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  • 1. Engström, Christer
    et al.
    Brändström, Sven
    Sigvardsson, Sören
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Cloninger, C Robert
    Nylander, Per-Olof
    Bipolar disorder. III: harm avoidance a risk factor for suicide attempts2004Inngår i: Bipolar Disorders, ISSN 1398-5647, E-ISSN 1399-5618, Vol. 6, nr 2, 130-138 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: The aim of the study was to examine whether personality, i.e. temperament and character influence suicide attempts in bipolar patients.

    Methods: Bipolar patients were recruited from lithium dispensaries. Temperament and character inventory (TCI) was administered to 100 euthymic bipolar patients and 100 controls.

    Results: Age of onset was significantly lower in patients with suicide attempts in the total bipolar group (I and II) and bipolar I patients compared with patients without suicide attempts. Bipolar (I and II) and bipolar I patients with suicide attempts were significantly higher in harm avoidance (HA) and reward dependence compared with patients without suicide attempts. Patients (I and II) with suicide attempts had significantly more anticipatory worry, fatigability and asthenia than patients without suicide attempts. Bipolar I patients with suicide attempts had significantly more fatigability and asthenia and were more dependent than patients without suicide attempts. HA was lowest in patients with no suicide attempts and no family history of suicide, higher in patients with family history of suicide or patients with suicide attempts, and significantly highest in patients with suicide attempts and family history of suicide. Patients with suicide attempts and family history of suicide had more anticipatory worry, fatigability and asthenia. Bipolar disorder was significantly correlated to HA and suicide attempts to HA and PS. Family history of suicide and gender were significantly correlated to suicide attempts.

    Conclusions: Age of onset, HA, PS, gender and family history of suicide had a moderate to very strong effect on suicide attempts in bipolar patients.

  • 2. Engström, Christer
    et al.
    Brändström, Sven
    Sigvardsson, Sören
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Cloninger, Robert
    Nylander, Per-Olof
    Bipolar disorder I. Temperament and character2004Inngår i: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 82, nr 1, 131-134 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The nature of the relationship between personality and bipolar affective disorders is an important but unanswered question. Methods: We have studied personality in bipolar patients by using the Temperament and Character Inventory (TCI). TCI were administered to 100 euthymic bipolar patients and 100 controls from the normal population.

    Results: Bipolar patients were significantly higher in harm avoidance (HA) and lower in reward dependence (RD), self-directedness (SD), and cooperativeness (CO) than controls. Bipolar patients are more fatigable, less sentimental, more independent, less purposeful, less resourceful, less empathic, less helpful, less pure-hearted, and have less impulse control than controls. Bipolar II patients are more impulsive, more fatigable, less resourceful, and have less impulse control than bipolar I patients.

    Limitations: Our results are limited to euthymic bipolar patients and cannot be generalized to affective disorders.

    Conclusions: Even when clinically euthymic on lithium maintenance, bipolar patients continue to have a characteristic cognitive deficit. This is in agreement with cognitive theories about cognitive deficits in depression that are regarded as important vulnerability factors in mood disorders.

  • 3.
    Grönblom-Lundström, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Conditions for acting: a theoretical discussion1998Inngår i: Nordisk fysioterapi, ISSN 1402-3024, Vol. 2, 37-40 s.Artikkel i tidsskrift (Annet vitenskapelig)
  • 4.
    Grönblom-Lundström, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Health as a measure of rehabilitation: outcome for patients with low-back pain1992Inngår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 8, nr 2, 67-77 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Low back pain (LBP) has become a serious economic problem and a multifactorial problem to be solved within medicine. Investigations have demonstrated that the problem may best be solved outside medicine or, if within, in cooperation with behavioural scientists and with involved elements outside medicine such as the National Health Insurance System. How is LBP defined? Do all people involved in the rehabilitation of LBP define it in the same way? Are there any alternative ways to define it? In this paper, I will present a humanistic-social perspective of how LBP can be denned. This perspective or theory of health takes into account these outside factors as well as a person's ability to act in relation to the social context within which that person is living. In order to provide more effective treatment, in the sense of giving people the support they need to get better, other methods of treating LBP must be developed. This humanistic-social perspective indicates that a person's goals and actual circumstances at the time of rehabilitation should be the base for the planned activity. From this perspective, the objective findings should only be the base for the choice of technical method, not the base for the overall rehabilitation strategy.

  • 5.
    Grönblom-Lundström, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Rehabilitation in light of different theories of health: Outcome for patients with low-back complaints - a theoretical discussion2001Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The aim of this thesis was to investigate if the outcome of rehabilitation efforts is depending on what view health care has in relation to what need of care people have and if the outcome for different groups of patients with low-back complaints (specific versus non-specific complaints) is various successful. The outcome is measured in length of sick leave, number of spells and granted sickness and disability pensions.

    This thesis combines a theoretical analysis of different theories of health with studies of two empirical materials. One material comprises a group of individuals with low-back complaints (specific versus non-specific complaints) from a nation-wide survey of Living Conditions conducted by Statistics Sweden in 1981. The other material comprises a sample of individuals on sick leave either due to low-back complaints or other kinds of complaints than low-back complaints. The outcome of these studies are measured as to what extent people with low-back complaints are granted a disability pension (Paper III) and which the characteristics are of those on sick leave due to low-back complaints compared to those with other kinds of complaints (Paper IV). The results from Paper III revealed a difference concerning socio-economic group and granted disability pension between those with specific, non-specific and frequent low-back complaints. Those with non-specific and frequent low-back complaints were to higher extent manual workers and disability pensioners. The results of Paper IV reveals also a socio-economic difference besides that those with low-back complaints had longer sick leave periods and more spells. 

    What does these results indicate? Are non-specific and frequent low-back complaints not successfully treated within the health care system? Is this due to how these matters have been identified? Are these individuals truly disabled due to their low-back complaints, if so how are they assessed and treated? I believe that the notions of health and disease as well as the social context in which people act influence the outcome of rehabilitation. If people judge their health as bad (here due to low-back troubles) and in need of health care and the health care system do not recognise their need when not identified as diseased a problem arises. These individuals claim that their ability to work is hampered due to the low-back complaint and the society has an obligation and needs a legitimate solution for those individuals that cannot support themselves due to ill health. This obligation makes a demand on the health care system.

    If non-specific complaints are assessed as non-medical problems, from a biomedical point of view, health care lacks measures to take care of these people if they ought to be taken care of within the health care system at all. But this outcome (a disability pension) may also indicate that people suffer from a “true” illness although not defined by objective findings. If that is the state one may ask if there is a lack of sufficient diagnostic procedures and measures as well. A rehabilitation approach stemming from a humanistic social perspective might lead to a more favourable outcome for people with low-back complaints, whether or not these complaints have been identified in a biomedical sense, as this perspective take into account both the goals, the resources and the social context of that individual. 

    This thesis has paid attention to the matter that conceptual notions, which seldom are considered within clinical praxis, are of vital importance for the outcome of rehabilitation. Health care falls short especially when it comes to non-specific and frequent low-back complaints and this may be due to the biomedical model being used too strictly within a domain where other models, here exemplified as Pörn’s Theory of Health, might result in a more favourable rehabilitation outcome for the individual.

  • 6.
    Grönblom-Lundström, Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Low-back complaints and other complaints as a reason for sick listing: a comparative study regarding work-related factors, socio-demographic factors, leisure-time, social support and perceived healthManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    The aim of this study was to investigate in what way people on sick leave due to low-back troubles distinguish as a group from other individuals on sick leave. The population in this study consisted of all individuals 20-64 years of age, who in 1991 belonged to a local health insurance office in northern Sweden. All individuals, born on day 5, 15 and 25, who had been on sick leave due to low-back (LB) complaints (low-back group) and a random sample of individuals, who had been on sick leave due to other kinds of complaints (reference group) constituted the study sample. Information was collected from their sickness records and from a questionnaire sent to each individual comprising questions about education, working environment, perceived health, social support, leisure time activities and smoking habits. There were no differences found regarding the sex of the individuals, leisure time activities or social support between the two studied groups. In the multivariate logistic regression analysis the result revealed that the LB group had longer sick leave periods, more spells and was to greater extent blue-collar workers.

    This may indicate differences in the working situation between the groups, which in turn may aggravate LB problems leading to longer sick leave or more spells. 

  • 7.
    Grönblom-Lundström, Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Self-reported low-back complaints in a random population sample: specific versus non-specific complaintsInngår i: Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    The purpose of this study was to investigate the distribution of selfreported low-back (LB) complaints in the social structure, and to investigate how the variables - physical work load, physical ability, Activities of Daily Living (ADL), mental job strain, social support, health and smoking - were associated with the different LB complaints. The Survey of Living Conditions carried out by Statistics Sweden 1980-81 has been used as the basis of the investigation. The LB complaints were dichotomised into specific and non-specific LB complaints according to an assumed grade of measurability. The non-specific LB complaints showed a social gradient which specific complaints did not despite the association with some of the variables. People, with a non-specific LB complaint, were besides that associated with a higher risk to become a sickness and disability pensioner than people with a specific LB complaint. This may indicate that either strategies used within the health care system in general are more suitable for specific complaints perhaps due to their higher grade of measurability or that people with a non-specific complaint suffers from an incapacitating illness that cannot be cured.

  • 8.
    Hallberg, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Developmental Unit, County Council of Dalarna, Falun, Sweden.
    Divorced middle-aged men: psychosocial and medical aspects1991Doktoravhandling, med artikler (Annet vitenskapelig)
  • 9.
    Hellström, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Dialogue medicine: a health-liberating attitude in general practice1998Inngår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 35, nr 3, 221-231 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Dialogue medicine is presented as the prime means of understanding patients' illnesses. It is a practical attitude especially aimed to assist or inspire patients to consider, see and manage their illness–demanding efforts to unwittingly suppress or disguise such self-reproaching thoughts as are worse to bear than the feeling of being afflicted with a disease. Along with diagnosing patients' perceived bodily disorders, doctors can choose to see them as persons whose ailments stand for efforts to manage their existence as communicative human beings. The core of the paper is an encounter between the author and a female patient which illuminates the usefulness of genuine dialogue in medical practice. The paper illustrates how the dialogical attitude helps patients to see and manage their difficult life-situations and how the doctor can be inspired to change and develop and improve his/her skills as a dialogue partner. Doctors' dialogical attitude in the encounter encompasses for example openness, empathy, sensitivity, courage, attentiveness and responsiveness, accompanied by concern, trust, respect, affection, appreciation and hope. The philosophical and theoretical foundations of the concept of dialogue medicine are sketched out and some practically significant traits are described.

  • 10.
    Hellström, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Patienten som person: om mening och dialog i allmänmedicinsk praktik1999Doktoravhandling, med artikler (Annet vitenskapelig)
  • 11.
    Hellström, Olle
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Bullington, J
    Karlsson, G
    Lindqvist, P
    Mattsson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    A phenomenological study of fibromyalgia: Patient perspectives1999Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 17, nr 1, 11-16 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To describe the way in which the fibromyalgia patients understand the meaning of their illness. DESIGN: Qualitative, empirical phenomenological psychological method. SETTING: A collaborative transdisciplinary interview study of patients' described experiences of living with fibromyalgia. No therapeutic relationships existed between patients and researchers. SUBJECTS: Eighteen patients with fibromyalgia were interviewed. Ten of the 18 taped interviews were transcribed and analysed. MAIN OUTCOME MEASURES: Patients' narratives, described experiences of living with fibromyalgia. RESULTS: The patients were intensively involved in efforts to get their self-images as ill persons confirmed. Their experience was that the disease started dramatically, with a variety of capriciously appearing symptoms of unknown cause that gave rise to the suffering. The fibromyalgia patients seemed to develop strategies to cope with a precarious self-image and find ways to manage the thought of what the future would bring. CONCLUSION: The meaning structures revealed in the patients' ways of describing their experiences of living with fibromyalgia seemed to be partially constituted by their efforts to stand forth as afflicted with a disease, which could be a way to help them to manage the demands that they placed upon themselves.

  • 12.
    Hellström, Olle
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Lindqvist, P
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Mattsson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    A phenomenological analysis of doctor-patient interaction: a case study1998Inngår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 33, nr 1, 83-89 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The fact that the biomedical model has been very successful in practice does not preclude that some health issues can be understood by way of other health care perspectives. Acquiring skills in meeting patients requires theories that structure other fields of knowledge than the biomedical sciences. An old man, who experiences himself as deeply misunderstood by the medical profession, is interviewed, his personal life-story is gone into and his case records and other available data are analysed. A phenomenological method is used, i.e. disciplined and rigorous reflection upon available data, remaining close to the particular pieces of the patient's narrative as they stand forth in their contextual relationships. The study shows that the doctors involved did not relate to the patient but to a biomedical image of him. His efforts to make himself understood were converted into instrumentally manageable disorders. Finally, dialogue medicine is briefly introduced as a model for counselling patients, especially when they need assistance to abandon the notion that they have been afflicted with a disease, a perception that might serve the purpose of keeping a threatening self-image out of consciousness.

  • 13.
    Lynöe, Niels
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Theoretical and empirical aspects of the assessment and practice of alternative medicine1991Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The main purpose of this dissertation is to elucidate the problem of assessing and providing alternative medical technologies. The purpose is divisible into three parts:

    1. To investigate the bases of assessment for the acceptance of an alternative medical technology; 2. To investigate the professional and ethical problems connected with the practice of alternative medical technologies and find out whether the views of laymen and physicians differ with regard to the provision of treatments which are not in accordance with science and proven experience; 3. To investigate the interest physicians have shown in alternative medicine and the motives for this interest.

      These investigations are based partly on a study of the literature on alternative medicine dealing with the effects of the following alternative medical technologies: manipulation therapy, acupuncture, reflexio (zone) therapy, homoeopathy and magnetic therapy, and partly on empirical research into the attitudes expressed by doctors and patients towards non-scientific treatments.

      The results of these studies show that the acceptance of empirical data cannot be separated from the scientific paradigm within which the investigation has been planned. The documentation of the effect of alternative medical technologies is often empirically insufficient and based, in many instances, on so-called ”personal experience”. The interest shown by accredited physicians in alternative medicine is often motivated by the fact that certain complaints brought to them by their patients cannot be rectified by academic medical methods. The study also shows that physicians have professional interests which the patient is not prepared to respect in the same way as the physician is prepared to respect the right of a patient to refuse to undergo life-saving medical treatment.

      The main conclusion is that alternative medicine is a heterogeneous field where the interest expressed can be interpreted as a crisis phenomenon and an indication of the need for the assessment of alternative medicine as well as academic medicine. Laymen perceive the ethical and professional problems connected with the practice of alternative medicine relatively differently when compared to physicians. The possibility of scientific co-operation between practitioners of alternative medicine and academic medicine is difficult due to the fact that alternative medicine and academic medicine relate to different scientific paradigms. Clinical co-operation in the case of individual patients, on the other hand, is likely to occur.

  • 14.
    Lynöe, Niels
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Dahlquist, Gisela
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Jacobsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Informed consent: study of quality of information given to participants in a clinical trial1991Inngår i: BMJ. British Medical Journal, ISSN 0959-535X, E-ISSN 1756-1833, Vol. 303, nr 6803, 610-613 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To determine whether the participants in a clinical trial had perceived adequate information about the trial according to the guidelines of the Declaration of Helsinki. DESIGN: About 18 months after the end of a gynaecological clinical trial the participants received a questionnaire by post, which focused on the quality of the information given to them before entering the trial. Neither researchers nor participants were aware in advance that the trial would become the subject of this follow up investigation. SETTING: Eight different centres in Sweden. SUBJECTS: 43 women out of the 53 who completed the trial (mean (range) age 23 (16 to 35) years) returned the questionnaire. MAIN OUTCOME MEASURES: Adequacy of the information (based on requirements of the Declaration of Helsinki) to enable the following: understanding of the aims of the study; awareness of what participation meant; and awareness of the possibility of withdrawing from participation at any time. Motives for agreeing to participate, and a subjective evaluation of the given information were also recorded. RESULTS: All but one of the participants had been aware that they were taking part in a research project. Five women stated that they had not been aware that a second laparoscopy was performed only for research reasons. Seven women reported that they had not been aware of the meaning of participating in the project and 17 that they had had no information about the possibility of withdrawing from the study whenever they wanted. In the subjective rating 22 women considered the information given as good or very good. There was a systematic variation in the quality of the given information among the eight centres. CONCLUSION: Although all but one of the participants had been aware that they were taking part in a clinical trial, the quality of the information understood and recalled by participants varied, and in many cases clearly did not meet the guidelines of the Declaration of Helsinki. Variations among centres in participants' perception of information suggest that deficiencies in perception may be caused by informers rather than the participants.

  • 15.
    Lynöe, Niels
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Jacobsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Clinical cancer research: some aspects on doctors' attitudes to informing participants1996Inngår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 35, nr 6, 749-754 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    With the aim to investigate the information policy of oncologists when recruiting patients for clinical trials a postal questionnaire was sent to 412 members of the Swedish Society of Oncology (response rate 74%). Depending on the situation, 20-40% of the doctors perceive that randomization before consent is an acceptable procedure. A majority of the physicians maintain that cancer patients are able to cope with adequate information but 45% of the doctors fear that the patients may withdraw from participating if they are adequately informed. It seems to be important to study the relationship between the quality of information given to participants and the motives they have for accepting or declining to participate.

  • 16.
    Westman, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Planning primary health care provision: assessment of development work at a health centre1986Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    At the Primary Health Care Centre in Vännäs (VPHCC), northern Sweden, a development work was implemented in 1976-1980. The overall purpose was to enhance primary health care planning. In trying to improve health care delivery cooperation with community members was initiated and some organizational changes like a new appointment system, a new medical record and local care programs for some common diseases were introduced. Official statistics were also used for comparative purposes.

    The aims of the work were postulated (increased accessibility, higher continuity, more equitable distribution and enhanced cooperation) and suitable methods were designed. From postal surveys, chartreviews and administrative data (from hospitals, out-patient clinics and health centres) figures and information were collected.

    Accessibility was studied by waiting room time which was reduced and continuity, analyzed with a new concept - visit based provider continuity - was improved. The question of equitable distribution was studied by the consultation rates at different out-patient clinics. It seemed as if the local development work changed the patterns of utilization but some important issues were not decisively answered.

    Repeated postal surveys reflected the question of equitable distribution and the cooperation between the VPHCC and the community members. Positive responses were recorded in aspects like telephone accessibility and health care information. In a tracer study of diabetes the quality of care was studied. The local care program was actually implemented in the daily practice but the question of care quality needs further penetration.

    Within the frames of the development work new methods in the health care planning were introduced. Our work started from the prerequisits of the VPHCC and other health centres might find other ways of planning for care provision. On a general level, however, the structure of our work - defining aims, means and evaluation methods - can be used by others.

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