Biomedical subjects

Toomas Timpka

Publications and source records attributed to Toomas Timpka.

At least 19 recordsLinked to original sources

PubMed2006

A population-based case-control study of work and psychosocial problems in patients with irritable bowel syndrome--women are more seriously affected than men.

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.

Adolescent↗

PubMed2006

Information infrastructure for inter-organizational mental health services: an actor network theory analysis of psychiatric rehabilitation.

In the supply of mental health services to communities, data and information are managed not only by clinical organizations, but also by welfare state agencies and charities. The aim of this study is to use methods of analysis from actor network theory to identify organizational interventions necessary for the development of an information infrastructure for inter-organizational mental health services. Data was collected in a project aimed at developing an information system that supports inter-organizational psychiatric rehabilitation in a Swedish municipality. Three organizational interventions were identified: an integrated service policy defined by the national government, a common legal framework allowing sharing of high-level client data, and commissioned support for local inter-agency workspaces. It is concluded that organizational interventions must be regarded when configuring an information infrastructure for mental health services. Organizational interventions should also routinely be addressed in systems design methods to be used in inter-organizational settings.

Interinstitutional Relations↗

PubMed2006

Ubiquitous computing to support co-located clinical teams: using the semiotics of physical objects in system design.

OBJECTIVES: Co-located teams often use material objects to communicate messages in collaboration. Modern desktop computing systems with abstract graphical user interface (GUIs) fail to support this material dimension of inter-personal communication. The aim of this study is to investigate how tangible user interfaces can be used in computer systems to better support collaborative routines among co-located clinical teams. METHODS: The semiotics of physical objects used in team collaboration was analyzed from data collected during 1 month of observations at an emergency room. The resulting set of communication patterns was used as a framework when designing an experimental system. Following the principles of augmented reality, physical objects were mapped into a physical user interface with the goal of maintaining the symbolic value of those objects. RESULTS: NOSTOS is an experimental ubiquitous computing environment that takes advantage of interaction devices integrated into the traditional clinical environment, including digital pens, walk-up displays, and a digital desk. The design uses familiar workplace tools to function as user interfaces to the computer in order to exploit established cognitive and collaborative routines. CONCLUSION: Paper-based tangible user interfaces and digital desks are promising technologies for co-located clinical teams. A key issue that needs to be solved before employing such solutions in practice is associated with limited feedback from the passive paper interfaces.

Computer Peripherals↗

PubMed2006

Evaluation of an osteoporosis and fall risk intervention program for community-dwelling elderly. A quasi-experimental study of behavioral modifications.

BACKGROUND AND AIMS: Osteoporosis and fall fractures are increasing problems amongst the elderly. The aim of this study was to explore whether combined population-based and individual interventions directed at risk factors for osteoporosis and falls result in behavioral changes in an elderly population. METHODS: A quasi-experimental design was used for the study. Persons aged >or=65 years were randomly selected in the intervention and control community. An intervention program was managed from the primary health care center and delivered to the community. Health education was designed to increase awareness of risk factors for the development of osteoporosis and falling. Questionnaires about lifestyle, health, previous fractures, safety behavior and physical activity level were distributed at baseline in 1989 and at the follow-ups in 1992 and 1994 in both communities. RESULTS: There was a difference of 17.7% between the dual intervention (receiving both population-based and individual interventions) and the control samples regarding the self-reported use of shoe/cane spikes, and a difference of 20.5% regarding the reported "moderate level" of physical activity in 1994. There was an increase in the number of participants in the dual intervention sample who, at baseline, had not reported equipping their homes with non-slip mats and removing loose rugs but who did report these changes in 1994. The increase in the reported use of shoe/cane spikes in the dual intervention sample was observed mainly for the period 1992-1994. CONCLUSIONS: A public health intervention model, including both population-based and individual interventions, can contribute to behavioral changes in the prevention of falls and changed physical activity patterns amongst elderly people.

Accidental Falls↗

PubMed2006

Designing a decision support system for existing clinical organizational structures: considerations from a rheumatology clinic.

The aim of this study was to identify the social and organizational requirements for a decision support system (DSS) to be implemented in a clinical rheumatology setting, utilizing data-mining techniques. Field observations and focus group interviews were used for data collection. The decision-making was found to be situated, patient-focused, and long-term in nature. At the same time, the main part of peer-to-peer communication was informal. Patient records were involved in almost every decision. The conclusion is that the main challenges, when introducing a DSS at a rheumatology unit, are adapting the system to informal communication structures and integrating it with patient records. Considering incentive structures, understanding workflow and incorporating awareness are relevant issues when addressing these issues in future studies.

Adolescent↗

PubMed2006

Adding value with 3D visualization and haptic forces to radiosurgery--a small theory-based, quasi-experimental study.

This study investigates the use of 3D representation and haptic technology in radiosurgery. The users, experienced users of the Leksell GammaKnife, prefer the 3D representation for constructing a first draft of their plan for neurosurgical intervention. When it comes to the final adjustments, however, they still choose the traditional 2D representation and interaction devices. The perceived control over the radiosurgical process is not considered adequate using the 3D interaction methods. Practitioners do not consider the haptic forces implemented in this test system useful. Possible explanations for these findings are discussed in the paper.

Humans↗

PubMed2006

From sports injury prevention to safety promotion in sports.

Every fifth unintentional injury treated at a healthcare facility in the industrialised part of the world is associated with sports or physical exercise. This article reviews the literature regarding the theoretical and practical underpinnings for community-based sports safety promotion, including both professional and recreational sports. While injury prevention entails the implementation of specific interventions in terms of structural or educational measures, sports safety promotion includes also the antecedent and wider campaigns that are required to succeed with these measures. Comprehensive sports safety promotion programmes thus require that the perspective on the sports injury problem is made broader than consideration of the individual athlete. The results display that involvement in sports safety issues from the sports federations that formulate policies and allocate resources is necessary for coordinated implementation of programme actions. The authorities responsible for sports facilities and legislations in the civil society also need to be included, because of the fact that they control many of the central safety determinants in the sporting environment. It is concluded that the sports injury problem needs to be addressed in liaison with the leaders of socially defined sports communities and the governments representing geographically defined civic communities, and that the safety-supporting environment in professional sports is underdeveloped compared with other areas of working life.

Accident Prevention↗

PubMed2005

Peer-to-peer computing in health-promoting voluntary organizations: a system design analysis.

A large part of the health promotion in today's society is performed as peer-to-peer empowerment in voluntary organisations such as sports clubs, charities, and trade unions. In order to prevent work-related illness and long-term sickness absence, the aim of this study is to explore computer network services for empowerment of employees by peer-to-peer communication. The 'technique trade-off method was used for the analysis of the system design. A Critical Incident Technique questionnaire was distributed to a representative sample of trade union shop stewards (n = 386), and focus-group seminars were arranged where a preliminary set of requirements was discussed. Seven basic requirements were identified and matched to a set of 12 design issues for computer network services, allocating a subset of design issues to each requirement. The conclusion is that the systems design displays an inexpensive and potentially feasible method for peer-to-peer computing in voluntary health-promoting organisations.

Computer Communication Networks↗

PubMed2005

Long-term sickness absence: women's opinions about health and rehabilitation.

AIMS: This paper reports a study to identify associations between ideas of health and rehabilitation in groups of women having first-hand experience of long-term sickness absence. BACKGROUND: As a central part of their work, nurses have to be able to understand people in distress. When someone is unable to work because of illness, nurses are one of the central professional categories involved in their rehabilitation. METHODS: Data were collected by Q-sort grid and biographical interviews from 82 women aged 30-49 years who had either been absent from work because of sickness for 60 days or more, or were receiving a disability pension. The data were first analysed by patterns and structures obtained from a modified factor analysis. The second phase of the analysis dealt with relocating the results from the statistical analyses to their social context. RESULTS: Six opinions representing different conceptions of health, illness, and rehabilitation were identified. These ranged from reflecting high levels of trust in the health care system to reliance on 'nature's course' and emphasizing the meaning of 'feeling all right'. CONCLUSIONS: For women on long-term sick leave, it is reasonable to expect that their communication with rehabilitation professionals will be founded in a mutual understanding of basic concepts. However, the disparate opinions about health and rehabilitation identified in this study show that future studies need to investigate the prospective value of this categorization to see whether and how these conceptions affect rehabilitation practices.

Absenteeism↗

PubMed2005

Use of cultural probes for representation of chronic disease experience: exploration of an innovative method for design of supportive technologies.

Chronic diseases do not only manifest themselves as sets of pathophysiological factors. They bring about an equally important psychosocial impact. Unfortunately, it is difficult to account for this impact in the development of supportive technologies. This study describes and explores a method for elicitation of requirements on technologies supporting self-management including emotional aspects. The method takes advantage of a self-documentary media kit for collection of data from the everyday context of chronic disease. The resulting contextual data can contribute new insights to multi-disciplinary teams in the design of supporting technologies.

Adolescent↗

PubMed2005

GammaKnife surgery: safety and the identity of users.

In this study we investigated safety-related usability issues of an advanced medical technology, a radiosurgery system. We were interested in which criteria are important for users when a system's usability and safety is to be improved. The data collection was based on interviews and observations at three different sites where the Leksell GammaKnife is used. The analysis was qualitative. The main finding was that the user's identity or professional background has a significant impact both on how he or she views his or her role in the clinical setting, and on how he or she defines what improvements are necessary and general safety issues. In fact, the opinion even of users experienced in safety-related problems was highly influenced by how they related to the technology and its development. None of the users actually considered Leksell GammaKnife as lacking in safety, instead, their assessment was directed towards potential future system improvements. Our findings suggest that the importance of user identity or professional background cannot be neglected during the development of advanced technology. They also suggest that the user feedback should always be related to user background and identity in order to understand how important different issues are for particular users.

Attitude of Health Personnel↗

PubMed2005

Towards a simulation environment for modeling of local influenza outbreaks.

OBJECTIVE: To analyze the design of a simulation environment for dynamic prediction of influenza transmission in local communities. METHODS: The technique trade-off method was used to identify and analyze basic design requirements on a simulation environment for modeling of influenza transmission. Data were collected through literature review and interviews with infectious disease experts. The identified requirements were matched to a set of design issues for the simulation environment,and a high-resolution prototype was implemented. RESULTS: Basic reproductive numbers for influenza transmission in a set of Swedish municipalities were calculated. Tradeoffs were necessary in the design between a focus on reproductive numbers vs. case fatality proportions, algorithm validity vs. model adaptability, and specificity in population description vs. generalizability. CONCLUSION: Computer-based simulations can become important tools for local authorities preparing for influenza outbreaks. Balanced tradeoffs between model detail and public health effectiveness are important in simulation environment design.

Adolescent↗

PubMed2004

Impact of a community-based osteoporosis and fall prevention program on fracture incidence.

Associations between a 10-year community-based osteoporosis and fall prevention program and fracture incidence amongst middle-aged and elderly residents in an intervention community are studied, and comparisons are made with a control community. A health-education program was provided to all residents in the intervention community, which addressed dietary intake, physical activity, smoking habits and environmental risk factors for osteoporosis and falls. Both communities are small, semi-rural and situated in Ostergotland County in southern Sweden. The analysis is based on incidences of forearm fractures in the population 40 years of age or older, and hip fractures in the population 50 years of age or older. Data for three 5-year periods (pre-, early and late intervention) are accumulated and compared. In the intervention community, forearm fracture incidence decreased in women. There are also tendencies towards decreasing forearm fracture incidence in men, and towards decreasing trochanteric hip fracture incidences in women and in men in the late intervention period. No such changes in fracture incidences are found in the control community. Cervical hip fracture incidence did not change in the intervention and the control communities. Although the reported numbers of fractures are small (a total of 451 forearm and 357 hip fractures), the numbers are based on total community populations and thus represent a true difference. The decrease in forearm fracture incidence among women, and the tendency towards decreasing trochanteric hip fractures, in contrast to the absence of change in cervical hip fractures, might be mainly due to a more rapid effect of fall preventive measures than an increase in bone strength in the population. For the younger age groups an expected time lag between intervention and effect might invalidate the short follow-up period for outcome measurements. Thus, the effect of the 10-year intervention program on fracture incidence should be followed during an extended post-intervention period.

Accident Prevention↗

PubMed2004

Is calcaneal stiffness more sensitive to physical activity than forearm bone mineral density? A population-based study of persons aged 20-79 years.

AIMS: The aim of this study was to investigate the associations between forearm bone mineral density (BMD), calcaneal stiffness, and physical activity levels in a normal population using different non-invasive methods. METHODS: The participants were invited to undergo bone measurements using single photon absorptiometry of the forearm and quantitative ultrasound (QUS) of the calcaneal bone, and also to complete a questionnaire. Physical activity levels were designated low, moderate, and high in the question on leisure-time activity. RESULTS: There were 956 participants included in the present study. Forearm BMD in the eighth age decade was 0.40 g/cm2 (95% CI 0.33-0.46 g/cm2) lower than in the third decade among women and 0.28 g/cm2 (95% CI 0.18-0.37 g/cm2) lower among men. The differences in calcaneal stiffness between the same age decades were 22.4 (95% CI 17.5-27.4) among women and 15.8 (95% CI 8.0-23.5) among men. The correlation between forearm BMD and calcaneal stiffness was 0.58 (95% CI 0.52-0.64) in women and 0.34 (95% CI 0.25-0.42) in men. Reported moderate and high leisure-time activity levels in both genders were associated with higher calcaneal stiffness but not with forearm BMD. CONCLUSIONS: The QUS may be used to measure the effect of present physical activity levels on calcaneal bone at the population level. Further longitudinal studies are warranted in order to determine the most appropriate non-invasive method in population-based studies.

Absorptiometry, Photon↗

PubMed2004

Design of interactive health drama built on social realism.

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.

Adolescent↗

PubMed2004

Towards integration of computer games in interactive health education environments: understanding gameplay challenge, narrative and spectacle.

CONTEXT: There is an alarming progress in the health status of the young in western countries, and new methods and tools for behavioural health interventions are urgently called for. OBJECTIVE: To explore how computer game designs can be integrated in the development of Interactive Health Education Environments. DESIGN: Qualitative analyses of adolescents' experiences of playing an action-adventure computer game, using data from in-depth interviews. RESULTS: A model is presented, where the gameplaying experience is connected to four components of computer games. Playing computer games was found to mainly be motivated by the challenges and competition represented in the gameplay scripts. CONCLUSIONS: Interactive health education environments can be improved by implementing challenging gameplay scripts, spectacular technical features and narratives.

Adolescent↗

PubMed2004

A management information system model for process-oriented health care.

OBJECTIVE: To develop a conceptual model of a management information system for process-oriented health care organizations. METHODS: Qualitative data was collected from two case studies in process-oriented health care settings. The first study addressed the information requirements of health care managers and the second study focused on organizational activities and clinical practice. From these data, preliminary models were iteratively developed, interpreted, and further revised. SETTING: A county hospital in southern Sweden with 30 clinics and 3,200 employees. RESULTS: A conceptual model of a management information system for process-oriented health care organizations was developed in two parts: one part that describes the organizational interface of the model and the other part that describes the architecture of the model. CONCLUSION: A conceptual model has been developed for local-level integration of management information systems and organizational procedures in process-oriented health care organizations

Delivery of Health Care↗

PubMed2003

A model for interpreting work and information management in process-oriented healthcare organisations.

BACKGROUND: To increase productivity, management in healthcare organisations have introduced different types of process-oriented organisational configurations. Few studies have addressed clinical practice and information management in these settings. METHODS: A case study was performed at a paediatric clinic. Data was collected from archives, through interviews, by participatory observation, and by performing a focus group session. The collected data was analysed using a qualitative and interpretative research strategy. RESULTS: A model was developed of care practitioners' daily work in process-oriented organisations. The model shows that clinical work was deeply integrated; the care activities were dependent on supply activities and tightly connected to management routines. CONCLUSION: The resulting model can be used to support development of health information system (HIS) embedded in process-oriented healthcare work.

Efficiency, Organizational↗