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  • 1.
    Agnew, L.
    et al.
    University of Queensland, Brisbane, Australia .
    Johnston, V.
    University of Queensland, Brisbane, Australia .
    Ludvigsson, M. L.
    Linköping University, Linköping, Sweden; Rehab Väst, County Council of Östergötland, Sweden.
    Peterson, G.
    Linköping University, Linköping, Sweden; Linköping University, Linköping, Sweden.
    Overmeer, Thomas
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Johansson, G.
    Karolinska Institutet, Stockholm, Sweden.
    Peolsson, A.
    University of Queensland, Brisbane, Australia; Linköping University, Linköping, Sweden.
    Factors associated with work ability in patients with chronic whiplash-associated disorder grade II-III: A cross-sectional analysis2015Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, nr 6, s. 546-551Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To investigate the factors related to self-perceived work ability in patients with chronic whiplash-associated disorder grades II-III. Design: Cross-sectional analysis. Patients: A total of 166 working age patients with chronic whiplash-associated disorder. Methods: A comprehensive survey collected data on work ability (using the Work Ability Index); demographic, psychosocial, personal, work- and condition-related factors. Forward, stepwise regression modelling was used to assess the factors related to work ability. Results: The proportion of patients in each work ability category were as follows: poor (12.7%); moderate (39.8%); good (38.5%); excellent (9%). Seven factors explained 65% (adjusted R2= 0.65, p < 0.01) of the variance in work ability. In descending order of strength of association, these factors are: greater neck disability due to pain; reduced self-rated health status and health-related quality of life; increased frequency of concentration problems; poor workplace satisfaction; lower self-efficacy for performing daily tasks; and greater work-related stress. Conclusion: Condition-specific and psychosocial factors are associated with self-perceived work ability of individuals with chronic whiplash-associated disorder.

  • 2.
    Blomgren, KB.
    et al.
    Mälardalens högskola, Institutionen för vård- och folkhälsovetenskap.
    Sundström, A.
    Medical Products Agency, Uppsala, Sweden .
    Steineck, G.
    Karolinska Institutet, Stockholm, Sweden.
    Wiholm, B-E.
    Medical Products Agency, Uppsala, Sweden.
    Interviewer Variability: Quality aspects in a case-control study.2006Ingår i: European Journal of Epidemiology, ISSN 0393-2990, Vol. 21, nr 4, s. 267-277Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Quality assurance and quality control are important for the reliability of case-control studies. Here we describe the procedures used in a previously published study, with emphasis on interviewer variability. To evaluate risk factors for acute pancreatitis, information including previous diagnoses and medication was collected from medical records and by telephone interviews from 462 cases and 1781 controls. Quality assurance procedures included education and training of interviewers and data validity checks. Quality control included a classification test, annual test interviews, expert case validation, and database validation. We found pronounced variations between interviewers. The maximal number of interviews per day varied from 3 to 9. The adjusted average (95% CI) number of diagnoses captured per interview of cases was 4.1 (3.8-4.3) and of controls 3.5 (3.4-3.7) (excluding one deviating interviewer). For drugs, the average (95% CI) number per interview was 3.9 (3.7-4.1) for cases and 3.3 (3.2-3.4) for controls (excluding one deviating interviewer). One of the fourteen interviewers deviated significantly from the others, and more so for controls than for cases. This interviewer's data ;were excluded. Nonetheless, data concerning controls more frequently needed correction and supplementation than for cases. Erroneous coding of diagnoses and medication was also more frequent among controls. Thus, a system for quality control of coding practices is crucial. Variability in interviewers' ability to ascertain information is a possible source of bias in interview-based case-control studies when "blinding" cannot be achieved.

  • 3.
    Faresjö, Å
    et al.
    Linköping University, Linköping, Sweden.
    Grodzinsky, E
    County Council of Östergötland, Linköping, Sweden.
    Johansson, S
    University of Gothenburg, Gothenburg, Sweden .
    Wallander, MA
    Uppsala University, Uppsala, Sweden.
    Timpka, T
    Linköping University, Linköping, Sweden.
    Åkerlind, Ingemar
    Linköping University, Sweden.
    A population based case control study of work and psychosocial problems in patients with irritable bowel syndrome - women are more seriously affected than men.2007Ingår i: American Journal of Gastroenterology, ISSN 0002-9270, Vol. 102, nr 2, s. 371-379Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Everyday psychosocial functioning and quality of life are known to be reduced for patients with irritable bowel syndrome (IBS), but few previous studies have analyzed associations with functioning in working life. Accordingly, we examined perceptions of working conditions, functioning in the workplace, quality of life, and psychological complaints among IBS patients compared with age- and sex-matched controls. METHODS: A case-control study design was used based on 347 IBS patients from Swedish general practice who were compared with age- and sex-matched controls (N = 1,041) randomly selected from the general population. A survey was performed including validated questions concerning job strain, quality of life (SF-36 [Short Form 36]), absence because of illness, depression, anxiety, and sleeping habits. RESULTS: The IBS patients reported considerably more often that their daily performance in working life was affected by their gastrointestinal problems (OR [odds ratio] 7.14, 95% CI 5.45-9.36). Male IBS cases only reported less authority regarding decisions on their working pace (OR 5.44, 95% CI 1.28-23.18), while female IBS patients reported less decision authority regarding planning their work (OR 2.29, 95% CI 1.13-4.64), fewer learning opportunities at work (OR 2.12, 95% CI 1.26-3.57), and more long-term sick leave than their controls (OR 3.70, 95% CI 1.94-7.07). The female IBS cases also reported lower quality of life in all dimensions than their controls. CONCLUSION: In particular, female IBS patients reported lower authority over decisions at work and problems in their daily functioning in the workplace. These associations persisted after adjustments for possible confounders such as mood, sleeping problems, and perceived health.

  • 4.
    Johansson, K.
    et al.
    Linköping University, Linköping, Sweden.
    Bendtsen, P.
    Linköping University, Linköping, Sweden.
    Åkerlind, Ingemar
    Linköping University, Linköping, Sweden.
    Advice to patients in Swedish primary care regarding alcohol and other life style habits: How patients report the actions of GPs in relation to their own expectations and satisfaction with the consultation2005Ingår i: European Journal of Public Health, ISSN 1101-1262, Vol. 15, nr 6, s. 615-620Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Lifestyle advice given by general practitioners (GPs) may be a cost-effective means of health promotion; however, it is not fully put into routine practice. The aim of this study was to explore to what extent GPs' patients expect and receive advice concerning alcohol, tobacco, exercise and diet in relation to sociodemographic characteristics, type of visit and patient satisfaction. METHODS: A postal questionnaire was sent to a representative sample (n = 9750) of patients who had consulted GPs in a county in Sweden. The response rate was 69% (n = 6734). RESULTS: Exercise was the most (16%) and alcohol the least (5%) common type of advice. The patients received advice more often than they expected in all areas except alcohol. The patients reported the highest rate of unfulfilled advice expectation and the lowest rate of unexpected advice in the case of alcohol. Male gender, poorer self-rated health and scheduled appointment were independent predictors of all types of advice. Continuity of GP contact was only favourable for exercise and diet advice. The patients who received advice were more satisfied with their visit to the doctor. CONCLUSIONS: A tertiary preventive perspective guides GPs' practice of giving advice. Male patients with advanced illnesses are given priority. Women and patients with long-term risk habits are more neglected. The GPs tend to misjudge the expectations and needs of their patients and are too restrained in their counselling practice. Alcohol is the most disregarded area of advice in proportion to the patients' expectations and needs.

  • 5.
    Martin, Lene
    Stockholm University, Sweden.
    Computer-assisted management of primary open-angle glaucoma. Knowledge acquisition and prototype testing1996Ingår i: Computers in Nursing, ISSN 0736-8593, Vol. 14, nr 5, s. 267-271Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Primary open-angle glaucoma is a common disease afflicting 1% to 2% of people older than 50 years of age. The care of patients with glaucoma is a subject of debate because the disease is incompletely understood. The diagnosis relies on a number of examinations, many of them performed by ophthalmic nurses, and the care of patients with glaucoma has become one of the main tasks for ophthalmic nurses in Sweden. This study describes a knowledge-based system for decision support in glaucoma management, which uses seven data elements about the patient to arrive at one of 25 different recommendations for appropriate action. In 267 patient visits to five different eye clinics, the program recommendations were compared with the actual decisions made by the responsible physician. The concordance was 92% to 100% when policy differences among the clinics were taken into account. The program appears to provide substantial decision support in the management of primary open-angle glaucoma. The program's ability to support the ophthalmic nurses in the care of patients with open-angle glaucoma is being evaluated.

  • 6.
    Martin, Lene
    Karolinska Institutet, Sweden.
    Knowledge acquisition and evaluation of an expert system for managing disorders of the outer eye2001Ingår i: Computers in Nursing, ISSN 0736-8593, Vol. 19, nr 3, s. 114-117Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of the current study was to develop and evaluate an expert system for diagnosing outer eye disorders, intended to support family physicians and nurse practitioners in the management of patients with minor eye complaints. The knowledge in the program was gathered from the scientific literature and from 6 experienced ophthalmologists and 6 ophthalmic nurses. Fourteen diagnoses must be considered, and the differential diagnosis is dependent upon 32 signs and symptoms. The program calculates the most likely diagnosis, presents photographs of the typical ocular findings, and provides information regarding management and treatment. The program's output was compared with the diagnosis made by 8 other ophthalmologists at a Swedish university clinic, based on data from 157 patients with disorders of the outer eye, who visited the emergency ward during a one-week period. The concordance between the diagnosis made by the ophthalmologists and the program was 96%. In conclusion, the expert system for disorders of the outer eye provided essentially the same diagnostic information as an examination by an ophthalmologist. Support from the program would make it possible for family physicians and nurse practitioners to manage most of these patients.

  • 7.
    Martin-Boglind, Lene
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd. Sabbatsberg Hospital, Sweden.
    Graves, Adrienne
    Sabbatsberg Hospital, Sweden.
    Wanger, Peter
    Sabbatsberg Hospital, Sweden.
    The effect of topical antiglaucoma drugs on the results of high-pass resolution perimetry1991Ingår i: American Journal of Ophthalmology, ISSN 0002-9394, E-ISSN 1879-1891, Vol. 11, nr 6, s. 711-714Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We conducted a randomly assigned, double-masked, crossover study of the effects of betaxolol, epinephrine, pilocarpine, and timolol on the high-passresolution perimetry results in normal subjects. The influence of topical administration of these intraocular pressure reducing drugs was negligible, which confirmed the reliability of high-pass resolution perimetry results. The method seems appropriate for the diagnosis of glaucoma and the follow-up ofpatients with glaucoma.

  • 8.
    Müllersdorf, Maria
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd. University of Uppsala, Uppsala, Sweden.
    Söderback, Ingrid
    Mälardalens högskola, Akademin för hälsa, vård och välfärd. University of Uppsala, Uppsala, Sweden.
    The actual state of the effects, treatment and incidence of disabling pain in a gender perspective-- a Swedish study.2000Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 22, nr 18, s. 840-54Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The purpose of the study was to elicit the actual state of self-perceived experience of long-term and/or recurrent pain and its effects as reported by women and men with disabilities due to pain, in order to determine criteria for assessing the need for measures in rehabilitation/occupational therapy. METHODS: The study used a comparative design with a sample randomized from the Swedish population aged 18-58 years (n = 10,000). The inclusion criterion was that the respondents had or had had pain causing activity limitation or restricting participation in daily life. A special questionnaire including items concerning demography, pain, coping, occupations in daily life, work, treatments, care institutions and hospital/care staff visited, was posted to 1,849 persons and was answered by 1,448 respondents (study group n = 1,305, control group n= 117). Results: Gender differences were found in the overall prevalence of pain, women reporting more frequent episodes of pain than men did. Differences were also found in pain variables, in daily occupations, days of sick-leave and work variables. Women completed more varied treatment than men. The incidence rate of long-term/recurrent pain in the population studied was 0.07. Conclusions: As a conclusion from this study, three essential components are suggested for use when assessing the need for rehabilitation/occupational therapy: (1) shoulder/arm or lower back pain of aching, tensed and/or searing character, particularly among women; (2) emotional/affective pain effects causing restlessness and depression, particularly among women; and (3) limitations in daily occupations assessed by FSQ and the demand/control/support model with results falling within the warning zones plus long sick-leave periods.

  • 9.
    Nilsson, M
    et al.
    Karolinska Institutet, Stockholm, Sweden .
    von Wendt, G
    St. Erik Eye Hospital, Stockholm, Sweden.
    Wanger, P
    Karolinska Institutet, Stockholm, Sweden .
    Martin, Lene
    Karolinska Institutet, Stockholm, Sweden .
    Early detection of macular changes in patients with diabetes using Rarebit Fovea Test and optical coherence tomography2007Ingår i: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 91, nr 12, s. 1596-1598Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To evaluate central retinal thickness and foveal function using optical coherence tomography (OCT) and the Rarebit Fovea Test (RFT) in patients with diabetes without previously known retinopathy or maculopathy. METHOD: Forty-two patients with diabetes mellitus (DM) were selected from the screening records at St Erik Eye Hospital. Inclusion criteria were absence of macular or other retinal changes at previous screening examination and best corrected visual acuity >/=1.0. These patients and 42 healthy controls were examined with the recently developed RFT, and retinal thickness was measured using OCT. Lens thickness and light scatter were evaluated by Scheimpflug photography. RESULTS: Significantly more DM subjects (12/42) had a subnormal RFT result compared with the controls (2/42) (p = 0.007). None of the 12 DM subjects had maculopathy, one had mild non proliferative diabetic retinopathy, and five had minimal non-proliferative diabetic retinopathy. The retinal thickness in the pericentral zone was significantly (p<0.05) thinner in DM patients with subnormal RFT compared with the controls. CONCLUSION: Decreased RT and subnormal RFT results were found in a subgroup of diabetes patients, despite normal screening results. Prospective studies are under way to evaluate the prognostic implications.

  • 10.
    Rasjö Wrååk, G.
    et al.
    Storvretens Primary Health Care Centre, Stockholm County, Sweden.
    Törnkvist, L.
    Karolinska Institutet, Stockholm, Sweden .
    Hasselström, J.
    Karolinska Institutet, Stockholm, Sweden .
    Wändell, P. E.
    Karolinska Institutet, Stockholm, Sweden .
    Josefsson, Karin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Nurse-led empowerment strategies for patients with hypertension: A questionnaire survey2015Ingår i: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 62, nr 2, s. 187-195Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Hypertension is common and may lead to cerebrovascular and cardiovascular events and mortality. District nurses frequently encounter patients requiring blood pressure monitoring, lifestyle counsel and support. Empowerment as a method enables patients to both increase their control over their health and improve it. Aim: This study aims to describe the effects of the counsel and support from district nurses to patients with hypertension. Methods: A randomized controlled intervention trial. Questionnaires were answered by patients with hypertension before and after the intervention comprising district nurses' counsel and support based upon empowerment. A specially developed card for blood pressure monitoring was also used. Results: Blood pressure decreased in intervention and the control groups. The intervention group experienced significantly improved health, with better emotional and physical health, and reduced stress. Living habits did not change significantly in either group. Satisfaction with knowledge of hypertension increased significantly in both groups. The intervention group reported that their care was based upon their health needs. Limitations: Conducting large multi-centre studies with long follow-ups is complicated and results sometimes have a tendency to decline with time. A shorter follow-up might have shown a greater difference between the groups. Conclusion: Nursing interventions through district nurses' counsel and support with empowerment improved patients' health. More research is needed to evaluate nursing interventions' effect on hypertension. Implications for nursing and health policy: This study highlighted that district nurses' counsel and support increased patients' health and decreased stress by focusing on empowerment.

  • 11.
    Svanberg, Mikael
    et al.
    Region Västmanland, Sweden.
    Johansson, Ann-Christina
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Boersma, Katja
    Örebro Universitet, Sweden.
    Does validation and alliance during the multimodal investigation affect patients' acceptance of chronic pain? An experimental single case study.2019Ingår i: Scandinavian Journal of Rehabilitation Medicine, ISSN 0036-5505, E-ISSN 1940-2228, Vol. 19, nr 1, s. 73-82Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims Among chronic pain patients who are referred to participation in a multimodal rehabilitation program (MMRP), pain catastrophizing and dysfunctional pain coping is common. In many cases it may have driven the patient to a range of unsuccessful searches for biomedical explanations and pain relief. Often these efforts have left patients feeling disappointed, hopeless and misunderstood. The MMRP process can be preceded by a multimodal investigation (MMI) where an important effort is to validate the patient to create a good alliance and begin a process of change towards acceptance of the pain. However, whether the MMI has such therapeutic effect is unclear. Using a repeated single case experimental design, the purpose of this study was to investigate the therapeutic effect of MMI by studying changes in patients' experience of validation, alliance, acceptance of pain, coping, catastrophizing, and depression before and during the MMI process. Methods Participants were six chronic pain patients with high levels of pain catastrophizing (>25 on the Pain Catastrophizing Scale) and risk for long term disability (>105 on the Örebro Musculoskeletal Pain Screening Questionnaire) who were subjected to MMI before planned MMRP. For each patient, weekly self-report measures of validation, alliance and acceptance of pain were obtained during a 5-10-weeks baseline, before the MMI started. Subsequently, these measures were also obtained during a 6-8 weeks MMI process in order to enable comparative analyses. Additionally, pain coping, depression and pain catastrophizing were measured using standardized questionnaires before and after the MMI. Results Irrespective of experiences of validation and alliance before MMI, all six patients felt validated and experienced a good alliance during MMI. Acceptance of pain improved only in one patient during MMI. None of the patients showed clinically relevant improvement in pain coping, depression or catastrophizing after the MMI. Conclusions The patients did not change their acceptance and pain coping strategies despite of good alliance and experience of validation during the MMI process. Even if the design of this study precludes generalization to chronic pain patients in general, the results suggest that MMI may not have a therapeutic effect.

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