, p. 561-569Article in journal (Refereed)
    Abstract [en]

    Background:Parkinson’s disease (PD) is a chronic neurodegenerative disorder. There is limited knowledge about the function of the hypothalamic-pituitary-adrenal axis in PD. The primary aim of this prospective study was to analyze diurnal salivary cortisol concentrations in patients with PD and correlate these with age, gender, body mass index (BMI), duration of PD, and pain. The secondary aim was to compare the results with a healthy reference group.

    Methods:Fifty-nine PD patients, 35 women and 24 men, aged 50–79 years, were recruited. The reference group comprised healthy individuals matched for age, gender, BMI, and time point for sampling. Salivary cortisol was collected at 8 am, 1 pm, and 8 pm, and 8 am the next day using cotton-based Salivette ®tubes and analyzed using Spectria®Cortisol I125. A visual analog scale was used for estimation of pain.

    Results:The median cortisol concentration was 16.0 (5.8–30.2) nmol/L at 8 am, 5.8 (3.0–16.4) at 1 pm, 2.8 (1.6–8.0) at 8 pm, and 14.0 (7.5–28.7) at 8 am the next day. Total secretion and rate of cortisol secretion during the day (8 am–8 pm) and the concentration of cortisol on the next morning were lower (12.5 nmol/L) in the reference group. No significant correlations with age, gender, BMI, duration of PD, Hoehn and Yahr score, Unified Parkinson’s Disease Rating Scale III score, gait, pain, or cortisol concentrations were found.

    Conclusion:The neurodegenerative changes in PD does not seem to interfere with the hypothalamic-pituitary-adrenal axis. Salivary cortisol concentrations in PD patients were increased in the morning compared with the reference group, and were not influenced by motor dysfunction, duration of disease, or coexistence of chronic or acute pain.

  • 381.
    Skop, Michelle
    et al.
    Univ Toronto, Canada.
    Lorentz, Justin
    Sunnybrook Hlth Sci Ctr, Canada.
    Jassi, Mobin
    Univ Toronto, Canada.
    Vesprini, Danny
    Univ Toronto, Canada.
    Einstein, Gillian
    Linköping University, Department of Thematic Studies, The Department of Gender Studies. Linköping University, Faculty of Arts and Sciences. Univ Toronto, Canada; Womens Coll Res Inst, Canada.
    Guys Dont Have Breasts: The Lived Experience of Men Who Have BRCA Gene Mutations and Are at Risk for Male Breast Cancer2018In: American Journal of Men's Health, ISSN 1557-9883, E-ISSN 1557-9891, Vol. 12, no 4, p. 961-972Article in journal (Refereed)
    Abstract [en]

    Men with BRCA1 or BRCA2 gene mutations are at increased risk of developing breast cancer and may have an indication for breast cancer screening using mammography. Since breast cancer is often viewed as a womans disease, visibilizing and understanding mens experience of having a BRCA mutation and specifically, of screening for breast cancer through mammography, were the objectives of this research study. The theoretical framework of interpretive phenomenology guided the process of data collection, coding, and analysis. Phenomenology is both a philosophy and research method which focuses on understanding the nature of experience from the perspectives of people experiencing a phenomenon, the essence of and commonalities among peoples experiences, and the ways in which people experience the world through their bodies. Data were collected via in-depth interviews with a purposive sample of 15 male participants recruited from the Male Oncology Research and Education (MORE) Program. This article reports findings about participants use of gender-specific language to describe their breasts, awareness of the ways in which their bodies changed overtime, and experiences of undergoing mammograms. This study is the first to describe men with BRCAs perceptions of their breasts and experiences of mammography in a high-risk cancer screening clinic. This study sheds light on an under-researched areabreasts and masculinitiesand could potentially lead to improved clinical understanding of mens embodied experiences of BRCA, as well as suggestions for improving the delivery of male breast cancer screening services.

  • 382.
    Spreco, Armin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Business support and Development, Department of Health and Care Development.
    Eriksson, Olle
    Linköping University, Department of Computer and Information Science, The Division of Statistics and Machine Learning. Linköping University, Faculty of Arts and Sciences.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Cowling, Benjamin John
    Univ Hong Kong, Peoples R China.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Business support and Development, Department of Health and Care Development.
    Evaluation of Nowcasting for Detecting and Predicting Local Influenza Epidemics, Sweden, 2009-20142018In: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 24, no 10, p. 1868-1873Article in journal (Refereed)
    Abstract [en]

    The growing availability of big data in healthcare and public health opens possibilities for infectious disease control in local settings. We prospectively evaluated a method for integrated local detection and prediction (nowcasting) of influenza epidemics over 5 years, using the total population in Ostergotland County, Sweden. We used routine health information system data on influenza-diagnosis cases and syndromic telenursing data for July 2009-June 2014 to evaluate epidemic detection, peak-timing prediction, and peak-intensity prediction. Detection performance was satisfactory throughout the period, except for the 2011-12 influenza A(H3N2) season, which followed a season with influenza B and pandemic influenza A(H1N1) pdm09 virus activity. Peak-timing prediction performance was satisfactory for the 4 influenza seasons but not the pandemic. Peak-intensity levels were correctly categorized for the pandemic and 2 of 4 influenza seasons. We recommend using versions of this method modified with regard to local use context for further evaluations using standard methods.

  • 383.
    Stadin, Magdalena
    et al.
    Jonköping University, Sweden.
    Nordin, Maria
    Stockholm University, Sweden; Umeå University, Sweden.
    Broström, Anders
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonköping University, Sweden.
    Magnusson Hanson, Linda L.
    Stockholm University, Sweden.
    Westerlund, Hugo
    Stockholm University, Sweden.
    Fransson, Eleonor I.
    Jonköping University, Sweden; Stockholm University, Sweden; Karolinska Institute, Sweden.
    Information and communication technology demands at work: the association with job strain, effort-reward imbalance and self-rated health in different socio-economic strata2016In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 89, no 7, p. 1049-1058Article in journal (Refereed)
    Abstract [en]

    The use of information and communication technology (ICT) is common in modern working life. ICT demands may give rise to experience of work-related stress. Knowledge about ICT demands in relation to other types of work-related stress and to self-rated health is limited. Consequently, the aim of this study was to examine the association between ICT demands and two types of work-related stress [job strain and effort-reward imbalance (ERI)] and to evaluate the association between these work-related stress measures and self-rated health, in general and in different SES strata. This study is based on cross-sectional data from the Swedish Longitudinal Occupational Survey of Health collected in 2014, from 14,873 gainfully employed people. ICT demands, job strain, ERI and self-rated health were analysed as the main measures. Sex, age, SES, lifestyle factors and BMI were used as covariates. ICT demands correlated significantly with the dimensions of the job strain and ERI models, especially with the demands (r = 0.42; p amp;lt; 0.01) and effort (r = 0.51; p amp;lt; 0.01) dimensions. ICT demands were associated with suboptimal self-rated health, also after adjustment for age, sex, SES, lifestyle and BMI (OR 1.49 [95 % CI 1.36-1.63]), but job strain (OR 1.93 [95 % CI 1.74-2.14) and ERI (OR 2.15 [95 % CI 1.95-2.35]) showed somewhat stronger associations with suboptimal self-rated health. ICT demands are common among people with intermediate and high SES and associated with job strain, ERI and suboptimal self-rated health. ICT demands should thus be acknowledged as a potential stressor of work-related stress in modern working life.

  • 384.
    Stadin, Magdalena
    et al.
    Jonkoping Univ, Sweden.
    Nordin, Maria
    Stockholm Univ, Sweden; Umea Univ, Sweden.
    Broström, Anders
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonkoping Univ, Sweden.
    Magnusson Hanson, Linda L.
    Stockholm Univ, Sweden.
    Westerlund, Hugo
    Stockholm Univ, Sweden.
    Fransson, Eleonor I.
    Jonkoping Univ, Sweden; Stockholm Univ, Sweden.
    Repeated exposure to high ICT demands at work, and development of suboptimal self-rated health: findings from a 4-year follow-up of the SLOSH study2019In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 92, no 5, p. 717-728Article in journal (Refereed)
    Abstract [en]

    The knowledge about the association between Information and Communication Technology (ICT) demands at work and self-rated health (SRH) is insufficient. The aim of this study was to examine the association between repeated exposure to high ICT demands at work, and risk of suboptimal SRH, and to determine modifications by sex or socioeconomic position (SEP). A prospective design was used, including repeated measurement of ICT demands at work, measured 2 years apart. SRH was measured at baseline and at follow-up after 4 years. The data were derived from the Swedish Longitudinal Occupational Survey of Health (SLOSH), including 4468 gainfully employees (1941 men, 2527 women) with good SRH at baseline. In the total study sample, repeated exposure to high ICT demands at work was associated with suboptimal SRH at follow-up (OR 1.34 [CI 1.06-1.70]), adjusted for age, sex, SEP, health behaviours, BMI, job strain and social support. An interaction between ICT demands and sex was observed (p = 0.010). The risk was only present in men (OR 1.53 [CI 1.09-2.16]), and not in women (OR 1.17 [CI 0.85-1.62]). The risk of suboptimal SRH after consistently high ICT demands at work was most elevated in participants with high SEP (OR 1.68 [CI 1.02-2.79]), adjusted for age, sex, health behaviours, BMI and job strain. However, no significant interaction between ICT demands and SEP regarding SRH was observed. Repeated exposure to high ICT demands at work was associated with suboptimal SRH at follow-up, and the association was modified by sex.

  • 385.
    Stenbäck, Victoria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Speech masking speech in everyday communication: The role of inhibitory control and working memory capacity2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Age affects hearing and cognitive abilities. Older people, with and without hearing impairment (HI), exhibit difficulties in hearing speech in noise. Elderly individuals show greater difficulty in segregating target speech from distracting background noise, especially if the noise is competing speech with meaningful contents, so called informational maskers. Working memory capacity (WMC) has proven to be a crucial factor in comprehending speech in noise, especially for people with hearing loss. In auditory scenes where speech is disrupted by competing speech, high WMC has proven to facilitate the ability to segregate target speech and inhibit responses to irrelevant information. People with low WMC are more prone to be disrupted by competing speech and exhibit more difficulties in hearing target speech in complex listening environments. Furthermore, elderly individuals with a HI experience more difficulties in switching attention between wanted and irrelevant stimuli, and they employ more resources and time to attend to the stimuli than do normally - hearing (NH) younger adults.

    This thesis investigated the importance of inhibitory control and WMC for speech recognition in noise, and perceived listening effort. Four studies were conducted. In the first study, the aim was to develop a test of inhibitory control for verbal content, and to investigate the relation between inhibitory control and WMC, and how these two abilities related to speech recognition in noise, in young normally – hearing (YNH) individuals.

    In the second study we aimed to investigate the same relationship as in the first study to further strengthen the validity of the inhibitory test developed, as well as the importance of lexical access. It was also an aim to investigate the influence of age and hearing status on lexical access and WMC, and their respective roles for speech recognition in noise in both YNH and elderly HI (EHI) individuals.

    Study one and two showed that, for YNH, inhibitory control was related to speech recognition in noise, indicating that inhibitory control can help to predict speech recognition in noise performance. The relationship between WMC and speech recognition in noise in YNH shifted in the studies, suggesting that this relationship is multifaceted and varying. Lexical access was of little importance for YNH, although for EHI individuals, both WMC and lexical access was of importance for speech recognition in noise, suggesting that different cognitive abilities were of importance for the YNH and EHI individuals Study three investigated the relationship between inhibitory control, WMC, speech recognition in noise, and perceived listening effort, in YNH and elderly, for their age, NH, individuals (ENH). In study four the same relationships as in study three were investigated, albeit in EHI individuals. Two speech materials with different characteristics, masked with four background noises were used. The results in study three showed that less favourable SNRs were needed for informational maskers than for maskers without semantic content. ENH individuals were more susceptible to informational maskers than YNH individuals. In contrast, in study four, more favourable SNRs were needed for informational maskers. In both studies, results showed that speech recognition in noise performance differed depending on the characteristics of the speech material.

    The studies showed that high WMC, compared to low WMC, was beneficial for speech recognition in noise, especially for informational maskers, and resulted in lower ratings of perceived effort. Varying results were found in study three and four regarding perceived effort and inhibitory control. In study three good inhibitory control was associated with lower effort rating, while in study four, individuals with a HI and good inhibitory control rated effort as higher.

    The results suggest that hearing status, age, and cognitive abilities, contribute to the differences in performance between YNH, ENH, and EHI individuals in speech – recognition – in – noise - and cognitive tasks.

    This thesis has, for the first time, demonstrated that a measure of inhibitory control of verbal content, is related to speech recognition in noise performance in YNH, ENH and EHI individuals. Results presented in this thesis also show that both WMC and inhibitory control are related to an individuals’ perception of how effortful a listening task is. It also adds to the literature that WMC is related to speech recognition in noise performance for ENH and EHI individuals, but that this relationship is not as robust in YNH individuals.

    List of papers
    1. The Swedish Hayling task, and its relation to working memory, verbal ability, and speech-recognition-in-noise
    Open this publication in new window or tab >>The Swedish Hayling task, and its relation to working memory, verbal ability, and speech-recognition-in-noise
    2015 (English)In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 56, no 3, p. 264-272Article in journal (Refereed) Published
    Abstract [en]

    Cognitive functions and speech-recognition-in-noise were evaluated with a cognitive test battery, assessing response inhibition using the Hayling task, working memory capacity (WMC) and verbal information processing, and an auditory test of speech recognition. The cognitive tests were performed in silence whereas the speech recognition task was presented in noise. Thirty young normally-hearing individuals participated in the study. The aim of the study was to investigate one executive function, response inhibition, and whether it is related to individual working memory capacity (WMC), and how speech-recognition-in-noise relates to WMC and inhibitory control. The results showed a significant difference between initiation and response inhibition, suggesting that the Hayling task taps cognitive activity responsible for executive control. Our findings also suggest that high verbal ability was associated with better performance in the Hayling task. We also present findings suggesting that individuals who perform well on tasks involving response inhibition, and WMC, also perform well on a speech-in-noise task. Our findings indicate that capacity to resist semantic interference can be used to predict performance on speech-in-noise tasks.

    Place, publisher, year, edition, pages
    Wiley, 2015
    Keywords
    executive functions, inhibition, cognitive control, working memory capacity, speech recognition in noise, hearing
    National Category
    Psychology (excluding Applied Psychology)
    Identifiers
    urn:nbn:se:liu:diva-117054 (URN)10.1111/sjop.12206 (DOI)000354185700003 ()25819210 (PubMedID)
    Projects
    Tal som störning vid språklig kommunikation
    Funder
    Swedish Research Council, 421-2009-1753
    Available from: 2015-04-14 Created: 2015-04-14 Last updated: 2017-12-04Bibliographically approved
    2. Executive functions and working memory capacity in speech communication under adverse conditions
    Open this publication in new window or tab >>Executive functions and working memory capacity in speech communication under adverse conditions
    2016 (English)In: Speech, Language and Hearing, ISSN 2050-571X, Vol. 19, no 4, p. 218-226Article in journal (Refereed) Published
    Abstract [en]

    Introduction: Working memory is assumed to play a major part in hearing and communication in everyday listening situations. Our working memory stores information, but in suboptimal listening conditions, interfering stimuli can lead to information only being partially stored, or even missed. Research suggests that a high working memory capacity (WMC) might not just be a result of a large store, but in addition good inhibitory control can facilitate working memory, and therefore aid in situations where focus on a target stimulus while ignoring distractors is needed.

    Objective: The aim of the present study was to investigate how individual WMC, cognitive inhibition, and lexical decision relate to listening to speech under adverse conditions in two separate groups: 46 young normally hearing (NH) and 40 elderly hearing-impaired (HI) individuals.

    Results: It showed that lexical access was of little importance for young NH individuals in a speech-in-noise test, but that high lexical decision-making was associated with lower signal-to-noise ratios for the elderly HI individuals. The results also showed that WMC was of importance for word recognition in a speech-in-noise test for elderly participants, when the 80% word recognition criterion was targeted, but not for the young NH individuals. Finally, results suggest that cognitive inhibition, as measured with the Hayling task, was important for young NH individuals when listening conditions are suboptimal.

    Conclusion: In conclusion, hearing loss is a strong contributing factor to declines in the ability to recognize speech in noise, and in order to assess speech-recognition-in-noise performance, individual differences in WMC and cognitive inhibition should be taken into consideration. Future research should include various age groups, with and without hearing loss, as well as measures of WMC, cognitive inhibition, and lexical access when assessing the ability to listen to speech under adverse conditions.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2016
    National Category
    Neurosciences Rheumatology and Autoimmunity Otorhinolaryngology Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-133193 (URN)10.1080/2050571X.2016.1196034 (DOI)
    Available from: 2016-12-14 Created: 2016-12-14 Last updated: 2018-01-13Bibliographically approved
  • 386.
    Stenbäck, Victoria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Hällgren, Mathias
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Larsby, Birgitta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Executive functions and working memory capacity in speech communication under adverse conditions2016In: Speech, Language and Hearing, ISSN 2050-571X, Vol. 19, no 4, p. 218-226Article in journal (Refereed)
    Abstract [en]

    Introduction: Working memory is assumed to play a major part in hearing and communication in everyday listening situations. Our working memory stores information, but in suboptimal listening conditions, interfering stimuli can lead to information only being partially stored, or even missed. Research suggests that a high working memory capacity (WMC) might not just be a result of a large store, but in addition good inhibitory control can facilitate working memory, and therefore aid in situations where focus on a target stimulus while ignoring distractors is needed.

    Objective: The aim of the present study was to investigate how individual WMC, cognitive inhibition, and lexical decision relate to listening to speech under adverse conditions in two separate groups: 46 young normally hearing (NH) and 40 elderly hearing-impaired (HI) individuals.

    Results: It showed that lexical access was of little importance for young NH individuals in a speech-in-noise test, but that high lexical decision-making was associated with lower signal-to-noise ratios for the elderly HI individuals. The results also showed that WMC was of importance for word recognition in a speech-in-noise test for elderly participants, when the 80% word recognition criterion was targeted, but not for the young NH individuals. Finally, results suggest that cognitive inhibition, as measured with the Hayling task, was important for young NH individuals when listening conditions are suboptimal.

    Conclusion: In conclusion, hearing loss is a strong contributing factor to declines in the ability to recognize speech in noise, and in order to assess speech-recognition-in-noise performance, individual differences in WMC and cognitive inhibition should be taken into consideration. Future research should include various age groups, with and without hearing loss, as well as measures of WMC, cognitive inhibition, and lexical access when assessing the ability to listen to speech under adverse conditions.

  • 387.
    Stridsman, Marie
    et al.
    Feelgood Foretagshalsa, Linkoping, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Hendriks, Jeroen
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Univ Adelaide, Australia; Royal Adelaide Hosp, Australia.
    Walfridsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Patients Experiences of Living with Atrial Fibrillation: A Mixed Methods Study2019In: Cardiology Research and Practice, ISSN 2090-8016, E-ISSN 2090-0597, Vol. 2019, article id 6590358Article in journal (Refereed)
    Abstract [en]

    Introduction. Awareness of epidemiological and clinical consequences of atrial fibrillation (AF) has increased, as have disease-related costs. Less attention has been paid to patient-related issues, such as understanding how symptoms, different therapies, and lifestyle adjustments affect daily life. We aimed to describe patients experiences of living with AF. Methods. The study design used a parallel convergent mixed methods approach. Patients with AF were included in the SMURF study and referred for catheter ablation. Patients completed questionnaires on symptoms, health-related quality of life, depression, anxiety, and perceived control and were interviewed. The datasets were analysed separately using inductive content analysis and descriptive statistics. Data were merged to obtain a final interpretation. Results. Nineteen patients were interviewed and 18 completed questionnaires. Twelve of the patients were male, mean age 60 years (45-75 years). Inductive qualitative analysis revealed three categories: (i) symptoms and concerns limiting life, (ii) dimensions of worries, and (iii) strategies for management. The most common symptoms were tiredness, weakness/fatigue, and breathlessness during activities, and the most pronounced negative impacts on health-related quality of life (HRQOL) were physically related, shown in the ASTA questionnaire. The most negative SF-36 scores were found in role limitations due to physical health problems and vitality. HADS revealed five patients with some degree of anxiety and four with some degree of depression. Patients had lower scores on perceived control than perceived helplessness in CAS. Patients perceived control was higher than their families, and families experienced more helplessness. Conclusions. The mixed methods design deepens our understanding of challenges faced by patients. Patients experienced a limited ability to perform activities of daily living due to AF which created different kinds of worries that encouraged the use of various strategies to manage their lives. Healthcare providers need to be aware that relationships between patients and their relatives can change, and therefore they need to be supported and integrated into the care system.

  • 388.
    Strömgren, M.
    et al.
    Umeå University, Sweden.
    Holm, E.
    Umeå University, Sweden.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Ekberg, Joakim
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Business support and Development, Department of Health and Care Development.
    Eriksson, Henrik
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering.
    Spreco, Armin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Computer and Information Science. Linköping University, Faculty of Science & Engineering. Region Östergötland, Center for Business support and Development, Department of Health and Care Development.
    Place-based social contact and mixing: a typology of generic meeting places of relevance for infectious disease transmission2017In: Epidemiology and Infection, ISSN 0950-2688, E-ISSN 1469-4409, Vol. 145, no 12, p. 2582-2593Article in journal (Refereed)
    Abstract [en]

    This study aims to develop a typology of generic meeting places based on social contact and mixing of relevance for infectious disease transmission. Data were collected by means of a contact diary survey conducted on a representative sample of the Swedish population. The typology is derived from a cluster analysis accounting for four dimensions associated with transmission risk: visit propensity and its characteristics in terms of duration, number of other persons present and likelihood of physical contact. In the analysis, we also study demographic, socio-economic and geographical differences in the propensity of visiting meeting places. The typology identifies the family venue, the fixed activity site, the family vehicle, the trading plaza and the social network hub as generic meeting places. The meeting place typology represents a spatially explicit account of social contact and mixing relevant to infectious disease modelling, where the social context of the outbreak can be highlighted in light of the actual infectious disease.

  • 389.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences and Learning, Sociology. Linköping University, Faculty of Arts and Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    From Cooperation to Conflict? Swedish Rehabilitation Professionals' Experiences of Interorganizational Cooperation.2011In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 21, no 3, p. 441-448Article in journal (Refereed)
    Abstract [en]

    Purpose This article analyses Swedish rehabilitation professionals' experiences of interorganizational cooperation in return-to-work and labour market reintegration.

    Method Two groups (n = 15) from different organizations met on a regular basis to discuss their practice from a cooperation perspective. The participants had experience of cooperation in the organizational setting of Coordination Associations. The groups worked with a tutor according to a problem-based methodology, to discuss how their practice is influenced by new structures for cooperation. The material was analysed inductively using qualitative content analysis.

    Results Interorganizational cooperation in rehabilitation is generally perceived as promoting coherence and communication. Nevertheless, there are several contradictory factors in the implementation of such work forms, primarily inflexible sickness insurance regulations and inability of managers to implement cooperation in regular practice.

    Conclusions While interorganizational cooperation promotes professional discretion and tailored solutions, the insurance system contradicts such ambitions through increased governance. Ultimately, the contradictory tendencies of cooperative initiatives and the stricter governance of sickness insurance regulations are political matters. If political attempts to promote interorganizational cooperation are to succeed, the increasing sectorization that results from strict governance of sickness insurance regulations needs to be targeted on a system level.

  • 390.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Svensson, Tommy
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences and Learning, Sociology.
    Petersson, Gunilla
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    A Matter of Trust?: A Study of Coordination of Swedish Stakeholders in Return-to-Work2010In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 20, p. 299-310Article in journal (Refereed)
    Abstract [en]

    Introduction Stakeholder cooperation in return-to-work has been increasingly emphasized over the last years. However, there is a lack of empirical studies on the subject. This study explores different public stakeholders' experiences of participating in Coordination Associations (CAs), a Swedish form of structured cooperation in return-to-work. The aim of the study is to determine the impact of stakeholder interests on the prerequisites for cooperation. Methods Thirty-five representatives from two CAs in eastern Sweden were interviewed regarding the aim, structure and strategies for their common work. Results Stakeholders' actions are to a high degree determined by their institutional preferences and self-interest. In the CAs, the motives for cooperation differ, and although these differences supposedly could be overcome, they are in fact not. One of the stakeholders, the Public Employment Service, limit its interest to coordinating resources, while the other three wishes to engage in elaborated cooperative work forms, implying the crossing of organizational borders. This discrepancy can largely be attributed to the difficulties for representatives from state authorities in changing their priorities in order to make cooperation work. Conclusions Stakeholders' interests have a high impact on the prerequisites for cooperation in return-to-work. By referring to organizational goals, stakeholders engage in non-cooperative behaviour, which threatens to spoil cooperative initiatives and to develop distrust in cooperative work forms. The results of this study expose the complexity of and threats to cooperation, and its conclusions may be used by return-to-work stakeholders in different jurisdictions to improve the possibilities for the development of cooperative structures.

  • 391.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences and Learning, Sociology . Linköping University, Faculty of Arts and Sciences.
    Petersson, Gunilla
    Linköping University, Department of Behavioural Sciences and Learning, Sociology . Linköping University, Faculty of Arts and Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.
    The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams2009In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 19, no 3, p. 264-273Article in journal (Refereed)
    Abstract [en]

    Stakeholder cooperation in return to work has been increasingly emphasised in research, while studies on how such cooperation works in practise are scarce. This article investigates the relationship between professionals in Swedish interdisciplinary rehabilitation teams, and the aim of the article is to determine the participants’ definitions and uses of the concept of work ability. Methods The methods chosen were individual interviews with primary health care centre managers and focus groups with twelve interdisciplinary teams including social insurance officers, physicians, physiotherapists, occupational therapists, medical social workers and coordinators. Results The results show that the teams have had problems with reaching a common understanding of their task, due to an inherent tension between the stakeholders. This tension is primarily a result of two factors: divergent perspectives on work ability between the health professionals and the Social Insurance Agency, and different approaches to cooperative work among physicians. Health professionals share a holistic view on work ability, relating it to a variety of factors. Social insurance officers, on the other hand, represent a reductionistic stance, where work ability is reduced to medical status. Assessments of work ability therefore tend to become a negotiation between insurance officers and physicians. Conclusions A suggestion from the study is that the teams, with proper education, could be used as an arena for planning and coordinating return-to-work, which would strengthen their potential in managing the prevention of work disability.

  • 392.
    Stålnacke, Britt-Marie
    et al.
    Institutionen för samhällsmedicin och rehabilitering, Umeå universitet.
    Bäckryd, Emmanuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Roeck Hansen, Elisabeth
    Rehabiliteringsmedicinska Universitetskliniken Stockholm, Danderyds Sjukhus AB.
    Novo, Mehmed
    Institutionen för samhällsmedicin och rehabilitering, Umeå universitet.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Smärtanalys och diagnossättning vid kroniska smärtor inom specialiserad smärtvård2014Report (Other academic)
    Abstract [sv]

    Vi har som modifiering av SoS diagnosriktlinje föreslagit att smärtdiagnostiken ska använda två system parallellt d.v.s. både ICD10 systemet som det föreslagits av Socialstyrelsen för den specialiserade smärtvården (exklusiveR52.2A-C och F45.4) (Bilaga 1) och en utvidgad smärtmekanistisk klassificering. Vid tillämpningen av det förra används lämpligen den lathund som har utarbetats av diagnosgruppen inom NRS (Bilaga 2). För den senare används kategorierna definierade i detta dokument (dvs. neuropatisk, nociceptiv, generaliserad, psykogen och/eller idiopatisk) tillsammans med ställningstagande till smärtkänslighet.

    Härigenom skapas mer enhetlig diagnossättning vilket är en förutsättning för kliniska riktlinjer, kliniska jämförelser och intensifierad forskning involverande diagnosaspekter.

  • 393.
    Sullivan, Rachel K.
    et al.
    University of Auckland, New Zealand.
    Marsh, Samantha
    University of Auckland, New Zealand.
    Halvarsson, Jakob
    Linköping University, Faculty of Medicine and Health Sciences.
    Holdsworth, Michelle
    University of Sheffield, England.
    Waterlander, Wilma
    University of Auckland, New Zealand.
    Poelman, Maartje P.
    University of Utrecht, Netherlands.
    Salmond, Jennifer Ann
    University of Auckland, New Zealand.
    Hayley, Christian
    University of Western Australia, Australia; University of Western Australia, Australia.
    Koh, Lenny S. C.
    University of Sheffield, England.
    Cade, Janet E.
    University of Leeds, England.
    Spence, John C.
    University of Alberta, Canada.
    Woodward, Alistair
    University of Auckland, New Zealand.
    Maddison, Ralph
    University of Auckland, New Zealand; Deakin University, Australia.
    Smartphone Apps for Measuring Human Health and Climate Change Co-Benefits: A Comparison and Quality Rating of Available Apps2016In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 4, no 4, article id e135Article in journal (Refereed)
    Abstract [en]

    Background: Climate change and the burden of noncommunicable diseases are major global challenges. Opportunities exist to investigate health and climate change co-benefits through a shift from motorized to active transport (walking and cycling) and a shift in dietary patterns away from a globalized diet to reduced consumption of meat and energy dense foods. Given the ubiquitous use and proliferation of smartphone apps, an opportunity exists to use this technology to capture individual travel and dietary behavior and the associated impact on the environment and health. Objective: The objective of the study is to identify, describe the features, and rate the quality of existing smartphone apps which capture personal travel and dietary behavior and simultaneously estimate the carbon cost and potential health consequences of these actions. Methods: The Google Play and Apple App Stores were searched between October 19 and November 6, 2015, and a secondary Google search using the apps filter was conducted between August 8 and September 18, 2016. Eligible apps were required to estimate the carbon cost of personal behaviors with the potential to include features to maximize health outcomes. The quality of included apps was assessed by 2 researchers using the Mobile Application Rating Scale (MARS). Results: Out of 7213 results, 40 apps were identified and rated. Multiple travel-related apps were identified, however no apps solely focused on the carbon impact or health consequences of dietary behavior. None of the rated apps provided sufficient information on the health consequences of travel and dietary behavior. Some apps included features to maximize participant engagement and encourage behavior change towards reduced greenhouse gas emissions. Most apps were rated as acceptable quality as determined by the MARS; 1 was of poor quality and 10 apps were of good quality. Interrater reliability of the 2 evaluators was excellent (ICC= 0.94, 95% CI 0.87-0.97). Conclusions: Existing apps capturing travel and dietary behavior and the associated health and environmental impact are of mixed quality. Most apps do not include all desirable features or provide sufficient health information. Further research is needed to determine the potential of smartphone apps to evoke behavior change resulting in climate change and health co-benefits.

  • 394.
    Sundelin, Heléne
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus. Orebro Univ, Sweden.
    Stephansson, Olof
    Karolinska Univ Hosp and Inst, Sweden; Univ Calif Berkeley, CA 94720 USA.
    Hultman, Christina M.
    Karolinska Inst, Sweden; Icahn Sch Med Mt Sinai, NY 10029 USA.
    Ludvigsson, Jonas F.
    Karolinska Inst, Sweden; Orebro Univ Hosp, Sweden; Univ Nottingham, England; Columbia Univ, NY USA.
    Pregnancy outcomes in women with autism: a nationwide population-based cohort study2018In: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 10, p. 1817-1826Article in journal (Refereed)
    Abstract [en]

    Background: The consequences of autism in pregnancy outcomes have not been explored before, although it is of crucial importance because of the frequent comorbidities and medication in this group of women. Objectives: To estimate the risk of adverse pregnancy outcomes in women diagnosed with autism. Design: Nationwide population-based cohort study. Setting: Sweden. Participants: Singleton births identified in the Swedish Medical Birth Registry, 2006-2014. A total of 2,198 births to women diagnosed with autism registered in the Swedish National Patient Registry were compared to 877,742 singleton births to women without such a diagnosis. Main outcome and measures: Preterm delivery. Secondary measures were cesarean delivery (emergency and elective), Apgar score amp;lt;7 at 5 minutes, small for gestational age, large for gestational age, stillbirth, gestational diabetes, and preeclampsia. ORs were calculated through logistic regression, adjusted for maternal age at delivery, maternal country of birth, smoking, maternal body mass index, parity, calendar year of birth, and psychotropic and antiepileptic medication during pregnancy. Results: Women with autism were at increased risk of preterm birth (OR=1.30; 95% CI=1.10-1.54), especially medically indicated preterm birth (OR=1.41; 95% CI=1.08-1.82), but not with spontaneous preterm birth. Maternal autism was also associated with an increased risk of elective cesarean delivery (OR=1.44; 95% CI=1.25-1.66) and preeclampsia (OR=1.34; 95% CI=1.08-1.66), but not with emergency cesarean delivery, low Apgar score (amp;lt;7), large for gestational age, gestational diabetes, and stillbirth. In women with medication during pregnancy, there was no increased risk of adverse pregnancy outcome except for induction of delivery (OR=1.33; 95% CI=1.14-1.55). Conclusion and relevance: Maternal autism is associated with preterm birth, likely due to an increased frequency of medically indicated preterm births, but also with other adverse pregnancy outcomes, suggesting a need for extra surveillance during prenatal care.

  • 395.
    Sundell, Anna Lena
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit. The Institute for Postgraduate Dental Education, Department of Paediatric Dentistry, Jönköping, Sweden.
    Children with orofacial clefts: dental caries and health-related quality of life2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background. The current understanding on caries and enamel developmental defects prevalence and frequency, caries risk, health-related quality life (HRQoL) and stress response in young children with cleft lip and/or palate (CL/P) are sparse. In this thesis these aspects were investigated in 5- and 10- year-old children with CL/P in comparison to non-cleft children in the same ages.

    Design. The studies in this thesis have a cross-sectional case-control design. Participants. The study group consisted of 139 children with CL/P (80 children aged 5 years and 59 aged 10 years) and 313 non-cleft controls (144 children aged 5 years and 169 aged 10 years).

    Method. Caries was scored according to International Caries Detection and Assessment System (ICDAS II) and developmental enamel defects were measured as presence and frequency of hypoplasia and hypomineralization. Oral hygiene was assessed using Quigley-Hein plaque index. Stimulated saliva samples were analyzed for mutans streptococci, lactobacilli, buffering capacity and secretion rates. Information regarding children’s oral hygiene routines, dietary habits and fluoride exposure were collected with questionnaires. Caries risk was evaluated with algorithm-based software, Cariogram while HRQoL was perceived with KIDSCREEN-52. Stress response was analyzed with cortisol concentration in saliva at three different time points using a commercial competitive radioimmunoassay.

    Results. Caries prevalence (36% versus 18%) and caries frequency (1.2 dmfs versus 0.9 dmfs) was significantly higher in 5-year-old children with CL/P in comparison to non-cleft controls. In 10-yearolds no significant difference was found between children with CL/P and non-cleft controls in caries prevalence (47% versus 38%) or in caries frequency (0.7 DMFS versus 0.5 DMFS). Children with CL/P had significantly higher prevalence of enamel defects, higher counts of salivary lactobacilli and less good oral hygiene. The odds of being categorized with high caries risk were elevated in children with CL/P. Children with CL/P had similar HRQoL and salivary cortisol concentrations as non-cleft controls. However, 10-year-old boys with CL/P had significantly higher cortisol concentrations in the evening than non-cleft boys.

    Conclusions. Preschool children with CL/P seem to have more caries in the primary dentition than non-cleft controls. Children with CL/P had increased odds of being categorized as high caries risk individuals compared to controls. Some of the contributing factors seem to be higher prevalence of enamel defects, impaired oral hygiene and elevated salivary lactobacilli. Furthermore, as measured with the help of cortisol concentrations in saliva, children with CL/P were not more stressed than noncleft controls and their HRQoL was comparable to a European norm population. It appears that regular comprehensive preventive oral care in children with CL/P is effective in preventing caries development in permanent teeth. However, children with CL/P are at risk of caries development and preventive oral care should be implemented and started earlier than today.

    List of papers
    1. Caries prevalence and enamel defects in 5-and 10-year-old children with cleft lip and/or palate: A case-control study
    Open this publication in new window or tab >>Caries prevalence and enamel defects in 5-and 10-year-old children with cleft lip and/or palate: A case-control study
    Show others...
    2016 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 74, no 2, p. 90-95Article in journal (Refereed) Published
    Abstract [en]

    Objective. To determine the prevalence of dental caries and enamel defects in 5- and 10-year-old Swedish children with cleft lip and/or palate (CL(P)) in comparison to non-cleft controls. Materials and methods. The study group consisted of 139 children with CL(P) (80 subjects aged 5 years and 59 aged 10 years) and 313 age-matched non-cleft controls. All children were examined by one of two calibrated examiners. Caries was scored according to the International Caries Detection and Assessment System (ICDAS-II) and enamel defects as presence and frequency of hypoplasia and hypomineralization. Results. The caries prevalence among the 5-year-old CL(P) children and the non-cleft controls was 36% and 18%, respectively (p &lt; 0.05). The CL(P) children had higher caries frequency (initial and cavitated lesions) in the primary dentition than their controls (1.2 vs 0.9; p &lt; 0.05). A significantly higher prevalence of enamel defects was found in CL(P) children of both age groups and anterior permanent teeth were most commonly affected. Conclusions. Preschool children with cleft lip and/or palate seem to have more caries in the primary dentition than age-matched non-cleft controls. Enamel defects were more common in CL(P) children in both age groups.

    Place, publisher, year, edition, pages
    TAYLOR & FRANCIS LTD, 2016
    Keywords
    Cleft palate; cleft lip and palate; dental caries; hypomineralization; hypoplasia
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-124077 (URN)10.3109/00016357.2015.1044562 (DOI)000366811600002 ()25972142 (PubMedID)
    Note

    Funding Agencies|FORSS Medical Research Council of Southeast Sweden; Futurum Academy of Health and Care Jonkoping County Council; Swedish Dental Association; Swedish Society of Paediatric Dentistry

    Available from: 2016-01-25 Created: 2016-01-19 Last updated: 2017-05-03
    2. Comparing caries risk profiles between 5-and 10-year-old children with cleft lip and/or palate and non-cleft controls
    Open this publication in new window or tab >>Comparing caries risk profiles between 5-and 10-year-old children with cleft lip and/or palate and non-cleft controls
    2015 (English)In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 15, no 85Article in journal (Refereed) Published
    Abstract [en]

    Background: Previous studies have suggested that children with oral clefts may have higher caries prevalence in comparison with non-cleft controls but the relative importance of the potential risk factors is not clear. The aim of this study was to compare the caries risk profiles in a group of cleft lip and/or palate (CL(P)) children with non-cleft controls in the same age using a computerized caries risk assessment model. Methods: The study group consisted of 133 children with CL(P) (77 subjects aged 5 years and 56 aged 10 years) and 297 non-cleft controls (133 aged 5 years and 164 aged 10 years). A questionnaire was used to collect data concerning the childs oral hygiene routines, dietary habits and fluoride exposure. Oral hygiene was assessed using Quigley-Hein plaque Index and the caries prevalence and frequency was scored according to the International Caries Detection and Assessment System. Whole saliva samples were analyzed for mutans streptococci, lactobacilli, buffering capacity and secretion rate. The risk factors and risk profiles were compared between the groups with aid of Cariogram and the estimated risk for future caries was categorized as "high" or "low". Results: Children with CL(P) (the entire study group) had significantly higher counts of salivary lactobacilli (p less than 0.05) and displayed less good oral hygiene (p less than 0.05). More 10-year-old children in the CL(P) group had low secretion rate but this difference was not significant. The average chance to avoid caries ranged from 59 to 67 % but there were no significant differences between the groups. The odds of being categorized with high caries risk in the CL(P) group was significantly elevated (OR = 1.89; 95 % CI = 1.25-2.86). In both groups, children in the high risk category had a higher caries experience than those with low risk. Conclusion: Children with CL(P) displayed increased odds of being categorized at high caries risk with impaired oral hygiene and elevated salivary lactobacilli counts as most influential factors. The results suggest that a caries risk assessment model should be applied in the routine CL(P) care as a basis for the clinical decision-making and implementation of primary and secondary caries prevention.

    Place, publisher, year, edition, pages
    BioMed Central, 2015
    Keywords
    Cleft lip; Cleft palate; Cleft lip and/or palate; Caries risk; Cariogram; Children
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-120739 (URN)10.1186/s12903-015-0067-x (DOI)000358428000002 ()26208495 (PubMedID)
    Note

    Funding Agencies|FORSS - Medical Research Council of Southeast Sweden, Futurum, - Academy of Health and Care Jonkoping County Council; Swedish Dental Association; Swedish Society of Paediatric Dentistry

    Available from: 2015-08-24 Created: 2015-08-24 Last updated: 2017-12-04
    3. A comparison of health-related quality of life in 5- and 10-year-old Swedish children with and without cleft lip and/or palate
    Open this publication in new window or tab >>A comparison of health-related quality of life in 5- and 10-year-old Swedish children with and without cleft lip and/or palate
    2017 (English)In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 27, no 4, p. 238-246Article in journal (Refereed) Published
    Abstract [en]

    Background The current understanding on health-related quality of life (HRQoL) in young Swedish children with cleft lip and/or palate (CL/P) is sparse, and therefore, research on impact of CL/P on HRQoL in children is needed.

    Aims To investigate HRQoL in 5- and 10-year-old Swedish children with CL/P in comparison with non-cleft controls. Also to analyse whether there were any differences in HRQoL between children with cleft lip (with or without cleft palate, CL ± P) and cleft palate only (CP) and/or gender differences. Design A total of 137 children with CL/P and 305 non-cleft controls participated. HRQoL was measured with KIDSCREEN-52.

    Results All children in the study exhibited HRQoL within or above the age-matched reference interval of the method with similar results in both groups; however, in the dimension ‘social support and peers’, the 10-year-old children with CL/P perceived lower HRQoL than the non-cleft controls, but it did not reach statistical significance. Type of cleft or gender did not influence HRQoL.

    Conclusions Both 5- and 10-year-old Swedish children with CL/P had HRQoL in the normal reference interval. Their general life situations were well adjusted to their clefts, but the older children with CL/P felt more excluded and less supported by peers.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2017
    National Category
    Surgery Dentistry
    Identifiers
    urn:nbn:se:liu:diva-132622 (URN)10.1111/ipd.12253 (DOI)000403011100002 ()27464906 (PubMedID)
    Available from: 2016-11-17 Created: 2016-11-17 Last updated: 2018-05-07Bibliographically approved
  • 396.
    Sundin, Jan
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department for Studies of Social Change and Culture, History and Media Studies.
    Not just one countryside: Life chances in pre-industrial Sweden2019In: Health Care and Government Policy / [ed] Laurinda Abreu, Publicações do Cidehus , 2019Chapter in book (Refereed)
    Abstract [en]

    The ‘urban penalty’, i.e. higher urban mortality compared with the countryside, existed at a national level in Sweden until the twentieth century. However, at a regional and local level, the urban-rural dichotomy was less true. In three countryside parishes in 1750-1859, three different patterns emerge. Socioeconomic and geographical factors defined life chances from cradle to grave. In a suburban parish, in a cohort born in the 1790s, about half of the females died before they were 30 years old and half of the males died before they were 20! This example is at the worse end of the scale with survival rates below the Swedish average – but it is not unique. In contrast, among those born during the same decade in a forest parish, about half of the females lived until they were 60 years old and half of the males were still alive at the age of 50! This second example is at the positive end with survival rates much better than the Swedish average. A third example, an iron foundry, had low infant mortality but high adult mortality, resulting in survival rates close to the Swedish average.

  • 397.
    Sundin, Jan
    Linköping University, Department for Studies of Social Change and Culture, History and Media Studies. Linköping University, Faculty of Arts and Sciences.
    Public Health is Politics2019In: Interchange, ISSN 0826-4805, E-ISSN 1573-1790Article in journal (Refereed)
    Abstract [en]

    ‘Public health’ investigates the determinants of health, born during the Enlightenment in the seventeenth/eighteenth century. But ‘public health’ is also policies, aiming at the improvement of a population’s health. There is a mutual interchange between public health as science and as politics. A brief historical background is followed by an analysis of the impacts of political changes during the first two decades of the twenty first century in Sweden. In 2005, a policy document accepted by all political parties except for the Moderate Party highlighted socio-economic factors and structural reforms to decrease the health gaps in the population. The general election in September 2006 resulted in a new majority in the parliament and a center-right coalition government, including the Moderates and three parties that had approved of the 2005 document. In 2007 a “new public health policy” was introduced. Its priority lists stressed individual behavior and the new policy should be incentives to work instead of “allowances”. The Public Health Institute got instructions in accordance with the new policy. The ten years following this policy change has seen public health policies and attitudes to research shifting almost year by year. The new policy met a counter-stream from the very beginning. Influenced by Michael Marmot’s WHO Commission on health inequalities, regional commissions started in Sweden, Recommendations how to decrease social health gaps was adopted with almost no opposition by regional health boards in 2012–2013. But new problems were now occupying politicians and media—how to finance the growth of the old, multi-sick part of the population and increasing costs for new medical technologies and drugs. Public health as an academic discipline was in the middle of this fluctuating political landscape with direct effects on what has been considered worth listening to or support by public money.

  • 398.
    Sundstrom, Johan
    et al.
    Uppsala Univ, Sweden; Uppsala Clin Res Ctr UCR, Sweden.
    Bjorkelund, Cecilia
    Univ Gothenburg, Sweden.
    Giedraitis, Vilmantas
    Uppsala Univ, Sweden.
    Hansson, Per-Olof
    Univ Gothenburg, Sweden.
    Högman, Marieann
    Uppsala Univ, Sweden.
    Janson, Christer
    Uppsala Univ, Sweden.
    Koupil, Ilona
    Stockholm Univ, Sweden; Karolinska Inst, Sweden.
    Kristensson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Trolle Lagerros, Ylva
    Karolinska Inst, Sweden; Karolinska Univ Hosp Huddinge, Sweden.
    Leppert, Jerzy
    Uppsala Univ, Sweden.
    Lind, Lars
    Uppsala Univ, Sweden.
    Lissner, Lauren
    Univ Gothenburg, Sweden.
    Johansson, Ingegerd
    Umea Univ, Sweden.
    Ludvigsso, Jonas F.
    Karolinska Inst, Sweden; Orebro Univ, Sweden.
    Nilsson, Peter M.
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Olsson, Hakan
    Lund Univ, Sweden.
    Pedersen, Nancy L.
    Karolinska Inst, Sweden.
    Rosenblad, Andreas
    Uppsala Univ, Sweden.
    Rosengren, Annika
    Univ Gothenburg, Sweden.
    Sandin, Sven
    Karolinska Inst, Sweden; Icahn Sch Med Mt Sinai, NY 10029 USA; Seaver Autism Ctr Res and Treatment Mt Sinai, NY USA.
    Snackerstrom, Tomas
    Uppsala Clin Res Ctr UCR, Sweden.
    Stenbeck, Magnus
    Karolinska Inst, Sweden.
    Soderberg, Stefan
    Umea Univ, Sweden; Umea Univ, Sweden.
    Weiderpass, Elisabete
    Karolinska Inst, Sweden; Inst Populat Based Canc Res, Norway; Univ Helsinki, Finland; Univ Tromso, Norway.
    Wanhainen, Ers
    Uppsala Univ, Sweden.
    Wennberg, Patrik
    Umea Univ, Sweden.
    Fortier, Isabel
    McGill Univ, Canada.
    Heller, Susanne
    Uppsala Clin Res Ctr UCR, Sweden.
    Storgards, Maria
    Uppsala Clin Res Ctr UCR, Sweden.
    Svennblad, Bodil
    Uppsala Clin Res Ctr UCR, Sweden.
    Rationale for a Swedish cohort consortium2019In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, no 1, p. 21-28Article in journal (Refereed)
    Abstract [en]

    We herein outline the rationale for a Swedish cohort consortium, aiming to facilitate greater use of Swedish cohorts for world-class research. Coordination of all Swedish prospective population-based cohorts in a common infrastructure would enable more precise research findings and facilitate research on rare exposures and outcomes, leading to better utilization of study participants data, better return of funders investments, and higher benefit to patients and populations. We motivate the proposed infrastructure partly by lessons learned from a pilot study encompassing data from 21 cohorts. We envisage a standing Swedish cohort consortium that would drive development of epidemiological research methods and strengthen the Swedish as well as international epidemiological competence, community, and competitiveness.

  • 399.
    Svanberg, Christina
    et al.
    Region Östergötland, Public Dental Health Care. County Council Jamtland, Sweden.
    Norevall, Lars-Inge
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ekman, Bertil
    Region Östergötland, Heart and Medicine Center, Department of Endocrinology. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Wahlberg Topp, Jeanette
    Region Östergötland, Heart and Medicine Center, Department of Endocrinology. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Bågesund, Mats
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Public Dental Health Care.
    Cephalometric analysis of adults with Turner syndrome2016In: Swedish Dental Journal, ISSN 0347-9994, Vol. 40, no 1, p. 33-41Article in journal (Refereed)
    Abstract [en]

    Turner syndrome (TS) is a genetic disorder of females with a prevalence of 1/2000-3000 live female births. The aim of this study was to compare cephalometric variables from adult women diagnosed with TS to a standardized reference group of 31-year old healthy women, and to evaluate the possible effects of human growth hormone (hGH) therapy in women with TS. Registered TS subjects in the Southeast region of Sweden were invited to take part in the study. Twenty-one women aged 36 +/- 13(18-57) years accepted participation. Lateral radiographs of the head were analyzed using standard cephalometric methods (Hasund analysis) and with the commercially available soft-ware program FACAD. Comparisons were made with roentgen-cephalometric standards from a reference group of nineteen 31-year old Swedish women. Analysis of the cephalometric radiographs from the TS subjects showed a more retrognathic maxilla (SNA 80.3 +/- 5.4) (p=0.0460) and mandible (SNB 77.0 +/- 5.2) (p=0.0014), and a correspondingly backward position of the chin (SN/Pg 78.9 +/- 5.5) (p=0.0046) as compared to the reference values of 31-year old women (SNA 83.2 +/- 3.0, SNB 81.5 +/- 2.3 and SNPg 83.0 +/- 2.3, respectively). In addition there was an increased posterior inclination of the maxilla (SN/NL 8.6 +/- 4.1), as compared to the reference values (SN/NL 5,3 +/- 2.7) (p=0.0048). There were no significant differences regarding sagittal or vertical jaw relations, mandibular inclination or cranial base angle between the TS-group and the 31-year olds with the reference values. No significant difference was seen in jaw relationship, as measured by the ANB value, however the Wits(index) (3.3 +/- 3.5) was higher (p=0.0001) than the reference values (-0.1 +/- 1.8). Subjects with or without previous hGH administration did not show any significant differences in cephalometric values. In conclusion, women with TS had a significantly more retrognathic maxilla (SNA) and mandible (SNB) and a correspondingly significantly posterior position of the chin (SN/Pg), a significantly increased posterior inclination of the maxilla (SN/NL) and a significantly increased Witsindex as compared to the reference group of 31-year old women. No craniofacial variables differed significantly between previously hGH-treated and not hGH-treated women with TS.

  • 400.
    Svefors, Pernilla
    et al.
    Uppsala Universitet, Uppsala, Sweden; Center for Epidemiology and Community Medicine, Stockholm, Sweden.
    Sysoev, Oleg
    Linköping University, Department of Computer and Information Science, The Division of Statistics and Machine Learning. Linköping University, Faculty of Arts and Sciences.
    Ekstrom, Eva-Charlotte
    Uppsala Universitet, Uppsala, Sweden.
    Persson, Lars Ake
    London School of Hygiene and Tropical Medicine, London, UK.
    Arifeen, Shams E
    International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
    Naved, Ruchira T
    International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
    Rahman, Anisur
    International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
    Khan, Ashraful Islam
    International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
    Selling, Katarina
    Uppsala Universitet, Uppsala, Sweden.
    Relative importance of prenatal and postnatal determinants of stunting: data mining approaches to the MINIMat cohort, Bangladesh2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 8Article in journal (Refereed)
    Abstract [en]

    Introduction WHO has set a goal to reduce the prevalence of stunted child growth by 40% by the year 2025. To reach this goal, it is imperative to establish the relative importance of risk factors for stunting to deliver appropriate interventions. Currently, most interventions take place in late infancy and early childhood. This study aimed to identify the most critical prenatal and postnatal determinants of linear growth 0–24 months and the risk factors for stunting at 2 years, and to identify subgroups with different growth trajectories and levels of stunting at 2 years.

    Methods Conditional inference tree-based methods were applied to the extensive Maternal and Infant Nutrition Interventions in Matlab trial database with 309 variables of 2723 children, their parents and living conditions, including socioeconomic, nutritional and other biological characteristics of the parents; maternal exposure to violence; household food security; breast and complementary feeding; and measurements of morbidity of the mothers during pregnancy and repeatedly of their children up to 24 months of age. Child anthropometry was measured monthly from birth to 12 months, thereafter quarterly to 24 months.

    Results Birth length and weight were the most critical factors for linear growth 0–24 months and stunting at 2 years, followed by maternal anthropometry and parental education. Conditions after birth, such as feeding practices and morbidity, were less strongly associated with linear growth trajectories and stunting at 2 years.

    Conclusion The results of this study emphasise the benefit of interventions before conception and during pregnancy to reach a substantial reduction in stunting.

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