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  • 51.
    Grankvist, Hannah
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Tales from the Frontier - Balancing scientific research, health and the profit motif: a U.S. case study2006In: The 8th World Congress of Bioethics,2006, 2006, p. 110-111Conference paper (Other academic)
  • 52.
    Grankvist, Hannah
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    The Future of Gene Therapy - Should Germ Line Interventions be avoided?2005In: XIXth European Conference on Philosphy of Medicine and Health Care,2005, 2005, p. 34-35Conference paper (Other academic)
  • 53.
    Grankvist, Hannah
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Borén, Kristina
    IFM Institutionen för Kemi.
    Hammarström, Per
    IFM Institutionen för Kemi.
    Carlsson, Uno
    IFM Institutionen för Kemi.
    Reshaping the folding energy landscape by chloride salt: Impact on molten-globule formation and aggregation behavior of carbonic anhydrase2004In: FEBS Letters, ISSN 0014-5793, E-ISSN 1873-3468, Vol. 566, no 1-3, p. 95-99Article in journal (Refereed)
    Abstract [en]

    During chemical denaturation different intermediate states are populated or suppressed due to the nature of the denaturant used. Chemical denaturation by guanidine-HCl (GuHCl) of human carbonic anhydrase II (HCA II) leads to a three-state unfolding process (Cm,NI=1.0 and Cm,IU=1.9 M GuHCl) with formation of an equilibrium molten-globule intermediate that is stable at moderate concentrations of the denaturant (1-2 M) with a maximum at 1.5 M GuHCl. On the contrary, urea denaturation gives rise to an apparent two-state unfolding transition (Cm=4.4 M urea). However, 8-anilino-1-naphthalene sulfonate (ANS) binding and decreased refolding capacity revealed the presence of the molten globule in the middle of the unfolding transition zone, although to a lesser extent than in GuHCl. Cross-linking studies showed the formation of moderate oligomer sized (300 kDa) and large soluble aggregates (>1000 kDa). Inclusion of 1.5 M NaCl to the urea denaturant to mimic the ionic character of GuHCl leads to a three-state unfolding behavior (Cm,NI=3.0 and Cm,IU=6.4 M urea) with a significantly stabilized molten-globule intermediate by the chloride salt. Comparisons between NaCl and LiCl of the impact on the stability of the various states of HCA II in urea showed that the effects followed what could be expected from the Hofmeister series, where Li+ is a chaotropic ion leading to decreased stability of the native state. Salt addition to the completely urea unfolded HCA II also led to an aggregation prone unfolded state, that has not been observed before for carbonic anhydrase. Refolding from this state only provided low recoveries of native enzyme. © 2004 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.

  • 54.
    Grankvist, Hannah
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, The Tema Institute.
    Juengst, Eric T
    Center for Genetic Research, Ethics and Law Case Western Reserve University.
    Ethical Issues in Human Gene Transfer: A Historical Overview2007In: Principles of Health Care Ethics, 2nd Edition / [ed] Richard Edmund Ashcroft,Angus Dawson ,Heather Draper,Ashcroft, Richard E, Chichester, West Sussex, England: John Wiley & Sons, Ltd , 2007, 2, p. 789-796Chapter in book (Other academic)
    Abstract [en]

    Edited by four leading members of the new generation of medical and healthcare ethicists working in the UK, respected worldwide for their work in medical ethics, Principles of Health Care Ethics, Second Edition  is a standard resource for students, professionals, and academics wishing to understand current and future issues in healthcare ethics. With a distinguished international panel of contributors working at the leading edge of academia, this volume presents a comprehensive guide to the field, with state of the art introductions to the wide range of topics in modern healthcare ethics, from consent to human rights, from utilitarianism to feminism, from the doctor–patient relationship to xenotransplantation. This volume is the Second Edition of the highly successful work edited by Professor Raanan Gillon, Emeritus Professor of Medical Ethics at Imperial College London and former editor of the Journal of Medical Ethics, the leading journal in this field. Developments from the First Edition include:   The focus on ‘Four Principles Method’ is relaxed to cover more different methods in health care ethics. More material on new medical technologies is included, the coverage of issues on the doctor/patient relationship is expanded, and material on ethics and public health is brought together into a new section.

  • 55.
    Grankvist, Hannah
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Welin, Stellan
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society.
    Germ line gene therapy - why not!2004In: XVIIIth European Conference on Philosophy of Medicine and Health Care,2004, 2004, p. 48-49Conference paper (Other academic)
  • 56.
    Gustafsson, Britt
    et al.
    Pediatrik Huddinge Universitetssjukhus.
    Carstensen, John
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Space-time clustering of childhood lymphatic leukaemias and non-Hodgkin's lymphomas in Sweden2000In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 16, no 12, p. 1111-1116Article in journal (Refereed)
    Abstract [en]

    Background: The discussion concerning clusters of childhood leukaemia has mainly been focused on their relation to the time and place of diagnosis. Recently some studies have indicated clustering not only at diagnosis, but also around time and place of birth. Space-time clustering at time of birth could be of special interest if the aetiological agent is of infectious origin and the induction of leukaemia either occurs pre- or perinatally or an infection at that time favours a poor subsequent immune response to the agent. Methods: To identify possible space-time clustering we have used the close-pair method of Knox. One-thousand-twenty recorded cases (0-14 years) of childhood acute lymphatic leukaemia and 293 cases (0-14 years) of malignant non-Hodgkin's lymphoma from Sweden between 1973-1996 were analysed. The records include date of birth and of diagnosis as well as addresses at birth and at diagnosis. Results: A significant excess of case-pairs (25 observed, 14.9 expected, p = 0.01) was observed close in date and place of birth in the 4-14 year age group with acute lymphatic leukaemia (ALL). However there was no statistically significant clustering found around time of diagnosis. When the cases of leukaemia and the non-Hodgkin's lymphomas were combined no statistically significant clustering was obtained neither at birth nor at diagnosis. Conclusions: This study strengthens the evidence of space-time clustering around the birth date in children whom later developed ALL. This observation is in support of the hypothesis that pre- or perinatal infections can induce a process leading to ALL.

  • 57.
    Heintz, Emelie
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Peebo, Bourghardt B.
    Ryhov County Hospital.
    Wiréhn, Ann-Britt
    Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, Faculty of Arts and Sciences.
    Rosenqvist, U.
    Motala Hospital.
    Levin, Lars-Åke
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    QUALITY-ADJUSTED LIFE-YEAR (QALY) WEIGHTS ASSOCIATED WITH DIFFERENT SEVERITY LEVELS OF DIABETIC RETINOPATHY in VALUE IN HEALTH, vol 13, issue 7, pp A297-A2972010In: VALUE IN HEALTH, Blackwell Publishing Ltd , 2010, Vol. 13, no 7, p. A297-A297Conference paper (Refereed)
    Abstract [en]

    n/a

  • 58.
    Jacobsson, Fredric
    et al.
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Arts and Sciences.
    Carstensen, John
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Borgquist, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Caring externalities in health economic evaluation: How are they related to severity of illness?2005In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 73, no 2, p. 172-182Article in journal (Refereed)
    Abstract [en]

    In health economic evaluations, altruistic preferences in the form of caring externalities, i.e. that people care about others' health, is usually not taken into account. In this study we examined how people value their own and others' health. This pilot study was carried out by letting people answer willingness to pay (WTP) questionnaires where internal WTP (own health) and altruistic WTP (others' health) were isolated and examined. A common method used in health economic evaluations is cost-utility analysis, which is based on the maximisation of QALYs. QALY maximisation may be appropriate if altruistic preferences are non-existent or if they are linear in relation to internal preferences (QALYs gained). We found evidence for the existence of altruistic preferences and that these preferences were relatively higher for severe health states (and lower for mild states of health) compared to internal preferences, i.e. when severity of illness increased, the relative increase in caring was higher concerning others than oneself. The difference was statistically significant (P < 0.001). Our results indicate that more attention and resources should be directed to severe health states, as compared to mild health states, than advocated by internal preferences in order to obtain more efficient resource allocation in the health care sector. © 2004 Elsevier Ireland Ltd. All rights reserved.

  • 59.
    Jonsson, Dick
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Ferraz-Nunes, José
    Rahmqvist, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Socioeconomic evaluation of mental health as a base for financing mental health care in Sweden2003In: International Advances in Economic Research, ISSN 1083-0898, E-ISSN 1573-966X, Vol. 8, p. 107-118Article in journal (Refereed)
  • 60.
    Karlsson, Nadine
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Borg (Festin), Karin
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, Faculty of Health Sciences.
    Hensing, Gunnel
    Department of Social Medicine, Sahlgrenska Academy, University of Göteborg, Göteborg, Sweden.
    Alexanderson, Kristina
    Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Mortality adjusted risk of disability pension in relation to sex and age in a Swedish county 1985-1996; A 12-year prospective cohort study.2003Conference paper (Refereed)
  • 61.
    Karlsson, Nadine
    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.
    Borg, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, Faculty of Health Sciences.
    Hensing, Gunnel
    Department of Social Medicine, Sahlgrenska Academy, University of Göteborg, Göteborg, Sweden.
    Alexanderson, Kristina
    Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Risk of disability pension in relation to sex and age in a Swedish county 1985-1996; A 12-year prospective cohort study.2004Conference paper (Other academic)
    Abstract [en]

    Background

    Number of persons on disability pension is increasing in many countries. So far the nowledge on risk for disability pension in a population over time is very limited.

    Aim

    To estimate the cumulative probability of disability pension among women and men in different age groups over a 12-year period.

    Methods

    A population-based prospective longitudinal cohort study. All the 229,864 sick-insured individuals, aged 16–64 years in the Swedish County of Östergötland in 1984 who then had no disability or old age pension were followed to 1996. The following data was obtained for each of the 12 years for all the individuals: disability pension status, old-age retirement status, and date of death. The probability of being granted disability pension over the study period was estimated using life tables. The risk for disability pension was modelled as a function of sex and age using a Cox's proportional hazards model. 95% confidence intervals were calculated.

    Results

    The cumulative estimates of the probability (in %) of being granted disability pension over 5 years adjusted for mortality and age retirement were, respectively 0.3, 0.9, 1.8, 6.3, and 22.8 for men and 0.4, 1.4, 3.2, 9.2, and 21.5 for women in the age groups 16–24, 25–34, 35–44, 45–54, and 55–64 years. The probabilities increased much over the years, more so for the women. The hazard ratios of disability pension for women vs. men were 1.6 (1.4–1.8), 1.9 (1.7–2.0), 1.7 (1.6–1.8), 1.2 (1.2–1.3), and 0.9 (0.9–0.9) in the same five age groups.

    Conclusions

    There were significant both age and sex differences in the risk of being granted disability pension. The former was expected but that the later was so large and differed with ages was not expected. Except for the age group 55–64 years, women had a higher risk of disability pension than men. More knowledge is needed on factors affecting this.

  • 62.
    Karlsson, Nadine
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Carstensen, John
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Gjesdal, Sturla
    Personskadeprevention Karolinska Institutet.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Mortality in relation to disability pension: findings from a 12-year prospective population-based cohort study in Sweden.2007In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 35, no 4, p. 341-347Article in journal (Refereed)
  • 63.
    Lerner, Henrik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Almfröfrossa?2007In: Fauna och flora / Naturhistoriska riksmuseet, ISSN 0014-8903, Vol. 102, no 4, p. 46-46Article in journal (Other (popular science, discussion, etc.))
  • 64.
    Lerner, Henrik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Att hata djur2007In: Människan och faunan. Etnobiologin i Sverige 3, Stockholm: Wahlström & Widstrand , 2007, p. 162-164Chapter in book (Other (popular science, discussion, etc.))
  • 65.
    Lerner, Henrik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Definitioner av begreppet hälsa respektive kondition hos veterinärer och läkare2008In: Djuren är väl också människor - en antologi om hälsa och välbefinnande i djurens och människornas värld, Skara: Institutionen för husdjurens miljö och hälsa, Sveriges Lantbruksuniversitet , 2008, p. 103-110Chapter in book (Other (popular science, discussion, etc.))
  • 66.
    Lerner, Henrik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Differences and similarities in the concepts of health and well-being in human medical law and animal welfare law2004In: XVIIIth European Conference on Philosophy of Medicine and Health Care,2004, 2004, p. 74-74Conference paper (Other academic)
  • 67.
    Lerner, Henrik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Fågelläten i Fokus: Talgoxens lätesrepertoar2008In: Vingspegeln, ISSN 0280-3941, Vol. 27, no 1Article in journal (Other (popular science, discussion, etc.))
  • 68.
    Lerner, Henrik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Fågelrapport för 20022003In: SOF, Fågelåret 2002, 2003Chapter in book (Other (popular science, discussion, etc.))
  • 69.
    Lerner, Henrik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Gråhägern som häckfågel i Västergötland2004In: Vår fågelvärld, ISSN 0042-2649, Vol. 63, no 4, p. 22-24Article in journal (Other (popular science, discussion, etc.))
  • 70.
    Lerner, Henrik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Gässens påverkan genom tillförsel av fosfor på sjöarna i området Kristianstad-Bromölla (Kristianstadsslätten)2006Report (Other academic)
  • 71.
    Lerner, Henrik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Hälsa som balans. En kritisk granskning av ett centralt begrepp inom medicinen och veterinärmedicinen.2006In: Essäer om hälsa: En antologi från forskarutbildningen på Tema Hälsa och samhälle. / [ed] Henrik Lerner & Nicklas Skillnäs, Linköping: Linköpings universitet , 2006, p. 33-44Chapter in book (Other academic)
  • 72.
    Lerner, Henrik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Is human and animal health the same how is it related to other concepts in medicine and veterinary medicine?2006In: XXth European Conference on Philosophy of Medicine and Health Care,2006, 2006, p. 45-46Conference paper (Other academic)
  • 73.
    Lerner, Henrik
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Kampe-Persson, Hakon
    Department of animal ecology Lunds universitet.
    Occurrence of hybrid geese in Sweden - a conversation problem?2007In: Ornis Svecica, ISSN 1102-6812, Vol. 17, p. 154-186Article in journal (Refereed)
  • 74.
    Lerner, Henrik
    et al.
    Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, Faculty of Arts and Sciences.
    Skillnäs, NicklasLinköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, Faculty of Arts and Sciences.
    Essäer om hälsa: En antologi från forskarutbildningen på Tema Hälsa och samhälle2006Collection (editor) (Other academic)
  • 75.
    Lerner, Henrik
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Wendel, Lotta
    Lunds universitet.
    Om möss och människor - försöksobjektens rättsliga ställning i human- och djurlagstiftningen2008In: Djuren är väl också människor - en antologi om hälsa och välbefinnande i djurens och människornas värld, Skara: Institutionen för husdjurens miljö och hälsa, Sveriges Lantbruksuniversitet , 2008, p. 93-101Chapter in book (Other (popular science, discussion, etc.))
  • 76.
    Lewander, Andreas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Oncology.
    Kumar Reddy Butchi, Anil
    Gao, Jingfang
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Oncology.
    He, Lu-Jun
    Lindblom, Annika
    Arbman, Gunnar
    Carstensen, John
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Zhang, Zhi-Yong
    Sun, Xiao-Feng
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Oncology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Polymorphism in the promoter region of the NFKB1 gene increases the risk of sporadic colorectal cancer in Swedish but not in Chinese populations2007In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 42, no 11, p. 1332-1338Article in journal (Refereed)
    Abstract [en]

    Objective. An insertion/deletion polymorphism (-94ins/delATTG) in the promoter region of the NFKB1 gene correlates to an increased risk of ulcerative colitis, a known risk factor for colorectal cancer, but this polymorphism has not been studied in colorectal cancer patients. The purpose of this study was to investigate whether this polymorphism is related to colorectal cancer risk and clinicopathological variables. Material and methods. Case samples were taken from four groups of Swedish patients: 193 unselected patients, 90 patients with ≥3 affected 1st-degree relatives, 85 patients with 2 affected 1st-degree relatives, and 109 sporadic cancer patients, and one group of 193 unselected Chinese patients. Controls included 439 Swedish and 458 Chinese healthy individuals. Genotypes were determined by polymerase chain reaction (PCR)-restriction fragment length polymorphism. Results. The deletion increased the risk of colorectal cancer among Swedish unselected patients (OR=3.81, 95% CI: 2.17-6.69, p<0.0001 for heterozygote deletion, and OR=4.65, 95% CI: 2.43-8.89, p<0.0001 for homozygote deletion) and sporadic cancer patients (OR=7.73, 95% CI: 3.06-19.57, p<0.0001 for heterozygote deletion, and OR=6.58, 95% CI: 2.35-18.43, p<0.0001 for homozygote deletion) compared to homozygote insertion (wild-type), but not among the other Swedish or Chinese patients (p>0.05). Similar evidence was seen in age-adjusted analyses (p<0.0001). The polymorphism did not correlate to clinicopathological variables (p>0.05). Conclusions. Deletion of the polymorphism was associated with increased susceptibility to sporadic colorectal cancers in the Swedish population, but not in the Swedish patients with a family history of colorectal cancer or in Chinese patients. © 2007 Taylor & Francis.

  • 77.
    Liss, Per-Erik
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Lundgren, Fredrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Ethical reasons motivate screening for abdominal aortic aneurysm in 65-year-old men. Aneurytsm-related mortality can be halved.2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102 32-33, p. 2216-2219Article in journal (Other academic)
  • 78.
    Liss, Per-Erik
    et al.
    Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, Faculty of Arts and Sciences.
    Nordin, Ingemar
    Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, Faculty of Arts and Sciences.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences, Sociology. Linköping University, Faculty of Arts and Sciences.
    Målsättningar och verklighet – vård och omsorg i kommunal regi: Del I Mål och prioriteringar2006Report (Other academic)
    Abstract [sv]

    Hur bra är vården och omsorgen i kommunal regi? Det är en vidsträckt fråga där svaren åtminstone delvis måste vara av rent subjektiv karaktär. ”Bra” respektive ”dålig” är inga objektiva egenskaper som saker bara har, utan de är något som vi människor tillskriver dem genom att relatera till våra personliga värderingar. Det blir lite mer lätthanterligt ur vetenskaplig synvinkel om vi istället frågar oss hur vården och omsorgen lever upp till de målsättningar som verksamheten själv ställt upp.

    Att diskutera och utvärdera vården inom landstingen är ju något vi vant oss vid under de senare decennierna. Men idag sker det faktiskt en hel del vård i kommunernas regi. Inom kommunerna har man bland annat ett uppdrag att sköta äldrevården. Hur ser det ut där? Hur bra lever man upp till sina egna ofta mycket ambitiösa målsättningar? I den här rapporten kommer vi inte att kunna ge något uttömmande svar på hur verkligheten stämmer med idealen men den innehåller en hel del intressanta indikationer och ledtrådar.

    När vi – Per-Erik Liss, Tommy Svensson och undertecknad – diskuterade upplägget för det här projektet sade vi oss att det var viktigt att angripa problemet från två håll samtidigt; dels att titta närmare på kommunernas målsättningar, dels att dyka ned i verkligheten och försöka ta reda på hur omsorgen fungerar i praktiken. Uppgiften rörande målsättningarna var först och främst att ta reda på vilka de var och hur de var formulerade. Det var bl a väsentligt att se hur målen var relaterade ”uppåt”, d v s hur de stämmer överens med de mål och prioriteringar som görs på ett nationellt plan. Inte minst borde prioriteringsprinciperna i Hälso- och sjukvårdslagen vara central, inte bara för hur landstingen, utan även kommunerna väljer att fördela sina vårdresurser. I vilken mån spelar exempelvis rättviseprincipen om att fördela efter ”vårdbehov” en roll inom den kommunala sektorn? Och vad utgör ”behov” när det gäller äldre människor? Vad behövs det för hjälp för att vara gammal på ett bra sätt?

    En annan väsentlig fråga är hur de kommunala vård- och omsorgsmålsättningarna relaterar till varandra internt. Vilka är de övergripande målsättningarna och vilka är blott operativa mål eller delmål? Om det exempelvis fastställs ett delmål att hemtjänsten skall vara behjälplig med städning men inte med att sitta ned och prata så har det därmed bestämts att det förra är nödvändigare än det andra för att nå övergripande syften. Det har gjorts en bedömning att den första åtgärden bättre fyller ett väsentligt behov hos de äldre än den andra.

    Men hur har man gått tillväga för att komma fram till denna slutsats? Är det så säkert att de olika delmålen verkligen leder mot de stolta proklamationerna i den övergripande visionen? När vi sedan kontemplerade dykt ner i verkligheten så stod det ganska snart klart att det borde bli en djupdykning snarare än blott ett snorklande vid ytan. Det vill säga, vi skulle kanske inte se så mycket av den övergripande statistiken beträffande budgetar och antal människor under åtgärd. Men för att nå de intressanta skikten där vi kan hoppas på att få syn på enskilda människors, i synnerhet äldre människors, behov av vård, trygghet och värdighet så måste vi dyka på djupet. Vi måste lyssna på enskilda människors berättelser om vilka de är, hur de ser på sina liv och vad som är viktigt för dem. Det är ju först på denna nivå som vi kan börja förstå vilka problem och behov det finns, och hur dessa sedan kan relateras till vårdens och omsorgens målsättningar. Hur betydelsefull är överhuvudtaget den kommunala omsorgsservicen i en människas liv på äldre dagar?

    I detta sammanhang är det också viktigt att beakta det vi kan kalla för ”mellangruppens” erfarenheter, d v s de som har att implementera målen i sin verksamhet; vårdare, biträden och assistenter. Detta är en grupp som ofta hamnar i kläm mellan politiker och allmänhet. I sin dagliga gärning möter de människorna som behöver vård och omsorg. Samtidigt skall deras verksamhet bedrivas i enlighet med de direktiv och riktlinjer som politikerna ställt upp. Går dessa krav ihop? Hur bedömer vårdaren att han/hon kan möta upp mot de dubbla kraven? Deras observationer, erfarenheter och intressen skiljer sig tydligt från de båda andra gruppernas, det utgör ett eget perspektiv.

    När jag, vid slutet av projekttiden, sträckläste först Per-Eriks analytiska diskussion om mål och prioriteringar och sedan Tommys djupintervjuer med hemtjänstens vårdbiträden och gamla, hade jag en stark impuls att vi skulle låta studierna stå helt okommenterade. De utgör alla en del av verkligheten, och jämförelsen inbjuder till många frågor och tankar. Varför inte låta läsaren själv dra sina slutsatser? Hur går dessa vitt skilda bilder ihop?

    Men, trots allt är det här en vetenskaplig rapport och forskare bör kommentera och dra slutsatser. Det hör väl ändå till? Så Per-Erik gör några avslutande kommentarer där han jämför målsättningar med verklighet. Men dessa kommentarer är blott en liten hjälp på traven. Studien om de officiella målsättningarna å ena sidan och studierna av verksamheten bland personal och mottagare å den andra står på egna ben. Att läsa dem tillsammans ger en stark läsupplevelse och mycket att fundera vidare på.

  • 79.
    Malmqvist, Erik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Arvsmassan som nationell egendom2006In: Axess, ISSN 1651-0941, p. 41-42Article in journal (Other academic)
    Abstract [en]

       

  • 80.
    Malmqvist, Erik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Genetic intervention and the freedom of future persons2005In: Ethics and philosophy of emerging medical technologies,2005, 2005, p. 60-61Conference paper (Other academic)
  • 81.
    Malmqvist, Erik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    The notion of health and the morality of genetic intervention2006In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 9, no 2, p. 181-192Article in journal (Refereed)
    Abstract [en]

    In the present paper it is argued that genetic interventions on human embryos are in principle permissible if they promote the health of the persons that these embryos will one day become and impermissible if they compromise their health. This so called health-intervention principle is reached by, inter alia, rejecting alternative approaches to the problem of the permissibility of genetic intervention. The health-intervention principle can be interpreted in different ways depending on how the notion of health is understood. The central part of the paper is an attempt to find a concept of health which is such that it makes the health-intervention principle normatively plausible. For this purpose I examine two influential competing theories of health: Cristopher Boorse's biostatistical theory of health and Lennart Nordenfelt's welfare theory of health. I argue that the health-intervention principle is more plausible if health is understood in the latter sense, although it is not ruled out that the principle may be given an even more plausible explication in terms of some other notion of health. © Springer 2006.

  • 82.
    Malmqvist, Erik
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Peetz Nielsen, Per
    Sveriges Lantbruksuniversitet, Skara.
    Transeminariet 2004: Begreppet hälsa2004In: Svensk veterinärtidning, ISSN 0346-2250, Vol. 10, p. 25-27Article in journal (Other academic)
  • 83.
    Neubeck, Anna-Karin
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Dagens psykiatri - finns en sund självreflektion?2006In: Essäer om hälsa.: En antologi från forskarutbildningen på Tema Hälsa och samhälle. / [ed] Henrik Lerner & Nicklas Skillnäs, Linköping: Linköpings universitet , 2006, p. -64Chapter in book (Other academic)
  • 84.
    Nilsson, Staffan
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, HELIX Vinn Excellence Centre.
    Samarbete kring och utredning av långtidssjukskrivna2001Report (Other academic)
  • 85.
    Nilsson, Staffan
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Yrke, Cancer och Alkohol: En studie av alkoholrelaterad cancer i olika yrken1999Report (Other academic)
    Abstract [en]

    The association between alcohol and e.g. liver cirrhosis, alcohol psychosis, alcohol poisoning, violence, accidents etc is well established . The connection between alcohol and cancer is less well known, however. Every third Swede will fall ill with cancer during their lifetime. Alcohol is considered to be the second most important risk factor of cancer, preceded by tobacco. Earlier studies on alcohol consumption in different occupations is scarce. There is however a well-established association between alcohol consumption and socio-economic group.

    The aim of this study is to examine the risks of alcohol-related cancer in men by different occupations. For this purpose the 1970 Census population was followed up for the period 1971-1984 by means of the Swedish Cancer-Environment Registry. Previous research have shown a strong association between alcohol and cancer in the oral cavity, oesophagus, larynx, and pharynx and a slightly weaker association with cancer of the liver. More than half of the incidence of aerodigestive cancer is caused by alcohol. There is a strong synergistic effect between alcohol and cancer in the aetiology of the aerodigestive cancers and more than 80% of these cancers is caused by alcohol in combination with smoking. Smoking is not a risk factor of cancer in the liver, though. The aetiology of cancer is very complex and factors and this complicates the discussion about causality. Lung cancer is largely caused by smoking and by observing the lung cancer incidence in a group the proportion of smokers can be roughly estimated. This is helpful in the estimation of impact of alcohol respectively smoking in the results. In occupational groups which display statistically significantly elevated standardised morbidity rates (SMR) of alcohol related cancer and lung cancer there is reason to take smoking into account in the discussion of the aetiology of aerodigestive cancer. This is a descriptive study is intended to be a base for further etiological or analytical studies. The aim is to establish hypotheses about the possible impact of alcohol in the aetiology of cancer at the aerodigestive sites and cancer of the liver in different occupational groups.

    The results implies a need for further research on alcohol consumption and cancer among literary and artistic workers, printing workers, housekeepers and related service workers, secretaries, typists and related workers, legal workers, travelling agents, waiters and waitresses, ship officers, post workers and other messengers, and finally packers, dockers and freight handlers, store and warehouse workers. It is difficult to draw any general conclusions from these results, but in several of these occupational groups there are several established risk factors of a higher alcohol consumption to be found, such as inadequate social contacts, low control, high demands resulting in high tension, among others. Whether the cancer, examined in this study, is caused by alcohol or some other risk factors it is important in a pubic health perspective to study these occupational groups and work environments in further detail to order to enable future prevention.

  • 86.
    Nilsson, Staffan
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    John, Carstensen
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Mortality among male and female smokers in Sweden2000In: Norweigian Journal of Epidemiology, ISSN 0803-4206, Vol. 10, no 2, p. 78-78Article in journal (Refereed)
    Abstract [en]

    n/a

  • 87.
    Nilsson, Staffan
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    John, Carstensen
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Pershagen, Göran
    Karolinska Institute.
    Mortality among male and female smokers in Sweden: A 33 year follow up2001In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 55, no 11, p. 825-830Article in journal (Refereed)
    Abstract [en]

    Study objective - It is still unclear if men and women are equally susceptible to the hazards of tobacco smoking. The objective of this study was to examine smoking-related mortality among men and women.

    Design - In 1963 a questionnaire concerning tobacco smoking habits was sent out to a random sample from the 1960 Swedish census population. Date and cause of death have been collected for the deceased in the cohort through 1996.

    Setting - Sweden

    Participants - The survey included a total of 27 841 men and 28 089 women, aged 18-69 years. The response rate was 93.1% among the men and 95.4% among the women.

    Main results - After adjustment for age and place of residence positive associations were found between cigarette smoking and mortality from ischaemic heart disease, aortic aneurysm, bronchitis and emphysema, cancer of the lung, upper aerodigestive sites, bladder, pancreas in both men and women, but not from cerebrovascular disease. When the effect of amount of the cigarette consumption was considered, female smokers displayed e.g. slightly higher relative death rates from ischaemic heart disease. However, no statistically significant gender differential in relative mortality rates was observed for any of the studied diseases.

    Conclusions - Women and men in this Swedish cohort seem equally susceptible to the hazards of smoking, when the gender differential in smoking characteristics is accounted for. Although the cohort under study is large, there were few female smokers in the high consuming categories and the relative risk estimates are therefore accompanied by wide confidence intervals in these categories.

  • 88.
    Nordenfelt, Lennart
    Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, Faculty of Arts and Sciences.
    Action, Ability and Health: Essays in the Philosophy of Action and Welfare2000Book (Refereed)
    Abstract [en]

    Contributes to the general philosophy of action and the philosophy of welfare. This book explores and substantiates the idea of a strong interdependence between the concept of action and some of the central concepts of welfare, in particular health and illness and related concepts.

  • 89.
    Nordenfelt, Lennart
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Action Theory, Disability and the ICF2003In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 25, no 18, p. 1075-1079Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper is to make a critical analysis of the conceptual platform of the recently introduced International Classification of Functioning, Disability and Health (ICF). Special attention is paid to the suggested definitions of the concepts of activity and participation. My argument intends to show that these definitions are not coherent.Method: The theoretical platform of this paper is philosophical action theory. My argument makes particular use of the distinction between capacity and opportunity and shows that both concepts are applicable to all actions. Capacity and opportunity are distinguished from the actual performance of actions. The latter presupposes the existence of a will. On this conceptual basis follows an analysis of the distinction between activity and participation as conceived by the WHO in ICF.Conclusions: The main conclusion of my reasoning is that the notions of activity and participation in ICF partly rest on confusion between capacity for action and the actual performance of an action. If my conclusion is sound this has far-reaching consequences for the application of the ICF in the practice of rehabilitation. My diagnosis therefore is that the conceptual framework of ICF is in great need of a strict action - theoretic reconstruction.

  • 90.
    Nordenfelt, Lennart
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Aktivitet, delaktighet och ICF: En vetenskapsteoretisk bakgrund2004In: Delaktighetens språk / [ed] Anders Gustavsson, Lund: Studentlitteratur , 2004, 1, p. 49-60Chapter in book (Other academic)
    Abstract [sv]

    När samhällets mest brännande frågor diskuteras talas det idag ofta om delaktighet. Men vad står det för? I den här boken framgår att delaktighet har olika betydelser i det politiska språkbruket och i vetenskapligt språk. Fjorton forskare analyserar delaktighetens olika språk och sammanfattar aktuella undersökningar av funktionshindrades delaktighet.En semantisk analys visar att delaktighet bland annat kan betyda inflytande, tillhörighet, engagemang och makt. Världshälsoorganisationens nya klassifikation (ICF) av människors delaktighet diskuteras och i andra kapitel presenteras forskning om barns delaktighet i skolan och i mer informella leksammanhang. Vidare diskuteras om delaktighet förutsätter likvärdiga levnadsvillkor, hur man kan förstå föräldrars inflytande i barnhabilitering och om det går att skapa delaktighet.Boken vänder sig till alla som har intresse för handikappolitik samt till ett brett spektrum av utbildningar som berör funktionshinder.Bokserien "Handikapp och samhälle" syftar till att tematiskt presentera aktuella socialvetenskapliga perspektiv på funktionshinder och handikapp för såväl universitets- och högskolestuderande som andra intresserade.

  • 91.
    Nordenfelt, Lennart
    Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, Faculty of Arts and Sciences.
    Animal and Human Health and Welfare: A Comparative Analysis2006Book (Refereed)
    Abstract [en]

    For many years scientists within human and animal science have extensively discussed the philosophy of medicine, but never have both sides communicated on their concepts of health, quality of life and welfare, with each other. This book helps clarify the difficult but central notions of health and welfare by comparing the human and animal variants of these concepts. Split into three parts this book starts by presenting a background of some of the major theories of human health and welfare, among these are the bio-statistical theory, classical theories such as Aristotle and Bentham, as well as objectivist and subjectivist contemporary theories. This is followed by a detailed discussion of theories on animal welfare and health; these include coping, feeling and preference theories. The final part of the book tests a comprehensive conceptual framework of a holistic kind, which focuses on the individual's ability to achieve it's vital goals

  • 92.
    Nordenfelt, Lennart
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Att karaktärisera hälsa2004In: Livsföreställningar : kultur, samhälle och biovetenskap / [ed] Christer Nordlund, Umeå: Kungl. Skytteanska Samfundet , 2004, p. 75-87Chapter in book (Other academic)
  • 93.
    Nordenfelt, Lennart
    Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, Faculty of Arts and Sciences.
    Begreppet vårdbehov: kritiska kommentarer1998In: Etik och ekonomi, Uppsala: Uppsala universitet: Studies in Ethics and Economics , 1998Chapter in book (Other academic)
  • 94.
    Nordenfelt, Lennart
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Commentary on the notions of genetic disease and causes of illness in clinical practice2006In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 9, p. 317-319Article in journal (Refereed)
  • 95.
    Nordenfelt, Lennart
    Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, Faculty of Arts and Sciences.
    Conversando sobre saude: Um dialogo filosofico2001Book (Other academic)
  • 96.
    Nordenfelt, Lennart
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Coping and Welfare in Animal and Human Science2004In: The XVIIIth Annual Conference of the European Society of the Philosophy of Medicine and Health Care,2004, 2004Conference paper (Refereed)
  • 97.
    Nordenfelt, Lennart
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Descriptive or normative conceptual analysis1998In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 1, p. 15-16Article in journal (Refereed)
  • 98.
    Nordenfelt, Lennart
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Dignity and the Care of the Elderly2003In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 6, p. 103-110Article in journal (Refereed)
  • 99.
    Nordenfelt, Lennart
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Dignity and the older european2005In: Quality in ageing, ISSN 1471-7794, Vol. 6, p. 17-20Article in journal (Refereed)
  • 100.
    Nordenfelt, Lennart
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Dignity of the elderly: An introduction2003In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 6, p. 99-101Article in journal (Refereed)
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