| 1. |
- Agrell, Wilhelm, et al.
(författare)
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Sweden: A Delicate Liaison
- 2016
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Ingår i: The Handbook of European Intelligence Cultures. - 9781442249417 ; , s. 371-382
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Bokkapitel (refereegranskat)
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| 2. |
- Bergström, Johan, et al.
(författare)
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Rule- and Role-Retreat: An Empirical Study of Procedures and Resilience
- 2009
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Ingår i: Journal of Maritime Research. - 1697-9133. ; 6:1, s. 75-90
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Tidskriftsartikel (refereegranskat)abstract
- To manage complex and dynamic socio-technical systems places demands on teams to deal with a range of more and less foreseeable situations. Three groups of participants with different maritime experiences were studied using the same simulation of a ship to better understand the role of generic competencies (e.g. information management, communication and coordination, decision making, and effect control) play in such high-demand situations. Groups with moderate maritime experience were able to balance contextual knowledge with use of generic competencies to successfully manage unexpected and escalating situations. Novices, lacking contextual knowledge, performed less well. Groups with the most maritime expertise remained committed to presumed procedures and roles and did not perform as well as the other two groups. The results suggest that training to operate complex socio-technical systems safely and effectively should go beyond procedures and include development of generic competencies. This could provide operators with better tools to enhance organizational resilience in unexpected and escalating situations.
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| 3. |
- Bergström, Johan, et al.
(författare)
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The Social Process of Escalation: A Promising Focus for Crisis Management Research
- 2012
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 12:161
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Tidskriftsartikel (refereegranskat)abstract
- Background This study identifies a promising, new focus for the crisis management research in the health care domain. After reviewing the literature on health care crisis management, there seems to be a knowledge-gap regarding organisational change and adaption, especially when health care situations goes from normal, to non-normal, to pathological and further into a state of emergency or crisis. Discussion Based on studies of escalating situations in obstetric care it is suggested that two theoretical perspectives (contingency theory and the idea of failure as a result of incomplete interaction) tend to simplify the issue of escalation rather than attend to its complexities (including the various power relations among the stakeholders involved). However studying the process of escalation as inherently complex and social allows us to see the definition of a situation as normal or non-normal as an exercise of power in itself, rather than representing a putatively correct response to a particular emergency. Implications The concept of escalation, when treated this way, can help us further the analysis of clinical and institutional acts and competence. It can also turn our attention to some important elements in a class of social phenomenon, crises and emergencies, that so far have not received the attention they deserve. Focusing on organisational choreography, that interplay of potential factors such as power, professional identity, organisational accountability, and experience, is not only a promising focus for future naturalistic research but also for developing more pragmatic strategies that can enhance organisational coordination and response in complex events.
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| 4. |
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| 5. |
- Dinka, David, 1974-
(författare)
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Role, Identity and Work : Extending the design and development agenda
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In order to make technology easier to handle for its users, the field of HCI (Human- Computer Interaction) has recently often turned the environment and the context of use. In this thesis the focus is on the relation between the user and the technology. More specifically, this thesis explores how roles and professional identity effects the use and views of the technology used. The exploration includes two different domains, a clinical setting and a media production setting, where the focus is on the clinical setting. These are domains that have strong professional identities in common, in the clinical setting neurosurgeons and physicists, and the media setting journalists. These settings also have a strong technological profile, in the clinical setting the focus has been on a specific neurosurgical tool called Leksell GammaKnife and in the journalistic setting the introduction of new media technology in general has been in focus. The data collection includes interviews, observations and participatory design oriented workshops. The data collected were analyzed with qualitative methods inspired by grounded theory. The work with the Leksell GammaKnife showed that there were two different approaches towards the work, the tool and development, depending on the work identity. Depending on if the user were a neurosurgeon or a physicist, the definition of the work preformed was inline with their identity, even if the task preformed was the same. When it comes to the media production tool, the focus of the study was a participatory design oriented development process. The outcome of the process turned out to be oriented towards the objectives that were inline with the users identity, more than with the task that were to be preformed. At some level, even the task was defined from the user dentity.
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| 6. |
- Dinka, David, et al.
(författare)
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Situated cognition in clinical visualization : the role of transparency in GammaKnife neurosurgery planning.
- 2009
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Ingår i: Artificial intelligence in medicine. - : Elsevier BV. - 1873-2860 .- 0933-3657. ; 46:2, s. 111-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to investigate how the clinical use of visualization technology can be advanced by the application of a situated cognition perspective. METHODS AND MATERIALS: The data were collected in the GammaKnife radiosurgery setting and analyzed using qualitative methods. Observations and in-depth interviews with neurosurgeons and physicists were performed at three clinics using the Leksell GammaKnife. RESULT: The users' ability to perform cognitive tasks was found to be reduced each time visualizations incongruent with the particular user's perception of clinical reality were used. The main issue here was a lack of transparency, i.e. a black box problem where machine representations "stood between" users and the cognitive tasks they wanted to perform. For neurosurgeons, transparency meant their previous experience from traditional surgery could be applied, i.e. that they were not forced to perform additional cognitive work. From the view of the physicists, on the other hand, the concept of transparency was associated with mathematical precision and avoiding creating a cognitive distance between basic patient data and what is experienced as clinical reality. The physicists approached clinical visualization technology as though it was a laboratory apparatus--one that required continual adjustment and assessment in order to "capture" a quantitative clinical reality. CONCLUSION: Designers of visualization technology need to compare the cognitive interpretations generated by the new visualization systems to conceptions generated during "traditional" clinical work. This means that the viewpoint of different clinical user groups involved in a given clinical task would have to be taken into account as well. A way forward would be to acknowledge that visualization is a socio-cognitive function that has practice-based antecedents and consequences, and to reconsider what analytical and scientific challenges this presents us with.
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| 7. |
- Ekberg, Joakim, et al.
(författare)
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Transparency and documentation in simulations of infectious disease outbreaks: Towards evidence-based public health decisions and communications
- 2009
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Ingår i: Proceedings of the Second International ICST Conference on Electronic Healthcare for the 21st century. - Berlin, Heidelberg : Springer Berlin Heidelberg. - 9783642117442 - 9783642117459 ; , s. 28-34
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Konferensbidrag (refereegranskat)abstract
- Computer simulations have emerged as important tools in the preparation for outbreaks of infectious disease. To support the collaborative planning and responding to the outbreaks, reports from simulations need to be transparent (accessible) with regard to the underlying parametric settings. This paper presents a design for generation of simulation reports where the background settings used in the simulation models are automatically visualized. We extended the ontology-management system Protégé to tag different settings into categories, and included these in report generation in parallel to the simulation outcomes. The report generator takes advantage of an XSLT specification and collects the documentation of the particular simulation settings into abridged XMLs including also summarized results. We conclude that even though inclusion of critical background settings in reports may not increase the accuracy of infectious disease simulations, it can prevent misunderstandings and less than optimal public health decisions.
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| 8. |
- Hermansson, Ann-Charlotte, et al.
(författare)
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Exploration of the life histories and future of war-wounded Salvadoran and Iranian Kurd quota refugees in Sweden : A qualitative approach
- 2003
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Ingår i: International Journal of Social Welfare. - 1369-6866 .- 1468-2397. ; 12:2, s. 142-153
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Tidskriftsartikel (refereegranskat)abstract
- This study explores the life histories of ten Salvadoran and twelve Iranian Kurd refugees. Both groups came to Sweden as war-wounded quota refugees and their migration was forced. They had spent many years in guerilla movements and were experienced soldiers despite their youth. They were interviewed during hospitalisation shortly after arrival in Sweden, and followed-up after two years. The findings suggest that repatriation is a recurrent theme in the future plans of these refugees. The reconstruction of identity may take many forms due to a background as youth soldiers as well as their different experiences of the culture in the host country. Longitudinal studies of how refugees rebuild their lives are needed, and comprehensive analysis from different theoretical perspectives is a necessary complement to general adaptation models.
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| 9. |
- Lützhöft, Margareta, et al.
(författare)
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Piloting by heart and by chart
- 2006
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Ingår i: Journal of navigation (Print). - 0373-4633 .- 1469-7785. ; 59:2, s. 221-237
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Tidskriftsartikel (refereegranskat)abstract
- This paper describes the complexity of the Baltic archipelago, and the navigational and operational processes involved in piloting these waters. This four year ethnographic study shows how piloting is learned, performed, and passed on to the next generation of pilots. The blend of new technology and old methods is discussed, the indivisibility of working and learning, and the individuality of the mental constructs of the mariners/pilots.
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| 10. |
- Lützhöft, Margareta, 1964-
(författare)
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“The technology is great when it works” : Maritime Technology and Human Integration on the Ship’s Bridge
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Several recent maritime accidents suggest that modern technology sometimes can make it difficult for mariners to navigate safely. A review of the literature also indicates that the technological remedies designed to prevent maritime accidents at times can be ineffective or counterproductive. To understand why, problem-oriented ethnography was used to collect and analyse data on how mariners understand their work and their tools. Over 4 years, 15 ships were visited; the ship types studied were small and large archipelago passenger ships and cargo ships. Mariners and others who work in the maritime industry were interviewed. What I found onboard were numerous examples of what I now call integration work. Integration is about co-ordination, co-operation and compromise. When humans and technology have to work together, the human (mostly) has to co-ordinate resources, co-operate with devices and compromise between means and ends. What mariners have to integrate to get work done include representations of data and information; rules, regulations and practice; human and machine work; and learning and practice.Mariners largely have to perform integration work themselves because machines cannot communicate in ways mariners see as useful. What developers and manufacturers choose to integrate into screens or systems is not always what the mariners would choose. There are other kinds of ‘mistakes’ mariners have to adapt to. Basically, they arise from conflicts between global rationality (rules, regulations and legislation) and local rationality (what gets defined as good seamanship at a particular time and place). When technology is used to replace human work this is not necessarily a straightforward or successful process. What it often means is that mariners have to work, sometimes very hard, to ‘construct’ a cooperational human-machine system. Even when technology works ‘as intended’ work of this kind is still required.Even in most ostensibly integrated systems, human operators still must perform integration work. In short, technology alone cannot solve the problems that technology created. Further, trying to fix ‘human error’ by incremental ‘improvements’ in technology or procedure tends to be largely ineffective due to the adaptive compensation by users. A systems view is necessary to make changes to a workplace. Finally, this research illustrates the value problem-oriented ethnography can have when it comes to collecting information on what users ‘mean’ and ‘really do’ and what designers ‘need’ to make technology easier and safer to use.
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| 11. |
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| 12. |
- Nyce, James M, et al.
(författare)
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The Reformist Triad and Institutional Forgetting of Culture : A Field Study into Twentieth-Century Swedish Social Medicine
- 2012
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Ingår i: International Journal of Health Services. - : Baywood Publishing. - 0020-7314 .- 1541-4469. ; 42:1, s. 95-107
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Tidskriftsartikel (refereegranskat)abstract
- Social medicine deals with the interplay between medicine and society. An awareness of how analytical categories have emerged historically can strengthen the role the discipline can play in the societal reinventions of health care now under way around the world. This study examines the categories that informed social medicine in Sweden during the 20th century. An anthropological field study was conducted over a 12-year period in a Swedish academic clinical setting. Historical documents were used to link local-level issues with macro-level (here, national and European) contexts. Social medicine, modernity, and social democracy were found to share a common history and a common vision of what society should be. As a result, concepts from politics, ideology, economy, and science tended to be conflated. As a clinician at the study site explained, "samhalle [community] is both society and state." The consequence for social medicine is that culture has become neglected as an analytical category. This institutional amnesia has strongly influenced how 21st century social medicine, in this region of the world, has defined itself and its interests. To return a cultural perspective to social medicine, a critical distance must be kept between the analyses the discipline undertakes and the prevailing societal ideologies.
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| 13. |
- Persson, Per-Arne, 1947-
(författare)
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Bringing power and knowledge together : information systems design for autonomy and control in command work
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- THIS THESIS PRESENTS an empirical ethnographic study that has been conducted as fieldwork within army command organizations, leading to a qualitative analysis of data. The title of the thesis captures the contents of both command work and research, both domains being affected by new technologies during a period of drastic changes in the military institution. The overriding research question was why efforts to implement modern information technology are so slow, costly, and why the contribution from the output as regards higher control efficiency is so uncertain. Two cases will be described and analysed. One is a meeting and the other is the development of a computer artefact. Based on these two cases, the study suggests that social value and not only rational control efficiency defines what is applied, both in the development process and in practice. Knowledge and power, expertise and authority, represented by experts and formal leaders have to be brought together if the work is to be efficient. Both knowledge from research and information technology will be rejected, if considered irrelevant. I have called this applying a rationality of practice.From the case analysis it can be said that command work is not ordinary managerial work. Rather, it is a kind of design work, dynamic and hard to define and control. Command work is knowledge-intensive; it designs and produces symbols. Therefore it is very flexible and involves interpretation and negotiation of both its content and products. The most important symbol is the Army, which must be visible and credible, built from real components.Command work is pragmatic and opportunistic, conducted by experts in the modern military command structure who transform the operational environment, and control it through controlling actions. In that respect autonomy, a prerequisite to meet evolving events—frictions—and power become core issues, interchangeable goals and means for flexible social control, in cybernetic terms variety. Key concepts are social value, function and visibility. Actors must be visible in the command work, and make work visible. Consequently, when designing control tools, such as information systems, the design challenge is to reconcile dynamic and pragmatic demands for power, autonomy and control with demands for stability. Such an organization becomes a viable system, one that can survive, because there is no conflict between its mind and physical resources. In operational terms, this means having freedom of action. The prerequisite to achieve this is one perspective on knowledge and information and that information systems match the needs growing from within the work because work builds the organization.
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| 14. |
- Persson, Per-Arne, et al.
(författare)
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Command and control : A biased combination?
- 2000
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Ingår i: The Human in Command. - New York : Kluwer Academic/Plenum Publishers. - 0306463660 - 9780306463662 ; , s. 201-216
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Although technology has come a long way in assisting the resolution of some of the conflicts, inevitably human conflict requires human intervention. This book aims to explore and understand the implications of this human intervention and the ways that science can make it more effective
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| 15. |
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| 16. |
- Pettersson, Ulrica, et al.
(författare)
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Hierarchy and Tacit Knowledge in the Swedish Armed Forces: An Organisational Approach
- 2011
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Ingår i: Proceedings of the 3rd European Conference on Intellectual Capital. ; , s. 328-332
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Konferensbidrag (refereegranskat)abstract
- This paper describes in what ways hierarchical organizations influence the utilization and dissemination of knowledge. Particular attention will be paid to the role that tacit knowledge has. The reporting system of incidents is one element in a larger institutional process, often termed 'lessons learned' (LL). This process helps to suggest solutions to identify shortcomings and facilitates in making positive experiences durable. In organizational learning, there is a need to get hold of valuable experience, in order to improve. A serious weakness in several organizations seems to be that numerous experiences are poorly reported. A common and well known reporting procedure is 'after action reviews/reports' (AAR), used e. g. by the US Army and Marine Corps. It is essential that an effective reporting system presumes trust between informants/staff and the organization they work for. However, institutional belief and practice tends to reduce the effectiveness LL might have. Our paper discusses some difficulties in the reporting system and makes some elements of the problem more understandable. Some alternatives to standard operating practice will be outlined here that could help remedy some of these problems. The 'just culture' literature will be used to point out the direction institutional redesign should take regarding responsibility and accountability. This paper could also help guide future research in this area, by identifying critical assumptions, defining why certain problems need to be refined and by looking at why current research techniques are not sufficient.
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| 17. |
- Raymer, Karen E., et al.
(författare)
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Anaesthesia monitor alarms: a theory-driven approach
- 2012
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Ingår i: Ergonomics. - : Informa UK Limited. - 0014-0139 .- 1366-5847. ; 55:12, s. 1487-1501
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Forskningsöversikt (refereegranskat)abstract
- The development of physiologic monitors has contributed to the decline in morbidity and mortality in patients undergoing anaesthesia. Diverse factors (physiologic, technical, historical and medico-legal) create challenges for monitor alarm designers. Indeed, a growing body of literature suggests that alarms function sub-optimally in supporting the human operator. Despite existing technology that could allow more appropriate design, most anaesthesia alarms still operate on simple, pre-set thresholds. Arguing that more alarms do not necessarily make for safer alarms is difficult in a litigious medico-legal environment and a competitive marketplace. The resultant commitment to the status quo exposes the risks that a lack of an evidence-based theoretical framework for anaesthesia alarm design presents. In this review, two specific theoretical foundations with relevance to anaesthesia alarms are summarised. The potential significance that signal detection theory and cognitive systems engineering could have in improving anaesthesia alarm design is outlined and future research directions are suggested.
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| 18. |
- Räsänen, Minna, et al.
(författare)
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A new role for anthropology? : rewriting "context" and "analysis" in HCI research
- 2006
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Ingår i: NordiCHI 2006. - New York, NY, USA : ACM. - 1595933255 - 9781595933256 ; , s. 175-184
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Konferensbidrag (refereegranskat)abstract
- In this paper we want to reconsider the role anthropology(both its theory and methods) can play within HCI research. One of the areas anthropologists can contribute to here is torethink the notion of social context where technology isused. Context is usually equated with the immediateactivities such as work tasks, when and by whom the task isperformed. This tends to under represent some fundamentalaspects of social life, like culture and history. In this paper,we want to open up a discussion about what context meansin HCI and to emphasize socio-structural and historicalaspects of the term. We will suggest a more inclusiveanalytic way that able the HCI community to make “better”sense of use situation. An example of technology use in aworkplace will be given to demonstrate the yields this kindof theoretical framework can bring into HCI.
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| 19. |
- Räsänen, Minna, 1964-
(författare)
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Islands of Togetherness : Rewriting Context Analysis
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A continuing debate within Human-Computer Interaction (HCI) research is how to elucidate, improve, and optimize the relationship between social context and technology use. Social context is conventionally understood as immediate use context while an understanding informed by social science suggests a wider scope, involving actors and structures. The focus of this thesis is the use of a communication environment using audio and video, established to span and connect three geographically distant call-centre workplaces in the Stockholm archipelago, Sweden. The research was carried out as intermittent fieldwork, spanning unevenly over a period of three years. The fieldwork was carried out at two sites: the premises of the Swedish Police Contact Centre in the archipelago and within the research project Community at a Distance. Methods included participant observation, interviews, and the analysis of documents, everyday talk, and images. This thesis offers a broad analysis of the socio-cultural context of technology use investigating the question how a sense of togetherness is promoted and negotiated at the Swedish Police Contact Centre and around and across the communication environment. The technology served as a means of overcoming the distance between the sites and making everyday encounters between the dispersed staff members possible. The sense of togetherness—fellowship and belonging, caring for each other, fostering a sense of solidarity, and achieving consensus in everyday practices—had an impact on the uses (and non-uses) of the technology. The use of the communication environment reflects the values and arrangements of the workplace and reproduces its conventions. The discussion is explorative, outlining an analytical approach to the socio-cultural context of technology use informed by interpretive social science, and provides a partial analysis of the organizational culture of the Contact Centre and its technology use. The argument is that analysis should aim at exploring the relationship between individual actors and social structures. Rewriting context allows us to understand the socio-cultural embeddedness of technology. While the analytic framework is not comprehensive for the purpose of detailed design implications in HCI research, it does provide a reconsidered terminology that links individual practices to socio-cultural context.
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| 20. |
- Räsänen, Minna, 1964-, et al.
(författare)
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The Raw is Cooked : Data in Intelligence Practice
- 2013
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Ingår i: Science, Technology and Human Values. - : SAGE Publications. - 0162-2439 .- 1552-8251. ; 38:5, s. 655-677
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Tidskriftsartikel (refereegranskat)abstract
- This article looks at some common assumptions and associated work practices within a military intelligence community. There intelligence practitioners use the term raw data as a common sense category, as a word that describes information they want or have gained access to. The practical and organizational processes that inform the construction of the term raw data are unpacked here. Examples presented are based on interviews, field observations, and document reviews. Theoretical descriptions and models of work, for example, the intelligence cycle, construction, and the use of computer databases, assume that work in this community starts with raw data. However, this data has already been (prior) processed by the work practices, political, practical, and other decisions even before data collection occurs. The technology and attendant categories and practices instrumentalize a certain world view. The model used frames not just the collection and organization of the institution's knowledge but those categories that inform how this institution organizes, legitimizes, and enacts its work, data, and knowledge. Given the kinds of opponents nations have to face today, intelligence practitioners and those who study their work have to understand practice, action, and contexts often quite different from ones own.
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| 21. |
- Timpka, Toomas, et al.
(författare)
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A neighborhood susceptibility index for planning of local physical interventions in response to pandemic influenza outbreaks
- 2010
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Ingår i: AMIA Annual Symposium Proceedings. - 1942-597X. ; 2010, s. 792-796
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Tidskriftsartikel (refereegranskat)abstract
- The global spread of a novel A (H1N1) influenza virus in 2009 has highlighted the possibility of a devastating pandemic similar to the 'Spanish flu' of 1917-1918. Responding to such pandemics requires careful planning for the early phases where there is no availability of pandemic vaccine. We set out to compute a Neighborhood Influenza Susceptibility Index (NISI) describing the vulnerability of local communities of different geo-socio-physical structure to a pandemic influenza outbreak. We used a spatially explicit geo-physical model of Linköping municipality (pop. 136,240) in Sweden, and employed an ontology-modeling tool to define simulation models and transmission settings. We found considerable differences in NISI between neighborhoods corresponding to primary care areas with regard to early progress of the outbreak, as well as in terms of the total accumulated share of infected residents counted after the outbreak. The NISI can be used in local preparations of physical response measures during pandemics.
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| 22. |
- Timpka, Toomas, et al.
(författare)
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Face mask use during the COVID-19 pandemic-the significance of culture and the symbolic meaning of behavior
- 2021
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Ingår i: Annals of Epidemiology. - : ELSEVIER SCIENCE INC. - 1047-2797 .- 1873-2585. ; 59
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- During public emergencies, a door can open on the fundamental elements upon which a societys social order is built. The Covid-19 pandemic has opened such a door in societies worldwide. We outline in this commentary some of these social elements and how they may have influenced face mask use during the early stages of the pandemic. The purpose is to expand the perspective on mechanisms that are relevant to consider in pandemic response planning. Our look at these fundamental elements showed that latent aspects of the dominant culture and various symbolic meanings of behaviors can reduce adherence with public health recommendations if they are overlooked in the strategic health plans. We conclude that when policymakers decide non-pharmacological interventions during pandemics, they should take into account fundamental attitudes and beliefs that may influence population behavior. This will require paying attention to variations in things like culture and symbolic meanings of behavior. (C) 2021 Elsevier Inc. All rights reserved.
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| 23. |
- Timpka, Toomas, et al.
(författare)
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Performance of eHealth data sources in local influenza surveillance : a 5-year open cohort study
- 2014
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 16:4, s. 216-225
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is abundant global interest in using syndromic data from population-wide health information systems-referred to as eHealth resources-to improve infectious disease surveillance. Recently, the necessity for these systems to achieve two potentially conflicting requirements has been emphasized. First, they must be evidence-based; second, they must be adjusted for the diversity of populations, lifestyles, and environments.OBJECTIVE: The primary objective was to examine correlations between data from Google Flu Trends (GFT), computer-supported telenursing centers, health service websites, and influenza case rates during seasonal and pandemic influenza outbreaks. The secondary objective was to investigate associations between eHealth data, media coverage, and the interaction between circulating influenza strain(s) and the age-related population immunity.METHODS: An open cohort design was used for a five-year study in a Swedish county (population 427,000). Syndromic eHealth data were collected from GFT, telenursing call centers, and local health service website visits at page level. Data on mass media coverage of influenza was collected from the major regional newspaper. The performance of eHealth data in surveillance was measured by correlation effect size and time lag to clinically diagnosed influenza cases.RESULTS: Local media coverage data and influenza case rates showed correlations with large effect sizes only for the influenza A (A) pH1N1 outbreak in 2009 (r=.74, 95% CI .42-.90; P<.001) and the severe seasonal A H3N2 outbreak in 2011-2012 (r=.79, 95% CI .42-.93; P=.001), with media coverage preceding case rates with one week. Correlations between GFT and influenza case data showed large effect sizes for all outbreaks, the largest being the seasonal A H3N2 outbreak in 2008-2009 (r=.96, 95% CI .88-.99; P<.001). The preceding time lag decreased from two weeks during the first outbreaks to one week from the 2009 A pH1N1 pandemic. Telenursing data and influenza case data showed correlations with large effect sizes for all outbreaks after the seasonal B and A H1 outbreak in 2007-2008, with a time lag decreasing from two weeks for the seasonal A H3N2 outbreak in 2008-2009 (r=.95, 95% CI .82-.98; P<.001) to none for the A p H1N1 outbreak in 2009 (r=.84, 95% CI .62-.94; P<.001). Large effect sizes were also observed between website visits and influenza case data.CONCLUSIONS: Correlations between the eHealth data and influenza case rates in a Swedish county showed large effect sizes throughout a five-year period, while the time lag between signals in eHealth data and influenza rates changed. Further research is needed on analytic methods for adjusting eHealth surveillance systems to shifts in media coverage and to variations in age-group related immunity between virus strains. The results can be used to inform the development of alert-generating eHealth surveillance systems that can be subject for prospective evaluations in routine public health practice.
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| 24. |
- Timpka, Toomas, et al.
(författare)
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Population-based simulations of influenza pandemics : validity and significance for public health policy
- 2009
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Ingår i: BULLETIN OF THE WORLD HEALTH ORGANIZATION. - 0042-9686 .- 1564-0604. ; 87:4, s. 305-311
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Tidskriftsartikel (refereegranskat)abstract
- Objective To examine the validity and usefulness of pandemic simulations aimed at informing practical decision-making in public health. Methods We recruited a multidisciplinary group of nine experts to assess a case-study simulation of influenza transmission in a Swedish county. We used a non-statistical nominal group technique to generate evaluations of the plausibility, formal validity (verification) and predictive validity of the simulation. A health-effect assessment structure was used as a framework for data collection. Findings The unpredictability, of social order during disasters was not adequately addressed by simulation methods; even minor disruptions of the social order may invalidate key infrastructural assumptions underpinning current pandemic simulation models. Further, a direct relationship between model flexibility and computation time was noted. Consequently, simulation methods cannot, in practice, support integrated modifications of microbiological, epidemiological and spatial submodels or handle multiple parallel scenarios. Conclusion The combination of incomplete surveillance data and simulation methods that neglect social dynamics limits the ability of national public health agencies to provide policy-makers and the general public with the critical and timely information needed during a pandemic.
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| 25. |
- Timpka, Toomas, et al.
(författare)
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Professional ethics for infectious disease control: moral conflict management in modern public health practice
- 2023
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Ingår i: Public Health. - : W B SAUNDERS CO LTD. - 0033-3506 .- 1476-5616. ; 221, s. 160-165
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: Despite scientific evidence that confirms their effectiveness, use of vaccines and microbiological mass testing during the COVID-19 pandemic has been associated with social and moral controversies. In this commentary, it is suggested how such conflicts originating from moral/normative imperatives can be managed in infectious disease control. Study design: This was a commentary analysis. Methods: A case example of scientific and public debate regarding infectious disease control and policy-making during the early pandemic response is first presented. The case is used to characterize how conflicts arising from moral constraints occurred during the COVID-19 pandemic. These features are thereafter used as a basis for outlining a strategy for moral conflict prevention and management. Results: A challenge for infectious disease control throughout the pandemic was how to manage persuasive initiatives originating from social forces competing with science for influence. Purposively maneuvered information distributed through social media and internet websites could predispose population factions to contest legitimate (evidence and legally based) pandemic response measures. During the pandemic, fact-based criticism of professionals responsible for infectious disease control was mixed with a critique of their moral standards and intentions so as to diminish effectiveness and credibility. Such blending could be curtailed if infectious disease control professionals are made accountable for public health decisions made in the light of prevalent scientific evidence and legislation. Conclusions: If the infectious disease control community would embrace the international code of medical professional ethics, this would help to deal with moral conflicts, especially ones arising from external threats, in modern public health. (c) 2023 The Author(s). Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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| 26. |
- Timpka, Toomas, et al.
(författare)
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Requirements and Design of the PROSPER Protocol for Implementation of Information Infrastructures Supporting Pandemic Response: A Nominal Group Study
- 2011
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 6:3, s. 0017941-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Advanced technical systems and analytic methods promise to provide policy makers with information to help them recognize the consequences of alternative courses of action during pandemics. Evaluations still show that response programs are insufficiently supported by information systems. This paper sets out to derive a protocol for implementation of integrated information infrastructures supporting regional and local pandemic response programs at the stage(s) when the outbreak no longer can be contained at its source. Methods: Nominal group methods for reaching consensus on complex problems were used to transform requirements data obtained from international experts into an implementation protocol. The analysis was performed in a cyclical process in which the experts first individually provided input to working documents and then discussed them in conferences calls. Argument-based representation in design patterns was used to define the protocol at technical, system, and pandemic evidence levels. Results: The Protocol for a Standardized information infrastructure for Pandemic and Emerging infectious disease Response (PROSPER) outlines the implementation of information infrastructure aligned with pandemic response programs. The protocol covers analyses of the community at risk, the response processes, and response impacts. For each of these, the protocol outlines the implementation of a supporting information infrastructure in hierarchical patterns ranging from technical components and system functions to pandemic evidence production. Conclusions: The PROSPER protocol provides guidelines for implementation of an information infrastructure for pandemic response programs both in settings where sophisticated health information systems already are used and in developing communities where there is limited access to financial and technical resources. The protocol is based on a generic health service model and its functions are adjusted for community-level analyses of outbreak detection and progress, and response program effectiveness. Scientifically grounded reporting principles need to be established for interpretation of information derived from outbreak detection algorithms and predictive modeling.
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| 27. |
- Timpka, Toomas, et al.
(författare)
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The Little Engine That Could: A Qualitative Study of Medical Service Access and Effectiveness among Adolescent Athletics Athletes Competing at the Highest International Level
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:14
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Tidskriftsartikel (refereegranskat)abstract
- Little is known about provision of medical services to adolescents prior to participating in international top-level sports. This study aimed to investigate experiences of medical service provision among high-level adolescent athletics (track and field) athletes from three continents. A thematic narrative analysis was applied to data collected from 14 athletes by semi-structured interviews. Although competing at the highest international level, these adolescent athletes had difficulties making sense of symptoms of ill health, especially on their own. With increasing exercise loads, the athletes medical support needs had extended beyond the capacity of parents and local communities. As there was no organized transfer of the responsibility for medical support to sports organizations, the athletes often had to manage their health problems by themselves. There were major variations among the adolescent athletes with regards to medical service access and quality. The services used ranged from sophisticated computer-assisted biomechanical analyses to traditional healers. Decreased exercise load was the common sports injury treatment. The results of this study demonstrate how the ethical standards underpinning youth sports as well as the equal provision of medical services to adolescents are challenged across the world. Further research on health service provision to adolescent top-level athletes is warranted.
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| 28. |
- Timpka, Toomas, 1957-, et al.
(författare)
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Value-Based Reimbursement in Collectively Financed Healthcare Requires Monitoring of Socioeconomic Patient Data to Maintain Equality in Service Provision
- 2018
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Ingår i: Journal of general internal medicine. - : SPRINGER. - 0884-8734 .- 1525-1497. ; 33:12, s. 2240-2243
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Tidskriftsartikel (refereegranskat)abstract
- Value-based purchasing is increasingly discussed in association with efforts to develop modern healthcare systems. These models are the most recent example of models derived from health economics research intended to reform collectively financed healthcare. Previous examples have ranged from creation of pseudo-markets to opening these markets for competition between publicly and privately owned enterprises. Most value-based purchasing models tend to ignore that health service provision in collectively financed settings is based on an insurance with political, social obligations attached that challenge the notion of free market and individualist premises which these models rest on. Central social issues related to healthcare in any modern complex society, such as inequality in service provision, can all too easily disappear in value-based reform efforts. Based on an analysis of Swedish policy development, we contend that management information systems need to be extended to allow routine monitoring of socioeconomic data when models such as value-based purchasing are introduced in collectively financed health services. The experiences from Sweden are important for health policy in Europe and other regions with collectively financed healthcare plans.
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