In order to get a better epidemiological base for preventive intervention in the county of Östergötland, Sweden, a comprehensive study of sickness absence was done. During the years 1985, 1986 and 1987, all new periods of sick-leave exceeding seven days were registered with demographic variables. This information was related to data about the total population of Östergötland. Each year approx. 45,000 persons had approx. 61,000 sickness spells. These figures were stable over the years while the number of sick-leave days increased. Blue-collar occupations had the highest sick-leave rates and the female sick-leave rate was higher in general and much higher in most male-dominated occupations. The male rate was lower within female-dominated areas, except among secretaries and textile workers. Females in extremely male-dominated groups had the highest rates, while both male and female sick-leave rates were lower in more gender-integrated occupations.

En genomsnittlig svensk läkare är varje år inblandad i försäkringsmedicinska frågeställningar som betingar kostnader i storleksordningen 2–3 miljoner kronor. Trots detta ingår inte försäkringsmedicin som eget kompetensområde i läkarnas grundbildning. Enligt en nyligen gjord enkät saknar mer än hälften av läkarna utbildning i vissa basala kunskaper såsom att skriva ett arbetsskadeintyg. Denna lärobok, skriven av 12 experter inom området, avser primärt att svara mot behovet av grundläggande kunskaper inom försäkringsmedicinens område för läkare under utbildning. En central del i en svensk lärobok i försäkringsmedicin är den allmänna försäkringen som bl.a. ligger till grund för sjukpenning och förtidspension. Privata livförsäkringar har funnits i många år, men ställer allt större krav på läkaren i takt med att nya tester utvecklas, bl.a. genetiska som kan förutsäga risker för förtida sjukdom och död. Andra försäkringar, t.ex. privata sjukförsäkringar, har blivit vanligare och frågor kring dessa belyses i boken. Det finns också andra försäkringar som är viktiga ur försäkringsmedicinsk synpunkt och som berör ansvarsfrågor och skadestånd, t.ex. patientförsäkring och läkemedelsförsäkring, vilka också behandlas. Boken innehåller även en översikt över viktiga juridiska frågor, liksom sekretess. Etiska frågeställningar är mycket vanliga inom försäkringsmedicinen och boken avslutas med ett kapitel om etik. Boken vänder sig i första hand till läkarstuderande men kan även fungera som referens- och uppslagsbok för personer verksamma inom sjukvård, försäkringsbolag och försäkringskassan.

En genomsnittlig svensk läkare är varje år inblandad i försäkringsmedicinska frågeställningar som betingar kostnader i storleksordningen 2–3 miljoner kronor. Trots detta ingår inte försäkringsmedicin som eget kompetensområde i läkarnas grundbildning. Enligt en nyligen gjord enkät saknar mer än hälften av läkarna utbildning i vissa basala kunskaper såsom att skriva ett arbetsskadeintyg. Denna lärobok, skriven av 12 experter inom området, avser primärt att svara mot behovet av grundläggande kunskaper inom försäkringsmedicinens område för läkare under utbildning. En central del i en svensk lärobok i försäkringsmedicin är den allmänna försäkringen som bl.a. ligger till grund för sjukpenning och förtidspension. Privata livförsäkringar har funnits i många år, men ställer allt större krav på läkaren i takt med att nya tester utvecklas, bl.a. genetiska som kan förutsäga risker för förtida sjukdom och död. Andra försäkringar, t.ex. privata sjukförsäkringar, har blivit vanligare och frågor kring dessa belyses i boken. Det finns också andra försäkringar som är viktiga ur försäkringsmedicinsk synpunkt och som berör ansvarsfrågor och skadestånd, t.ex. patientförsäkring och läkemedelsförsäkring, vilka också behandlas. Boken innehåller även en översikt över viktiga juridiska frågor, liksom sekretess. Etiska frågeställningar är mycket vanliga inom försäkringsmedicinen och boken avslutas med ett kapitel om etik. Boken vänder sig i första hand till läkarstuderande men kan även fungera som referens- och uppslagsbok för personer verksamma inom sjukvård, försäkringsbolag och försäkringskassan.

En genomsnittlig svensk läkare är varje år inblandad i försäkringsmedicinska frågeställningar som betingar kostnader i storleksordningen 2–3 miljoner kronor. Trots detta ingår inte försäkringsmedicin som eget kompetensområde i läkarnas grundbildning. Enligt en nyligen gjord enkät saknar mer än hälften av läkarna utbildning i vissa basala kunskaper såsom att skriva ett arbetsskadeintyg. Denna lärobok, skriven av 12 experter inom området, avser primärt att svara mot behovet av grundläggande kunskaper inom försäkringsmedicinens område för läkare under utbildning. En central del i en svensk lärobok i försäkringsmedicin är den allmänna försäkringen som bl.a. ligger till grund för sjukpenning och förtidspension. Privata livförsäkringar har funnits i många år, men ställer allt större krav på läkaren i takt med att nya tester utvecklas, bl.a. genetiska som kan förutsäga risker för förtida sjukdom och död. Andra försäkringar, t.ex. privata sjukförsäkringar, har blivit vanligare och frågor kring dessa belyses i boken. Det finns också andra försäkringar som är viktiga ur försäkringsmedicinsk synpunkt och som berör ansvarsfrågor och skadestånd, t.ex. patientförsäkring och läkemedelsförsäkring, vilka också behandlas. Boken innehåller även en översikt över viktiga juridiska frågor, liksom sekretess. Etiska frågeställningar är mycket vanliga inom försäkringsmedicinen och boken avslutas med ett kapitel om etik. Boken vänder sig i första hand till läkarstuderande men kan även fungera som referens- och uppslagsbok för personer verksamma inom sjukvård, försäkringsbolag och försäkringskassan.

This article summarizes the proceedings of a symposium at the 2002 RSA meeting in San Francisco, California. The chair was Peter Monti and co-chair was Nancy Barnett. The aim of the symposium was to bring together researchers from the United States, Sweden, and Mexico to present current findings on the development and implementation of screening and intervention research in Emergency Departments (ED). Cheryl Cherpitel presented findings on the performance of the Rapid Alcohol Problems Screen (RAPS4), a 4-item instrument used for screening for alcohol dependence and harmful drinking in the ED. Dr. Cherpitel also presented for her collaborator, Guilherme Borges, their research on the performance of a number of screening measures including the RAPS among Mexicans and Mexican-Americans with alcohol-related disorders in the ED. Preben Bendtsen described the implementation of an alcohol screening and intervention procedure delivered by ordinary ED staff in Sweden. Nancy Barnett presented data on characteristics related to readiness to change alcohol use in a sample of young adults who were treated in an ED for injury or intoxication.

[No abstract available]

This study included all individuals attending a community-based treatment centre during a 4-year period. Patients were referred to the treatment centre from the primary health care (17%), social insurance office (8%), social workers (19%), employers (7%), prisons and probation administration (3%), on their own initiative (25%), and by other means (21%). The participants, 355 men and 164 women, all between 18 and 64 years of age, were compared with the total population in the municipality with regards to gender differences in sociodemographic characteristics. Adult life circumstances such as legal problems, broken relationships, unemployment and lower social class, in both men and women, were clearly associated with an alcohol dependence or at least of seeking help for this problem. The study also emphasises important social consequences of alcohol dependence in women, such as legal problems and drunk driving, normally associated with male alcohol dependence. The study revealed that living with an abusing partner was associated with a higher frequency of alcohol dependence in women. The findings are important issues to address when offering treatment to women with alcohol dependence. ⌐ 2001 Elsevier Science Ltd. All rights reserved.

Cognitive behavioral therapy (CBT) for psychological disorders is becoming increasingly popular on the Internet. However when using this workstation approach, components such as training and learning relaxation skills, problem solving, exposure exercises, and sleep management guidance must be done in the domestic environment. This paper describes design concepts for providing spatially explicit CBT with mobile phones. We reviewed and analyzed a set of treatment manuals to distinguish elements of CBT that can be improved and supported using mobile phone applications. The key advantage of mobile computing support in CBT is that multimedia can be applied to record, scale, and label anxiety-provoking situations where the need arises, which helps the CBT clients formulate and convey their thoughts and feelings to relatives and friends, as well as to therapists at subsequent treatment sessions.

The health of women has risen to a priority position in medical research. Comparative studies of female morbidity are called for as an intermediary stage for generation of hypotheses and design of deeper studies of determinants, such as social, ecological, and individual factors. In previous studies, we have noted differences in female hospitalization between Heraklion in Greece and Linköping in Sweden. They were related to age and to urban versus rural dwelling, and fit projections for a more archaic and a more technocratic society, respectively. This paper aims at showing how the study of women's health may proceed from relevant hospitalization observations to the next level, of exploring already available indicators of self‐perceived health in elderly females.

This thesis reports comparative studies of admissions to regional hospitals in two communities, one in Greece and one in Sweden, during a two-year period, 1986-1987. The comparison was made using care episode diagnoses coded in the International Classification of Diseases, ICD 9. All cases hospitalised during this period were distributed by age, sex, residence and diagnoses.

The results indicate that even if there were cultural and socio-economic differences between the two areas, there were also important similarities in the hospitalisation patterns. The hospitalisations seemed to be more equally distributed between the sexes and between urban and rural areas in Sweden than in Greece, where it appeared that the rural population, and women in particular, did not get hospital care according to their needs. It was also found that study of hospital admission is associated with methodological difficulties because the use of hospital services is a complex phenomenon. The thesis includes discussions about the variety of factors that can have influenced the results.

[No abstract available]

Background: In 1994, the mortality in coronary heart disease was four times higher among Lithuanian middle-aged men than among Swedish men. Over the period 1993-1995, the LiVicordia study investigated possible causes for this difference. We have earlier reported lower serum levels of cholesterol and higher susceptibility of low-density lipoprotein cholesterol for oxidation among Lithuanian men. Objective: In this part of the study, the aim was to compare mean estimates of food intake. Design: Cross-sectional study of random samples of 50-year-old men from each of the cities of Link÷ping, Sweden and Vilnius, Lithuania (n=150). The volunteers were interviewed about their food intake with the 24-hour recall method. Results: We found no differences in total energy intake, but Vilnius men had a higher energy intake from fat. Vilnius men consumed more fat from meat and less vegetable fat, while fat intake from dairy products was almost the same. Also, Vilnius men had a higher intake of vegetables, while Link÷ping men had a higher intake of fruit and berries. Conclusion: The observed differences in food consumption and dietary composition are partly consistent with the higher CHD mortality among Lithuanian men. However, data on biomarkers indicate that other dietary and lifestyle factors play a role.

Studies have shown that the effect of passengers on accident propensity among young drivers is ambiguous—in some cases positive and some negative. In Sweden, various kinds of information are compiled in registers, including a national accident database and exposure data collected in a national investigation of the driving habits of license holders. Access to such data offers a good opportunity to study crash risks related to driving with and without passengers. This was done for drivers in three different age groups (18–24, 25–64 and >65 years) accompanied by one, two or three or more passengers. Differences in crash risk were estimated using incidence density ratios (IDRs) and 95% confidence intervals. The results show that passengers had an overall protective effect, that is, the crash risk was higher for those who drove alone, regardless of their age or gender. This protective effect increased with every extra passenger (up to eight), indicating that the more passengers in the vehicle, the safer the driving. The influence of passengers was weakest (albeit still positive) among the youngest drivers (ages 18–24 years), especially the males in that group. The protective impact showed the same pattern on all days of the week, but was most marked from Friday to Sunday for most of the drivers, regardless of age.

Computer-based simulation of influenza outbreaks in local communities can help researchers, epidemiologists, and decision makers better understand the impact of the community structure on the reproduction rate of disease, and the relative benefits of different types of prevention and interventions. The goal of scenario modeling is to develop a description of scenario components, such us the disease, the community and interventions. An ontology-based representation of the scenario model together with a modeling tool, which is based on an extension to Protege assist scenario developers in formulating simulation specifications. This approach allows the exploration of new ideas by rapidly formulating and reconstructing scenarios from novel components.

Purpose. The importance of the visual system as the input channel for sensory information necessary when driving is often stated. There are several reports on differences in visual search strategies between experienced and inexperienced drivers, as well as in relation to the roadway. However, the results are ambiguous and are not sampled by similar procedures. Based on previous findings, the aim of the present study was to gain further knowledge on these differences by testing the hypotheses that inexperienced drivers, in comparison to experienced drivers, fixate closer to the vehicle, fixate more often on in-vehicle objects, spread their fixations less along the horizontal meridian, fixate more often on relevant traffic cues, and fixate more often on objects classified as potential hazards. Methods. Data from eye-tracker recordings of visual search strategies of the driver in real-world traffic were used for the analyses. Results. The results confirmed all stated hypotheses regarding differences between inexperienced and experienced drivers, with the exception of fixations closer to the vehicle, in which ambiguous results were found. Conclusions. The present study provides normative data for the understanding of the development of visual search strategies among drivers. The methodology used in the present study, i.e., to combine a quantitative analysis with a qualitative analysis proved, to be useful to compare visual search strategies among inexperienced and experienced drivers. Copyright © 2005 American Academy of Optometry.

In many countries, the community has a legal obligation to help persons with disabilities to participate in society on the same level as other groups. One aspect of such participation is access to unlimited and spontaneous transportation through the ability to drive a car. In the case of persons with cerebral palsy (CP), the possibility of becoming a driver is related to several factors such as the severity of the impairment, the individual’s financial situation and the quality of driver education. One of the aims of this study was to analyse the education process among learner drivers with CP, in order to understand where and why problems are encountered. A further aim was to enhance the development of test methods for predicting the ability of a person with CP to become a licensed driver. In the analysis of the learning process, logbooks from one of the two national Swedish centres for educating disabled learner drivers were analysed. The analysis showed that certain key tasks in the education process were critical for the outcome in terms of becoming a licensed driver or not. The results suggest that it may be possible to develop a test battery, which, in combination with an analysis of the performance of these key tasks, will assist prediction of the outcome of driving education for persons with CP.

In order to reduce the monetary and personal costs of driver training for persons with cerebral palsy, it is of interest to find a predictor that is able to select potential license holders. Previous research has shown that such a predictor could be one that assesses visual perception. In the present study, the Test of Visual Perceptual Skills (non-motor) Upper Level, was validated for predicting the outcome of driver education. It was found that using the test for this purpose could not be recommended. The findings of the present study were not in accordance with the results of other studies on the predictive value of perceptual tests regarding the ability to drive, owing to the use of different methods. Future studies should focus on cross-validation of perceptual tests for different types of independent variables, such as driving license or not, accident involvement and driving ability.

An interdisciplinary research group entitled ”Twincities Research Group” has been initiated at Linköping University. The term twin cities refer to the Swedish cities Linköping and Norrköping, neighbours that are nearly equal in size. These two cities, located within a distance of only 40 km, are governed by the same county council and consequently have the same health care structure. However, health is remarkably different in these twin cities. The comparison of public health in these two cities during the development from the industrial to the post-industrial era has a design similar to classical experiments with a control and an experiment group, since the social history and the socio-economic structures of the cities are radically different. Through an interdisciplinary research design including historical, epidemiological and clinical competence we have a unique opportunity to increase our understanding of how social environment may affect public health.

The aim of this exploratory study was to investigate mothers' experiences of their encounters with the child health (CH) nurse. A cross-sectional design was used for the study, based on data from 140 mothers gathered by the critical incident technique. The analysis was accomplished by a thematic content analysis, using inductive reasoning in three steps. Symbolic interactionism was used as a frame of reference. The results suggest that the central factor in the encounter between mother and nurse is that they are able to share the realm of motherhood, meaning that the nurse is open and willing to share all types of emotions, experiences and attitudes related to being a mother. Given this basis, other important factors are the supply of sound advice and practical interventions, and that the nurse is reassuring and accessible. The majority of the participating mothers had experienced CH nurses who had provided them with valuable support during troublesome incidents. However, there were also several dissatisfied mothers who had expected support but thought they received insulting treatment instead. The mothers and the nurses have varying experiences and background and therefore different perspectives, which may lead to difficulties in understanding each other. Knowledge about the important factors, that affect the mother–nurse encounter, can be used to strengthen the nurses' positive behaviours and facilitate understanding of how disappointed mothers have experienced their health care encounters.

Aims: To study the introduction of Haemophilus influenzae type b (Hib) vaccination in Sweden, and to identify factors promoting and inhibiting the process. Methods. The introduction of general childhood vaccination against Hib in Sweden in 1992-93 was studied using the Cultural Historical Activity Theory as a theoretical framework. Results: Five activity systems were found to be involved in the introduction process, the systems of vaccine production, government administration, news distribution, science, and disease prevention. The critical factors for introduction of the programme were found to be the vaccine product, conception of the disease, government economy and public decision-making. Conclusions: The results show that a broad range of non-biomedical aspects must be considered when a public health intervention such as a general vaccination programme is introduced.

Objective: When cortisol measurements are to be studied in large populations, cost-effective analyses are needed. This study aimed at testing whether one pooled cortisol value over three consecutive days is as reliable as using the arithmetic mean of the samples from the same measure points.

Material and methods: Thirty participants aged between 45 and 69 collected saliva in salivettes immediately after awakening (t₁), 30 min after awakening (t₂) and in the evening (t₃) during 3 consecutive days. A fixed volume from each of the samples (t₁, t₂ and t₃) was pooled prior to laboratory analysis. Mean levels over 3 days for t₁, t₂ and t₃ were compared to corresponding levels of pooled vials. Cortisol levels were analysed using a radio immunoassay.

Results: All measures tested had high correlations between mean values and pooled samples, exemplified with diurnal deviation rdif t_2–t350.974 (CI 0.946;0.987), and awakening response r_dif t_2–t150.982 (CI 0.963;0.991). There were no statistical differences between the pooled values and the arithmetic means.

Conclusion: Pooling samples gave as reliable results as arithmetic means did. Pooling samples prior to laboratory analysis is a cost-effective method for measuring general diurnal cortisol variation in field research projects.

There are many psychosocial aspects of chronic diseases, such as diabetes. Educational multimedia can support patients with chronic diseases and their families by communicating narratives based on social realism. The production of such socio-realistic interactive health dramas requires systematic methods, especially for the identification of significant stories. The aim of this study is to explore the use of self-documentary video in the design of an Interactive Health Drama environment to support diabetic adolescents and their families. In particular, the potential of the self-documentary video for story development in combination with qualitative interviews were explored. The proposed approach, when further developed, is intended to enable all types of chronic disease patients to work with their specific psychosocial problems in a supportive and stimulating environment adapted to their personality and preferences.

This study focuses on the problem of traffic safety among children and the effectiveness of voluntary traffic clubs. General doubts are growing in regard to this traditional strategy of teaching and training children how to act in specific traffic situations. It has been shown that their knowledge and behavior improve, but the effect on accident risk is not clear. In this study, one model for traditional teaching of this type, a voluntary traffic safety club for children, is evaluated in terms of accident risk. The data have been collected through questionnaires to members and nonmembers of the club. Approximately 20% of Swedish children are members of the club. The results show that members do not have a lower accident risk than nonmembers. On the contrary, the risk in this nonexperimental study is found to be higher among members. The use of safety equipment is, however, higher among members. The results are discussed in terms of systematic differences between the groups, i.e. socioeconomics, and in terms of the possibility that the general strategy of the club leads to overestimation of the safety effect.

Conventional smart card-based authentication systems used in health care alleviate some of the security issues in user and system authentication. Existing models still do not cover all security aspects. To enable new protective measures to be developed, an extended model of the authentication process is presented. This model includes a new entity referred to as secure server. Assuming a secure server, a method where the smart card is aware of the status of the terminal integrity verification becomes feasible. The card can then act upon this knowledge and restrict the exposure of sensitive information to the terminal as required in order to minimize the risks. The secure server model can be used to illuminate the weaknesses of current approaches and the need for extensions which alleviate the resulting risks.