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  • 51.
    Bouwman, Hindrik
    et al.
    North-West University, South Africa.
    Kylin, Henrik
    Linköping University, The Tema Institute, Tema Environmental Change. Linköping University, Faculty of Arts and Sciences.
    Bornman, Riana
    University of Pretoria, South Africa.
    Is Indoor Residual Spraying broken and what should be fixed?2015In: Proceedings of the 7th International Toxicology Symposium in Africa, 2015, p. 2-3Conference paper (Refereed)
    Abstract [en]

    Indoor residual spraying (IRS) has been and is still a very successful method to controlmalaria. We are concerned that not enough research attention is given to improvingIRS and that most funding goes towards modern but seemingly still ineffectualmethods. We believe that there is ample scope for improving IRS, while reducinginsecticide exposure

  • 52.
    Bredström, Anna
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Social and Welfare Studies. Linköping University, REMESO - Institute for Research on Migration, Ethnicity and Society.
    Alkohol och  sexuellt risktagande: Teoretiska perspektiv och en kvalitativ studie om alkohol och sexuellt risktagande bland ungdomar och unga vuxna2011Report (Other academic)
  • 53.
    Bredström, Anna
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Social and Welfare Studies. Linköping University, REMESO - Institute for Research on Migration, Ethnicity and Society.
    Sociokulturellt sammanhang som etnisk skiljelinje i psykiatrisk diagnostik: kulturbegreppet i DSM-52015In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 92, no 1, p. 47-55Article in journal (Refereed)
    Abstract [sv]

    I arbetet med revisionen av DSM-5 (2013) betonades vikten av att kulturanpassa diagnosmanualen. Den kulturformulering som fanns i DSM-IV utvärderades, och förslag på förändringar lades fram av experter tillsatta av DSM-5:s styrgrupp. Artikeln visar att den reviderade manualen på flera sätt försöker bemöta tidigare kritik om etnocentrism och individorienterat kulturbegrepp. Trots detta bygger DSM-5 fortfarande på en etnocentrisk uppdelning mellan universella diagnoser och kulturspecifika avvikelser där kultur likställs med icke-västerländsk. Genom att betona sociokulturellt sammanhang bryter kulturavsnitten också med den dominerande symptombaserade förståelsen som annars genomsyrar diagnoskriterierna. Mot denna bakgrund, argumenterar artikelförfattaren, finns det risk att lyhördhet för sociokulturellt sammanhang blir en etnisk skiljelinje i psykiatrisk diagnostik istället för att omfamna alla med psykiskt lidande. 

  • 54.
    Broström, Anders
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonkoping Univ, Sweden.
    Pakpour, Amir H.
    Jonkoping Univ, Sweden; Qazvin Univ Med Sci, Iran.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Gardner, Benjamin
    Kings Coll London, England.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Promoting CPAP adherence in clinical practice: A survey of Swedish and Norwegian CPAP practitioners beliefs and practices2018In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27, no 6, article id UNSP e12675Article in journal (Refereed)
    Abstract [en]

    The benefits of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea are well established, but adherence tends to be low. Research exploring CPAP practitioners beliefs around determinants of CPAP adherence, and the actions they use in clinical practice to promote CPAP adherence is lacking. This study aimed to: (i) develop and validate a questionnaire to assess beliefs and current practices among CPAP practitioners; (ii) explore practitioners beliefs regarding the main determinants of patient adherence, and the actions practitioners most commonly use to promote CPAP adherence; and (iii) explore the associations between perceived determinants and adherence-promotion actions. One-hundred and forty-two CPAP practitioners in Sweden and Norway, representing 93% of all Swedish and 62% of all Norwegian CPAP centres, were surveyed via a questionnaire exploring potential determinants (18 items) and adherence-promotion actions (20 items). Confirmatory factor analysis and second-order structural equational modelling were used to identify patterns of beliefs, and potential associations with adherence-promotion actions. Patients knowledge, motivation and attitudes were perceived by practitioners to be the main determinants of CPAP adherence, and educating patients about effects, management and treatment adjustments were the most common practices. Knowledge was shown to predict educational and informational actions (e.g. education about obstructive sleep apnea and CPAP). Educational and informational actions were associated with medical actions (e.g. treatment adjustment), but knowledge, attitude and support had no association with medical actions. These findings indicate that a wide variety of determinants and actions are considered important, though the only relationship observed between beliefs and actions was found for knowledge and educational and informational actions.

  • 55.
    Broström, Anders
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Department of Nursing, School of Health and Welfare, Jönköping University, Sweden.
    Wahlin, Ake
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Alehagen, Urban
    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.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Johansson, Peter
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Sex-Specific Associations Between Self-reported Sleep Duration, Cardiovascular Disease, Hypertension, and Mortality in an Elderly Population.2018In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 5, p. 422-428Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Both short and long sleep durations have been associated to increased mortality. Knowledge about sex-specific differences among elderly regarding associations between sleep duration, cardiovascular health, and mortality is sparse.

    OBJECTIVE: The aims of this study are to examine the association between self-reported sleep duration and mortality and to investigate whether this association is sex specific and/or moderated by cardiovascular morbidity, and also to explore potential mediators of sleep duration effects on mortality.

    METHODS: A population-based, observational, cross-sectional design with 6-year follow-up with mortality as primary outcome was conducted. Self-rated sleep duration, clinical examinations, echocardiography, and blood samples (N-terminal fragment of proBNP) were collected. A total of 675 persons (50% women; mean age, 78 years) were divided into short sleepers (≤6 hours; n = 231), normal sleepers (7-8 hours; n = 338), and long sleepers (≥9 hours; n = 61). Data were subjected to principal component analyses. Cardiovascular disease (CVD) and hypertension factors were extracted and used as moderators and as mediators in the regression analyses.

    RESULTS: During follow-up, 55 short sleepers (24%), 68 normal sleepers (20%), and 21 long sleepers (34%) died. Mediator analyses showed that long sleep was associated with mortality in men (hazard ratio [HR], 1.8; P = .049), independently of CVD and hypertension. In men with short sleep, CVD acted as a moderator of the association with mortality (HR, 4.1; P = .025). However, when using N-terminal fragment of proBNP, this effect became nonsignificant (HR, 3.1; P = .06). In woman, a trend to moderation involving the hypertension factor and short sleep was found (HR, 4.6; P = .09).

    CONCLUSION: Short and long sleep duration may be seen as risk markers, particularly among older men with cardiovascular morbidity.

  • 56.
    Brüggemann, Adrianus Jelmer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Forsberg, Camilla
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Colnerud, Gunnel
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Wijma, Barbro
    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.
    Thornberg, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Bystander passivity in health care and school settings: Moral disengagement, moral distress, and opportunities for moral education2019In: Journal of Moral Education, ISSN 0305-7240, E-ISSN 1465-3877, Vol. 48, no 2, p. 199-213Article in journal (Refereed)
    Abstract [en]

    Bystander passivity has received increased attention in the prevention of interpersonal harm, but it is poorly understood in many settings. In this article we explore bystander passivity in three settings based on existing literature: patient abuse in health care; bullying among schoolchildren; and oppressive treatment of students by teachers. Throughout the article we develop a theoretical approach that connects Obermann's unconcerned and guiltybystanders to theories of moral disengagement and moral distress respectively. Despite differences between the three settings, we show striking similarities between processes of disengagement, indicators of distress, and the constraints for intervention that bystanders identify. In relation to this, we discuss moral educational efforts that aim to strengthen bystanders’ moral agency in health care and school settings. Many efforts emphasize shared problem descriptions and collective responsibilities. As challenging as such efforts may be, there can be much to gain in terms of welfare and justice.

  • 57.
    Brüggemann, Jelmer
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Ett potentiellt problem: Om maskulinitet och behandling för prostatacancer2018In: Prostatan – det ständiga gisslet?: mannen och prostatan i kultur, medicin och historia / [ed] Maria Björkman, Lund: Nordic Academic Press, 2018, p. 89-103Chapter in book (Other academic)
  • 58.
    Bucardo, F.
    et al.
    National Autonomous University of Leon UNAN Leon, Nicaragua.
    Gonzalez, F.
    National Autonomous University of Leon UNAN Leon, Nicaragua.
    Reyes, Y.
    National Autonomous University of Leon UNAN Leon, Nicaragua.
    Blandon, P.
    National Autonomous University of Leon UNAN Leon, Nicaragua.
    Saif, L.
    Ohio State University, OH USA.
    Nordgren, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Seroprevalence in Household Raised Pigs Indicate High Exposure to GII Noroviruses in Rural Nicaragua2016In: Zoonoses and Public Health, ISSN 1863-1959, E-ISSN 1863-2378, Vol. 63, no 8, p. 600-607Article in journal (Refereed)
    Abstract [en]

    Information about porcine norovirus (PoNoV), genetically similar to human NoV (HuNoV), is limited from rural areas where household-raised pigs are heavily exposed to faecal material which could facilitate transmission. Histoblood group antigens (HBGAs) are known susceptibility factors to NoV in humans and in a germfree piglet model but their role in susceptibility in the porcine population remains unknown. This study reports: (i) the seroprevalence and antibody titres to human norovirus (NoV) VLPs in household raised pigs; (ii) the distribution of HBGAs in relation to NoV IgG antibody titres and further characterization by blocking of GII. 4 VLP binding to pig gastric mucins (PGM). The majority of pigs were seropositive to all three VLPs tested (58-70%) with seropositivity and cross-reactivity increasing significantly with age. However, pig sera could not block the binding of NoV GII. 4 VLPs (Dijon) to PGM suggesting no previous infection with this genotype. The majority of the pigs were H-positive (84%), a susceptibility factor for human infections. IgG antibody titres were however higher in H-negative (GMT = 247) as compared with H-positive (GMT = 57) pigs, but after age stratification, this difference in antibody titres was only observed in pigs = 1 month of age. In conclusion, serological data show that the porcine population of Nicaragua is highly exposed to NoV infections, and the association to HBGAs warrants further investigation.

  • 59.
    Bygren, Lars Olov
    et al.
    Department of Bioscience and Nutrition, Karolinska, Huddinge, Sweden .
    Tinghög, Petter
    Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Division of Health and Society. Linköping University, Faculty of Arts and Sciences.
    Edvinsson, Sören
    The Demographic Database, University of Umeå, Sweden.
    Kaati, Gunnar
    Department of Bioscience and Nutrition, Karolinska Institutet, Huddinge, Sweden .
    Pembrey, Marcus E
    Institute of Child Health, University College London, UK.
    Sjöström, Michael
    Department of Bioscience and Nutrition, Karolinska Institutet, Huddinge, Sweden .
    Change in paternal grandmothers' early food supply influenced cardiovascular mortality of the female grandchildren2014In: BMC Genetics, ISSN 1471-2156, E-ISSN 1471-2156, Vol. 15, no 12Article in journal (Refereed)
    Abstract [en]

    Background

    This study investigated whether large fluctuations in food availability during grandparents' early development influenced grandchildren's cardiovascular mortality. We reported earlier that changes in availability of food - from good to poor or from poor to good - during intrauterine development was followed by a double risk of sudden death as an adult, and that mortality rate can be associated with ancestors´ childhood availability of food. We have now studied transgenerational responses (TGR) to sharp differences of harvest between two consecutive years´ for ancestors of 317 people in Överkalix, Sweden.

    Results

    The confidence intervals were very wide but we found a striking TGR. There was no response in cardiovascular mortality in the grandchild from sharp changes of early exposure, experienced by three of the four grandparents (maternal grandparents and paternal grandfathers). If, however, the paternal grandmother up to puberty lived through a sharp change in food supply from one year to next, her sons´ daughters had an excess risk for cardiovascular mortality (HR 2.69, 95% confidence interval 1.05-6.92). Selection or learning and imitation are unlikely explanations. X-linked epigenetic inheritance via spermatozoa seemed to be plausible, with the transmission, limited to being through the father, possibly explained by the sex differences in meiosis.

    Conclusion

    The shock of change in food availability seems to give specific transgenerational responses.

  • 60.
    Bygren, Magnus
    et al.
    Linköping University, Department of Management and Engineering, The Institute for Analytical Sociology, IAS. Linköping University, Faculty of Arts and Sciences. Stockholm University, Sweden.
    Szulkin, Ryszard
    Stockholm University, Sweden.
    Using register data to estimate causal effects of interventions: An ex post synthetic control-group approach2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, p. 50-55Article in journal (Refereed)
    Abstract [en]

    Aims: It is common in the context of evaluations that participants have not been selected on the basis of transparent participation criteria, and researchers and evaluators many times have to make do with observational data to estimate effects of job training programs and similar interventions. The techniques developed by researchers in such endeavours are useful not only to researchers narrowly focused on evaluations, but also to social and population science more generally, as observational data overwhelmingly are the norm, and the endogeneity challenges encountered in the estimation of causal effects with such data are not trivial. The aim of this article is to illustrate how register data can be used strategically to evaluate programs and interventions and to estimate causal effects of participation in these. Methods: We use propensity score matching on pretreatment-period variables to derive a synthetic control group, and we use this group as a comparison to estimate the employment-treatment effect of participation in a large job-training program. Results: We find the effect of treatment to be small and positive but transient. Conclusions: Our method reveals a strong regression to the mean effect, extremely easy to interpret as a treatment effect had a less advanced design been used (e.g. a within-subjects panel data analysis), and illustrates one of the unique advantages of using population register data for research purposes.

  • 61.
    Bäckryd, Emmanuel
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Plasma pro-inflammatory markers in chronic neuropathic pain: A multivariate, comparative, cross-sectional pilot study2016In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, no 10, p. 1-5Article in journal (Refereed)
    Abstract [en]

    Background: Caused by a lesion or disease of the somatosensory system, neuropathic pain is notoriously difficult to treat with conventional analgesics. It has been suggested that inflammatory cytokines play a role in the development and maintenance of neuropathic pain. But human studies of these substances are relatively few and partly contradictory. Objectives: To simultaneously investigate the plasma levels of chemokine interleukin 8 (IL-8) and the cytokines IL-6, IL-1, and Granulocyte macrophage colony-stimulating factor (GM-CSF) in patients with peripheral neuropathic pain (most of whom due to failed back surgery syndrome) (n = 14) compared to controls (n = 17). Results: IL-6 was significantly higher in patients than in controls (0.92 ± 0.12 pg/ml vs. 0.57 ± 0.08 pg/ml, p = 0.012). IL-1, IL-8, and GM-CSF levels did not differ between the two groups. A multivariate analysis showed a tendency for patients also to have higher GM-CSF plasma levels than controls. Conclusions: This study found an increased level of IL-6 in plasma in patients with neuropathic pain, but not for the other pro-inflammatory substances investigated. There are several possible confounders not registered or controlled for in this and other studies of neuropathic pain. Implications: Larger studies that take several possible confounders into consideration are needed to further investigate the levels of plasma cytokines in different pain conditions. © 2015 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  • 62.
    Bäckryd, Emmanuel
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Heilig, Markus
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Hoffmann, Mikael
    Stiftelsen NEPI - nätverk för läkmedelsepidemiologi - Linköping, Sweden .
    Dynamiken i förskrivningen av opioider i Sverige 2000–2015 - Markanta omfördelningar inom opioidgruppen, men ingen »epidemi«2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114Article in journal (Refereed)
    Abstract [en]

    Opioid prescription changes in Sweden 2000-2015 In contrast to the well-established »opioid epidemic« in the US, very little is known about how the prescription of opioids in Sweden has developed during the last decade. Aggregated data from the open Statistical database of the Swedish Board of Health and Welfare were analyzed descriptively. The yearly prevalence of opioid prescription did not change 2006-2015, but there were dramatic shifts in the choice of opioids. During this period, dextropropoxyphene was pulled off the market. Tramadol was used by fewer individuals (-54 % over the decade), but dosages expressed as Defined Daily Dose/patient/year (DDD/pat/y) increased (+41 %). In contrast, oxycodone and morphine were used by more individuals (+465 % and +137 %, respectively), but DDD/pat/y decreased during the period (-56% and -54%). Studies on non-aggregated data from available registries are needed to further elucidate the circumstances and possible consequences of these shifts in opioid prescription patterns.

  • 63.
    Bäckström, Denise
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Injury mortality in Sweden; changes over time and the effect of age and injury mechanism2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Injuries are one of the most common causes of death in the world. Varying types of injuries dominate in different parts of the world, which also have separate influences mortality. In Scandinavia blunt injuries dominates and the majority of those who die do so pre hospital. Over time different injury pattern may vary and by analyzing this we can assess when, where and how preventive work can be reinforced. The aim of this thesis was to study injury epidemiology in Sweden and assess the contribution of different injury patters on mortality.

    Method: We used the Swedish cause of death and the national patient registries which have a complete national coverage. ICISS was calculated (based on ICD-10) in the in hospital population. We have chosen to do this investigation with a broad perspective using the term injury, which includes trauma but also other diagnoses like suffocation and drowning.

    Results: During the study period (1999-2012) the number of deaths because of injury was 1213, 25 388, and 18 332 among children, working age and elderly, respectively. Mortality declined in the children and in the working age but inclined in the elderly. Mortality increased with each age group except between the ages of 15–25 and 26–35 years. One thousand two hundred sixty four (97%) of those who died because of penetrating trauma (sharp objects and firearms) were killed by intentional trauma (assault and intentional self-harm). One thousand and seventeen (83%) of the children died prehospital. In the working age 22 211 (80%) of 25 388 died pre hospital. Nine thousand six hundred and eighteen (53%) of 18 332 of the elderly died prehospital. During 2001- 2011 the risk adjusted in hospital mortality decreased in traffic and assault but not in fall related injuries.

    Discussion: Largely, the anticipated injury mortality picture was found, with blunt injuries (traffic accidents) dominating in the working age and falls in elderly. Further a significant portion of the deaths occurred pre hospital. The intentional injuries are dominated by intentional selfharm. The decrease in child injury mortality is notable as Sweden already has one of the lowest incidences in child injury mortality in the world. The decrease in injury mortality in the working age also implies that preventive work has had an effect. The incline in injury mortality in elderly on the other hand needs to be further studied. Areas of particular importance for future preventive work is the incline in injury mortality in elderly and intentional injuries among children. 

    List of papers
    1. Change in child mortality patterns after injuries in Sweden: a nationwide 14-year study.
    Open this publication in new window or tab >>Change in child mortality patterns after injuries in Sweden: a nationwide 14-year study.
    2017 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 43, no 3, p. 343-349Article in journal (Refereed) Published
    Abstract [en]

    INTRODUCTION: Sweden has one of the world's lowest child injury mortality rates, but injuries are still the leading cause of death among children. Child injury mortality in the country has been declining, but this decline seems to decrease recently. Our objective was therefore to further examine changes in the mortality of children's death from injury over time and to assess the contribution of various effects on mortality. The underlying hypothesis for this investigation is that the incidence of lethal injuries in children, still is decreasing and that this may be sex specific.

    PATIENTS AND METHODS: We studied all deaths from injury in Sweden under-18-year-olds during the 14 years 1999-2012. We identified those aged under 18 whose underlying cause of death was recorded as International Classification of Diseases, 10th Revision (ICD-10) diagnosis from V01 to X39 in the Swedish cause of death, where all dead citizens are registered.

    RESULTS: From the 1 January 1999 to 31 December 2012, 1213 children under the age of 18 died of injuries in Sweden. The incidence declined during this period (r = -0.606, p = 0.02) to 3.3 deaths/100,000 children-years (95 % CI 2.6-4.2). Death from unintentional injury was more common than that after intentional injury (p < 0.0001). There was a reduction in the incidence of unintentional injuries during the study period (r = -0.757, p = 0.03). The most common causes of death were injury to the brain (n = 337, 41 %), followed by drowning (n = 109, 13 %). The number of deaths after intentional injury increased (r = 0.585, p = 0.03) and at the end of the period was 1.5 deaths/100,000 children-years. The most common causes of death after intentional injuries were asphyxia (n = 177, 45 %), followed by injury to the brain (n = 76, 19 %).

    DISCUSSION: Mortality patterns in injured children in Sweden have changed from being dominated by unintentional injuries to a more equal distribution between unintentional and intentional injuries as well as between sexes and the overall rate has declined further. These findings are important as they might contribute to the preventive work that is being done to further reduce mortality in injured children.

    Place, publisher, year, edition, pages
    Springer, 2017
    Keywords
    Children, Injury, Mortality, Scandinavia, Trauma
    National Category
    Other Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-135548 (URN)10.1007/s00068-016-0660-y (DOI)000402789500010 ()27084542 (PubMedID)
    Note

    Funding agencies: Swedish Carnegie Hero Fund

    Available from: 2017-03-16 Created: 2017-03-16 Last updated: 2017-11-02Bibliographically approved
    2. Deaths caused by injury among people of working age (18-64) are decreasing, while those among older people (64+) are increasing
    Open this publication in new window or tab >>Deaths caused by injury among people of working age (18-64) are decreasing, while those among older people (64+) are increasing
    Show others...
    2018 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 44, no 4, p. 589-596Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Injury is an important cause of death in all age groups worldwide, and contributes to many losses of human and economic resources. Currently, we know a few data about mortality from injury, particularly among the working population. The aim of the present study was to examine death from injury over a period of 14 years (1999-2012) using the Swedish Cause of Death Registry (CDR) and the National Patient Registry, which have complete national coverage.

    METHOD: CDR was used to identify injury-related deaths among adults (18 years or over) during the years 1999-2012. ICD-10 diagnoses from V01 to X39 were included. The significance of changes over time was analyzed by linear regression.

    RESULTS: The incidence of prehospital death decreased significantly (coefficient -0.22, r (2) = 0.30; p = 0.041) during the study period, while that of deaths in hospital increased significantly (coefficient 0.20, r (2) = 0.75; p < 0.001). Mortality/100,000 person-years in the working age group (18-64 years) decreased significantly (coefficient -0.40, r (2) = 0.37; p = 0.020), mainly as a result of decrease in traffic-related deaths (coefficient -0.34, r (2) = 0.85; p < 0.001). The incidence of deaths from injury among elderly (65 years and older) patients increased because of the increase in falls (coefficient 1.71, r (2) = 0.84; p < 0.001) and poisoning (coefficient 0.13, r (2) = 0.69; p < 0.001).

    CONCLUSION: The epidemiology of injury in Sweden has changed during recent years in that mortality from injury has declined in the working age group and increased among those people 64 years old and over.

    Place, publisher, year, edition, pages
    Springer, 2018
    Keywords
    Elderly, Injury, Mortality, Prehospital, Trauma, Working age
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-142763 (URN)10.1007/s00068-017-0827-1 (DOI)000440981100014 ()28825159 (PubMedID)2-s2.0-85027836250 (Scopus ID)
    Available from: 2017-11-02 Created: 2017-11-02 Last updated: 2019-04-30Bibliographically approved
  • 64.
    Bäckström, Denise
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Larsen, Robert
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Steinvall, Ingrid
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Gedeborg, Rolf
    Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden..
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Deaths caused by injury among people of working age (18-64) are decreasing, while those among older people (64+) are increasing2018In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 44, no 4, p. 589-596Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Injury is an important cause of death in all age groups worldwide, and contributes to many losses of human and economic resources. Currently, we know a few data about mortality from injury, particularly among the working population. The aim of the present study was to examine death from injury over a period of 14 years (1999-2012) using the Swedish Cause of Death Registry (CDR) and the National Patient Registry, which have complete national coverage.

    METHOD: CDR was used to identify injury-related deaths among adults (18 years or over) during the years 1999-2012. ICD-10 diagnoses from V01 to X39 were included. The significance of changes over time was analyzed by linear regression.

    RESULTS: The incidence of prehospital death decreased significantly (coefficient -0.22, r (2) = 0.30; p = 0.041) during the study period, while that of deaths in hospital increased significantly (coefficient 0.20, r (2) = 0.75; p < 0.001). Mortality/100,000 person-years in the working age group (18-64 years) decreased significantly (coefficient -0.40, r (2) = 0.37; p = 0.020), mainly as a result of decrease in traffic-related deaths (coefficient -0.34, r (2) = 0.85; p < 0.001). The incidence of deaths from injury among elderly (65 years and older) patients increased because of the increase in falls (coefficient 1.71, r (2) = 0.84; p < 0.001) and poisoning (coefficient 0.13, r (2) = 0.69; p < 0.001).

    CONCLUSION: The epidemiology of injury in Sweden has changed during recent years in that mortality from injury has declined in the working age group and increased among those people 64 years old and over.

  • 65.
    Bülow, Pia
    et al.
    Avdelningen för beteendevetenskap och socialt arbete, Hälsohögskolan i Jönköping.
    Ekberg, Kerstin
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.
    Avstämningsmötet som mötesplats och metod för återgång i arbete - ur ett kommunikativt perspektiv2009Report (Other academic)
    Abstract [sv]

    Rapporten redovisar resultatet av en studie av avstämningsmöten som ett effektivt redskap i den en­skildes rehabilitering. Nio avstämningsmöten spelades in på ljud­band­spelare och följdes genom del­tag­ande observation. Varje möte har följts upp med intervjuer med samtliga mötes­deltagare. Studerade möten och efterföljande intervjuer har analyserats med frågeställningar uti­från avstämnings­mötets kommunikativa processer och deltagarnas upplevelse av mötet och dess betydelse.

    Analysen visar att de försäkrade har en relativt stor andel av det totala talutrymmet räknat i procent av det antalet ord som yttras under ett möte. Samtidigt visar efterintervjuerna att hälften av de försäkrade upplevde sig stå utanför händelsernas centrum under mötet. Detta uppfattades istället mest som en sak mellan andra deltagande parter såsom mellan Försäkrings­kassan och arbetsgivaren eller mellan Försäkringskassan och sjukvården. Det tycktes kräva ett relativt stort mått av initiativ från den försäkrade själv för ta aktiv del av mötet.

    Analysen av interaktionen vid inspelade avstämningsmöten visar att en stor del av mötena ut­veck­lade sig som en slags förhandling där olika ”myndighetsröster” utgick från ”sitt” perspektiv i arbetet med att rehabilitera den försäkrade tillbaka till arbete. Under förhandlingen i mer okomplicerade fall tenderade handläggarna från Försäkringskassan snabbt acceptera de hinder för att förkorta rehabiliteringsprocessen som arbetsgivaren, stödd av den försäkrade, presenterade. I mer komplicerade fall tycks sjukvården utgöra den främsta gränspostering som legitimerar vid vilken tidpunkt och i vilken ut­sträck­­ning arbetsåtergång är möjlig. I diskussioner omkring individens arbetsförmåga domi­nerade aspekter som fysisk arbetso­för­måga hos individen tillsammans med fysiska hinder på arbets­platsen. Andra aspekter av arbets­för­måga så som motivation, social förmåga, kompetens etc. diskuterades i ringa utsträckning om alls.

    Trots intentionen att avstämningsmöten ska bygga på samverkan mellan olika parter involv­erade i individens sjukskrivnings- och rehabiliteringsprocess tycks det finnas en väsentlig poten­tial för för­bättring av samordningen mellan framför allt Försäkringskassan och sjukvården, men även mellan Försäkringskassan och arbetsförmedlingen. En annan möj­­lig­het till för­bättring som framträder är hur resultatet av SASSAM-kartläggningen prak­tiskt kommer till användning under mötet för att öppna för en diskussion omkring resurser snarare än hinder och om arbetsförmåga ur ett flerdimensionellt perspektiv. Generellt saknades diskussioner om den försäkrades arbetsförmåga i relation till arbeten på arbetsmarknaden i stort.

    Utifrån studiens resultat finns fog för fortsatt diskussion om avstämningsmötet ska vara den själv­klara metoden i alla sjukfall som överstiger en viss tidsgräns eller om det behövs en differentiering av såväl mötets upplägg och syfte som vilka som kommer ifråga för ett sådant möte. Mer varierande och målgruppsanpassade möten med en tydlig målsättning om samverkan och samarbete mellan medverkande parter skulle sannolikt öka mötets effektivitet och menings­fullhet. Färre avstämningsmöten skulle ge utrymme för större satsning på möten omkring försäkrade med svårare problematik. Det skulle vidare öka möjligheten för handläggare att specialisera sig också utifrån den problematik som gäller för olika grupper av försäkrade.

  • 66.
    Cacciata, Marysol
    et al.
    Univ Calif Irvine, CA 92697 USA.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Lee, Jung-Ah
    Univ Calif Irvine, CA 92697 USA.
    Sorkin, Dara
    Univ Calif Irvine, CA USA.
    Lombardo, Dawn
    Univ Calif Irvine Hlth, CA USA.
    Clancy, Steve
    Univ Calif Irvine, CA USA.
    Nyamathi, Adeline
    Univ Calif Irvine, CA 92697 USA.
    Evangelist, Lorraine S.
    Univ Calif Irvine, CA 92697 USA.
    Effect of exergaming on health-related quality of life in older adults: A systematic review2019In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 93, p. 30-40Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Exercise through video or virtual reality games (i.e. exergames) has grown in popularity among older adults; however, there is limited evidence on efficacy of exergaming on well-being related to health in this population. This systematic review examined the effectiveness of exergaming on health related quality of life in older adults. Methods: PRISMA guidelines for this systematic review. Several databases were searched using keywords to identify peer-reviewed journal articles in English. Randomized control trials that evaluated the effect of exergaming on health-related quality of life in older adults when compared to a control group and published between January 2007 to May 2017 were included. Results: Nine articles that in total included 614 older adults with varying levels of disability, mean age 73.6 + 7.9 years old, and 67% female were analyzed. Significant improvements in health-related quality of life of older adults engaged in exergaming were reported in three studies. Sample sizes were small in 7 of the studies (N amp;lt; 60). The study participants, exergaming platforms, health-related quality of life instruments, study settings and length, duration and frequency of exergaming varied across studies. Conclusion: Exergaming is a new emerging form of exercise that is popular among older adults. However, findings from this analysis were not strong enough to warrant recommendation due to the small sample sizes and heterogeneity in the study participants, exergaming platforms, health-related quality of life instruments, length, duration and frequency of the intervention and study settings. Further research is needed with larger sample sizes and less heterogeneity to adequately explore the true effects of exergaming on health-related quality of life of older adults. (C) 2019 Elsevier Ltd. All rights reserved.

  • 67.
    Caravita, Simona C. S.
    et al.
    Univ Cattolica Sacro Cuore, Italy.
    Stefanelli, Sara
    Univ Cattolica Sacro Cuore, Italy.
    Mazzone, Angela
    Dublin City Univ, Ireland.
    Cadel, Livia
    Univ Cattolica Sacro Cuore, Italy.
    Farkas, Ildiko
    Linköping University, Department of Physics, Chemistry and Biology, Semiconductor Materials. Linköping University, Faculty of Science & Engineering.
    Ambrosini, Barbara
    Univ Cattolica Sacro Cuore, Italy.
    When the bullied peer is native-born vs. immigrant: A mixed-method study with a sample of native-born and immigrant adolescents2019In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450Article in journal (Refereed)
    Abstract [en]

    An increasing number of immigrant students attend Italian schools, with the possibility of being involved in bullying episodes. A few studies have investigated this phenomenon, providing some evidence that immigrant students may face an increased risk of being bullied compared to native-born students. The present study adopted a mixed-method design, which may better detect the dynamics of bullying towards immigrant peers. Participants were 692 native-born and immigrant students (20.5% with immigrant background; 54.8% females) who filled in self-report measures about their bullying experiences, popularity, acceptance of diversity at school, and prejudice. Thirty-five pupils (54% with immigrant background) were also interviewed. Two hypothetical bullying scenarios were presented: one depicting a native-born victim and one depicting an immigrant victim. After each scenario, adolescents were encouraged to reason about the motives for bullying. Quantitative data showed that general bullying was associated with perceived popularity status among peers, while racial bullying was associated with prejudice but not peer status. The relevance of anti-immigrant prejudices in driving racial bullying emerged also from adolescents interviews. The qualitative data indicated that among the reasons for bullying, adolescents mentioned a desire for dominance and popularity, in particular when the victim was non-immigrant. Findings suggest that, in addition to individual and peer group-related risk factors, prejudice also needs to be addressed in anti-bullying interventions aimed to counteract racial bullying.

  • 68.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care Centres.
    The Challenge of Changing Practice: Applying Theory in the Implementation of an Innovation in Swedish Primary Health Care2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The translation of new knowledge, such as research findings, new tools or methods into health care practice has gained increased  interest in recent years. Important factors that determine implementation outcome have been identified, and models and checklists to be followed in planning as well as in carrying out an implementation process have been produced. However, there are still knowledge gaps regarding what approach should be used in which setting and for which problems. Primary health care (PHC) in Sweden is an area where there is a paucity of research regarding implementation of new methods into practice. The aim of the thesis was to apply theory in the study of the implementation of an innovation in Swedish PHC, and identify factors that influenced outcome.

    Methods: The study was performed using a quasi-experimental design, and included six PHC units, two from each one of three county councils in the southeast part of Sweden. A computer-based lifestyle intervention tool (CLT) developed to facilitate addressing lifestyle issues, was introduced at the units. Two different strategies were used for the introduction, both aiming to facilitate the process: a theory-based explicit strategy and an implicit strategy requiring a minimum of effort. Data collection was performed at baseline, and after six, nine and 24 months. Questionnaires were distributed to staff and managers, and data was also collected from the CLT database and county council registers. Implementation outcome was defined as the proportion of eligible patients being referred to the CLT, and was also measured in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance according to the RE-AIM framework. Interviews were performed in order to explore experiences of the implementation process as perceived by staff and managers.

    Results: A positive organizational climate seemed to promote implementation. Organizational changes or staff shortages coinciding with the implementation process had a negative influence on outcome. The explicit implementation strategy seemed to be more effective than the implicit strategy in the short term, but the differences levelled out over time. The adopters’ perceptions of the implementation seemed to be influenced by the existing professional sub-cultures. Successful implementation was associated with positive expectations, perceptions of the innovation being compatible with existing routines and perceptions of relative advantage.

    Conclusions: The general conclusion is that when theory was applied in the implementation of a lifestyle intervention tool in Swedish PHC, factors related to the adopters and to the innovation seemed to be more important over time than the strategy used. Staff expectations, perceptions of the innovation’s relative advantage and potential compatibility with existing routines were found to be positively associated with implementation outcome, and other major organizational changes concurrent with implementation seemed to affect the outcome in a negative way. Values, beliefs and behaviour associated with the existing sub-cultures in PHC appeared to influence how the implementation of an innovation was perceived by managers and the different professionals.

    List of papers
    1. The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care
    Open this publication in new window or tab >>The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care
    2010 (English)In: Journal of Evaluation in Clinical Practice, ISSN 1356-1294, Vol. 16, no 6, p. 1326-1332Article in journal (Refereed) Published
    Abstract [en]

    Rationale, aims and objectives The transmission of research findings into routine care is a slow and unpredictable process. Important factors predicting receptivity for innovations within organizations have been identified, but there is a need for further research in this area. The aim of this study was to describe contextual factors and evaluate if organizational climate and implementation strategy influenced outcome, when a computer-based concept for lifestyle intervention was introduced in primary health care (PHC). Method The study was conducted using a prospective intervention design. The computer-based concept was implemented at six PHC units. Contextual factors in terms of size, leadership, organizational climate and political environment at the units included in the study were assessed before implementation. Organizational climate was measured using the Creative Climate Questionnaire (CCQ). Two different implementation strategies were used: one explicit strategy, based on Rogers theories about the innovation-decision process, and one implicit strategy. After 6 months, implementation outcome in terms of the proportion of patients who had been referred to the test, was measured. Results The CCQ questionnaire response rates among staff ranged from 67% to 91% at the six units. Organizational climate differed substantially between the units. Managers scored higher on CCQ than staff at the same unit. A combination of high CCQ scores and explicit implementation strategy was associated with a positive implementation outcome. Conclusions Organizational climate varies substantially between different PHC units. High CCQ scores in combination with an explicit implementation strategy predict a positive implementation outcome when a new working tool is introduced in PHC.

    Place, publisher, year, edition, pages
    Blackwell Publishing Ltd, 2010
    Keywords
    implementation, life style, organizational climate, primary health care
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-65943 (URN)10.1111/j.1365-2753.2009.01336.x (DOI)000285763900048 ()
    Note
    This is the authors’ version of the following article: Siw Carlfjord, A Andersson and Per Nilsen, The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care, 2010, JOURNAL OF EVALUATION IN CLINICAL PRACTICE, (16), 6, 1326-1332. which has been published in final form at: http://dx.doi.org/10.1111/j.1365-2753.2009.01336.x Copyright: Blackwell Publishing Ltd http://eu.wiley.com/WileyCDA/Brand/id-35.htmlAvailable from: 2011-02-28 Created: 2011-02-28 Last updated: 2013-09-30
    2. Applying the RE-AIM framework to evaluate two implementation strategies used to introduce a tool for lifestyle intervention in Swedish primary health care
    Open this publication in new window or tab >>Applying the RE-AIM framework to evaluate two implementation strategies used to introduce a tool for lifestyle intervention in Swedish primary health care
    Show others...
    2012 (English)In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 27, no 2, p. 167-176Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to evaluate two implementation strategies for the introduction of a lifestyle intervention tool in primary health care (PHC), applying the RE-AIM framework to assess outcome. A computer-based tool for lifestyle intervention was introduced in PHC. A theory-based, explicit, implementation strategy was used at three centers, and an implicit strategy with a minimum of implementation efforts at three others. After 9 months a questionnaire was sent to staff members (n= 159) and data from a test database and county council registers were collected. The RE-AIM framework was applied to evaluate outcome in terms of reach, effectiveness, adoption and implementation. The response rate for the questionnaire was 73%. Significant differences in outcome were found between the strategies regarding reach, effectiveness and adoption, in favor of the explicit implementation strategy. Regarding the dimension implementation, no differences were found according to the implementation strategy. A theory-based implementation strategy including a testing period before using a new tool in daily practice seemed to be more successful than a strategy in which the tool was introduced and immediately used for patients.                 

    Place, publisher, year, edition, pages
    Oxford University Press, 2012
    Keywords
    Implementation; Primary health care; RE-AIM
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-73379 (URN)10.1093/heapro/dar016 (DOI)000304016100004 ()
    Available from: 2012-01-13 Created: 2012-01-02 Last updated: 2017-12-08Bibliographically approved
    3. Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory
    Open this publication in new window or tab >>Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory
    Show others...
    2010 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 11, no 60Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Bridging the knowledge-to-practice gap in health care is an important issue that has gained interest in recent years. Implementing new methods, guidelines or tools into routine care, however, is a slow and unpredictable process, and the factors that play a role in the change process are not yet fully understood. There is a number of theories concerned with factors predicting successful implementation in various settings, however, this issue is insufficiently studied in primary health care (PHC). The objective of this article was to apply implementation theory to identify key factors influencing the adoption of an innovation being introduced in PHC in Sweden.

    METHODS: A qualitative study was carried out with staff at six PHC units in Sweden where a computer-based test for lifestyle intervention had been implemented. Two different implementation strategies, implicit or explicit, were used. Sixteen focus group interviews and two individual interviews were performed. In the analysis a theoretical framework based on studies of implementation in health service organizations, was applied to identify key factors influencing adoption.

    RESULTS: The theoretical framework proved to be relevant for studies in PHC. Adoption was positively influenced by positive expectations at the unit, perceptions of the innovation being compatible with existing routines and perceived advantages. An explicit implementation strategy and positive opinions on change and innovation were also associated with adoption. Organizational changes and staff shortages coinciding with implementation seemed to be obstacles for the adoption process.

    CONCLUSION: When implementation theory obtained from studies in other areas was applied in PHC it proved to be relevant for this particular setting. Based on our results, factors to be taken into account in the planning of the implementation of a new tool in PHC should include assessment of staff expectations, assessment of the perceived need for the innovation to be implemented, and of its potential compatibility with existing routines. Regarding context, we suggest that implementation concurrent with other major organizational changes should be avoided. The choice of implementation strategy should be given thorough consideration.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-59064 (URN)10.1186/1471-2296-11-60 (DOI)
    Available from: 2010-09-08 Created: 2010-09-08 Last updated: 2017-12-12Bibliographically approved
    4. Experiences of the implementation of a tool for lifestyle intervention in primary health care: a qualitative study among managers and professional groups
    Open this publication in new window or tab >>Experiences of the implementation of a tool for lifestyle intervention in primary health care: a qualitative study among managers and professional groups
    2011 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 11, no 195Article in journal (Refereed) Published
    Abstract [en]

    Background:In recent years there has been increasing interest in transferring new knowledge into health care practices, a process often referred to as implementation. The various subcultures that exist among health care workers may be an obstacle in this process. The aim of this study was to explore how professional groups and managers experienced the implementation of a new tool for lifestyle intervention in primary health care (PHC). The computer-based tool was introduced with the intention of facilitating the delivery of preventive services.

    Methods:Focus group interviews with staff and individual interviews with managers at six PHC units in the southeast of Sweden were performed 9 months after the introduction of the new working tool. Staff interviews were conducted in groups according to profession, and were analysed using manifest content analysis. Experiences and opinions from the different staff groups and from managers were analysed.

    Results: Implementation preconditions, opinions about the lifestyle test, and opinions about usage were the main areas identified. In each of the groups, managers and professionals, factors related to the existing subcultures seemed to influence their experiences of the implementation. Managers were visionary, GPs were reluctant, nurses were open, and nurse assistants were indifferent.

    Conclusion: This study indicates that the existing subcultures in PHC influence how the implementation of an innovation is perceived by managers and the different professionals. In PHC, an organization with several subcultures and an established hierarchical structure, an implementation strategy aimed at all groups did not seem to result in a successful uptake of the new method.

    Place, publisher, year, edition, pages
    BioMed Central, 2011
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-71112 (URN)10.1186/1472-6963-11-195 (DOI)000294735700002 ()
    Available from: 2011-09-30 Created: 2011-09-30 Last updated: 2017-12-08
    5. Sustained use of a tool for lifestyle intervention implemented in primary health care: a 2-year follow-up
    Open this publication in new window or tab >>Sustained use of a tool for lifestyle intervention implemented in primary health care: a 2-year follow-up
    2013 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 19, no 2, p. 327-334Article in journal (Refereed) Published
    Abstract [en]

    Rational, aims and objectives: Sustainability of new methods implemented in health care is one of the most central issues in addressing the gap between research and practice, but is seldom assessed in implementation studies. The aim of this study was to evaluate the implementation of a new tool for lifestyle intervention in primary health care (PHC) 2 years after the introduction, and assess if the implementation strategy used influenced sustainability.

    Method: A computer-based lifestyle intervention tool (CLT) was introduced at six PHC units in Sweden in 2008, using two implementation strategies: explicit and implicit. The main difference between the strategies was a 4-week test period followed by a decision session, included in the explicit strategy. Evaluations were performed after 6, 9 and 24 months. After 24 months, the RE-AIM framework was applied to assess and compare outcome according to strategy.

    Results: A more positive outcome regarding Reach, Effectiveness, Adoption and Implementation in the explicit group could be almost completely attributed to one of the units. Maintenance was low and after 24 months, differences according to strategy were negligible.

    Conclusion: After 24 months the most positive outcomes regarding all RE-AIM dimensions were found in one of the units where the explicit strategy was used. The explicit strategy per se had some effect on the dimension Effectiveness, but was not associated with sustainability overall. Staff at the most successful unit earlier had positive expectations regarding the CLT and found it compatible with existing routines.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2013
    Keywords
    implementation, lifestyle, primary health care, sustainability
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-74877 (URN)10.1111/j.1365-2753.2012.01827.x (DOI)000315964800017 ()
    Note

    Funding Agencies|Medical Research Council of Southeast Sweden (FORSS)||Swedish Council for Working Life and Social Research (FAS)||

    Available from: 2012-02-10 Created: 2012-02-10 Last updated: 2017-12-07Bibliographically approved
  • 69.
    Carlsson, E
    et al.
    1The Biomedical Platform, Department of Natural Science and Biomedicine, School of Health Sciences, Jönköping University, Jönköping.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Huus, K
    CHILD Research Group, Department of Nursing, School of Health Sciences, Jönköping University, Jönköping.
    Faresjö, M
    The Biomedical Platform, Department of Natural Science and Biomedicine, School of Health Sciences, Jönköping University, Jönköping.
    High physical activity in young children suggests positive effects by altering autoantigen-induced immune activity2016In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 26, no 4, p. 441-450Article in journal (Refereed)
    Abstract [en]

    Physical activity in children is associated with several positive health outcomes such as decreased cardiovascular risk factors, improved lung function, enhanced motor skill development, healthier body composition, and also improved defense against inflammatory diseases. We examined how high physical activity vs a sedentary lifestyle in young children influences the immune response with focus on autoimmunity. Peripheral blood mononuclear cells, collected from 55 5-year-old children with either high physical activity (n = 14), average physical activity (n = 27), or low physical activity (n = 14), from the All Babies In Southeast Sweden (ABIS) cohort, were stimulated with antigens (tetanus toxoid and beta-lactoglobulin) and autoantigens (GAD65 , insulin, HSP60, and IA-2). Immune markers (cytokines and chemokines), C-peptide and proinsulin were analyzed. Children with high physical activity showed decreased immune activity toward the autoantigens GAD65 (IL-5, P < 0.05), HSP60 and IA-2 (IL-10, P < 0.05) and also low spontaneous pro-inflammatory immune activity (IL-6, IL-13, IFN-γ, TNF-α, and CCL2 (P < 0.05)) compared with children with an average or low physical activity. High physical activity in young children seems to have positive effects on the immune system by altering autoantigen-induced immune activity.

  • 70.
    Carlsson, Martin
    et al.
    County Hospital Kalmar, Sweden; Linnaeus University, Sweden.
    Wanby, Pär
    County Hospital Kalmar, Sweden.
    Brudin, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. County Hospital, Sweden.
    Lexne, Erik
    County Hospital Kalmar, Sweden.
    Mathold, Karin
    County Hospital Kalmar, Sweden.
    Nobin, Rebecca
    County Hospital Kalmar, Sweden.
    Ericson, Lisa
    Linnaeus University, Sweden.
    Nordqvist, Ola
    Kalmar County Council, Sweden.
    Petersson, Goran
    Linnaeus University, Sweden.
    Older Swedish Adults with High Self-Perceived Health Show Optimal 25-Hydroxyvitamin D Levels Whereas Vitamin D Status Is Low in Patients with High Disease Burden2016In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 8, no 11, article id 717Article in journal (Refereed)
    Abstract [en]

    Controversy pervades the definition of adequate and optimal vitamin D status. The Institutes of Medicine have recommended serum 25(OH) D levels above 50 nmol/L based upon evidence related to bone health, but some experts, including the Endocrine Society and International Osteoporosis Foundation, suggest a minimum serum 25(OH) D level of 75 nmol/L to reduce the risk of falls and fractures in older adults. In a cross-sectional study, we compared vitamin D status in people amp;gt;= 75 years selected from four groups with a frailty phenotype, combined with a control group free from serious illness, and who considered themselves completely healthy. Only 13% of the 169 controls were vitamin D deficient (S-25(OH) D) amp;lt; 50 nmol/L), in contrast with 49% of orthopedic patients with hip fractures (n = 133), 31% of stroke patients (n = 122), 39% of patients visiting the hospitals emergency department amp;gt;= 4 times a year (n = 81), and 75% of homebound adult residents in long-term care nursing homes (n = 51). The mean vitamin D concentration of the healthy control group (74 nmol/L) was similar to a suggested optimal level based on physiological data and mortality studies, and much higher than that of many officially recommended cut-off levels for vitamin D deficiency (amp;lt; 50 nmol/L). The present study provides a basis for planning and implementing public guidelines for the screening of vitamin D deficiency and vitamin D treatment for frail elderly patients.

  • 71.
    Ceccato, Vania
    et al.
    KTH, Skolan för arkitektur och samhällsbyggnad (ABE), Samhällsplanering och miljö, Urbana och regionala studier..
    Wiebe, Douglas J
    University of Pennsylvania, Philadelphia, USA.
    Eshraghi, Bita
    Karolinska Institute, Stockholm, Sweden.
    Vrotsou, Katerina
    Linköping University, Department of Science and Technology, Media and Information Technology. Linköping University, Faculty of Science & Engineering.
    Women’s Mobility and the Situational Conditions of Rape: Cases Reported to Hospitals2017In: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518Article in journal (Refereed)
    Abstract [en]

    A third of all rapes in Stockholm, the capital of Sweden, take place in public outdoor places. Yet, little is known about the events that precede this type of sexual offence and less about the situational context of rape. This study aims to improve the understanding of the nature of situational conditions that immediately precede events of rape. Using medical records of 147 rape victims during 2012 and 2013, we constructed time- and place-specific records of the places women traveled through or spent time at, the activities they engaged in, and the people they interacted with sequentially over the course of the day when they were raped. The analysis uses visualization tools (VISUAL-TimePAcTS), Geographical Information Systems, and conditional logistic regression to identify place-, context-, and social interaction–related factors associated with the onset of rape. Results for this sample of cases reported to hospitals show that being outdoors was not necessarily riskier for women when compared with indoor public settings; some outdoor environments were actually protective, such as streets. Being in a risky social context and engaging in a risky activity before the event was associated with an increased risk of rape, and the risk escalated over the day. Among those women who never drank alcohol, the results were similar to what was observed in the overall sample, which suggests that risky social interaction and risky activity made independent contributions to the risk of rape. The article finishes with suggestions for rape prevention.

  • 72.
    Charalampopoulos, Dimitrios
    et al.
    UCL, England.
    Hermann, Julia M.
    Ulm Univ, Germany; German Ctr Diabet Res DZD, Germany.
    Svensson, Jannet
    Herlev Univ Hosp, Denmark.
    Skrivarhaug, Torild
    Oslo Univ Hosp, Norway.
    Maahs, David M.
    Stanford Univ, CA 94305 USA.
    Åkesson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Warner, Justin T.
    Childrens Hosp Wales, Wales.
    Holl, Reinhard W.
    Ulm Univ, Germany; German Ctr Diabet Res DZD, Germany.
    Birkebaek, Niels H.
    Aarhus Univ Hosp, Denmark.
    Drivvoll, Ann K.
    Oslo Univ Hosp, Norway.
    Miller, Kellee M.
    Jaeb Ctr Hlth Res, FL USA.
    Svensson, Ann-Marie
    Ctr Registers Reg Vastra Gotaland, Sweden.
    Stephenson, Terence
    University College London, London, U.K..
    Hofer, Sabine E.
    Med Univ Innsbruck, Austria.
    Fredheim, Siri
    Herlev University Hospital, Herlev, Denmark.
    Kummernes, Siv J.
    Oslo Univ Hosp, Norway.
    Foster, Nicole
    Jaeb Ctr Hlth Res, FL USA.
    Hanberger, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Amin, Rakesh
    UCL, England.
    Rami-Merhar, Birgit
    Med Univ Vienna, Austria.
    Johansen, Anders
    Univ Copenhagen, Denmark.
    Dahl-Jorgensen, Knut
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Clements, Mark
    Childrens Mercy Hosp, MO 64108 USA; Univ Missouri Kansas City, MO USA; Univ Kansas, KS 66103 USA.
    Hanas, Ragnar
    NU Hosp Grp, Sweden; Univ Gothenburg, Sweden.
    Exploring Variation in Glycemic Control Across and Within Eight High-Income Countries: A Cross-sectional Analysis of 64,666 Children and Adolescents With Type 1 Diabetes2018In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 41, no 6, p. 1180-1187Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE International studies on childhood type 1 diabetes (T1D) have focused on whole-country mean HbA(1c) levels, thereby concealing potential variations within countries. We aimed to explore the variations in HbA(1c) across and within eight high-income countries to best inform international benchmarking and policy recommendations. RESEARCH DESIGN AND METHODS Data were collected between 2013 and 2014 from 64,666 children with T1D who were amp;lt; 18 years of age across 528 centers in Germany, Austria, England, Wales, U.S., Sweden, Denmark, and Norway. We used fixed-and random-effects models adjusted for age, sex, diabetes duration, and minority status to describe differences between center means and to calculate the proportion of total variation in HbA(1c) levels that is attributable to between-center differences (intraclass correlation [ICC]). We also explored the association between within-center variation and childrens glycemic control. RESULTS Sweden had the lowest mean HbA(1c) (59mmol/mol [7.6%]) and together with Norway and Denmark showed the lowest between-center variations (ICC amp;lt;= 4%). Germany and Austria had the next lowest mean HbA(1c) (61-62 mmol/mol [7.7-7.8%]) but showed the largest center variations (ICC similar to 15%). Centers in England, Wales, and the U.S. showed low-to-moderate variation around high mean values. In pooled analysis, differences between counties remained significant after adjustment for children characteristics and center effects (P value amp;lt; 0.001). Across all countries, children attending centers with more variable glycemic results had higher HbA(1c) levels (5.6mmol/mol [0.5%] per 5mmol/mol [0.5%] increase in center SD of HbA(1c) values of all children attending a specific center). CONCLUSIONS A tsimilar average levels of HbA(1c), countries display different levels of center variation. The distribution of glycemic achievement within countries should be considered in developing informed policies that drive quality improvement.

  • 73.
    Charitakis, Emmanouil
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Neurohormonal activation, Symptoms and health-related quality of life in patients with atrial fibrillation eligible for radiofrequency ablation2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Atrial fibrillation (AF) is the most common cardiac arrhythmia. In order to improve the management of patients with AF, a better understanding of patients’ arrhythmia-related symptoms and health-related quality of life (HRQoL), as well as a finer grasp of the effect of AF initiation and the revolutionary treatment of radiofrequency ablation (RFA) on neurohormonal balance are of great importance.

    The aim of this dissertation was to study the effects of RFA and AF initiation on four different neurohormonal systems represented by two cardiac biomarkers: the N-terminal fragment of the proB-type natriuretic peptide (NT-proBNP), the mid-regional fragment of the N-terminal of pro-atrial natriuretic peptide (MR-proANP); and two extra-cardiac biomarkers: the C-terminal fragment of the prodromal molecule of arginine vasopressin (copeptin) and the mid-regional portion of pro-adrenomedullin (MR-proADM). Furthermore, we aimed to correlate objective indicators with the variety of arrhythmiarelated symptoms and HRQoL in patients with AF.

    We studied 192 consecutive AF patients, eligible for RFA, referred to the University Hospital, Linköping, Sweden between January 2012 and April 2014. Forty-five patients, out of the initially selected sample, were included in the interventional part of the study. Biomarkers were collected from the femoral vein (fv), the coronary sinus (CS) and the left atrium (LA), and from fv immediately and the day after RFA. With regard to the interventional part of the study, 36 patients were randomized to AF initiation and 19 to control group. Biomarkers were retrieved from fv, CS and LA prior to AF initiation (baseline) and 30 minutes later. The Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA) symptom scale was used in order to assess patients’ arrhythmiarelated symptoms. The ASTA HRQoL scale and the generic short-form 36 (SF-36) physical and mental component summaries were used in order to express patients’ disease-specific and overall HRQoL respectively.

    While analysing the effect of RFA on biomarkers, it was noticed that the level of NTproBNP decreased the day after RFA in participants in AF, compared with the participants in sinus rhythm who showed a slight increase. Regardless of the actual rhythm, the level of MR-proANP showed an increase immediately after RFA was carried out, followed by a decrease the day after. The copeptin level showed a six-fold increase, compared with baseline, immediately after the RFA procedure, while the MR-proADM level increased the day after. The levels of copeptin and MR-proADM were similar in the CS compared to peripheral blood.

    When it came to the effects of AF initiation on biomarkers, compared with the control group, MR-proANP and NT-proBNP concentrations were increased. Copeptin levels in patients without ischemic heart disease were decreased after the initiation of AF.

    We also found that signs of anxiety, low-grade inflammation (defined by high-sensitive C-reactive protein levels>3mg/l) and LA dilatation significantly predicted arrhythmiarelated symptoms. Probable depression was the most important predictor of arrhythmiaspecific HRQoL, and obesity and signs of anxiety were the most important predictors of the physical and mental component summaries respectively.

    AF is a complex arrhythmia that affects the cardiac and extra-cardiac neurohormonal balance directly after its initiation. RFA causes a neurohormonal imbalance not only due to secondary myocardial injury, but also due to other factors such as patient’s actual rhythm, volume overload and procedural stress. Treatable factors such as anxiety, depression and obesity, which can affect HRQoL and symptoms in patients with AF, should be addressed, and possibly a more intensive life style factor modification can be of value.

    List of papers
    1. Symptom burden, Metabolic profile, Ultrasound findings, Rhythm, neurohormonal activation, haemodynamics and health-related quality of life in patients with atrial Fibrillation (SMURF): a protocol for an observational study with a randomised interventional component
    Open this publication in new window or tab >>Symptom burden, Metabolic profile, Ultrasound findings, Rhythm, neurohormonal activation, haemodynamics and health-related quality of life in patients with atrial Fibrillation (SMURF): a protocol for an observational study with a randomised interventional component
    Show others...
    2015 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 12, article id e008723Article in journal (Refereed) Published
    Abstract [en]

    INTRODUCTION: Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an estimated prevalence of 1.5-2%. It is an independent risk factor for ischaemic stroke and is estimated to cause about 20-25% of all stroke cases. AF has a great impact on health-related quality of life (HRQoL); however, one unresolved issue related to AF is the wide variation in its symptoms.

    METHODS AND ANALYSIS: The symptom burden, metabolic profile, ultrasound findings, rhythm, neurohormonal activation, haemodynamics and HRQoL in patients with AF (Symptom burden, Metabolic profile, Ultrasound findings, Rhythm, neurohormonal activation, haemodynamics and health-related quality of life in patients with atrial Fibrillation, SMURF) study is a prospective observational, cohort study, with a randomised interventional part. The aim of the study is to investigate, in patients with AF, the relationship between symptom burden and metabolic aspects, atrial function and different neurohormones, and the effect of radiofrequency ablation (RFA). The interventional part of the study will give an insight into the neurohormonal and intracardiac pressure changes directly after initiation of AF. Consecutive patients with symptomatic AF accepted for treatment with RFA for the first time at Linköping University Hospital are eligible for participation. The enrolment started in January 2012, and a total of 200 patients are to be included into the study, with 45 of them being enrolled into the interventional study with initiation of AF. The sample size of the interventional study is based on a small pilot study with 5 patients induced to AF while 2 served as controls. The results indicated that, in order to find a statistically significant difference, there was a need to include 28 patients; for safety reasons, 45 patients will be included.

    ETHICS AND DISSEMINATION: The SMURF study is approved by the Regional Ethical Review Board at the Faculty of Health Sciences, Linköping, Sweden. The results will be presented through peer-review journals and conference presentation.

    TRIAL REGISTRATION NUMBER: NCT01553045; Pre-results.

    Place, publisher, year, edition, pages
    BMJ Publishing Group, 2015
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:liu:diva-124290 (URN)10.1136/bmjopen-2015-008723 (DOI)000368839100047 ()26692555 (PubMedID)
    Note

    Funding agencies: ALF grants (County Council of Ostergotland); Carldavid Jonsson Research Foundation; Heart Foundation; Linkoping University; Biosense Webster; Johnson and Johnson

    Available from: 2016-01-25 Created: 2016-01-25 Last updated: 2017-11-30
    2. Short‐Term Influence of Radiofrequency Ablation on NT‐proBNP, MR‐proANP, Copeptin, and MR‐proADM in Patients With Atrial Fibrillation: Data From the Observational SMURF Study
    Open this publication in new window or tab >>Short‐Term Influence of Radiofrequency Ablation on NT‐proBNP, MR‐proANP, Copeptin, and MR‐proADM in Patients With Atrial Fibrillation: Data From the Observational SMURF Study
    2016 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 5, no 9Article in journal (Refereed) Published
    Abstract [en]

    Background There is limited knowledge on the short‐term influence of radiofrequency ablation (RFA) of atrial fibrillation (AF) on 2 cardiac biomarkers; the N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) and the midregional fragment of the N‐terminal of pro‐ANP (MR‐proANP) and 2 extracardiac biomarkers; the c‐terminal provasopressin (copeptin) and the midregional portion of proadrenomedullin (MR‐proADM). There are also limited data concerning cardiac production of the latter two.

    Methods and Results We studied 192 consecutive patients eligible for RFA of AF referred to the University Hospital, Linköping, Sweden. NT‐proBNP, MR‐proANP, copeptin, and MR‐proADM levels were measured in peripheral blood, the coronary sinus (CS), and the left atrium before ablation, and in peripheral blood immediately and the day after RFA. The level of NT‐proBNP decreased the day after RFA in participants in AF at the time of RFA, compared to the participants in sinus rhythm who showed a slight increase (P<0.001). Furthermore, regardless of the actual rhythm, the level of MR‐proANP showed an increase immediately after RFA (P<0.001), followed by a decrease the day after ablation (P<0.001). Copeptin level showed a 6‐fold increase immediately after RFA compared to baseline (P<0.001), whereas MR‐proADM level increased the day after RFA (P<0.001). Levels of copeptin and MR‐proADM were not higher in the CS compared to peripheral blood.

    Conclusions RFA of AF is a strong stimulus with a significant and direct impact on different neurohormonal systems. We found no sign of a cardiac release of MR‐proADM or copeptin.

    Place, publisher, year, edition, pages
    Wiley-Blackwell Publishing Inc., 2016
    Keywords
    Atrial fibrillation, biomarkers, catheter ablation
    National Category
    Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-132725 (URN)10.1161/JAHA.116.003557 (DOI)000386716900022 ()27633393 (PubMedID)
    Note

    Funding agencies: ALF grants (County Council of Ostergotland); Carldavid Jonsson Research Foundation; Heart Foundation; Linkoping University; Biosense Webster; Johnson Johnson

    Available from: 2016-11-21 Created: 2016-11-21 Last updated: 2017-11-29Bibliographically approved
  • 74.
    Charitakis, Emmanouil
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Walfridsson, Håkan
    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.
    Alehagen, Urban
    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.
    Short‐Term Influence of Radiofrequency Ablation on NT‐proBNP, MR‐proANP, Copeptin, and MR‐proADM in Patients With Atrial Fibrillation: Data From the Observational SMURF Study2016In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 5, no 9Article in journal (Refereed)
    Abstract [en]

    Background There is limited knowledge on the short‐term influence of radiofrequency ablation (RFA) of atrial fibrillation (AF) on 2 cardiac biomarkers; the N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) and the midregional fragment of the N‐terminal of pro‐ANP (MR‐proANP) and 2 extracardiac biomarkers; the c‐terminal provasopressin (copeptin) and the midregional portion of proadrenomedullin (MR‐proADM). There are also limited data concerning cardiac production of the latter two.

    Methods and Results We studied 192 consecutive patients eligible for RFA of AF referred to the University Hospital, Linköping, Sweden. NT‐proBNP, MR‐proANP, copeptin, and MR‐proADM levels were measured in peripheral blood, the coronary sinus (CS), and the left atrium before ablation, and in peripheral blood immediately and the day after RFA. The level of NT‐proBNP decreased the day after RFA in participants in AF at the time of RFA, compared to the participants in sinus rhythm who showed a slight increase (P<0.001). Furthermore, regardless of the actual rhythm, the level of MR‐proANP showed an increase immediately after RFA (P<0.001), followed by a decrease the day after ablation (P<0.001). Copeptin level showed a 6‐fold increase immediately after RFA compared to baseline (P<0.001), whereas MR‐proADM level increased the day after RFA (P<0.001). Levels of copeptin and MR‐proADM were not higher in the CS compared to peripheral blood.

    Conclusions RFA of AF is a strong stimulus with a significant and direct impact on different neurohormonal systems. We found no sign of a cardiac release of MR‐proADM or copeptin.

  • 75.
    Cohen, Adam
    et al.
    St Olavs Hosp, Norway.
    Mathiasen, Victor Dahl
    Statens Serum Inst, Denmark; Aarhus Univ Hosp, Denmark.
    Schön, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences.
    Wejse, Christian
    INDEPTH Network, Guinea Bissau; Aarhus Univ GloHAU, Denmark.
    The global prevalence of latent tuberculosis: a systematic review and meta-analysis2019In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 54, no 3, article id 1900655Article, review/survey (Refereed)
    Abstract [en]

    In 1999, the World Health Organization (WHO) estimated that one-third of the worlds population had latent tuberculosis infection (LTBI), which was recently updated to one-fourth. However, this is still based on controversial assumptions in combination with tuberculin skin test (TST) surveys. Interferon-gamma release assays (IGRAs) with a higher specificity than TST have since been widely implemented, but never used to estimate the global LTBI prevalence. We conducted a systematic review and meta-analysis of LTBI estimates based on both IGRA and TST results published between 2005 and 2018. Regional and global estimates of LTBI prevalence were calculated. Stratification was performed for low, intermediate and high TB incidence countries and a pooled estimate for each area was calculated using a random effects model. Among 3280 studies screened, we included 88 studies from 36 countries with 41 IGRA (n=67 167) and 67 TST estimates (n=284 644). The global prevalence of LTBI was 24.8% (95% CI 19.7-30.0%) and 21.2% (95% CI 17.9-24.4%), based on IGRA and a 10-mm TST cut-off, respectively. The prevalence estimates correlated well to WHO incidence rates (Rs=0.70, pamp;lt;0.001). In the first study of the global prevalence of LTBI derived from both IGRA and TST surveys, we found that one-fourth of the worlds population is infected. This is of relevance, as both tests, although imperfect, are used to identify individuals eligible for preventive therapy. Enhanced efforts are needed targeting the large pool of latently infected individuals, as this constitutes an enormous source of potential active tuberculosis.

  • 76.
    Dahlberg, Lena
    et al.
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Andersson, Lars
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Lennartsson, Carin
    Aging Research Center, Karolinska Institutet, Solna, Sweden; Stockholm University, Stockholm, Sweden.
    Long-term predictors of loneliness in old age: results of a 20-year national study2018In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 22, no 2, p. 190-196Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The understanding of social phenomena is enhanced if individuals can be studied over longer periods. Regarding loneliness in old age, there is a general lack of longitudinal research. The aim of this study was to examine whether there is an association between loneliness in old age and social engagement 20 years earlier, as stated by life course theory and the convoy model.

    METHOD: Data from the nationally representative Swedish Panel Study of Living Conditions of the Oldest Old (2002 and 2011 data collection waves) and the Swedish Level of Living Survey (1981 and 1991 data collection waves) were used. The sample included 823 individuals with an average age of 62.2 years at baseline and 82.4 years at follow-up.

    RESULTS: Each form of social engagement in old age was significantly associated with the same form of social engagement 20 years earlier. Close forms of social engagement were associated with loneliness in old age; as were more distant forms of social engagement, but only when they were considered solely in old age.

    CONCLUSION: Patterns of social engagement in old age were established at least 20 years earlier and close forms of social engagement are long-term predictors of loneliness, although current social engagement tended to be more influential on loneliness. The study underlines the importance of interventions targeted at close relationships that can provide social support in old age.

  • 77.
    Dahlström, Örjan
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences.
    Zetterqvist, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Lundh, Lars-Gunnar
    Department of Psychology, Lund University, Lund, Sweden..
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Functions of Nonsuicidal Self-Injury: Exploratory and Confirmatory Factor Analyses in a Large Community Sample of Adolescents2015In: Psychological Assessment, ISSN 1040-3590, E-ISSN 1939-134X, Vol. 27, no 1, p. 302-313Article in journal (Refereed)
    Abstract [en]

    Given that nonsuicidal self-injury (NSSI) is prevalent in adolescents, structured assessment is an essential tool to guide treatment interventions. The Functional Assessment of Self-Mutilation (FASM) is a self-report scale that assesses frequency, methods, and functions of NSSI. FASM was administered to 3,097 Swedish adolescents in a community sample. With the aim of examining the underlying factor structure of the functions of FASM in this sample, the adolescents with NSSI who completed all function items (n = 836) were randomly divided into 2 subsamples for cross-validation purposes. An exploratory factor analysis (EFA) was followed by a confirmatory factor analysis (CFA) using the mean and variance adjusted weighted least squares (WLSMV) estimator in the Mplus statistical modeling program. The results of the EFA suggested a 3-factor model (social influence, automatic functions, and nonconformist peer identification), which was supported by a good fit in the CFA. Factors differentiated between social/interpersonal and automatic/intrapersonal functions. Based on learning theory and the specific concepts of negative and positive reinforcement, the nonconformist peer identification factor was then split into 2 factors (peer identification and avoiding demands). The resulting 4-factor model showed an excellent fit. Dividing social functions into separate factors (social influence, peer identification, and avoiding demands) can be helpful in clinical practice, where the assessment of NSSI functions is an important tool with direct implications for treatment.

  • 78.
    Dale, Richard Allan
    et al.
    Sahlgrenska Academy, University of Gothenburg, Sweden.
    Sverker, Annette
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Hasselberg, Marie
    Karolinska Institutet, Sweden.
    Östlund, Gunnel
    School of Health and Social Welfare, Mälardalen University, Sweden.
    Hensing, Gunnel
    University of Gothenburg, Sweden.
    Young adults' experiences with near-injury situations: a critical incident study in Sweden2017In: International Journal of Child, Youth & Family Studies, ISSN 1920-7298, E-ISSN 1920-7298, Vol. 8, no 1, p. 97-111Article in journal (Refereed)
    Abstract [en]

    As injuries are the main health threat for young adults (18–29 years) in industrial countries, a better understanding of injury risk is needed for this population. Using the Critical Incident Technique, this study explores how young people experience situations that have the potential to cause physical injury (i.e., near-injury situations). Clearly, understanding how and why near-injury situations arise can be used to develop strategies to help prevent severe injury. Content analysis was used to categorize the characteristics of the experiences into unexpected risk in ordinary tasksduty first, and price for learning. Young adults’ exposures to new or unusual environmental conditions, especially in unexpected risk in ordinary tasks, should be considered when planning injury prevention strategies. A combination of individual, social, and contextual demands and expectations was identified in both work- and sports-related experiences with near-injury situations. The price for learning, which arises from the added risk involved in learning situations, is another condition that was identified and requires further attention. The Critical Incident Technique proved to be a useful method for identifying near-injury situations that might otherwise have been difficult to recall. Young adults’ efforts to display their ability to handle difficult situations at work and in their everyday lives was identified as a major contributor to near-injury situations.

  • 79.
    Danemalm Jägervall, Carina
    et al.
    Växjö county hospital, Växjö, Sweden.
    Brüggemann, Jelmer
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Johnson, Ericka
    Linköping University, Department of Thematic Studies, The Department of Gender Studies. Linköping University, Faculty of Arts and Sciences.
    Gay men’s experiences of sexual changes after prostate cancer treatment: a qualitative study in Sweden2019In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, no 1, p. 40-44Article in journal (Refereed)
    Abstract [en]

    Background: The needs of gay men after prostate cancer treatment are becoming visible. This patient group reports a more negative impact of treatment than heterosexual men. Yet, gay men’s experiences of post-treatment sexual changes are still little explored. This study aims to determine specific concerns of gay men’s post-treatment sexual practices.

    Methods: A qualitative study design was deployed using semi-structured interviews as data. Participants were purposefully sampled through advertisements and the snowball method. Eleven self-identifying gay men aged 58–81 years and treated for prostate cancer participated in interviews during 2016–2017. The interviews were transcribed, coded and thematically analysed.

    Results: The analysis highlights sexual changes in relation to the physical body, identity and relations. Problematic physical changes included loss of ejaculate and erectile dysfunction. Some respondents reported continued pleasure from anal stimulation and were uncertain about the role of the prostate. These physical changes prompted reflections on age and (dis)ability. Relationship status also impacted perception of physical changes, with temporary sexual contacts demanding more of the men in terms of erection and ejaculations.

    Conclusions: Gay prostate cancer survivors’ narratives about sexual changes circle around similar bodily changes as heterosexual men’s, such as erectile problems and weaker orgasms. The loss of ejaculate was experienced as more debilitating for gay men. Men who had anal sex were concerned about penetration difficulties as well as sensations of anal stimulation. Additional studies are required to better understand the role of the prostate among a diversity of men, regardless of sexuality.

  • 80.
    Divanoglou, Anestis
    et al.
    Univ Iceland, Iceland; Cent Queensland Univ, Australia.
    Augutis, Marika
    Sundsvall Hosp, Sweden; Karonlinska Inst, Sweden.
    Sveinsson, Thorarinn
    Univ Iceland, Iceland.
    Hultling, Claes
    Karonlinska Inst, Sweden; Spinalis Fdn, Sweden.
    Levi, Richard
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    SELF-REPORTED HEALTH PROBLEMS AND PRIORITIZED GOALS IN COMMUNITY-DWELLING INDIVIDUALS WITH SPINAL CORD INJURY IN SWEDEN2018In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 10, p. 872-878Article in journal (Refereed)
    Abstract [en]

    Objective: To explore self-reported health problems and functional goals in community-dwelling individuals with spinal cord injury in Sweden. Design: Cross-sectional descriptive study that used a survey designed by an experienced peer mentor with spinal cord injury. Subjects: Community-dwelling individuals with spinal cord injury from Sweden. Methods: The survey was distributed online by the community peer-based organization RG Active Rehabilitation. Results: A total of 203 individuals (55% males, 90% acquired spinal cord injury) from all regions in Sweden completed the survey. Of these, 33% reported living with amp;gt; 2 unbearable physical or psychological problems. While some problems (e.g. problems related to bladder and balance) were consistently ranked to be common across all years since injury and type of spinal cord injury, distribution of some other unbearable problems (e.g. type of pain, excessive weight) varied between subgroups. Years since injury, level of acquired spinal cord injury and sex, but not age-group or type of spinal cord injury, explained some of the variation in the goals. Conclusion: The high proportion of reported "unbearable" problems point to the stronger need for systematic, comprehensive, life-long, multi-disciplinary follow-up for people with spinal cord injury. The high rate of goals related to improving strength and fitness across all participants independently of their characteristics highlight the important role of community organizations that offer such lifetime services.

  • 81.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Longitudinal Associations between Anatomical Regions of Pain and Work Conditions: A Study from The SwePain Cohort2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 12, article id 2167Article in journal (Refereed)
    Abstract [en]

    We investigated the time-based associations between workload (physical and mechanical), psychosocial work stressors (demands, control, and support), and the number of anatomical regions with pain (ARP). This population-based study with a two-year follow-up included 11,386 responders (5125 men, 6261 women; mean age: 48.8 years; SD: 18.5) living in south-eastern Sweden. Predictive associations were assessed through generalised linear models, and changes over time were examined using a generalised estimating equation. The results of both models were reported as parameter estimates (B) with 95% confidence interval (CIs). Mean changes in the number of ARP, workload, and psychosocial work stressors were stable over time. High mechanical workload and job demands were likely associated with the number of ARP at the two-year follow-up. In the reverse prospective model, we found that the number of ARP was also associated with high physical and mechanical workload and low job control and support. In the two time-based models of changes, we found a reciprocal association between number of ARP and mechanical workload. Our results add epidemiological evidence to the associations between work conditions and the extent of pain on the body. Components of work conditions, including job demands and mechanical strain, must be considered when organisations and health policy makers plan and employ ergonomic evaluations to minimise workplace hazards in the general population.

  • 82.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Insomnia severity and its relationship with demographics, pain features, anxiety, and depression in older adults with and without pain: cross-sectional population-based results from the PainS65+cohort2017In: Annals of General Psychiatry, ISSN 1744-859X, E-ISSN 1744-859X, Vol. 16, article id 15Article in journal (Refereed)
    Abstract [en]

    Background: Insomnia is a major cause of concern in the elderly with and without pain. This study set out to examine the insomnia and its correlates in a large sample of community adults aged amp;gt;= 65 years. Methods: A cross-sectional postal survey was completed by 6205 older individuals (53.8% women; mean age = 76.2 years; SD = 7.5). The participants also completed the Insomnia Severity Index (ISI) and questionnaires assessing pain intensity, pain spreading, anxiety, depression, and basic demographic information. The sample was divided into three groups based on the presence and duration of pain: chronic pain (CP; n = 2790), subacute pain (SP; n = 510), and no pain (NP; n = 2905). Results: A proportion of each of the groups had an ISI score of 15 or greater (i.e., clinical insomnia): CP = 24.6%; SP = 21.3%; and NP = 13.0%. The average scores of ISI differed significantly among CP, SP, and NP groups (p amp;lt; 0.001). Stratified regression analyses showed that pain intensity, pain spreading, anxiety, and depression were independently related to insomnia in the CP group. Anxiety and depression were independently related to insomnia in the SP group, but only anxiety was significantly associated with insomnia in the NP group. Age and sex were not associated with insomnia. Conclusions: This study confirms that insomnia is not associated with chronological aging per se within the elderly population. Although the possible associations of insomnia with pain are complex, ensuing from pain intensity, pain spreading, anxiety, and depression, our results highlighted that anxiety was more strongly associated with insomnia in all groups than the depression and pain characteristics. Therapeutic plans should consider these relations during the course of pain, and a comprehensive assessment including both pain and psychological features is essential when older people are seeking primary health care for insomnia complaints.

  • 83.
    Eckerblad, Jeanette
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Symptom burden among people with chronic disease2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Chronic diseases tend to increase with old age. Older people with chronic disease are commonly suffering from conditions which produce a multiplicity of symptoms and a decreased health-related quality of life. Nurses have a responsibility to prevent, ease or delay a negative outcome through symptom management, or assist in achieving an acceptable level of symptom relief.

    Aim: The overall aim of the thesis was to describe different aspects of symptom burden from the perspective of community-dwelling people with chronic disease.

    Methods: This thesis is based upon four papers that used both quantitative and qualitative data to describe different aspects of symptom burden, experienced by people with chronic diseases. Paper (I) is a cross-sectional study with 91 participants diagnosed with chronic obstructive pulmonary disease. Papers (II and IV) are based upon secondary outcome data from a randomized controlled trial with 382 community-dwelling older people with multimorbidity. Paper (II) is a cross-sectional study and Paper (IV) has a descriptive and an explorative design reporting on the trajectory of symptom prevalence and symptom burden. Paper (III) is a qualitative study with participants from the AGe-FIT.

    Results: Among people diagnosed with COPD the most prevalent symptoms with the highest symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy, with just a few differences between participants with moderate and severe airflow limitation (I). For older people with multimorbidity, pain was the symptom with the highest prevalence and burden. Other highly prevalent symptoms were lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score (II). The symptoms experienced by the older people were persistent and the symptom burden remained high over time (IV). The experience of living with a high symptom burden was described as an endless struggle. The analysis revealed an overall theme, “To adjust and endure” and three sub-themes, “to feel inadequate and limited”, “to feel dependent”, and “to feel dejected” (III).

    Conclusions: The results of this thesis indicate the importance of early symptom identification. People with chronic diseases have an unmet need for optimized treatment that focuses on the total symptom burden, and not only disease specific symptoms. A large proportion of older people with multimorbidity suffer a high and persistent symptom burden, and the prevalence and trajectory of pain are high. Older people sometimes think their high age is the reason they experience a diversity of symptoms, and they do not always communicate these to their health-care provider.

    List of papers
    1. Symptom burden in stable COPD patients with moderate or severe airflow limitation
    Open this publication in new window or tab >>Symptom burden in stable COPD patients with moderate or severe airflow limitation
    Show others...
    2014 (English)In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 43, no 4, p. 351-357Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVES:

    To describe a multidimensional symptom profile in patients with stable chronic obstructive pulmonary disease (COPD) and determine whether symptom experience differed between patients with moderate or severe airflow limitations.

    BACKGROUND:

    Patients with severe airflow limitation experience numerous symptoms, but little is known regarding patients with moderate airflow limitation.

    METHODS:

    A multidimensional symptom profile (Memorial Symptom Assessment Scale) was assessed in 42 outpatients with moderate and 49 with severe airflow limitations.

    RESULTS:

    The mean number of symptoms in the total sample was 7.9 (±4.3) with no difference between patients with moderate and severe airflow limitations. The most prevalent symptoms with the highest MSAS symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy in both groups.

    CONCLUSIONS:

    Patients with moderate or severe airflow limitations experience multiple symptoms with high severity and distress. An assessment of their multidimensional symptom profile might contribute to better symptom management.

    Place, publisher, year, edition, pages
    Elsevier, 2014
    Keywords
    Chronic obstructive pulmonary disease; Symptom assessment; Symptom experience; Respiratory nursing
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-109384 (URN)10.1016/j.hrtlng.2014.04.004 (DOI)000338972500022 ()24856227 (PubMedID)
    Available from: 2014-08-15 Created: 2014-08-15 Last updated: 2017-12-05Bibliographically approved
    2. Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study
    Open this publication in new window or tab >>Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study
    Show others...
    2015 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, no 1Article in journal (Refereed) Published
    Abstract [en]

    Background: Globally, the population is ageing and lives with several chronic diseases for decades. A high symptom burden is associated with a high use of healthcare, admissions to nursing homes, and reduced quality of life. The aims of this study were to describe the multidimensional symptom profile and symptom burden in community-dwelling older people with multimorbidity, and to describe factors related to symptom burden. Methods: A cross-sectional study including 378 community-dwelling people greater than= 75 years, who had been hospitalized greater than= 3 times during the previous year, had greater than= 3 diagnoses in their medical records. The Memorial Symptom Assessment Scale was used to assess the prevalence, frequency, severity, distress and symptom burden of 31 symptoms. A multiple linear regression was performed to identify factors related to total symptom burden. Results: The mean number of symptoms per participant was 8.5 (4.6), and the mean total symptom burden score was 0.62 (0.41). Pain was the symptom with the highest prevalence, frequency, severity and distress. Half of the study group reported the prevalence of lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score. Conclusion: The older community-dwelling people with multimorbidity in this study suffered from a high symptom burden with a high prevalence of pain. Persons with poor vision, likelihood of depression, and diseases of the digestive system are at risk of a higher total symptom burden and might need age-specific standardized guidelines for appropriate management.

    Place, publisher, year, edition, pages
    BioMed Central, 2015
    Keywords
    Chronic disease; Older people; Symptom assessment
    National Category
    Sociology Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-114010 (URN)10.1186/1471-2318-15-1 (DOI)000347569800001 ()25559550 (PubMedID)
    Note

    Funding Agencies|Faculty of Health sciences, Linkoping University; county council of Ostergotland; Signe and Olof Wallenius trust fund; Solstickan; Swedish Association of Geriatric Medicine; Mundipharma

    Available from: 2015-02-06 Created: 2015-02-05 Last updated: 2019-06-27
    3. To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity
    Open this publication in new window or tab >>To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity
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    2015 (English)In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 28, no 4, p. 322-327Article in journal (Refereed) Published
    Abstract [en]

    Context Older people with multimorbidity are vulnerable and often suffer from conditions that produce a multiplicity of symptoms and a reduced health-related quality of life. Objectives The aim of this study is to explore the experience of living with a high symptom burden from the perspective of older community-dwelling people with multi-morbidity.

    Method A qualitative descriptive design with semi-structured interviews, including 20 community-dwelling older people with multi-morbidity and a high symptom burden. The participants were 79-€“89 years old with a mean of 12 symptoms per person. Data were analyzed using content analyses.

    Results The experience of living with a high symptom burden revealed the overall theme, “To adjust and endure” and three sub-themes. The first sub-theme was "To feel inadequate and limited". Participants reported that they no longer had the capacity or the ability to manage, and they felt limited and isolated from friends or family. The second sub-theme was "To feel dependent". This was a new and inconvenient experience; the burden they put on others caused a feeling of guilt. The final sub-theme was "To feel dejected". The strength to manage and control their conditions was gone; the only thing left to do was to sit or lie down and wait for it all to pass.

    Conclusion This study highlights the importance of a holistic approach when taking care of older people with multi-morbidity. This approach should employ a broad symptom assessment to reveal diseases and conditions that are possible to treat or improve.

    Place, publisher, year, edition, pages
    Elsevier, 2015
    Keywords
    Multimorbidity, Older people, Symptom burden, Content analysis
    National Category
    Nursing Gerontology, specialising in Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-122740 (URN)10.1016/j.apnr.2015.03.008 (DOI)000366148700012 ()
    Available from: 2015-11-19 Created: 2015-11-19 Last updated: 2019-06-27Bibliographically approved
    4. Symptom trajectory and symptom burden in older people with multimorbidity, secondary outcome from the RCT AGe-FIT study
    Open this publication in new window or tab >>Symptom trajectory and symptom burden in older people with multimorbidity, secondary outcome from the RCT AGe-FIT study
    2016 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 11, p. 2773-2783Article in journal (Refereed) Published
    Abstract [en]

    Aim

    The aim of this study was to follow the symptom trajectory of community-dwelling older people with multimorbidity and to explore the effect on symptom burden from an ambulatory geriatric care unit, based on comprehensive geriatric assessment.

    Background

    Older community-dwelling people with multimorbidity suffer from a high symptom burden with a wide range of co-occurring symptoms often resulting to decreased health-related quality of life. There is a need to move from a single-disease model and address the complexity of older people living with multimorbidity.

    Design

    Secondary outcome data from the randomized controlled Ambulatory Geriatric Assessment Frailty Intervention Trial (AGe-FIT).

    Methods

    Symptom trajectory of 31 symptoms was assessed with the Memorial Symptom Assessment Scale. Data from 247 participants were assessments at baseline, 12 and 24 months, 2011–2013. Participants in the intervention group received care from an ambulatory geriatric care unit based on comprehensive geriatric assessment in addition to usual care.

    Results

    Symptom prevalence and symptom burden were high and stayed high over time. Pain was the symptom with the highest prevalence and burden. Over the 2-year period 68–81% of the participants reported pain. Other highly prevalent and persistent symptoms were dry mouth, lack of energy and numbness/tingling in the hands/feet, affecting 38–59% of participants. No differences were found between the intervention and control group regarding prevalence, burden or trajectory of symptoms.

    Conclusions

    Older community-dwelling people with multimorbidity had a persistent high burden of symptoms. Receiving advanced interdisciplinary care at an ambulatory geriatric unit did not significantly reduce the prevalence or the burden of symptoms.

    Place, publisher, year, edition, pages
    Wiley-Blackwell Publishing Inc., 2016
    Keywords
    Registration clinicaltrials.gov identifier: NCT01446757 Keywords Symptom management, Community Care, Older people, Quality of care
    National Category
    Nursing Gerontology, specialising in Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-122741 (URN)10.1111/jan.13032 (DOI)000386079500019 ()27222059 (PubMedID)
    Note

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

    At the time for thesis presentation publication was named: Symptom trajectory and symptom burden in older people with multimorbidity, data from the RCT AGe-FIT study

    Available from: 2015-11-19 Created: 2015-11-19 Last updated: 2019-06-27Bibliographically approved
  • 84.
    Eckhardt, Anna
    et al.
    Institute of Tropical Medicine and International Health, Charité Universitätsmedizin, Berlin, Germany.
    Aguilar Zambrano, Enrique
    Universidad Central del Ecuador, Instituto de Investigación y Postgrado, Facultad de Sciencias Médicas, Quito, Ecuador.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Traumatic experiences and dissociation in a non-clinical group of university students in Ecuador: a cross-sectional study2018In: Journal of Child and Adolescent Mental Health, ISSN 1728-0583, E-ISSN 1728-0591, Vol. 30, no 3, p. 191-202Article in journal (Refereed)
    Abstract [en]

    Background: In Ecuador, as in most Latin American countries, scientific research on trauma and dissociation is scarce. The aim of this study was to examine the prevalence of potentially traumatic experiences and dissociative symptoms in adolescents and young adults who were students at the Central University in Quito, Ecuador.

    Methods: A cross-sectional study in which 144 students completed a self-administrated questionnaire consisting of Linköping Youth Life Experience Scale (LYLES), Adolescent-Dissociation Experience Scale (A-DES ) and background variables. Data collection was conducted in autumn 2012. Standard multiple regression analysis was used to analyse the data.

    Results: All students reported a history of a minimum of five potentially traumatic experiences with a mean of 14.8. Eight participants (5.6%) scored above 3.7 on the Adolescent-Dissociation Experience Scale, which is considered clinically significant dissociation. No correlation was found between high scores on LYLES and A-DES.

    Conclusions: The prevalence of potentially traumatic experiences in the study population is very high compared to studies conducted in high-income settings. The low prevalence of dissociation suggests high resilience in the study population but more research on morbidity is needed to draw conclusions about mental health outcomes. Further research should include study populations in less advantageous contexts.

  • 85.
    Edouard, Pascal
    et al.
    Univ Jean Monnet, France; Univ Hosp St Etienne, France; French Athlet Federat FFA, France.
    Junge, Astrid
    MSH, Germany; Swiss Concuss Ctr, Switzerland; Schulthess Clin Zurich, Switzerland.
    Kiss-Polauf, Marianna
    Hungarian Athlet Federat, Hungary; Natl Inst Sport Med, Hungary.
    Ramirez, Christophe
    Royal Spanish Athlet Federat, Spain.
    Sousa, Monica
    Polytechinc Leiria, Portugal.
    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.
    Branco, Pedro
    EAA, Switzerland; IAAF, Monaco.
    Interrater reliability of the injury reporting of the injury surveillance system used in international athletics championships2018In: Journal of Science and Medicine in Sport, ISSN 1440-2440, E-ISSN 1878-1861, Vol. 21, no 9, p. 894-898Article in journal (Refereed)
    Abstract [en]

    Objectives: The quality of epidemiological injury data depends on the reliability of reporting to an injury surveillance system. Ascertaining whether all physicians/physiotherapists report the same information for the same injury case is of major interest to determine data validity. The aim of this study was therefore to analyse the data collection reliability through the analysis of the interrater reliability. Design: Cross-sectional survey. Methods: During the 2016 European Athletics Advanced Athletics Medicine Course in Amsterdam, all national medical teams were asked to complete seven virtual case reports on a standardised injury report form using the same definitions and classifications of injuries as the international athletics championships injury surveillance protocol. The completeness of data and the Fleiss kappa coefficients for the inter-rater reliability were calculated for: sex, age, event, circumstance, location, type, assumed cause and estimated time-loss. Results: Forty-one team physicians and physiotherapists of national medical teams participated in the study (response rate 89.1%). Data completeness was 96.9%. The Fleiss kappa coefficients were: almost perfect for sex (k = 1), injury location (k = 0.991), event (k = 0.953), circumstance (k = 0,942), and age = 0.870), moderate for type (k = 0.507), fair for assumed cause (k = 0.394), and poor for estimated time loss (k = 0.155). Conclusions: The injury surveillance system used during international athletics championships provided reliable data for "sex", "location", "event", "circumstance", and "age". More caution should be taken for "assumed cause" and "type", and even more for "estimated time-loss". This injury surveillance system displays satisfactory data quality (reliable data and high data completeness), and thus, can be recommended as tool to collect epidemiology information on injuries during international athletics championships. (C) 2018 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  • 86.
    Ehn, Mattias
    et al.
    Orebro Univ Hosp, Sweden; Orebro Univ, Sweden; Orebro Univ, Sweden.
    Wahlqvist, Moa
    Orebro Univ Hosp, Sweden; Orebro Univ, Sweden; Orebro Univ, Sweden.
    Danermark, Berth
    Orebro Univ Hosp, Sweden; Orebro Univ, Sweden; Orebro Univ, Sweden.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Orebro Univ, Sweden.
    Moller, Claes
    Orebro Univ Hosp, Sweden; Orebro Univ, Sweden; Orebro Univ, Sweden.
    Health, work, social trust, and financial situation in persons with Usher syndrome type 12018In: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 60, no 2, p. 209-220Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Research has demonstrated that persons with Usher syndrome type 1 (USH1) have significantly poorer physical and psychological health compared to a reference group. PURPOSE: To explore the relation between work, health, social trust, and financial situation in USH1 compared to a reference group. MATERIAL: Sixty-six persons (18-65 y) from the Swedish Usher database received a questionnaire and 47 were included, 23 working and 24 non-working. The reference group comprised 3,049 working and 198 non-working persons. METHODS: The Swedish Health on Equal Terms questionnaire was used and statistical analysis with multiple logistic regression was conducted. RESULTS: The USH1 non-work group had a higher Odds ratio (95% CI) in poor psychological and physical health, social trust, and financial situation compared to the USH1 work group and reference groups. Age, gender, hearing, and vision impairment did not explain the differences. The relation between the USH1 work and non-work groups showed the same pattern as the reference groups, but the magnitude of problems was significantly higher. CONCLUSIONS: Both disability and unemployment increased the risk of poor health, social trust and financial situation in persons with USH1, but having an employment seemed to counteract the risks related to disability.

  • 87.
    Ekberg, Joakim
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Online health promoting communities: Design, implementation and formative evaluation of an intervention2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In Sweden, obesity among children has not yet reached the epidemic proportions reported from other parts of the world. However, among adolescents, being overweight and self-consciousness regarding body shape, diet and exercise influence social, psychological and physical health. Obese children may be in need of secondary prevention because of adverse effects related to obesity, but it is less obvious exactly what to prevent in the rest of the population. General interventions to prevent overweight and obesity are problematic because of the lack of associations for general application; there is a need for personalized community-based health promotion. Online interventions are especially suitable considering the amount of time adolescents spend online.

    This thesis takes a design approach to interventions and describes the design of an online health promoting community as a path to health promotion among adolescents. The first two studies use data from the first 15 years of a 1991 cohort living in Östergötland to determine the predictability of obesity from childhood body mass index and to investigate interventions and available evidence to suggest appropriate interventions. The next two studies use these findings to design and formatively evaluate a health promotion intervention.

    In Study I we found reasons for offering population-based interventions systematically from 5 years of age. It would be worthwhile identifying at an early age those relatively few children with substantially increased risk of maintaining obesity in adulthood and offering them interventions; but interventions must be avoided when they are not necessary. The projections in Study II indicate that more specified interventions would benefit adolescents without increasing the costs. In Study III, we found than an online health promoting community can be designed simply at relatively low cost and can be negotiated to satisfy both the needs of the user community and public health goals and service capabilities. In Study IV, a checklist for pre-launch evaluation of online health promoting communities was developed and the most important result was the delicate balance between community autonomy and quality control. Future studies addressing health outcome constructs for use in online health promoting community evaluations are warranted.

    List of papers
    1. Prediction of obesity from infancy to adolescence
    Open this publication in new window or tab >>Prediction of obesity from infancy to adolescence
    2011 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 9, p. 1249-1252Article in journal (Refereed) Published
    Abstract [en]

    Aim: To examine the development of childhood obesity and to determine the earliest age when estimating body mass using only weight and height data is associated with a corresponding estimate at the age of 15. less thanbrgreater than less thanbrgreater thanMethods: Subjects included are all children born in 1991 in Ostergotland County, Sweden. Weight and height data collected during regular check-ups at well-child centres and school health care assessments up to 15 years of age were assembled from health records. Correlations between childhood estimates of body mass and the body mass index (BMI) at 15 years of age were computed pairwise. Correlations with r andgt; 0.5 were defined as reliably strong. less thanbrgreater than less thanbrgreater thanResults: Complete data were available for 3579 children (62%). Fewer girls (2.6%; C.I. 1.9-3.3) than boys (4.6%; C.I. 3.7-5.5) were obese at 15 years of age. Correlations with BMI at 15 years of age were strong (significantly higher than 0.5) from 5 years of age. Only 23% of girls and 8% of boys found to be obese at 5 years of age were of normal weight at the age of 15. less thanbrgreater than less thanbrgreater thanConclusion: From 5 years of age, point estimates of body mass using only weight and height data are strongly associated with BMI at the age of 15. More data sources are needed to predict weight trajectories in younger children.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2011
    Keywords
    Childhood obesity, Obesity prevalence, Predictive correlations
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-70319 (URN)10.1111/j.1651-2227.2011.02326.x (DOI)000293942500028 ()
    Available from: 2011-09-02 Created: 2011-09-02 Last updated: 2017-12-08Bibliographically approved
    2. History matters: childhood weight trajectories as a basis for planning community-based obesity prevention to adolescents
    Open this publication in new window or tab >>History matters: childhood weight trajectories as a basis for planning community-based obesity prevention to adolescents
    Show others...
    2012 (English)In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 36, no 4, p. 524-528Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To use epidemiological data and a standardized economic model to compare projected costs for obesity prevention in late adolescence accrued using a cross-sectional weight classification for selecting adolescents at age 15 years compared with a longitudinal classification. less thanbrgreater than less thanbrgreater thanMETHODS: All children born in a Swedish county (population 440 000) in 1991 who participated in all regular measurements of height and weight at ages 5, 10 and 15 years (n=4312) were included in the study. The selection strategies were compared by calculating the projected financial load resulting from supply of obesity prevention services from providers at all levels in the health care system. The difference in marginal cost per 1000 children was used as the primary end point for the analyses. less thanbrgreater than less thanbrgreater thanRESULTS: Using the cross-sectional selection strategy, 3.8% of adolescents at age 15 years were selected for evaluation by a pediatric specialist, and 96.2% were chosen for population-based interventions. In the trajectory-based strategy, 2.4% of the adolescents were selected for intensive pediatric care, 1.4% for individual clinical interventions in primary health care, 14.0% for individual primary obesity prevention using the Internet and 82.1% for population-based interventions. Costs for the cross-sectional selection strategy were projected to USD463 581 per 1000 adolescents and for the trajectory-based strategy were USD 302 016 per 1000 adolescents. less thanbrgreater than less thanbrgreater thanCONCLUSIONS: Using projections from epidemiological data, we found that by basing the selection of adolescents for obesity prevention on weight trajectories, the load on highly specialized pediatric care can be reduced by one-third and total health service costs for obesity management among adolescents reduced by one-third. Before use in policies and prevention program planning, our findings warrant confirmation in prospective cost-benefit studies.

    Place, publisher, year, edition, pages
    Nature Publishing Group, 2012
    Keywords
    economics, epidemiology, decision support, cohort
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-77329 (URN)10.1038/ijo.2011.263 (DOI)000302776300008 ()
    Note

    Funding Agencies|Ostergotland County Council, Sweden||

    Available from: 2012-05-11 Created: 2012-05-11 Last updated: 2017-12-07Bibliographically approved
    3. Design of an online health-promoting community: negotiating user community needs with public health goals and service capabilities
    Open this publication in new window or tab >>Design of an online health-promoting community: negotiating user community needs with public health goals and service capabilities
    Show others...
    2013 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 258Article in journal (Refereed) Published
    Abstract [en]

    Background

    An online health-promoting community (OHPC) has the potential to promote health and advance new means of dialogue between public health representatives and the general public. The aim of this study was to examine what aspects of an OHPC that are critical for satisfying the needs of the user community and public health goals and service capabilities.

    Methods

    Community-based participatory research methods were used for data collection and analysis, and participatory design principles to develop a case study OHPC for adolescents. Qualitative data from adolescents on health appraisals and perspectives on health information were collected in a Swedish health service region and classified into categories of user health information exchange needs. A composite design rationale for the OHPC was completed by linking the identified user needs, user-derived requirements, and technical and organizational systems solutions. Conflicts between end-user requirements and organizational goals and resources were identified.

    Results

    The most prominent health information needs were associated to food, exercise, and well-being. The assessment of the design rationale document and prototype in light of the regional public health goals and service capabilities showed that compromises were needed to resolve conflicts involving the management of organizational resources and responsibilities. The users wanted to discuss health issues with health experts having little time to set aside to the OHPC and it was unclear who should set the norms for the online discussions.

    Conclusions

    OHPCs can be designed to satisfy both the needs of user communities and public health goals and service capabilities. Compromises are needed to resolve conflicts between users’ needs to discuss health issues with domain experts and the management of resources and responsibilities in public health organizations.

    Keywords
    community-based participatory research, health promotion, adolescents, health service
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-81727 (URN)10.1186/1472-6963-13-258 (DOI)000321580500001 ()
    Available from: 2012-09-21 Created: 2012-09-21 Last updated: 2017-12-07
    4. Checklist for online health promoting communities
    Open this publication in new window or tab >>Checklist for online health promoting communities
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Disease prevention via web-based interventions has matured into a relatively inexpensive health intervention alternative; however, few studies on web-based health promotion have been published. Despite the apparent potential of online health promoting communities (OHPC), not much guidance is available for developers on the basic design features that characterize successful applications. The aim of this study was to develop a checklist for a pre-launch evaluation of OHPCs. The checklist is required to take the perspectives of both the user community and the health services into account.

    Methods: The study was based on an action research design. Constructs used in an evaluation for information system success, applicable before the introduction of the OHPC to the end users, were used as the basis for a checklist. Each construct was contextually adapted for the OHPC context and formatively evaluated in the case study project, and then organized into a checklist applicable to both the end-user community and the health care services.

    Results: The checklist applicable to OHPC included the following constructs: information quality, service quality, and subjective norms. The contextual adaptation of the information quality construct resulted in items for content area, trust, and format. The contextual adaptation of the service quality construct resulted in items for staff competence, prompt service and empathy. The contextual adaptation of the subject norms construct resulted in items for social facilitation, interconnectivity and communication.

    Conclusions: The most important result from the formative evaluation was the delicate balance between community autonomy and quality control in the formulation of the information and service quality constructs. Before the checklist is implemented, a comparison of the infrastructure and processes of the study context and the target context is needed to determine what aspects of the checklist are irrelevant. Future studies addressing health outcome constructs for use in OHPC evaluations are warranted.

    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-81728 (URN)
    Available from: 2012-09-21 Created: 2012-09-21 Last updated: 2013-09-05Bibliographically approved
  • 88.
    Ekberg, Joakim
    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
    Analytic Services Inc., Arlington, VA, USA.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Checklist for online health promoting communitiesManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Disease prevention via web-based interventions has matured into a relatively inexpensive health intervention alternative; however, few studies on web-based health promotion have been published. Despite the apparent potential of online health promoting communities (OHPC), not much guidance is available for developers on the basic design features that characterize successful applications. The aim of this study was to develop a checklist for a pre-launch evaluation of OHPCs. The checklist is required to take the perspectives of both the user community and the health services into account.

    Methods: The study was based on an action research design. Constructs used in an evaluation for information system success, applicable before the introduction of the OHPC to the end users, were used as the basis for a checklist. Each construct was contextually adapted for the OHPC context and formatively evaluated in the case study project, and then organized into a checklist applicable to both the end-user community and the health care services.

    Results: The checklist applicable to OHPC included the following constructs: information quality, service quality, and subjective norms. The contextual adaptation of the information quality construct resulted in items for content area, trust, and format. The contextual adaptation of the service quality construct resulted in items for staff competence, prompt service and empathy. The contextual adaptation of the subject norms construct resulted in items for social facilitation, interconnectivity and communication.

    Conclusions: The most important result from the formative evaluation was the delicate balance between community autonomy and quality control in the formulation of the information and service quality constructs. Before the checklist is implemented, a comparison of the infrastructure and processes of the study context and the target context is needed to determine what aspects of the checklist are irrelevant. Future studies addressing health outcome constructs for use in OHPC evaluations are warranted.

  • 89.
    Ekberg, Joakim
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, The Institute of Technology.
    Angbratt, Marianne
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Frank, Linda
    Department of Health, Jönköping County Council, Jönköping, Sweden.
    Norén, Anna-Maria
    Centre for Public Health, Kalmar County Council, Oskarshamn, Sweden.
    Andersen, Emelie
    Department of Health, Jönköping County Council, Jönköping, Sweden.
    Gursky, Elin
    Analytic Services Inc., Arlington, VA, USA.
    Andersson Gäre, Boel
    Futurum, Jönköping County Council, Jönköping, Sweden.
    Design of an online health-promoting community: negotiating user community needs with public health goals and service capabilities2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 258Article in journal (Refereed)
    Abstract [en]

    Background

    An online health-promoting community (OHPC) has the potential to promote health and advance new means of dialogue between public health representatives and the general public. The aim of this study was to examine what aspects of an OHPC that are critical for satisfying the needs of the user community and public health goals and service capabilities.

    Methods

    Community-based participatory research methods were used for data collection and analysis, and participatory design principles to develop a case study OHPC for adolescents. Qualitative data from adolescents on health appraisals and perspectives on health information were collected in a Swedish health service region and classified into categories of user health information exchange needs. A composite design rationale for the OHPC was completed by linking the identified user needs, user-derived requirements, and technical and organizational systems solutions. Conflicts between end-user requirements and organizational goals and resources were identified.

    Results

    The most prominent health information needs were associated to food, exercise, and well-being. The assessment of the design rationale document and prototype in light of the regional public health goals and service capabilities showed that compromises were needed to resolve conflicts involving the management of organizational resources and responsibilities. The users wanted to discuss health issues with health experts having little time to set aside to the OHPC and it was unclear who should set the norms for the online discussions.

    Conclusions

    OHPCs can be designed to satisfy both the needs of user communities and public health goals and service capabilities. Compromises are needed to resolve conflicts between users’ needs to discuss health issues with domain experts and the management of resources and responsibilities in public health organizations.

  • 90.
    Ekberg, Kerstin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Karlsson, Nadine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Linderoth, Catharina
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Arbetsgivares kostnader, åtgärder och anpassningar för sjuknärvarande och sjukfrånvarande medarbetare: samband med återgång i arbete och produktion2017Report (Other academic)
    Abstract [sv]

    Studien syftade till att undersöka vilka åtgärder arbetsgivare gör för sjukskrivna medarbetare och vilka kostnader arbetsgivare och samhället har i samband med sjuknärvaro och sjukfrånvaro.

    Totalt 3000 sjukskrivna personer i AFA Försäkrings register med diagnoserna psykiska besvär eller besvär i rörelseorganen fick ett informationsbrev och förfrågan om samtycke till att forskarna skulle få skicka en enkät till deras arbetsledare; 393 sjukskrivna gav samtycke. En  webbenkät skickades till dessa arbetsledare. Totalt 198 arbetsledare (50 %) till sjukskrivna personer besvarade enkäten.

    Resultaten visar att arbetsgivare genomför en rad olika åtgärder och anpassningar när en medarbetare blir sjukskriven. Analyserna visade att dessa åtgärder och anpassningar i viss mån beror på vem den sjukskrivne medarbetaren är. Åtgärder och anpassningar var vanligare för sjukskrivna med psykiska diagnoser, för högutbildade och för sjukskrivna i högkvalificerade yrken. Kvinnor fick i högre grad anpassningar och åtgärder såsom ändrade arbetsuppgifter och psykosocialt stöd jämfört med män.

    Demografiska faktorer visade sig ha mindre betydelse för om den sjukskrivne återgick i arbete eller ej. Multipla logistiska regressionsanalyser visade att åtgärder och anpassningar på arbetsplatsen hade signifikanta samband med en ökad chans för återgång i arbete. Resultaten visade också att för sjukskrivna medarbetare vars arbetsledare hade tagit många kontakter med andra aktörer, som HR-avdelningen, företagshälsan och/eller Försäkringskassan var sannolikheten lägre att den sjukskrivne medarbetaren återgick i arbete. Arbetsledare tog fler kontakter, om den sjukskrivne medarbetaren hade en psykisk diagnos.

    Sjuknärvaro och produktionsförlust före, under och efter sjukskrivningen skattades av arbetsledarna. Sammanlagt beräknades produktionsförlusterna till cirka SEK 100 000 per sjukskrivningsfall. Härutöver lägger arbetsgivare tid på att ta kontakter, genomföra åtgärder och anpassningar och organisera om arbetet. Arbetsledare hade mycket oklar eller saknade helt uppfattning om vad tid, åtgärder och anpassningar kostar, varför detta inte har kunnat analyseras närmare. De beräknade genomsnittliga kostnaderna till följd av produktivitetsförluster är således en underskattning av de faktiska kostnaderna för arbetsgivare.

    Studien visar att arbetsledares kunskap om vad sjuknärvaro och sjukfrånvaro kostar för verksamheten och för samhället är begränsad. En ökad kostnadsmedvetenhet skulle kunna stimulera till att större resurser läggs på att implementera policys för hälsofrämjande åtgärder och att utbilda arbetsledare i att hantera frågor om hälsa och arbetsförmåga på arbetsplatsen.

  • 91.
    Ekdahl, Christer
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Infective Endocarditis: aspects of pathophysiology, epidemiology, management and prognosis2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Infective endocarditis (IE) is a rare but complex disease that is fatal if untreated. With a modern combination of antimicrobial therapy and heart valve surgery, mortality is still 10-20 %. The structure of the endocarditis vegetation impedes the penetration of phagocytic cells such as monocytes and granulocytes. This leads to high bacterial counts inside the vegetation and the need for long treatment courses with a combination of intravenously administered bactericidal antibiotics.

    The aim of this thesis was to study the changes in epidemiology, management, and mortality at our hospital between 1980 and 2001, and to identify prognostic factors associated with mortality. To assess the issue of referral bias, differences between referred episodes and episodes from our local community were studied. Additional aims were to study the occurrence of the pro-chemotactic cytokines IL-8 and TNF-α in heart valves and vegetations during the active phase of IE, and to study the effect of the glycopeptide antibiotic vancomycin in dense staphylococcal cultures in vitro. As it is a rare and complex disease, management of IE is usually complicated for non-specialists. For this reason a computerised decision support system for IE was developed and evaluated.

    Between 1980 and 2001, the occurrence of Staphylococcus aureus IE and the use of early heart valve surgery increased significantly, regardless of whether the episodes were referred or of local origin. Glycopeptide antibiotics, mainly vancomycin, were used more frequently, especially among referred patients. Referred patients were younger, predominantly male, had more complications, and received surgical treatment more often than patients from our local community. The reason for the lower frequency of female patients in the referral cohort cannot be explained by more comorbidity or fewer complications. The differences between referred and local episodes seen in our study highlight the need for assessment and adjustment for referral bias in IE studies (Paper I).

    In six patients who needed early heart valve surgery, the largest numbers of IL-8-containing cells, and the greatest amount of inflammation, were seen in patients with short preoperative antimicrobial treatment courses. No such relationships were seen with respect to TNF-α-containing cells. The IL-8-containing cells and the inflammatory cells were predominantly scattered in the heart valve stroma or in the margin of the vegetation (Paper II). The primary effect of IL-8 is to stimulate chemotaxis of polymorphonuclear neutrophil granulocytes. This indicates that there is no deficiency of IL-8 in the area close to the vegetation as a cause of the localised agranulocytosis often present inside the vegetation.

    Our study revealed a need for computerised decision support systems (DSSs) in the field of IE, but to be used in clinical practice these DSSs need be part of knowledge bases covering larger domains (Paper IV). Some of our initial ideas described in Paper III, especially the use of Internet technology and the combination of rule-based advice and explanatory hypertext, will probably be included in these knowledge bases.

    In vitro, there is a rapid reduction of free vancomycin in broth containing dense staphylococcal cultures. Consequently, there is a simultaneous increase in broth MICs, particularly in high inocula, which is not caused by a development of resistance (Paper V). These findings need further evaluation in vivo, but indicate that the dosing regimen of vancomycin is of particular importance in staphylococcal infections with dense inocula, e.g. infective endocarditis.

    Diabetes mellitus and moderate to severe heart failure were independent risk factors for 6-month mortality in left-sided, Duke definite IE episodes, regardless of referral or local origin of the episodes. Early heart valve surgery had a positive impact on the 6-month mortality in the referral cohort of episodes, which may be due to referral bias (Paper VI).

    List of papers
    1. Changes in left-sided infective endocarditis over two decades at a Swedish university hospital: and evaluation of the importance of referral bias
    Open this publication in new window or tab >>Changes in left-sided infective endocarditis over two decades at a Swedish university hospital: and evaluation of the importance of referral bias
    Manuscript (Other academic)
    Identifiers
    urn:nbn:se:liu:diva-13331 (URN)
    Available from: 2008-06-18 Created: 2008-06-18 Last updated: 2010-01-13
    2. IL-8 and tumor necrosis factor alpha in heart valves from patients with infective endocarditis
    Open this publication in new window or tab >>IL-8 and tumor necrosis factor alpha in heart valves from patients with infective endocarditis
    Show others...
    2002 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, Vol. 34, no 10, p. 759-762Article in journal (Refereed) Published
    Abstract [en]

    The embedding of bacteria in the vegetation of infective endocarditis impedes the penetration of phagocytic cells. IL-8 has a stimulating effect on the immune system, particularly with respect to chemotaxis and activation of granulocytes. Tumor necrosis factor alpha (TNF-) is 1 of the major proinflammatory cytokines. IL-8 and TNF- were visualized by means of immunohistochemistry in paraffin-embedded heart valve biopsies from 6 patients with infective endocarditis who required cardiac surgery during the active phase of the infection. In 5/6 patients there were signs of inflammation, and in these patients IL-8- and TNF- -containing cells were visualized in the heart valve stromas or vegetations. The largest numbers of IL-8-containing cells, and the greatest amount of inflammation, were seen in patients with short preoperative treatment courses. No such relationships were seen with respect to TNF- -containing cells. These observations may suggest that the occurrence of IL-8-containing cells in infected heart valves could be used as a marker of disease activity.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13332 (URN)10.1080/00365540210147912 (DOI)
    Available from: 2008-06-18 Created: 2008-06-18 Last updated: 2009-08-17
    3. Extended telemedical consultation using Arden Syntax based decision support, hypertext and WWW technique
    Open this publication in new window or tab >>Extended telemedical consultation using Arden Syntax based decision support, hypertext and WWW technique
    Show others...
    1997 (English)In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 36, no 2, p. 108-114Article in journal (Refereed) Published
    Abstract [en]

    There is an obvious need for geographic distribution of expert knowledge among several health care units without increasing the cost of on-site expertise in locations where health care is provided. This paper describes the design of a knowledge-based decision-support system for extended consultation in clinical medicine. The system is based on Arden Syntax for Medical Logic Modules and hypertext using World Wide Web technology. It provides advice and explanations regarding the given advice. The explanations are presented in a hypertext format allowing the user to browse related information and to verify the relevance of the given advice. The system is intended to be used in a closed local network. With special precautions regarding issues of safety and patient security, the system can be used over wider areas such as in rural medicine. A prototype has been developed in the field of clinical microbiology and infectious diseases regarding infective endocarditis.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13333 (URN)9242006 (PubMedID)
    Available from: 2008-06-18 Created: 2008-06-18 Last updated: 2017-12-13
    4. A study of the usage of a decision-support system for infective endocarditis
    Open this publication in new window or tab >>A study of the usage of a decision-support system for infective endocarditis
    2000 (English)In: Medical informatics and the Internet in medicine (Print), ISSN 1463-9238, E-ISSN 1464-5238, Vol. 25, no 1, p. 1-18Article in journal (Refereed) Published
    Abstract [en]

    The objective of this study was to examine a design for a World Wide Web-based decision-support system in use by clinically active physicians. A prototype implementation of the design concerned management of infective endocarditis patient cases. The design was based on an integration of hypertext and rule-based knowledge. In the study sessions, physicians in the field of internal medicine worked on managing authentic patient cases in a laboratory setting. Data was collected from interviews with the physicians using video recordings and stimulated recall technique. The qualitative data was analysed according to the constant comparative method in order to develop a model of the physicians' usage of the system. The resulting model describes perceived contributions and criteria for usefulness of the system. The ways the physicians used the system showed that it was able to provide patient-specific support for confirming clinical decisions, for higher-level patient management, and for preparing for and initiating expert consultations. Users also stated that new medical knowledge could be gained as a side effect of using the system.

    Keywords
    Decision-support System, Endocarditis, Qualitative Methodology, Evaluation
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13334 (URN)10.1080/146392300298229 (DOI)
    Available from: 2008-06-18 Created: 2008-06-18 Last updated: 2017-12-13
    5. Rapid decrease of free vancomycin in dense staphylococcal cultures
    Open this publication in new window or tab >>Rapid decrease of free vancomycin in dense staphylococcal cultures
    Show others...
    2005 (English)In: European journal of clinical microbiology and infectious diseases, ISSN 0934-9723, Vol. 24, no 9, p. 596-602Article in journal (Refereed) Published
    Abstract [en]

    Bacterial numbers in broth cultures were determined by bioluminescence assay of intracellular bacterial ATP. Broth MICs for strains of Staphylococcus epidermidis (ATCC 14990 and 35984) and Staphylococcus aureus (ATCC 25923, 29213 and 6538) were determined for cultures with different inocula (105–108 bacteria/ml) after 24 h of incubation in supplemented Mueller–Hinton broth containing vancomycin. All of the tested strains except one were susceptible to methicillin, and all of the strains were susceptible to vancomycin. Free vancomycin concentrations in the broth cultures of all strains were determined with an agar well bioassay after 24 h of incubation. Free vancomycin concentrations and bacterial numbers of ATCC 35984 and ATCC 29213 were also determined after 0.5, 2, 4, and 8 h. In a low inoculum (105 bacteria/ml), the broth MICs were 1–4 μg/ml. In a high inoculum (∼108 bacteria/ml), the broth MICs increased two- to fourfold to 4–8 μg/ml. In dense inocula (∼109–1010 bacteria/ml), the concentrations of free vancomycin in the broth were reduced, in most cases below the detection limit of the bioassay (≤0.5 μg/ml). This reduction of free vancomycin was fast, occurring in initially dense inocula in less than 30 min. No emergence of resistance was seen. These results show a rapid reduction of free vancomycin in the broth and a simultaneous increase in broth MICs in high inocula, without development of resistance. This indicates that the dosing regimen of vancomycin is of particular importance in staphylococcal infections with dense inocula, e.g. infective endocarditis.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13335 (URN)10.1007/s10096-005-0011-0 (DOI)
    Available from: 2008-06-18 Created: 2008-06-18
    6. Prognostic factors for 6-month mortality in infective endocarditis: a retrospective study in a Swedish referral hospital
    Open this publication in new window or tab >>Prognostic factors for 6-month mortality in infective endocarditis: a retrospective study in a Swedish referral hospital
    Manuscript (Other academic)
    Identifiers
    urn:nbn:se:liu:diva-13336 (URN)
    Available from: 2008-06-18 Created: 2008-06-18 Last updated: 2010-01-13
  • 92.
    Ekstrom, Magnus Pär
    et al.
    Lund Univ, Sweden.
    Blomberg, Anders
    Umea Univ, Sweden.
    Bergström, Göran
    Univ Gothenburg, Sweden.
    Brandberg, John
    Univ Gothenburg, Sweden.
    Caidahl, Kenneth
    Univ Gothenburg, Sweden.
    Engström, Gunnar
    Lund Univ, Sweden.
    Engvall, Jan
    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 Clinical Physiology in Linköping.
    Eriksson, Maria
    Karolinska Inst, Sweden.
    Gränsbo, Klas
    Lund Univ, Sweden.
    Hansen, Tomas
    Uppsala Univ, Sweden.
    Jernberg, Tomas
    Karolinska Inst, Sweden.
    Nilsson, Lars
    Umea Univ, Sweden.
    Nilsson, Ulf
    Umea Univ, Sweden.
    Olin, Anna-Carin
    Univ Gothenburg, Sweden.
    Persson, Lennart
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Respiratory Medicine.
    Rosengren, Annika
    Univ Gothenburg, Sweden.
    Sandelin, Martin
    Uppsala Univ, Sweden.
    Sköld, Magnus
    Karolinska Inst, Sweden; Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Sundström, Johan
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Swahn, Eva
    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.
    Söderberg, Stefan
    Umea Univ, Sweden.
    Tanash, Hanan A.
    Lund Univ, Sweden.
    Torén, Kjell
    Sahlgrens Univ Hosp, Sweden.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, "Primary Health Care in Motala".
    Lindberg, Eva
    Uppsala Univ, Sweden.
    The association of body mass index, weight gain and central obesity with activity-related breathlessness: the Swedish Cardiopulmonary Bioimage Study2019In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 74, no 10, p. 958-964Article in journal (Refereed)
    Abstract [en]

    Introduction Breathlessness is common in the population, especially in women and associated with adverse health outcomes. Obesity (body mass index (BMI) amp;gt;30 kg/m(2)) is rapidly increasing globally and its impact on breathlessness is unclear. Methods This population-based study aimed primarily to evaluate the association of current BMI and self-reported change in BMI since age 20 with breathlessness (modified Research Council score amp;gt;= 1) in the middle-aged population. Secondary aims were to evaluate factors that contribute to breathlessness in obesity, including the interaction with spirometric lung volume and sex. Results We included 13 437 individuals; mean age 57.5 years; 52.5% women; mean BMI 26.8 (SD 4.3); mean BMI increase since age 20 was 5.0 kg/m(2); and 1283 (9.6%) reported breathlessness. Obesity was strongly associated with increased breathlessness, OR 3.54 (95% CI, 3.03 to 4.13) independent of age, sex, smoking, airflow obstruction, exercise level and the presence of comorbidities. The association between BMI and breathlessness was modified by lung volume; the increase in breathlessness prevalence with higher BMI was steeper for individuals with lower forced vital capacity (FVC). The higher breathlessness prevalence in obese women than men (27.4% vs 12.5%; pamp;lt;0.001) was related to their lower FVC. Irrespective of current BMI and confounders, individuals who had increased in BMI since age 20 had more breathlessness. Conclusion Breathlessness is independently associated with obesity and with weight gain in adult life, and the association is stronger for individuals with lower lung volumes.

  • 93.
    Ekström, Anna
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Majlesi, Ali Reza
    Linköping University, Department of Social and Welfare Studies. Linköping University, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Samarbete och delaktighet2016In: Att leva med demens / [ed] Ingrid Hellström, Lars-Christer Hydén, Malmö: Gleerups Utbildning AB, 2016, p. 55-62Chapter in book (Other academic)
  • 94.
    Emilsson, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Department of Health Science, University West, Trollhättan, Sweden.
    Treatment adherence in Asthma and Attention Deficit Hyperactivity Disorder (ADHD), Personality traits, Beliefs about medication and Illness perception2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Adherence to medication in asthma and attention deficit hyperactivity disorder (ADHD) is important because medication may prevent serious consequences, possibly with lifelong effects. Several factors have been identified that influence adherence to medication in these disorders, but the importance of personality traits, beliefs about medication and illness perception has been insufficiently explored.

    The overall aim of this thesis was to study adherence to medication in asthma and ADHD, and in particular factors associated with adherence.

    The participants (n=268) in Study I were recruited epidemiologically and consisted of young adults with asthma, aged 22 years (±1 year). Impulsivity and, in men Antagonism and Alexithymia were associated with low adherence among respondents with regular asthma medication (n=109).

    The participants (n=35) in Study II were recruited from primary care clinics and consisted of adults (mean age 53 years). In men, Neuroticism was associated with low adherence, but Conscientiousness with high adherence. Beliefs about the necessity of medication were positively associated with adherence behaviour in women. In the total sample, a positive necessity-concern differential of beliefs predicted higher adherence.

    The participants in Study III, IV (n=101) and V (n=99) were recruited from Child and Adolescent Psychiatric clinics and consisted of adolescents with ADHD on long-term ADHD medication. Study IV assessed the reliability and validity of Swedish translations of the Beliefs about Medicines Questionnaire-specific (BMQ-Specific) and Brief Illness Perception Questionnaire (B-IPQ) for use in adolescents with ADHD. Exploratory Principal Component Analysis (PCA) loadings of the BMQ-Specific items confirmed the original components, the specific-necessity and specific-concerns. The exploratory PCA for B-IPQ revealed two components; the first one, B-IPQ Consequences, captured questions regarding perceptions of the implication of having ADHD (items 1, 2, 5, 6 and 8) and the second one, B-IPQ-Control, the perceptions of the ability to manage the ADHD disorder (items 3, 4 and 7). Adherence correlated positively with BMQ-necessity-concern differential but negatively with beliefs about medication regarding concerns and side effects as well as Antagonism. Adolescents with more beliefs in the necessity, but with less concerns and side effects were less intentionally non-adherent. Adolescents with more perceptions that ADHD affected life showed less unintentional non-adherence. Negative Affectivity was associated with beliefs in the necessity of medication, but also with concern about medication and side effects. Negative Affectivity was positively associated with perceived consequences in life caused by ADHD and less control over ADHD. Hedonic Capacity was associated with less concerns about medication.

    In conclusion: In asthma and ADHD, adherence was associated with personality and beliefs about medications treatment. The personality traits showed numerous associations with perception about ADHD and beliefs about asthma and ADHD medication. This thesis increases our understanding of these person-related underlying factors of non-adherence, which may enable targeted actions intended to turn non-adherence into adherence as well as to identify individuals at risk for non-adherence. The Swedish translation of BMQ-Specific and B-IPQ proved to be valid and reliable, suggesting that the scales are useful in clinical work to identify risks of low adherence and to increase knowledge about how adolescents perceive ADHD. 

    List of papers
    1. Personality, adherence, asthma control and health-related quality of life in young adult asthmatics
    Open this publication in new window or tab >>Personality, adherence, asthma control and health-related quality of life in young adult asthmatics
    Show others...
    2009 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 103, no 7, p. 1033-1040Article in journal (Refereed) Published
    Abstract [en]

    Background

    Striving for improved adherence and asthma control is of vital concern in today's asthma management. Several influential factors have been identified, but the importance of personality traits has been insufficiently explored. The aim was first to determine whether personality traits in young adult asthmatics are related to asthma control and health-related quality of life (HRQL), and second to examine the influences of personality traits on adherence to regular asthma medication treatment.

    Methods

    Young adult asthmatics, 22 years of age (n = 268) completed questionnaires. Statistical analyses were performed.

    Results

    The personality traits Negative Affectivity and Impulsivity correlated negatively with asthma control, whereas in women Hedonic Capacity correlated positively with asthma control. Negative Affectivity, Impulsivity, Hedonic Capacity, Alexithymia and asthma control predicted the mental dimension of HRQL. Asthma control and physical activity predicted the physical dimension of HRQL. Among respondents with regular asthma medication (n = 109), Impulsivity correlated negatively with adherence. In men, Antagonism and Alexithymia were associated with low adherence. Additionally, Alexithymia, Hedonic Capacity and Negative Affectivity showed non-linear relationships with adherence, meaning that initially increased scores on these personality traits scales were associated with increased adherence but higher scores did not increase adherence. Respondents who were prescribed a single inhaler combining ICS and LABA reported higher adherence than those with monotherapies.

    Conclusion

    These data suggest that personality can influence how asthma patients adhere to asthma medication treatment, and report their control and HRQL. Tools determining personality traits may be useful in the future in individualizing management of asthma patients.

    Place, publisher, year, edition, pages
    Elsevier, 2009
    Keywords
    Adherence, Asthma, Asthma control, Health-related quality of life, Personality traits, Young adults
    National Category
    Nursing
    Research subject
    NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
    Identifiers
    urn:nbn:se:liu:diva-142758 (URN)10.1016/j.rmed.2009.01.013 (DOI)09546111 (ISSN) (ISBN)
    Available from: 2009-09-21 Created: 2017-11-02 Last updated: 2017-11-02Bibliographically approved
    2. The Influence of personality traits and beliefs about medicines on adherence to asthma treatment
    Open this publication in new window or tab >>The Influence of personality traits and beliefs about medicines on adherence to asthma treatment
    Show others...
    2011 (English)In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 20, no 2, p. 141-147Article, review/survey (Refereed) Published
    Abstract [en]

    Aim:To explore the influence of personality traits and beliefs about medicines on adherence to treatment with asthma medication.

    Methods:Respondents were 35 asthmatic adults prescribed controller medication. They answered questionnaires about medication adherence, personality traits, and beliefs about medicines.

    Results:In gender comparisons, the personality traits “Neuroticism” in men and “adherence to medication” were associated with lower adherent behaviour. Associations between personality traits and beliefs in the necessity of medication for controlling the illness were identified. Beliefs about the necessity of medication were positively associated with adherent behaviour in women. In the total sample, a positive “necessity-concern” differential predicted adherent behaviour.

    Conclusion:The results imply that personality and beliefs about medicines may influence how well adults with asthma adhere to treatment with asthma medication.

    Place, publisher, year, edition, pages
    The Primary Care Respiratory Society U K, 2011
    Keywords
    adherence, asthma, medication beliefs, personality traits, treatment
    National Category
    Nursing
    Research subject
    NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
    Identifiers
    urn:nbn:se:liu:diva-142759 (URN)10.4104/pcrj.2011.00005 (DOI)
    Available from: 2011-02-18 Created: 2017-11-02 Last updated: 2017-11-29Bibliographically approved
    3. Beliefs regarding medication and side effects influence treatment adherence in adolescents with attention deficit hyperactivity disorder
    Open this publication in new window or tab >>Beliefs regarding medication and side effects influence treatment adherence in adolescents with attention deficit hyperactivity disorder
    2017 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 26, no 5, p. 559-571Article in journal (Refereed) Published
    Abstract [en]

    Adherence to attention deficit hyperactivity disorder (ADHD) treatment is important because, when untreated, it may have serious consequences with lifelong effects. In the case of adolescents on long-term medicine prescription, more knowledge is needed regarding adherence and factors influencing adherence, which was the purpose of this study. Adolescents (n = 101) on ADHD medication ≥6 months were administrated questionnaires at a monitoring appointment: Medication Adherence Report Scale (MARS), beliefs about medicines (BMQ) and the Brief Illness Perception Questionnaire (B-IPQ). Adherence was high, the mean value was 88% of the maximum MARS score, and correlated positively with the “BMQ-necessity-concerns differential” but negatively with “BMQ-concerns” and “BMQ-side effects”. Adolescents with more belief in the necessity of the medication, less concerns and less experience of side effects tended to be more adherent to medication prescription (“intentional non-adherence”), while “unintentional non-adherence” (forgetfulness) was associated with how much they perceived that their ADHD affected their lives. In a multiple regression model, the variance of MARS total (R2 = 0.21) and “intentional non-adherence” (R2 = 0.24) was explained by the “BMQ-necessity–concern differential” and “BMQ-experienced side effects”. The variance of “unintentional non-adherence” (R2 = 0.12) was explained by the “BMQ-necessity–concern differential” and “B-IPQ-consequences of ADHD”. In conclusion, adolescents on long-term medication reported good adherence, mainly influenced by more beliefs in the necessity versus concerns of the medications, less experienced side effects and more perceived consequences of ADHD. BMQ could be useful to identify risks of low adherence, which should be counteracted by partially gender-specific interventions.

    Place, publisher, year, edition, pages
    Springer, 2017
    Keywords
    Electron beam melting, IN718, microstructure, texture, hardness
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:liu:diva-132825 (URN)10.1007/s00787-016-0919-1 (DOI)000399701900007 ()27848023 (PubMedID)
    Note

    Funding agencies: Medical Research Council of Southeast Sweden [FORSS-466211]; "Child and Youth Studies" at the University West

    Available from: 2016-11-30 Created: 2016-11-30 Last updated: 2018-04-18Bibliographically approved
  • 95.
    Erichsén, Eva
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Constipation in palliative care: Prevalence, definitions, symptom distress and risk-factors2015Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and aims: Constipation for patients in palliative care is common and described with variations in prevalence. Side -effects from opioid- treatment, is considered to be one of the main factors leading to constipation. The overall aim of the thesis was to study constipation among patients admitted to specialized palliative care- settings in Sweden. The specific aims of the thesis were 1) To describe and explore the prevalence, definition and symptom distress of constipation by applying different definitions of constipation, in patients admitted to specialized palliative care settings in Sweden. 2) To identify factors related to constipation in patients in specialized palliative care and comparing these factors for patients with different types of constipation to patients without constipation.

    Methods: A literature- search were conducted where prevalence of- and factors related to constipation was explored and included in a questionnaire, developed for this thesis. Data was collected in a cross- sectional design with a response rate of 50% and analysed with logistic regression.

    Results: A total of 485 patients from 38 specialized palliative care- units in Sweden participated. Prevalence of constipation for patients in specialized palliative care varied between 7- 43 % depending on definition used. Two different constipation- groups were identified: Medical constipation- group 23% (MCG) and Perceived constipation- group 35% (PCG). Three sub- groups was also identified: patients with i) only ≤ 3 defecations/week, 7%, ii) only perception of being constipated, 19%, and iii) patients with both ≤ 3 defecations/ week and perception of being constipated,16%. Several factors were found to be related to constipation as hospitalisation, absence of laxative- treatment, haemorrhoids, poor appetite, hard stool form and opioids.

    Conclusions: Prevalence of constipation may differ depending on definitions used. Distress from constipation and other factors related to constipation, than opioids, needs to be incorporated into the clinical constipation- assessment. Validated constipation assessment tool needs to be developed.

    List of papers
    1. Constipation in specialized palliative care: prevalence, definition and patient perceived symptom distress
    Open this publication in new window or tab >>Constipation in specialized palliative care: prevalence, definition and patient perceived symptom distress
    2015 (English)In: Journal of Palliative Medicine, ISSN 1096-6218, E-ISSN 1557-7740, Vol. 18, no 7, p. 585-592Article in journal (Refereed) Published
    Abstract [en]

    Context: The prevalence of constipation among patients in palliative care has varied in prior research, from 18-90 %, depending on different study factors.

    Objectives: The aim of this study was to describe and explore the prevalence and symptom distress of constipation, using different definitions of constipation, in patients admitted to specialized palliative care settings.

    Methods: Data was collected in a cross-sectional survey from 485 patients in 38 palliative care units in Sweden. Variables were analyzed using logistic regression and summarized as odds ratio (OR).

    Result: The prevalence of constipation varied between 7 – 43 %, depending on the definition used. Two constipation- groups were found: (i) Medical constipation- group (MCG; ≤ 3 defecations/week n=114; 23%); (ii) Perceived constipation- group (PCG; Patients with a perception of being constipated the last two weeks; n= 171; 35%). Three sub-groups emerged: patients with (a) only medical constipation (7 %), (b) only perceived constipation (19 %), and (c) with both medical and perceived constipation (16%). There were no differences in symptom severity between groups; 71% of all constipated patients had severe constipation.

    Conclusion: The prevalence of constipation may differ, depending on the definition used and how constipation is assessed. In this study we found two main groups and three sub-groups, analyzed from the definitions of frequency of bowel movements and experience of being constipated. To be able to identify constipation, the patients’ definition has to be further explored and assessed.

    Place, publisher, year, edition, pages
    Mary Ann Liebert, 2015
    Keywords
    Palliative care, constipation, prevalence, definition, symptom-distress
    National Category
    Other Medical Sciences Nursing Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-117184 (URN)10.1089/jpm.2014.0414 (DOI)000361880600005 ()25874474 (PubMedID)
    Note

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

    Available from: 2015-04-21 Created: 2015-04-21 Last updated: 2019-06-27Bibliographically approved
    2. Constipation in specialized palliative care: factors related to constipation when applying different definitions
    Open this publication in new window or tab >>Constipation in specialized palliative care: factors related to constipation when applying different definitions
    2016 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, no 2, p. 691-698Article in journal (Refereed) Published
    Abstract [en]

    CONTEXT:

    For patients in palliative care, constipation is primarily a result of opioid treatment. Impacts from other factors related to constipation in palliative care are rarely studied.

    OBJECTIVES:

    The aim was to identify factors related to constipation in patients in palliative care, and then to compare these factors between patients with different types of constipation and patients without constipation.

    METHODS:

    Cross-sectional data on constipation was collected with a 26-item questionnaire from 485 patients in 38 specialist palliative care units in Sweden. Three different constipation groups were used; MC ONLY, PC ONLY, and MC & PC. Logistic regression analyses were used to calculate odds ratios.

    RESULTS:

    Patients with <3 defecations/week, MC ONLY, (n = 36) had higher odds of being hospitalized, bed-restricted, in need of personal assistance for toilet visits, and of having a poor fluid intake. Patients with the perception of being constipated, PC ONLY, (n = 93) had higher odds of having poor appetite, hemorrhoids, hard stool, more opioid treatment, less laxative treatment and of being more dissatisfied with constipation information. Patients with both <3 defecations/week and a perception of being constipated, MC & PC, (n = 78) had higher odds of having cancer- disease.

    CONCLUSION:

    There were several significant factors related to constipation with higher odds than opioid- treatment, for patients in palliative care, such as; hard stool, cancer diagnosis, dissatisfaction with information, low fluid intake, hemorrhoids, bed restriction, hospitalization, and need of personal assistance for toilet visits.

    Place, publisher, year, edition, pages
    Springer Berlin/Heidelberg, 2016
    Keywords
    Constipation, Palliative care, Risk factors, Symptom assessment
    National Category
    Nursing
    Identifiers
    urn:nbn:se:liu:diva-121720 (URN)10.1007/s00520-015-2831-5 (DOI)000367458200022 ()26160464 (PubMedID)
    Funder
    Medical Research Council of Southeast Sweden (FORSS), 228731
    Note

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

    Funding agencies: Medical Research Council of Southeast Sweden (FORSS); Vrinnevi Hospital Research Board

    Available from: 2015-10-02 Created: 2015-10-02 Last updated: 2019-06-27Bibliographically approved
  • 96.
    Erichsén, Eva
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Advanced Home Care in Norrköping. Region Östergötland, Local Health Care Services in East Östergötland, Center of Palliative Care.
    Milberg, Anna
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Advanced Home Care in Linköping. Region Östergötland, Local Health Care Services in East Östergötland, Center of Palliative Care.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Friedrichsen, Maria
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Advanced Home Care in Norrköping. Region Östergötland, Local Health Care Services in East Östergötland, Center of Palliative Care.
    Constipation in specialized palliative care: prevalence, definition and patient perceived symptom distress2015In: Journal of Palliative Medicine, ISSN 1096-6218, E-ISSN 1557-7740, Vol. 18, no 7, p. 585-592Article in journal (Refereed)
    Abstract [en]

    Context: The prevalence of constipation among patients in palliative care has varied in prior research, from 18-90 %, depending on different study factors.

    Objectives: The aim of this study was to describe and explore the prevalence and symptom distress of constipation, using different definitions of constipation, in patients admitted to specialized palliative care settings.

    Methods: Data was collected in a cross-sectional survey from 485 patients in 38 palliative care units in Sweden. Variables were analyzed using logistic regression and summarized as odds ratio (OR).

    Result: The prevalence of constipation varied between 7 – 43 %, depending on the definition used. Two constipation- groups were found: (i) Medical constipation- group (MCG; ≤ 3 defecations/week n=114; 23%); (ii) Perceived constipation- group (PCG; Patients with a perception of being constipated the last two weeks; n= 171; 35%). Three sub-groups emerged: patients with (a) only medical constipation (7 %), (b) only perceived constipation (19 %), and (c) with both medical and perceived constipation (16%). There were no differences in symptom severity between groups; 71% of all constipated patients had severe constipation.

    Conclusion: The prevalence of constipation may differ, depending on the definition used and how constipation is assessed. In this study we found two main groups and three sub-groups, analyzed from the definitions of frequency of bowel movements and experience of being constipated. To be able to identify constipation, the patients’ definition has to be further explored and assessed.

  • 97.
    Ericsson, Maria
    et al.
    Linköping University, Department of Physics, Chemistry and Biology, Biology. Linköping University, Faculty of Science & Engineering.
    Jensen, Per
    Linköping University, Department of Physics, Chemistry and Biology, Biology. Linköping University, Faculty of Science & Engineering.
    Domestication and ontogeny effects on the stress response inyoung chickens (Gallus gallus)2016In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 6, article id 6_35818Article in journal (Refereed)
    Abstract [en]

    Domestication is thought to increase stress tolerance. The connection between stressor exposure,glucocorticoids and behavioural responses has been studied in adults, where domestication effectsare evident. Early stress exposure may induce detrimental effects both in short-and long term.Previous research has reported a lack of glucocorticoid response in newly hatched chickens (Gallusgallus), whereas others have found opposite results. Hence it remains unclear whether the HPA-axis isfunctional from hatch, and if domestication has affected the early post-hatch ontogeny of the stressresponse. Our aims were to investigate the early ontogeny of the HPA-axis and characterize behaviouraland hormonal stress responses in ancestral Red Junglefowl and in two domestic layer strains. Plasmacorticosteone and behavioural responses before and after physical restraint was measured on dayone, nine, 16 and 23 post hatch. The results showed significant increases of corticosterone after stressin all three breeds at all the different ages. The HPA-response decreased with age and was lower inRed Junglefowl. Behavioural responses also decreased with age, and tended to be stronger in RedJunglefowl. In summary, the HPA-axis is reactive from day one, and domestication may have affectedits development and reactivity, alongside with related behaviour responses.

  • 98.
    Eriksson, Mikael
    et al.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Kaerlev, Linda
    Univ Southern Denmark, Denmark; Odense Univ Hosp, Denmark.
    Johansen, Preben
    Aalborg Hosp, Denmark.
    Afonso, Noemia
    Inst Portugues Oncol IPO Porto, Portugal.
    Ahrens, Wolfgang
    Leibniz Inst Prevent Res and Epidemiol BIPS, Germany.
    Costa-Pereira, Altamiro
    Univ Porto, Portugal.
    Guenel, Pascal
    INSERM U1018, France; Univ Paris Sud, France.
    Joeckel, Karl-Heinz
    Univ Clin Essen, Germany.
    Llopis Gonzalez, Agustin
    Univ Valencia, Spain; CIBER Epidemiol and Salud Publ CIBERESP, Spain.
    Merletti, Franco
    Univ Turin, Italy.
    Morales Suarez-Varela, Maria
    Univ Valencia, Spain; CIBER Epidemiol and Salud Publ CIBERESP, Spain.
    Tretarre, Brigitte
    Registre Tumeurs Herault, France.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Richiardi, Lorenzo
    Univ Padua, Italy.
    Sabroe, Svend
    Univ Aarhus, Denmark.
    Tobacco smoking and alcohol consumption as risk factors for thymoma - A European case-control study2019In: Cancer Epidemiology, ISSN 1877-7821, E-ISSN 1877-783X, Vol. 61, p. 133-138Article in journal (Refereed)
    Abstract [en]

    Purpose: Hardly anything is known about the aetiology of thymoma. This paper presents data regarding tobacco smoking and alcohol consumption in relation to thymoma from the first case-control study performed on this rare tumour. Methods: A European multi-centre case-control study including incident cases aged 35-69 years with thymoma between 1995 and 1997, was conducted in seven countries. A set of controls, used in seven parallel case-control studies by the same research group was used, including population-based controls from five countries and hospital controls with colon cancer from two countries. Altogether 103 cases, accepted by a reference pathologist, 712 colon cancer controls, and 2071 population controls were interviewed. Results: Tobacco smoking was moderately related with thymoma (OR 1.4, 95% CI 0.9-2.2), and a tendency to dose-response was shown (p = 0.04), with an increased risk for heavy smokers defined as amp;gt;= 41 pack-years (OR 2.1, 95% CI 1.1-3.9). A high consumption of spirits defined as amp;gt;= 25 g of alcohol per day was associated with an increased risk of thymoma (OR 2.4, 95% CI 1.1-5.4), whereas no association was found with beer or wine. Conclusions: Tobacco smoking and a high intake of spirits were indicated as risk factors for thymoma.

  • 99.
    Ertzgaard, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Studies on Spasticity from an Interventional Perspective2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis focuses on interventional aspects of spasticity, but has a very holistic approach, grounded in the specialty of Rehabilitation medicine. This means capturing the effects of spasticity, on such a complex biological system as the human being, living in a psychosocial context affecting the situation. When evaluating spasticity there are a number of levels of evidence. The first of course, understanding what we mean with spasticity, where there unfortunately is no consensus. The second level is to study if our treatments affect spasticity in a positive direction. The third is to grasp if a decrease in spasticity improve or normalize patient’s movement patterns. The fourth level investigates if improvement in movement patterns improve patient’s ability to perform activities; and the fifth level, comprising whether this intervention improves life satisfaction. Finally, on a societal level, we wish to investigate whether the improvement in life satisfaction or health related quality of life would motivate society to fund the intervention.

    Paper I on Goal Attainment Scaling pointed out necessary aspects to consider when using this instrument. This relates, among other things, to the need of learning (“the art of”) goal setting and deciding the purpose of the measurements. Research and clinical use puts different demands on the instrument, for the latter time-efficiency and simplicity to use being most important. For research, it is important to be able to register deterioration, and this can be achieved using the 6-step version.

    In paper II, concerning validation of the portable motion system, we showed this system to be valid for short-term measurements and that the use of Exposure Variation Analysis (EVA) seems to be a valuable tool for graphically elucidating different movements. The equipment needs further development in handling long-term measurements (which is effectuated), and norms for normal movements in different activities has to be produced. The discriminative value of EVA needs confirmation in coming studies. For the future, there is the intriguing possibility of long-term measurements in patients’ every-day life, thereby getting objective measures on how our patients use their abilities, thus capturing the difference between what you can do and what you actually do.

    The results from paper III demonstrated a large inequality in Sweden regarding the accessibility of BoNT-A treatment for spasticity. We could also show that treatment with BoNT-A is sound from a health-economic perspective, accounting for the uncertainty of data via the sensitivity analysis. For the future, we need to explore if this inequality also exists for other modes of spasticity treatments, e.g. multidisciplinary spasticity treatment and ITB pumps, and in other countries.

    In paper IV evaluating multifocal TES, the results could not confirm efficacy with the treatment according to the protocol of the manufacturer. The results have to be interpreted with care, as low compliance and frequent adverse events made deduction not captured in the RCT study. Further studies are needed in a number of areas, e.g. what is the optimal stimulation frequency, what patients can gain from the treatment and how should adjunct treatment be organized.

    In this thesis, I have had the privilege to explore different methods of evaluating spasticity interventions from a multimodal perspective as a starting point in an effort to understand more of this intriguing phenomenon. Some of the research questions above are already in the “pipeline” for coming studies; others are to be planned by our research group and others.

    List of papers
    1. PRACTICAL CONSIDERATIONS FOR GOAL ATTAINMENT SCALING DURING REHABILITATION FOLLOWING ACQUIRED BRAIN INJURY
    Open this publication in new window or tab >>PRACTICAL CONSIDERATIONS FOR GOAL ATTAINMENT SCALING DURING REHABILITATION FOLLOWING ACQUIRED BRAIN INJURY
    2011 (English)In: JOURNAL OF REHABILITATION MEDICINE, ISSN 1650-1977, Vol. 43, no 1, p. 8-14Article in journal (Refereed) Published
    Abstract [en]

    Objective: Goal attainment scaling represents a unique approach to identifying and quantifying individualized, meaningful treatment outcomes, and its use in the rehabilitation medicine setting is increasing. The aim of this paper is to discuss the available literature for goal attainment scaling in patients with acquired brain injury, in terms of its advantages, disadvantages and practical application, including examples of goal setting and scaling.

    Place, publisher, year, edition, pages
    Foundation for Rehabilitation Information, 2011
    Keywords
    acquired brain injury, goal attainment scaling, rehabilitation
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-66870 (URN)10.2340/16501977-0664 (DOI)000288105200002 ()
    Available from: 2011-03-22 Created: 2011-03-21 Last updated: 2018-11-22
    2. A new way of assessing arm function in activity using kinematic Exposure Variation Analysis and portable inertial sensors - A validity study
    Open this publication in new window or tab >>A new way of assessing arm function in activity using kinematic Exposure Variation Analysis and portable inertial sensors - A validity study
    2016 (English)In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 21, p. 241-249Article in journal (Refereed) Published
    Abstract [en]

    Portable motion systems based on inertial motion sensors are promising methods, with the advantage compared to optoelectronic cameras of not being confined to a laboratory setting. A challenge is to develop relevant outcome measures for clinical use. The aim of this study was to characterize elbow and shoulder motion during functional tasks, using portable motion sensors and a modified Exposure Variation Analysis (EVA) and evaluate system accuracy with optoelectronic cameras. Ten healthy volunteers and one participant with sequel after stroke performed standardised functional arm tasks. Motion was registered simultaneously with a custom developed motion sensor system, including gyroscopes and accelerometers, and an optoelectronic camera system. The EVA was applied on elbow and shoulder joints, and angular and angular velocity EVA plots was calculated. The EVA showed characteristic patterns for each arm task in the healthy controls and a distinct difference between the affected and unaffected arm in the participant with sequel after stroke. The accuracy of the portable system was high with a systematic error ranging between -1.2 degrees and 2.0 degrees. The error was direction specific due to a drift component along the gravity vector. Portable motion sensor systems have high potential as clinical tools for evaluation of arm function. EVA effectively illustrates joint angle and joint angle velocity patterns that may capture deficiencies in arm function and movement quality. Next step will be to manage system drift by including magnetometers, to further develop clinically relevant outcome variables and apply this for relevant patient groups. (C) 2015 Elsevier Ltd. All rights reserved.

    Place, publisher, year, edition, pages
    CHURCHILL LIVINGSTONE, 2016
    Keywords
    Upper extremity motion analysis; Portable motion sensors; Exposure Variation Analysis; Validity
    National Category
    Basic Medicine
    Identifiers
    urn:nbn:se:liu:diva-127585 (URN)10.1016/j.math.2015.09.004 (DOI)000373615100033 ()26456185 (PubMedID)
    Available from: 2016-05-03 Created: 2016-05-03 Last updated: 2018-11-22
    3. Regional disparities in botulinum toxin A (BoNT-A) therapy for spasticity in Sweden: budgetary consequences of closing the estimated treatment gap
    Open this publication in new window or tab >>Regional disparities in botulinum toxin A (BoNT-A) therapy for spasticity in Sweden: budgetary consequences of closing the estimated treatment gap
    2017 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 135, no 3, p. 366-372Article in journal (Refereed) Published
    Abstract [en]

    Objectives: As no national treatment guidelines for spasticity have been issued in Sweden, different regional treatment practices may potentially occur. This study examines botulinum toxin A (BoNT-A) treatment for spasticity on a regional level in Sweden and presents budgetary consequences of closing the estimated treatment gap. Materials and Methods: Prevalence of spasticity in Sweden was estimated from published data. Regional sales data for BoNT-A were acquired from IMS Health. A set proportion of hospital BoNT-A use was assumed to represent treatment of spasticity. Total intervention cost of BoNT-A treatment was gathered from healthcare regional tariffs, while costs associated with spasticity were derived from publications on multiple sclerosis and stroke. Results: Results show that the regional variation in treatment of spasticity with BoNT-A is large, with approximately every fourth patient being treated in Southern healthcare region compared to every tenth in the Stockholm-Gotland or Western healthcare regions. The incremental cost of filling the reported treatment gap was also assessed and was estimated at around 9.4 million EUR. However, for the incremental cost to be offset by savings in spasticity-related costs, only a small proportion of treatment responders (defined as patients transitioning to a lower severity grade of spasticity) was required (12%). Conclusions: The study revealed apparent regional disparities of BoNT-A treatment for spasticity in Sweden. The results further suggest that the incremental cost of eliminating the treatment gap has a high probability of being offset by savings in direct costs, even at a low proportion of the patients reaching clinical improvement.

    Place, publisher, year, edition, pages
    WILEY, 2017
    Keywords
    botulinum toxins; costs and cost analysis; muscle spasticity; regional variation
    National Category
    Neurology
    Identifiers
    urn:nbn:se:liu:diva-136626 (URN)10.1111/ane.12610 (DOI)000397285600014 ()27220381 (PubMedID)
    Note

    Funding Agencies|University of Linkoping

    Available from: 2017-04-21 Created: 2017-04-21 Last updated: 2018-11-22
    4. Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomized placebo-controlled trial
    Open this publication in new window or tab >>Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomized placebo-controlled trial
    Show others...
    2018 (English)In: European Journal of Physical and Rehabilitation Medicine, ISSN 1973-9087, E-ISSN 1973-9095, Vol. 54, no 4, p. 507-517Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Spasticity is a common consequence of injury to the central nervous system negatively affecting patients everyday activities. Treatment mainly consists of training and different drugs, often with side effects. There is a need for treatment options that can be performed by the patient in their home environment. AIM: The objective of this study was to assess the effectiveness of an assistive technology (AT), Mono, a garment with integrated electrodes for multifocal transcutaneous electrical stimulation intended for self-treatment of spasticity, in study participants with spasticity due to stroke or CP. DESIGN: The study was a randomized, controlled, double-blind study with a cross-over design. SETTING: Participants were recruited from two rehabilitation clinics. Treatments were performed in participants homes and all follow-ups were performed in the two rehabilitation clinics. POPULATION: Thirty-one participants were included in the study and 27 completed the study. Four participants discontinued the study. Two declined participation before baseline and two withdrew due to problems handling the garment. METHODS: Participants used the AT with and without electrical stimulation (active/non-active period) for six weeks each. followed by six weeks without treatment. Goal Attainment Scaling (GAS), change in mobility, arm-hand ability, spasticity and pain were measured at baseline and after 6, 12 and 18 weeks. RESULTS: Fifteen of the 27 participants fulfilled the treatment protocol in terms of recommended use. Deviations were frequent. No statistically significant differences in outcome were found between the active and the non-active treatment periods. During the active period, an improvement was seen in the 10-meter comfortable gait test, time and steps. An improvement was seen in both the active and non-active periods for the GAS. CONCLUSIONS: Compliance was low, partly due to deviations related to the garment, complicating the interpretation of the results. Further research should focus on identifying the target population and concomitant rehabilitation strategies. CLINICAL REHABILITATION IMPACT: The evaluated concept of multifocal transcutaneous electrical stimulation (TES) represents an interesting addition to the existing repertoire of treatments to alleviate muscle spasticity. The evaluated concept allows TES to be self-administered by the patient in the home environment. A more elaborate design of training activities directly related to patients own rehabilitation goals is recommended and may increase the value of the evaluated concept.

    Place, publisher, year, edition, pages
    EDIZIONI MINERVA MEDICA, 2018
    Keywords
    Muscle spasticity; Randomized controlled trial; Cerebral palsy; Stroke; Transcutaneous electric nerve stimulation
    National Category
    Rheumatology and Autoimmunity
    Identifiers
    urn:nbn:se:liu:diva-151798 (URN)10.23736/S1973-9087.17.04791-8 (DOI)000445298800001 ()29072043 (PubMedID)
    Note

    Funding Agencies|Region Ostergotland; Promobilia Foundation; Inerventions AB (Vinnova)

    Available from: 2018-10-04 Created: 2018-10-04 Last updated: 2018-11-22
  • 100.
    E:son Jennersjö, Pär
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Risk factors in type 2 diabetes with emphasis on blood pressure, physical activity and serum vitamin D2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Type 2 diabetes is a common chronic disease with a two-fold increased risk for cardiovascular morbidity and mortality and has an increasing prevalence worldwide. This thesis is based on a study conducted in primary health care in Östergötland and Jönköping, Sweden. The aim of the thesis was to evaluate new risk markers to identify patients with high risk of developing cardiovascular disease in middle-aged men and women with type 2 diabetes.

    Methods

    Data from the cohort study CArdiovascular Risk in type 2 DIabetes – a Prospective study in Primary care (CARDIPP) was used. In paper III data were also used from CARDIPP-Revisited where all participants in the CARDIPP study were invited four years after the baseline investigation for a re-investigation. In paper IV data were used from CAREFUL which is a control group of 185 subjects without diabetes. The investigation included a standard medical history including data on diabetes duration and on-going medication. Anthropometric data were recorded and both office and ambulatory blood pressure were measured. The patients filled out a detailed questionnaire and physical activity was measured by using waist-mounted pedometers. Pedometer-determined physical activity was classified in four groups: Group 1: <5000 steps/day (‘sedentary’); Group 2: 5000-7499 steps/day (‘low active’); Group 3: 7500-9999 steps/day (‘somewhat active’); Group 4: and ≥10 000 steps/day (‘active’). Blood samples were drawn for routine analyses and also frozen for later analyses. The investigations at the departments of physiology included echocardiography, measurements of the carotid intima-media thickness, applanation tonometry and measurements of  sagittal abdominal diameter.

    Results

    Paper 1:

    Patients with a non-dipping systolic blood pressure pattern showed higher left ventricular mass index and pulse wave velocity (PWV) compared with patients with ≥10% decline in nocturnal systolic blood pressure. Patients with <10% decline in nocturnal systolic blood pressure had higher BMI and sagittal abdominal diameter, lower GFR and higher albumin:creatinine ratio and also higher levels of NT-proBNP than patients with a dipping pattern of the nocturnal blood pressure.

    Paper 2:

    The number of steps/day were inversely significantly associated with BMI, waist circumference and sagittal abdominal diameter, levels of CRP, levels of interleukin-6 and PWV.

    Paper 3:

    At the 4-year follow-up the change in PWV (ΔPWV) from baseline was calculated. The group with the lowest steps/day had a significantly higher increase in ΔPWV compared with the group with the highest steps/day. The associations between baseline steps/day and ΔPWV remained after further adjustment in a multivariate linear regression statistically significant (p=0.005). 23% of the variation in the study could be explained by our model. Every 1000 extra steps at baseline reduced the change in ΔPWV by 0.103 m/s between baseline and follow-up.

    Paper 4:

    Low vitamin D levels were associated with significantly increased risk for premature mortality in men with type 2 diabetes. High levels of parathyroid hormone were associated with significantly increased risk for premature mortality in women with type 2 diabetes. These relationships were still statistically significant also when two other well-established risk markers for mortality, PWV and carotid intima-media thickness, were added to the analyses.

    Conclusions

    Ambulatory blood pressure recording can by addressing the issue of diurnal blood pressure variation, explore early cardiovascular organ damage and microvascular complications that goes beyond effects of standardised office blood pressure measurements. Pedometer-determined physical activity may serve as a surrogate marker for inflammation and subclinical organ damage in patients with type 2 diabetes. There is novel support for the durable vascular protective role of a high level of daily physical activity, which is independent of BMI and systolic blood pressure. The use of pedometers is feasible in clinical practice and provides objective information not only about physical activity but also the future risk for subclinical organ damage in middle-aged people with type 2 diabetes. Our results indicate that low vitamin D levels in men or high parathyroid hormone levels in women give independent prognostic information of an increased risk for total mortality.

    List of papers
    1. Circadian blood pressure variation in patients with type 2 diabetes - relationship to macro- and microvascular subclinical organ damage
    Open this publication in new window or tab >>Circadian blood pressure variation in patients with type 2 diabetes - relationship to macro- and microvascular subclinical organ damage
    Show others...
    2011 (English)In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 5, no 3, p. 167-173Article in journal (Refereed) Published
    Abstract [en]

    Aims

    To explore the association between nocturnal blood pressure (BP) dipper status and macro- and microvascular organ damage in type 2 diabetes.

    Methods

    Cross-sectional data from 663 patients with type 2 diabetes, aged 55–66 years, were analysed. Nurses measured office BP and ambulatory BP during 24 h. Individuals with ≥10% difference in nocturnal systolic blood pressure (SBP) relative to daytime values were defined as dippers. Non-dippers were defined as <10% nocturnal decrease in SBP. Estimated glomerular filtration rate (GFR) was calculated and microalbuminuria was measured by albumin:creatinine ratio (ACR). Aortic pulse wave velocity (PWV) was measured with applanation tonometry over the carotid and femoral arteries.

    Results

    We identified 433 dippers and 230 subjects with a nocturnal non-dipping pattern. Nocturnal SBP dipping was independently of office SBP associated with decreased PWV (p = 0.008), lower ACR (p = 0.001) and NT-proBNP (p = 0.001) and increased GFR (p < 0.001).

    Conclusions

    We conclude that diurnal BP variation provides further information about early macro- and microvascular subclinical organ damage that goes beyond standardized office BP measurements in patients with type 2 diabetes.

    Place, publisher, year, edition, pages
    Elsevier, 2011
    Keywords
    Type 2 diabetes mellitus ambulatory blood pressure arterial stiffness microalbuminuria diurnal blood pressure variation
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-75571 (URN)10.1016/j.pcd.2011.04.001 (DOI)000304279600004 ()
    Note

    funding agencies|Medical Research Council of Southeast Sweden||Center for Medical Image Science and Visualization (CMIV)||Linkoping University||GE Healthcare||Swedish Heart-Lung Foundation||Swedish Research Council| 12661 |

    Available from: 2012-03-08 Created: 2012-03-08 Last updated: 2017-12-07Bibliographically approved
    2. Pedometer-determined physical activity is linked to low systemic inflammation and low arterial stiffness in Type 2 diabetes
    Open this publication in new window or tab >>Pedometer-determined physical activity is linked to low systemic inflammation and low arterial stiffness in Type 2 diabetes