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Lännerström, L., Holmström, I. K., Svärdsudd, K. & Wallman, T. (2017). Possible causes of experiencing problems with sick leave questions in telephone nursing. Upsala Journal of Medical Sciences, 122(4), 249-253
Open this publication in new window or tab >>Possible causes of experiencing problems with sick leave questions in telephone nursing
2017 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 4, p. 249-253Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Registered nurses at primary health care centres in Sweden receive about 20 million telephone calls annually. Questions related to sick leave occur regularly. Previous studies conclude that those calls often are perceived as problematic. The aim of this study was to explore factors associated with problems regarding sick leave questions in telephone nursing.

METHODS: A questionnaire was distributed to all registered nurses (n = 185) working with telephone nursing in 26 Swedish primary health care centres, of whom 114 (61.6%) responded. Based on the results of a Spearman correlation analysis a logistic regression analysis was performed of significant exposure variables on outcome (perceived problems).

RESULTS: Significant exposure variables were: experience of telephone nursing, age, being educated in social insurance medicine, and frequency of telephone calls with sick leave questions. Young age was associated with more problems than old age. Those having education in social insurance medicine reported fewer problems than those who had not, and so did those having few telephone calls with sick leave questions as compared with those who had many.

CONCLUSIONS: Young age, lack of education in insurance medicine, and high frequency of sick leave questions increased the perceived problem level in telephone nursing.

Place, publisher, year, edition, pages
Taylor & Francis, 2017
Keyword
Nursing, primary health care, sick leave, sick-listing, sickness certification, social insurance medicine, telephone nursing
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-332688 (URN)10.1080/03009734.2017.1385665 (DOI)000423294800007 ()29045168 (PubMedID)
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2018-03-15Bibliographically approved
Norlund, F., Olsson, E. M., Pingel, R., Held, C., Svärdsudd, K., Gulliksson, M. & Burell, G. (2017). Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial. Paper presented at International Society of Behavioral Medicine, Groningen 2014. European Journal of Preventive Cardiology, 24(9), 917-925
Open this publication in new window or tab >>Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial
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2017 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 9, p. 917-925Article in journal (Refereed) Published
Abstract [en]

Background:The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) was a randomized controlledtrial of a group-based cognitive behavioural therapy stress management programme for patients with coronary heartdisease. The project was successful in reducing the risk of fatal or non-fatal first recurrent cardiovascular events. The aimof this study was to analyse the effect of cognitive behavioural therapy on self-rated stress, somatic anxiety, vitalexhaustion and depression and to study the associations of these factors with the reduction in cardiovascular events.

Methods:A total of 362 patients were randomly assigned to intervention or usual care groups. The psychologicaloutcomes were assessed five times during 24 months and analysed using linear mixed models. The mediating roles of theoutcomes were analysed using joint modelling of the longitudinal and time to event data.

Results:The intervention had a positive effect on somatic anxiety (p<0.05), reflecting a beneficial development overtime compared with the controls. Stress, vital exhaustion and depression did not differ between the groups over time.Mediator analysis suggested that somatic anxiety may have mediated the effect of treatment on cardiovascular events.

Conclusions:The intervention had a small positive effect on somatic anxiety, but did not affect stress, vital exhaustionor depression in patients with coronary heart disease. Somatic anxiety was associated with an increased risk of cardio-vascular events and might act as a partial mediator in the treatment effect on cardiovascular events. However, themechanisms between the intervention and the protective cardiovascular outcome remain to be identified.

Keyword
Stress management, cognitive behavioural therapy, coronary heart disease, depression, anxiety, vital exhaustion
National Category
Psychology Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-315597 (URN)10.1177/2047487317693131 (DOI)000401147700004 ()28195501 (PubMedID)
Conference
International Society of Behavioral Medicine, Groningen 2014
Funder
Vårdal FoundationForte, Swedish Research Council for Health, Working Life and WelfareSwedish National Board of Health and WelfareSwedish Research Council
Available from: 2017-02-16 Created: 2017-02-16 Last updated: 2017-12-20Bibliographically approved
Zhong, Y., Rosengren, A., Fu, M., Welin, L., Welin, C., Caidahl, K., . . . Hansson, P.-O. (2017). Secular changes in cardiovascular risk factors in Swedish 50-year-old men over a 50-year period: The study of men born in 1913, 1923, 1933, 1943, 1953 and 1963. European Journal of Preventive Cardiology, 24(6), 612-620
Open this publication in new window or tab >>Secular changes in cardiovascular risk factors in Swedish 50-year-old men over a 50-year period: The study of men born in 1913, 1923, 1933, 1943, 1953 and 1963
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2017 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 6, p. 612-620Article in journal (Refereed) Published
Abstract [en]

Background: During the past decades, declining trends in mean cholesterol levels and smoking have been observed in Western Europe, whereas obesity and a sedentary lifestyle have increased. Simultaneously, there has been a marked decrease in mortality from cardiovascular (CV) diseases. Methods: The aim of the study was to determine whether these trends in CV risk factors continued over a period of 50 years. Six systematic or random population samples of 50-year-old men (n = 3563) living in Gothenburg, Sweden, were investigated between 1963 and 2013. Results: During the 50 years, mean body mass index (BMI) at 50 years of age increased by 2 kg/m(2), from 24.8 kg/m(2) in 1963 to 26.8 kg/m(2) in 2013 (p< 0.001). A decrease in systolic blood pressure of nearly 10mmHg was observed from 1963 to 1993, but was not sustained through the past two decades. Mean serum cholesterol fell from 6.42 (SD 1.12) mmol/L to 5.34 (SD 0.97) mmol/L. The prevalence of smoking at 50 years of age decreased markedly from 56.1% in 1963 to 11.9% in 2013. The number of participants with a sedentary lifestyle during leisure time decreased until 1993, but has remained unchanged since. In 2013, 50-year-old men had a 6.9-times higher likelihood of lacking CV risk factors than 50-year-old men in 1963 (95% confidence interval (CI): 3.5-13.3, p< 0.001). The odds ratio for having four or more risk factors was only 0.13 (95% CI: 0.062-0.29, p< 0.001). Conclusion: Despite increasing body weight, the total CV risk factor burden has decreased in 50-year-old men over the past 50 years.

Keyword
Secular trends, cardiovascular risk factors, obesity, lifestyle
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-321341 (URN)10.1177/2047487316676905 (DOI)000397435200006 ()27794107 (PubMedID)
Available from: 2017-05-31 Created: 2017-05-31 Last updated: 2017-05-31Bibliographically approved
Olafsdottir, E., Andersson, D. K. G., Dedorsson, I., Svärdsudd, K., Jansson, S. P. O. & Stefansson, E. (2016). Early detection of type 2 diabetes mellitus and screening for retinopathy are associated with reduced prevalence and severity of retinopathy. Acta Ophthalmologica, 94(3), 232-239
Open this publication in new window or tab >>Early detection of type 2 diabetes mellitus and screening for retinopathy are associated with reduced prevalence and severity of retinopathy
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2016 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 94, no 3, p. 232-239Article in journal (Refereed) Published
Abstract [en]

PurposeTo explore whether the prevalence and severity of retinopathy differ in diabetes cohorts diagnosed through screening as compared with conventional health care. MethodsA total of 257 diabetes patients, 151 detected through screening and 106 through conventional clinical care, were included. Retinopathy was evaluated by fundus photography. The modified Airlie House adaptation of the Early Treatment Retinopathy Study protocol was used to grade the photographs. Averages of clinically collected fasting blood glucose (FBG), blood pressure and body mass index values were compiled from diabetes diagnosis until the eye examination. Blood chemistry, smoking habits and peripheral neuropathy were assessed at the time of the eye examination. ResultsAmong the screening-detected patients, 22% had retinopathy as compared to 51% among those clinically detected (p<0.0001). In a multivariate analysis, patients with retinopathy were more likely to have increased average FBG (OR 1.42, 95% CI 1.19-1.70 per mmol/l) and peripheral neuropathy (OR 2.75, 95% CI 1.40-5.43), but less likely to have screening-detected diabetes (OR 0.31, 95% CI 0.17-0.57). Similar results were found using increasing severity grade of retinopathy as outcome. The cumulative retinopathy prevalence for the screening-detected diabetes cohort as compared with the clinically diagnosed cohort was significantly lower from 10years' follow-up and onwards (p=0.0002). ConclusionsAmong patients with screening-detected diabetes, the prevalence of retinopathy and increasing severity of retinopathy were significantly lower than among those who had their diabetes diagnosed through conventional care, even when other risk factors for retinopathy such as duration, hyperglycaemia and blood pressure were considered. Early detection of diabetes reduces prediagnostic time spent with hyperglycaemia. In combination with early and regular screening for retinopathy, more effective prevention against retinopathy can be provided.

Keyword
diabetes duration, longitudinal data, opportunistic case finding, peripheral neuropathy, retinopathy, screening, type 2 diabetes mellitus
National Category
Endocrinology and Diabetes Ophthalmology
Identifiers
urn:nbn:se:uu:diva-297106 (URN)10.1111/aos.12954 (DOI)000374693000014 ()26855250 (PubMedID)
Available from: 2016-06-22 Created: 2016-06-21 Last updated: 2017-11-28Bibliographically approved
Jansson, S. P., Andersson, D. K. & Svärdsudd, K. (2016). Mortality and cardiovascular disease outcomes among 740 patients with new-onset Type 2 diabetes detected by screening or clinically diagnosed in general practice.. Diabetic Medicine, 33(3), 324-331
Open this publication in new window or tab >>Mortality and cardiovascular disease outcomes among 740 patients with new-onset Type 2 diabetes detected by screening or clinically diagnosed in general practice.
2016 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, no 3, p. 324-331Article in journal (Refereed) Published
Abstract [en]

AIM: Screening for Type 2 diabetes among people at high risk is recommended by many organizations. The aim of this study was to analyse all-cause mortality and cardiovascular disease (CVD) outcomes in patients with Type 2 diabetes detected by screening or diagnosed clinically.

METHODS: A diabetes register was established at the primary healthcare centre in Laxå, Sweden beginning in 1972. The register was based on data from clinical records with information on medical treatment and laboratory data, as well as all-cause mortality, CVD, myocardial infarction and stroke events from national registers until 31 December 2013. A total of 740 patients with new-onset Type 2 diabetes were registered between 1972 and 2001. In addition, an opportunistic diabetes-screening programme involving people aged 35-79 years started in 1983 and was repeated onwards in 5-year cycles.

RESULTS: Baseline characteristics showed a significantly higher CVD risk, mainly depending on more prevalent CVD events in the screened compared with the clinically detected group (propensity score 0.59 vs. 0.46, P < 0.0001). After mean follow-up periods of 12.9 and 13.6 years for screening detected vs. clinically detected patients, respectively, hazard ratios were as follows: all-cause mortality, 0.99 (P = 0.89); CVD, 1.17 (P = 0.10); myocardial infarction, 1.08 (P = 0.49); and stroke, 1.03 (P = 0.83).

CONCLUSIONS: No reduction in total mortality or CVD outcomes was found in patients with Type 2 diabetes that was detected by screening compared with those diagnosed clinically.

National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-270471 (URN)10.1111/dme.13019 (DOI)000370162000009 ()26516107 (PubMedID)
Available from: 2015-12-29 Created: 2015-12-29 Last updated: 2017-12-01Bibliographically approved
Olofson, J., Bake, B., Bergman, B. & Svärdsudd, K. (2016). The single breath nitrogen test and mortality: A 38 years follow up. Respiratory Medicine, 112, 75-80
Open this publication in new window or tab >>The single breath nitrogen test and mortality: A 38 years follow up
2016 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 112, p. 75-80Article in journal (Refereed) Published
Abstract [en]

Background: Spirometry data predict mortality, but are less sensitive to detect dysfunction in small airways as compared to the slope of phase III (the N-2 slope) of the single breath nitrogen test. The association between the N-2 slope and mortality has been studied with conflicting results. In the present study the prognostic importance of the N-2 slope was tested taking spirometry variables into account. Methods: A systematic general population sample of 595 middle-aged men had a baseline investigation with lung function tests including spirometry and the N-2 slope. Age, smoking, and anthropometry variables were registered. The cohort was followed up regarding survival for 38 years. Results: The sample was subdivided by tertiles of the N-2 slope. A proportional hazards regression analysis was performed for each group of covariates: anthropometric, smoking variables, and spirometry variables, after accounting for age. Covariates with significant impact on mortality and the highest chi-square levels were smoking habit score and forced expired volume in 1 s corrected for height. These variables, in addition to age and the N-2 tertiles were entered into a final proportional hazards regression analysis. In this multivariate model, mortality was significantly related to age (p < .0001), smoking habit score (p < .0001) and the N-2 tertiles (p = .0004), but not to FEV1 when N-2 slope was allowed for in the model. Conclusions: Dysfunction in small airways as measured by the N-2 slope is significantly associated with overall mortality in middle-aged men, and outrivals spirometry as a predictor in multivariate analysis.

Keyword
Mortality, Single breath nitrogen test, Spirometry, Smoking, Small airways function, Epidemiology
National Category
Respiratory Medicine and Allergy Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-282310 (URN)10.1016/j.rmed.2016.01.002 (DOI)000371096800011 ()26803380 (PubMedID)
Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2017-11-30Bibliographically approved
Di Angelantonio, E., Kaptoge, S., Wormser, D., Willeit, P., Butterworth, A. S., Bansal, N., . . . Danesh, J. (2015). Association of Cardiometabolic Multimorbidity With Mortality: The Emerging Risk Factors Collaboration. Journal of the American Medical Association (JAMA), 314(1), 52-60
Open this publication in new window or tab >>Association of Cardiometabolic Multimorbidity With Mortality: The Emerging Risk Factors Collaboration
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2015 (English)In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 314, no 1, p. 52-60Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE The prevalence of cardiometabolic multimorbidity is increasing.

OBJECTIVE To estimate reductions in life expectancy associated with cardiometabolic multimorbidity.

DESIGN, SETTING, AND PARTICIPANTS Age-and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689 300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128 843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499 808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates. EXPOSURES A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI).

MAIN OUTCOMES AND MEASURES All-cause mortality and estimated reductions in life expectancy.

RESULTS In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy.

CONCLUSIONS AND RELEVANCE Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-259089 (URN)10.1001/jama.2015.7008 (DOI)000357455900014 ()
Funder
EU, European Research Council, 268834
Available from: 2015-07-29 Created: 2015-07-27 Last updated: 2017-12-04Bibliographically approved
Bardel, A., Wallander, M.-A. & Svärdsudd, K. (2015). Factors associated with adherence to drug therapy. In: Mehmet Ungen & Carl Steylaerts (Ed.), The world book of family medicine: European edition published on the ocction of the 20th Anniversary of WONCA Europe, Istanbul, October 2015 (pp. 100-102). Ljubljana: Narodna in univerzitetna
Open this publication in new window or tab >>Factors associated with adherence to drug therapy
2015 (English)In: The world book of family medicine: European edition published on the ocction of the 20th Anniversary of WONCA Europe, Istanbul, October 2015 / [ed] Mehmet Ungen & Carl Steylaerts, Ljubljana: Narodna in univerzitetna , 2015, p. 100-102Chapter in book (Other academic)
Place, publisher, year, edition, pages
Ljubljana: Narodna in univerzitetna, 2015
National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-280548 (URN)978-961-281-983-5 (ISBN)
Available from: 2016-03-11 Created: 2016-03-11 Last updated: 2018-01-10Bibliographically approved
Ladenvall, P., Persson, C., Mandalenakis, Z., Wilhelmsen, L., Grimby, G., Svärdsudd, K. & Hansson, P.-O. -. (2015). High aerobic capacity is associated with increased survival. A 44 years follow-up of the study of men born in 1913. Paper presented at Congress of the European-Society-of-Cardiology (ESC), AUG 29-SEP 02, 2015, London, ENGLAND. European Heart Journal, 36(Suppl. 1), 518-518
Open this publication in new window or tab >>High aerobic capacity is associated with increased survival. A 44 years follow-up of the study of men born in 1913
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2015 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no Suppl. 1, p. 518-518Article in journal, Meeting abstract (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-266243 (URN)000361205104030 ()
Conference
Congress of the European-Society-of-Cardiology (ESC), AUG 29-SEP 02, 2015, London, ENGLAND
Note

Meeting Abstract: 2966

Available from: 2015-11-18 Created: 2015-11-05 Last updated: 2017-12-01Bibliographically approved
Wilhelmsen, L., Dellborg, M., Velin, L. & Svärdsudd, K. (2015). [In Process Citation].. Läkartidningen, 112
Open this publication in new window or tab >>[In Process Citation].
2015 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Article in journal (Refereed) Published
National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-270472 (URN)26440944 (PubMedID)
Available from: 2015-12-29 Created: 2015-12-29 Last updated: 2018-01-10
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8925-9670

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