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Kalliokoski, Paul
Publikationer (5 of 5) Visa alla publikationer
Kalliokoski, P. (2019). Vitamin D, muscle strength, prolonged labour, Caesarean sections and lifestyle: Clinical and intervention studies in pregnant Somali and Swedish women and new mothers. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Öppna denna publikation i ny flik eller fönster >>Vitamin D, muscle strength, prolonged labour, Caesarean sections and lifestyle: Clinical and intervention studies in pregnant Somali and Swedish women and new mothers
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Long-term severe vitamin D deficiency may cause osteomalacia with muscle weakness, pain, soft bones, cramps and eventually death. In a pilot study, I found many Somali women to be vitamin D deficient and very weak. This raised my interest and resulted in the research questions regarding if and how this weakness was linked to vitamin D deficiency, if it could be treated with simple lifestyle advice and supplementation, and if pronounced deficiency could cause serious birth outcomes due to prolonged labour?

Study I showed that 90% of pregnant Somali women (n = 52) and new mothers from primary antenatal care suffered from vitamin D deficiency with pronounced muscular weakness and signs of skeletal degradation, compared with 10% of the Swedish women (n = 71). Handgrip strength was predicted by vitamin D levels.

Study II showed that vitamin D supplementation among those with insufficient levels at baseline reversed deficiency and skeletal degradation. Furthermore, increased strength in hands and legs was predicted by the amount of supplement intake.

Study III aimed to investigate the vitamin D levels and the birth outcomes of cesarean sections and assisted birth for prolonged labour. A directed acyclic graph was established to adjust for covariates. A causal effect of critically low (unmeasurable) vitamin D levels on the outcomes of caesarean sections, emergency caesarean sections and assisted birth for prolonged labour was found with the increased odds of four, nine and six times to one for the birth outcomes, respectively.

Lifestyle associated with vitamin D may concern many due to risk of low sun exposure, for example, when working long office hours, engaging in excessive computer gaming, using sunscreen, wearing veiled clothes, or when having special diets like vegan food.

It is important to monitor individuals in primary- and antenatal care with muscle weakness and risk factors for vitamin D deficiency, especially in the high-risk group of Somali pregnant women and new mothers.         

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2019. s. 68
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1594
Nyckelord
: caesarean section, dystocia, immigrant, muscle strength, obstetric labour complications, osteomalacia, physical performance, Somalia, vitamin D, vitamin D deficiency
Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
Allmänmedicin
Identifikatorer
urn:nbn:se:uu:diva-392475 (URN)978-91-513-0741-1 (ISBN)
Disputation
2019-10-25, A1:111a, BMC, Husargatan 3, Uppsala, 13:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2019-10-03 Skapad: 2019-09-04 Senast uppdaterad: 2019-10-23
Kalliokoski, P. (2016). 20th Wonca Europe Conference 2015 Istanbul. Distriktsläkaren (1), pp. 28-31
Öppna denna publikation i ny flik eller fönster >>20th Wonca Europe Conference 2015 Istanbul
2016 (Svenska)Ingår i: Distriktsläkaren, ISSN 0283-9830, nr 1, s. 28-31Artikel i tidskrift, Dagstidning (Övrig (populärvetenskap, debatt, mm)) Published
Ort, förlag, år, upplaga, sidor
Stockholm: , 2016
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:uu:diva-281022 (URN)
Tillgänglig från: 2016-03-16 Skapad: 2016-03-16 Senast uppdaterad: 2017-05-04Bibliografiskt granskad
Kalliokoski, P., Bergqvist, Y. & Löfvander, M. (2013). Physical performance and 25-hydroxyvitamin D: a cross-sectional study of pregnant Swedish and Somali immigrant women and new mothers. BMC Pregnancy and Childbirth, 13, Article ID 237.
Öppna denna publikation i ny flik eller fönster >>Physical performance and 25-hydroxyvitamin D: a cross-sectional study of pregnant Swedish and Somali immigrant women and new mothers
2013 (Engelska)Ingår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 13, artikel-id 237Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background:

Severe vitamin D deficiency can impair muscle strength. The study aims were to examine physical performance in the hands and upper legs, and analyze plasma 25-hydroxyvitamin D (25(OH) D) concentrations in women with presumably low (veiled, Somali-born) and high levels (unveiled, Swedish-born).

Methods:

Women (n = 123, 58% Swedish) enrolled at a Swedish antenatal clinic, latitude 60 degrees N, were recruited. Plasma 25(OH) D was analyzed, measured as nmol/L, then categorized as <10 = undetectable, 10-24, 25-49, 50-74 or >75. Muscle strength was tested: maximal hand grip strength (in Newtons, N), and upper leg performance (categorized as able/unable to perform squatting, standing on one leg, standing from a chair, and lifting their hips). Social and anthropometric data were collected. Non-parametric statistics tested the data for differences in their ability to perform the tests across 25(OH) D categories. Undetectable values (< 10 nmol/L) were replaced with '9' in the linear correlation statistics. A final main effect model for grip strength (in N) was calculated using stepwise linear regression for independent variables: country of birth, 25(OH) D levels, age, height, weight, physical activity, lactation status, parity, and gestational age.

Results:

Somali participants (35%) had 25(OH) D levels of < 10 nmol/L, and 90% had < 25 nmol/L; 10% of Swedish participants had < 25 nmol/L of 25(OH) D, and 54% had < 50 nmol/L. Somali women had a relatively weak grip strength compared with Swedish women: median 202 N (inter-quartile range 167-246) vs. median 316 N (inter-quartile range 278-359), respectively. Somali women were also weak in upper leg performance: 73% were unable to squat, 29% unable to stand on one leg, and 21% could not lift their hips (not significant across 25(OH) D categories); most Swedish women could perform these tests. In the final model, grip strength (N) was significantly associated with 25(OH) D levels (B 0.94, p=0.013) together with Somali birth (B -63.9, p<0.001), age (B 2.5, p=0.02) and height (B 2.6, p=0.01).

Conclusions:

Many Somali women had undetectable/severely low 25(OH) D concentrations and pronounced hand and upper leg weakness; grip strength was strongly associated with 25(OH) D. Maternity health care personnel should be aware of this increased frequency and manage care accordingly.

Nyckelord
Vitamin D, 25(OH)D, Ultraviolet B radiation, Grip strength, Clinical observation, Physical performance, Primary care, Somalia, Pregnancy
Nationell ämneskategori
Allmänmedicin
Identifikatorer
urn:nbn:se:uu:diva-217631 (URN)10.1186/1471-2393-13-237 (DOI)000329252000003 ()
Tillgänglig från: 2014-02-06 Skapad: 2014-02-04 Senast uppdaterad: 2019-09-05Bibliografiskt granskad
Kalliokoski, P., Nohlert, E., Rodhe, N. & Löfvander, M.Critically low vitamin D may cause emergency caesarean sections:a cohort study of Somali and Swedish women in antenatal primary care.
Öppna denna publikation i ny flik eller fönster >>Critically low vitamin D may cause emergency caesarean sections:a cohort study of Somali and Swedish women in antenatal primary care
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Nyckelord
Caesarean section, dystocia, immigrant, muscle strength, obstetric labour 70 complications, osteomalacia, Somalia, vitamin D
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Forskningsämne
Obstetrik och gynekologi
Identifikatorer
urn:nbn:se:uu:diva-392423 (URN)
Tillgänglig från: 2019-09-03 Skapad: 2019-09-03 Senast uppdaterad: 2019-09-05
Kalliokoski, P., Widarsson, M., Rodhe, N. & Löfvander, M.Impact on Vitamin D related lifestyle in Somali women with severe deficiency following medical advice by doctor: A mixed method study of before and after treatment.
Öppna denna publikation i ny flik eller fönster >>Impact on Vitamin D related lifestyle in Somali women with severe deficiency following medical advice by doctor: A mixed method study of before and after treatment
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Nyckelord
Clinical trial, Food, Lifestyle, Somalia, Vitamin D, Pregnant
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Forskningsämne
Allmänmedicin
Identifikatorer
urn:nbn:se:uu:diva-392424 (URN)
Tillgänglig från: 2019-09-03 Skapad: 2019-09-03 Senast uppdaterad: 2019-09-05
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