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  • 85201.
    Östh, Martin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Health Sciences.
    Öst, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Health Sciences.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Strålfors, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Health Sciences.
    The Concentration of beta-Carotene in Human Adipocytes, but Not the Whole-Body Adipocyte Stores, Is Reduced in Obesity2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 1, p. 85610-Article in journal (Refereed)
    Abstract [en]

    We have examined the concentration of beta-carotene in the fat of isolated abdominal subcutaneous adipocytes obtained from lean (BMIless than23 kg/m(2)), non-obese with higher BMI (23 less than= BMIless than28 kg/m(2)), obese (BMI greater than= 28 kg/m(2)), and from a group of obese subjects with type 2 diabetes. The concentration of b-carotene was 50% lower in the adipocytes from the obese and obese/diabetic groups compared with the lean and non-obese groups. Interestingly, the total amount of beta-carotene in the adipocyte stores of each subject was constant among all groups. Triacylglycerol constituted 92 +/- 1% (by weight) of the adipocyte lipids in the lean group and this was increased to 99 +/- 2% in the obese group with diabetes (pless than0.05). The concentration of cholesteryl esters was in all cases less than0.1 g per 100 g of total lipids, demonstrating that mature human adipocytes have negligible stores of cholesteryl ester. Our findings demonstrate that adipocyte concentrations of beta-carotene are reduced in obese subjects. The lower concentrations in adipocytes from subjects with type 2 diabetes apparently reflect subjects obesity. Our finding that whole-body stores of beta-carotene in adipocytes are constant raises new questions regarding what function it serves, as well as the mechanisms for maintaining constant levels in the face of varied adipose tissue mass among individuals over a period of time.

  • 85202.
    Östholm Balkhed, Åse
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Extended-Spectrum ß-Lactamase-Producing Enterobacteriaceae: Antibiotic consumption, Detection and Resistance Epidemiology2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    ESBL-producing Enterobacteriaceae are emerging worldwide and they are frequently multi-drug resistant, thus limiting treatment options for infections caused by these pathogens.

    The overall aim of the thesis was to investigate ESBL-producing Enterobacteriaceae in a Swedish county.

    First, we developed a molecular method, a multiplex PCR assay for identification of SHV, TEM and CTX-M genes in clinical isolates of Enterobacteriaceae with an ESBL phenotype.

    From 2002 until the end of 2007 all isolates of ESBL-producing Enterobacteriaceae in Östergötland, Sweden were further investigated. The prevalence of ESBL-producing Enterobacteriaceae was low, <1%, but increasing,while the antibiotic consumption remained unchanged. CTX-M enzymes, particularly CTX-M group 1, dominate in our region as well as in the rest of Europe.

    Furthermore, we have investigated antimicrobial susceptibility by performing MIC-testing in a large, well-characterized population of CTX-M-producing E. coli. Only three oral antimicrobial agents (fosfomycin, nitrofurantoin and mecillinam) demonstrated susceptibility above 90%. High susceptibility, >90%, was also demonstrated for carbapenems, colistin, tigecycline and amikacin. Sixty-eight per cent of ESBL-producing E. coli was multi-resistant, and the most common multi-resistance pattern was the ESBL phenotype with decreased susceptibility to trimethoprim, trimethoprim-sulfamethoxazole, ciprofloxacin, gentamicin and tobramycin. Isolates belonging to CTX-M group 9 are generally more susceptible to antibiotics than the CTX-M group 1-producing E. coli.

    Finally, a prospective multicentre case-control study examined the prevalence of ESBL-producing Enterobacteriaceae in faecal samples before and after travel abroad and the risk factors of acquisition. Sixty-eight of 226 travellers (30%) had ESBL-producing Enterobacteriaceae in the faecal flora. The geographical area visited had the highest impact on acquisition, with highest the risk for travellers visiting the Indian subcontinent, followed by Asia and Africa north of the equator. Also, acquisition of ESBL-producing Enterobacteriaceae during travel is associated with abdominal symptoms such as diarrhoea. Age also seemed to affect the risk of acquiring ESBL-producing Enterobacteriaceae, the highest risks were found among travellers ≥ 65 years.

    This thesis has contributed to increased understanding of the epidemiology of ESBL-producing Enterobacteriaceae and their susceptibility to both beta-lactam and non-beta-lactam agents.

    List of papers
    1. Multiplex PCR amplification assay for the detection of blaSHV, blaTEM and blaCTX-M genes in Enterobacteriaceae
    Open this publication in new window or tab >>Multiplex PCR amplification assay for the detection of blaSHV, blaTEM and blaCTX-M genes in Enterobacteriaceae
    Show others...
    2007 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 115, no 12, p. 1400-1408Article in journal (Refereed) Published
    Abstract [en]

    Extended-spectrum β-lactamases (ESBLs) are often mediated by bla-SHV, blaTEM and blaCTX-M genes in Enterobacteriaceae and other Gram-negative bacteria. Numerous molecular typing methods, including PCR-based assays, have been developed for their identification. To reduce the number of PCR amplifications needed we have developed a multiplex PCR assay which detects and discriminates between bla-SHV, blaTEM and blaCTX-M PCR amplicons of 747, 445 and 593 bp, respectively. This multiplex PCR assay allowed the identification of bla-SHV, blaTEM and blaCTX-M genes in a series of clinical isolates of Enterobacteriaceae with previously characterised ESBL phenotype. The presence of blaSHV, blaTEM and blaCTX-M genes was confirmed by partial DNA sequence analysis. Apparently, the universal well-established CTX-M primer pair used here to reveal plasmid-encoded blaCTX-M genes would also amplify the chromosomally located K-1 enzyme gene in all Klebsiella oxytoca strains included in the study.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-41186 (URN)10.1111/j.1600-0463.2007.00722.x (DOI)55314 (Local ID)55314 (Archive number)55314 (OAI)
    Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
    2. Prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae and trends in antibiotic consumption in a county of Sweden
    Open this publication in new window or tab >>Prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae and trends in antibiotic consumption in a county of Sweden
    Show others...
    2010 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 42, no 11-12, p. 831-838Article in journal (Refereed) Published
    Abstract [en]

    In the last decade extended-spectrum beta-lactamase (ESBL)-producing bacteria have become an increasing problem. Our aims were to investigate the prevalence of ESBL-producing Enterobacteriaceae and trends in antibiotic use in the county of Ostergotland, Sweden. From 2002 through 2007 there were 224 ESBL-producing Escherichia coli and 23 Klebsiella pneumoniae isolates with an ESBL-phenotype identified among all Enterobacteriaceae isolated at the clinical laboratory. Trends in antibiotic consumption expressed as defined daily doses (DDD) per 1000 inhabitants and day (DID) were studied. The prevalence of ESBL-producing isolates among Enterobacteriaceae in our region is still low (andlt; 1%). Patients with ESBL-producing E. coli increased significantly (p andlt; 0.001) from 5 in y 2002 to 47 in y 2007. CTX-M group 1 was the dominant enzyme group in both E. coli and K. pneumoniae. Antibiotic susceptibility testing of ciprofloxacin, gentamicin and trimethoprim-sulfamethoxazole revealed that 58% of E. coli and 50% of K. pneumoniae isolates were multi-resistant. Antibiotic use remained unchanged from 2001 through 2009, but there was a trend towards increased use of drugs with low ESBL selection potential, which was probably due to the increased prevalence of ESBL producers.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2010
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-63145 (URN)10.3109/00365548.2010.498017 (DOI)000284168300006 ()
    Available from: 2010-12-13 Created: 2010-12-13 Last updated: 2017-12-11Bibliographically approved
    3. In vitro activity of beta-lactam antibiotics against CTX-M-producing Escherichia coli
    Open this publication in new window or tab >>In vitro activity of beta-lactam antibiotics against CTX-M-producing Escherichia coli
    Show others...
    2011 (English)In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 30, no 8, p. 981-987Article in journal (Refereed) Published
    Abstract [en]

    Beta-lactam antibiotics have been discussed as options for the treatment of infections caused by multiresistant extended-spectrum beta-lactamase (ESBL)-producing bacteria if the minimum inhibitory concentration (MIC) is low. The objective of this study was to investigate the in vitro activity of different beta-lactam antibiotics against CTX-M-producing Escherichia coli. A total of 198 isolates of E. coli with the ESBL phenotype were studied. Polymerase chain reaction (PCR) amplification of CTX-M genes and amplicon sequencing were performed. The MICs for amoxicillin-clavulanic acid, aztreonam, cefepime, cefotaxime, ceftazidime, ceftibuten, ertapenem, imipenem, mecillinam, meropenem, piperacillin-tazobactam, and temocillin were determined with the Etest. Susceptibility was defined according to the breakpoints of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). MIC(50) and MIC(90) values were calculated. Isolates from CTX-M group 9 showed higher susceptibility to the beta-lactam antibiotics tested than isolates belonging to CTX-M group 1. More than 90% of the isolates belonging to CTX-M group 9 were susceptible to amoxicillin-clavulanic acid, ceftazidime, ceftibuten, piperacillin-tazobactam, and temocillin. The susceptibility was high to mecillinam, being 91%, regardless of the CTX-M group. All isolates were susceptible to imipenem and meropenem, and 99% to ertapenem. This study shows significant differences in susceptibility to different beta-lactam antibiotics among the CTX-M-producing E. coli isolates and a significant difference for many antibiotics tested between the CTX-M-producing groups 1 and 9. The good in vitro activity of other beta-lactam antibiotics compared to carbapenems indicate that clinical studies are warranted in order to examine the potential role of these beta-lactam antibiotics in the treatment of infections caused by multiresistant ESBL-producing E. coli.

    Place, publisher, year, edition, pages
    Springer Science Business Media, 2011
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-69787 (URN)10.1007/s10096-011-1183-4 (DOI)000292553500008 ()
    Available from: 2011-08-10 Created: 2011-08-08 Last updated: 2017-12-08Bibliographically approved
    4. High frequency of co-resistance in CTX-M-producing Escherichia coli to non-beta-lactam antibiotics, with the exception of amikacin, nitrofurantoin, colistin, tigecycline, and fosfomycin, in a county of Sweden
    Open this publication in new window or tab >>High frequency of co-resistance in CTX-M-producing Escherichia coli to non-beta-lactam antibiotics, with the exception of amikacin, nitrofurantoin, colistin, tigecycline, and fosfomycin, in a county of Sweden
    Show others...
    2013 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 45, no 4, p. 271-278Article in journal (Refereed) Published
    Abstract [en]

    Background: The objective of this study was to investigate the in vitro activity of different antibiotics against CTX-M-producing Escherichia coli in a county of Sweden, and to determine the occurrence of multi-resistance and plasmid- mediated quinolone resistance among these isolates. Methods: A total of 198 isolates of E. coli with extended-spectrum beta-lactamase (ESBL) phenotype and mainly CTX-M genotype were studied. The minimum inhibitory concentrations (MICs) for amikacin, chloramphenicol, ciprofloxacin, colistin, fosfomycin, gentamicin, nalidixic acid, nitrofurantoin, tigecycline, tobramycin, trimethoprim, and trimethoprim-sulfamethoxazole were determined with the Etest. Susceptibility was defined according to the breakpoints of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). MIC(50) and MIC(90) values were calculated. Results: Ninety-five percent or more of the isolates were susceptible to amikacin, nitrofurantoin, colistin, tigecycline, and fosfomycin. CTX-M group 9 was more susceptible than CTX-M group 1 to ciprofloxacin, gentamicin, and tobramycin. Sixty-eight percent of the isolates were multi-resistant, and the most common multi-resistance pattern was ESBL phenotype with decreased susceptibility to trimethoprim, trimethoprim-sulfamethoxazole, ciprofloxacin, gentamicin, and tobramycin. Only 1 isolate carried a qnrS1 gene, but 37% carried aac(6')-Ib-cr. Conclusions: A high frequency of co-resistance between ESBL-producing E. coli and non-beta-lactam antibiotics was seen. On the other hand, very high susceptibility was seen for amikacin, nitrofurantoin, colistin, tigecycline, and fosfomycin. These data support the replacement of gentamicin and tobramycin, normally used in Sweden, with amikacin, for severe infections.

    Keywords
    Etest, minimum inhibitory concentration, extended-spectrum beta-lactamase
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-87612 (URN)10.3109/00365548.2012.734636 (DOI)000316693600005 ()23113731 (PubMedID)
    Available from: 2013-01-19 Created: 2013-01-19 Last updated: 2017-12-06
    5. Travel-associated faecal colonization with ESBL-producing Enterobacteriaceae: incidence and risk factors
    Open this publication in new window or tab >>Travel-associated faecal colonization with ESBL-producing Enterobacteriaceae: incidence and risk factors
    Show others...
    2013 (English)In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 68, no 9, p. 2144-2153Article in journal (Refereed) Published
    Abstract [en]

    Objectives To study the acquisition of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) among the faecal flora during travel, with a focus on risk factors, antibiotic susceptibility and ESBL-encoding genes.

    Methods An observational prospective multicentre cohort study of individuals attending vaccination clinics in south-east Sweden was performed, in which the submission of faecal samples and questionnaires before and after travelling outside Scandinavia was requested. Faecal samples were screened for ESBL-PE by culturing on ChromID ESBL and an in-house method. ESBL-PE was confirmed by phenotypic and genotypic methods. Susceptibility testing was performed with the Etest. Individuals who acquired ESBL-PE during travel (travel-associated carriers) were compared with non-carriers regarding risk factors, and unadjusted and adjusted ORs after manual stepwise elimination were calculated using logistic regression.

    Results Of 262 enrolled individuals, 2.4% were colonized before travel. Among 226 evaluable participants, ESBL-PE was detected in the post-travel samples from 68 (30%) travellers. The most important risk factor in the final model was the geographic area visited: Indian subcontinent (OR 24.8, P < 0.001), Asia (OR 8.63, P < 0.001) and Africa north of the equator (OR 4.94, P  = 0.002). Age and gastrointestinal symptoms also affected the risk significantly. Multiresistance was seen in 77 (66%) of the ESBL-PE isolates, predominantly a combination of reduced susceptibility to third-generation cephalosporins, trimethoprim/sulfamethoxazole and aminoglycosides. The most common species and ESBL-encoding gene were Escherichia coli (90%) and CTX-M (73%), respectively.

    Conclusion Acquisition of multiresistant ESBL-PE among the faecal flora during international travel is common. The geographical area visited has the highest impact on ESBL-PE acquisition.

    Place, publisher, year, edition, pages
    Oxford University Press, 2013
    Keywords
    travel medicine, CTX-M, antibiotic resistance
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-97437 (URN)10.1093/jac/dkt167 (DOI)000323424100029 ()23674762 (PubMedID)
    Note

    Funding Agencies|Medical Research Council of Southeast Sweden|FORSS-12368FORSS-36511FORSS-87551|ALF grants, Ostergotland County Council|LIO-10885LIO-16741LIO-61341LIO-127281|

    Available from: 2013-09-12 Created: 2013-09-12 Last updated: 2017-12-06Bibliographically approved
  • 85203.
    Östholm Balkhed, Åse
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Microbiology.
    Tärnberg, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Monstein, Hans-Jurg
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Microbiology.
    Hällgren, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Infectious Diseases in Östergötland.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Infectious Diseases in Östergötland.
    Nilsson, Lennart E
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    In vitro susceptibility of CTX-M-producing Escherichia coli to non-beta-lactam agentsManuscript (preprint) (Other academic)
    Abstract [en]

    Background: The objective of this study was to investigate the in vitro activity of different antibiotics against CTX-M-producing Escherichia coli, to determine the occurrence of multiresistance and plasmid mediated quinolone resistance among these isolates.

    Methods: A total of 198 isolates of E. coli with ESBL phenotype and mainly CTX-M genotype, were studied. The MICs for amikacin, chloramphenicol, ciprofloxacin, colistin, fosfomycin, gentamicin, nalidixic acid, nitrofurantoin, tigecycline, tobramycin, trimethoprim and trimethoprim-sulphamethoxazole were determined with the Etest. Susceptibility was defined according to the breakpoints of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). MIC(50) and MIC(90) values were calculated.

    Results: ≥95% of isolates were susceptible to amikacin, nitrofurantoin, colistin, tigecyclin, and fosfomycin. CTX-M group 9 was more susceptible than CTX-M group 1 to ciprofloxacin, gentamicin, and tobramycin. 68% of the isolates were multiresistant, and the most common multi-resistance pattern was ESBL-phenotype with decreased susceptibility to trimethoprim, trimethoprim-sulphamethoxazol, ciprofloxacin, gentamicin and  tobramycin. Only one isolate carried a qnrS1-gene, nine isolates carried aac(6’)-Ib-cr.

    Conclusions: The high frequency of multi-resistance found in this study is alarming and it is urgent to find strategies to limit the emergence and spread of these multi-resistant strains.

  • 85204.
    Östholm Balkhed, Åse
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Infectious Diseases in Östergötland.
    Tärnberg, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences.
    Monstein, Hans-Jürg
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Hällgren, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Infectious Diseases in Östergötland.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Infectious Diseases in Östergötland.
    Nilsson, Lennart E.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    High frequency of co-resistance in CTX-M-producing Escherichia coli to non-beta-lactam antibiotics, with the exception of amikacin, nitrofurantoin, colistin, tigecycline, and fosfomycin, in a county of Sweden2013In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 45, no 4, p. 271-278Article in journal (Refereed)
    Abstract [en]

    Background: The objective of this study was to investigate the in vitro activity of different antibiotics against CTX-M-producing Escherichia coli in a county of Sweden, and to determine the occurrence of multi-resistance and plasmid- mediated quinolone resistance among these isolates. Methods: A total of 198 isolates of E. coli with extended-spectrum beta-lactamase (ESBL) phenotype and mainly CTX-M genotype were studied. The minimum inhibitory concentrations (MICs) for amikacin, chloramphenicol, ciprofloxacin, colistin, fosfomycin, gentamicin, nalidixic acid, nitrofurantoin, tigecycline, tobramycin, trimethoprim, and trimethoprim-sulfamethoxazole were determined with the Etest. Susceptibility was defined according to the breakpoints of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). MIC(50) and MIC(90) values were calculated. Results: Ninety-five percent or more of the isolates were susceptible to amikacin, nitrofurantoin, colistin, tigecycline, and fosfomycin. CTX-M group 9 was more susceptible than CTX-M group 1 to ciprofloxacin, gentamicin, and tobramycin. Sixty-eight percent of the isolates were multi-resistant, and the most common multi-resistance pattern was ESBL phenotype with decreased susceptibility to trimethoprim, trimethoprim-sulfamethoxazole, ciprofloxacin, gentamicin, and tobramycin. Only 1 isolate carried a qnrS1 gene, but 37% carried aac(6')-Ib-cr. Conclusions: A high frequency of co-resistance between ESBL-producing E. coli and non-beta-lactam antibiotics was seen. On the other hand, very high susceptibility was seen for amikacin, nitrofurantoin, colistin, tigecycline, and fosfomycin. These data support the replacement of gentamicin and tobramycin, normally used in Sweden, with amikacin, for severe infections.

  • 85205.
    Östholm Balkhed, Åse
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Infectious Diseases in Östergötland.
    Tärnberg, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Nilsson, Maud
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Johansson, Anita
    Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Microbiology.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Monstein, Hans-Jurg
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Molecular Biological Techniques.
    Nilsson, Lennart E
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae and trends in antibiotic consumption in a county of Sweden2010In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 42, no 11-12, p. 831-838Article in journal (Refereed)
    Abstract [en]

    In the last decade extended-spectrum beta-lactamase (ESBL)-producing bacteria have become an increasing problem. Our aims were to investigate the prevalence of ESBL-producing Enterobacteriaceae and trends in antibiotic use in the county of Ostergotland, Sweden. From 2002 through 2007 there were 224 ESBL-producing Escherichia coli and 23 Klebsiella pneumoniae isolates with an ESBL-phenotype identified among all Enterobacteriaceae isolated at the clinical laboratory. Trends in antibiotic consumption expressed as defined daily doses (DDD) per 1000 inhabitants and day (DID) were studied. The prevalence of ESBL-producing isolates among Enterobacteriaceae in our region is still low (andlt; 1%). Patients with ESBL-producing E. coli increased significantly (p andlt; 0.001) from 5 in y 2002 to 47 in y 2007. CTX-M group 1 was the dominant enzyme group in both E. coli and K. pneumoniae. Antibiotic susceptibility testing of ciprofloxacin, gentamicin and trimethoprim-sulfamethoxazole revealed that 58% of E. coli and 50% of K. pneumoniae isolates were multi-resistant. Antibiotic use remained unchanged from 2001 through 2009, but there was a trend towards increased use of drugs with low ESBL selection potential, which was probably due to the increased prevalence of ESBL producers.

  • 85206.
    Östholm Balkhed, Åse
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Tärnberg, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Nilsson, Maud
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Nilsson, Lennart E.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Hällgren, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Travel-associated faecal colonization with ESBL-producing Enterobacteriaceae: incidence and risk factors2013In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 68, no 9, p. 2144-2153Article in journal (Refereed)
    Abstract [en]

    Objectives To study the acquisition of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) among the faecal flora during travel, with a focus on risk factors, antibiotic susceptibility and ESBL-encoding genes.

    Methods An observational prospective multicentre cohort study of individuals attending vaccination clinics in south-east Sweden was performed, in which the submission of faecal samples and questionnaires before and after travelling outside Scandinavia was requested. Faecal samples were screened for ESBL-PE by culturing on ChromID ESBL and an in-house method. ESBL-PE was confirmed by phenotypic and genotypic methods. Susceptibility testing was performed with the Etest. Individuals who acquired ESBL-PE during travel (travel-associated carriers) were compared with non-carriers regarding risk factors, and unadjusted and adjusted ORs after manual stepwise elimination were calculated using logistic regression.

    Results Of 262 enrolled individuals, 2.4% were colonized before travel. Among 226 evaluable participants, ESBL-PE was detected in the post-travel samples from 68 (30%) travellers. The most important risk factor in the final model was the geographic area visited: Indian subcontinent (OR 24.8, P < 0.001), Asia (OR 8.63, P < 0.001) and Africa north of the equator (OR 4.94, P  = 0.002). Age and gastrointestinal symptoms also affected the risk significantly. Multiresistance was seen in 77 (66%) of the ESBL-PE isolates, predominantly a combination of reduced susceptibility to third-generation cephalosporins, trimethoprim/sulfamethoxazole and aminoglycosides. The most common species and ESBL-encoding gene were Escherichia coli (90%) and CTX-M (73%), respectively.

    Conclusion Acquisition of multiresistant ESBL-PE among the faecal flora during international travel is common. The geographical area visited has the highest impact on ESBL-PE acquisition.

  • 85207.
    Östlin, Johan
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Assembly technology.
    Effectiveness in the Closed-Loop Supply Chain: A Study Regarding Remanufacturing2005In: EEE International Engineering Management Conference IEMC 2005,2005, 2005Conference paper (Refereed)
  • 85208.
    Östlin, Johan
    Linköping University, Department of Management and Engineering, Assembly technology . Linköping University, The Institute of Technology.
    Material and Process Complexity: Implications for Remanufacturing2005In: Proceedings of EcoDesign-05, 4th International Symposium on Environmentally Conscious Design and Inverse Manufacturing, Tokyo, Japan, 12-14 December, 2005, p. 154-161Conference paper (Other academic)
    Abstract [en]

    Remanufacturing is a complex business. Many different factors and decisions affect the performance of a remanufacturing process. In this paper, four different remanufacturing cases are analyzed in how they manage these complexities. Based on the generic remanufacturing process, remanufacturing can be divided into the five phases of pre-disassembly, disassembly, reprocessing, reassembly and post-assembly. In each of these phases, a discussion is made regarding the specific factors and decisions that influence the order and purpose of the individual operations.

  • 85209.
    Östlin, Johan
    Linköping University, Department of Management and Engineering, Assembly technology . Linköping University, The Institute of Technology.
    On Remanufacturing Systems: Analysing and Managing Material Flows and Remanufacturing Processes2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of remanufacturing is to retrieve a product’s inherent value when the product no longer fulfils the user’s desired needs. By taking advantage of this inherent value through different product recovery alternatives, there is a potential for both economically and environmental advantageous recovery of products.

    Remanufacturing is a complex business due to the high degree of uncertainty in the production process, mainly caused by two factors: the quantity and the quality of returned products. These factors have implications both on the external processes, e.g. coordinating input of returned products with the demand for remanufactured products, as well as the internal processes that coordinates the operations within the factory walls. This additional complexity needs to be considered when organising the remanufacturing system.

    The objective of this dissertation is to explore how remanufacturing companies can become more competitive through analysing and managing material flows and remanufacturing processes.

    The first issue discussed in this dissertation is the drivers that make companies interested in remanufacturing products in the first place. The conclusion is that the general drivers are profit, company policy and the environmental drivers. In a general sense, the profit motivation is the most prevalent business driver, but still there are situations where this motivation is secondary to policy and environmental drivers. Secondly, the need to balance the supply of returned products with the demand for remanufactured products shows that the possible remanufacturing volumes for a product are dependent on the shape of the supply and demand distributions. By using a product life cycle perspective, the supply and demand situations can be foreseen and support is given on possible strategies in these different supply and demand situations. Thirdly, how used products are gathered from customers is categorised by seven different customer relationship types. These types all have different effects on the remanufacturing system, and the characteristics of these relationships are disused in detail.

    When considering the remanufacturing process within the factory walls, a generic remanufacturing process was developed that divides the remanufacturing process into five different phases; pre-disassembly, disassembly, reprocessing, reassembly and the post-assembly phase. These different phases are separated by three different key decision points in the process that also have a major impact on the material planning of the process. For the remanufacturing material planning and production planning, the possibility to apply lean principles can be difficult. One foundation for implementing lean principles in new production is the existence of standardised processes that are stable and predictable. In the remanufacturing system, the possibilities to realise a predictable process is limited by the “normal” variations in quantity and the quality of the returned cores. Even though lean principles can be problematic to implement in the remanufacturing environment, this dissertation proposes a number of solutions that can be used to make the remanufacturing process leaner.

    List of papers
    1. Business drivers for remanufacturing
    Open this publication in new window or tab >>Business drivers for remanufacturing
    2008 (English)In: Proceedings of CIRP Life Cycle Engineering Seminar , 15th edition, Sidney, Australia, 2008, p. 581-586Conference paper, Published paper (Other academic)
    Abstract [en]

    In this paper the aim is to explore what drives companies to get involved in the remanufacturing operations. In the previous research there have been numerous case studies that partly have addresses the issue of why a company is getting involved in remanufacturing. A main conclusion from this study is that the motives for remanufacturing a product are very case-dependent e.g. in what industry sector the company have business in and what product type being remanufactured. In this study it is found that there are mainly three general business drivers for remanufacturing. These are: profit, company policy and the environmental drivers. For remanufacturing to be successful, these drivers are crucial, although it does not propose that all of theses drivers have to be present for a successful remanufacturing system. When combining the profit, policy and environmental factors there is a great potential for a win-win-win situation, meaning that the customer gets a quality product at a lower price, the manufacturer reduces their manufacturing costs and the environment gains from a lower environmental impact.

    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-13320 (URN)1877040673 (ISBN)
    Conference
    15th CIRP International Conference on Life Cycle Engineering
    Available from: 2008-05-27 Created: 2008-05-27 Last updated: 2016-04-12
    2. Product life-cycle implications for remanufacturing strategies
    Open this publication in new window or tab >>Product life-cycle implications for remanufacturing strategies
    2009 (English)In: Journal of Cleaner Production, ISSN 0959-6526, Vol. 17, no 11, p. 999-1009Article in journal (Refereed) Published
    Abstract [en]

    For remanufacturing to be successful, there is a need to gain information on future market needs of remanufactured products, and match this to information on the magnitude of return flows. One of the major issues impacting remanufacturing is in the difficulty of obtaining used products (cores) that are suitable for remanufacturing. The timing and quantity of product returns is dependent on the type of product. Factors such as the mean product lifetime, rate of technical innovation, and failure rate of components all influence the return rate of products from end-of-use and end-of-life. The balance between product returns and demand for remanufactured products is a function of many variables, where the rate of technological innovation and the expected life of a product are the major influencing characteristics. The main contribution of this paper is the support that is provided in different supply and demand situations. By using a product life-cycle perspective, the supply and demand situations can be foreseen, and support given regarding possible strategies in these situations.

    Keywords
    Remanufacturing; Component cannibalization; Product life-cycle; Remanufacturing strategies
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-13321 (URN)10.1016/j.jclepro.2009.02.021 (DOI)
    Note

    Original Publication: Johan Östlin, Erik Sundin and Mats Björkman, Product Lifecycle Implications for Remanufacturing Strategies, 2009, Journal of Cleaner Production, (17), 11, 999-1009. http://dx.doi.org/10.1016/j.jclepro.2009.02.021 Copyright: Elsevier Science B.V., Amsterdam. http://www.elsevier.com/

    Available from: 2009-06-12 Created: 2009-03-09 Last updated: 2016-04-12Bibliographically approved
    3. Importance of Closed Loop Supply Chain Relationships for Product Remanufacturing
    Open this publication in new window or tab >>Importance of Closed Loop Supply Chain Relationships for Product Remanufacturing
    2008 (English)In: International Journal of Production Economics, ISSN 0925-5273, E-ISSN 1873-7579, Vol. 115, no 2, p. 336-348Article in journal (Refereed) Published
    Abstract [en]

    Remanufacturing is an industrial process where used products are restored (remanufactured) to useful life. In comparison to manufacturing, remanufacturing has some general characteristics that complicate the supply chain and production system. For example, a company must collect the used products from the customers, and thus the timing and quality of the used products are usually unknown. Remanufacturing companies are dependent on customers to return used products (cores). In this paper, seven different types of closed-loop relationships for gathering cores for remanufacturing have been identified. The relationships identified are ownership-based, service-contract, direct-order, deposit-based, credit-based, buy-back and voluntary-based relationships. Building theory around these different types of relationships, several disadvantages and advantages are described in the paper. By exploring these relationships, a better understanding can be gained about the management of the closed-loop supply chain and remanufacturing.

    Keywords
    Product recovery, Reverse logistics, Relationship marketing
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-13322 (URN)10.1016/j.ijpe.2008.02.020 (DOI)
    Note
    Original Publication: Johan Östlin, Erik Sundin and Mats Björkman, Importance of Closed Loop Supply Chain Relationships for Product Remanufacturing, 2008, International Journal of Production Economics, (115), 2, 336-348. http://dx.doi.org/10.1016/j.ijpe.2008.02.020 Copyright: Elsevier Science B.V., Amsterdam. http://www.elsevier.com/ Available from: 2009-06-14 Created: 2009-03-09 Last updated: 2017-12-13Bibliographically approved
    4. Material and Process Complexity: Implications for Remanufacturing
    Open this publication in new window or tab >>Material and Process Complexity: Implications for Remanufacturing
    2005 (English)In: Proceedings of EcoDesign-05, 4th International Symposium on Environmentally Conscious Design and Inverse Manufacturing, Tokyo, Japan, 12-14 December, 2005, p. 154-161Conference paper, Published paper (Other academic)
    Abstract [en]

    Remanufacturing is a complex business. Many different factors and decisions affect the performance of a remanufacturing process. In this paper, four different remanufacturing cases are analyzed in how they manage these complexities. Based on the generic remanufacturing process, remanufacturing can be divided into the five phases of pre-disassembly, disassembly, reprocessing, reassembly and post-assembly. In each of these phases, a discussion is made regarding the specific factors and decisions that influence the order and purpose of the individual operations.

    Series
    Keywords
    assembling, manufacturing processes, recycling, disassembly, generic remanufacturing process, process complexity, reassembly, reprocessing
    National Category
    Engineering and Technology
    Identifiers
    urn:nbn:se:liu:diva-13323 (URN)10.1109/ECODIM.2005.1619192 (DOI)
    Available from: 2008-05-27 Created: 2008-05-27 Last updated: 2009-06-09
    5. Lean Remanufacturing: a Study Regarding Material Flow
    Open this publication in new window or tab >>Lean Remanufacturing: a Study Regarding Material Flow
    2008 (English)Article in journal (Refereed) Submitted
    National Category
    Engineering and Technology
    Identifiers
    urn:nbn:se:liu:diva-13324 (URN)
    Available from: 2008-05-27 Created: 2008-05-27 Last updated: 2016-04-12
    6. Lean Production Principles in Remanufacturing: A Case Study at a Toner Cartridge Remanufacturer
    Open this publication in new window or tab >>Lean Production Principles in Remanufacturing: A Case Study at a Toner Cartridge Remanufacturer
    2007 (English)In: Proceedings of IEEE International Symposium on Electronics and the Environment, IEEE , 2007, p. 216-221Conference paper, Published paper (Other academic)
    Abstract [en]

    Scandi-Toner AB works with remanufacturing of toner cartridges; both color cartridges and black cartridges The company Scandi-Toner and the remanufacturing industry in general do, compared to ordinary manufacturing, have some specific characteristics that might limit the possibilities to apply lean production principles, due to the high degree of uncertainty in the production process. These uncertainties are mainly caused by two factors: the quantity and quality of returned cores. Overall, these characteristics make the remanufacturing material flow harder to control. Hence the purpose of this paper is to analyze if lean productions principles for material flow can be applied in a remanufacturing environment, and especially at the Swedish remanufacturer Scandi-Toner AB. The analysis shows that lean production principles can be applied in remanufacturing environments, with some constraints. For the case company the study showed that for example the workshop layout could be improved significantly according to lean production principles. The one major conclusion that can be drawn from this analysis are that the inherent characteristics of variable processing times and uncertainty in materials recovered have the major negative impact for implementing a lean production process. Vice versa, given an accurate supply of parts for reassembly, all the appropriate principles of a lean production material flow can be implemented in the phases of reassembly and testing.

    Place, publisher, year, edition, pages
    IEEE, 2007
    Series
    IEEE International Symposium on Electronics and the Environment, ISSN 1095-2020
    Keywords
    Lean Productlon, Value stream mapping, Rapid Plant Assesment, Remanufacturing
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-13325 (URN)10.1109/ISEE.2007.369397 (DOI)000248562400042 ()1-4244-0861-X (ISBN)
    Conference
    15th International Symposium on Electronics and the Environment (ISEE) , May 7-10, Orlando, USA
    Available from: 2008-05-27 Created: 2008-05-27 Last updated: 2012-08-23
    7. Material handling in the remanufacturing industry: a case study of a diesel engine remanufacturing process
    Open this publication in new window or tab >>Material handling in the remanufacturing industry: a case study of a diesel engine remanufacturing process
    2005 (English)In: Proceedings of CIRP Life Cycle Engineering Seminar, 12th edition, April 3-5, Laboratorie 3S, Grenoble France, 2005Conference paper, Published paper (Other academic)
    National Category
    Engineering and Technology
    Identifiers
    urn:nbn:se:liu:diva-13326 (URN)
    Available from: 2008-05-27 Created: 2008-05-27 Last updated: 2009-06-09
  • 85210.
    Östlin, Johan
    et al.
    Linköping University, Department of Management and Engineering, Assembly technology. Linköping University, The Institute of Technology.
    Ekholm, Helene
    Linköping University, Department of Management and Engineering. Linköping University, The Institute of Technology.
    Lean Production Principles in Remanufacturing: A Case Study at a Toner Cartridge Remanufacturer2007In: Proceedings of IEEE International Symposium on Electronics and the Environment, IEEE , 2007, p. 216-221Conference paper (Other academic)
    Abstract [en]

    Scandi-Toner AB works with remanufacturing of toner cartridges; both color cartridges and black cartridges The company Scandi-Toner and the remanufacturing industry in general do, compared to ordinary manufacturing, have some specific characteristics that might limit the possibilities to apply lean production principles, due to the high degree of uncertainty in the production process. These uncertainties are mainly caused by two factors: the quantity and quality of returned cores. Overall, these characteristics make the remanufacturing material flow harder to control. Hence the purpose of this paper is to analyze if lean productions principles for material flow can be applied in a remanufacturing environment, and especially at the Swedish remanufacturer Scandi-Toner AB. The analysis shows that lean production principles can be applied in remanufacturing environments, with some constraints. For the case company the study showed that for example the workshop layout could be improved significantly according to lean production principles. The one major conclusion that can be drawn from this analysis are that the inherent characteristics of variable processing times and uncertainty in materials recovered have the major negative impact for implementing a lean production process. Vice versa, given an accurate supply of parts for reassembly, all the appropriate principles of a lean production material flow can be implemented in the phases of reassembly and testing.

  • 85211.
    Östlin, Johan
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Assembly technology.
    Lindahl, Mattias
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Environmental Technique and Management.
    Sundin, Erik
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Assembly technology.
    Managing Functional Sales Systems - Important Aspects for Making Functional Sales an Effective Business System2005In: 10th International Conference of Sustainable Innovation,,2005, 2005Conference paper (Refereed)
  • 85212.
    Östlin, Johan
    et al.
    Linköping University, Department of Management and Engineering, Assembly technology . Linköping University, The Institute of Technology.
    Mähl, M.
    Sundin, Erik
    Linköping University, Department of Management and Engineering, Assembly technology . Linköping University, The Institute of Technology.
    Björkman, Mats
    Linköping University, Department of Management and Engineering, Assembly technology . Linköping University, The Institute of Technology.
    Lean Remanufacturing: a Study Regarding Material Flow2008Article in journal (Refereed)
  • 85213.
    Östlin, Johan
    et al.
    Linköping University, Department of Management and Engineering, Assembly technology. Linköping University, The Institute of Technology.
    Sundin, Erik
    Linköping University, Department of Management and Engineering, Assembly technology. Linköping University, The Institute of Technology.
    Björkman, Mats
    Linköping University, Department of Management and Engineering, Assembly technology. Linköping University, The Institute of Technology.
    Business drivers for remanufacturing2008In: Proceedings of CIRP Life Cycle Engineering Seminar , 15th edition, Sidney, Australia, 2008, p. 581-586Conference paper (Other academic)
    Abstract [en]

    In this paper the aim is to explore what drives companies to get involved in the remanufacturing operations. In the previous research there have been numerous case studies that partly have addresses the issue of why a company is getting involved in remanufacturing. A main conclusion from this study is that the motives for remanufacturing a product are very case-dependent e.g. in what industry sector the company have business in and what product type being remanufactured. In this study it is found that there are mainly three general business drivers for remanufacturing. These are: profit, company policy and the environmental drivers. For remanufacturing to be successful, these drivers are crucial, although it does not propose that all of theses drivers have to be present for a successful remanufacturing system. When combining the profit, policy and environmental factors there is a great potential for a win-win-win situation, meaning that the customer gets a quality product at a lower price, the manufacturer reduces their manufacturing costs and the environment gains from a lower environmental impact.

  • 85214.
    Östlin, Johan
    et al.
    Linköping University, Department of Management and Engineering, Assembly technology . Linköping University, The Institute of Technology.
    Sundin, Erik
    Linköping University, Department of Management and Engineering, Assembly technology . Linköping University, The Institute of Technology.
    Björkman, Mats
    Linköping University, Department of Management and Engineering, Assembly technology . Linköping University, The Institute of Technology.
    Importance of Closed Loop Supply Chain Relationships for Product Remanufacturing2008In: International Journal of Production Economics, ISSN 0925-5273, E-ISSN 1873-7579, Vol. 115, no 2, p. 336-348Article in journal (Refereed)
    Abstract [en]

    Remanufacturing is an industrial process where used products are restored (remanufactured) to useful life. In comparison to manufacturing, remanufacturing has some general characteristics that complicate the supply chain and production system. For example, a company must collect the used products from the customers, and thus the timing and quality of the used products are usually unknown. Remanufacturing companies are dependent on customers to return used products (cores). In this paper, seven different types of closed-loop relationships for gathering cores for remanufacturing have been identified. The relationships identified are ownership-based, service-contract, direct-order, deposit-based, credit-based, buy-back and voluntary-based relationships. Building theory around these different types of relationships, several disadvantages and advantages are described in the paper. By exploring these relationships, a better understanding can be gained about the management of the closed-loop supply chain and remanufacturing.

  • 85215.
    Östlin, Johan
    et al.
    Linköping University, Department of Management and Engineering, Assembly technology. Linköping University, The Institute of Technology.
    Sundin, Erik
    Linköping University, Department of Management and Engineering, Assembly technology. Linköping University, The Institute of Technology.
    Björkman, Mats
    Linköping University, Department of Management and Engineering, Assembly technology. Linköping University, The Institute of Technology.
    Product life-cycle implications for remanufacturing strategies2009In: Journal of Cleaner Production, ISSN 0959-6526, Vol. 17, no 11, p. 999-1009Article in journal (Refereed)
    Abstract [en]

    For remanufacturing to be successful, there is a need to gain information on future market needs of remanufactured products, and match this to information on the magnitude of return flows. One of the major issues impacting remanufacturing is in the difficulty of obtaining used products (cores) that are suitable for remanufacturing. The timing and quantity of product returns is dependent on the type of product. Factors such as the mean product lifetime, rate of technical innovation, and failure rate of components all influence the return rate of products from end-of-use and end-of-life. The balance between product returns and demand for remanufactured products is a function of many variables, where the rate of technological innovation and the expected life of a product are the major influencing characteristics. The main contribution of this paper is the support that is provided in different supply and demand situations. By using a product life-cycle perspective, the supply and demand situations can be foreseen, and support given regarding possible strategies in these situations.

  • 85216.
    Östlin, Johan
    et al.
    Linköping University, Department of Management and Engineering, Assembly technology . Linköping University, The Institute of Technology.
    Svensson, R.
    Material handling in the remanufacturing industry: a case study of a diesel engine remanufacturing process2005In: Proceedings of CIRP Life Cycle Engineering Seminar, 12th edition, April 3-5, Laboratorie 3S, Grenoble France, 2005Conference paper (Other academic)
  • 85217.
    Östlin, Johan
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Management and Engineering.
    Östlin, Johan
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Assembly technology.
    Lindahl, Mattias
    Linköping University, The Institute of Technology. Linköping University, Department of Management and Engineering.
    Lindahl, Mattias
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Environmental Technique and Management.
    Sundin, Erik
    Linköping University, The Institute of Technology. Linköping University, Department of Management and Engineering.
    Sundin, Erik
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Assembly technology.
    Managing Functional Sales Systems - Important Aspects for Making Functional Sales an Effective Business System2006In: 10th International Conference of Sustainable Innovation,2006, Linköping: Linköpings universitet , 2006Conference paper (Refereed)
  • 85218.
    Östling, Ann
    et al.
    Landstinget Västmanland.
    Weitz, Per
    Landstinget Västmanland.
    Bäckman, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Department of Molecular and Clinical Medicine.
    Garpenby, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Öppna prioriteringar i Landstinget Västmanland2010Report (Other academic)
    Abstract [sv]

    Landstinget Västmanland genomförde under 2009 en öppen prioriteringsprocess. I landstinget hade en medvetenhet vuxit fram bland politiker, högre tjänstemän och medarbetare om att de traditionella metoderna ‒ såsom att förändra strukturer, effektivisera och rationalisera ‒ inte räckte som verktyg för en bra resursfördelning.

    Motivet för landstinget att påbörja detta arbete var främst de stora utmaningar som väntade i form av ökade medicinska möjligheter som gör att fler människor kan bli föremål för insatser från hälso- och sjukvården. Ett medel för landstinget att möta detta var öppna prioriteringar – såväl vertikalt (inom verksamheter och specialiteter) som horisontellt (mellan verksamheter och specialiteter). Samtliga partier inom såväl majoritet som opposition ställde sig bakom processen. Syftet med prioriteringsprocessen var att den skulle bidra till en mer rättvis öppen fördelning av landstingets tillgängliga resurser. Arbetet med "Öppna prioriteringar", som processen kom att kallas, ingick också som en del av en större förändringsprocess inom landstinget – som gick under namnet HOPP (Helhet Och PatientPerspektiv.

    I denna rapport presenteras planeringen och genomförandet av prioriteringsprocessen i Landstinget Västmanland 2009/2010. Beskrivningen bygger till största delen på erfarenheter sammanställda av landstingets två projektledare. I Appendix presenteras även delar av den uppföljning av arbetet som Prioriteringscentrum gjorde genom enkäter till olika aktörer i prioriteringsarbetet.

    Ett viktigt inslag i förberedelsearbetet var att genomföra ett antal studiebesök i landsting som tidigare genomfört prioriteringsarbeten, såsom Västerbottens läns landsting, Landstinget Kronoberg och Jämtlands läns landsting. Avsikten var att ta fasta på deras erfarenheter och överväga dessa inför byggandet av den egna prioriteringsprocessen. Det som kom att utmärka Västmanlands prioriteringsprocess var ansträngningarna att skapa en process där intern öppenhet och interaktion mellan många olika parter stod i fokus; verksamhetsföreträdare, politiker och koncernledningen. Förutsättningar för insyn och dialog skapades genom att de tillsammans arbetade med förslagen fram till slutresultatet.

    Den 15 januari 2010 fattade Landstingsstyrelsen i Västmanland slutligen det formella beslutet om vilka objekt som skulle ingå i listan över öppna prioriteringar som arbetats fram. Beslutsunderlaget omfattade såväl effektiviseringsobjekt som prioriteringsobjekt, motsvarande 2,4 procent av nettobudgeten, i siffror 106 miljoner kronor.

     

    Den lista över prioriteringsobjekt som slutligen presenterades för verksamheterna och för allmänheten innehöll ca 160 objekt fördelade under fyra olika rubriker:

    1.  Objekt för bortprioritering

    2.  Objekt med lägre ambitionsnivå alternativt högre indikationsnivå

    3.  Objekt som underlag för dialog med framför allt kommunerna

    4.  Objekt som rörde avgifter och bidrag.

  • 85219.
    Östling, Ann-Katrine
    et al.
    Rehabiliteringsmedicinska klinkken, Sandvikens sjukhus, Landstinget i Gävleborg.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Behandling av beteendeproblem2014In: Klinisk neuropsykologi / [ed] Håkan Nyman och Aniko Bartfai, Lund: Studentlitteratur AB, 2014, 2, p. 411-423Chapter in book (Other academic)
  • 85220.
    Östling, Johan
    et al.
    Lunds universitet, Lund, Sverige.
    Bernhardsson, Katarina
    Lunds universitet, Lund, Sverige.
    Björkman, Jenny
    Riksbankens jubileumsfond, Stockholm, Sverige.
    Olsson, Jesper
    Linköping University, Department of Culture and Communication, Language and Literature. Linköping University, Faculty of Arts and Sciences.
    Kunskapens nya rörelser: framtidens humanistiska och samhällsvetenskapliga samverkan2016Book (Other academic)
  • 85221.
    Östlund, Britt
    Linköping University, The Tema Institute, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Gammal är äldst: En studie om teknik i äldre människors liv1995Doctoral thesis, monograph (Other academic)
    Abstract [en]

    This thesis deals with the role of technology in elderly peoples everydaylife, to what extent technology can facilitate or prevent them from havinga social life. The intension is to describe the role of technology from olderpeoples own perspective. Four activities in everyday life in which technology is involved are emphasised: social contacts, security, information and distribution of services and goods. Technology related to these activities are telephones, televisions, safety alarms and homeshopping-terminals. The aim of the study is to describe how these fourtechnologies are used by the elderly and what function and meaning theygive to the technology; and to describe old peoples attitudes to newtechnology in general and to the home shopping-terminals specificallyand how this technology affects their everyday life contacts and routins.The main emphirical work consists of recurrent interviews andobservations of a group of old people living in a city (Malmo) and in a rural district (Kinda).

    The results show that the function of technologies such as the telephoneand the television becomes more specific and even more important to connect the home with the outside world. By this kind of technology the interviewees remain socially integrated but, which is one of their expressed preferences, with no demands on social participation. A growing need of privacy is succesfully combined with an increased need of security and help. Technology is not used to establish new contacts but relations to relatives and friends are maintained. The attitude and acceptance of new technology in general is positive due to their lifelong experiences of improvements. The difference is that they are not that interested anymore, referring to an increased pragmatic vue towards modernity, to a limited future-perspective and to their basic values.

  • 85222.
    Östlund, G
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Cedersund, E
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Hensing, Gunnel
    It was really nice to have someone: Lay people with musculoskeletal disorders request supportive relationships in rehabilitation2001In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 29, no 4, p. 285-291Article in journal (Refereed)
    Abstract [en]

    Aims : To explore the lay person's perspective on the rehabilitation process. Methods : A total of 20 interviews were conducted with women and men who had recent or more distant experience of sickness absence with musculoskeletal diagnoses. Grounded theory was used, which includes an inductive approach and theoretical sampling. The interviews focused on the individuals' own stories and experiences of factors that promoted or hindered the rehabilitation process. Results : The interviewees emphasized how and by whom they had been treated rather than what type of rehabilitation programmes they had attended. They focused on the importance of supportive relationships from the private, occupational, and health care arenas. The relationship with rehabilitation agents (professionals who implemented rehabilitation) was described as having either supportive or non-supportive qualities. Based on the interviewees' descriptions, a model was developed on the socioemotional qualities of the rehabilitation agent. The most promoting factor in the rehabilitation process was to have a professional mentor that is a rehabilitation agent who combines a supportive approach with individually chosen rehabilitation measures and goals. Conclusions : The lay person's perspective gave additional knowledge regarding rehabilitation and recovery from musculoskeletal disorders. The socioemotional qualities of the rehabilitation agents were emphasized by the interviewees and a model regarding these qualities was developed. This model needs to be tested further. A clinical implication of the present study is the need for rehabilitation agents to develop their communication skills further.

  • 85223.
    Östlund, Gunnel
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Att bedöma professionsspecifika kompetenser2012In: Utbildning - undervisning - utmaning - utveckling :: en rapport från LiU:s utvecklingskonferens 10 mars 2011 / [ed] Elinor Edvardsson Stiwne, Linköping: Linköpings universitet. Centrum för undervisning och lärande , 2012, p. 78-100Conference paper (Other academic)
    Abstract [en]

    As the critical friend concept, peer visit was introduced in our pedagogic course in higher education, in which each course participant was required to perform a peer teaching session visited by one teacher and two classmates;  and additionally paid two visits to others peer teaching sessions as an evaluator.Based on my own experiences, the processes of each other mutually evaluating and being evaluated have provided a great possibility for collectively developing our teaching knowledge. It also enhances self knowledge and confidence through the recognition of others. A regular base in the long run will definitely enhance professional development.

  • 85224.
    Östlund, Gunnel
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Social and Welfare Studies, Society, Diversity, Identity .
    Citizenship in Nordic Welfare States: Dynamics of choice duties, and participation in a changing Europe by B Hvinden and H Johansson2008In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 17, no 4, p. 407-407Article in journal (Other academic)
  • 85225.
    Östlund, Gunnel
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Social and Welfare Studies, Society, Diversity, Identity .
    Disability as prospect and hinder in work life2007In: Nordic Network on Disability Research NNDR,2007, NNDR , 2007, p. 171-171Conference paper (Other academic)
  • 85226.
    Östlund, Gunnel
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Personlig utveckling- vägen till profssionskompetens i socialt arbete2012In: Personlig och professionell utveckling inom socionomutbildningen: En antologi / [ed] Magnus Ottelid, Östersund: Institutionen för socialt arbete, Mittuniversitetet , 2012, p. 17-29Chapter in book (Other academic)
    Abstract [en]

    Det är med stor glädje som vi nu kan presentera ett första svenskt bidrag till att mer samlat presentera erfarenheter, studier och exempel från PPU-området för socionomutbildning i Sverige. Hela åtta universitet och högskolor är representerade i denna antologi och resultatet är både tänkvärt och inspirerande. Att det finns ett stort intresse och engagemang för dessa frågor är inte att ta miste på. Eftersom detta just var ett första försök att sammanställa bidrag från utbildningarna gavs alla stor frihet att välja vad de ville skriva om. Resultatet blev därmed lika vildvuxet och spretande som man kunde väntat. Men det är verkligen inget problem. Tvärtom! Det visar väl snarare hur komplext området är – det finns mycket att dokumentera och undersöka. Vi börjar här och får se var det tar vägen. Kanske en nästa antologi kan koncentrera sig på en eller ett par viktiga frågor som belyses från flera håll.

  • 85227.
    Östlund, Gunnel
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Promoting return to work: lay experiences after sickness absence with musculoskeletal diagnoses2002Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Musculoskeletal disorders constitute the greatest cause of sickness absence from work. Despite research and efforts at rehabilitation, sickness absence due to these disorders has not decreased, but has instead increased, particularly in women. Clients’ perceptions of care and rehabilitation, i.e. knowledge generated from a lay perspective, is a neglected area of research. This thesis deals with lay experiences of rehabilitation following sickness absence due to back, neck or shoulder problems, termed musculoskeletal disorders (MSD).

    Aim: The overall aim was to examine hindering and promoting processes in rehabilitation after sickness absence due to MSD from a lay perspective. Specific aims were to study how lay persons experience rehabilitation agents and rehabilitation activities (paper I), how they describe themselves and their experience in relation to work (paper II), the significance of the private arena regarding return to work (paper III), and how clients who have experienced sickness absence due to MSD perceive contact with rehabilitation agents (paper IV).

    Method: The study population in the four papers is part of a cohort of persons living in the same municipality and who in 1985 were aged 25-34 years and were sick-listed due to back, neck or shoulder diagnoses for 28 days or  more, n=213. During 1995, 148 persons in the cohort responded to a questionnaire, and in 1997-1998, 20 of these persons were interviewed concerning their experiences with rehabilitation. In papers I, II and III the qualitative method of Grounded Theory was used with a focus on creating an empirically-based theory concerning the area under study. Data collection was strategic and analysis of the tape-recorded interviews was done on a continual basis. How previously sick-listed persons experienced contact with professional rehabilitation agents in t he health care sector and social insurance office was investigated in paper IV. Factor analysis and multiple regression analysis were used to analyse the data in this study.

    Results: The interview study shed light on lay persons’ experiences with medical, social and work-related measures in rehabilitation, their perceptions of rehabilitation actors and family members in relation to rehabilitation, and their self-presentations. The descriptions of lay persons concerned three arenas, the health care arena, the occupational arena, and the private arena. Dilemmas and difficulties in these arenas were described, such as handling the duty to work, experiencing domestic strain, and the experience of lacking socioemotional support from significant persons during the rehabilitation process. In paper I some ideal types of rehabilitation agents emerged from the interviewees’ descriptions concerning the health care arena, and we called these the routine bureaucrat, the empathic administrator, the distant technician, and the professional mentor. The latter agent was requested and was described as a person who could provide socioemotional support, who had professional competence, and who could function as a unifying link during the rehabilitation process. The results from paper II showed that in their self-presentations, the interviewees expressed having a duty to work and that there were differences in how they handled this sense of duty. The selfpresentations contained descriptions of work as a part of personal identity and could be summarised in the following ideal types: the work manic, the workhorse, the workaholic and the relaxed worker. The latter used a strategy that can be considered to promote rehabilitation in that the individual himself/herself had control over his/her work and worked in accordance with his/her own needs rather than those of others. Paper III focused on the private arena. Different patterns were found in the experiences of men and women. Women related that their responsibility for the home and domestic work seldom left any time for themselves, including any time for rehabilitation. Men more often reported having time for themselves that could be used for leisure activities and rehabilitation. Some of the women said that they lacked socioemotional support from their partner and that they had a great deal of responsibility for housework, which seemed to be a hindrance in returning to work after sickness absence. Furthermore, these women, like most of the men, had little education, which could make finding other work alternatives more difficult. Based on the interviews, a hypothesis was developed regarding domestic strain that is related to the distribution of domestic work, the distribution of responsibility for the home, and the quality of the marital relationship. Paper IV dealt with clients’ perceptions of contact with rehabilitation agents in health care and the social insurance office. Three latent dimensions were found in the respondents’ ratings of these contacts: supportive treatment, distant treatment, and empowering treatment. Sex, disability pension status, mental health and diagnostic group were significantly related to how these dimensionswere rated. Women perceived the treatment from both types of rehabilitation agents as more supportive than men. Contact with the social insurance offices were rated higher by persons with disability pensions than by those who had returned to work. Men rated their contact with rehabilitation agents at social insurance offices high on the dimension of distant treatment. Respondents with mental health problems rated the contact as distant for both types of rehabilitation agents, but contact with health care was also scored low on the supportive dimension. Finally, respondents with neck/shoulder diagnoses rated contact with rehabilitation agents in health care as more empowering than was done by persons with back diagnoses.

    Conclusions: From a lay perspective rehabilitation following sickness absence due to MSD occured in three arenas, the health care arena, the occupational arena and the private arena, where the quality of relationships both with rehabilitation agents, persons at work and in one’s private life was described as important regarding the rehabilitation process. This thesis also showed that both sex and health were important factors regarding how lay persons’ perceived contacts with rehabilitation agents during the rehabilitation process following sickness absence due to MSD.

    List of papers
    1. It was really nice to have someone: Lay people with musculoskeletal disorders request supportive relationships in rehabilitation
    Open this publication in new window or tab >>It was really nice to have someone: Lay people with musculoskeletal disorders request supportive relationships in rehabilitation
    2001 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 29, no 4, p. 285-291Article in journal (Refereed) Published
    Abstract [en]

    Aims : To explore the lay person's perspective on the rehabilitation process. Methods : A total of 20 interviews were conducted with women and men who had recent or more distant experience of sickness absence with musculoskeletal diagnoses. Grounded theory was used, which includes an inductive approach and theoretical sampling. The interviews focused on the individuals' own stories and experiences of factors that promoted or hindered the rehabilitation process. Results : The interviewees emphasized how and by whom they had been treated rather than what type of rehabilitation programmes they had attended. They focused on the importance of supportive relationships from the private, occupational, and health care arenas. The relationship with rehabilitation agents (professionals who implemented rehabilitation) was described as having either supportive or non-supportive qualities. Based on the interviewees' descriptions, a model was developed on the socioemotional qualities of the rehabilitation agent. The most promoting factor in the rehabilitation process was to have a professional mentor that is a rehabilitation agent who combines a supportive approach with individually chosen rehabilitation measures and goals. Conclusions : The lay person's perspective gave additional knowledge regarding rehabilitation and recovery from musculoskeletal disorders. The socioemotional qualities of the rehabilitation agents were emphasized by the interviewees and a model regarding these qualities was developed. This model needs to be tested further. A clinical implication of the present study is the need for rehabilitation agents to develop their communication skills further.

    Keywords
    Lay; Experiences; Neck; Qualitative; Interviews; Rehabilitation; Shoulder; And; Low; Back; Pain
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25751 (URN)10.1080/140349401317115240 (DOI)10184 (Local ID)10184 (Archive number)10184 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13
    2. Developing a typology of the 'duty to work', as experienced by lay persons with musculoskeletal disorders
    Open this publication in new window or tab >>Developing a typology of the 'duty to work', as experienced by lay persons with musculoskeletal disorders
    2002 (English)In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 11, no 2, p. 150-158Article in journal (Refereed) Published
    Abstract [en]

    Musculoskeletal diagnoses account for the majority of cases of reduced work capacity. This article investigates lay persons' strategies in relation to work and musculoskeletal disorders. Twenty interviews were conducted and analysed using grounded theory. A typology of self-presentations was developed. The interviewees' self-presentations revealed a strong sense of a 'duty to work'. This sense of duty took four different forms, leading us to categorise persons expressing particular forms as workaholics, work manics, workhorses or relaxed workers. Relaxed workers seem to have the best prognosis for recovery as they had a confident self-agency and worked to fulfil their own needs rather than those of others. This was in contrast to work manics, with an uncertain self-agency and driven to work by others' needs. In conclusion, awareness of such linguistic forms as self-attributions and idiomatic phrases provides an opportunity to identify and talk about individual's self-agency and driving forces in the recovery process.

    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-26250 (URN)10754 (Local ID)10754 (Archive number)10754 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13
    3. Domestic strain: A hindrance in rehabilitation?
    Open this publication in new window or tab >>Domestic strain: A hindrance in rehabilitation?
    2004 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 18, no 1, p. 49-56Article in journal (Refereed) Published
    Abstract [en]

    Long-term sick leave due to musculoskeletal disorders has increased, especially for women. The aim of this paper was to explore women's and men's descriptions of the private arena in relation to rehabilitation and sickness absence. This study is part of a larger project focusing on consequences of sick leave. Individual interviews were conducted in 1997 and 1998 with 20 women and men who had been long-term sick-listed in 1985 with musculo-skeletal diagnoses. The data were analysed using Grounded theory in combination with gender analysis, which involved separately comparing men's and women's statements in order to find similarities and differences. According to the interviewees, factors in the private arena were closely associated with the rehabilitation process. Women described themselves as being responsible for the domestic work while men more often 'helped out' when asked to do so. Women and men described similar strategies to facilitate domestic work. Three dimensions of domestic life were identified, comprising division of domestic work and division of responsibility for domestic life and the amount of socio-emotional support or isolation at home. Using these dimensions, a 'domestic strain model' was developed. Our study indicates that long-term sicklisted women experiencing domestic strain would rather stay at home than return to work. Domestic strain involves inequities in the division of work and responsibilities and a lack of socio-emotional support at home. However, the model of domestic strain needs further empirical testing.

    Keywords
    gender, sick leave, sickness absence, back, neck or shoulder pain, qualitative interview, musculoskeletal diagnoses.
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-22066 (URN)10.1111/j.1471-6712.2004.00254.x (DOI)1143 (Local ID)1143 (Archive number)1143 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
    4. Client’s perceptions of contacts with professionals within health care and social insurance offices
    Open this publication in new window or tab >>Client’s perceptions of contacts with professionals within health care and social insurance offices
    Show others...
    2003 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 31, no 4, p. 275-282Article in journal (Refereed) Published
    Abstract [en]

    Aims: An increasing number of people interact with professionals within healthcare and social insurance offices during periods of sick leave due to musculoskeletal disorders. Knowledge of clients' perceptions of such contact is scarce. This study analysed clients' perceptions of their contact with professionals within healthcare and social insurance offices.

    Methods: A cohort study was conducted in the municipality of Linköping, Sweden. Participants were all citizens who in 1985 were aged 25 - 34 years and had at least one new sick-leave spell due to back, neck, or shoulder diagnoses exceeding 28 days (n=213). In 1996, 11 years after inclusion, a questionnaire about perception of contact with professionals, self-perceived health, and mental health was administered. Register data on sickness absence and disability pension from 1985 - 96 were also obtained.

    Results: Factor analysis indicated the existence of three dimensions of contact with professionals: supportive treatment, distant treatment, and empowering treatment. Women perceived their contact with both social insurance officers and healthcare professionals as more supportive than did the men. Respondents with disability pensions perceived their contact with social insurance officers as more supportive and empowering than persons without disability pensions. Respondents with mental health problems perceived their contact with both types of professionals as more distant. Respondents with neck/shoulder diagnoses perceived their contact with healthcare professionals as more empowering than respondents with low back diagnoses.

    Conclusion: There was a relationship between clients' perceptions of contact with professionals and the sex, disability pension, diagnosis, and mental health of clients.

    Keywords
    clients' perspective of treatment, musculoskeletal diagnoses, sick leave
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13676 (URN)10.1080/14034940210165037 (DOI)
    Available from: 2006-01-18 Created: 2006-01-18 Last updated: 2017-12-13
  • 85228.
    Östlund, Gunnel
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Reflektionspass som pedagogiskt verktyg för PPU: - en uppföljning av samtalsledaruppdraget2012In: Personlig och professionell utveckling inom socionomutbildningen / [ed] Magnus Ottelid, Östersund: Institutionen för socialt arbete, Mittuniversitetet , 2012, p. 131-143Chapter in book (Other academic)
    Abstract [en]

    Det är med stor glädje som vi nu kan presentera ett första svenskt bidrag till att mer samlat presentera erfarenheter, studier och exempel från PPU-området för socionomutbildning i Sverige. Hela åtta universitet och högskolor är representerade i denna antologi och resultatet är både tänkvärt och inspirerande. Att det finns ett stort intresse och engagemang för dessa frågor är inte att ta miste på. Eftersom detta just var ett första försök att sammanställa bidrag från utbildningarna gavs alla stor frihet att välja vad de ville skriva om. Resultatet blev därmed lika vildvuxet och spretande som man kunde väntat. Men det är verkligen inget problem. Tvärtom! Det visar väl snarare hur komplext området är – det finns mycket att dokumentera och undersöka. Vi börjar här och får se var det tar vägen. Kanske en nästa antologi kan koncentrera sig på en eller ett par viktiga frågor som belyses från flera håll.

  • 85229.
    Östlund, Gunnel
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Social and Welfare Studies, Society, Diversity, Identity.
    Rehabilitering efter sjukfrånvaro ur ett genus- och lekmannaperspektiv2006In: Den komplexa sjukfrånvaron / [ed] Marianne Upmark, Curt Edlund, Lund: Studentlitteratur , 2006, 1, p. 109-116Chapter in book (Other academic)
    Abstract [sv]

    En lättillgänglig bok som sammanfattar patientens, läkarens och försäkringskassans aspekter på sjukfrånvaron. Boken behandlar rehabilitering, förtidspension, hälsoekonomi, och hur de olika välfärdssystemen fungerar gentemot varandra och övriga inblandade. Det sista kapitlet belyser medikalisering som en tänkbar orsak till ökad sjukfrånvaro. Boken är ingen traditionell lärobok som bara bygger på fakta. Den ska i stället ses som en hjälp att öka den allmänna kompetensen och det kritiska tänkandet inför olika typer av beslut. Boken riktar sig till högskolestuderande i utbildningar inom vård, folkhälsovetenskap,  socialt arbete, sociologi och personalområdet. Den lämpar sig också för vidareutbildning av anställda/förtroendevalda inom försäkringskassan, socialtjänsten, arbetsförmedlingen och sjukvården. Även politiker och den som är allmänt samhällsintresserad och som önskar bättre  förstå komplexiteten bakom den svårförklarliga sjukfrånvaron har utbyte av boken.

  • 85230.
    Östlund, Gunnel
    et al.
    Mälardalen University, Eskilstuna, Sweden .
    Björk, Mathilda
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Rehabilitation Center. Jönköping University, Sweden.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Rheumatology.
    Thyberg, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Valtersson, Eva
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Rehabilitation in Central County.
    Stenström, Birgitta
    Swedish Rheumatism Association, Stockholm, Sweden .
    Sverker, Annette
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Rehabilitation in Central County.
    Emotions related to participation restrictions as experienced by patients with early rheumatoid arthritis: a qualitative interview study (the Swedish TIRA project)2014In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 33, no 10, p. 1403-1413Article in journal (Refereed)
    Abstract [en]

    Psychological distress is a well-known complication in rheumatoid arthritis (RA), but knowledge regarding emotions and their relationship to participation restrictions is scarce. The objective of the study was to explore emotions related to participation restrictions by patients with early RA. In this study, 48 patients with early RA, aged 20-63 years, were interviewed about participation restrictions using the critical incident technique. Information from transcribed interviews was converted into dilemmas and linked to International Classification of Functioning, Disability, and Health (ICF) participation codes. The emotions described were condensed and categorized. Hopelessness and sadness were described when trying to perform daily activities such as getting up in the mornings and getting dressed, or not being able to perform duties at work. Sadness was experienced in relation to not being able to continue leisure activities or care for children. Examples of fear descriptions were found in relation to deteriorating health and fumble fear, which made the individual withdraw from activities as a result of mistrusting the body. Anger and irritation were described in relation to domestic and employed work but also in social relations where the individual felt unable to continue valued activities. Shame or embarrassment was described when participation restrictions became visible in public. Feelings of grief, aggressiveness, fear, and shame are emotions closely related to participation restrictions in everyday life in early RA. Emotions related to disability need to be addressed both in clinical settings in order to optimize rehabilitative multi-professional interventions and in research to achieve further knowledge.

  • 85231.
    Östlund, Gunnel
    et al.
    Division of Social Work, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden.
    Björk, Mathilda
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Valtersson, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Sverker, Annette
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Womens situation-specific strategies in managing participation restrictions due to early rheumatoid arthritis: A gender comparison2018In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 16, no 2, p. 251-259Article in journal (Refereed)
    Abstract [en]

    Introduction

    The present study explored how women describe their use of situation‐specific strategies when managing rheumatoid arthritis (RA). The aim was also to compare women's strategies with those of men, and see the extent to which they used the same strategies.

    Methods

    The data were collected using semi‐structured interviews based on the critical incident technique. The sample consisted of women with early rheumatic arthritis (n = 34), and the results were compared with data reported in a previous study on men (n = 25) from the same cohort. The patient‐described participation restrictions due to RA were firstly linked to the domains of the International Classification of Functioning, Disability and Health (ICF). The different strategies used were then categorized. The study was approved by the Research Ethics Committee of the Faculty of Health Sciences, Linköping University, Sweden.

    Results

    The study found that women used four situation‐specific strategies: adjustment, avoidance, interaction and acceptance. The same strategies had been found previously in interviews with men with RA. Women and men used these strategies to a similar extent in the ICF domains of mobility; major life arenas; domestic life; interpersonal interactions and relationships; and community, social and civic life. However, some differences were found, relating to the reported activities in self‐care and domestic life, in which women reported using strategies to a greater extent than men.

    Conclusions

    Women and men used four types of situation‐specific strategies in managing RA; adjustment, avoidance, interaction and acceptance. These situation‐specific strategies provide useful knowledge, in terms of multidisciplinary rehabilitation and for patients' significant others.

  • 85232.
    Östlund, Gunnel
    et al.
    Department of Social Work, School of Health Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden.
    Björk, Mathilda
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Rehabilitation Center. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Valtersson, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Rehabilitation Center.
    Sverker, Annette
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Rehabilitation in Central County. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Lived Experiences of Sex Life Difficulties in Men and Women with Early RA - The Swedish TIRA Project.2015In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 13, no 4, p. 248-257Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Men and women with rheumatoid arthritis (RA) experience restrictions in everyday life, in spite of the development of new medications. Recent research has described in detail how participation limitations are experienced in everyday life from a patient perspective. However, knowledge of how sex and intimate relationships are affected is still scarce.

    OBJECTIVES: The aim of the present study was to explore sex life experiences in relation to sexual function and sexual relationships in men and women with early RA.

    METHODS: The study formed part of TIRA-2 (the Swedish acronym for the prospective multicentre early arthritis project). The data collection included 45 interviews with 21 men and 24 women, aged 20-63, which were recorded and transcribed verbatim. The critical incident technique was used to collect data, and content analysis to categorize the results.

    RESULTS: Half the participants stated that RA affected their sex life. The general descriptions formed five categories: sex life and tiredness; sex life and ageing; emotional consequences of impaired sexual function; facilitators of sexual function and sexual relationships; and strain on the sexual relationship.

    CONCLUSIONS: Sex life is affected in early RA, in spite of new effective treatment strategies. New strategies of communication, assessment and self-managing interventions concerning the sex lives of patients with RA need to be implemented by a multidisciplinary healthcare team. Copyright © 2015 John Wiley & Sons, Ltd.

  • 85233.
    Östlund, Gunnel
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Borg, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Wide, P
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Hensing, G
    Göteborgs universitet.
    Alexandersson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Client´s perceptions of their contacts with rehabilitation agents - reports from persons with exeriences of back, neck, or shoulder disorders2002In: Seventh International Congress of behavioral Medicine 28-31 Augusti 2002,2002, 2002, p. 304-304Conference paper (Refereed)
  • 85234.
    Östlund, Gunnel
    et al.
    Linköping University, Department of Social and Welfare Studies, Society, Diversity, Identity . Linköping University, Faculty of Arts and Sciences.
    Borg, Karin
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Wide, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Hensing, Gunnel
    Department of Social Medicine, Sahlgrenska Academy, University of Göteborg, Sweden.
    Alexandersson, Kristina
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Client’s perceptions of contacts with professionals within health care and social insurance offices2003In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 31, no 4, p. 275-282Article in journal (Refereed)
    Abstract [en]

    Aims: An increasing number of people interact with professionals within healthcare and social insurance offices during periods of sick leave due to musculoskeletal disorders. Knowledge of clients' perceptions of such contact is scarce. This study analysed clients' perceptions of their contact with professionals within healthcare and social insurance offices.

    Methods: A cohort study was conducted in the municipality of Linköping, Sweden. Participants were all citizens who in 1985 were aged 25 - 34 years and had at least one new sick-leave spell due to back, neck, or shoulder diagnoses exceeding 28 days (n=213). In 1996, 11 years after inclusion, a questionnaire about perception of contact with professionals, self-perceived health, and mental health was administered. Register data on sickness absence and disability pension from 1985 - 96 were also obtained.

    Results: Factor analysis indicated the existence of three dimensions of contact with professionals: supportive treatment, distant treatment, and empowering treatment. Women perceived their contact with both social insurance officers and healthcare professionals as more supportive than did the men. Respondents with disability pensions perceived their contact with social insurance officers as more supportive and empowering than persons without disability pensions. Respondents with mental health problems perceived their contact with both types of professionals as more distant. Respondents with neck/shoulder diagnoses perceived their contact with healthcare professionals as more empowering than respondents with low back diagnoses.

    Conclusion: There was a relationship between clients' perceptions of contact with professionals and the sex, disability pension, diagnosis, and mental health of clients.

  • 85235.
    Östlund, Gunnel
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Cedersund, Elisabet
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV).
    Hensing, G
    Göteborg.
    Alexandersson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Developing a typology of the 'duty to work', as experienced by lay persons with musculoskeletal disorders2002In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 11, no 2, p. 150-158Article in journal (Refereed)
    Abstract [en]

    Musculoskeletal diagnoses account for the majority of cases of reduced work capacity. This article investigates lay persons' strategies in relation to work and musculoskeletal disorders. Twenty interviews were conducted and analysed using grounded theory. A typology of self-presentations was developed. The interviewees' self-presentations revealed a strong sense of a 'duty to work'. This sense of duty took four different forms, leading us to categorise persons expressing particular forms as workaholics, work manics, workhorses or relaxed workers. Relaxed workers seem to have the best prognosis for recovery as they had a confident self-agency and worked to fulfil their own needs rather than those of others. This was in contrast to work manics, with an uncertain self-agency and driven to work by others' needs. In conclusion, awareness of such linguistic forms as self-attributions and idiomatic phrases provides an opportunity to identify and talk about individual's self-agency and driving forces in the recovery process.

  • 85236.
    Östlund, Gunnel
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV).
    Cedersund, Elisabet
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV).
    Hensing, Gunnel
    Göteborgs Universitet.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society.
    Domestic strain: A hindrance in rehabilitation?2004In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 18, no 1, p. 49-56Article in journal (Refereed)
    Abstract [en]

    Long-term sick leave due to musculoskeletal disorders has increased, especially for women. The aim of this paper was to explore women's and men's descriptions of the private arena in relation to rehabilitation and sickness absence. This study is part of a larger project focusing on consequences of sick leave. Individual interviews were conducted in 1997 and 1998 with 20 women and men who had been long-term sick-listed in 1985 with musculo-skeletal diagnoses. The data were analysed using Grounded theory in combination with gender analysis, which involved separately comparing men's and women's statements in order to find similarities and differences. According to the interviewees, factors in the private arena were closely associated with the rehabilitation process. Women described themselves as being responsible for the domestic work while men more often 'helped out' when asked to do so. Women and men described similar strategies to facilitate domestic work. Three dimensions of domestic life were identified, comprising division of domestic work and division of responsibility for domestic life and the amount of socio-emotional support or isolation at home. Using these dimensions, a 'domestic strain model' was developed. Our study indicates that long-term sicklisted women experiencing domestic strain would rather stay at home than return to work. Domestic strain involves inequities in the division of work and responsibilities and a lack of socio-emotional support at home. However, the model of domestic strain needs further empirical testing.

  • 85237.
    Östlund, Gunnel
    et al.
    Linköping University, Department of Social and Welfare Studies, Society, Diversity, Identity . Linköping University, Faculty of Arts and Sciences.
    Marie, Gustavsson Holmström
    Linköping University, Department for Studies of Social Change and Culture. Linköping University, Faculty of Arts and Sciences.
    Vad innebär ett "serviceinriktat" förhållningssätt?: Pilotstudie i Linköpings kommun2008Report (Other academic)
    Abstract [sv]

    Detta är en rapport om en pilotstudie som genomfördes under våren 2006 i Linköpings kommun inom individ- och familjeomsorgen och äldreomsorgen. Syftet var att ringa in områden/verksamheter där ett serviceinriktat för­hållningssätt är lämpligt att studera. Inom individ- och familjeomsorg är de verksamheter som ges som service mer varierade än inom äldre- och handikappomsorgen. På så sätt blir avtrycken där otydligare än inom äldreomsorgen och det serviceinriktade förhållningssättet blir också svårare att studera. I rapporten ges förslag på några specifika fält som är möjliga att fördjupa i framtida studier. Rapporten kan ses som en inspirationskälla till pågående, planerad eller kommande forskning med ett särskilt intresse av nya former för organisering av socialt välfärdsarbete inom socialtjänst.

  • 85238.
    Östlund, Gunnel
    et al.
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Sverker, Annette
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Björk, Mathilda
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Thyberg, Ingela
    Thyberg, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Valtersson, Eva
    Stenström, Birgitta
    Linköping University, Department of Medical and Health Sciences.
    Känslor relaterade till delaktighet begränsningar – erfarenheter från patienter med reumatoid artrit,en kvalitativ intervjustudie2014In: Reumatologi, no 18Article in journal (Other academic)
  • 85239.
    Östlund, Gunnel
    et al.
    Division of Social Work, School of Health, Care and Social Welfare, Mälardalen University.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Rheumatology. Linköping University, Faculty of Medicine and Health Sciences.
    Valtersson, Eva
    Linköping University, Department of Medical and Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Activity and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Björk, Mathilda
    Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Rehabilitation Center. Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy.
    Sverker, Annette
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    The Use of Avoidance, Adjustment, Interaction and Acceptance Strategies to Handle Participation Restrictions Among Swedish Men with Early Rheumatoid Arthritis.2016In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 14, no 4, p. 206-218Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Living with a chronic disease means learning to live under new circumstances and involves a continuous adaptation to new ways of living. There is increasing knowledge about how people cope with stressful life events and adapt to new life situations. Approximately a third of patients diagnosed with rheumatoid arthritis (RA) are men; however, few studies have described the needs and experiences of men living with RA. The aim of the present study was to explore men's strategies for handling challenges related to participation in everyday life.

    METHODS: The present study was associated with the prospective Swedish multicentre early arthritis project (given the Swedish acronym TIRA), which, in 2006-2009, included patients with early RA, contemporarily treated, with a mean disease duration of three years. From this cohort, 25 men, aged 20-63 years, were recruited consecutively. Data were collected in individual interviews, using the critical incident technique. The strategies for dealing with the challenges of RA in everyday life were analysed and categorized using content analysis.

    RESULTS: Men with RA described four types of strategy for dealing with participation restrictions in everyday life: (i) Adjustment strategies - adjust behaviour, movements, medication, equipment and clothing to find new ways to conduct tasks or activities; (ii) Avoidance strategies - avoid activities, movements, social contacts and sometimes medication; (iii) Interaction strategies - say no, ask for help and work together to handle participation restrictions; and (iv) Acceptance strategies - learn to accept RA, with the pain, the slower work pace and the extended time needed.

    CONCLUSIONS: According to men's lived experiences, a combination of strategies was used to deal with RA, depending on the situation and the experienced restriction. The results provided an understanding of how men with RA manage their disease, to reduce physical, social and emotional challenges. This knowledge may be used further to develop multi-professional interventions and patient education tailored to men with RA.

  • 85240.
    Östlund, Martin
    Linköping University, Department of Computer and Information Science, NLPLAB - Natural Language Processing Laboratory. Linköping University, The Institute of Technology.
    AssistancePlus: 3D-mediated Advice-giving on Pharmaceutical Products2008Licentiate thesis, monograph (Other academic)
    Abstract [en]

    In the use of medication and pharmaceutical products, non‐compliance is a major problem. One thing we can do something about is making sure consumers have the information they need. This thesis investigates how remote communication technology can be used to improve the availability for expressive advice‐giving services. Special attention is given to the balancing of expressiveness and availability. A solution is presented that uses 3D visualisation in combination with audio and video communication to convey advice on complex pharmaceutical products. The solution is tested and evaluated in two user studies. The first study is broad and explorative, the second more focused and evaluative. The solution was well received by participating subjects. They welcomed the sense of personal contact that seeing the communicating party over video link produced and appreciated the expressive power and pedagogical value of the 3D materials. Herbert Clark’s theory of use of language is suggested as a framework for the analysis of the dynamics of the relationship between

    consumer and advisor.

  • 85241.
    Östlund, Martin
    et al.
    Linnaeus University, Kalmar.
    Dahlbäck, Nils
    Linköping University, Department of Computer and Information Science, NLPLAB - Natural Language Processing Laboratory. Linköping University, Faculty of Arts and Sciences.
    Petersson, Göran Ingemar
    Linnaeus University, Kalmar.
    3D Visualization as a Communicative Aid in Pharmaceutical Advice-Giving over Distance2011In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 13, no 3Article in journal (Refereed)
    Abstract [en]

    Background: Medication misuse results in considerable problems for both patient and society. It is a complex problem with many contributing factors, including timely access to product information. less thanbrgreater than less thanbrgreater thanObjective: To investigate the value of 3-dimensional (3D) visualization paired with video conferencing as a tool for pharmaceutical advice over distance in terms of accessibility and ease of use for the advice seeker. less thanbrgreater than less thanbrgreater thanMethods: We created a Web-based communication service called AssistancePlus that allows an advisor to demonstrate the physical handling of a complex pharmaceutical product to an advice seeker with the aid of 3D visualization and audio/video conferencing. AssistancePlus was tested in 2 separate user studies performed in a usability lab, under realistic settings and emulating a real usage situation. In the first study, 10 pharmacy students were assisted by 2 advisors from the Swedish National Co-operation of Pharmacies call centre on the use of an asthma inhaler. The student-advisor interview sessions were filmed on video to qualitatively explore their experience of giving and receiving advice with the aid of 3D visualization. In the second study, 3 advisors from the same call centre instructed 23 participants recruited from the general public on the use of 2 products: (1) an insulin injection pen, and (2) a growth hormone injection syringe. First, participants received advice on one product in an audio-recorded telephone call and for the other product in a video-recorded AssistancePlus session (product order balanced). In conjunction with the AssistancePlus session, participants answered a questionnaire regarding accessibility, perceived expressiveness, and general usefulness of 3D visualization for advice-giving over distance compared with the telephone and were given a short interview focusing on their experience of the 3D features. less thanbrgreater than less thanbrgreater thanResults: In both studies, participants found the AssistancePlus service helpful in providing clear and exact instructions. In the second study, directly comparing AssistancePlus and the telephone, AssistancePlus was judged positively for ease of communication (P = .001), personal contact (P = .001), explanatory power (P andlt;.001), and efficiency (P andlt;.001). Participants in both studies said that they would welcome this type of service as an alternative to the telephone and to face-to-face interaction when a physical meeting is not possible or not convenient. However, although AssistancePlus was considered as easy to use as the telephone, they would choose AssistancePlus over the telephone only when the complexity of the question demanded the higher level of expressiveness it offers. For simpler questions, a simpler service was preferred. less thanbrgreater than less thanbrgreater thanConclusions: 3D visualization paired with video conferencing can be useful for advice-giving over distance, specifically for issues that require a higher level of communicative expressiveness than the telephone can offer. 3D-supported advice-giving can increase the range of issues that can be handled over distance and thus improve access to product information.

  • 85242.
    Östlund, Nils
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Karlsson, Stefan
    Umeå Universitetssjukhus.
    Location of innervation zone determined with multichannel surface electromyography using an optical flow technique2007In: Journal of Electromyography & Kinesiology, ISSN 1050-6411, E-ISSN 1873-5711, Vol. 17, no 5, p. 549-555Article in journal (Refereed)
    Abstract [en]

    Multichannel surface electromyography has developed towards more channels and higher spatial resolution. This allows the study of multichannel electromyograms as images of the potential distribution on the skin. In this paper, a method that estimates the motion of the potential distribution using an optical-flow-based technique is introduced. The optical flow is a vector field that describes how images change with time. The aim of this study was to introduce a new method for innervation zone (IZ) localization and to evaluate its performance. The new method was compared with a method that uses the position of the lowest root-mean-square (RMS) value in an electrode array as an estimate of the IZ localization. Comparisons were made with both simulated signals and with recorded multichannel electromyogram signals. Simulations showed that the methods performed similarly for high signal-to-noise ratio (SNR) and that the optical-flow-based method was superior for lower SNR. When the experimental signals were used, localization with the optical-flow-based method gave a mean absolute deviation of 2.4 mm from the location given by an expert group. The lowest RMS method gave a significantly higher deviation (13.6 mm). Due to the low computational complexity of the optical flow algorithm it is possible to get the estimations of the IZ localization in real time. © 2006 Elsevier Ltd. All rights reserved.

  • 85243.
    Östlund, Nils
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine .
    Yu, J.
    Centre for Biomedical Engineering and Physics, Umeå University, Umeå, Sweden, Centre of Biostochastics, Swedish University of Agricultural Sciences, Umeå, Sweden.
    Karlsson, J.S.
    Department of Biomedical Engineering and Informatics, University Hospital, 901 85 Umeå, Sweden, Centre for Biomedical Engineering and Physics, Umeå University, Umeå, Sweden.
    Adaptive spatio-temporal filtering of multichannel surface EMG signals2006In: Medical and Biological Engineering and Computing, ISSN 0140-0118, E-ISSN 1741-0444, Vol. 44, no 3, p. 209-215Article in journal (Refereed)
    Abstract [en]

    A motor unit (MU) is defined as an anterior horn cell, its axon, and the muscle fibres innervated by the motor neuron. A surface electromyogram (EMG) is a superposition of many different MU action potentials (MUAPs) generated by active MUs. The objectives of this study were to introduce a new adaptive spatio-temporal filter, here called maximum kurtosis filter (MKF), and to compare it with existing filters, on its performance to detect a single MUAP train from multichannel surface EMG signals. The MKF adaptively chooses the filter coefficients by maximising the kurtosis of the output. The proposed method was compared with five commonly used spatial filters, the weighted low-pass differential filter (WLPD) and the marginal distribution of a continuous wavelet transform. The performance was evaluated using simulated EMG signals. In addition, results from a multichannel surface EMG measurement fro from a subject who had been previously exposed to radiation due to cancer were used to demonstrate an application of the method. With five time lags of the MKF, the sensitivity was 98.7% and the highest sensitivity of the traditional filters was 86.8%, which was obtained with the WLPD. The positive predictivities of these filters were 87.4 and 80.4%, respectively. Results from simulations showed that the proposed spatio-temporal filtration technique significantly improved performance as compared with existing filters, and the sensitivity and the positive predictivity increased with an increase in number of time lags in the filter. © International Federation for Medical and Biological Engineering 2006.

  • 85244.
    Östlund, Nils
    et al.