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  • 401.
    Timpka, Toomas
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Eriksson, Olle
    Linköping University, Department of Computer and Information Science, Statistics. Linköping University, Faculty of Arts and Sciences.
    Spreco, Armin
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Gursky, Elin A
    National Strategies Support Directorate, ANSER/Analytic Services Inc, Arlington, Virginia, USA.
    Strömgren, Magnus
    Umeå University.
    Holm, Einar
    Umeå University.
    Ekberg, Joakim
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Dahlström, Örjan
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Valter, Lars
    Östergötlands Läns Landsting, Center for Health and Developmental Care, Center for Public Health.
    Eriksson, Henrik
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Age as a determinant for dissemination of seasonal and pandemic influenza: an open cohort study of influenza outbreaks in Östergötland County, Sweden2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 2, p. e31746-Article in journal (Refereed)
    Abstract [en]

    An understanding of the occurrence and comparative timing of influenza infections in different age groups is important for developing community response and disease control measures. This study uses data from a Scandinavian county (population 427.000) to investigate whether age was a determinant for being diagnosed with influenza 2005-2010 and to examine if age was associated with case timing during outbreaks. Aggregated demographic data were collected from Statistics Sweden, while influenza case data were collected from a county-wide electronic health record system. A logistic regression analysis was used to explore whether case risk was associated with age and outbreak. An analysis of variance was used to explore whether day for diagnosis was also associated to age and outbreak. The clinical case data were validated against case data from microbiological laboratories during one control year. The proportion of cases from the age groups 10-19 (p<0.001) and 20-29 years old (p<0.01) were found to be larger during the A pH1N1 outbreak in 2009 than during the seasonal outbreaks. An interaction between age and outbreak was observed (p<0.001) indicating a difference in age effects between circulating virus types; this interaction persisted for seasonal outbreaks only (p<0.001). The outbreaks also differed regarding when the age groups received their diagnosis (p<0.001). A post-hoc analysis showed a tendency for the young age groups, in particular the group 10-19 year olds, led outbreaks with influenza type A H1 circulating, while A H3N2 outbreaks displayed little variations in timing. The validation analysis showed a strong correlation (r = 0.625;p<0.001) between the recorded numbers of clinically and microbiologically defined influenza cases. Our findings demonstrate the complexity of age effects underlying the emergence of local influenza outbreaks. Disentangling these effects on the causal pathways will require an integrated information infrastructure for data collection and repeated studies of well-defined communities.

  • 402.
    Timpka, Toomas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Gursky, Elin A
    ANSER/Analytic Services Inc, Arlington, Virginia, USA.
    Spreco, Armin
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Eriksson, Olle
    Linköping University, Department of Computer and Information Science, Statistics. 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.
    Strömgren, Magnus
    Umeå University, Sweden.
    Holm, Einar
    Umeå University, Sweden.
    Ekberg, Joakim
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hinkula, Jorma
    Linköping University, Department of Clinical and Experimental Medicine, Molecular Virology. Linköping University, Faculty of Health Sciences.
    Nyce, Jim M
    Ball State University, Muncie, IN, USA..
    Eriksson, Henrik
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, The Institute of Technology.
    Predictive value of telenursing complaints in influenza surveillance: a prospective cohort study in Sweden2013Conference paper (Other academic)
  • 403.
    Timpka, Toomas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Jacobsson, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bargoria, Victor
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Moi Univ, Kenya.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Injury Pain in Track and Field Athletes: Cross-Sectional Study of Mediating Factors2019In: SPORTS, ISSN 2075-4663, Vol. 7, no 5, article id 110Article in journal (Refereed)
    Abstract [en]

    This exploratory study aimed to investigate whether data from track and field athletes support a conceptual model where the perception of pain affects self-evaluated health directly, yet is also indirectly mediated through personal factors and external stressors. A cross-sectional study was performed among athletes (n = 278) competing at the highest national level in the sport. Data for the dependent and independent variables were collected using the EuroQol-5 dimensions (EQ-5D) standardized measure of health status, and the mediator variables were collected by the Body Consciousness Scale (BCS-HA), Perceived Motivational Climate in Sport Questionnaire (PMCSQ), Commitment to Exercise Scale (CtES), and Brief Cope survey instruments. Two hundred and twenty-five (81%) athletes provided complete data sets. A strong direct association (c = -16.49; p amp;lt; 0.001) was found between pain and self-estimated health, and a global mediation was found through the mediators (mediation effect (ME), -1.814, 90% confidence interval (CI), -3.414, -0.351). Specific mediation was observed for body competence (ME, -0.721; 90% CI, -2.028, -0.097) and private body consciousness (ME, -0.514; 90% CI, -1.761, -0.017). In conclusion, we found a negative association between perceived pain and self-evaluated health among competitive track and field athletes, and we found that a portion of the association was mediated through mediating factors. Under the assumption that the analyzed pain data primarily represented noxious pain, the conceptual model of the relationships between pain and self-estimated health among high-level track and field athletes was supported.

  • 404.
    Timpka, Toomas
    et al.
    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.
    Jacobsson, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Swedish Athlet Assoc, Sweden.
    Bargoria, Victor
    Linköping University. Moi University, Kenya.
    Periard, Julien D.
    Aspetar Orthopaed and Sports Medical Hospital, Qatar.
    Racinais, Sebastien
    Aspetar Orthopaed and Sports Medical Hospital, Qatar.
    Ronsen, Ola
    Medical and Antidoping Commiss, Monaco; Aker Solut, Norway.
    Halje, Karin
    Region Östergötland, Local Health Care Services in Central Östergötland.
    Andersson, Christer A.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    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.
    Spreco, Armin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Edouard, Pascal
    University Hospital St Etienne, France; University of Lyon, France; Medical Commiss, France.
    Alonso, Juan-Manuel
    Medical and Antidoping Commiss, Monaco; Aspetar Orthopaed and Sports Medical Hospital, Qatar.
    Preparticipation predictors for championship injury and illness: cohort study at the Beijing 2015 International Association of Athletics Federations World Championships2017In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 51, no 4, p. 272-+Article in journal (Refereed)
    Abstract [en]

    Objectives To determine preparticipation predictors of injury and illness at a major Athletics championship. Methods A cohort study design was used. Before the 2015 International Association of Athletics Federations World Championships in Athletics, all 207 registered national teams were approached about partaking in a study of preparticipation health; 50 teams accepted. The athletes (n=957) in the participating teams were invited to complete a preparticipation health questionnaire (PHQ). New injuries and illnesses that occurred at the championships were prospectively recorded. Logistic regression analyses were performed with simple and multiple models using any in-championship injury and in-championship illness as outcomes. Results The PHQ was completed by 307 (32.1%) of the invited athletes; 116 athletes (38.3%) reported an injury symptom during the month before the championships, while 40 athletes (13%) reported an illness symptom. 20 (6.5%) of the participating athletes sustained a health problem during the championships. Endurance athletes were almost 10-fold more likely to sustain an in-championship illness than speed/power athletes (OR, 9.88; 95% CI 1.20 to 81.31; p=0.033). Participants reporting a preparticipation gradual-onset injury symptom were three times more likely (OR, 3.09; 95% CI 1.08 to 8.79; p=0.035) and those reporting an illness symptom causing anxiety were fivefold more likely (OR, 5.56; 95% CI 1.34 to 23.15; p=0.018) to sustain an in-championship injury. Summary and conclusions Analyses of preparticipation predictors of injury and illness at a major Athletics championship suggest that endurance athletes require particular clinical attention. Preparticipation symptoms causing anxiety are interesting predictors for in-championship health problems.

  • 405.
    Timpka, Toomas
    et al.
    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.
    Schyllander, Jan
    Swedish Civil Contingencies Agcy, Sweden.
    Ekman, Diana Stark
    Walden Univ, MN USA; Univ Skovde, Sweden.
    Ekman, Robert
    Chalmers Univ Technol, Sweden.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Kristenson, Karolina
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Jacobsson, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Community-level football injury epidemiology: traumatic injuries treated at Swedish emergency medical facilities2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 1, p. 94-99Article in journal (Refereed)
    Abstract [en]

    Despite the popularity of the sport, few studies have investigated community-level football injury patterns. This study examines football injuries treated at emergency medical facilities using data from three Swedish counties. An open-cohort design was used based on residents aged 0-59 years in three Swedish counties (pop. 645 520). Data were collected from emergency medical facilities in the study counties between 1 January 2007 and 31 December 2010. Injury frequencies and proportions for age groups stratified by sex were calculated with 95% confidence intervals (95% CIs) and displayed per diagnostic group and body location. Each year, more than 1/200 person aged 0-59 years sustained at least one injury during football play that required emergency medical care. The highest injury incidence was observed among adolescent boys [2009 injuries per 100 000 population years (95% CI 1914-2108)] and adolescent girls [1413 injuries per 100 000 population years (95% CI 1333-1498)]. For female adolescents and adults, knee joint/ligament injury was the outstanding injury type (20% in ages 13-17 years and 34% in ages 18-29 years). For children aged 7-12 years, more than half of the treated injuries involved the upper extremity; fractures constituted about one-third of these injuries. One of every 200 residents aged 0-59 years in typical Swedish counties each year sustained a traumatic football injury that required treatment in emergency healthcare. Further research on community-level patterns of overuse syndromes sustained by participation in football play is warranted.

  • 406.
    Tinghög, Petter
    et al.
    Department of Bioscience and Nutrition, Karolinska Institutet, Novum, Huddinge.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Kaati, Gunnar
    Department of Bioscience and Nutrition, Karolinska Institutet, Novum, Huddinge.
    Edvinsson, Sören
    Demographic Database, Umeå University, Umeå.
    Sjöström, Michael
    Department of Bioscience and Nutrition, Karolinska Institutet, Novum, Huddinge.
    Bygren, Lars Olov
    Department of Bioscience and Nutrition, Karolinska Institutet, Novum, Huddinge.
    Migration and mortality trajectories: a study of individuals born in the rural community of Överkalix, Sweden2011In: Social Science & Medicine, ISSN 0277-9536, Vol. 73, no 5, p. 744-751Article in journal (Refereed)
    Abstract [en]

    Migration may result in exposure to factors that are both beneficial and harmful for good health. How the act of migration is associated with mortality, or whether the socio-economic condition of migrants prior to migration influences their mortality trajectory, is not well understood. In the present study, a cohort of 413 randomly selected individuals born in the rural community of Överkalix, Sweden, between 1890 and 1935 were followed from birth to either death or old age. Around 50% of the study-population moved away from Överkalix at one time or another. To adjust for a potential bias resulting from self-selection among the migrants, the father’s occupational status was used together with parents’ and grandparents’ longevity. Overall, migration could not be shown to predict mortality when the backgrounds of the migrants were taken into account. Nonetheless, socio-economic background conditions appeared to moderate the association, decreasing the mortality rates for migrants with relatively good pre-migratory socio-economic conditions, while increasing it for migrants with poorer pre-migratory conditions. However, further scrutiny revealed that this effect modification mainly affected the female migrants’ mortality. In conclusion, the study suggests that there is no general association between migration and mortality, but that migrants with better socio-economic resources are more likely to improve their mortality trajectories than migrants with poorer resources. Better pre-migratory conditions hence appear to be important for avoiding health-adverse circumstances and gaining access to health beneficial living conditions when moving to foreign environments – especially for women.

  • 407.
    Tjulin, Åsa
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Workplace Social Relations in the Return-to-Work process2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to explore the impact of workplace social relations on the implementation of return-to-work interventions. The thesis consists of four separate papers with specific aims. In Paper I, the overall purpose of the study was to analyse how a multi-stakeholder return-to-work programme was implemented and experienced from the perspective of the stakeholders involved, i.e. supervisors, occupational health consultants and a project coordinator. The objective was to identify and analyse how these stakeholders perceived that the programme had been implemented in relation to its intentions. In Paper II, the objective was to explore how workplace actors experience social relations, and how organisational dynamics in workplace-based return-to-work start before and extend beyond the initial return of the sick-listed worker to the workplace. In Paper III, the objective was to explore the meaning of early contact in return-to-work, and how social relational actions and conditions can facilitate or impede early contact among workplace actors. In Paper IV, the objective was to explore the role of co-workers in the return-to-work process, and their contribution to the process, starting from when a colleague falls ill, continuing when he/she subsequently becomes sick-listed and finally when he/she re-enters the workgroup.

    The general methodological approach to the papers in this thesis has been explorative and interpretive; qualitative methods have been used, involving interviews, group interviews and collection of employer policies on return-to-work. The data material has been analysed through back-and-forth abductive (Paper I), and inductive (Papers II-IV) content analysis.

    The main findings from Paper I show that discrepancies in the interpretations of policy intentions between key stakeholders (project coordinator, occupational health consultants and supervisors) created barriers for implementing the employer-based return-to-work programme, due to lack of communication, support, coaching and training activities of key stakeholders dedicated to the biopsychosocial intentions of the programme. In Papers II-IV, the workplace actors (re-entering workers, co-workers, supervisors and/or human resources manager) experienced the return-to-work process as phases (time before the sick leave, when on sick leave, when re-entering the workplace, and future sustainability). The findings highlight the importance and relevance of the varied roles of the different workplace actors during the identified phases of the return-to-work process. In particular, the positive contribution of co-workers, and their experience of shifting demands and expectations during each phase, is acknowledged. During the period of time before sick leave the main findings show how workplace actors experience the meaning of early contact within a social relational context, and how early contact is more than an activity that is merely carried out (or not carried out). The findings show how workplace actors experience uncertainties about how and when contact should take place, and the need to balance possible infringement that early contact might cause for the re-entering worker between pressure to return to work and their private health management.

    The findings in this thesis show how the workplace is a socially complex dynamic setting, which challenges some static models of return-to-work. The biopsychosocial and ecological/case management models and policies for return-to-work have been criticised for neglecting social relations in a return-to-work process at the workplace. This thesis provides increased knowledge and explanations regarding important factors in workplace social relations that facilitate an understanding of what might “make or break” the return-to-work process.

    List of papers
    1. Experience of the Implementation of a Multi-Stakeholder Return-to-Work Programme
    Open this publication in new window or tab >>Experience of the Implementation of a Multi-Stakeholder Return-to-Work Programme
    2009 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 19, no 4, p. 409-418Article in journal (Refereed) Published
    Abstract [en]

    Introduction Employers can use several strategies to facilitate return-to-work for workers on sick leave, but there seems to be limited knowledge of how workplace-based interventions are actually implemented in organisations. One public Swedish employer initiated a return-to-work programme which incorporated interventions suggested by earlier research, e.g. multi-professional health assessment, case management, educational peer-support groups and adapted workplace training. The overall purpose of the study is to analyse how the programme was implemented and experienced in the organisation, from the perspective of involved stakeholders, i.e. supervisors, occupational health consultants and a project coordinator. The objective of this paper is to identify and analyse how these stakeholders perceived that the programme had been implemented in relation to its intentions. Methods A qualitative method was used, consisting of individual interviews with eight supervisors and the project leader. Two group interviews with five occupational health service consultants were also conducted. Results The study revealed barriers to the implementation of return-to-work interventions. Not all of the intended interventions had been implemented as expected in policy. One explanation is that the key stakeholders expressed a more biomedical, individual view of work ability, while the programme was based on a more holistic, biopsychosocial view. Conclusion Implementation of a return-to-work programme is an ongoing, long-term multi-level strategy, requiring time for reflection, stakeholder participation, openness to change of intervention activities, and continuous communication.

    Keywords
    Implementation; Qualitative; Return-to-work programme; Sweden; Workplace
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-21801 (URN)10.1007/s10926-009-9195-y (DOI)
    Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2017-12-13
    2. Exploring Workplace Actors Experiences of the Social Organization of Return-to-Work.
    Open this publication in new window or tab >>Exploring Workplace Actors Experiences of the Social Organization of Return-to-Work.
    2010 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 20, no 3, p. 311-321Article in journal (Refereed) Published
    Abstract [en]

    Introduction: There is a limited body of research on how the actual social exchange among workplace actors influences the practice of return-to-work. The objective of this study was to explore how workplace actors experience social relations at the workplace and how organizational dynamics in workplace-based return-to-work extends before and beyond the initial return of the sick listed worker to the workplace. Method An exploratory qualitative method approach was used, consisting of individual open-ended interviews with 33 workplace actors at seven worksites that had re-entering workers. The workplace actors represented in these interviews include: re-entering workers, supervisors, co-workers, and human resource managers. Results The analysis identified three distinct phases in the return to work process: while the worker is off work, when the worker returns back to work, and once back at work during the phase of sustainability of work ability. The two prominent themes that emerged across these phases include the theme of invisibility in relation to return-to-work effort and uncertainty, particularly, about how and when to enact return-to-work. Conclusion The findings strengthen the notion that workplace-based return-to-work interventions need to take social relations amongst workplace actors into account. They also highlight the importance and relevance of the varied roles of different workplace actors during two relatively unseen or grey areas, of return-to-work: the pre-return and the post-return sustainability phase. Attention to the invisibility of return-to-work efforts of some actors and uncertainty about how and when to enact return-to-work between workplace actors can promote successful and sustainable work ability for the re-entering worker.

    Place, publisher, year, edition, pages
    SpringerLink, 2010
    Keywords
    Social relations, Social organization, Workplace-based return-to-work, Qualitative
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-51369 (URN)10.1007/s10926-009-9209-9 (DOI)19844778 (PubMedID)
    Available from: 2009-10-29 Created: 2009-10-29 Last updated: 2017-12-12
    3. Exploring the meaning of early contact in return-to-work from workplace actors' perspective
    Open this publication in new window or tab >>Exploring the meaning of early contact in return-to-work from workplace actors' perspective
    2011 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 2, p. 137-145Article in journal (Refereed) Published
    Abstract [en]

    Purpose. The objective of this article was to explore the meaning of early contact in return-to-work, and how social relational actions and conditions can facilitate or impede early contact among actors in the workplace. Method. An exploratory qualitative method was used, consisting of individual open-ended interviews with 33 workplace actors at seven worksites across three public employers in Sweden. The workplace actors represented in these interviews included re-entering workers, supervisors, co-workers and human resources managers. Organisational policies on return-to-work were collected from the three employers. Results. The analysis indicated that early contact is a complex return-to-work measure with shifting incentives among workplace actors for making contact. For instance, the findings indicated obligation and responsibilities as incentives, incentives through social relations, and the need to acknowledge and balance the individual needs in relation to early contact. Conclusion. The findings strengthen the importance of early contact as a concept with a social relational context that comprises more than just an activity carried out (or not) by the employer, and suggest that early contact with a sick-listed worker is not always the best approach for a return-to-work situation. This study provides a starting point for a more articulated conceptualisation of early contact.

    Place, publisher, year, edition, pages
    Informa, 2011
    Keywords
    Early contact, return-to-work, Sweden
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-57253 (URN)10.3109/09638288.2010.489630 (DOI)000284952300007 ()20513163 (PubMedID)
    Note
    Original Publication: Åsa Tjulin, Ellen MacEachen and Kerstin Ekberg, Exploring the meaning of early contact in return-to-work from workplace actors' perspective, 2011, Disability and Rehabilitation, (33), 2, 137-145. http://dx.doi.org/10.3109/09638288.2010.489630 Copyright: Informa Healthcare http://informahealthcare.com/ Available from: 2010-06-15 Created: 2010-06-15 Last updated: 2017-12-12Bibliographically approved
    4. The social interaction of return-to-work explored from co-workers experinces.
    Open this publication in new window or tab >>The social interaction of return-to-work explored from co-workers experinces.
    2011 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 21-22, p. 1979-1989Article in journal (Refereed) Published
    Abstract [en]

    Purpose The objective was to explore the role and contribution of co-workers in the return-to-work process. The social interaction of co-workers and supervisors are analysed within the framework of the Swedish national and local employer organisational return-to-work policies.

    Methods An exploratory qualitative method was used, consisting of open-ended interviews with 33 workplace actors across seven work units. Organisational return-towork policies were collected from the three public sector employers.

    Results Three key themes about the return-to-work process emerged during analysis: (1) policies and organizational structure for return to work do not take co-workers into account; (2) return-to-work social demands and expectations interact with broader social interaction and attitudes in the workgroup; (3) supervisory management of return to workis linked to workgroup communication and management.

    Conclusion An examination of the role of co-workers suggests that the social location matters, and highlights how different return-to-work actors interpret the return-to-work situation differently. Employers and workplaces should consider re-integration of sicklisted workers in the light of workgroup social relations and acknowledge social interaction and the heterogeneous experiences of returning workers, supervisors and coworkers.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2011
    Keywords
    Return to work, Sweden, Co-workers, Social relations, Qualitative
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-57655 (URN)10.3109/09638288.2011.553708 (DOI)000295340600006 ()
    Note
    Funding agencies|Canadian Institutes of Health Research (CHIR)| FRN: 53909 |HELIX Vinn Excellence Centre, Linkoping University, Sweden||Institute for Work & Health, Toronto, Canada||Available from: 2010-06-28 Created: 2010-06-28 Last updated: 2017-12-12
  • 408.
    Tjulin, Åsa
    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.
    MacEachen, Ellen
    The Institute for Work & Health, Toronto, Canada.
    Edvardsson Stiwne, Elinor
    Linköping University, Department of Behavioural Sciences and Learning, Centre for Teaching 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.
    The social interaction of return-to-work explored from co-workers experinces.2011In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 21-22, p. 1979-1989Article in journal (Refereed)
    Abstract [en]

    Purpose The objective was to explore the role and contribution of co-workers in the return-to-work process. The social interaction of co-workers and supervisors are analysed within the framework of the Swedish national and local employer organisational return-to-work policies.

    Methods An exploratory qualitative method was used, consisting of open-ended interviews with 33 workplace actors across seven work units. Organisational return-towork policies were collected from the three public sector employers.

    Results Three key themes about the return-to-work process emerged during analysis: (1) policies and organizational structure for return to work do not take co-workers into account; (2) return-to-work social demands and expectations interact with broader social interaction and attitudes in the workgroup; (3) supervisory management of return to workis linked to workgroup communication and management.

    Conclusion An examination of the role of co-workers suggests that the social location matters, and highlights how different return-to-work actors interpret the return-to-work situation differently. Employers and workplaces should consider re-integration of sicklisted workers in the light of workgroup social relations and acknowledge social interaction and the heterogeneous experiences of returning workers, supervisors and coworkers.

  • 409.
    Tjulin, Åsa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    MacEachen, Ellen
    The Institute for Work and Health, Toronto, Canada.
    Ekberg, Kerstin
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Exploring the meaning of early contact in return-to-work from workplace actors' perspective2011In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 2, p. 137-145Article in journal (Refereed)
    Abstract [en]

    Purpose. The objective of this article was to explore the meaning of early contact in return-to-work, and how social relational actions and conditions can facilitate or impede early contact among actors in the workplace. Method. An exploratory qualitative method was used, consisting of individual open-ended interviews with 33 workplace actors at seven worksites across three public employers in Sweden. The workplace actors represented in these interviews included re-entering workers, supervisors, co-workers and human resources managers. Organisational policies on return-to-work were collected from the three employers. Results. The analysis indicated that early contact is a complex return-to-work measure with shifting incentives among workplace actors for making contact. For instance, the findings indicated obligation and responsibilities as incentives, incentives through social relations, and the need to acknowledge and balance the individual needs in relation to early contact. Conclusion. The findings strengthen the importance of early contact as a concept with a social relational context that comprises more than just an activity carried out (or not) by the employer, and suggest that early contact with a sick-listed worker is not always the best approach for a return-to-work situation. This study provides a starting point for a more articulated conceptualisation of early contact.

  • 410.
    Tondel, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Occupational and Environmental Medicine Centre.
    Malignancies in Sweden after the Chernobyl accident in 19862007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    On 26 April 1986 an accident occurred in the Chernobyl nuclear power plant resulting in the release of large amount of radionuclides. Almost five percent of the total released caesium-137 was deposited in Sweden. The incidence of malignancies in the most affected counties in Sweden was investigated in three epidemiological studies.

    In the first study the incidence of malignancies in children and adolescents was studied for the period 1978-1992. The parishes and their inhabitants were classified according to the ground deposition of caesium-137 on an analogue map provided be the Swedish Radiological Protection Authority. A continuous increase of brain tumour incidence observed during the time of the study had no clear relationship to the Chernobyl fallout. A somewhat decreased relative risk of ALL was observed in areas with increased deposition. Other malignancies showed no changes in incidence over time or with regard to the exposure of caesium-137. In study II and III we enlarged the study base by including adults. We improved the methodology by defining a cohort of subjects who lived in the same parish from 31 December 1985 to 31 December 1987. The inhabitants from seven counties were included. Parishes were classified the same way as in study I. Due to the large number of individuals six exposure categories could be created; <3, 3–29, 30–39, 40–59, 60–79, and 80–120 kBq caesium-137/m2. The inhabitants of the 117 non-affected parishes (<3 kBq/m2) served as reference. During the 1988-1996 followup, 22,409 malignancies were recorded. The MH-IRR in the fully adjusted model was 1.00 (reference), 1.05, 1.03, 1.08, 1.10 and 1.21, respectively. ERR was 0.11 per 100 kBq/m2 (95% CL 0.03;0.20). A more advanced method was used in Study III by ignoring the exposure classification for parishes, and instead matching the dwelling coordinate to a digital map of deposition of casesium-137. In spite of a more valid exposure classification the risk estimates were similar in study II and III. Also, the ERR during the longer follow-up of 1988-1999 was almost identical, 0.10 per 100 kBq/m2 (95% CL 0.00;0.23). The strongest dose-response relationship was seen in the first four years (1988-1991). No obvious excess for leukaemia or thyroid cancer was recognised in either study II or III. The estimated number of exposure related cases was calculated to 849 in study II and 1,278 in study III. Our interpretation is that we have shown an increased incidence of total malignancies with dose-response relationship for caesium-137, only a few years after the Chernobyl accident. In study IV we compared the two different ways of classifying the exposure in study II and III. Out of the 450 parishes 111 got a different classification. The similar risk estimates in study II and III could probably be explained by relatively homogenous exposure in the parishes making the intra-parish difference less influential, especially when included in categories. In study V we examined the urinary excretion of 8-OHdG in Belarussian children from areas with high and low fallout of caesium-137, respectively. We found significantly lower urinary 8-OHdG levels in children from rural contaminated areas compared to urban uncontaminated areas, suggesting an urban, rather than a radiation related, risk factor.

    Using the Hill criteria for causality there is support for a causal inference between the fallout of caesium-137 from the Chernobyl accident and the increased incidence in total malignancies in Northern Sweden.

    List of papers
    1. Incidence of neoplasms in ages 0-19 y in parts of Sweden with high 137Cs fallout after the Chernobyl accident
    Open this publication in new window or tab >>Incidence of neoplasms in ages 0-19 y in parts of Sweden with high 137Cs fallout after the Chernobyl accident
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    1996 (English)In: Health Physics, ISSN 0017-9078, Vol. 71, no 6, p. 947-950Article in journal (Refereed) Published
    Abstract [en]

    The incidence of neoplasms in childhood and adolescence in northern and central Sweden before and after the radioactive fallout from the Chernobyl accident was investigated in an ecologic study, 1978 to 1992. The study included all parishes in the six most contaminated counties classified after aerial mapping of ground radiation from 137Cs and investigated 746 cases of neoplasms in ages 0-19 y, diagnosed in the six counties. Incidence and relative risks of neoplasms were compared in areas with high, intermediate, and low contamination after versus before the Chernobyl accident in 1986. A continuous increase of brain tumor incidence in the ages 0-19 y during the period 1978-92 without clear relationship to the Chernobyl fallout was discovered. No clear relationship between the incidence of brain tumor and the exposure to varying levels of radiation from 137Cs was apparent. A somewhat decreased relative risk of acute lymphatic leukemia appeared in areas with increased exposure. Other neoplasms showed no changes in incidence over time or with regard to exposure. Until now, there is no indication that the Chernobyl accident has affected the incidence of childhood and adolescence neoplasms in Sweden, but it is still too early for any final conclusion about the effect of this event.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14505 (URN)
    Available from: 2007-05-15 Created: 2007-05-15 Last updated: 2018-10-08
    2. Increase of regional total cancer incidence in North Sweden due to the Chernobyl accident?
    Open this publication in new window or tab >>Increase of regional total cancer incidence in North Sweden due to the Chernobyl accident?
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    2004 (English)In: Journal of epidemiology and community health, ISSN 0143-005X, Vol. 58, no 12, p. 1011-1016Article in journal (Refereed) Published
    Abstract [en]

    Study objective: Is there any epidemiologically visible influence on the cancer incidence after the Chernobyl fallout in Sweden?

    Design: A cohort study was focused on the fallout of caesium-137 in relation to cancer incidence 1988–1996.

    Setting: In northern Sweden, affected by the Chernobyl accident in 1986, 450 parishes were categorised by caesium-137 deposition: <3 (reference), 3–29, 30–39, 40–59, 60–79, and 80–120 kiloBecquerel/m2.

    Participants: All people 0–60 years living in these parishes in 1986 to 1987 were identified and enrolled in a cohort of 1 143 182 persons. In the follow up 22 409 incident cancer cases were retrieved in 1988–1996. A further analysis focused on the secular trend.

    Main results: Taking age and population density as confounding factors, and lung cancer incidence in 1988–1996 and total cancer incidence in 1986–1987 by municipality as proxy confounders for smoking and time trends, respectively, the adjusted relative risks for the deposition categories were 1.00 (reference <3 kiloBecquerel/m2), 1.05, 1.03, 1.08, 1.10, and 1.21. The excess relative risk was 0.11 per 100 kiloBecquerel/m2 (95% CI 0.03 to 0.20). Considering the secular trend, directly age standardised cancer incidence rate differences per 100 000 person years between 1988 to 1996 and the reference period 1986–1987, were 30.3 (indicating a time trend in the reference category), 36.8, 42.0, 45.8, 50.1, and 56.4. No clear excess occurred for leukaemia or thyroid cancer.

    Conclusions: Unless attributable to chance or remaining uncontrolled confounding, a slight exposure related increase in total cancer incidence has occurred in northern Sweden after the Chernobyl accident.

    Keywords
    ionising radiation, epidemiology, environment
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14506 (URN)10.1136/jech.2003.017988 (DOI)
    Available from: 2007-05-15 Created: 2007-05-15 Last updated: 2018-10-08
    3. Increased incidence of malignancies in Sweden after the Chernobyl accident: a promoting effect?
    Open this publication in new window or tab >>Increased incidence of malignancies in Sweden after the Chernobyl accident: a promoting effect?
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    2006 (English)In: American Journal of Industrial Medicine, ISSN 0271-3586, Vol. 49, no 3, p. 159-168Article in journal (Refereed) Published
    Abstract [en]

    Background After the Chernobyl accident in 1986, as much as 5% of the released caesium-137 was deposited in Sweden due to a heavy rainfall 2 days after the event. A study of increased incidence of malignancies was initiated after the accident.

    Methods The cohort included 1,137,106 inhabitants who were 0-60 years old in 1986 and lived in 8 counties of Sweden with the highest fallout of caesium-137. With the dwelling coordinate, GIS-technique and a digital map on caesium-137, each individual was matched for the exposure. Adjustments were made for several potential confounding factors. During the follow-up 33,851 malignancies was recorded 1988-1999.

    Results Exposure categories were: 0-8 (reference), 9-23, 24-43, 44-66, 67-84, and 85 nGy/hr. The corresponding adjusted Mantel-Haenszel incidence rate ratios for total malignancies during follow-up amounted to 1.000, 0.997, 1.072, 1.114, 1.068, 1.125, respectively. The excess relative risk per 100 nGy/hr with the same adjustments and time period was 0.042 95% confidence limit 0.001;0.084. An excess for thyroid cancer or leukemia could not be ruled out.

    Conclusion Increased incidence of total malignancies possibly related to the fallout from the Chernobyl accident is seen.

    Keywords
    caesium-137, ionising radiation, nuclear power, low dose, epidemiology, environment, background radiation, cancer, GIS, cohort
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14507 (URN)10.1002/ajim.20271 (DOI)
    Available from: 2007-05-15 Created: 2007-05-15 Last updated: 2018-02-20
    4. Parish classification or dwelling coordinate for exposure assessment in environmental epidemiology: A comparative study using Geographical information System
    Open this publication in new window or tab >>Parish classification or dwelling coordinate for exposure assessment in environmental epidemiology: A comparative study using Geographical information System
    2008 (English)In: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 405, no 1-3, p. 324-329Article in journal (Refereed) Published
    Abstract [en]

    Background: Two previous epidemiological studies on the incidence of total malignancies in Sweden after the Chernobyl accident have shown consistently increased risks. The first study used an analogue map on (CS)-C-137 from 1986 to classify individuals in terms of the parish they lived in. In the second study, dwelling coordinates were matched to a digital map from the year 2000 to assess the individual exposure. To establish the accuracy of the exposure assessment using the larger unit of parish, instead of coordinates, we decided to compare the methods.

    Methods: On the analogue map eleven isolines on the deposition of Cs-137 (kBq/m(2)) were used to classify all individuals in each of the 450 parishes. Using the digital map, by contrast, each dwelling with its inhabitants could be matched to Cs-137 deposition at a coordinate level. A population-weighted average of Cs-137 deposition was calculated for each parish. In total, 1,126,960 individuals and 450 parishes were included and analysed into six different exposure categories.

    Results: Using the new parish exposure index, 111 out of the 450 parishes were reclassified as a result of the increased resolution of the digital map (86 parishes) or unequal distribution of the population compared with the deposition (25 parishes). Seventy-five per cent of the parishes remained in the same exposure category as on the analogue map.

    Conclusion: Using dwelling coordinates for exposure assessment may not always be superior to parish classification. Nor is it always a cost-effective way of estimating the exposure, especially if the exposure in a parish is relatively homogenous or if parishes can be merged into broader categories with little intra-parish difference.

    Keywords
    Analysis, Caesium-137, Chernobyl, Disease, GIS, Health, Malignancies, Method, Spatial
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16141 (URN)10.1016/j.scitotenv.2008.07.019 (DOI)
    Available from: 2009-01-08 Created: 2009-01-07 Last updated: 2017-12-14
    5. Urinary 8-hydroxydeoxyguanosine in Belarussian children relates to urban living rather than radiation dose after the Chernobyl accident: A pilot study
    Open this publication in new window or tab >>Urinary 8-hydroxydeoxyguanosine in Belarussian children relates to urban living rather than radiation dose after the Chernobyl accident: A pilot study
    Show others...
    2005 (English)In: Archives of Environmental Contamination and Toxicology, ISSN 0090-4341, Vol. 48, no 4, p. 515-519Article in journal (Refereed) Published
    Abstract [en]

    As a result of the Chernobyl accident in 1986, exposure to radioactive cesium is still a concern in the contaminated regions of Belarus. We tested the hypothesis that long-term radiation exposure from the Chernobyl accident might increase the urinary excretion of the oxidative stress marker, 8-hydroxydeoxyguanosine (8-OHdG), in Belarussian children. Urinary 8-OHdG was determined in two groups of children (—n = 31 and n = 46) —living in contaminated and uncontaminated areas of Belarus, respectively (the majority of the unexposed children lived in the capital Minsk). The children from the contaminated areas had a significantly higher annual summary effective dose but significantly lower urinary 8-OHdG levels than the children from the uncontaminated areas. Unexpectedly, children living in uncontaminated urban areas had significantly higher urinary 8-OHdG levels than children living in uncontaminated rural areas. There was no statistically significant effect of sex or body mass index on urinary 8-OHdG, but there was a weak significant inverse correlation to age as well as to the annual summary effective dose. These findings suggest that radiation from the Chernobyl accident is now a less important contributor to oxidative stress in Belarussian children than urban living.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14509 (URN)10.1007/s00244-004-0079-z (DOI)
    Available from: 2007-05-15 Created: 2007-05-15 Last updated: 2009-06-05
  • 411.
    Tran, Dien M.
    et al.
    Vietnam National Children’s Hospital, Hanoi, Vietnam,.
    Larsson, Mattias
    Training and Research Academic Collaboration Sweden-Vietnam / Department of Public Health Sciences, Karolinska Institutet, Sweden.
    Olson, Linus
    Training and Research Academic Collaboration Sweden-Vietnam / Department of Public Health Sciences, Karolinska Institutet, Sweden.
    Hoang, Ngoc T.B.
    Vietnam National Children’s Hospital, Hanoi, Vietnam.
    Le, Ngai K.
    Vietnam National Children’s Hospital, Hanoi, Vietnam / Training and Research Academic Collaboration Sweden-Vietnam.
    Khu, Dung T.K.
    Vietnam National Children’s Hospital, Hanoi, Vietnam / Training and Research Academic Collaboration Sweden-Vietnam.
    Nguyen, Hung D.
    St Paul Hospital, Hanoi, Vietnam.
    Vu, Tam V.
    Uong Bi Hospital, Quang Ninh, Vietnam.
    Trinh, Tinh H.
    Binh Dinh General Hospital, Vietnam.
    Le, Thinh Q.
    Children’s Hospital 1, Ho Chi Minh City (HCMC), Vietnam.
    Phan, Phuong T.T.
    Phu San Hanoi, Vietnam.
    Nguyen, Binh G.
    Bach Mai Hospital, Hanoi, Vietnam.
    Pham, Nhung H.
    Bach Mai Hospital, Hanoi, Vietnam.
    Mai, Bang H.
    108 Military Central Hospital, Hanoi, Vietnam.
    Nguyen, Tuan V.
    108 Military Central Hospital, Hanoi, Vietnam.
    Nguyen, Phuong T.K.
    108 Military Central Hospital, Hanoi, Vietnam.
    Le, Nhan D.
    Da Nang General Hospital, Vietnam.
    Huynh, Tuan M.
    University Medical Clinic, HCMC, Vietnam.
    Thu, Le T.H.
    Cho Ray Hospital, HCMC, Vietnam.
    Thanh, Tran Chi
    Training and Research Academic Collaboration Sweden-Vietnam.
    Berglund, Björn
    Vietnam National Children’s Hospital, Hanoi, Vietnam / St Paul Hospital, Hanoi, Vietnam.
    Nilsson, Lennart E.
    Vietnam National Children’s Hospital, Hanoi, Vietnam / St Paul Hospital, Hanoi, Vietnam.
    Bornefall, Elin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences.
    Song, Le H.
    108 Military Central Hospital, Hanoi, Vietnam.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases. Training and Research Academic Collaboration Sweden-Vietnam.
    High prevalence of colonisation with carbapenem-resistant Enterobacteriaceae among patients admitted to Vietnamese hospitals: Risk factors and burden of disease2019In: Journal of Infection, ISSN 0163-4453, E-ISSN 1532-2742, Vol. 79, no 2, p. 115-122Article in journal (Refereed)
    Abstract [en]

    Background

    Carbapenem-resistant Enterobacteriaceae (CRE) is an increasing problem worldwide, but particularly problematic in low- and middle-income countries (LMIC) due to limitations of resources for surveillance of CRE and infection prevention and control (IPC).

    Methods

    A point prevalence survey (PPS) with screening for colonisation with CRE was conducted on 2233 patients admitted to neonatal, paediatric and adult care at 12 Vietnamese hospitals located in northern, central and southern Vietnam during 2017 and 2018. CRE colonisation was determined by culturing of faecal specimens on selective agar for CRE. Risk factors for CRE colonisation were evaluated. A CRE admission and discharge screening sub-study was conducted among one of the most vulnerable patient groups; infants treated at an 80-bed Neonatal ICU from March throughout June 2017 to assess CRE acquisition, hospital-acquired infection (HAI) and treatment outcome.

    Results

    A total of 1165 (52%) patients were colonised with CRE, most commonly Klebsiella pneumoniae (n=805), Escherichia coli (n=682) and Enterobacter spp. (n=61). Duration of hospital stay, HAI and treatment with a carbapenem were independent risk factors for CRE colonisation. The PPS showed that the prevalence of CRE colonisation increased on average 4.2 % per day and mean CRE colonisation rates increased from 13% on the day of admission to 89% at day 15 of hospital stay. At the NICU CRE colonisation increased from 32% at admission to 87% at discharge, mortality was significantly associated (OR 5•5, P < 0•01) with CRE colonisation and HAI on admission.

    Conclusion

    These data indicate that there is an epidemic spread of CRE in Vietnamese hospitals with rapid transmission to hospitalised patients.

  • 412.
    Tu, Jiong
    Linköping University, Department of Medicine and Health Sciences, Health and Society.
    Privatisation of Health Care in Transitional China: A Study of Private Clinics at the County Level2010Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The thesis examines the privatisation of China's health care since the 1980s, focusingon the privatisation of primary health care at the county level. The research choosesprivate clinics as research objects, includes a brief historical description of privatehealth care evolution and the existing health care system in China; based on theempirical data collected in the field work, it provides a current picture of private clinicand its privatisation process in a Chinese city, discusses the problems in privatemedical practice and challenges private clinic faces, and the influence of privatisationon health sector performance.The thesis notes the privatisation of primary health care by private clinics supplies analternative way for health care services. It plays a significant role in compensatingpublic system and promotes more equal health access, although the radicalprivatisation of all health sectors undermines the accessibility and quality of healthservices in general. Currently the private health sector in China is still small and yet toform a mature market, and there are multiple challenges for its further development,but it can be expected that the private sector in the health care area will expand rapidly,and China could hopefully find a suitable way of public/private mix under the newhealth reform.

  • 413.
    Vallejo-Vaz, Antonio J.
    et al.
    Imperial Coll London, England.
    De Marco, Martina
    Imperial Coll London, England.
    Stevens, Christophe A. T.
    Imperial Coll London, England.
    Akram, Asif
    Living Goods, Kenya.
    Freiberger, Tomas
    Ctr Cardiovasc Surg and Transplantat, Czech Republic; Masaryk Univ, Czech Republic.
    Hovingh, G. Kees
    Acad Med Ctr, Netherlands.
    Kastelein, John J. P.
    Acad Med Ctr, Netherlands.
    Mata, Pedro
    Fdn Hipercolesterolemia Familiar, Spain.
    Raal, Frederick J.
    Univ Witwatersrand, South Africa.
    Santos, Raul D.
    Univ Sao Paulo, Brazil; Hosp Israelita Albert Einstein, Brazil.
    Soran, Handrean
    Manchester Univ Hosp NHS Fdn Trust, England.
    Watts, Gerald F.
    Univ Western Australia, Australia; Royal Perth Hosp, Australia; FH Australasia Network FHAN, Australia.
    Abifadel, Marianne
    St Joseph Univ, Lebanon.
    Aguilar-Salinas, Carlos A.
    Inst Nacl Ciencias Med and Nutr Salvador Zubiran, Mexico.
    Al-Khnifsawi, Mutaz
    Al Qadisiyah Univ, Iraq.
    AlKindi, Fahad A.
    Hamad Med Corp, Qatar.
    Alnouri, Fahad
    Prince Sultan Cardiac Ctr Riyadh, Saudi Arabia.
    Alonso, Rodrigo
    Clin Las Condes, Chile.
    Al-Rasadi, Khalid
    Sultan Qaboos Univ Hosp, Oman.
    Al-Sarraf, Ahmad
    Kuwait Canc Control Ctr, Kuwait.
    Ashavaid, Tester F.
    PD Hinduja Natl Hosp and Med Res Ctr, India.
    Binder, Christoph J.
    Med Univ Vienna, Austria.
    Bogsrud, Martin P.
    Oslo Univ Hosp, Norway; Oslo Univ Hosp, Norway.
    Bourbon, Mafalda
    Inst Nacl Saude Doutor Ricardo Jorge, Portugal; Univ Lisbon, Portugal.
    Bruckert, Eric
    Hop La Pitie Salpetriere, France; Hop La Pitie Salpetriere, France.
    Chlebus, Krzysztof
    Med Univ Gdansk, Poland; Univ Clin Ctr, Poland.
    Corral, Pablo
    FASTA Univ, Argentina.
    Descamps, Olivier
    Ctr Hosp Jolimont, Belgium.
    Durst, Ronen
    Hadassah Hebrew Univ Med Ctr, Israel; Hadassah Hebrew Univ Med Ctr, Israel.
    Ezhov, Marat
    Minist Hlth Russian Federat, Russia.
    Fras, Zlatko
    Univ Med Ctr Ljubljana, Slovenia; Univ Ljubljana, Slovenia.
    Genest, Jacques
    McGill Univ, Canada.
    Groselj, Urh
    Univ Med Ctr Ljubljana, Slovenia.
    Harada-Shiba, Mariko
    Natl Cerebral and Cardiovasc Ctr, Japan.
    Kayikcioglu, Meral
    Ege Univ, Turkey.
    Lalic, Katarina
    Univ Belgrade, Serbia; Clin Ctr Serbia, Serbia.
    Lam, Carolyn S. P.
    Natl Heart Ctr, Singapore; Duke NUS Med Sch, Singapore.
    Latkovskis, Gustavs
    Univ Latvia, Latvia.
    Laufs, Ulrich
    Univ Klinikum Leipzig, Germany.
    Liberopoulos, Evangelos
    Univ Ioannina, Greece.
    Lin, Jie
    Capital Med Univ, Peoples R China.
    Maher, Vincent
    Adv Lipid Management and Res ALMAR Ctr, Ireland.
    Majano, Nelson
    Hosp Mil Caracas, Venezuela.
    Marais, A. David
    Univ Cape Town, South Africa; Natl Hlth Lab Serv, South Africa.
    Maerz, Winfried
    Heidelberg Univ, Germany; Med Univ Graz, Austria; Synlab Holding Deutschland GmbH, Germany; Synlab Holding Deutschland GmbH, Germany; D A CH Gesell Pravent Herz Kreislauf Erkrankungen, Germany.
    Mirrakhimov, Erkin
    Kyrgyz State Med Acad, Kyrgyzstan.
    Miserez, Andre R.
    Swiss FH Ctr, Switzerland; Univ Basel, Switzerland.
    Mitchenko, Olena
    Natl Acad Med Sci Ukraine, Ukraine.
    Nawawi, Hapizah M.
    Inst Pathol Lab and Forens Med I PPerForM, Malaysia; Univ Teknol Malaysia, Malaysia.
    Nordestgaard, Borge G.
    Copenhagen Univ Hosp, Denmark; Copenhagen Univ Hosp, Denmark; Univ Copenhagen, Denmark.
    Paragh, Gyorgy
    Univ Debrecen, Hungary.
    Petrulioniene, Zaneta
    Vilnius Univ, Lithuania; Vilnius Univ Hosp Santaros Klin, Lithuania.
    Pojskic, Belma
    Cantonal Hosp Zenica, Bosnia and Herceg.
    Postadzhiyan, Arman
    Med Univ Sofia, Bulgaria.
    Reda, Ashraf
    Menoufia Univ, Egypt; Egyptian Assoc Vernacular Biol and Atherosclerosis, Egypt.
    Reiner, Zeljko
    Univ Zagreb, Croatia.
    Sadoh, Wilson E.
    Univ Benin, Nigeria.
    Sahebkar, Amirhossein
    Mashhad Univ Med Sci, Iran; Mashhad Univ Med Sci, Iran; Mashhad Univ Med Sci, Iran.
    Shehab, Abdullah
    United Arab Emirates Univ, U Arab Emirates.
    Shek, Aleksander B.
    Minist Hlth Republ Uzbekistan, Uzbekistan.
    Stoll, Mario
    Honorary Commiss Cardiovasc Hlth CHSCV, Uruguay.
    Su, Ta-Chen
    Natl Taiwan Univ Hosp, Taiwan.
    Subramaniam, Tavintharan
    Admiralty Med Ctr, Singapore; Khoo Teck Puat Hosp, Singapore; Khoo Teck Puat Hosp, Singapore.
    Susekov, Andrey V.
    Acad Postgrad Med Educ, Russia; Acad Med Sci, Russia.
    Symeonides, Phivos
    Hippocrateon Private Hosp, Cyprus.
    Tilney, Myra
    Univ Malta, Malta; Mater Dei Hosp, Malta.
    Tomlinson, Brian
    Chinese Univ Hong Kong, Peoples R China.
    Thanh-Huong, Truong
    Hanoi Med Univ, Vietnam; Bach Mai Hosp, Vietnam.
    Tselepis, Alexandros D.
    Univ Ioannina, Greece.
    Tybjaerg-Hansenb, Anne
    Copenhagen Univ Hosp, Denmark; Copenhagen Univ Hosp, Denmark; Univ Copenhagen, Denmark; Copenhagen Univ Hosp, Denmark.
    Vazquez-Cardenas, Alejandra
    Univ Autonoma Guadalajara, Mexico.
    Viigimaa, Margus
    Tallinn Univ Technol, Estonia.
    Vohnout, Branislav
    Slovak Med Univ, Slovakia.
    Widen, Elisabeth
    Univ Helsinki, Finland.
    Yamashita, Shizuya
    Rinku Gen Med Ctr, Japan; Osaka Univ, Japan.
    Banach, Maciej
    Med Univ Lodz, Poland.
    Gaita, Dan
    Univ Med and Farm Victor Babes Timisoara, Romania.
    Jiang, Lixin
    Natl Ctr Cardiovasc Dis, Peoples R China.
    Nilsson, Lennart
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Santos, Lourdes E.
    Univ Philippines, Philippines.
    Schunkert, Heribert
    Tech Univ Munich, Germany.
    Tokgozoglu, Lale
    Hacettepe Univ, Turkey.
    Car, Josip
    Imperial Coll London, England; Nanyang Technol Univ, Singapore.
    Catapano, Alberico L.
    Univ Milan, Italy; IRCCS MultiMed, Italy.
    Ray, Kausik K.
    Imperial Coll London, England.
    Overview of the current status of familial hypercholesterolaemia care in over 60 countries - The EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC)2018In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 277, p. 234-255Article in journal (Refereed)
    Abstract [en]

    Background and aims: Management of familial hypercholesterolaemia (FH) may vary across different settings due to factors related to population characteristics, practice, resources and/or policies. We conducted a survey among the worldwide network of EAS FHSC Lead Investigators to provide an overview of FH status in different countries. Methods: Lead Investigators from countries formally involved in the EAS FHSC by mid-May 2018 were invited to provide a brief report on FH status in their countries, including available information, programmes, initiatives, and management. Results: 63 countries provided reports. Data on FH prevalence are lacking in most countries. Where available, data tend to align with recent estimates, suggesting a higher frequency than that traditionally considered. Low rates of FH detection are reported across all regions. National registries and education programmes to improve FH awareness/knowledge are a recognised priority, but funding is often lacking. In most countries, diagnosis primarily relies on the Dutch Lipid Clinics Network criteria. Although available in many countries, genetic testing is not widely implemented (frequent cost issues). There are only a few national official government programmes for FH. Under-treatment is an issue. FH therapy is not universally reimbursed. PCSK9-inhibitors are available in similar to 2/3 countries. Lipoprotein-apheresis is offered in similar to 60% countries, although access is limited. Conclusions: FH is a recognised public health concern. Management varies widely across countries, with overall suboptimal identification and under-treatment. Efforts and initiatives to improve FH knowledge and management are underway, including development of national registries, but support, particularly from health authorities, and better funding are greatly needed.

  • 414.
    van Vliet, Jolanda S.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Balancing body perception during growth and development2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Among children and adolescents, the drive to be slender and the fear of being fat is a growing public health concern. This trend stands in contrast to the increasing prevalence of overweight reported worldwide. Both feeling too fat and being overweight are associated with physical, psychological and social health-related issues from a shortand long-term perspective. The aim of this thesis is to study body perception in relation to actual body size and the bodily changes that occur naturally during puberty. Another objective is to identify risk factors for overweight, overweight perception and unhealthy eating habits in childhood and adolescence.

    This thesis describes the prevalence of 1) perception of overweight, 2) overweight/obesity and 3) unhealthy eating habits in Finland and Sweden. We compare our results with the World Health Organization (WHO) Health Behaviour in Schoolchildren (HBSC) survey in 2001/2002 and 2009/2010. Our cross-sectional studies were performed on a female cohort of 11-18 year old girls in Finland and a cohort of boys and girls 7-17 years in Sweden.

    In both Finland and Sweden, the prevalence of overweight increased over time, especially among boys. Also perception of overweight increased over time – not just among girls, but also among boys. We found social inequality in overweight, particularly in boys in relation to maternal socioeconomic status. No social inequality, but age and gender differences were found in relation to perception of overweight, where girls older than 13 years showed the highest prevalence. Body perception among girls agreed better with international reference values for waist circumference (WC) than for body mass index (BMI). Breast development and acne increased the risk for overweight perception, particularly among non-overweight girls. Perception of overweight was the strongest risk factor for dieting and skipping breakfast in both boys and girls. These behaviours were more common among adolescents than among younger boys and girls. Skipping breakfast was related to unbalanced food consumption patterns in both sexes, but in a gender-specific way.

    We have shown that body perception during growth and development relates to a complex age- and gender-specific balance between body size, stage and timing of pubertal maturation, eating habits as well as parental and peer influences. From a broader perspective, improving adequate body perception entails optimising this balance by influencing one or more of the individual, societal and environmental factors that determine health outcomes among children and adolescents, tracking into adulthood.

    List of papers
    1. Waist circumference in relation to body perception reported by Finnish adolescent girls and their mothers
    Open this publication in new window or tab >>Waist circumference in relation to body perception reported by Finnish adolescent girls and their mothers
    Show others...
    2009 (English)In: ACTA PAEDIATRICA, ISSN 0803-5253, Vol. 98, no 3, p. 501-506Article in journal (Refereed) Published
    Abstract [en]

    Aim: To study how waist circumference (WC) relates to body perception in adolescent girls and to maternal perception of the girls body size.

    Methods: Three hundred and four girls, 11-18 years, were measured for height, weight and WC. 294 girls provided self-report data on weight, height and body image before anthropometric measurements. Paired data from 237 girls and mothers on perception of the girls body size were collected.

    Results: In girls, self-reported weight indicated awareness of actual body size. The girls body perception showed an overestimation of body size relative to international reference values for body mass index (BMI) (p &lt; 0.05), but not for WC. Girls body perception exceeded that of their mothers (p &lt; 0.05). Maternal perception agreed better than the girls perception with international reference values for BMI (p &lt; 0.05). No significant difference between mothers and girls were found concerning agreement of body perception with international reference values for WC.

    Conclusion: WC rather than BMI agrees with perception of body size, possibly due to its relation to abdominal fat at different ages. For effective prevention and treatment programmes for weight-related health problems among adolescent girls, we recommend measuring WC to diminish the discrepancy between measured and perceived body size.

    Keywords
    Adolescent girls, Body mass index, Body perception, Maternal perception, Waist circumference
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16890 (URN)10.1111/j.1651-2227.2008.01112.x (DOI)
    Available from: 2009-02-22 Created: 2009-02-20 Last updated: 2016-01-12
    2. Overweight perception among adolescent girls in relation to appearance of female characteristics
    Open this publication in new window or tab >>Overweight perception among adolescent girls in relation to appearance of female characteristics
    2014 (English)In: Paediatrics and Health, ISSN 2052-935X, Vol. 2, no 1, p. 1-7Article in journal (Refereed) Published
    Abstract [en]

    Background: Overweight perception has been shown to be important for health related adolescent behavior, particularly in girls. Body perception may be affected by bodily changes, especially changes visible for others. Female pubertal development is characterized by many physical changes, such as accelerated growth and altered body fat distribution. This study examined the role of appearance of female characteristics in the risk for overweight perception among healthy adolescent girls.

    Methods: 220 girls, aged 11–16, provided self-reports on body perception and pubertal maturation before anthropometric measurements of height, weight, hip and waist circumference (WC). Logistic regression modeling was used to study the appearance of pubertal characteristics in relation to body perception.

    Results: Of the 76 girls (35%) perceiving themselves as overweight, only 14 and 36 girls were overweight according to body mass index and waist circumference respectively. Girls reporting breast development and acne (n=144) were more likely to perceive themselves as overweight than girls who did not report this appearance (n=76). These findings persist after adjusting for overweight according to WC. Non-overweight (n=170) rather than overweight girls reporting characteristics (n=50) were at risk of perceiving themselves overweight.

    Conclusions: Girls may confuse natural changes occurring during adolescent development with being overweight. It is therefore important to improve the understanding about the physical changes that normally occur during puberty along with the girls' own perception of these bodily changes among girls themselves, their parents, at schools, and other healthcare services.

    Place, publisher, year, edition, pages
    Herbert Open Access Journals, 2014
    Keywords
    Adolescent girls, self-reports, body perception, female pubertal development, anthropometric measurements
    National Category
    Clinical Science
    Identifiers
    urn:nbn:se:liu:diva-113130 (URN)10.7243/2052-935X-2-1 (DOI)
    Available from: 2015-01-12 Created: 2015-01-12 Last updated: 2016-01-12
    3. Social inequality and age-specific gender differences in overweight and perception of overweight among Swedish children and adolescents: a cross-sectional study
    Open this publication in new window or tab >>Social inequality and age-specific gender differences in overweight and perception of overweight among Swedish children and adolescents: a cross-sectional study
    2015 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, no 628Article in journal (Refereed) Published
    Abstract [en]

    Background: Overweight among children and adolescents related to social inequality, as well as age and gender differences, may contribute to poor self-image, thereby raising important public health concerns. This study explores social inequality in relation to overweight and perception of overweight among 263 boys and girls, age 7 to 17, in Vaxjo, Sweden. Methods: Data were obtained through a questionnaire and from physical measurements of height, weight and waist circumference [WC]. To assess social, age and gender differences in relation to overweight, the independent sample t- and chi-square tests were used, while logistic regression modeling was used to study determinants for perception of overweight. Results: Social inequality and gender differences as they relate to high ISO-BMI [Body Mass Index for children] and WC were associated with low maternal socioeconomic status [SES] among boys less than 13 years [mean age = 10.4; n = 65] and with low paternal education level among boys = 13 years [mean age = 15.0; n = 39] [p less than 0.05]. One suggested explanation for this finding is maternal impact on boys during childhood and the influence of the father as a role model for adolescent boys. The only association found among girls was between high ISO-BMI in girls = 13 years [mean age = 15.0; n = 74] and low paternal occupational status. Concerning perception of overweight, age and gender differences were found, but social inequality was not the case. Among boys and girls less than 13 years, perception of overweight increased only when overweight was actually present according to BMI or WC [p less than 0.01]. Girls = 13 years [mean age = 15.0] were more likely to unrealistically perceive themselves as overweight or "too fat," despite factual measurements to the contrary, than boys [p less than 0.05] and girls less than 13 years [mean age = 10.4; n = 83] [p less than 0.001]. Conclusions: The association between social inequality and overweight in adolescence in this study is age-and gender-specific. Gender differences, especially in perception of overweight, tend to increase with age, indicating that adolescence is a crucial period. When planning interventions to prevent overweight and obesity among children and adolescents, parental SES as well as age and gender-specific differences in social norms and perception of body weight status should be taken into account.

    Place, publisher, year, edition, pages
    BioMed Central, 2015
    Keywords
    Social inequality; Overweight; Obesity; Perception of overweight; Childhood; Adolescence
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-120339 (URN)10.1186/s12889-015-1985-x (DOI)000357559600001 ()26156095 (PubMedID)
    Note

    Funding Agencies|Erik Johan Ljungberg Educational Fund; County Council of Ostergotland; Medical Research Council of Southeast Sweden [FORSS-233111]

    Available from: 2015-07-31 Created: 2015-07-31 Last updated: 2017-12-04
    4. Feeling ‘too fat’ rather than being ‘too fat’ increases unhealthy eating habits among adolescents – even in boys
    Open this publication in new window or tab >>Feeling ‘too fat’ rather than being ‘too fat’ increases unhealthy eating habits among adolescents – even in boys
    2016 (English)In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 60, article id 29530Article in journal (Refereed) Published
    Abstract [en]

    Background: Adolescence is a period of gender-specific physical changes, during which eating habits develop. To better understand what factors determine unhealthy eating habits such as dieting to lose weight, skipping meals and consumption of unhealthy foods, we studied how physical measurements and body perception relate to eating habits in boys and girls, before and during adolescence.

    Methods: For this cross-sectional study, we obtained data from both written questionnaires and physical measurements of height, weight and waist circumference (WC).

    Results: Dieting to lose weight and skipping breakfast were more common among adolescents than among younger boys and girls (p<0.05). The strongest risk factor for dieting in both boys and girls was perception of overweight, which persisted after adjusting for age and for being overweight (p<0.01). Another independent risk factor for dieting behaviour was overweight, as defined by body mass index (BMI) among boys (p<0.01) and WC among girls (p<0.05). In both boys and girls, skipping breakfast was associated with both a more negative body perception and higher BMI (p<0.05). Skipping breakfast was also associated with age- and gender-specific unhealthy eating habits such as skipping other meals, lower consumption of fruits and vegetables, and higher consumption of sweets and sugary drinks (p<0.05).

    Conclusion: Body perception among adolescents is an important factor relating to unhealthy eating habits, not only in girls, but even in boys. Focus on body perception and eating breakfast daily is crucial for the development of healthy food consumption behaviours during adolescence and tracking into adulthood.

    Place, publisher, year, edition, pages
    Co-Action Publishing, 2016
    Keywords
    Body image, overweight, adolescent behaviour, food habits, prevention
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-123852 (URN)10.3402/fnr.v60.29530 (DOI)000370126700001 ()
    Note

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

    Funding agencies:  Erik Johan Ljungberg Educational Fund; County Council of Ostergotland; Medical Research Council of south-east Sweden [FORSS-233111]

    Available from: 2016-01-11 Created: 2016-01-11 Last updated: 2017-12-01Bibliographically approved
  • 415.
    Veronese, N.
    et al.
    Department of Medicine - DIMED, Geriatrics section, University of Padova, Padova, Italy.
    Cereda, E.
    Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
    Solmi, M
    Department of Neurosciences, University of Padova, Padova, Italy.
    Fowler, S.A.
    Becker Medical Library, Washington University, St Louis, MO, USA.
    Manzato, E
    Department of Medicine - DIMED, Geriatrics section, University of Padova, Padova, Italy; National Research Council, Institute of Neuroscience, Padova, Italy.
    Maggi, S
    National Research Council, Institute of Neuroscience, Padova, Italy.
    Manu, P
    The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA; Hofstra North Shore LIJ School of Medicine, Hemstead, New York, USA; The Feinstein Institute for Medical Research, Manhasset, New York, USA; Albert Einstein College of Medicine, Bronx, New York, USA.
    Abe, E
    Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan.
    Hayashi, K
    Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan.
    Allard, J.P.
    Toronto General Hospital, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada.
    Arendt, B.M.
    Toronto General Hospital, University Health Network, Toronto, Canada.
    Beck, A
    Research Unit for Nutrition (EFFECT), Herlev University Hospital, Herlev, Denmark.
    Chan, M
    Department of Geriatric Medicine, Tan Tock Seng Hospital, Jalan, Tan Tock Seng, Singapore.
    Audrey, Y.J.P.
    Department of Geriatric Medicine, Tan Tock Seng Hospital, Jalan, Tan Tock Seng, Singapore.
    Lin, W-Y
    Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
    Hsu, H-S
    Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
    Lin, C-C
    Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
    Diekmann, R
    Institute for Biomedicine of Aging, Friedrich-Alexander Universität Erlangen-Nurnberg, Nurnberg, Germany.
    Kimyagarov, S
    The Gilad Geriatric Center, Ramat-Gan, Israel.
    Miller, M
    Nutrition and Dietetics, Flinders University, Adelaide, Australia.
    Cameron, I.D.
    Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia.
    Pitkälä, K.H.
    Unit of Primary Health Care, Department of General Practice, Helsinki University Central Hospital, Helsinki, Finland.
    Lee, J
    The S.H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
    Woo, J
    The S.H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
    Nakamura, K
    Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
    Smiley, D
    Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
    Umpierrez, G
    Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
    Rondanelli, M
    Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, University of Pavia, Pavia, Italy.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Valentini, L
    Section of Dietetics, Department of Agriculture and Food Sciences, University of Applied Sciences, Neubrandenburg, Germany.
    Schindler, K
    Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Italy.
    Törmä, J
    Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
    Volpato, S
    Department of Medical Sciences, University of Ferrara, Ferrar, Italy.
    Zuliani, G
    Department of Medical Sciences, University of Ferrara, Ferrar, Italy.
    Wong, M
    Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
    Lok, K
    Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
    Kane, J.M.
    The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA; Hofstra North Shore LIJ School of Medicine, Hemstead, New York, USA; The Feinstein Institute for Medical Research, Manhasset, New York, USA; Albert Einstein College of Medicine, Bronx, New York, USA.
    Sergi, G
    Department of Medicine - DIMED, Geriatrics section, University of Padova, Padova, Italy.
    Correll, C.U.
    The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA; Hofstra North Shore LIJ School of Medicine, Hemstead, New York, USA; The Feinstein Institute for Medical Research, Manhasset, New York, USA; Albert Einstein College of Medicine, Bronx, New York, USA.
    Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects2015In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 16, no 11, p. 1001-1015Article, review/survey (Refereed)
    Abstract [en]

    Body mass index (BMI) and mortality in old adults from the general population have been related in a U-shaped or J-shaped curve. However, limited information is available for elderly nursing home populations, particularly about specific cause of death. A systematic PubMed/EMBASE/CINAHL/SCOPUS search until 31 May 2014 without language restrictions was conducted. As no published study reported mortality in standard BMI groups (<18.5, 18.5–24.9, 25–29.9, ≥30 kg/m2), the most adjusted hazard ratios (HRs) according to a pre-defined list of covariates were obtained from authors and pooled by random-effect model across each BMI category. Out of 342 hits, 20 studies including 19,538 older nursing home residents with 5,223 deaths during a median of 2 years of follow-up were meta-analysed. Compared with normal weight, all-cause mortality HRs were 1.41 (95% CI = 1.26–1.58) for underweight, 0.85 (95% CI = 0.73–0.99) for overweight and 0.74 (95% CI = 0.57–0.96) for obesity. Underweight was a risk factor for higher mortality caused by infections (HR = 1.65 [95% CI = 1.13–2.40]). RR results corroborated primary HR results, with additionally lower infection-related mortality in overweight and obese than in normal-weight individuals. Like in the general population, underweight is a risk factor for mortality in old nursing home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting.

  • 416.
    Vikström Eckevall, Josefin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    The influence of infertility and in vitro fertilization treatment on postpartum and long-term mental health in women2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: It is estimated that about 10-15% of couples suffer from infertility, i.e. the inability to achieve a clinical pregnancy after at least one year of regular, unprotected intercourse and that between 2-5% of births are a result of in vitro fertilization (IVF) treatment. Infertility and its treatment can have adverse effects on psychological well-being. While previous studies on postpartum depression (PPD) in IVF women suffer some methodological issues, there are no published studies on the risk of postpartum psychosis (PPP) after IVF pregnancies. Long-term, most women adjust well emotionally after IVF treatment but some, especially the childless, still suffer negative consequences. Meanwhile, few studies have extended beyond the first decade after treatment. Some studies have found that the childless elderly have social networks of less support potential but most show that psychological well-being is not affected by parental status. None of the studies have focused on the oldest old (≥85 years) and many have excluded those who live in institutional care, thus the frailest.

    Objective: The overall aim of this thesis was to study postpartum mental health in women who have undergone IVF treatment, using psychiatric diagnoses as outcomes, while controlling for major PPD and PPP risk factors as well as to determine the influences of childlessness, infertility and IVF treatment on long-term mental health in women. Materials and methods: Studies I-II are register-based, case control studies of 3532 (I) and 10,412 (II) primiparous women included in the Swedish IVF register. A control group of 8,553 (I) and 18,624 (II) primiparous women with spontaneous conceptions was selected from the Medical Birth Register. The main outcomes were PPD and PPP diagnoses the 1st year postpartum collected from the National Patient Register. Studies III-IV are cross-sectional. Study III included 470 women who had undergone IVF treatment 20-23 years previously. The Symptom Checklist-90 was used to investigate self-reported mental health. The results were compared with those from a population-based study and by parental status group. Study IV included 496 85-year olds. Psychological well-being, living situation, demographics and social network was investigated through a questionnaire and an interview.

    Results: Study I-II: There were no differences between the IVF and control group in the risk of receiving a PPD or PPP diagnosis. Having previously been diagnosed with any psychiatric, an affective or personality disorder increased  the risk of PPD while any previous psychiatric, psychotic, bipolar, depressive, anxiety or personality disorder diagnosis increased the risk of PPP. None of the women had committed suicide. Study III: The IVF women reported symptoms of higher intensity and were at increased risk of symptoms of depression, obsessive-compulsion and somatisation compared with the reference group. Childless women, compared with parents, reported a higher level of mental health problems as well as symptoms of depression and phobic anxiety. Study IV: No differences in psychological wellbeing, living situation or having friends close by were found across parental status groups. The childless 85-year olds were less likely to have relatives close by and to receive help.

    Discussion: This thesis indicates that the risk of receiving a PPD or PPP diagnosis from in- or outpatient psychiatric care or of committing suicide during the first year postpartum is not increased in women who have undergone IVF treatment. Any negative effects of infertility and its treatment might have been mitigated by the “healthy patient effect”; those who choose to enter treatment are generally psychologically robust. A history of mental illness is a major risk factor for PPD and PPP. The risk of some adverse symptoms of mental illness might be increased in women who have undergone IVF treatment twenty years previously, especially in those who have remained childless. The childless elderly appear to have social networks of less support potential but are not more likely to live in institutional care and do not experience more adverse effects on psychological well-being than the elderly who are parents.

    List of papers
    1. Risk of postnatal depression or suicide after in vitro fertilisation treatment: a nationwide case–control study
    Open this publication in new window or tab >>Risk of postnatal depression or suicide after in vitro fertilisation treatment: a nationwide case–control study
    Show others...
    2017 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 124, no 3, p. 435-442Article in journal (Refereed) Published
    Abstract [en]

    Objective

    To examine whether women who undergo in vitro fertilisation (IVF) treatment are at greater risk of postnatal suicide or postnatal depression (PND) requiring psychiatric care, compared with women who conceive spontaneously.

    Design

    Case–control study using data from national registers.

    Setting

    Sweden during the period 2003–2009.

    Population

    Cases were 3532 primiparous women who had given birth following IVF treatment. An aged-matched control group of 8553 mothers was randomly selected from the medical birth register.

    Methods

    Logistic regression analyses were performed with PND as the outcome, and with known risk factors of PND as well as IVF/spontaneous birth as covariates.

    Main outcome measures

    Postnatal depression (PND), defined as diagnoses F32–F39 of the tenth edition of the International Classification of Diseases (ICD–10), within 12 months of childbirth.

    Results

    Initial analyses showed that PND was more common in the control group than in the IVF group (0.8 versus 0.4%; P = 0.04); however, these differences disappeared when confounding factors were controlled for. A history of any psychiatric illness (P = 0.000; odds ratio, OR = 25.5; 95% confidence interval, 95% CI = 11.7–55.5), any previous affective disorder (P = 0.000; OR = 26.0; 95% CI = 10.5–64.0), or specifically a personality disorder (P = 0.028; OR = 3.8; 95% CI = 1.2–12.7) increased the risk of PND. No woman in either group committed suicide during the first year after childbirth.

    Conclusions

    Whereas mothers who receive IVF treatment are not at increased risk of PND, the risk is increased among mothers with a history of mental illness. Tweetable abstract A Swedish study on 3532 women showed that IVF treatment does not increase the risk of postnatal depression.

    Place, publisher, year, edition, pages
    Chichester: Wiley-Blackwell Publishing Inc., 2017
    Keywords
    In vitro fertilisation, infertility treatment, postnatal depression, postnatal mental illness
    National Category
    Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology Geriatrics General Practice
    Identifiers
    urn:nbn:se:liu:diva-132763 (URN)10.1111/1471-0528.13788 (DOI)000397007500016 ()26663705 (PubMedID)2-s2.0-84983109530 (Scopus ID)
    Available from: 2016-11-23 Created: 2016-11-23 Last updated: 2019-06-28Bibliographically approved
    2. Mental health in women 20-23 years after IVF treatment: a Swedish cross-sectional study
    Open this publication in new window or tab >>Mental health in women 20-23 years after IVF treatment: a Swedish cross-sectional study
    2015 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 10, p. e009426-Article in journal (Refereed) Published
    Abstract [en]

    Objective To assess self-perceived mental health in women treated with in vitro fertilisation (IVF) 20-23years previously, while comparing them to a reference group, and to determine any differences in mental health between those who had given birth, those who had adopted a child, those who had given birth and adopted a child and those who remained childless. Design A cross-sectional study. Setting A Center of Reproductive Medicine (RMC) at a Swedish University hospital. Participants 520 women who had undergone at least one IVF cycle at the University Hospital in Linkoping between 1986 and 1989. 504 of 520 women (97%) were eligible for follow-up. While 34 women declined, 93 per cent (n=470) of the women agreed to participate. The reference group consisted of 150 women of the Swedish population included in a study that was used to validate the Symptom CheckList (SCL)-90. Interventions Follow-up was conducted in 2008-2009. The SCL-90 was used to measure the womens self-perceived mental health and a questionnaire specific for this study was used to retain demographic information. Outcome measures The SCL-90 assesses 9 primary dimensions; somatisation, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism. There is also a global index of distress. Results Women who had previously undergone IVF treatment were at increased risk of symptoms of depression (p=0.017), obsessive-compulsion (p=0.02) and somatisation (p0.001) when compared to a reference group. In addition, the women who have remained childless are at increased risk of symptoms of depression (p=0.009) and phobic anxiety (p=0.017). Conclusions The majority of the women who have been treated with IVF 20-23years previously appear to be in good mental health. However, women who remain childless and/or without partner after unsuccessful infertility treatment constitute a vulnerable group even later on in life.

    Place, publisher, year, edition, pages
    BMJ PUBLISHING GROUP, 2015
    Keywords
    Infertility; childlessness; MENTAL HEALTH; IVF; depression
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-123849 (URN)10.1136/bmjopen-2015-009426 (DOI)000365467600111 ()26510732 (PubMedID)
    Note

    Funding Agencies|Health Research Council in the south east of Sweden

    Available from: 2016-01-11 Created: 2016-01-11 Last updated: 2019-06-28
    3. The influences of childlessness on the psychological well-being and social network of the oldest old
    Open this publication in new window or tab >>The influences of childlessness on the psychological well-being and social network of the oldest old
    Show others...
    2011 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 11, no 78Article in journal (Refereed) Published
    Abstract [en]

    Background: The ELSA 85 project is a population-based study with the purpose to learn more about the “elderly elderly”. The aim of this part of the ELSA 85 study is to explore the effects of childlessness on the psychological wellbeing, living situation and social support of 85-year old individuals.

    Methods: A postal questionnaire was sent to all (650) 85-year old men and women living in Linköping Municipality in 2007. Psychological well-being and social network was measured using a number of questions.

    Results: 496 individuals participated in the study. No differences in psychological wellbeing were found between the 85-year olds who were childless and those who were parents. The childless 85-year olds were less likely to have relatives close by and to receive help than those who were parents. Individuals of both groups were equally likely to end up in institutional care, to have friends close by and to be in contact with neighbours.

    Conclusions: Even though elderly childless individuals have social networks of less support potential than those who are parents there are no differences in certain psychological wellbeing indicators between the two groups. Apparently, childless elderly individuals find ways to cope with whatever negative effects of childlessness they may have experienced.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-73616 (URN)10.1186/1471-2318-11-78 (DOI)000208731700078 ()
    Available from: 2012-01-10 Created: 2012-01-10 Last updated: 2017-12-08Bibliographically approved
  • 417.
    Vikström, Josefin
    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.
    Sydsjö, Gunilla
    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, Department of Gynaecology and Obstetrics in Linköping.
    Hammar, Mats
    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, Department of Gynaecology and Obstetrics in Linköping.
    Bladh, Marie
    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, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health.
    Risk of postnatal depression or suicide after in vitro fertilisation treatment: a nationwide case–control study2017In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 124, no 3, p. 435-442Article in journal (Refereed)
    Abstract [en]

    Objective

    To examine whether women who undergo in vitro fertilisation (IVF) treatment are at greater risk of postnatal suicide or postnatal depression (PND) requiring psychiatric care, compared with women who conceive spontaneously.

    Design

    Case–control study using data from national registers.

    Setting

    Sweden during the period 2003–2009.

    Population

    Cases were 3532 primiparous women who had given birth following IVF treatment. An aged-matched control group of 8553 mothers was randomly selected from the medical birth register.

    Methods

    Logistic regression analyses were performed with PND as the outcome, and with known risk factors of PND as well as IVF/spontaneous birth as covariates.

    Main outcome measures

    Postnatal depression (PND), defined as diagnoses F32–F39 of the tenth edition of the International Classification of Diseases (ICD–10), within 12 months of childbirth.

    Results

    Initial analyses showed that PND was more common in the control group than in the IVF group (0.8 versus 0.4%; P = 0.04); however, these differences disappeared when confounding factors were controlled for. A history of any psychiatric illness (P = 0.000; odds ratio, OR = 25.5; 95% confidence interval, 95% CI = 11.7–55.5), any previous affective disorder (P = 0.000; OR = 26.0; 95% CI = 10.5–64.0), or specifically a personality disorder (P = 0.028; OR = 3.8; 95% CI = 1.2–12.7) increased the risk of PND. No woman in either group committed suicide during the first year after childbirth.

    Conclusions

    Whereas mothers who receive IVF treatment are not at increased risk of PND, the risk is increased among mothers with a history of mental illness. Tweetable abstract A Swedish study on 3532 women showed that IVF treatment does not increase the risk of postnatal depression.

  • 418.
    Vogt, Hartmut
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Bråbäck, Lennart
    Occupational & Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Zetterström, Olof
    Linköping University, Department of Clinical and Experimental Medicine, Allergy Centre. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Allergy Center.
    Zara, Katalin
    Linköping University, Department of Clinical and Experimental Medicine, Allergy Centre. Linköping University, Faculty of Health Sciences.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Nilsson, Lennart
    Linköping University, Department of Clinical and Experimental Medicine, Allergy Centre. Linköping University, Faculty of Health Sciences.
    Asthma heredity, cord blood IgE and asthma-related symptoms and medication in adulthood: a long-term follow-up in a Swedish birth cohort2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 6, p. e66777.-Article in journal (Refereed)
    Abstract [en]

    Cord blood IgE has previously been studied as a possible predictor of asthma and allergic diseases. Results from different studies have been contradictory, and most have focused on high-risk infants and early infancy. Few studies have followed their study population into adulthood. This study assessed whether cord blood IgE levels and a family history of asthma were associated with, and could predict, asthma medication and allergy-related respiratory symptoms in adults.

    A follow-up was carried out in a Swedish birth cohort comprising 1701 consecutively born children. In all, 1661 individuals could be linked to the Swedish Prescribed Drug Register and the Medical Birth Register, and 1227 responded to a postal questionnaire. Cord blood IgE and family history of asthma were correlated with reported respiratory symptoms and dispensed asthma medication at 32–34 years.

    Elevated cord blood IgE was associated with a two- to threefold increased risk of pollen-induced respiratory symptoms and dispensed anti-inflammatory asthma medication. Similarly, a family history of asthma was associated with an increased risk of pollen-induced respiratory symptoms and anti-inflammatory medication. However, only 8% of the individuals with elevated cord blood IgE or a family history of asthma in infancy could be linked to current dispensation of anti-inflammatory asthma medication at follow-up.

    Elevated cord blood IgE and a positive family history of asthma were associated with reported respiratory symptoms and dispensed asthma medication in adulthood, but their predictive power was poor in this long-time follow-up.

  • 419.
    Waldréus, Nana
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Thirst in Patients with Heart Failure: Description of thirst dimensions and associated factors with thirst2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Nurses and other health care professionals meet patients with heart failure (HF) who report they are thirsty. Thirst is described by the patients as a concern, and it is distressing. Currently there are no standardized procedures to identify patients with increased thirst or to help a patient to manage troublesome thirst and research in the area of thirst is scarce. In order to prevent and relieve troublesome thirst more knowledge is needed on how thirst is experienced and what factors cause increased thirst.

    Aim: The aim of this thesis was to describe the thirst experience of patients with HF and describe the relationship of thirst with physiologic, psychologic and situational factors. The goal was to contribute to the improvement of the care by identifying needs and possible approaches to prevent and relieve thirst in patients with HF.

    Methods: The studies in this thesis used a cross-sectional design (Study I) and prospective observational designs (II-IV). Studies include data from patients with HF who were admitted to the emergency department for deterioration in HF (I, IV) or visited an outpatient HF clinic for worsening of HF symptoms (III); others were patients who were following up after HF hospitalization (II), and patients with no HF diagnosis who sought care at the emergency department for other illness (I). Patients completed questionnaires on thirst intensity, thirst distress, HF self-care behaviour, feeling depressive and feeling anxious. Data on sociodemographic, clinical characteristics, pharmacological treatment and prescribed fluid restriction were retrieved from hospital medical records and by asking the patients. Data were also collected from blood, urine and saliva samples to measure biological markers of dehydration, HF severity and stress.

    Results: Thirst was prevalent in 1 out of 5 patients (II) and 63% of patients with worsening of HF symptoms experienced moderate to severe thirst distress at hospital admission (IV). Patients at an outpatient HF clinic who reported thirst at the first visit were more often thirsty at the follow-up visits compared to patients who did not report thirst at the first visit (II). Thirst intensity was significantly higher in patients hospitalized with decompensated HF compared to patients with no HF (median 75 vs. 25 mm, visual analogue scale [VAS] 0-100 mm; P < 0.001) (I). During optimization of pharmacological treatment of HF, thirst intensity increased in 67% of the patients. Thirst intensity increased significantly more in patients in the high thirst intensity group compared to patients in the low thirst intensity group (median +18 mm vs. -3 mm; P < 0.001) (III). Patients who were admitted to the hospital with high thirst distress continued to have high thirst distress over time (IV). A large number of patients were bothered by thirst and feeling dry in the mouth when they were thirsty (III, IV). Patients with a fluid restriction had high thirst distress over time and patients who were feeling depressed had high thirst intensity over time (IV). Thirst was associated with fluid restriction (III-IV), a higher serum urea (IIIII), and depressive symptoms (II).

    Conclusions: A considerable amount of patients with HF experiences thirst intensity and thirst distress. Patients who reported thirst at the first follow-up more often had thirst at the subsequent follow-ups. The most important factors related to thirst intensity or thirst distress were a fluid restriction, a higher plasma urea, and depressive symptoms. Nurses should ask patients with HF if they are thirsty and measure the thirst intensity and thirst distress, and ask if thirst is bothering them. Each patient should be critically evaluated if a fluid restriction really is needed, if the patient might be dehydrated or needs to be treated for depression.

    List of papers
    1. Thirst in the elderly with and without heart failure
    Open this publication in new window or tab >>Thirst in the elderly with and without heart failure
    2011 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 53, no 2, p. 174-178Article in journal (Refereed) Published
    Abstract [en]

    Elderly patients with heart failure (HF) may be troubled by thirst, despite the fact that elderly have an impaired ability to sense thirst. The present study was undertaken to compare the intensity of thirst in patients with and without HF and to evaluate how this symptom relates to the health-related quality of life and indices of the fluid balance. Forty-eight patients (mean age 80 years) admitted to hospital with worsening HF (n = 23) or with other acute illness (n = 25) graded their thirst and estimated their health-related quality of life (HRQoL). Serum sodium was measured and urine samples were assessed for color and electrolyte content. The HF patients reported significantly more intensive thirst (median = 75 mm) compared with those in the control group (median = 25 mm; p less than 0.0001). There was no statistically significant relationship between thirst and HRQoL, which was low overall. Serum sodium and urine color did not differ significantly between the groups, but the urine of the HF patients had a lower sodium concentration and osmolality. We conclude that elderly patients with worsening HF have considerably increased thirst and, hence, intense thirst should be regarded as a symptom of HF.

    Place, publisher, year, edition, pages
    Elsevier, 2011
    Keywords
    Thirst of elderly; Aged heart failure patients; Quality of life; Dehydration
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-69768 (URN)10.1016/j.archger.2010.10.003 (DOI)000292547000044 ()
    Available from: 2011-08-10 Created: 2011-08-08 Last updated: 2017-12-08Bibliographically approved
    2. Thirst Trajectory and Factors Associated With Persistent Thirst in Patients With Heart Failure
    Open this publication in new window or tab >>Thirst Trajectory and Factors Associated With Persistent Thirst in Patients With Heart Failure
    Show others...
    2014 (English)In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 20, no 9, p. 689-695Article in journal (Refereed) Published
    Abstract [en]

    Background: Thirst is often increased in patients with heart failure (HF) and can cause distress during the course of the condition. The aim of the present study was to describe the trajectory of thirst during an 18-month period and to identify variables associated with persistent thirst in patients with HF. Methods and Results: Data were collected from 649 patients with HF with the use of the Revised Heart Failure Compliance Scale at 1, 6, 12, and 18 months after a period of hospital treatment for worsening HF. Thirst trajectory was described for the 4 follow-up visits and logistic regression analysis was used to identify factors independently associated with persistent thirst. In total, 33% (n = 212) of the patients reported thirst on greater than= 1 occasions and 34% (n = 46) continued to have thirst at every follow-up visit. Nineteen percent (n = 121) of the patients had persistent thirst. Patients with persistent thirst were more often younger and male and had more HF symptoms. Higher body mass index and serum urea also increased the risk of persistent thirst. Conclusions: Patients with HF who were thirsty at the 1-month follow-up were more often also thirsty at subsequent visits. Assessment of thirst is warranted in clinical practice because one-fifth of patients suffer from persistent thirst.

    Place, publisher, year, edition, pages
    Elsevier, 2014
    Keywords
    Thirst; heart failure; trajectory; persistent thirst
    National Category
    Clinical Medicine Sociology
    Identifiers
    urn:nbn:se:liu:diva-111268 (URN)10.1016/j.cardfail.2014.06.352 (DOI)000341799300010 ()24951934 (PubMedID)
    Available from: 2014-10-15 Created: 2014-10-14 Last updated: 2019-06-27Bibliographically approved
    3. Changes in Thirst Intensity During Optimization of Heart Failure Medical Therapy by Nurses at the Outpatient Clinic.
    Open this publication in new window or tab >>Changes in Thirst Intensity During Optimization of Heart Failure Medical Therapy by Nurses at the Outpatient Clinic.
    Show others...
    2016 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 31, no 5, p. E17-E24Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Thirst can be aggravated in patients with heart failure (HF), and optimization of HF medication can have positive impact on thirst.

    OBJECTIVES: The aims of this study were to describe changes in thirst intensity and to determine factors associated with high thirst intensity during optimization of HF medication.

    METHODS AND RESULTS: Patients with HF (N = 66) who were referred to an HF clinic for up-titration of HF medication were included. Data were collected during the first visit to the clinic and at the end of the treatment program. Data were dichotomized by the median visual analog scale score for thirst, dividing patients into 2 groups: low thirst intensity (0-20 mm) and high thirst intensity (>20 mm on a visual analog scale of 0-100 mm). In total, 67% of the patients reported a higher thirst intensity after the HF up-titration program. There was no difference in thirst intensity between the patients who reached target doses and those who did not. Plasma urea level (odds ratio, 1.33; 95% confidence interval, 1.07-1.65) and fluid restriction (odds ratio, 6.25; 95% confidence interval, 1.90-20.5) were independently associated with high thirst intensity in patients with HF.

    CONCLUSIONS: Thirst intensity increased in two-thirds of the patients during a time period of optimization of HF medication. Fluid restriction and plasma urea levels were associated with high thirst intensity.

    Place, publisher, year, edition, pages
    Lippincott Williams & Wilkins, 2016
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:liu:diva-125914 (URN)10.1097/JCN.0000000000000319 (DOI)000382251400003 ()26696035 (PubMedID)
    Note

    Funding agencies: Mats Klebergs Stiftelse; Lindhes Advokatbyra

    Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2019-06-27Bibliographically approved
  • 420.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Epidemiology of injuries in elite football2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The purpose of this thesis was to study the injury characteristics in elite football, and risk factors for injury with special emphasis on anterior cruciate ligament injury. All five papers followed a prospective design using a standardised methodology. Individual training and match exposure was recorded for all players participating as well as all injuries resulting in time loss. Severe injury was defined as absence from play longer than 4 weeks.

    In Paper I, all 14 teams in the Swedish men’s elite league were studied during the 2001 season. In this paper, all tissue damage regardless of subsequent time loss was also recorded. There were no differences in injury incidence between the two injury definitions during match play (27.2 vs. 25.9 injuries per 1000 hours, p=0.66) or training (5.7 vs. 5.2 injuries per 1000 hours, p=0.65). Significantly higher injury incidences for training injury, overuse injury and re-injury were found during the pre-season compared to the competitive season. Thigh strain was the single most common injury (14%).

    In Paper II, 8% of all players in the Swedish men’s elite league 2001 had a history of previous ACL injury at the start of the study period. These players had a higher incidence of new knee injury during the season than players without previous ACL injury (4.2 vs. 1.0 injuries per 1000 hours, p=0.02). The higher incidence of new knee injury was seen both when using the player (relative risk 3.4, 95% CI 1.8-6.3) and the knee (relative risk 4.5, 95% CI 2.3-8.8) as the unit of analysis.

    In Paper III, eleven clubs in the men’s elite leagues of five European countries were studied during the 2001-2002 season. The incidence of match injury was higher for the English and Dutch teams compared to the Mediterranean teams (41.8 vs. 24.0 injuries per 1000 hours, p=0.008) as well as the incidence of severe injury (2.0 vs. 1.1 injuries per 1000 hours, p=0.04). Players having international duty had a higher match exposure (42 vs. 28 matches, p<0.001), but a tendency to a lower training injury incidence (4.1 vs. 6.2 injuries per 1000 hours, p=0.051). Thigh strain was the most common injury (16%) with posterior strains being more frequent than anterior ones (67 vs. 36, p<0.0001).

    In Paper IV, the national teams of all 32 countries that qualified for the men’s European Championship 2004, the women’s European Championship 2005 and the men’s Under-19 European Championship 2005 were studied during the tournaments. There were no differences in match and training injury incidences between the championships. Teams eliminated after the group stage in the women’s championship had a significantly higher match injury incidence compared to teams going to the semi-finals (65.4 vs. 5.0 injuries per 1000 hours, p=0.02). Non-contact mechanisms were ascribed for 41% of the match injuries and these injuries were more common in the second half.

    In Paper V, all 12 clubs in the Swedish women’s elite league and 11 of 14 clubs in the men’s elite league were studied during the 2005 season. The prevalence of a history of previous ACL injury at the start of the study was three times higher among the female players (15% vs. 5%, p=0.0002). During the season, 16 new ACL injuries were recorded. There was a tendency to a lower mean age at injury among the women (20 vs. 24 years, p=0.069). Adjusted for age, no gender-related difference in the incidence of ACL injury was seen (relative risk 0.99, 95% CI 0.37-2.6). Age was associated with ACL injury incidence in women where the risk decreased by 24% for each year increase in age (relative risk 0.76, 95% CI 0.59-0.96).

    List of papers
    1. Injuries in Swedish elite football - a prospective study on injury definitions, risk for injury and injury pattern during 2001
    Open this publication in new window or tab >>Injuries in Swedish elite football - a prospective study on injury definitions, risk for injury and injury pattern during 2001
    2005 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, Vol. 15, no 2, p. 118-125Article in journal (Refereed) Published
    Abstract [en]

    The purpose of this study was to study the risk for injury and injury pattern in Swedish male elite football and to compare two different injury definitions. A prospective cohort study was conducted during 2001 on all 14 teams (310 players) in the Swedish top division. Injuries and individual exposure were recorded. Injury was defined as time-lost injury (715 injuries) and for comparison as tissue injury (765 injuries). No significant difference in the risk for injury between tissue injuries and time-lost injuries was found during matches (27.2 vs. 25.9 injuries per 1000 match hours, P=0.66) or training sessions (5.7 vs. 5.2 injuries per 1000 training hours, P=0.65). The risk for injury during training was significantly higher during the pre-season compared with the competitive season (P=0.01).

    Thigh strain was the single most common injury (14%). Knee sprain was the most common major injury (absence >4 weeks). Overuse injuries and re-injuries were frequent and constituted 37% and 22% of all injuries. Re-injuries caused significantly longer absence than their corresponding initial injuries (P=0.02). The risk for re-injury (P=0.02) and overuse injury (P<0.01) was significantly higher during the pre-season compared with the competitive season.

    Keywords
    definition, epidemiology, incidence, soccer, sports injuries
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14381 (URN)10.1111/j.1600-0838.2004.00393.x (DOI)
    Available from: 2013-04-03 Created: 2007-04-05 Last updated: 2013-09-04Bibliographically approved
    2. High risk of new knee injury in elite footballers with previous anterior cruciate ligament injury
    Open this publication in new window or tab >>High risk of new knee injury in elite footballers with previous anterior cruciate ligament injury
    2006 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, Vol. 40, no 2, p. 158-162Article in journal (Refereed) Published
    Abstract [en]

    Background: Anterior cruciate ligament (ACL) injury is a severeevent for a footballer, but it is unclear if the knee injuryrate is higher on returning to football after ACL injury.

    Objective: To study the risk of knee injury in elite footballerswith a history of ACL injury compared with those without.

    Method: The Swedish male professional league (310 players) wasstudied during 2001. Players with a history of ACL injury atthe study start were identified. Exposure to football and alltime loss injuries during the season were recorded prospectively.

    Results: Twenty four players (8%) had a history of 28 ACL injuriesin 27 knees (one rerupture). These players had a higher incidenceof new knee injury of any type than the players without ACLinjury (mean (SD) 4.2 (3.7) v 1.0 (0.7) injuries per 1000 hours,p = 0.02). The risk of suffering a knee overuse injury wassignificantly higher regardless of whether the player (relativerisk 4.8, 95% confidence interval 2.0 to 11.2) or the knee (relativerisk 7.9, 95% confidence interval 3.4 to 18.5) was used as theunit of analysis. No interactive effects of age or any otheranthropometric data were seen.

    Conclusion: The risk of new knee injury, especially overuseinjury, was significantly increased on return to elite footballafter ACL injury regardless of whether the player or the kneewas used as the unit of analysis.

    Keywords
    football; injury incidence; knee; prevalence; anterior cruciate ligament
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14382 (URN)10.1136/bjsm.2005.021055 (DOI)
    Available from: 2013-04-03 Created: 2007-04-05 Last updated: 2013-09-04Bibliographically approved
    3. UEFA Champions League study: a prospective study of injuries in professional football during the 2001-2002 season
    Open this publication in new window or tab >>UEFA Champions League study: a prospective study of injuries in professional football during the 2001-2002 season
    2005 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, Vol. 39, no 8, p. 542-546Article in journal (Refereed) Published
    Abstract [en]

    Background: No previous study on adult football involving severaldifferent countries has investigated the incidence and patternof injuries at the highest club competitive level.

    Objective: To investigate the risk exposure, risk of injury,and injury pattern of footballers involved in UEFA ChampionsLeague and international matches during a full football season.

    Method: Eleven top clubs (266 players) in five European countrieswere followed prospectively throughout the season of 2001–2002.Time-lost injuries and individual exposure times were recordedduring all club and national team training sessions and matches.

    Results: A total of 658 injuries were recorded. The mean (SD)injury incidence was 9.4 (3.2) injuries per 1000 hours (30.5(11.0) injuries per 1000 match hours and 5.8 (2.1) injuriesper 1000 training hours). The risk of match injury was significantlyhigher in the English and Dutch teams than in the teams fromFrance, Italy, and Spain (41.8 (3.3) v 24.0 (7.9) injuries per1000 hours; p = 0.008). Major injuries (absence >4 weeks)constituted 15% of all injuries, and the risk of major injurywas also significantly higher among the English and Dutch teams(p = 0.04). National team players had a higher match exposure,with a tendency towards a lower training injury incidence thanthe rest of the players (p = 0.051). Thigh strain was themost common injury (16%), with posterior strains being significantlymore common than anterior ones (67 v 36; p<0.0001).

    Conclusions: The risk of injury in European professional footballis high. The most common injury is the thigh strain typicallyinvolving the hamstrings. The results suggest that regionaldifferences may influence injury epidemiology and traumatology,but the factors involved are unclear. National team playershave a higher match exposure, but no higher risk of injury thanother top level players.

    Keywords
    elite; epidemiology; injury incidence; professional; football; soccer
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14383 (URN)10.1136/bjsm.2004.014571 (DOI)
    Available from: 2013-04-03 Created: 2007-04-05 Last updated: 2013-09-04Bibliographically approved
    4. Football injuries during European Championships 2004-2005
    Open this publication in new window or tab >>Football injuries during European Championships 2004-2005
    2007 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 15, no 9, p. 1155-1162Article in journal (Refereed) Published
    Abstract [en]

    The risk of injury in football is high, but few studies have compared men's and women's football injuries. The purpose of this prospective study was to analyse the exposure and injury characteristics of European Championships in football and to compare data for men, women and male youth players. The national teams of all 32 countries (672 players) that qualified to the men's European Championship 2004, the women's European Championship 2005 and the men's Under-19 European Championship 2005 were studied. Individual training and match exposure was documented during the tournaments as well as time loss injuries. The overall injury incidence was 14 times higher during match play than during training (34.6 vs. 2.4 injuries per 1000 h, P < 0.0001). There were no differences in match and training injury incidences between the championships. Teams eliminated in the women's championship had a significantly higher match injury incidence compared to teams going to the semi-finals (65.4 vs. 5.0 injuries per 1000 h, P = 0.02). Non-contact mechanisms were ascribed for 41% of the match injuries. One-fifth of all injuries were severe with absence from play longer than 4 weeks. In conclusion, injury incidences during the European Championships studied were very similar and it seems thus that the risk of injury in international football is at least not higher in women than in men. The teams eliminated in the women's championship had a significantly higher match injury incidence than the teams going to the final stage. Finally, the high frequency of non-contact injury is worrying from a prevention perspective and should be addressed in future studies.

    Keywords
    Athletic injuries, Epidemiology, Football, Incidence
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14384 (URN)10.1007/s00167-007-0290-3 (DOI)
    Available from: 2013-04-03 Created: 2007-04-05 Last updated: 2017-12-13Bibliographically approved
    5. Anterior cruciate ligament injury in elite football: a prospective three-cohort study.
    Open this publication in new window or tab >>Anterior cruciate ligament injury in elite football: a prospective three-cohort study.
    2011 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 19, no 1, p. 11-19Article in journal (Refereed) Published
    Abstract [en]

    Anterior cruciate ligament (ACL) injury causes long lay-off time and is often complicated with subsequent new knee injury and osteoarthritis. Female gender is associated with an increased ACL injury risk, but few studies have adjusted for gender-related differences in age although female players are often younger when sustaining their ACL injury. The objective of this three-cohort study was to describe ACL injury characteristics in teams from the Swedish men's and women's first leagues and from several European men's professional first leagues. Over a varying number of seasons from 2001 to 2009, 57 clubs (2,329 players) were followed prospectively and during this period 78 ACL injuries occurred (five partial). Mean age at ACL injury was lower in women compared to men (20.6 ± 2.2 vs. 25.2 ± 4.5 years, P = 0.0002). Using a Cox regression, the female-to-male hazard ratio (HR) was 2.6 (95% CI 1.4-4.6) in all three cohorts studied and 2.6 (95% CI 1.3-5.3) in the Swedish cohorts; adjusted for age, the HR was reduced to 2.4 (95% CI 1.3-4.2) and 2.1 (95% CI 1.0-4.2), respectively. Match play was associated with a higher ACL injury risk with a match-to-training ratio of 20.8 (95% CI 12.4-34.8) and 45 ACL injuries (58%) occurred due to non-contact mechanisms. Hamstrings grafts were used more often in Sweden than in Europe (67 vs. 34%, P = 0.028), and there were no differences in time to return to play after ACL reconstruction between the cohorts or different grafts. In conclusion, this study showed that the ACL injury incidence in female elite footballers was more than doubled compared to their male counterparts, but also that they were significantly younger at ACL injury than males. These findings suggest that future preventive research primarily should address the young female football player.

    Place, publisher, year, edition, pages
    Springer, 2011
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-64457 (URN)10.1007/s00167-010-1170-9 (DOI)000286529200003 ()20532869 (PubMedID)
    Note

    Titled "Anterior cruciate ligament injuries in elite football: the influence of gender and age" in while in manuscript.

    Available from: 2011-01-25 Created: 2011-01-25 Last updated: 2017-12-11
  • 421.
    Waldén, Markus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    The epidemiology of groin injury in senior football: a systematic review of prospective studies2015In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 49, no 12Article, review/survey (Refereed)
    Abstract [en]

    Background Groin injuries are troublesome in mens and womens football. Aim To review the literature on the epidemiology of groin injury in senior football and compare injury occurrence between sexes. Methods Studies were identified through a search of PubMed, EMBASE, CINAHL and Web of Science, in the reference lists of the selected articles and the authors bibliographies. The number of injuries, percentage of groin injury from all injuries and rate of groin injury per 1000 h were extracted. Exposure and injury data were aggregated across included studies and the absolute differences in groin injury proportion and rate of groin injury were compared between sexes. Risk of bias was assessed using a 5-item checklist. Results 34 articles met the study criteria and were included. The proportion of groin injury in club-seasonal football was 4-19% in men and 2-14% in women. Aggregated data analysis (29 studies) showed a higher relative proportion of groin injury in men than in women (12.8% vs 6.9%, absolute difference 5.9%, 95% CI 4.6% to 7.1%). The rate of groin injury varied from 0.2 to 2.1/1000 h in men and 0.1 to 0.6/1000 h in womens club football, and aggregated analysis (23 studies) showed a more than two-fold higher rate in men (0.83/1000 h vs 0.35/1000 h, rate ratio 2.4, 95% CI 2.0 to 2.9). High risk of bias was identified for participant selection (18 studies), exposure (17 studies) and precision estimate (16 studies). Conclusions Groin injuries are frequent in senior football and are more common in men than women. Future research needs to be of higher quality.

  • 422.
    Wallerstedt, Birgitta
    et al.
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Sweden.
    Behm, Lina
    Department of Health Sciences, Faculty of Medicine, Lund University, Sweden.
    Alftberg, Åsa
    Department of Social Work, Faculty of Health and Society, Malmö University, Sweden.
    Sandgren, Anna
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus Univers.
    Benzein, Eva
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus Univers.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ahlström, Gerd
    Department of Health Sciences, Faculty of Medicine, Lund University, Sweden.
    Striking a Balance: A Qualitative Study of Next of Kin Participation in the Care of Older Persons in Nursing Homes in Sweden.2018In: Healthcare, ISSN 2227-9032, Vol. 6, no 2, article id E46Article in journal (Refereed)
    Abstract [en]

    Most of the care in nursing homes is palliative in nature, as it is the oldest and the frailest people who live in nursing homes. The aim of this study was to explore next of kin's experiences of participating in the care of older persons at nursing homes. A qualitative design was used, based on semi-structured interviews with 40 next of kin, and analyzed using qualitative content analysis. An overarching theme emerged, a balancing act consisting of three categories: (1) visiting the nursing home; (2) building and maintaining relationships; and (3) gathering and conveying information. The next of kin have to balance their own responsibility for the older person's wellbeing by taking part in their care and their need to leave the responsibility to the staff due to critical health conditions. The next of kin wanted to participate in care meetings and conversations, not only in practical issues. The findings indicate the need to improve the next of kin's participation in the care as an equal partner. Increased knowledge about palliative care and decision-making of limiting life-prolonging treatment may lead to a higher quality of care.

  • 423.
    Ward, Richard
    et al.
    Faculty of Social Science, University of Stirling, UK of Great Britain and Northern Ireland.
    Clark, Andrew
    School of Nursing, Midwifery, Social Work and Social Sciences, University of Salford, Salford, Greater Manchester, UK of Great Britain and Northern Ireland..
    Campbell, Sarah
    School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK of Great Britain and Northern Ireland..
    Graham, Barbara
    Faculty of Social Science, University of Stirling, UK of Great Britain and Northern Ireland.
    Kullberg, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Manji, Kainde
    Faculty of Social Science, University of Stirling, UK of Great Britain and Northern Ireland.
    Rummery, Kirstein
    Faculty of Social Science, University of Stirling, UK of Great Britain and Northern Ireland.
    Keady, John
    School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK of Great Britain and Northern Ireland..
    The lived neighborhood: understanding how people with dementia engage with their local environment.2018In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 30, no 6, p. 867-880Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In this paper, we report progress on "Neighborhoods: our people, our places" an international study about how people living with dementia interact with their neighborhoods. The ideas of social health and citizenship are drawn upon to contextualize the data and make a case for recognizing and understanding the strengths and agency of people with dementia. In particular, we address the lived experience of the environment as a route to better understanding the capabilities, capacities, and competencies of people living with dementia. In doing this, our aim is to demonstrate the contribution of social engagement and environmental support to social health.

    METHODS: The study aims to "map" local spaces and networks across three field sites (Manchester, Central Scotland and Linkoping, Sweden). It employs a mix of qualitative and participatory approaches that include mobile and visual methods intended to create knowledge that will inform the design and piloting of a neighborhood-based intervention.

    RESULTS: Our research shows that the neighborhood plays an active role in the lives of people with dementia, setting limits, and constraints but also offering significant opportunities, encompassing forms of help and support as yet rarely discussed in the field of dementia studies. The paper presents new and distinctive insights into the relationship between neighborhoods and everyday life for people with dementia that have important implications for the debate on social health and policy concerning dementia friendly communities.

    CONCLUSION: We end by reflecting on the messages for policy and practice that are beginning to emerge from this on-going study.

  • 424.
    Wassar Kirk, Jeanette
    et al.
    Amager-Hvidovre Hospital, Denmark.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    The influence of flow culture on nurses’ use of research in emergency care: An ethnographic study2015In: Klinisk Sygepleje, ISSN 0902-2767, E-ISSN 1903-2285, Vol. 29, no 2, p. 16-34Article in journal (Refereed)
    Abstract [en]

    Within the field of implementation science there is increasing recognition of the relevance of organizational context and culture, i.e. influences beyond the individual level, for successful implementation of evidence-based nursing practices. Applying the Cultural Historical Activity Theory (CHAT), the aim of this study was to explore how the organizational culture in an emergency department in Denmark influenced nurses’ priorities with regard to the use of research. The study was designed as an ethnographic inquiry based on fieldwork and semi-structured interviews. Based on an activity system analysis, the concept of flow culture emerged. This culture is defined as a cultural–historical activity system, mediated by artefacts, in which the objective of the nursing staff is primarily to free up beds, thus ensuring a flow of patients. A flow culture leads to a strong focus on securing vacant beds which impeded the nurses’ use of research in everyday clinical practice.

  • 425.
    Wenemark, Marika
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    The respondent’s perspective in health-related surveys2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Declining response rates are threatening the usefulness of and confidence in survey data. Survey practitioners have therefore studied why nonrespondents refuse to respond and have tried to counter the declining response rates by intensified follow-up methods. Such efforts sometimes yield negative reactions among respondents. This thesis focuses on the respondent’s perspective in self-administered health-related surveys. The aim was to investigate positive and negative aspects that respondents experience when participating in surveys, to study factors that could increase motivation and to study possibilities to increase response rates in a way that promotes data quality as well as positive experiences among respondents. Self-Determination Theory is a motivation theory that was used as a theoretical framework.

    Paper I is a study regarding two self-administered health questionnaires among patients in 20 intervention groups in 18 Swedish hospitals. Paper II is a qualitative analysis of data from telephone interviews with respondents to a self-administered health-related survey of the population in the county of Östergötland. Paper III is a randomized experiment in a self-administered survey of a random sample of parents in the municipality of Stockholm. Paper IV is an experimental study concerning a self-administered health questionnaire in a random sample of the general adult population in the county of Östergötland.

    The results from paper I show that questionnaire length and ease of response were not crucial arguments in choosing between two health questionnaires for use in routine health care. Instead, the most common motives for the choice concerned aspects of the questions’ comprehensiveness and ability to describe the health condition. Respondent satisfaction as described by respondents in paper II includes being able to give correct and truthful information as well as reflection and new insights from the questions. Respondent burden includes experiences of being manipulated or controlled by the researcher as well as worry, anxiety or sadness caused by the questions. Experiences of satisfaction and burden differed depending on the respondents’ primary motive for participating in surveys. The findings of paper III illustrate that the use of lottery tickets as incentives to parents may be less valuable or even harmful as a means of increasing response rates. In paper IV a survey design inspired by Self-Determination Theory yielded higher satisfaction among respondents and improved response rates with similar or better data quality compared with a standard design.

    Focusing on the respondents’ perspective provided important new knowledge. The results show a broad spectrum of positive as well as negative aspects of survey participation. The results support Self-Determination Theory as a useful theoretical framework for studying motivation in survey research and an interesting additional source to provide ideas on how to design surveys with the potential to motivate respondents. The results suggest that it is possible to improve response rates in a way that promotes data quality as well as positive experiences among the respondents.

    List of papers
    1. Respondent satisfaction regarding SF-36 and EQ-5D, and patients' perspectives concerning health outcome assessment within routine health care
    Open this publication in new window or tab >>Respondent satisfaction regarding SF-36 and EQ-5D, and patients' perspectives concerning health outcome assessment within routine health care
    2007 (English)In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 16, no 10, p. 1647-1654Article in journal (Refereed) Published
    Abstract [en]

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

    Keywords
    outcome assessment, SF-36, EQ-5D, patient perspective, respondent satisfaction
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-39617 (URN)10.1007/s11136-007-9263-8 (DOI)50285 (Local ID)50285 (Archive number)50285 (OAI)
    Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
    2. Respondent Satisfaction and Respondent Burden among Differently Motivated Participants in a Health-Related Survey
    Open this publication in new window or tab >>Respondent Satisfaction and Respondent Burden among Differently Motivated Participants in a Health-Related Survey
    2010 (English)In: Field Methods, ISSN 1525-822X, E-ISSN 1552-3969, Vol. 22, no 4, p. 378-390Article in journal (Refereed) Published
    Abstract [en]

    Response rates in surveys have declined in many countries over the last decade. Reasons for refusal by nonrespondents have been discussed in many studies, but less attention has been paid to motivation among respondents who do take part. One theoretical framework for studying motivation is self-determination theory, which distinguishes between extrinsic and intrinsic motivation. This article describes respondents' experiences of participating in a self-administered health-related survey. Qualitative content analysis was used to analyze data from semistructured telephone interviews with 30 Swedish respondents aged 45–64 years. The results show a broad spectrum of positive as well as negative aspects of survey participation.

    Place, publisher, year, edition, pages
    Sage, 2010
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-60180 (URN)10.1177/1525822X10376704 (DOI)000283656600005 ()
    Note
    The final, definitive version of this paper has been published in: Field Methods, (22), 4, 378-390, 2010. Marika Wenemark, Gunilla Hollman Frisman, Tommy Svensson and Margareta Kristenson, Respondent Satisfaction and Respondent Burden among Differently Motivated Participants in a Health-Related Survey http://dx.doi.org/10.1177/1525822X10376704 by SAGE Publications Ltd, All rights reserved. http://www.uk.sagepub.com/ Available from: 2010-10-07 Created: 2010-10-07 Last updated: 2017-12-12
    3. Can incentives undermine intrinsic motivation to participate in epidemiologic surveys?
    Open this publication in new window or tab >>Can incentives undermine intrinsic motivation to participate in epidemiologic surveys?
    2010 (English)In: EUROPEAN JOURNAL OF EPIDEMIOLOGY, ISSN 0393-2990, Vol. 25, no 4, p. 231-235Article in journal (Refereed) Published
    Abstract [en]

    Response rates to surveys are decreasing. The purpose of this study was to evaluate the use of lottery tickets as incentives in an epidemiologic control group. A self-administered questionnaire was sent to parents in the municipality of Stockholm, Sweden, who were to be used as a control group in a study addressing stress in parents of children with cancer. A stratified random sample of 450 parents were randomized into three incentive groups: (a) no incentive; (b) a promised incentive of one lottery ticket to be received upon reply; (c) a promised incentive of one lottery ticket to be received upon reply and an additional lottery ticket upon reply within 1 week. The overall response rate across the three groups was 65.3%. The response rate was highest in the no incentive group (69.3%) and lowest in the one plus one lottery ticket group (62.0%). In a survival analysis, the difference between the two response curves was significant by the log-rank test (P = 0.04), with the no incentive group having a shorter time to response than the incentive group. Our findings suggest that the use of lottery tickets as incentives to increase participation in a mail questionnaire among parents may be less valuable or even harmful. Incentives may undermine motivation in studies in which the intrinsic motivation of the respondents is already high.

    Place, publisher, year, edition, pages
    Springer Science Business Media, 2010
    Keywords
    Data collection, Incentives, Participation, Response rate, Self-administered questionnaire, Survey
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-55054 (URN)10.1007/s10654-010-9434-8 (DOI)000276478800003 ()
    Note
    The original publication is available at www.springerlink.com: Marika Wenemark, Åsa Vernby and Annika Lindahl Norberg, Can incentives undermine intrinsic motivation to participate in epidemiologic surveys?, 2010, EUROPEAN JOURNAL OF EPIDEMIOLOGY, (25), 4, 231-235. http://dx.doi.org/10.1007/s10654-010-9434-8 Copyright: Springer Science Business Media http://www.springerlink.com/ Available from: 2010-04-28 Created: 2010-04-28 Last updated: 2013-10-09
    4. Applying Motivation Theory to Achieve Increased Respondent Satisfaction, Response Rate and Data Quality in a Self-administered Survey
    Open this publication in new window or tab >>Applying Motivation Theory to Achieve Increased Respondent Satisfaction, Response Rate and Data Quality in a Self-administered Survey
    Show others...
    2011 (English)In: Journal of Official Statistics, ISSN 0282-423X, E-ISSN 2001-7367, Vol. 27, no 2, p. 393-414Article in journal (Refereed) Published
    Abstract [en]

    Response rates to surveys are declining in most countries. Attempts to persuade or pressure respondents to increase response might be counterproductive in the long-term because they can negatively affect attitudes towards future surveys. Targeting respondents’ own motivation to participate in surveys is an alternative approach to achieve higher response rates. Self-determination theory provides a theoretical framework for how intrinsic motivation can be stimulated. We used self-determination theory as inspiration to re-design a self-administered health-related survey. Two versions of the questionnaire and two data collection methods were used in an experimental design. Effects were measured in terms of respondent satisfaction, response rate, and data quality. The results suggest that it is possible to improve response rates in a way that also promotes data quality and positive experiences for the respondents.

    Place, publisher, year, edition, pages
    Almqvist & Wiksell International / Statistics Sweden, 2011
    Keywords
    Survey design; respondent motivation; self-determination theory; intrinsic motivation; questionnaire
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-60182 (URN)000292708100013 ()
    Available from: 2010-10-07 Created: 2010-10-07 Last updated: 2017-12-12
  • 426.
    Wenemark, Marika
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Endocrinology and Gastroenterology UHL.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences and Learning, Sociology. Linköping University, Faculty of Arts and Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Respondent Satisfaction and Respondent Burden among Differently Motivated Participants in a Health-Related Survey2010In: Field Methods, ISSN 1525-822X, E-ISSN 1552-3969, Vol. 22, no 4, p. 378-390Article in journal (Refereed)
    Abstract [en]

    Response rates in surveys have declined in many countries over the last decade. Reasons for refusal by nonrespondents have been discussed in many studies, but less attention has been paid to motivation among respondents who do take part. One theoretical framework for studying motivation is self-determination theory, which distinguishes between extrinsic and intrinsic motivation. This article describes respondents' experiences of participating in a self-administered health-related survey. Qualitative content analysis was used to analyze data from semistructured telephone interviews with 30 Swedish respondents aged 45–64 years. The results show a broad spectrum of positive as well as negative aspects of survey participation.

  • 427.
    Wenemark, Marika
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Health and Developmental Care, Centre for Public Health.
    Persson, Andreas
    Statistics Sweden, Örebro, Sweden.
    Noorlind Brage, Helle
    Östergötlands Läns Landsting, Centre for Health and Developmental Care, Centre for Public Health.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences and Learning, Sociology. Linköping University, Faculty of Arts and Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Health and Developmental Care, Centre for Public Health.
    Applying Motivation Theory to Achieve Increased Respondent Satisfaction, Response Rate and Data Quality in a Self-administered Survey2011In: Journal of Official Statistics, ISSN 0282-423X, E-ISSN 2001-7367, Vol. 27, no 2, p. 393-414Article in journal (Refereed)
    Abstract [en]

    Response rates to surveys are declining in most countries. Attempts to persuade or pressure respondents to increase response might be counterproductive in the long-term because they can negatively affect attitudes towards future surveys. Targeting respondents’ own motivation to participate in surveys is an alternative approach to achieve higher response rates. Self-determination theory provides a theoretical framework for how intrinsic motivation can be stimulated. We used self-determination theory as inspiration to re-design a self-administered health-related survey. Two versions of the questionnaire and two data collection methods were used in an experimental design. Effects were measured in terms of respondent satisfaction, response rate, and data quality. The results suggest that it is possible to improve response rates in a way that also promotes data quality and positive experiences for the respondents.

  • 428.
    Wennerholm, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Risks for cardiovascular disease in middle-aged women in different social environments2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The importance of the social environment and human life conditions for public health was early recognized in community medicine. Despite major reductions in recent decades, cardiovascular diseases (CVD) is one of the leading causes of mortality and morbidity for both genders in all European countries. 

    Aim: The overall aim of this thesis was to increase our knowledge of factors in the social environment and of individual psychosocial factors that could explain why some women in working ages are affected by cardiovascular diseases.

    Methods: The Swedish sample comes from the urban population in two major cities in a region in the south-east of Sweden, the Twin cities. According to their social history they could be labelled a “blue-collar” and a “white-collar” city. Cardiovascular morbidity data in all papers for the Twin cities was derived from a computerized population-based administrative Health Care Register (HCR). In Paper IV, we made a comparative study between Sweden and Scotland, the Scottish data comes from the Scottish Health Survey.

    Results: In Paper I, the cumulative incidence of different cardiovascular diagnoses for younger and also elderly men and women were significantly higher in the population of the blue collar city in all ages and for both sexes. The qualitative interviews of women after an MI, in Paper II, the findings revealed a broad picture of social factors, life circumstances, personalities and, not least, psychosocial factors that are important to middle-aged women who have suffered an MI. Paper III demonstrated that women with a high level of the personality trait “being a Good Girl” reported significantly more psychosocial risk factors for CVD and more commonly report chest pain without seeking medical care, no increased incidence for various CVD-diagnoses were found. The comparative study (Paper IV) clearly showed that Scottish middle-aged women are – relative to Swedish women - particularly affected by a worse profile of CVD risks, even after adjustment for education.  

    Conclusions: The social environment is of importance for cardiovascular risks and cardiovascular morbidity and mortality. This has been shown in Swedish Twin cities context and also in comparative studies between Swedish and Scottish women. The thesis gives strong implications for an upstream public health approach initiating long-term community intervention program in the blue collar city and among Scottish middle-aged women.

    List of papers
    1. Cardiovascular disease occurrence in two close but different social environments
    Open this publication in new window or tab >>Cardiovascular disease occurrence in two close but different social environments
    Show others...
    2011 (English)In: INTERNATIONAL JOURNAL OF HEALTH GEOGRAPHICS, ISSN 1476-072X, Vol. 10, no 5Article in journal (Refereed) Published
    Abstract [en]

    Background: Cardiovascular diseases estimate to be the leading cause of death and loss of disability-adjusted life years globally. Conventional risk factors for cardiovascular diseases only partly account for the social gradient. The purpose of this study was to compare the occurrence of the most frequent cardiovascular diseases and cardiovascular mortality in two close cities, the Twin cities. Methods: We focused on the total population in two neighbour and equally sized cities with a population of around 135 000 inhabitants each. These twin cities represent two different social environments in the same Swedish county. According to their social history they could be labelled a "blue-collar" and a "white-collar" city. Morbidity data for the two cities was derived from an administrative health care register based on medical records assigned by the physicians at both hospitals and primary care. The morbidity data presented are cumulative incidence rates and the data on mortality for ischemic heart diseases is based on official Swedish statistics. Results: The cumulative incidence of different cardiovascular diagnoses for younger and also elderly men and women revealed significantly differences for studied cardiovascular diagnoses. The occurrence rates were in all aspects highest in the population of the "blue-collar" twin city for both sexes. Conclusions: This study revealed that there are significant differences in risk for cardiovascular morbidity and mortality between the populations in the studied different social environments. These differences seem to be profound and stable over time and thereby give implication for public health policy to initiate a community intervention program in the "blue-collar" twin city.

    Place, publisher, year, edition, pages
    BioMed Central, 2011
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-66880 (URN)10.1186/1476-072X-10-5 (DOI)000286525800001 ()
    Note
    Original Publication: Carina Wennerholm, Björn Grip, AnnaKarin Johansson, Hans Nilsson, Marja-Liisa Honkasalo and Tomas Faresjö, Cardiovascular disease occurrence in two close but different social environments, 2011, INTERNATIONAL JOURNAL OF HEALTH GEOGRAPHICS, (10), 5. http://dx.doi.org/10.1186/1476-072X-10-5 Licensee: BioMed Central http://www.biomedcentral.com/Available from: 2011-03-22 Created: 2011-03-21 Last updated: 2017-09-18
    2. Life before myocardial infarction - a qualitative study of middle-aged women
    Open this publication in new window or tab >>Life before myocardial infarction - a qualitative study of middle-aged women
    2014 (English)In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 6, p. 2765-2774Article in journal (Refereed) Published
    Abstract [en]

    The health burden of myocardial infarction is rising for middle-aged women and they are underrepresented in research of cardiovascular diseases. The aim of this qualitative study was to explore how life had been for middle-aged women before they suffered a myocardial infarction (MI). Through a health care register, we identified all women (n = 46) under 65 years of age in a defined region in southeast Sweden who had suffered an MI the past 2 years and a strategic selection of n = 16 women from these was made. These selected women were interviewed and their narratives were interpreted by qualitative content analysis. The qualitative interviews generated five general themes: “Serious life events”, “Negative affectivity”, “Loneliness”, “Being a good girl” and “Lack of control”. The interviews revealed that many of these women had been exposed to extreme and repeated traumatic life events in their lives. Many had a cynical attitude towards others, felt lonely and experienced a lack of social support. Many of these women endeavored to “be a good girl”, which was a special psychosocial phenomenon found. This study uncovered that these women before they suffered an MI were affected by a variety of psychosocial factors. The study stresses the importance of psychosocial risk factors in the assessment of middle-aged women’s risk profile for MI. A general conclusion for clinical practice is that in the assessment of the individual risk for myocardial infarction for middle-aged women, potential psychosocial factors might also be considered.

    Place, publisher, year, edition, pages
    Wuhan, Hubei Province, China: Scientific Research Publishing, 2014
    National Category
    General Practice
    Identifiers
    urn:nbn:se:liu:diva-115734 (URN)10.4236/health.2014.620316 (DOI)
    Available from: 2015-03-18 Created: 2015-03-18 Last updated: 2018-01-11Bibliographically approved
    3. Two tales of cardiovascular risks-middle-aged women living in Sweden and Scotland: a cross-sectional comparative study
    Open this publication in new window or tab >>Two tales of cardiovascular risks-middle-aged women living in Sweden and Scotland: a cross-sectional comparative study
    Show others...
    2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 8, article id e016527Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVES: To compare cardiovascular risk factors as well as rates of cardiovascular diseases in middle-aged women from urban areas in Scotland and Sweden.

    DESIGN: Comparative cross-sectional study.

    SETTING: Data from the general population in urban areas of Scotland and the general population in two major Swedish cities in southeast Sweden, south of Stockholm.

    PARTICIPANTS: Comparable data of middle-aged women (40-65 years) from the Scottish Health Survey (n=6250) and the Swedish QWIN study (n=741) were merged together into a new dataset (n=6991 participants).

    MAIN OUTCOME MEASURE: We compared middle-aged women in urban areas in Sweden and Scotland regarding risk factors for cardiovascular disease (CVD), CVD diagnosis, anthropometrics, psychological distress and lifestyle.

    RESULTS: In almost all measurements, there were significant differences between the countries, favouring the Swedish women. Scottish women demonstrated a higher frequency of alcohol consumption, smoking, obesity, low vegetable consumption, a sedentary lifestyle and also more psychological distress. For doctor-diagnosed coronary heart disease, there were also significant differences, with a higher prevalence among the Scottish women.

    CONCLUSIONS: This is one of the first studies that clearly shows that Scottish middle-aged women are particularly affected by a worse profile of CVD risks. The profound differences in CVD risk and outcome frequency in the two populations are likely to have arisen from differences in the two groups of women's social, cultural, political and economic environments.

    Place, publisher, year, edition, pages
    London: BMJ Publishing Group Ltd, 2017
    Keywords
    cardiovascular risk factors, comparative study, lifestyle, middle-aged women, psychological distress, public health
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-140935 (URN)10.1136/bmjopen-2017-016527 (DOI)000411802700172 ()28790040 (PubMedID)2-s2.0-85027162863 (Scopus ID)
    Note

    Funding agencies: Swedish Heart and Lung Association [E136-15/E106/13]; Clinic ALF funds, Region Ostergotland, Sweden [LiO-446241]; Research and PhD studies Committee (FUN), Linkoping University, Sweden [LiU-2014-020251]

    Available from: 2017-09-18 Created: 2017-09-18 Last updated: 2018-05-03Bibliographically approved
  • 429.
    Wennerholm, Carina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Bromley, Catherine
    Public Health Observatory Division, NHS Health Scotland, Edinburgh, UK..
    Johansson, AnnaKarin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Vikbolandet.
    Frank, John
    Scottish Collaboration of Public Health Research & Policy (SCPHRP); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Two tales of cardiovascular risks-middle-aged women living in Sweden and Scotland: a cross-sectional comparative study2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 8, article id e016527Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To compare cardiovascular risk factors as well as rates of cardiovascular diseases in middle-aged women from urban areas in Scotland and Sweden.

    DESIGN: Comparative cross-sectional study.

    SETTING: Data from the general population in urban areas of Scotland and the general population in two major Swedish cities in southeast Sweden, south of Stockholm.

    PARTICIPANTS: Comparable data of middle-aged women (40-65 years) from the Scottish Health Survey (n=6250) and the Swedish QWIN study (n=741) were merged together into a new dataset (n=6991 participants).

    MAIN OUTCOME MEASURE: We compared middle-aged women in urban areas in Sweden and Scotland regarding risk factors for cardiovascular disease (CVD), CVD diagnosis, anthropometrics, psychological distress and lifestyle.

    RESULTS: In almost all measurements, there were significant differences between the countries, favouring the Swedish women. Scottish women demonstrated a higher frequency of alcohol consumption, smoking, obesity, low vegetable consumption, a sedentary lifestyle and also more psychological distress. For doctor-diagnosed coronary heart disease, there were also significant differences, with a higher prevalence among the Scottish women.

    CONCLUSIONS: This is one of the first studies that clearly shows that Scottish middle-aged women are particularly affected by a worse profile of CVD risks. The profound differences in CVD risk and outcome frequency in the two populations are likely to have arisen from differences in the two groups of women's social, cultural, political and economic environments.

  • 430.
    Wesnes, Kristin
    et al.
    Univ Bergen, Norway; Haukeland Hosp, Norway.
    Myhr, Kjell-Morten
    Univ Bergen, Norway; Haukeland Hosp, Norway.
    Riise, Trond
    Haukeland Hosp, Norway; Univ Bergen, Norway.
    Cortese, Marianna
    Univ Bergen, Norway; Haukeland Hosp, Norway.
    Pugliatti, Maura
    Univ Bergen, Norway; Univ Ferrara, Italy.
    Boström, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology.
    Landtblom, Anne-Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology. Uppsala Univ, Sweden.
    Wolfson, Christina
    McGill Univ, Canada.
    Bjornevik, Kjetil
    Haukeland Hosp, Norway; Univ Bergen, Norway.
    Physical activity is associated with a decreased multiple sclerosis risk: The EnvIMS study2018In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 24, no 2, p. 150-157Article in journal (Refereed)
    Abstract [en]

    Background: The lifestyle factors smoking and obesity have been associated with the risk of multiple sclerosis (MS). Physical activity (PA) may also be of importance. Objective: To examine the association between PA and MS risk in Italy, Norway, and Sweden and to evaluate the possible influence by established risk factors. Methods: In this case-control study, 1904 cases and 3694 controls were asked to report their average weekly amounts of light and vigorous PA during adolescence on a scale ranging from none to more than 3 hours activity. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) and adjusted for potential confounders. Results: Vigorous PA was inversely associated with MS risk in the pooled analysis (p-trend amp;lt; 0.001) with an age-and sex-adjusted OR of 0.74 (95% CI: 0.63-0.87) when comparing the highest and lowest levels. Adjusting for outdoor activity, infectious mononucleosis, body size, and smoking yielded similar results. The association was present in all countries and was not affected by exclusion of patients with early disease onset. Light PA was not associated with the risk of MS. Conclusion: Our findings suggest that vigorous PA can modify the risk of developing MS independent of established risk factors.

  • 431.
    Westerberg, Ingvar
    Linköping University, Department of Thematic Studies. Linköping University, Faculty of Arts and Sciences.
    Produktion, produktivitet och kostnader i svensk tandvård1987Doctoral thesis, monograph (Other academic)
    Abstract [en]

    The thesis contains projects at a national as well as a clinical level.

    On a national level a study is made of productivity in adult dental care in both its private and its public·sectors. By using the calculated productivity for the years 1975-1984 a variety of factors are tested for the ability to explain firstly the development of productivity in private dental care and in public dental care respectively, and secondly the differences in productivity between the two sectors.

    The productivity measures used are the number of patients treated per dentist hour and the dentist fee per dentist hour. The results show in the case of the first mentioned productivity measure a somewhat higher value for public dental care for all of the years studied. For the productivity measures, dentist's fee per dentist hour, private dental care shows a 20-30 percent higher productivity.

    Differences in the age structure of the patients and different treatment panoramas can explain a great many of the differences in productivity. However the question is why the treatment panoramas of the two sectors are so different, a difference that can scarcely be explained by differences in the patient population. There are grounds, therefore, for believing that the differences can be explained on the basis of differences in the activity goals of the two sectors.

    As a complement to the productivity studies outlined above the costs of treating a patient have also been compared. The results show considerably higher costs in public dental care, though the difference has been greatly reduced during the 80s due largely to a lower rate of increase in the overheads of dentists in the public sector over the last few years.

    The second study comprises a production economic study of 144 public dental care clinics in five counties in southern Sweden. The variation in productivity is tested on the basis of various explanatory factors using multiple regression analysis according to OLS. The regression models used were a linear function, an exponential function of the Cobb-Douglas type as well as a transcendental function of the type first formulated by Reinhardt in 1972. The results show that the high productivity clinic is smaller (1-2 dentists), has a larger staff of assistants, has fewer children and adolescents among its patients and shows higher productivity also in the case of the other productivity measure.

    The study also contains an estimation of the production function for the 144 clinics. A Cobb-Douglas production function is used as a regression mode. The results point to significant estimated coefficient values for all production factors. The coefficient values are, as could be expected, positive and between zero and one in size. The results are in agreement with most of the estimations obtained from previous studies.

  • 432.
    Westgren, N
    et al.
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Hultling, C
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Levi, Richard
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Seiger, A
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Westgren, M
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Sexuality in women with traumatic spinal cord injury.1997In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 76, no 10, p. 977-983Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sexuality in spinal cord injured women has largely been neglected. One reason may be the male dominance amongst traumatically spinal cord injured individuals. The purpose of this study is to elucidate sexual issues in women with spinal cord injuries.

    METHODS: Survey of near-total prevalence population in the greater Stockholm area. Structured interview, based on a standardized questionnaire. Self-rating scales for evaluation of the importance of sexual activity before and after injury and for defining and rating the medical problem most significantly interfering with sexual activity. Marital status and/or partnership pre- and post-injury and information on sexual matters provided after injury were evaluated in detail. Out of a total 65 women, 62 participated in the study.

    RESULT: Women with complete and incomplete cervical lesions rated the importance of sexual activity significantly lower after, as compared to before, spinal cord injury. No significant differences were found in women with lower-level lesions. Urinary leakage, spasticity and positioning problems were the medical problems most significantly interfering with partner-related sexual activity. Only six women had received information on sexual matters before discharge from hospital. None of the partners had received such information.

    CONCLUSION: The women's neurological status affect their ability to adapt sexually after injury. Medical problems commonly interfere with sexuality and should be identified and treated. No adverse impact of spinal cord injury on marital status could be confirmed. Sexual counseling has yet to become an integral part of rehabilitation.

  • 433.
    Westgren, Ninni
    et al.
    Spinalis SCI Research Unit, Karolinska Hospital and Department of Clinical Neuroscience and Family Medicine,Karolinska Institute, Stockholm, Sweden .
    Levi, Richard
    Spinalis SCI Research Unit, Karolinska Hospital and Department of Clinical Neuroscience and Family Medicine,Karolinska Institute, Stockholm, Sweden .
    Sexuality After Injury: Interviews with Women After Traumatic Spinal Cord Injury1999In: Sexuality and disability, ISSN 0146-1044, E-ISSN 1573-6717, Vol. 7, no 4, p. 309-319Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to illuminate sexual experiences in women after traumatic spinal cord injury (SCI), including psychological, physical and social barriers that will have to be overcome to resume a sexually active life with a partner. Interviews with eight women were performed. The women were 20–43 years old, previously healthy, with experience of stable heterosexual relationships both before and after SCI. The interviews covered three main areas: 1. The first sexual contact after injury: expectations, concerns, outcome; 2. Communication with partner on sexual matters, before and after injury; and 3. Sexual activity after injury: limitations, compensatory strategies. In addition, advice from the women to newly injured and rehabilitation staff/counselors was requested. Results suggest a strong influence of pre-injury sexual behaviour on post-injury sexual adaptation. A positive attitude towards sexuality and good communicative skills seem to be of particular importance for a favourable outcome of sexual rehabilitation. Even under such circumstances, however, SCI as a rule leads to significant loss of sexual ability. A realistic approach is therefore recommended in counseling, taking the mourning of loss of function into consideration, and allowing the patients to express their grief. Thus, sexual rehabilitation programs need to address a dynamic process of mourning and coping, rather than merely teaching skills for having sexual intercourse after SCI.

  • 434.
    Wickström, Anne
    et al.
    Umeå University, Sweden.
    Fagerström, Maria
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Rehabilitation Center.
    Wickström, Lucas
    Linköping University, Department of Computer and Information Science. Linköping University, Faculty of Science & Engineering.
    Granasen, Gabriel
    Umeå University, Sweden.
    Dahle, Charlotte
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Vrethem, Magnus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology.
    Sundstrom, Peter
    Umeå University, Sweden.
    The impact of adjusted work conditions and disease-modifying drugs on work ability in multiple sclerosis2017In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 23, no 8, p. 1137-1147Article in journal (Refereed)
    Abstract [en]

    Background: Multiple sclerosis (MS) is a neurological disorder that causes significantly reduced ability to work, and the Expanded Disability Status Scale (EDSS) is one of the main predictors for reduced work ability. Objectives: To investigate how work requirements, flexible work conditions and disease-modifying drugs (DMDs) influence the work ability in relation to different EDSS grades in two MS populations. Methods: Work ability was studied in two MS populations: one in the southern and one in the northern part of Sweden, both demographically similar. In the latter population, more active work-promoting interventions have been practised and second-generation DMDs have been widely used from the onset of disease for several years. Results: The proportion of MS patients who participated in the workforce or studied was significantly higher in the northern compared with the southern population (pamp;lt;0.001). The employees in the northern population had significantly lower requirements, greater adapted work conditions and were able to work more hours per week. Higher EDSS was associated with lower reduction in number of worked hours per week in the northern population (p=0.042). Conclusion: Our data indicated that treatment strategy and adjusted work conditions have impact on work ability in MS.

  • 435.
    Wickström, William
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Spreco, Armin
    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.
    Bargoria, Victor
    Department of Orthopaedics and Rehabilitation, Moi University, Eldoret, Kenya.
    Elinder, Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Divison of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences.
    Hansson, Per-Olof
    Linköping University, Department of Management and Engineering, Political Science. Linköping University, Faculty of Arts and Sciences.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    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.
    Perceptions of Overuse Injury Among Swedish Ultramarathon and Marathon Runners: Cross-Sectional Study Based on the Illness Perception Questionnaire Revised (IPQ-R)2019In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, p. 1-11, article id 2406Article in journal (Refereed)
    Abstract [en]

    Background: Long-distance runners’ understandings of overuse injuries are not well known which decreases the possibilities for prevention. The common sense model (CSM) outlines that runners’ perceptions of a health problem can be described using the categories identity, consequence, timeline, personal control, and cause. The aim of this study was to use the CSM to investigate perceptions of overuse injury among long-distance runners with different exercise loads.

    Methods: The study used a cross-sectional design. An adapted version of the illness perception questionnaire revised (IPQ-R) derived from the CSM was used to investigate Swedish ultramarathon and marathon runners’ perceptions of overuse injuries. Cluster analysis was employed for categorizing runners into high and low exercise load categories. A Principal Component Analysis was thereafter used to group variables describing injury causes. Multiple logistic regression methods were finally applied using high exercise load as endpoint variable and CSM items representing perceptions of injury identity, consequence, timeline, personal control, and causes as explanatory variables.

    Results: Complete data sets were collected from 165/443 (37.2%) runners. The symptoms most commonly associated with overuse injury were pain (80.1% of the runners), stiff muscles (54.1%), and stiff joints (42.0%). Overuse injury was perceived to be characterized by the possibility of personal control (stated by 78.7% of the runners), treatability (70.4%), and that the injury context was comprehensible (69.3%). The main injury causes highlighted were runner biomechanics (stated by 78.3%), the runner’s personality (72.4%), and running surface biomechanics (70.0%). Among men, a belief in that personality contributes to overuse injury increased the likelihood of belonging to the high exercise load category [Odds ratio (OR) 2.10 (95% Confidence interval (95% CI) 1.38–3.19); P = 0.001], while beliefs in that running biomechanics [OR 0.56 (95% CI 0.37–0.85); P = 0.006) and mileage (OR 0.72 (95% CI 0.54–0.96); P = 0.026] causes injury decreased the likelihood. In women, a strong perception that overuse injuries can be controlled by medical interventions decreased the likelihood of high exercise load [OR 0.68 (95% CI 0.52–0.89); P = 0.005].

    Conclusion: This study indicates that recognition among long-distance runners of the association between own decisions in overuse injury causation is accentuated by increased exercise loads.

  • 436.
    Wiger, Malin
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering.
    Logistics management operationalised in a healthcare context: Understanding care chain effectiveness through logistics management theories and systems theory2018Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Healthcare improvements is constantly relevant and an important topic. Healthcare is frequently being called upon to be more cost-efficient and still fulfil demands regarding waiting times, quality and availability. Experience from structural changes in other contexts gives reason to be positive about the potential for logistics improvements in the healthcare sector as well. From a logistics perspective patients pass different care functions, units, organisations and health facilities. It is assumed that logistics management knowledge applied in healthcare can lead to lower costs, shorter waiting times, better patient service, shorter treatment times and increased capacity. This dissertation therefore presents an exploration of how logistics management theories can be operationalised in a healthcare context to understand care chain effectiveness.

    Theoretically, the operationalisation is done by systems theory creating compatibility between logistics management theories and the healthcare context. As a first step, features for a logistics system forms features for achieving care chain effectiveness. High care chain effectiveness is thus a desired condition and the care delivery system is the tool to achieve it. As the final step in the operationalisation the features for care chain effectiveness are in turn used to analyse today’s practices. Empirically, the research is based on qualitative data from a single case study with multiple units of analysis. It includes four care units at one of Sweden’s university hospitals, where the data is gathered through interviews, insight into management systems and document analysis. One of the main results is the 21 areas identified for analysing today’s practices by means of features for care chain effectiveness. Another main result is the four important concepts revealed through the operationalisation:

    • Lead time - the episode of care from order to delivery as the amount of time for patient cases between first contact with healthcare and the last.
    • Patient order fulfilment - fulfilment of patients’ needs, broken down into several smaller steps performed over time within different care units in one or several organisations, consisting of five sub-processes - order handling, diagnosis, treatment, follow-up, and discharge.
    • True demand – patients’ needs that is to be met and thus sets what care to deliver, i.e. the production plan and the subordinate resource plan.
    • System boundaries - defines which care units to include when focusing on the care delivery system’s performance as a whole and should be more important than the performance and productivity of each individual care unit.

    A number of direct suggestions for care chain improvement can also be found in the concluding remarks, for example that objectives linked to economic influx or penalty narrow the system and that lead time data on an aggregated level is needed to cover episodes of care. The theoretical contribution of the dissertation is to the field of logistics management through the methodological development of using these theories in a new context. The managerial contribution is to healthcare managers through providing opportunities to improve care chains primarily by means of a greater understanding of care delivery systems.

  • 437.
    Wihlborg, Elin
    et al.
    Linköping University, Department of Management and Engineering, Political Science. Linköping University, Faculty of Arts and Sciences.
    Norstedt, Anna
    Linköping University.
    New ways and actors when diplomacy goes digital: The e-Diplomacy Campaign “Midwives4All2017In: Proceedings of the 50th Hawaii International Conference on System Sciences, 2017, Waikoloa: University of Hawaii , 2017, p. 2438-2447Conference paper (Refereed)
    Abstract [en]

    This article focuses on Midwives4All, an e-diplomacy campaign launched by the Swedish MFA in 2015. The campaign aims to spread knowledge about the benefits of midwives and evidence-based midwifery. Within the campaign, the Swedish MFA, and in particular its Communications Department (UD-KOM), combines e-diplomacy and networking and the campaign has become one key activity within the Swedish feminist foreign policy. It is organizing diplomacy in new ways that regards both choices of channels and the networking with inter- and nongovernmental organizations. The limited impacts of the campaign are seen as consequences of the peripheral status of the issue and the lack of systematic structures for e-diplomacy so far. In spite of this the case indicates that e-diplomacy has the potential to raise and empower both new actor groups and new issues on the diplomatic agenda.

  • 438.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    A Data-Rich World: Population‐based registers in healthcare research2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Advances and integration of information and communication technologies into healthcare systems offer new opportunities to improve public health worldwide. In Sweden, there are already unique possibilities for epidemiological research from registers because of a long tradition of centralized data collection into population-based registers and their allowance for linkage. The growing efficiency of automated digital storage provides growing volumes of archived data that increases the potential of analyses further.

    The purpose of this thesis can be divided into two parallel themes: illustrations and discussions of the use and usefulness of population-based registers on the one hand, and specific research questions in epidemiology and healthcare research on the other. The research questions are addressed in separate papers.

    From the Swedish Cancer Registry, 25 years of incidence data on testicular cancer was extracted for a large cohort. Record linkage to survey data on serum cholesterol showed a highly significant positive association, suggesting that elevated serum cholesterol concentration is a risk factor for testicular cancer. Since the finding is the first of its kind and because of wide confidence intervals further studies are needed to confirm the association.

    Östergötland County council’s administra-tive database (the Care Data Warehouse in Östergötland (CDWÖ)) provided data for preva-lence estimations of four common chronic diseases.

    The prevalence rate agreed very well with previous estimates for diabetes and fairly well with those for asthma. For hypertension and chronic obstructive pulmonary disease, the observed rates were lower than previous prevalence estimates. Data on several consecutive years covering all healthcare levels are needed to achieve valid prevalence estimates.

    CDWÖ data was also used to analyse the impact of diabetes on the prevalence of ischemic heart disease. Women had higher diabetes/non-diabetes prevalence rate ratios across all ages. The relative gender difference remained up to the age of 65 years and thereafter decreased considerably.

    The age-specific direct healthcare cost of diabetes was explored using data from the CDWÖ, the county council’s Cost Per Patient database and the Swedish Prescribed Drug Register. The cost per patient and the relative magnitude of different cost components varied considerably by age, which is important to consider in the future planning of diabetes management.

    The Cancer Registry was established mainly as a basis for epidemiological surveillance and research, exemplified in this thesis by a study on testicular cancer. In contrast, the newly established and planned healthcare databases in different Swedish counties are mainly for managerial purposes. As is shown in this thesis, these new databases may also be used to address problems in epidemiology and healthcare research.

    List of papers
    1. Serum cholesterol and testicular cancer incidence in 45 000 men followed for 25 years
    Open this publication in new window or tab >>Serum cholesterol and testicular cancer incidence in 45 000 men followed for 25 years
    2005 (English)In: British Journal of Cancer, ISSN 0007-0920, Vol. 92, no 9, p. 1785-1786Article in journal (Refereed) Published
    Abstract [en]

    In a 25-year follow-up study of 44 864 men with measured serum cholesterol levels, the testicular cancer hazard ratios for the serum cholesterol categories 5.7–6.9 and ≥7.0 mmol l-1 vs the reference category (<5.7 mmol l-1) were 1.3 and 4.5, respectively; P-value for trend=0.005. This highly significant association suggests that high-serum cholesterol is a risk factor for testicular cancer.

    Keywords
    epidemiology, testicular neoplasm, cholesterol
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-12757 (URN)10.1038/sj.bjc.6602539 (DOI)
    Available from: 2007-11-06 Created: 2007-11-06 Last updated: 2011-02-03
    2. Estimating disease prevalence using a population-based administrative healthcare database
    Open this publication in new window or tab >>Estimating disease prevalence using a population-based administrative healthcare database
    2007 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, Vol. 35, no 4, p. 424-431Article in journal (Refereed) Published
    Abstract [en]

    Aims: In Östergötland County, Sweden, all data on hospital care and primary healthcare (PHC) have been entered in a diagnosis-related administrative database since 1999. This database was used to estimate the prevalence of four chronic diseases and to examine the capture of data in PHC, outpatient hospital care, and inpatient hospital care, considered in different time frames.

    Methods: A case-finding algorithm identified patients with at least one healthcare contact involving a diagnosis of diabetes, hypertension, asthma, or chronic obstructive pulmonary disease (COPD) in 1999—2003. Prevalence rates were calculated as the ratio of the number of identified patients alive to the total number of inhabitants on 31 December 2003 (n~415,000).

    Results: Prevalence rates were 4.4% for diabetes, 10.3% for hypertension, 4.5% for asthma, and 1.2% for COPD. For all four diagnoses, the proportions of patients identified on only one healthcare level were greatest for PHC, reaching rates of 23%, 68%, 53%, and 48%, respectively. The cases identified solely in PHC comprised larger proportions of women and patients over the age of 65 years. Considering the proportion of patients identified in 2003 in relation to the total five-year period gave values of 71%, 50%, 38%, and 58%, respectively, for the four diagnoses.

    Conclusions: The administrative healthcare databases in Sweden today can be important tools in epidemiological research. However, data on several consecutive years and both PHC and hospital data are needed to achieve valid prevalence estimates.

    Keywords
    Asthma, COPD, diabetes mellitus, epidemiology, healthcare, hypertension, inpatients, prevalence, primary outpatients, registries
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-12758 (URN)10.1080/14034940701195230 (DOI)
    Available from: 2007-11-06 Created: 2007-11-06 Last updated: 2009-05-19
    3. Age and Gender Differences in the Impact of Diabetes on the Prevalence of Ischemic Heart Disease: a Population-Based Register Study
    Open this publication in new window or tab >>Age and Gender Differences in the Impact of Diabetes on the Prevalence of Ischemic Heart Disease: a Population-Based Register Study
    2008 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 79, no 3, p. 497-502Article in journal (Refereed) Published
    Abstract [en]

    Objective: To explore age and gender differences in the impact of diabetes on the prevalence of ischemic heart disease (IHD) in a defined population.

    Methods: Data were obtained from an administrative health care register covering a population of about 415 000. The study included all patients aged 45-74 years diagnosed between 1999-2003 with IHD (n=11 311) and diabetes (n=10 364) by physicians at all primary health care centres (PHCs) and out- and inpatient clinics at all hospitals in the county of Östergötland, Sweden.

    Results: In the 45-54 year-old age group, diabetes was associated with an increase in IHD prevalence equivalent to ageing about 20 years in women and 10 years in men. The diabetes/nondiabetes IHD prevalence rate ratio (IPR) decreased with age in both men and women (trend p-values < 0.001). The IPR was higher among women than men in each age group, though the female relative excess decreased from 75% higher in the 45-54 year-old age group to 33% higher in the 65-74 year-old age group (trend p-value = 0.018).

    Conclusions: The relative gender difference in the impact of diabetes on IHD in younger middle-aged patients remained up to the age of 65 years, decreasing considerably thereafter.

    Place, publisher, year, edition, pages
    Institutionen för medicin och hälsa, 2008
    Keywords
    aging, coronary disease, diabetes mellitus, prevalence, sex differences
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-11241 (URN)10.1016/j.diabres.2007.10.009 (DOI)
    Note
    Original publication: Ann-Britt E. Wiréhn, Carl Johan Östgren and John M. Carstensen, Age and Gender Differences in the Impact of Diabetes on the Prevalence of Ischemic Heart Disease: a Population-Based Register Study, 2008, Diabetes Research and Clinical Practice, (79), 3, 497-502. http://dx.doi.org/10.1016/j.diabres.2007.10.009. Copyright: Elsevier B.V., http://www.elsevier.com/Available from: 2008-03-12 Created: 2008-03-12 Last updated: 2017-12-13
    4. Age-specific direct health care costs attributable to diabetesin a Swedish population: a register-based analysis
    Open this publication in new window or tab >>Age-specific direct health care costs attributable to diabetesin a Swedish population: a register-based analysis
    2008 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 25, no 6, p. 732-737Article in journal (Refereed) Published
    Abstract [en]

    Aims: The aim of this population-based study was to explore the age-specific additional direct healthcare cost for patients with diabetes compared with the non-diabetic population.

    Methods: In 1999-2005, patients with diabetes in the Swedish county of Östergötland (n = 20 876) were identified from an administrative database. Cost data on the healthcare expenditure in primary healthcare, out-patient hospital care and in-patient care for the entire county population (n = ∼415 000) in 2005 were extracted from a cost per patient (CPP) database, which includes information on all utilized healthcare resources in the county. Data on drug sales were obtained from the Swedish Prescribed Drug Register.

    Results: The cost per person was 1.8 times higher in patients with diabetes than in the non-diabetic population, 7.7 times higher in children and 1.3 times higher in subjects aged > 75 years. The additional cost per person for diabetes was €1971; €3930 and €1367, respectively, for children and subjects aged > 75 years. The proportion of total additional diabetes costs attributable to in-patient care increased with age from 25 to 50%; in-patient care was the most expensive component at all ages except in children, for whom visiting a specialist was most expensive. The diabetes-related segment of the total healthcare cost was 6.6%, increasing from 2.0% in children to 10.3% in the age group 65-74 years, declining to 6.2% in the oldest age group.

    Conclusions: The direct medical cost of diabetes varies considerably by age. Knowledge about the influence of age on healthcare costs to society will be important in future planning of diabetes management.

    Keywords
    Diabetes, Economics, Healthcare delivery, Prevalence, Registers
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-12760 (URN)10.1111/j.1464-5491.2008.02444.x (DOI)
    Available from: 2007-11-06 Created: 2007-11-06 Last updated: 2017-12-14
  • 439.
    Workineh, Meseret
    et al.
    Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia.
    Mathewos, Biniam
    Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia.
    Moges, Beyene
    Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia.
    Gize, Adissu
    St. Pauls Millennium Medical College, Addis Ababa, Ethiopia.
    Getie, Sisay
    Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia.
    Stendahl, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Schön, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department of Clinical Microbiology and Infectious Diseases, Kalmar county Hospital, Kalmar, Sweden.
    Abate, Ebba
    Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia.
    Vitamin D deficiency among newly diagnosed tuberculosis patients and their household contacts: a comparative cross-sectional study2017In: Archives of Public Health, ISSN 0778-7367, E-ISSN 2049-3258, Vol. 75, article id 25Article in journal (Refereed)
    Abstract [en]

    Recent studies suggest that the incidence and severity of tuberculosis is associated with low levels of vitamin D. Even though individuals living in Ethiopia have a high exposure to sunlight which is a source of vitamin D, tuberculosis is still one of the major causes of morbidity and mortality in the country. Therefore, this study aimed to determine the prevalence and associated factors of vitamin D deficiency in newly diagnosed tuberculosis patients, household contacts and community controls in Gondar, Ethiopia.

  • 440.
    Wästfelt, Maja
    et al.
    Örebro Univ, Sweden.
    Cao, Yang
    Orebro Univ, Sweden; Karolinska Inst, Sweden.
    Ström, Jakob
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry. Orebro Univ, Sweden.
    Predictors of post-stroke fever and infections: a systematic review and meta-analysis2018In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 18, article id 49Article in journal (Refereed)
    Abstract [en]

    Background: fever after stroke is common, and often caused by infections. In the current study, we aimed to test the hypothesis that pneumonia, urinary tract infection and all-cause fever (thought to include at least some proportion of endogenous fever) have different predicting factors, since they differ regarding etiology. Methods: PubMed was searched systematically for articles describing predictors for post-stroke pneumonia, urinary tract infection and all-cause fever. A total of 5294 articles were manually assessed; first by title, then by abstract and finally by full text. Data was extracted from each study, and for variables reported in 3 or more articles, a meta-analysis was performed using a random effects model. Results: Fifty-nine articles met the inclusion criteria. It was found that post stroke pneumonia is predicted by age OR 1.07 (1.04-1.11), male sex OR 1.42 (1.17-1.74), National Institutes of Health Stroke Scale (NIHSS) OR 1.07 (1.05-1.09), dysphagia OR 3.53 (2.69-4.64), nasogastric tube OR 5.29 (3.01-9.32), diabetes OR 1.15 (1.08-1.23), mechanical ventilation OR 4.65 (2.50-8.65), smoking OR 1.16 (1.08-1.26), Chronic Obstructive Pulmonary Disease (COPD) OR 4.48 (1.82-11.00) and atrial fibrillation OR 1.37 (1.22-1.55). An opposite relation to sex may exist for UTI, which seems to be more common in women. Conclusions: The lack of studies simultaneously studying a wide range of predictors for UTI or all-cause fever calls for future research in this area. The importance of new research would be to improve our understanding of fever complications to facilitate greater vigilance, monitoring, prevention, diagnosis and treatment.

  • 441.
    Wåhlin Norgren, Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Professional based classification versus self reported measures as a basis for choice of intervention - patients’ with musculoskeletal and mental disorders2010Conference paper (Refereed)
  • 442.
    Yuan, Xi-Ming
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Sultana, Nargis
    Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Siraj, Nabeel
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ward, Liam J
    Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Li, Wei
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences.
    Autophagy Induction Protects Against 7-Oxysterol-induced Cell Death via Lysosomal Pathway and Oxidative Stress2016In: Journal of cell death, ISSN 1179-0660, no 9, p. 1-7Article in journal (Refereed)
    Abstract [en]

    7-Oxysterols are major toxic components in oxidized low-density lipoprotein and human atheroma lesions, which cause lysosomal mem-brane permeabilization (LMP) and cell death. Autophagy may function as a survival mechanism in this process. Here, we investigated whether 7-oxysterols mixed in an atheroma-relevant proportion induce autophagy, whether autophagy induction influences 7-oxysterol-mediated cell death, and the underlying mechanisms, by focusing on cellular lipid levels, oxidative stress, and LMP in 7-oxysterol-treated macrophages. We found that 7-oxysterols induced cellular lipid accumulation, autophagy dysfunction, and cell death in the form of both apoptosis and necrosis. Exposure to 7-oxysterols induced autophagic vacu-ole synthesis in the form of increased autophagy marker microtubule-associated protein 1A/1B-light chain 3 (LC3) and LC3-phosphatidylethanolamine conjugate (LC3-II) and autophagic vacuole formation. This led to an accumulation of p62, indicating a reduction in autophagic vacuole degradation. Importantly, autophagy induction significantly reduced 7-oxysterol-mediated cell death by diminishing LMP and oxidative stress. Moreover, autophagy induction minimized cellular lipid accumulation induced by 7-oxysterols. These findings highlight the importance of autophagy in combating cellular stress, LMP, and cell death in atherosclerosis. Therefore, activation of the autophagy pathway may be a potential therapeutic strategy for prevention of necrotic core formation in atherosclerotic lesions.

  • 443.
    Zarenoe, Reza
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Tinnitus in Patients with Sensorineural Hearing Loss: Management, Quality of Life and Treatment Strategies2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Approximately 15% of Swedish people experience tinnitus, but only 2.4% experience severe problems. Treatment modalities for tinnitus vary, but the most common treatment is counseling. The majority of patients with tinnitus report some degree of hearing loss, and hearing aids have been used for many years in patients who suffer from both tinnitus and hearing impairment. The aim of the present thesis was to investigate disease management, determine quality of life and identify treatment strategies for patients with tinnitus and sensorineural hearing loss.

    The first two studies described here are retrospective, descriptive studies of patients who sought care for tinnitus and hearing loss at two Ear-Nose-Throat (ENT) clinics in Östergötland County, Sweden, during the years 2004 - 2007. Study I showed that 70% of the cohort had tinnitus; however, many did not initially receive a diagnosis of tinnitus. Information about vertigo, heredity for hearing loss and tinnitus, diabetes history, cardiovascular disease history and other factors related to health was often missing from the patients’ medical records. The results could show that the overall scores using the Tinnitus Handicap Inventory (THI) were higher in female patients than in male patients. Although it is likely that hearing aids would be beneficial for the majority of these patients, 314 (44%) of the 714 total patients had hearing aids. Furthermore, the outcomes from study II demonstrated that a majority of the patients (61%) who were dissatisfied with the care they had obtained had no hearing aids. This finding may indicate that the fitting of hearing aids is an important treatment for patients with both tinnitus and hearing loss.

    Studies III and IV were prospective studies. Data collection was based on patients who sought care for tinnitus and/or hearing loss at the ENT clinic in Linköping during 2012-2013. In study III, 92 patients were divided into two groups: one group contained individuals with both tinnitus and hearing loss, and the other group contained patients with only hearing loss. The patients were assessed using the Reading Span test, the Hearing in Noise Test (HINT) and three questionnaires (the THI, the Hearing Handicap Inventory for Elderly and the Pittsburg Sleep Quality Index) at baseline and follow-up. The results from the age-matched subgroups (n=30+30) generated from the full clinical groups (46+46) showed significantly improved Reading Span test performance and sleep quality in patients with both tinnitus and hearing loss. Similar results were observed in our full clinical population (n=46+46). However, the interpretation of this finding is difficult due to age differences between the groups. In conclusion, hearing aid fitting had a significantly positive impact on working memory capacity and sleep quality in patients with both tinnitus and hearing loss compared with patients with only hearing loss.

    In study IV, a brief Motivational Interviewing (MI) guide was integrated into the hearing rehabilitation process for 23 patients with both tinnitus and hearing loss, and they were compared against a control group (n=23) of patients with both tinnitus and hearing loss who underwent traditional hearing rehabilitation. The results showed that the patients who received the brief MI guide required fewer visits to complete their hearing rehabilitation compared with the patients in the control group. In addition, there was a significant difference in THI scores between the groups, which indicated that the intervention reduced tinnitus annoyance more in the MI group. Furthermore, both groups showed higher scores at follow-up compared with baseline on the International Outcome Inventory for Hearing Aids (IOI-HA) scale, which indicated that both approaches showed a positive effect on hearing aid satisfaction.

    Study V was a retrospective, descriptive study that focused on a part of a Stepped Care model and included patients who participated in half-day tinnitus information meetings from 2004 to 2011 in the audiology clinic at Linköping University Hospital. A total of 426 tinnitus patients with complete questionnaires (the THI and the Hospital Anxiety and Depression Scale, HADS) were included in the study. The results showed significant decreases in scores on the THI and the anxiety module of the HADS before and after the information session. However, there were no statistically significant changes in the depression module of the HADS.

    In conclusion, this thesis underscores the importance of hearing impairment, cognitive variables and motivational procedures in the management of tinnitus. Multidisciplinary group information needs to be further validated.

    List of papers
    1. A cohort study of patients with tinnitus and sensorineural hearing loss in a Swedish population
    Open this publication in new window or tab >>A cohort study of patients with tinnitus and sensorineural hearing loss in a Swedish population
    2013 (English)In: Auris, nasus, larynx, ISSN 0385-8146, E-ISSN 1879-1476, Vol. 40, no 1, p. 41-45Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: We aimed to describe a large cohort of patients with tinnitus and sensorineural hearing loss (SNHL) in Sweden, and also to explore the possibility of finding potential possible differences between various diagnoses within SNHL. It is also of great interest to see how a multidisciplinary team was used in the different subgroups and the frequency of hearing aids use in patients with tinnitus.

    METHODS: Medical records of all patients who had received the diagnosis SNHL in Östergötland County, Sweden between 2004 and 2007 were reviewed. Patients between 20 and 80 years with tinnitus and a pure tone average (PTA) lower than 70dB HL were included in the study. Patients were excluded from the analyses if they had a cochlear implantation, middle ear disorders or had a hearing loss since birth or childhood. The investigators completed a form for each included patient, covering background facts, and audiograms taken at the yearly check up.

    RESULTS: Of a total 1672 patients' medical record review, 714 patients were included. The majority of patients (79%) were in the age group over 50 years. In male patients with bilateral tinnitus, the PTA for the left ear was significantly higher than for the right ear. The results regarding the configuration of hearing loss revealed that 555 patients (78%) had symmetric and 159 (22%) asymmetric hearing loss. Retrocochlear examinations were done in 372 patients and MRI was the most common examination. In all patients, 400 had no hearing aids and out of those 220 had unilateral tinnitus and 180 patients had bilateral tinnitus. 219 patients had a PTA>20dB HL and did not have any hearing aid. Results demonstrated that the Stepped Care model was not used widely in the daily practice. In our study, patients with bilateral-, unilateral hearing loss or Mb Ménière were the most common patients included in the Stepped Care model.

    CONCLUSION: In a large cohort of patients with SNHL and tinnitus, despite their hearing loss only 39% had hearing aids. It was observed that the medical record review often showed a lack of information about many background factors, such as; patients' general health condition, which could be a quality factor that needs improvement. Our results show that the Stepped Care model could be an effective option for providing a better access for tinnitus-focused treatment, although the number of patients in this study who were included in the Stepped Care model was low.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-81411 (URN)10.1016/j.anl.2012.05.005 (DOI)22652486 (PubMedID)
    Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2017-12-07Bibliographically approved
    2. Quality of life in patients with tinnitus and sensorineural hearing loss
    Open this publication in new window or tab >>Quality of life in patients with tinnitus and sensorineural hearing loss
    2014 (English)In: B-ENT, ISSN 1781-782X, Vol. 10, no 1, p. 41-51Article in journal (Refereed) Published
    Abstract [en]

    Purpose: The aim of this study was to evaluate the quality of life in patients with tinnitus and SNHL, to investigate patients’ mental and physical health and to measure the level of satisfaction concerning the care experienced by the patients.

    Methods: Three questionnaires related to patients` physical and psychological health, were mailed to 714 Swedish patients with tinnitus and sensorineural hearing loss.

    Results: Female patients had significantly higher Tinnitus Handicap Inventory scores than male patients. Patients who were satisfied with the care they obtained had significantly higher PTA. It was found that the satisfied group had significantly lower THI-scores. In the dissatisfied group, 61% of patients had no hearing aids compared to 42% in the satisfied group.

    Conclusion: Our cohort of patients estimated their life quality and general health at a good level almost 4.5 years after their first report of tinnitus. Another finding was that 47% of patients were not satisfied with the treatment they obtained. In the dissatisfied group, 61% of patients had no hearing aids. Further research is required to find an approach that could motivate patients with both tinnitus and hearing impairment to use hearing aids.

    Place, publisher, year, edition, pages
    ROYAL BELGIAN SOC EAR, NOSE, THROAT, HEAD & NECK SURGERY, 2014
    Keywords
    Tinnitus, Sensorineural hearing loss, Questionnaire, Quality of life
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-81412 (URN)000334566200007 ()24765828 (PubMedID)
    Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2017-02-20Bibliographically approved
    3. Working Memory, Sleep, and Hearing Problems in Patients with Tinnitus and Hearing Loss Fitted with Hearing Aids
    Open this publication in new window or tab >>Working Memory, Sleep, and Hearing Problems in Patients with Tinnitus and Hearing Loss Fitted with Hearing Aids
    2017 (English)In: Journal of the American Academy of Audiology, ISSN 1050-0545, Vol. 28, no 2, p. 141-151Article in journal (Refereed) Published
    Abstract [en]

    Background: Tinnitus is a common condition and there is a need to evaluate effects of tinnitus management in relation to moderating factors such as degree of hearing loss. As it is possible that tinnitus influences concentration, and thus is likely to disturb cognitive processing, the role of cognitive functioning also needs to be investigated.

    Purpose: To compare a group of patients with sensorineural hearing loss and tinnitus to a control group with only sensorineural hearing loss (and no tinnitus). To investigate working memory, sleep, and hearing problems measured before and after hearing rehabilitation.

    Research Design: A prospective study.

    Study Sample: The sample consisted of 100 patients, 50 with hearing loss and tinnitus, and 50 controls with hearing loss but no tinnitus. All patients were between 40 and 82 yr old and had a pure-tone average (PTA; average of 0.5, 1, 2, and 4 kHz) ,70 dB HL.

    Intervention: Patients were tested before and after rehabilitation with hearing aids with regard to their working memory capacity, sleep quality, hearing problems, speech recognition, and tinnitus annoyance.

    Data Collection and Analysis: Eight patients dropped out of the study. Thus, a total of 92 patients were included for analysis, with 46 in each group. As a consequence of unplanned age and PTA differences between the groups, an age-matched subsample (n 5 30 1 30) was selected for further analysis. Tests including the Reading Span, Hearing-in-Noise Test (HINT), Tinnitus Handicap Inventory (THI), Hearing Handicap Inventory for the Elderly (HHIE), and Pittsburgh Sleep Quality Index (PSQI) were administered before and after hearing aid rehabilitation.

    Results: There were no between-group differences at baseline in the full sample (n 5 92), with the exception of the THI (p , 0.001) and the PSQI (p , 0.002), on which the hearing loss and tinnitus group had significantly higher scores. Pre/post changes were significant for both groups on the Reading Span, and HHIE. However, these improvements were significantly larger for the patients in the hearing loss and tinnitus group on the Reading Span test (p , 0.001) and the PSQI (p , 0.001). Patients with tinnitus and hearing loss also exhibited significantly improved THI scores at follow-up, compared to baseline ( p, 0.001). We conducted the same analyses for the age-matched subsample (n 5 30 1 30). For the baseline data, only the THI (p , 0.001) and the PSQI (p , 0.015) difference remained significant. With regard to the pre/post changes, we found the same differences in improvement in Reading Span ( p , 0.001) and the PSQI (p , 0.015) as in the full sample.

    Conclusions: Patients with tinnitus benefited from hearing aid rehabilitation. The observed differences in cognitive function were unexpected, and there were larger score improvements on the Reading Span test in the hearing loss and tinnitus group than in the hearing loss group. Patients with tinnitus and hearing loss may receive extra benefit in terms of cognitive function following hearing aid rehabilitation.

    Place, publisher, year, edition, pages
    American Academy of Audiology, 2017
    Keywords
    sensorineural hearing loss; hearing aids; tinnitus; working memory capacity
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Neurology Otorhinolaryngology Psychology
    Identifiers
    urn:nbn:se:liu:diva-132160 (URN)10.3766/jaaa.16023 (DOI)000394478500005 ()28240981 (PubMedID)2-s2.0-85014508703 (Scopus ID)
    Available from: 2016-10-19 Created: 2016-10-19 Last updated: 2018-05-02Bibliographically approved
    4. Motivational Interviewing as an Adjunct to Hearing Rehabilitation for Patients with Tinnitus: A Randomized Controlled Pilot Trial.
    Open this publication in new window or tab >>Motivational Interviewing as an Adjunct to Hearing Rehabilitation for Patients with Tinnitus: A Randomized Controlled Pilot Trial.
    2016 (English)In: Journal of the American Academy of Audiology, ISSN 2157-3107, Vol. 27, no 8, p. 669--676Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE: To test the effects of a brief motivational interviewing (MI) program as an adjunct to hearing aid rehabilitation for patients with tinnitus and sensorineural hearing loss.

    RESEARCH DESIGN: This was a pilot randomized controlled trial.

    STUDY SAMPLE: The sample consisted of 50 patients aged between 40 and 82 yr with both tinnitus and sensorineural hearing loss and a pure-tone average (0.5, 1, 2, and 4 kHz) < 70 dB HL. All patients were first-time hearing aid users.

    INTERVENTION: A brief MI program was used during hearing aid fitting in 25 patients, whereas the remainder received standard practice (SP), with conventional hearing rehabilitation.

    DATA COLLECTION AND ANALYSIS: A total of 46 patients (N = 23 + 23) with tinnitus were included for further analysis. The Tinnitus Handicap Inventory (THI) and the International Outcome Inventory for Hearing Aids (IOI-HA) were administered before and after rehabilitation. THI was used to investigate changes in tinnitus annoyance, and the IOI-HA was used to determine the effect of hearing aid treatment.

    RESULTS: Self-reported tinnitus disability (THI) decreased significantly in the MI group (p < 0.001) and in the SP group (p < 0.006). However, there was greater improvement in the MI group (p < 0.013). Furthermore, the findings showed a significant improvement in patients' satisfaction concerning the hearing aids (IOI-HA, within both groups; MI group, p < 0.038; and SP group, p < 0.026), with no difference between the groups (p < 0.99).

    CONCLUSION: Tinnitus handicap scores decrease to a greater extent following brief MI than following SP. Future research on the value of incorporating MI into audiological rehabilitation using randomized controlled designs is required.

    Place, publisher, year, edition, pages
    Reston: Americ