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  • 51.
    Gelhaus, Petra
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Psykiatri- och habiliteringsenheten.
    The desired moral attitude of the physicians: (III) Care2013Inngår i: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 16, nr 2, s. 125-139Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In professional medical ethics, the physician traditionally is obliged to fulfil specific duties as well as to embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired moral attitude of physicians. In a series of three articles, three of the discussed concepts are presented in an interpretation that is meant to characterise the morally emotional part of this attitude: “empathy”, “compassion” and “care”. In the first article of the series, “empathy” has been developed as a mainly cognitive and morally neutral capacity of understanding. In the second article, the emotional and virtuous core of the desired professional attitude—compassion—has been presented. Compassion as a professional attitude has been distinguished from a spontaneous feeling of compassion, and has been related to a general idea of man as vulnerable and solidary being. Thus, the dignity of the patient is safeguarded in spite of the asymmetry of compassion. In this article, the third concept of the triad—“care”—is presented. Care is conceived as an attitude as well as an activity which can be directed to different objects: if it is directed to another sentient being, it is regarded as intrinsically morally valuable; implying (1) the acceptance of being addressed, (2) a benevolent inclination to help and to foster, and (3) activity to realize this. There are different forms of benevolence that can underlie caring. With regard to the professional physician’s ethos, the attitude of empathic compassion as developed in the two previous articles is proposed to be the adequate underlying attitude of care which demands the right balance between closeness and professionalism and the right form of attention to the person of the patient. ‘Empathic compassionate care’ does not, however, describe the whole of the desired attitude of a physician, but focuses on the morally-emotive aspects. In order to get also the cognitive and practical aspects of biomedicine into the picture, ‘empathic compassionate care’ has to be combined with an attitude of responsibility that is more directed to decision-making and outcome than a caring attitude alone can be. The reconstruction of the desired professional attitude in terms of “empathic compassionate care” and “responsibility” is certainly not the only possible description, but it is a detailed proposal in order to give an impulse for the discussion about the inner tacit values and the meaning of medicine and clinical healthcare professions.

  • 52.
    Gunnarsson, Nina
    et al.
    Jönköping University, Sweden.
    Hemmingsson, Helena
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Hydén, Lars-Christer
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Mothers’ accounts of healthcare encounters: Negotiating culpability and fulfilling the active mother role2013Inngår i: Discourse & Society, ISSN 0957-9265, E-ISSN 1460-3624, Vol. 24, nr 4, s. 1-15Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This article explores mothers’ accounts of initial interactions and encounters with healthcare professionals and the outcomes where questions about their children’s problems are concerned. A case-based storyline was reconstructed as part of the analysis, focusing on

    when and how mothers claimed to be responsible parents. The outcomes of these encounters were presented by the mothers in this study as a drawn-out process, with disagreement between mothers and healthcare providers, resulting in different performances of moral agency. Some mothers portrayed themselves as dependent on healthcare expertise and made moral claims by attributing and deflecting blame, negotiating back and forth about their own and the healthcare professionals’ culpability, restoring moral agency. Other mothers did not generally defend or justify their actions or place blame, but appealed instead to fulfilment of the active mother role where they controlled the interaction and claimed full responsibility for their child’s care, hence presenting their moral agency as indisputable.

  • 53.
    Gunnarsson, Nina
    et al.
    Karolinska Institutet, Stockholm.
    Hydén , Lars-Christer
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Organizing allergy and being a good parent: parents narratives about their childrens emerging problems2009Inngår i: Health, ISSN 1363-4593, E-ISSN 1461-7196, Vol. 13, nr 2, s. 157-174Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The article focuses on the early and problem-solving phases of the childs illness trajectory and on how child allergies are constructed and organized by the parents in a moral everyday context. The parents narratives were reconstructed as narratives, describing the pathways parents take before they decide to seek professional medical aid as well as showing how they construct themselves as responsible parents. Before consulting health professionals the parents have often tried a range of different ways to define, control and manage their childrens various problems. Allergy problems were interpreted and responded to differently, depending on the way they emerged in everyday life. Acute reactions quickly led to an illness definition and a diagnosis. Gradual and diffuse problems were not so easily defined. They were at first interpreted and responded to as normal infant problems, but, through the parents readiness and various situational and temporal clues, they were organized as symptoms of illness. Parents seek medical aid when their own strategies fail or do not fully work, but their decisions are also formed within a pre-problem context of their moral accountability as parents.

  • 54.
    Gustafsson, Britt
    et al.
    Huddinge Hospital, Karolinska Institute.
    Carstensen, John
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Onkologiskt centrum.
    Evidence of space-time clustering of childhood acute lymphoblastic leukaemia in Sweden1999Inngår i: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 79, nr 3/4, s. 655-657Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We have examined 645 recorded cases of childhood acute lymphatic leukaemia (ALL) in Sweden during 1973–89 to identify space–time clustering by using the close-pair method of Knox. The records included date of birth and of diagnosis as well as addresses at birth and at diagnosis. There was a significant excess of case pairs close in date of birth and place of birth in the 5- to 15-year age group.

  • 55.
    Hallert, Eva
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Husberg, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Jonsson, Dick
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Skogh, Thomas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Reumatologi. Linköpings universitet, Hälsouniversitetet.
    Rheumatoid arthritis is already expensive during the first year of the disease (the Swedish TIRA Project)2004Inngår i: Rheumatology, ISSN 1462-0324, Vol. 43, nr 11, s. 1374-1382Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To calculate direct and indirect costs in early rheumatoid arthritis (RA) and to characterize patients generating high and low costs respectively.

    Methods. Two hundred and ninety-seven patients with recent-onset (≤12 months) RA were recruited. Clinical/laboratory data and 'health assessment questionnaire' (HAQ) were registered at inclusion and after 3, 6 and 12 months. After 6 and 12 months, the patients completed a questionnaire concerning health-care utilization and days lost from work. A cut-off point for direct costs was set at 34 000 Swedish kronor (3675) defining one-third of the patients as a high-cost group and two-thirds as low-cost group. Indirect costs were calculated for patients aged <65 yr.

    Results. Two hundred and eleven patients completed the HAQ on both occasions. Indirect costs exceeded direct costs by a factor of 2.3. Sixty three per cent experienced work disability during the first year and were identified as the 'high-indirect-cost group'. Indirect costs accounted for >70% of total costs. Direct costs included ambulatory health care (76%), hospitalization (12%) and medication (9%). Men aged ≥65 yr had low costs compared with younger men and women of all ages. In multiple logistic regression tests, HAQ, high levels of IgM rheumatoid factor (IgM RF) and poor hand function increased the odds of entering the high-direct-cost group, and poor hand function and pain increased the odds of entering the high-indirect-cost group.

    Conclusions. Substantial costs were incurred during the first year after diagnosis of early RA, mainly due to work disability. Indirect costs were two to three times higher than direct costs. High levels of IgM RF, high HAQ score, poor hand function and pain increased the odds of entering high-cost groups.

  • 56.
    Hallqvist, Anders
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och sociologi. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Institutionen för beteendevetenskap och lärande, Arbete och arbetsliv.
    Ellström, Per-Erik
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och sociologi. Linköpings universitet, Filosofiska fakulteten.
    Hydén, Lars-Christer
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    The many faces of biographical learning2012Inngår i: Studies in the Education of Adults, ISSN 0266-0830, E-ISSN 1478-9833, Vol. 44, nr 1, s. 70-84Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Our aim in this article is to look for more diversity within the concept of biographical leaning. As a conceptual tool for investigating learning in life transitions, biographical learning has gained some recognition over recent years. The concept centres on people’s abilities and possibilities to cope with change in a rapidly changing environment. As transitions have become more common, ‘learning processes within transition’ has become an important area for educational research. The development of the concept of biographical learning is related to this trend, since biographical learning processes appear to be more explicitly triggered when a person’s life course is changing and people are faced with transitions in it. In this article, biographical learning will be discussed in relation to research on restructuring, job loss and enforced work transitions. The article will suggest that such transitions may be understood in terms of biographical learning, acknowledging that learning in work transitions is not only about ensuring one’s ‘professional competence’ or ‘employability’ but includes identity issues and decision-making that affect one’s biography.

    Alheit and Dausien portray biographical learning as a certain perspective on lifelong learning, suggesting a ‘shift in analytic perspective’ and a departure from the policy-focused view in which lifelong learning is framed by political and economic precepts. Acknowledging the inner tensions between the ‘instrumentalist’ and ‘emancipative’ power of lifelong learning, the authors place some confidence in the latter, calling for an outlook in which the learning individual ‘is taken more seriously’. There are empirical reasons for such a preference. Although traditional lifeworlds are eroding, people’s responses are not inevitably a ‘panic’ reaction. Instead, people cope with changes rather creatively by using different action strategies that affect both their own biography and the social world in which they live.

    The concept of biographical learning is regarded as useful in this context, firstly because it takes account both of social structures and of the individual’s subjectivity. Hence, it recognizes people’s sense of being able to control their own lives interacting with biographical and structural conditions. Even though life chances are unequally distributed and agency is always ‘bounded’, when people face transitions decisions must be made and actions taken that are affected by and affect their biography. Secondly, biographical learning could be considered valuable because its scope is wider than predominant lifelong learning policies and because its aim extends beyond instrumental skills and ‘employability’. Thirdly, biographical learning can be regarded as helpful because it includes not only formal and organized aspects of learning, but also ‘cognitive and reflexive dimensions of learning as much as the emotional, embodied, pre-reflexive and non-cognitive aspects of everyday learning processes and practices’.

    However, further investigations of the concept are called for, as pointed out by Alheit and Dausien. One possible development concerns challenging its somewhat uniform character. While Alheit has identified three current ‘biographical coping patterns’ (‘patchworking’, ‘networking’ and ‘designing’; Alheit, 1999, p. 75), further analysis will probably reveal new insights and perhaps lead to a more complex description of what biographical learning is. It seems reasonable to assume, for example, that there might be differences between more continuous and more disruptive versions of biographical learning. In order to encompass a wider spectrum of approaches, the aim of this paper is to analyse, explore and expand the notion of biographical learning and to suggest a number of different modes of such learning.

  • 57.
    Hallqvist, Anders
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och sociologi. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Institutionen för beteendevetenskap och lärande, Arbete och arbetsliv.
    Hydén, Lars-Christer
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Learning in occupational transitions: a study of the process following job loss2012Inngår i: Work: A Journal of Prevention, Assessment and Rehabilitation, ISSN 1051-9815, Vol. 43, nr 3, s. 331-343Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: This article examines how workers supported by outplacement services engage with an occupational transition through problem solving and learning.

    Participants: The participants were 23 mid-life redundant white collar workers with at least eight years in their sector, organization or occupation. The selected interviewees either participated in training to broaden their professional competence or did not make any such ‘expansive’ efforts.

    Methods: The study was based on narrative interviews, which enabled a detailed cross case examination of individuals’ actions and choices and how the process unfolds over time.

    Results: The results showed that people treat their job loss as a practical problem to be solved using various strategies. This problemsolving process is structured, with people passing similar crossroads defining particular challenges and opportunities giving people limited sets of choices.

    Conclusion: The results point to the significance of creativity and learning in occupational transitions.

  • 58.
    Hallqvist, Anders
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och sociologi. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Institutionen för beteendevetenskap och lärande, Arbete och arbetsliv. Linköpings universitet, Utbildningsvetenskap.
    Hydén, Lars-Christer
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Work transitions as told: a narrative approach to biographical learning2013Inngår i: Studies in Continuing Education, ISSN 0158-037X, E-ISSN 1470-126X, Vol. 35, nr 1, s. 1-16Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In this article, we introduce a narrative approach to biographical learning; that is, an approach that considers autobiographical storytelling as a practice through which claims about life history are performed and negotiated. Using insights from narrative theory, we highlight evaluations in those narratives and suggest their crucial role in promoting self-reflective thought. The research area is unemployment, more specifically, work transitions following company restructuring and redundancy supported by outplacement services. Recognizing the learning potential in autobiographical storytelling, the article examines job-loss narratives told by people made redundant. The analysis focuses on strategies used in moments of evaluation. Our findings point to a variety of rhetorical strategies, different kinds of reflexivity and, in turn, variation in the potential for biographical learning.

  • 59.
    Hatschek, T
    et al.
    Karolinska Institute.
    Carlsson, L
    Sundsvall General Hospital.
    Einbeigi, Z
    Sahlgrens University Hospital.
    Lidbrink, E
    Karolinska Institute.
    Linderholm, B
    Sahlgrens University Hospital.
    Lindh, B
    Umeå University Hospital.
    Loman, N
    Skåne University Hospital Lund.
    Malmberg, M
    Helsingborg General Hospital.
    Rotstein, S
    Karolinska Institute.
    Soderberg, M
    Skåne University Hospital.
    Sundquist, M
    Kalmar General Hospital.
    Walz, Thomas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Hellstrom, M
    Karolinska University Hospital.
    Svensson, H
    Sahlgrens University Hospital.
    Astrom, G
    Karolinska Institute.
    Brandberg, Y
    Karolinska Institute.
    Carstensen, John
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Ferno, M
    Lund University.
    Bergh, J
    Karolinska Institute.
    Individually tailored treatment with epirubicin and paclitaxel with or without capecitabine as first-line chemotherapy in metastatic breast cancer: a randomized multicenter trial2012Inngår i: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 131, nr 3, s. 939-947Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Anthracyclines and taxanes are active cytotoxic drugs in the treatment of early metastatic breast cancer. It is yet unclear whether addition of capecitabine to the combination of these drugs improves the treatment outcome. Patients with advanced breast cancer were randomized to first-line chemotherapy with a combination of epirubicin (Farmorubicin(A (R))) and paclitaxel (Taxol(A (R))) alone (ET) or in combination with capecitabine (Xeloda(A (R)), TEX). Starting doses for ET were epirubicin 75 mg/m(2) plus paclitaxel 175 mg/m(2), and for TEX epirubicin 75 mg/m(2), paclitaxel 155 mg/m(2), and capecitabine 825 mg/m(2) BID for 14 days. Subsequently, doses were tailored related to side effects. Primary endpoint was progression-free survival (PFS); secondary endpoints were overall survival (OS), time to treatment failure (TTF), objective response (OR), safety and quality of life (QoL). 287 patients were randomized, 143 to ET and 144 to TEX. Median PFS was 10.8 months for patients treated with ET, and 12.4 months for those treated with TEX (HR 0.84, 95% CI 0.65-1.07, P = 0.16); median OS was 26.0 months for women in the ET versus 29.7 months in the TEX arm (HR 0.84, 95% CI 0.63-1.11, P = 0.22). OR was achieved in 44.8% (ET) and 54.2% (TEX), respectively (chi(2) 3.66, P = 0.16). TTF was significantly longer for patients treated with TEX, 6.0 months, versus 5.2 months following ET (HR 0.73, 95% CI 0.58-0.93, P = 0.009). Severe hematological side effects related to epirubicin and paclitaxel were evenly distributed between the treatment arms, mucositis, diarrhea, and Hand-Foot syndrome were significantly more frequent in the TEX arm. Toxicity-adjusted treatment with ET and TEX showed similar efficacy in terms of PFS, OS, and OR. In this trial with limited power, the addition of capecitabine to epirubicin and paclitaxel as first-line treatment did not translate into clinically relevant improvement of the outcome.

  • 60.
    Heintz, Emelie
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Bourghardt Peebo, Beatrice
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Ögonkliniken US/LiM.
    Wiréhn, Ann-Britt
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Rosenqvist, Ulf
    Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Medicinska specialistkliniken .
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Health-related quality of life profiles of patients with diabetic retinopathyManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Purpose: There are various instruments for estimating health-related quality of life (HRQoL) in patients with diabetic retinopathy (DR). However, if the results are to be compared with those for other diseases, it is essential to use measures that are applicable to all disease areas. The aim of this study was to explore the HRQoL profiles of patients with DR using two generic multi-attribute instruments, the Health State Utilities Index Mark 3 (HUI-3) and the EQ-5D questionnaire, and to investigate these questionnaires’ sensitivity to differences in HRQoL due to DR.

    Methods: The study population comprised 166 Swedish diabetes patients diagnosed with DR at different severities. Patients were interviewed over the telephone using HUI-3 and EQ-5D. The vision-specific National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) was also included, to give an empirical framework for the results of the generic instruments. Linear and logistic regression models were used to adjust for possible confounders.

    Results: Patients with vision impairment (VI) reported lower scores in Vision, Ambulation, and Pain in HUI-3 and more problems with Usual activities and Anxiety/depression in EQ-5D. However, even though NEI VFQ-25 showed a negative association between DR severity and Mental health and Near activities, neither EQ-5D nor HUI-3 identified a negative relationship between DR severity and HRQoL.

    Conclusion: The generic instruments show lowered HRQoL for patients with VI in various dimensions but were not sensitive to decrements related to the diagnosis of DR alone. The questionnaire of HUI-3 was more sensitive than EQ-5D to differences in HRQoL due to DR-related VI.

  • 61.
    Heintz, Emelie
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Wiréhn, Ann-Britt
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Bourghardt Peebo, Beatrice
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Ögonkliniken US/LiM.
    Rosenqvist, Ulf
    Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Medicinska specialistkliniken .
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    QALY weights for diabetic retinopathy: a comparison of health state valuations with HUI-3, EQ-5D, EQ-VAS, and TTO.2012Inngår i: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 15, nr 3, s. 475-484Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To estimate quality-adjusted life-year weights for patients with diabetic retinopathy by using various methods and to investigate the empirical validity of the different measures.

    Methods: The study population comprised 152 patients with diabetes in Östergötland County, Sweden. Participants were interviewed by telephone by using the time trade-off (TTO) method and a visual analogue scale (EQ-VAS) (direct valuations) as well as the EuroQol five-dimensional questionnaire (EQ-5D) and the health utilities index mark 3 (HUI-3) (indirect valuations). The quality-adjusted life-year weights were adjusted for potential confounders by using analysis of covariance. The empirical validity of the measures was examined by testing their ability to detect hypothetical differences between severity levels of diabetic retinopathy and by investigating the correlation between the measures and the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25).

    Results: All measures detected significant differences in scores between patient groups classified according to visual impairment in the better eye (analysis of covariance, P < 0.05), but only HUI-3 and EQ-VAS detected significant differences between patient groups classified according to visual impairment or pathological progression in the worse eye. HUI-3 recorded a difference of 0.43 in values between normal vision and blindness in the better eye, which was more than twice the differences captured by the other measures (0.15–0.20). In addition, HUI-3 showed the highest correlation with NEI VFQ-25 (r = 0.54; P < 0.001).

    Conclusions: In cost-utility analyses, the choice of quality-adjusted life-year measure may affect whether an intervention is considered cost-effective. Furthermore, if decisions are to be based on values from the general public, HUI-3 can be recommended for cost-utility analyses of interventions directed at diabetic retinopathy.

  • 62.
    Heintz, Emelie
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Wiréhn, Ann-Britt
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Peebo Bourghardt, Beatrice
    Östergötlands Läns Landsting, Rekonstruktionscentrum, Ögonkliniken US/LiM.
    Rosenqvist, U
    Motala Hospital, Sweden.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Prevalence and healthcare costs of diabetic retinopathy: a population-based register study in Sweden2010Inngår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 53, nr 10, s. 2147-2154Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims/hypothesis

    The aim of the present study was to estimate the prevalence and healthcare costs of diabetic retinopathy (DR).

    Methods

    This population-based study included all residents (n = 251,386) in the catchment area of the eye clinic of Linköping University Hospital, Sweden. Among patients with diabetes (n  = 12,026), those with and without DR were identified through register data from both the Care Data Warehouse in Östergötland, an administrative healthcare register, and the Swedish National Diabetes Register. Healthcare cost data were elicited by record linkage of these two registers to data for the year 2008 in the Cost Per Patient Database developed by Östergötland County Council.

    Results

    The prevalence of any DR was 41.8% (95% CI 38.9–44.6) for patients with type 1 diabetes and 27.9% (27.1–28.7) for patients with type 2 diabetes. Sight-threatening DR was present in 12.1% (10.2–14.0) and 5.0% (4.6–5.4) of the type 1 and type 2 diabetes populations respectively. The annual average healthcare cost of any DR was €72 (€53–91). Stratified into background retinopathy, proliferative DR, maculopathy, and the last two conditions combined, the costs were €26 (€10–42), €257 (€155–359), €216 (€113–318) and €433 (€232–635) respectively. The annual cost for DR was €106 000 per 100,000 inhabitants.

    Conclusions

    This study presents new information on the prevalence and costs of DR. Approximately one-third of patients with diabetes have some form of DR. Average healthcare costs increase considerably with the severity of DR, which suggests that preventing progression of DR may lower healthcare costs.

  • 63.
    Hellström, Ingrid
    et al.
    Ersta Sköndal University College, Stockholm, Sweden.
    Nolan, Mike
    University of Sheffield, UK .
    Nordenfelt, Lennart
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Lundh, Ulla
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier. Linköpings universitet, Hälsouniversitetet.
    Ethical and methodological issues in interviewing persons with dementia2007Inngår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 14, nr 5, s. 608-619Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    People with dementia have previously not been active participants in research, with ethical difficulties often being cited as the reason for this. A wider inclusion of people with dementia in research raises several ethical and methodological challenges. This article adds to the emerging debate by reflecting on the ethical and methodological issues raised during an interview study involving people with dementia and their spouses. The study sought to explore the impact of living with dementia. We argue that there is support for the inclusion of people with dementia in research and that the benefits of participation usually far outweigh the risks, particularly when a ;safe context' has been created. The role of gatekeepers as potentially responsible for excluding people with dementia needs further consideration, with particular reference to the appropriateness of viewing consent as a primarily cognitive, universalistic and exclusionary event as opposed to a more particularistic, inclusive and context relevant process.

  • 64.
    Hjalmarsson Österholm, Johannes
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Björk, Mathilda
    Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönkïping, Sweden.
    Håkansson, Carita
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Factors of importance for maintaining work as perceived by men with arthritis2013Inngår i: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 45, nr 4, s. 439-448Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Employment rates are significantly lower among individuals with arthritis compared to a general population. There is, however, limited research about how men with arthritis perceive their ability to maintain working. The aim of this study was thus to explore their perception of this.

    PARTICIPANTS: Nine employed men with arthritis were purposively sampled.

    METHODS: Interviews were performed and were informed by the central concepts of the Model of Human Occupation. The Empirical Phenomenological Psychological method was modified and used to analyze and interpret collected data.

    RESULTS: The findings showed that men with arthritis perceived a desire to work, adjusted their activity pattern, were aware of their own capabilities, had good work conditions, had environmental support and used effective medication to maintain their ability to work.

    CONCLUSIONS: The findings suggest that health care professionals can help men with arthritis to find strategies and a balance between recreation and work. Ultimately, this knowledge could guide health care professionals to target men needing interventions to prevent sick leave.

  • 65.
    Holm, S
    et al.
    Linkoping Univ, Dept Hlth & Soc, S-58183 Linkoping, Sweden Univ Manchester, Ctr Social Eth & Policy, Manchester M13 9PL, Lancs, England Univ Bergen, Dept Publ Hlth & Primary Hlth Care, Div Gen Practice, Bergen, Norway.
    Liss, Per-Erik
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle.
    Norheim, OF
    Linkoping Univ, Dept Hlth & Soc, S-58183 Linkoping, Sweden Univ Manchester, Ctr Social Eth & Policy, Manchester M13 9PL, Lancs, England Univ Bergen, Dept Publ Hlth & Primary Hlth Care, Div Gen Practice, Bergen, Norway.
    Access to health care in the scandinavian countries: Ethical aspects1999Inngår i: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 7, nr 4, s. 321-330Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The health care systems are fairly similar in the Scandinavian countries. The exact details vary, but in all three countries the system is almost exclusively publicly funded through taxation, and most (or all) hospitals are also publicly owned and managed. The countries also have a fairly strong primary care sector (even though it varies between the countries), with family physicians to various degrees acting as gatekeepers to specialist services. In Denmark most of the GP services are free. For the patient in Norway and Sweden there are out-of-pocket co-payments for GP consultations, with upper limits, but consultations for children are free. Hospital treatment is free in Denmark while the other countries use a system with out-of-pocket co-payment. There is a very strong public commitment to access to high quality health care for all. Solidarity and equality form the ideological basis for the Scandinavian welfare state. Means testing, for instance, has been widely rejected in the Scandinavian countries on the grounds that public services should not stigmatise any particular group. Solidarity also means devoting special consideration to the needs of those who have less chance than others of making their voices heard or exercising their rights. Issues of limited access are now, however, challenging the thinking about a health care system based on solidarity.

  • 66.
    Holmqvist, A
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet.
    Gao, Jingfang
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet.
    Adell, Gunnar
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Onkologiska kliniken US.
    Carstensen, John
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Sun, Xiao-Feng
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Onkologiska kliniken US.
    The location of lymphangiogenesis is an independent prognostic factor in rectal cancers with or without preoperative radiotherapy2010Inngår i: ANNALS OF ONCOLOGY, ISSN 0923-7534, Vol. 21, nr 3, s. 512-517Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Lymphangiogenesis and angiogenesis are essential for tumour development and progression. The lymphatic vessel density (LVD) and blood vessel density (BVD) and their relationship to outcome have been studied extensively, however the clinical significance of the location of LVD/BVD in tumour is not known. In the present study, the location and degree of LVD/BVD and their relationship to preoperative radiotherapy (RT), clinicopathological, histopathological and biological factors were studied in rectal cancer patients participating in a Swedish clinical trial of preoperative RT. Patients and methods: The location and degree of LVD/BVD were analysed in primary tumours (n = 138/140) and in their subgroups of non-RT (n = 74) and RT (n = 64/66). Further, the degree of LVD/BVD was examined in the corresponding distant normal mucosa (n = 35/31) and adjacent normal mucosa (n = 72/91). All sections were immunohistochemically examined by using D2-40 and CD34 antibodies. Results: In the whole series of the patients, a higher LVD at the periphery was related to negative p53 expression (P = 0.03) and favourable survival independent of tumour-node-metastasis stage, differentiation and p53 expression (P = 0.03). LVD was increased in p53-negative tumours after RT (P = 0.01). Conclusion: LVD at the periphery of the tumour was an independent prognostic factor in rectal cancer patients.

  • 67.
    Holmqvist Knutsen, Annica
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Gao, Jing-Fang
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet.
    Holmlund, Birgitta
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Adell, Gunnar
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Carstensen, John
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Sun, Xiao-Feng
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    PINCH is an independent prognostic factor in rectal cancer patients without preoperative radiotherapy: A study in a Swedish rectal cancer trial of preoperative radiotherapy2012Inngår i: BMC Cancer, ISSN 1471-2407, E-ISSN 1471-2407, Vol. 12, nr 65Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and Purpose: The clinical significance between particularly interesting new cysteine-histidine rich protein (PINCH) expression and radiotherapy (RT) in tumours is not known. In this study, the expression of PINCH and its relationship to RT, clinical, pathological and biological factors were studied in rectal cancer patients.

    Material and Methods: PINCH expression determined by immunohistochemistry was analysed at the invasive margin and inner tumour area in 137 primary rectal adenocarcinomas (72 cases without RT and 65 cases with RT). PINCH expression in colon fibroblast cell line (CCD-18 Co) was determined by Western blot.

    Results: In patients without RT, strong PINCH expression at the invasive margin of primary tumours was related to worse survival, compared to patients with weak expression, independent of TNM stage and differentiation (p = 0.03). No survival relationship in patients with RT was observed (p = 0.64). Comparing the non-RT with RT subgroup, there was no difference in PINCH expression in primary tumours (invasive margin (p = 0.68)/inner tumour area (p = 0.49).

    Conclusions: PINCH expression at the invasive margin was an independent prognostic factor in patients without RT. RT does not seem to directly affect the PINCH expression.

     

  • 68.
    Honkasalo , Marja-Liisa
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Grips and Ties: Agency, Uncertainty, and the Problem of Suffering in North Karelia2009Inngår i: MEDICAL ANTHROPOLOGY QUARTERLY, ISSN 0745-5194 , Vol. 23, nr 1, s. 51-69Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In medical anthropological research, the question of suffering has been a topic of salient interest mostly from two theoretical viewpoints: those of endurance and of agency. The concept "suffering" derives its origins from two etymological roots, those of suffering-souffrance-sofferanza and of misery-misere-miseria. According to the first approach, that of "endurance" and founded largely on Judeo-Christian theology, suffering is regarded as an existential experience at the borders of human meaning making. The question then is: how to endure, how to suffer ? The latter view, that of "agency," follows the Enlightenment, and later the Marxist view on mundane suffering, misery, and the modern question of how to avoid or diminish it. This article follows the lines of the second approach, but my aim is also to try to build a theoretical bridge between the two. I ask whether agency would be understood as a culturally shared and interpreted modes of enduring, and if so, which conceptual definition of agency applies in this context ? I theorize the relationship between suffering and agency using Ernesto de Martinos notion la crisi della presenza. In line with Pierre Bourdieu, I think that in peoples lives, there may be sufferings in a plural form, as a variety of sufferings. The article is based on a one-year long fieldwork in Finnish North Karelia.

  • 69.
    Honkasalo, M.-M.
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Enduring as a mode of living with uncertainty2008Inngår i: Health, Risk and Society, ISSN 1369-8575, E-ISSN 1469-8331, Vol. 10, nr 5, s. 491-503Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In addition to management and control, which in risk research have been studied extensively, there is a diversity and heterogeneity in people's responses to uncertainty that has mostly remained hidden. The aim of my article is to discuss some of the variation in people's ways of 'living with uncertainty,' an expression that is widely applied among many anthropologists and sociologists dealing with research into issues of risk and chronic illness. My intent is to open up and theorise the expression further with the argument that 'living' consists in a variety of actions and practices. I want to attend not only to the different empirical meanings of action and agency as they emerge within the activities of modern everyday life, but also to attend to the kinds of analytical questions that are opened up when action is analysed in its wide variety of modalities, as control, resistance, embracing, and enduring. What then does it mean to endure? According to the ethnographic results, enduring is constituted occasionally just in dwelling, or lingering, or embedded deeply within the everyday. What is created in these processes is ethical agency. The vocabulary of agency that the social sciences have in circulation, however, does not grasp this kind of agency to its fullest extent. This article thus is aimed at contributing to discussions on the relations between the uncertainty of the lived-everyday, which has been brought about by illness, and the varieties of human action by emphasising the potentialities and possibilities this agency has to offer.

  • 70.
    Hyden, Lars- Christer
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    The Importance of Providing Scaffolding to Support Patient Narratives When Brain Damage Impairs Storytelling Ability2011Inngår i: TOPICS IN STROKE REHABILITATION, ISSN 1074-9357, Vol. 18, nr 1, s. 52-54Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Boundaries connected to illness are defined and redefined through new ways of interacting with other people and especially by storytelling and listening to the stories of others. Diseases or traumas that affect the brain can result in memory loss, impaired cognition, and difficulties in expressing oneself clearly, hence making it difficult to present and negotiate identities. In such situations, others often try to remediate the communicative problems by taking over those narrative functions that are lost or impaired and thereby scaffolding the injured persons storytelling capacity. This narrative scaffolding is directed at keeping interpersonal relationships functional and makes it possible for persons with communicative disabilities to continue to be participants in a shared life.

  • 71.
    Hydén, Lars-Christer
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Ansikten i möte2012Inngår i: Människans ansikten: Känslor, karaktärer och karikatyrer / [ed] Viveka Adelswärd och Per-Aanders Forstorp, Stockholm: Carlsson Bokförlag, 2012, s. 107-123Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [sv]

    "There will be time, there will be time, To prepare a face to meet the faces that you meet", lyder några rader ur T. S. Eliots dikt The Love Song of J. Alfred Prufrock. Människans ansikte är komplext och mångtydigt. Det uttrycker våra känslor och reaktioner, medvetet eller omedvetet. När vi ser en annan människas ansikte läser vi  eller tror oss läsa  hennes sinnesstämning och karaktär, hennes tankar och intentioner. Samtidigt är vi medvetna om att andra läser våra ansikten. Ett intrikat samspel mellan genuint och spelat, medvetet och omedvetet, pågår.

    I denna antologi presenterar sju forskare i åtta bidrag en del av den mångfacetterade forskning som finns kring hur människan tolkar ansikten, såväl naturliga som animerade och skulpterade. Vi kan bland annat läsa om datoranimerade ansikten och deras användningsområden; om ansiktet i mänskliga möten, hur människor gestaltar och reglerar sitt samspel i ansikte-mot-ansikte-situationer; om karikatyren och ansiktet som skämt. Bidragen kommer från ett brett mångvetenskapligt fält och vill ge underlag för diskussioner om ansiktets kraft, dess implikationer och innebörder. En tankeväckande och användbar bok, både för forskare och allmänhet. Boken innehåller intressanta bilder av konstnärer som Gert Germeraad, Mark Gilbert och Lovisa Ringborg.

  • 72.
    Hydén, Lars-Christer
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Identity, Self, Narrative2010Inngår i: Beyond Narrative Coherence / [ed] Hyvärinen, M. Hyden, L.C. Saarenheimo, M. Tamboukou, M., John Benjamins Publishing Company, 2010, 1, s. 33-48Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [en]

    Beyond Narrative Coherence" reconsiders the way we understand and work with narratives. Even though narrators tend to strive for coherence, they also add complexity, challenge canonical scripts, and survey lives by telling highly perplexing and contradictory stories. Many narratives remain incomplete, ambiguous, and contradictory. Obvious coherence cannot be the sole moral standard, the only perspective of reading, or the criterion for selecting and discarding research material. "Beyond Narrative Coherence" addresses the limits and aspects of narrative (dis)cohering by offering a rich theoretical and historical background to the debate. Limits of narrative coherence are discussed from the perspective of three fields of life that often threaten the coherence of narrative: illness, arts, and traumatic political experience. The authors of the book cover a wide range of disciplines such as psychology, sociology, arts studies, political science and philosophy.

  • 73.
    Hydén, Lars-Christer
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Letting Stories Breathe: A Socio-narratology2012Inngår i: Sociology of Health and Illness, ISSN 0141-9889, E-ISSN 1467-9566, Vol. 34, nr 1, s. 159-160Artikkel, omtale (Annet vitenskapelig)
    Abstract [en]

    n/a

  • 74.
    Hydén, Lars-Christer
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Narrative collaboration and scaffolding in dementia2011Inngår i: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 25, nr 4, s. 339-347Artikkel i tidsskrift (Annet vitenskapelig)
  • 75.
    Hydén, Lars-Christer
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Narrative Collaboration and Scaffolding in Dementia2011Inngår i: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 25, nr 4, s. 339-347Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    n/a

  • 76.
    Hydén, Lars-Christer
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle.
    Narrative in illness: A methodological note2008Inngår i: Qualitative sociology review, ISSN 1733-8077, Vol. 4, nr 3, s. 49-58Artikkel i tidsskrift (Fagfellevurdert)
  • 77.
    Hydén, Lars-Christer
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Non-verbal vocalizations, dementia and social interaction2011Inngår i: Communication & Medicine: An Interdisciplinary Journal of Healthcare, Ethics and Society, ISSN 1612-1783, E-ISSN 1613-3625, Vol. 8, nr 2, s. 135-144Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In later stages of Alzheimer’s disease many people will engage in noise-making (screaming and other kinds of sounds), often experienced as interruptive by others. A problem with the noise-making is the difficulty in understanding the meaning of the noise. This study addresses two questions: to what extent is noise-making responsive to the ongoing interac- tion and is noise-making regarded as meaningless behavior by other participants? The analysis of selec- tive examples shows that noises may be fitted into the conversational interaction to a certain degree and in some instances is also responsive to interac- tion. The co-participants tend to treat the noises as meaningful. A general conclusion is that if utteranc- es and responses in interaction are treated as if they are meaningful, they will become meaningful in their consequences for all participants. 

  • 78.
    Hydén, Lars-Christer
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Storytelling in dementia: Embodiment as a resource2013Inngår i: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 12, nr 3, s. 359-367Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In narrative research about persons with dementia, much research focuses on individual storytellers and their stories often stressing the discursive or textual aspects of stories. As persons with Alzheimer’s disease generally have difficulties in telling stories according to often implicit narrative norms, they may appear to be less competent and agentive than what is actually the case. In the article, I argue for a change of focus from the textual aspects of narratives and the story as a product, to a focus on performative aspects and the embodied aspects of storytelling. A focus on the storytelling activity implies a change from the individual storyteller to the interaction with other participants in the storytelling situation. Drawing on two particular cases of storytelling, I stress the collaborative and embodied aspects of storytelling and argue that embodiment is less an individual expressive phenomenon than it is an interactive resource. 

  • 79.
    Hydén, Lars-Christer
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Antelius, Eleonor
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Communicative disability and stories: Towards an embodied conception of narratives2011Inngår i: Health, ISSN 1363-4593, E-ISSN 1461-7196, Vol. 15, nr 6, s. 588-603Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In this article we show that persons with communicative disabilities are often involved in storytelling that does not necessarily conform to the conventional expectations of what constitutes a narrative. By analyzing the relationship between story and storytelling event, and the relation between what could be called the primary storyteller and the vicarious storyteller, we show that storytellers with communicative disabilities are often quite inventive in finding ways of presenting themselves as competent storytellers even though they may have certain problems vocally animating a coherent, structured story. This lead us to conclude a necessary redefinition of what a narrative is – that it could be performed as well as it could be told – and that such a redefinition stresses methodological issues: in order to be able to study the life stories of people with communicative disabilities we need to use both narrative and ethnographic research methods.

  • 80.
    Hydén, Lars-Christer
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Örulv, Linda
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Interaction and narrative structure in dementia2010Inngår i: Telling Stories: Language, Narrative, and Social Life / [ed] Schiffrin, D. De Fina, A. Nylund, A., Washington, DC: Georgetown University Press , 2010, s. 149-160Kapittel i bok, del av antologi (Annet (populærvitenskap, debatt, mm))
  • 81.
    Hydén, Lars-Christer
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Örulv, Linda
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Narrative and identity in Alzheimer’s disease: a case study2009Inngår i: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 23, nr 4, s. 205-214Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In this case study, focus is on how persons with AD use their remaining linguistic and cognitive resources, together with non-verbal aspects of the storytelling event, as resources in communicating and negotiating their identities in everyday encounters. The results of the analysis, focusing on the telling of the stories, indicate that other aspects than the temporal and referential organization of the narratives has become important resources for the teller in establishing and negotiating identity. The telling of temporally discontinuous narratives does not appear to affect or disrupt the teller's experience of some sort of a continuous sense of self and identity but are probably more a problem to persons without this kind of diagnosis. Being afflicted by AD most likely leads persons to try to invent and use alternative communicative recourses in order to sustain factors like their senses of self and identities. For researchers this makes it important to try to base their analysis on the actual organization of the talk and to focus on the functions of various responses and utterances in the interaction.

  • 82.
    Jaarsma, Pier
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Gelhaus, Petra
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Psykiatri- och habiliteringsenheten.
    Welin, Stellan
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Living the Categorical Imperative: autistic perspectives on lying and truth telling-between Kant and care ethics2012Inngår i: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 15, nr 3, s. 271-277Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Lying is a common phenomenon amongst human beings. It seems to play a role in making social interactions run more smoothly. Too much honesty can be regarded as impolite or downright rude. Remarkably, lying is not a common phenomenon amongst normally intelligent human beings who are on the autism spectrum. They appear to be 'attractively morally innocent' and seem to have an above average moral conscientious objection against deception. In this paper, the behavior of persons with autism with regard to deception and truthfulness will be discussed in the light of two different ethical theories, illustrated by fragments from autobiographies of persons with autism. A systemizing 'Kantian' and an empathizing 'ethics of care' perspective reveal insights on high-functioning autism, truthfulness and moral behavior. Both perspectives are problematic from the point of view of a moral agent with autism. High-functioning persons with autism are, generally speaking, strong systemizes and weak empathizers. Particularly, they lack 'cognitive empathy' which would allow them to understand the position of the other person. Instead, some tend to invent a set of rules that makes their behavior compatible with the expectations of others. From a Kantian point of view, the autistic tendency to always tell the truth appears praiseworthy and should not be changed, though it creates problems in the social life of persons with autism. From a care ethics perspective, on the other hand, a way should be found to allow the high-functioning persons with autism to respect the feelings and needs of other persons as sometimes overruling the duty of truthfulness. We suggest this may even entail 'morally educating' children and adolescents with autism to become socially skilled empathic 'liars'.

  • 83.
    Jaarsma, Pier
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Welin, Stellan
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Autism as a Natural Human Variation: Reflections on the Claims of the Neurodiversity Movement2012Inngår i: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 20, nr 1, s. 20-30Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Neurodiversity has remained a controversial concept over the last decade. In its broadest sense the concept of neurodiversity regards atypical neurological development as a normal human difference. The neurodiversity claim contains at least two different aspects. The first aspect is that autism, among other neurological conditions, is first and foremost a natural variation. The other aspect is about conferring rights and in particular value to the neurodiversity condition, demanding recognition and acceptance. Autism can be seen as a natural variation on par with for example homosexuality. The broad version of the neurodiversity claim, covering low-functioning as well as high-functioning autism, is problematic. Only a narrow conception of neurodiversity, referring exclusively to high-functioning autists, is reasonable. We will discuss the effects of DSM categorization and the medical model for high functioning autists. After a discussion of autism as a culture we will analyze various possible strategies for the neurodiversity movement to claim extra resources for autists as members of an underprivileged culture without being labelled disabled or as having a disorder. We will discuss their vulnerable status as a group and what obligation that confers on the majority of neurotypicals.

  • 84.
    Jaarsma, Pier
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Welin, Stellan
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Human capabilities, mild autism, deafness and the morality of embryo selection2013Inngår i: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 16, nr 4, s. 817-824Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A preimplantation genetic test to discriminate between severe and mild autism spectrum disorder might be developed in the foreseeable future. Recently, the philosophers Julian Savulescu and Guy Kahane claimed that there are strong reasons for prospective parents to make use of such a test to prevent the birth of children who are disposed to autism or Asperger’s disorder. In this paper we will criticize this claim. We will discuss the morality of selection for mild autism in embryo selection in a hypothetical in vitro fertilization (IVF) situation where preimplantation genetic diagnosis is performed and compare this with a similar selection for congenital deafness. To do this we first discuss relevant human differences. We then introduce the principle of human capabilities (PC) and compare this principle with the principle of procreative beneficence (PB) introduced by Savulescu and Kahane. We apply the two principles to selection for mild autism and selection for congenital deafness. We argue that PC allows for the selection for mild autism but rules out selection for congenital deafness. PB will not give clear answers; the ruling of PB depends to a large extent on expected social, cultural and political developments. We will argue that PC is preferable to PB. We will discuss arguments for the value of mild autism for individuals who have this condition and argue that they are able to lead a life with human dignity provided autism-friendly social circumstances are present. Neither PC nor PB yields strong reasons for prospective parents to seek to prevent the birth of children who are disposed to mild autism spectrum disorder.

  • 85.
    Jackisch, Josephine
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle.
    Cultivating Well-Being: A study on Community Gardening and Health in Berlin and Paris2012Independent thesis Advanced level (degree of Master (Two Years)), 80 poäng / 120 hpOppgave
    Abstract [en]

    This paper reports experiences of health and well-being common to actors in community gardens in Berlin and Paris. Community gardening has become an ever growing phenomenon since the 1990s, and to a larger extend since 2000 in western European cities. Despite the promising research from the US that has shown that community gardens have a potential for health promotion, there is a dearth of evidence from Europe. This study tries to fill this gap and maps the potential of community gardens for health and well-being as explained and experienced by the gardeners.

    The effect of community garden projects on human health and well-being cannot be reduced to the effect of nature on health alone. This study shows that there are at least two other major mechanisms at play, if we want to understand the phenomenon or evaluate its effects, namely the effects of community and 'free and open spaces'. Gardeners report health-related experiences with green space, such as stress relief and feeling of calm and vitality and increased well-being through sensual experiences and observing nature. Furthermore the garden projects open up a social space, which for many gardeners creates experiences of health through regular social contact, experiences of joy of sharing and having activities together. Furthermore, the community garden project was proposed to create a context and opportunities for flow, creativity and self-efficacy if it is a free and open space. However, not all experiences on well-being in CGPs are postive, and to all these spaces and their effects there are also certain limitations and conditions.

    Moreover, this study makes a theoretical contribution to the concept of health and well-being on the basis of the fuzziness around the concept of health encountered in the field. I propose that a holistic concept of health might be most suitable to describe health related to bottom-up community action like community gardens. To assess the effects of such projects in terms of well-being, this concepts should be dissentagled into the concept of health and happiness, whereas happiness in turn relates not only to life satisfaction but also to eudaimonian happiness related to meaning and doing good. Although this research project could not be comprehensive enough to provide all necessary evidence to evaluate health effects of community gardens, we believe that it provides viable paths for investigations into community driven health promotion and emerging healthy settings.

  • 86.
    Jansson, Marie
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Taghizadeh Larsson, Annika
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, NISAL - Nationella institutet för forskning om äldre och åldrande. Linköpings universitet, Filosofiska fakulteten.
    Dementia and citizenship2012Konferansepaper (Annet vitenskapelig)
  • 87.
    Jennersjo, P E
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Wiréhn, Ann-Britt
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Länne, Toste
    Linköpings universitet, Institutionen för medicin och hälsa, Fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Engvall, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Nyström, Fredrik
    Linköpings universitet, Institutionen för medicin och hälsa, Internmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Primärvården i västra länsdelen.
    Circadian blood pressure variation in patients with type 2 diabetes - relationship between dipper status and early cardiovascular organ damage2009Inngår i: in DIABETOLOGIA, vol 52, 2009, Vol. 52, s. S430-S430Konferansepaper (Fagfellevurdert)
    Abstract [en]

    n/a

  • 88.
    Johannesson, A.
    et al.
    Lund University.
    Larsson, G.-U.
    Department of Orthopedics Hassleholm-Kristianstad.
    Ramstrand, N.
    Jönköping University.
    Turkiewicz, A.
    Lund University.
    Wiréhn, Ann-Britt
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Atroshi, I.
    Lund University.
    Incidence of lower-limb amputation in the diabetic and nondiabetic general population: A 10-year population-based cohort study of initial unilateral and contralateral amputations and reamputations2009Inngår i: Diabetes Care, ISSN 0149-5992, Vol. 32, nr 2, s. 275-280Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE -The purpose of this study was to compare the incidence of vascular lower- limb amputation (LLA) in the diabetic and nondiabetic general population. RESEARCH DESIGN AND METHODS -A population-based cohort study was conducted in a representative Swedish region. All vascular LLAs (at or proximal to the transmetatarsal level) performed from 1997 through 2006 were consecutively registered and classified into initial unilateral amputation, contralateral amputation, or reamputation. The incidence rates were estimated in the diabetic and nondiabetic general population aged =45 years. RESULTS -During the 10-year period, LLA was performed on 62 women and 71 men with diabetes and on 79 women and 78 men without diabetes. The incidence of initial unilateral amputation per 100,000 person-years was 192 (95% CI 145-241) for diabetic women, 197 (152-244) for diabetic men, 22 (17-26) for nondiabetic women, and 24 (19-29) for nondiabetic men. The incidence increased from the age of 75 years. Of all amputations, 74% were transtibial. The incidences of contralateral amputation and of reamputation per 100 amputee- years in diabetic women amputees were 15 (7-27) and 16 (8-28), respectively; in diabetic men amputees 18 (10 -29) and 21 (12-32); in nondiabetic women amputees 14 (7-24) and 18 (10-28); and in nondiabetic men amputees 13 (6-22) and 24 (15-35). CONCLUSIONS -In the general population aged =45 years, the incidence of vascular LLA at or proximal to the transmetatarsal level is eight times higher in diabetic than in nondiabetic individuals. One in four amputees may require contralateral amputation and/or reamputation.

  • 89.
    Johansson, Yvonne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Bachrach-Lindström, Margareta
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Carstensen, John
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Ek, Anna-Christina
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Akutkliniken.
    Malnutrition in a home-living older population: prevalence, incidence and risk factors. A prospective study2009Inngår i: JOURNAL OF CLINICAL NURSING, ISSN 0962-1067, Vol. 18, nr 9, s. 1354-1364Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To prospectively investigate and describe the prevalence and incidence of malnutrition among home-living older people, related to demographic and medical factors, self-perceived health and health-related quality of life. Another aim was to find predictors for developing risk of malnutrition.

    Risk factors for malnutrition have previously been identified as diseases, several medications, low functional status, symptoms of depression and inadequate nutrient intake. Most studies are cross-sectionally performed at hospitals or in nursing care settings.

    A prospective study with a sample of 579 home-living older people, randomly selected from a local national register. Examinations were performed at baseline and yearly follow-ups two to four times.

    Questionnaires validated and tested for reliability, to detect risk of malnutrition (Mini Nutritional Assessment), symptoms of depression (Geriatric Depression Scale-20), cognitive function (Mini Mental State Examination), health-related quality of life (Nottingham Health Profile), well-being (Philadelphia Geriatric Center Multilevel Assessment Instrument) self-perceived health, demographic factors, anthropometry and biochemical examinations. Predictors were searched for through multiple logistic regression analysis with the MNA as dependent factor.

    The prevalence of risk for malnutrition was 14.5%, according to the MNA. Two risk factors for malnutrition were lower handgrip strength and lower self-perceived health. The incidence of risk for malnutrition at follow-ups was between 7.6% and 16.2%. Predictors for developing malnutrition were higher age, lower self-perceived health and more symptoms of depression. Men with symptoms of depression had a higher risk of developing malnutrition.

    Lower self-perceived health had the highest power to predict risk for malnutrition, with increased number of depression symptoms and higher age as second and third predictors.

    A regular and combined assessment using the Mini Nutrition Assessment, Geriatric Depression Scale-20 and self-perceived health as a base for identifying people in need, is one way to prevent the development of malnutrition.

  • 90.
    Jonasson, Lise-Lotte
    et al.
    Department of Nursing Science, School of Health Sciences, University of Jönköping.
    Liss, Per-Erik
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Westerlind, Björn
    Geriatriska kliniken, Länssjukhuset Ryhov, Jönköping.
    Berterö, Carina
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Corroborating indicates nurses' ethical values in a geriatric ward2011Inngår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 6, nr 3, s. 7291-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of the study was to identify nurses’ ethical values, which become apparent through their behaviour in the interactions with older patients in caring encounters at a geriatric clinic. Descriptions of ethics in a caring practice are a problem since they are vague compared with the four principles of autonomy, beneficence, non-maleficence, and justice. A Grounded Theory methodology was used. In total, 65 observations and follow-up interviews with 20 nurses were conducted, and data were analysed by constant comparative analysis. Three categories were identified: showing consideration, connecting, and caring for. These categories formed the basis of the core category: ‘‘Corroborating.’’ In corroborating, the focus is on the person in need of integrity and self-determination; that is, the autonomy principle. A similar concept was earlier described in regard to confirming. Corroborating deals more with support and interaction. It is not enough to be kind and show consideration (i.e., to benefit someone); nurses must also connect and care for the older person (i.e., demonstrate non-maleficence) in order to corroborate that person. The findings of this study can improve the ethics of nursing care. There is a need for research on development of a high standard of nursing care to corroborate the older patients in order to maintain their autonomy, beneficence, and nonmaleficence. The principal of justice was not specifically identified as a visible nursing action. However, all older patients received treatment, care, and reception in an equivalent manner.

  • 91.
    Juelson, Kristin
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle.
    The Struggles of Youth in a Time of HIV/AIDS Awareness and Prevention Programs: A discussion of the personal, interpersonal, and social challenges youth face against the backdrop of media-oriented campaign discourses in South Africa 2008Independent thesis Advanced level (degree of Master (Two Years)), 20 poäng / 30 hpOppgave
    Abstract [en]

    This thesis examines the different discourses on sexuality put forth by two prominent media-oriented HIV/AIDS awareness and prevention campaigns, Soul City and Love Life, in South Africa, and the ways in which they resonate with youth as they struggle to negotiate their own sexual identities in a rapidly changing society. It uses qualitative methods to consider the struggles of individuals in the personal, interpersonal, and larger social realms and how campaigns speak to them in different ways and, in turn, how youth negotiate their own identities. On the personal level, this thesis considers individual negotiations of knowledge and awareness of HIV/AIDS in the face of campaigns, particularly as they work within certain frameworks of morals and values. Then, on the interpersonal level, struggles concerning conflicting ideals and realities in love and relationships are considered, as are gender issues and the realities of exchange values and notions of responsibility in relationships. Building on personal and interpersonal struggles, larger social challenges involving the influence of traditional and modern values on sexual expression, as well as the influences of popular culture are discussed. In many ways this paper is a commentary on some of the major challenges of being young, but because of this it inherently lends itself to discussions of the challenges that campaigns face as they attempt to speak to youth about HIV/AIDS and where their good intentions might be failing. Furthermore, it also helps to understand the ways that the risk of HIV/AIDS has come to inform discourses on youth sexuality.

  • 92.
    Karlsson, Kristina
    et al.
    Linköpings universitet, Institutionen för tema, Tema Kommunikation. Linköpings universitet, Filosofiska fakulteten.
    Hydén, Lars-Christer
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Democracy in talk: Dominance in ”usercentered” team meetings2007Inngår i: Scandinavian Journal of Disability Research, ISSN 1501-7419, Vol. 9, nr 2, s. 91-111Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim is to examine the discursive organization of “user-centred” team meetings in the Swedish rehabilitation sector. The “users” are aged between 4 and 30 and have been ascribed different kinds of impairments. The teams consist of one user and/or her/his relatives and different professionals. The analysis is primarily based on transcriptions of 18 audiotaped team meetings held by 10 different teams and focuses on two dimensions of dominance in interaction: the amount of talk and topic control. The findings point to professional dominance, but parents also have a great influence on the topic control. The degree of participation and the control of topics of the users who participate in the meetings vary, but most of the users become involved primarily by responding to the questions and suggestions of professionals and parents. In order to increase the users' control of the interactions the participants need to continuously discuss the organization of the conversations. The findings are related to complicating aspects of the conversations, including institutionalization, representation difficulties, varying communicative abilities, and expectations of expertise and adult liabilities.

  • 93.
    Karlsson, Nadine
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Borg, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Carstensen, John
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle.
    Hensing, Gunnel
    Department of Social Medicine, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
    Alexanderson, Kristina
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Risk of disability pension in relation to gender and age in a Swedish county: A 12-year population based, prospective cohort study2006Inngår i: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 27, nr 2, s. 173-179Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Residents of the county of Östergötland, Sweden, who were 16-64 years of age in December 1984 and not pensioned (n=229,864), were followed in a prospective, cohort, study of data collected between 1985 and 1996. Using survival methods as the method of analysis, the likelihood of being granted a disability pension was 14% for women, 11% for men, and increased with age. Women less than 54 years of age were at higher risk than men (P<0.001), 69% of disability pensions granted were full-time and 31% were part-time, more women received part-time pensions (P<0.001). Whether the differences observed are due to gender bias in social insurance practices, to disease patterns, to occupational and work-related factors, or to a cohort effect has yet to be determined.

  • 94.
    Karlsson, Nadine
    et al.
    Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Carstensen, John
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Gjesdal, Sturla
    Section of Social Medicine, Department of Public Health and Primary Health Care, University of Bergen, Norway.
    Alexanderson, Kristina
    Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Mortality in relation to disability pension, gender, and age in a Swedish county 1985-1996; a 12-year population-based prospective cohort study.2005Konferansepaper (Annet vitenskapelig)
  • 95.
    Karlsson, Nadine
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap.
    Carstensen, John
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle.
    Gjesdal, Sturla
    Socialmedicin Bergen Norge.
    Alexanderson, Kristina
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap.
    Risk factors for disability pension in a population-based cohort of men and women on long-term sick leave in Sweden2008Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 18, nr 3, s. 224-231Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Knowledge on predictors of disability pension is very limited. The aim was to assess the importance of sick-leave diagnosis and socio-demographic variables as risk factors for disability pension among individuals on long-term sickness absence and to compare these factors by gender and over time. Methods: A prospective population-based cohort study in Östergötland County, Sweden, included 19 379 individuals who, in 1985-87, were aged 16-60 years and had a new spell of long-term sickness absence lasting <56 days. Follow-up was done in two time frames: 0-5 and 6-10 years after inclusion. The risk of disability pension in relation to sick-leave diagnosis and socio-demographic factors was assessed by Cox proportional hazard regression analysis. Results: In 5 years, after inclusion, 28% of the cohort had been granted disability pension. Those with higher age, low income, previous sick leave, no employment and non-Swedish origin had higher risk of disability pension, while those with young children had lower risk. Considering the inclusion diagnosis, the pattern differed between men and women (P < 0.001). Among men, those with mental disorders had the highest risk and among women those with musculoskeletal disorders. Except for income, the effect of which was reversed over time, the overall pattern of disability pension predictors remained 6-10 years after inclusion but was attenuated. Conclusion: Besides socio-demographic risk factors, the sick-leave diagnoses constitute an important both medium and long-term predictor of disability pension among both men and women on long-term sickness absence. © 2008. The Author(s).

  • 96.
    Karlén, Jerker
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Ludvigsson, Johnny
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Frostell, Anneli
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för kognition, utveckling och handikapp (CDD). Linköpings universitet, Hälsouniversitetet.
    Theodorsson, Elvar
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk kemi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Diagnostikcentrum, Klinisk kemi.
    Faresjö, Tomas
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Cortisol in hair measured in young adults - a biomarker of major life stressors?2011Inngår i: BMC Clinical Pathology, ISSN 1472-6890, E-ISSN 1472-6890, Vol. 11, nr 1, s. 12-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Stress as a cause of illness has been firmly established. In public health and stress research a retrospective biomarker of extended stress would be an indispensible aid. The objective of this pilot study was to investigate whether concentrations of cortisol in hair correlate with perceived stress, experiences of serious life events, and perceived health in young adults. Methods Hair samples were cut from the posterior vertex area of (n = 99) university students who also answered a questionnaire covering experiences of serious life events, perceived Stress Scale and perceived health during the last three months. Cortisol was measured using a competitive radioimmunoassay in methanol extracts of hair samples frozen in liquid nitrogen and mechanically pulverised. Results Mean cortisol levels were significantly related to serious life events (p = 0.045), weakly negatively correlated to perceived stress (p = 0.025, r = -0.061) but nor affected by sex, coloured/permed hair, intake of pharmaceuticals or self-reported health. In a multiple regression model, only the indicator of serious life events had an independent (p = 0.041) explanation of increased levels of cortisol in hair. Out of four outliers with extremely high cortisol levels two could be contacted, both reported serious psychological problems. Conclusions These findings suggest that measurement of cortisol in hair could serve as a retrospective biomarker of increased cortisol production reflecting exposure to major life stressors and possibly extended psychological illness with important implications for research, clinical practice and public health. Experience of serious life events seems to be more important in raising cortisol levels in hair than perceived stress.

  • 97.
    Kärner, Anita
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Vårdcentraler i östra länsdelen.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Andersson, Agneta
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Wiréhn, Ann-Britt
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Wodlin, Peter
    Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Hjelmfors, Lisa
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Tingström, Pia
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    The effect of problem-based learning in patient education after an event of CORONARY heart disease - a randomised study in PRIMARY health care: design and methodology of the COR-PRIM study2012Inngår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 13, nr 110Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Even though there is convincing evidence that self-care, such as regular exercise         and/or stopping smoking, alters the outcomes after an event of coronary heart disease         (CHD), risk factors remain. Outcomes can improve if core components of secondary prevention         programmes are structurally and pedagogically applied using adult learning principles         e.g. problem-based learning (PBL). Until now, most education programs for patients         with CHD have not been based on such principles. The basic aim is to discover whether         PBL provided in primary health care (PHC) has long-term effects on empowerment and         self-care after an event of CHD.     

    Methods/Design

    A randomised controlled study is planned for patients with CHD. The primary outcome         is empowerment to reach self-care goals. Data collection will be performed at baseline         at hospital and after one, three and five years in PHC using quantitative and qualitative         methodologies involving questionnaires, medical assessments, interviews, diaries and         observations. Randomisation of 165 patients will take place when they are stable in         their cardiac condition and have optimised cardiac medication that has not substantially         changed during the last month. All patients will receive conventional care from their         general practitioner and other care providers. The intervention consists of a patient         education program in PHC by trained district nurses (tutors) who will apply PBL to         groups of 6–9 patients meeting on 13 occasions for two hours over one year. Patients         in the control group will not attend a PBL group but will receive home-sent patient         information on 11 occasions during the year.     

    Discussion

    We expect that the 1-year PBL-patient education will improve patients’ beliefs, self-efficacy         and empowerment to achieve self-care goals significantly more than one year of standardised         home-sent patient information. The assumption is that PBL will reduce cardiovascular         events in the long-term and will also be cost-effective compared to controls. Further,         the knowledge obtained from this study may contribute to improving patients’ ability         to handle self-care, and furthermore, may reduce the number of patients having subsequent         CHD events in Sweden.

  • 98.
    Kärner, Anita
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Tingström, Pia
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för studier av vuxenutbildning, folkbildning och högre utbildning (VUFo). Linköpings universitet, Utbildningsvetenskap.
    Dahl, Lena
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Wiréhn, Ann-Britt
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Asklund, Eva
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    COR-PRIM: Patient education after coronary disease - Long-term evaluation in primary care2010Konferansepaper (Annet vitenskapelig)
  • 99.
    Launiala, Annika
    et al.
    University of Tampere.
    Honkasalo, Marja-Liisa
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
      Malaria, Danger, and Risk Perceptions among the Yao in Rural Malawi2010Inngår i: Medical Anthropology Quarterly, ISSN 0745-5194, E-ISSN 1548-1387, Vol. 24, s. 399-420Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Findings from a study designed to discover how local understanding of malaria among Yao in Malawi relate to pregnancy risk definitions reveal that malaria in pregnancy is not perceived as a major risk. Using extended ethnographic field research and multiple methods, we argue a shift from narrow single-disease approaches to malaria during pregnancy is required and document women's concerns about exposure to multiple vulnerabilities during pregnancy, including witchcraft, extramarital affairs, and multiple dangerous illnesses. Four dimensions are implicated in Yao perceptions of risk: perceived adverse consequences in pregnancy; ease of treatment and cure; transmission and agency to control; and type of risk (social–medical). We discuss implications and consider malaria program features needed to address the complexity of perceived vulnerabilities and living conditions in resource-poor settings.

  • 100.
    Lerner, Henrik
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle.
    Rollin, B.E. Science and ethics2009Inngår i: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 12, nr 2, s. 226-227Artikkel, omtale (Annet vitenskapelig)
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