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Bardel, A., Wallander, M.-A., Wallman, T., Rosengren, A., Johansson, S., Eriksson, H. & Svärdsudd, K. (2019). Age and sex related self-reported symptoms in a general population across 30 years: Patterns of reporting and secular trend. PLoS ONE, 14(2), Article ID e0211532.
Open this publication in new window or tab >>Age and sex related self-reported symptoms in a general population across 30 years: Patterns of reporting and secular trend
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2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 2, article id e0211532Article in journal (Refereed) Published
Abstract [en]

Objective To study age and sex specific prevalence of 30 symptoms in random samples from the general population and to analyze possible secular trends across time. Study population The study was based on data from eight on-going Swedish cohort studies, with baseline investigations performed between 1973 and 2003. Samples were drawn from the general population of the cities of Gothenburg and Eskilstuna, and of Uppsala County. Overall, 20,160 subjects were sampled, 14,470 (71.8%) responded, of whom 12.000 were unique subjects, and 2548 were part of more than one sample. Methods The Complaint score sub-scale of the Gothenburg Quality of Life instrument, listing 30 general symptoms was used. Responders were asked to indicate which symptoms they had experienced during the last three months. Results Women reported on average 7.8 symptoms, and men 5.3 (p<0.0001). Women reported higher prevalence than men for 24 of the 30 symptoms. In multivariate analyses four patterns of prevalence across age were identified in both men and women; increasing prevalence, decreasing, stable and biphasic prevalence. The symptoms in the various pattern groups differed somewhat between men and women. However, symptoms related to strain were prominent among symptoms decreasing with age. Moreover, there were secular trends. Across all symptoms reporting prevalence increased over time in men (p<0.001) as well as in women (p<0.0001). Conclusions Women reported higher total symptom prevalence than men. Symptoms related to health generally increased with age, while symptoms related to stress decreased markedly. Significant secular trends across time regarding symptom prevalence were found.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-377595 (URN)10.1371/journal.pone.0211532 (DOI)000457744200030 ()30716129 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2019-03-01 Created: 2019-03-01 Last updated: 2019-03-07Bibliographically approved
Karlsson, B., Burell, G., Kristiansson, P., Björkegren, K., Nyberg, F. & Svärdsudd, K. (2019). Decline of substance P levels after stress management with cognitive behaviour therapy in women with the fibromyalgia syndrome. Scandinavian Journal of Pain, 19(3), 473-482
Open this publication in new window or tab >>Decline of substance P levels after stress management with cognitive behaviour therapy in women with the fibromyalgia syndrome
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2019 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 19, no 3, p. 473-482Article in journal (Refereed) Published
Abstract [en]

Background and aims: Substance P (CSF-SP) is known to be elevated in females with fibromyalgia syndrome (FMS). The aims of this study were to evaluate the effect of cognitive behaviour therapy (CBT) on plasma SP levels in women with FMS and to find possible clinical behavioural correlates to plasma SP level changes. Methods: Forty-eight women with FMS were randomly allocated into two groups. Group 1 received the CBT treatment intervention over the course of 6 months while group 2 was waitlisted. CBT was given with a protocol developed to diminish stress and pain. After 6 months, group 2 was given the same CBT treatment as well. All were followed up 1 year after the start of CBT treatment. This approach allowed for two analytical designs a randomised controlled trial (RCT) (n=24 vs. n=24) and a before-and-after treatment design (n=48). All women were repeatedly evaluated by the West Haven-Yale Multidimensional Pain Inventory (MPI) and three other psychometric questionnaires and plasma SP was analysed. Results: In the RCT design, the plasma SP level was 8.79 fmol/mL in both groups at the start of the trial, after adjustment for initial differences. At the end of the RCT, the plasma SP level was 5.25 fmol/mL in the CBT intervention group compared to 8.39 fmol/mL in the control group (p=0.02). In the before-and-after design, the plasma SP was reduced by 33% (p <0.01) after CBT, but returned to the pre-treatment level at follow-up 1 year after the start of CBT treatment. Plasma SP was associated with the MPI dimensions experienced "support from spouses or significant others" and "life control". Conclusions: Plasma SP might be a marker of the effect of CBT in FMS associated with better coping strategies and reduced stress rather than a biochemical marker of pain.

Place, publisher, year, edition, pages
Walter de Gruyter, 2019
Keywords
fibromyalgia, substance P, cognitive behaviour therapy, stress, Westhaven-Yale Multidimensional Pain Inventory, Montgomery-Asberg Depression Rating Scale
National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-390922 (URN)10.1515/sjpain-2018-0324 (DOI)000473300500007 ()30796851 (PubMedID)
Funder
Swedish Research Council, 9459Swedish Rheumatism Association, 51/04Swedish Social Insurance Agency, 11124
Available from: 2019-08-15 Created: 2019-08-15 Last updated: 2019-08-15Bibliographically approved
Fu, M., Rosengren, A., Thunström, E., Mandalenakis, Z., Welin, L., Caidahl, K., . . . Hansson, P.-O. (2018). Although Coronary Mortality Has Decreased, Rates of Cardiovascular Disease Remain High: 21 Years of Follow-Up Comparing Cohorts of Men Born in 1913 With Men Born in 1943. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 7(9), Article ID e008769.
Open this publication in new window or tab >>Although Coronary Mortality Has Decreased, Rates of Cardiovascular Disease Remain High: 21 Years of Follow-Up Comparing Cohorts of Men Born in 1913 With Men Born in 1943
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2018 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 9, article id e008769Article in journal (Refereed) Published
Abstract [en]

Background - Despite a decline in mortality rates from cardiovascular disease (CVD) in the past few decades, the burden of CVD in a contemporary population remains inadequately addressed. Therefore, this study was aimed to investigate secular trends in mortality from coronary artery disease and all-cause mortality over 2 decades, by comparing 2 cohorts of men born 30 years apart and evaluate the prediction of the risk of CVD and all-cause death in a contemporary random sample of Swedish men.

Methods and Results - Two cohorts of randomly selected men born in 1913 (855 men) and 1943 (798 men) were first examined at age 50 in 1963 and 1993, respectively, and followed longitudinally over 21 years. All-cause mortality and coronary artery disease death were lower in 50-to 71-year-old men born in 1943 compared with those born in 1913, with unadjusted hazard ratios of 0.57 (0.45-0.71) and 0.34 (0.22-0.53), respectively. After adjustment for risk factors (smoking, serum cholesterol, hypertension, systolic blood pressure, diabetes mellitus, body mass index, and physical activity), the differences between the cohorts remained significant for coronary artery disease, hazard ratios 0.57 (0.34-0.94), P=0.029, but not for all-cause mortality hazard ratios 0.82 (0.62-1.07), P=0.14. However, the rate of CVD events during follow-up was still high (30.7%) for the men born in 1943. No statistically significant interaction by birth cohort in contribution of risk factors to death was found between 2 cohorts except physical inactivity.

Conclusions - Despite a marked reduction in the rate of coronary artery disease death over the past 30 years, the burden of CVD events and all-cause mortality remains high. Therefore, intensified efforts to modify contributing risk factors are still required.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
cardiovascular disease, death, longitudinal cohort study, population studies, risk factor
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-356319 (URN)10.1161/JAHA.118.008769 (DOI)000432332800022 ()29674335 (PubMedID)
Funder
Swedish Research Council, 2013-5187Swedish Research Council, 2013-4236Swedish Heart Lung FoundationRegion Västra Götaland
Available from: 2018-07-25 Created: 2018-07-25 Last updated: 2018-07-25Bibliographically approved
Persson, C. U., Svärdsudd, K., Rusek, L., Blomstrand, C., Blomstrand, A., Welin, L., . . . Hansson, P.-O. (2018). Determinants of Stroke in a General Male Population: Forty-Eight Year Time-Dependent Updated Follow-Up of the Study of Men Born in 1913. Stroke, 49(12), 2830-2836
Open this publication in new window or tab >>Determinants of Stroke in a General Male Population: Forty-Eight Year Time-Dependent Updated Follow-Up of the Study of Men Born in 1913
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2018 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 49, no 12, p. 2830-2836Article in journal (Refereed) Published
Abstract [en]

Background and Purpose - To further improve preventive strategies against stroke, there is a need for epidemiological long-term studies. The study aimed at a prospective investigation of stroke determinants in the general male population.

Methods - During a period of 48 years, from 50 to 98 years of age, a population-based sample of 854 men was followed using repeated medical examinations, lifestyle questionnaires, data from hospital records and the National Cause of Death Register.

Results - Determinants of ischemic stroke were atrial fibrillation (hazard ratio [HR], 6.61; 95% CI, 4.47-9.77); mother dead from cardiovascular disease (HR, 1.53; 1.09-2.17); high education (HR, 0.81; 0.69-0.96); and high physical activity level during leisure time (HR, 0.68; 0.50-0.93). For hemorrhagic stroke heart rate (HR, 1.04; 1.01-1.06) and mother dead from stroke (HR, 3.56; 1.43-8.87) constituted an increased risk. Statistically significant determinants for all stroke were atrial fibrillation (HR, 5.34; 3.68-7.75); high diastolic blood pressure (HR, 1.02; 1.01-1.03); high body weight (HR, 0.96; 0.94-0.99); high educational level (HR, 0.79; 0.68-0.92); wide waist circumference (HR, 1.04; 1.01-1.07); smoking (HR, 1.25; 1.06-1.48); mother dead from cerebrovascular disease (HR, 1.43; 1.05-1.94); and diabetes mellitus (HR, 1.65; 1.02-2.68). Of all men diagnosed with atrial fibrillation, 88% had a stroke during follow-up.

Conclusions - Atrial fibrillation was by far the strongest determinant of stroke during 48 years of follow-up in a male population sample followed until the age of 98 years. The results warrant improved prophylaxis through intense treatment of modifiable determinants.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2018
Keywords
atrial fibrillation, cardiovascular diseases, epidemiology, risk factors, stroke
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-376899 (URN)10.1161/STROKEAHA.118.022740 (DOI)000456427700018 ()30571393 (PubMedID)
Funder
Swedish Heart Lung Foundation
Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-02-12Bibliographically approved
Olofson, J., Bake, B., Bergman, B., Ullman, A. & Svärdsudd, K. (2018). Prediction of COPD and Related Events Improves by Combining Spirometry and the Single Breath Nitrogen Test. COPD: Journal of Chronic Obstructive Pulmonary Disease, 15(5), 424-431
Open this publication in new window or tab >>Prediction of COPD and Related Events Improves by Combining Spirometry and the Single Breath Nitrogen Test
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2018 (English)In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 15, no 5, p. 424-431Article in journal (Refereed) Published
Abstract [en]

Chronic obstructive pulmonary disease (COPD) develops in small airways. Severity of small airway pathology relates to progression and mortality. The present study evaluated the prediction of COPD of a validated test for small airway disease, i.e. a slope of the alveolar plateau of the single breath nitrogen test (N2-slope). The N2-slope, spirometry, age, smoking habits, and anthropometric variables at baseline were obtained in a population-based sample (n = 592). The cohort was followed for first COPD events (first hospital admission of COPD or related conditions or death from COPD) during 38 years. During follow-up, 52 subjects (8.8%) had a first COPD event, of which 18 (3.0%) died with a first COPD diagnosis. In the proportional hazard regression analysis adjusted for age and smoking habits, the cumulative COPD event incidence increased from 5% among those with high forced expired volume in one second (FEV1) to 25% among those with low FEV1, while increasing from 4% among those with the lowest N2-slope to 26% among those with the highest. However, combining the N2-slope and FEV1 resulted in considerable synergy in the prediction of first COPD event and even more so when taking account of smoking habits. The cumulative COPD event incidence rate was 75% among heavy smokers with the highest N2-slope and lowest FEV1, and less than 1% among never smokers with the lowest N2-slope and highest FEV1. Thus, combining the results of the single breath N2-slope and FEV1 considerably improved the prediction of COPD events as compared to either test alone.

Keywords
Epidemiology, longitudinal study, COPD event, respiratory functions tests
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-375786 (URN)10.1080/15412555.2018.1538330 (DOI)000455642300003 ()
Funder
Swedish Society of MedicineSwedish Heart Lung Foundation
Available from: 2019-02-01 Created: 2019-02-01 Last updated: 2019-02-01Bibliographically approved
Olsson, E., Norlund, F., Pingel, R., Burell, G., Gulliksson, M., Larsson, A., . . . Held, C. (2018). The effect of group-based cognitive behavioral therapy on inflammatory biomarkers in patients with coronary disease: results from the SUPRIM-trial. Upsala Journal of Medical Sciences, Supplement, 123(3), 167-173
Open this publication in new window or tab >>The effect of group-based cognitive behavioral therapy on inflammatory biomarkers in patients with coronary disease: results from the SUPRIM-trial
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2018 (English)In: Upsala Journal of Medical Sciences, Supplement, ISSN 0300-9726, Vol. 123, no 3, p. 167-173Article in journal (Refereed) Published
Abstract [en]

Background: The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) is a prospective randomized controlled trial of a group-based cognitive behavioral therapy (CBT) stress management program for coronary heart disease (CHD) patients. The intervention reduced the risk of fatal or non-fatal first recurrent cardiovascular (CV) events. The aim of the present study was to analyze if the positive effects of the CBT program on clinical outcomes could have been mediated by changes in biomarkers for inflammation.

Methods: Altogether 362 patients with CHD were randomly assigned to intervention or usual care. The inflammatory biomarkers (VCAM-1, TNF-R1, TNF-R2, PTX3, and hs-CRP) were serially assessed at five time points every six months from study start until 24 months later, and analyzed with linear mixed models.

Results: Baseline levels of the inflammatory markers were near normal, indicating a stable phase. The group-based CBT stress management program did not significantly affect the levels of inflammatory biomarkers in patients with CHD. Three out of five (VCAM-1, TNF-R2, and PTX3) inflammatory biomarkers showed a slight increase over time in both study groups, and all were positively associated with age.

Conclusion: Group-based CBT stress management did not affect biomarkers for inflammation in patients with CHD. It is therefore unlikely that inflammatory processes including these biomarkers were mediating the effect the CBT program had on the reduction in CV events. The close to normal baseline levels of the biomarkers and the lack of elevated psychological distress symptoms indicate a possible floor effect which may have influenced the results.

Keywords: Biomarkers, CBT, CHD, inflammation, stress management

National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-356841 (URN)10.1080/03009734.2018.1490829 (DOI)000446977000005 ()30086659 (PubMedID)
Funder
Vårdal Foundation, V96-160Vårdal Foundation, V98-403Vårdal Foundation, 2014-0114Swedish Heart Lung Foundation, E010-95Swedish Heart Lung Foundation, E019-96Swedish Heart Lung Foundation, E019-98Swedish Heart Lung Foundation, E010-00Swedish Heart Lung Foundation, E009-01Swedish Heart Lung Foundation, E45-04Swedish Heart Lung Foundation, K-97-21x-12256-01ASwedish Heart Lung Foundation, K98-21X-12256-02BSwedish Heart Lung Foundation, K99-21X-12256-03CSwedish Heart Lung Foundation, 2009-1093Swedish National Board of Health and Welfare, 1471-601:Var95-161Forte, Swedish Research Council for Health, Working Life and Welfare, F0196/99Forte, Swedish Research Council for Health, Working Life and Welfare, 2001-1049Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4947
Available from: 2018-08-08 Created: 2018-08-08 Last updated: 2018-12-10Bibliographically approved
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
Keywords
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.

Keywords
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.

Keywords
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.

Keywords
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
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8925-9670

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