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Gedeborg, Rolf
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Publications (10 of 47) Show all publications
Larsen, R., Backstrom, D., Fredrikson, M., Steinvall, I., Gedeborg, R. & Sjoberg, F. (2019). Female risk-adjusted survival advantage after injuries caused by falls, traffic or assault: a nationwide 11-year study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 27, Article ID 24.
Open this publication in new window or tab >>Female risk-adjusted survival advantage after injuries caused by falls, traffic or assault: a nationwide 11-year study
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2019 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 27, article id 24Article in journal (Refereed) Published
Abstract [en]

Background

A female survival advantage after injury has been observed, and animal models of trauma have suggested either hormonal or genetic mechanisms as component causes. Our aim was to compare age and risk-adjusted sex-related mortality in hospital for the three most common mechanisms of injury in relation to hormonal effects as seen by age.

Methods

All hospital admissions for injury in Sweden during the period 2001-2011 were retrieved from the National Patient Registry and linked to the Cause of Death Registry. The International Classification of Diseases Injury Severity Score (ICISS) was used to adjust for injury severity, and the Charlson Comorbidity Index to adjust for comorbidity. Age categories (0-14, 15-50, and 51years) were used to represent pre-menarche, reproductive and post- menopausal women.

Results

Women had overall a survival benefit (OR 0.51; 95% CI 0.50 to 0.53) after adjustment for injury severity and comorbidity. A similar pattern was seen across the age categories (0-14years OR 0.56 (95% CI 0.25 to 1.25), 15-50years OR 0.70 (95% CI 0.57 to 0.87), and 51years OR 0.49 (95% CI 0.48 to 0.51)).

Conclusion

In this 11-year population-based study we found no support for an oestrogen-related mechanism to explain the survival advantage for females compared to males following hospitalisation for injury.

Keywords
Risk-adjusted mortality, ICISS, Trauma, Injury, Nationwide, Epidemiological
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-380442 (URN)10.1186/s13049-019-0597-3 (DOI)000461309000001 ()30871611 (PubMedID)
Available from: 2019-03-28 Created: 2019-03-28 Last updated: 2019-03-28Bibliographically approved
Lipcsey, M., Aronsson, A., Larsson, A., Renlund, H. & Gedeborg, R. (2019). Multivariable models using administrative data and biomarkers to adjust for case mix in the ICU. Acta Anaesthesiologica Scandinavica, 63(6), 751-760
Open this publication in new window or tab >>Multivariable models using administrative data and biomarkers to adjust for case mix in the ICU
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2019 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 63, no 6, p. 751-760Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Routinely collected laboratory biomarkers could improve control of confounding from disease severity in non-interventional studies of general intensive care unit (ICU) patients. Their ability to predict both short- and long-term mortality was evaluated.

METHODS: The performance of age, sex, Charlson co-morbidity index, and baseline values of ten predefined blood biomarkers as predictors of 30-day and 1-year mortality was evaluated in 5505 general ICU stays.

RESULTS: Regression models based on age, sex, Charlson index, and biomarkers were somewhat less accurate in predicting 30-day mortality (c-index 0.83, Brier score 0.27) compared to the SAPS II score (c-index = 0.88, Brier score = 0.09) and in predicting 1-year mortality (c-index = 0.82, Brier score = 0.31) compared to the SAPS II score (c-index = 0.85, Brier score = 0.13). Cystatin C improved predictive ability slightly compared to creatinine, but age and Charlson comorbidity index were more important predictors. Using multiple imputation to replace missing biomarker values notably improved predictive ability of the models.

CONCLUSIONS: Automatically collected baseline variables are almost as predictive of both short- and long-term mortality in general ICU patients, as the SAPS II score. This can facilitate internal control of confounding in non-interventional studies of mortality using administrative data.

Keywords
creatinine, cystatin C, intensive care, logistic models, mortality
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-377642 (URN)10.1111/aas.13338 (DOI)000472664500008 ()30734281 (PubMedID)
Available from: 2019-02-23 Created: 2019-02-23 Last updated: 2019-09-12Bibliographically approved
Bäckström, D., Larsen, R., Steinvall, I., Fredrikson, M., Gedeborg, R. & Sjöberg, F. (2018). Deaths caused by injury among people of working age (18-64) are decreasing, while those among older people (64+) are increasing.. European Journal of Trauma and Emergency Surgery, 44(4), 589-596
Open this publication in new window or tab >>Deaths caused by injury among people of working age (18-64) are decreasing, while those among older people (64+) are increasing.
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2018 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 44, no 4, p. 589-596Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Injury is an important cause of death in all age groups worldwide, and contributes to many losses of human and economic resources. Currently, we know a few data about mortality from injury, particularly among the working population. The aim of the present study was to examine death from injury over a period of 14 years (1999-2012) using the Swedish Cause of Death Registry (CDR) and the National Patient Registry, which have complete national coverage.

METHOD: CDR was used to identify injury-related deaths among adults (18 years or over) during the years 1999-2012. ICD-10 diagnoses from V01 to X39 were included. The significance of changes over time was analyzed by linear regression.

RESULTS: The incidence of prehospital death decreased significantly (coefficient -0.22, r (2) = 0.30; p = 0.041) during the study period, while that of deaths in hospital increased significantly (coefficient 0.20, r (2) = 0.75; p < 0.001). Mortality/100,000 person-years in the working age group (18-64 years) decreased significantly (coefficient -0.40, r (2) = 0.37; p = 0.020), mainly as a result of decrease in traffic-related deaths (coefficient -0.34, r (2) = 0.85; p < 0.001). The incidence of deaths from injury among elderly (65 years and older) patients increased because of the increase in falls (coefficient 1.71, r (2) = 0.84; p < 0.001) and poisoning (coefficient 0.13, r (2) = 0.69; p < 0.001).

CONCLUSION: The epidemiology of injury in Sweden has changed during recent years in that mortality from injury has declined in the working age group and increased among those people 64 years old and over.

Keywords
Elderly, Injury, Mortality, Prehospital, Trauma, Working age
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-333286 (URN)10.1007/s00068-017-0827-1 (DOI)000440981100014 ()28825159 (PubMedID)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2018-10-18Bibliographically approved
Larsen, R., Bäckström, D., Fredrikson, M., Steinvall, I., Gedeborg, R. & Sjoberg, F. (2018). Decreased risk adjusted 30-day mortality for hospital admitted injuries: a multi-centre longitudinal study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26, Article ID 24.
Open this publication in new window or tab >>Decreased risk adjusted 30-day mortality for hospital admitted injuries: a multi-centre longitudinal study
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2018 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, article id 24Article in journal (Refereed) Published
Abstract [en]

Background: The interpretation of changes in injury-related mortality over time requires an understanding of changes in the incidence of the various types of injury, and adjustment for their severity. Our aim was to investigate changes over time in incidence of hospital admission for injuries caused by falls, traffic incidents, or assaults, and to assess the risk-adjusted short-term mortality for these patients. Methods: All patients admitted to hospital with injuries caused by falls, traffic incidents, or assaults during the years 2001-11 in Sweden were identified from the nationwide population-based Patient Registry. The trend in mortality over time for each cause of injury was adjusted for age, sex, comorbidity and severity of injury as classified from the International Classification of diseases, version 10 Injury Severity Score (ICISS). Results: Both the incidence of fall (689 to 636/100000 inhabitants: p = 0.047, coefficient -4.71) and traffic related injuries (169 to 123/100000 inhabitants: p < 0.0001, coefficient -5.37) decreased over time while incidence of assault related injuries remained essentially unchanged during the study period. There was an overall decrease in risk-adjusted 30-day mortality in all three groups (OR 1.00; CI95% 0.99-1.00). Decreases in traffic (OR 0.95; 95% CI 0.93 to 0.97) and assault (OR 0.93; 95% CI 0.87 to 0.99) related injuries was significant whereas falls were not during this 11-year period. Discussion: Risk-adjustment is a good way to use big materials to find epidemiological changes. However after adjusting for age, year, sex and risk we find that a possible factor is left in the pre-and/or in-hospital care. Conclusions: The decrease in risk-adjusted mortality may suggest changes over time in pre-and/or in-hospital care. A non-significantdecrease in risk-adjusted mortality was registered for falls, which may indicate that low-energy trauma has not benefited for the increased survivability as much as high-energy trauma, ie traffic-and assault related injuries.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2018
Keywords
Risk-adjusted mortality, ICISS, Trauma, Injury, Nationwide, Epidemiological
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-352695 (URN)10.1186/s13049-018-0485-2 (DOI)000429285700002 ()29615089 (PubMedID)
Funder
Linköpings universitet
Available from: 2018-06-08 Created: 2018-06-08 Last updated: 2018-06-08Bibliographically approved
Gedeborg, R., Cline, C., Zethelius, B. & Salmonson, T. (2018). Pragmatic clinical trials in the context of regulation of medicines. Upsala Journal of Medical Sciences, 1-5
Open this publication in new window or tab >>Pragmatic clinical trials in the context of regulation of medicines
2018 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, p. 1-5Article in journal (Refereed) Epub ahead of print
Abstract [en]

The pragmatic clinical trial addresses scientific questions in a setting close to routine clinical practice and sometimes using routinely collected data. From a regulatory perspective, when evaluating a new medicine before approving marketing authorization, there will never be enough patients studied in all subgroups that may potentially be at higher risk for adverse outcomes, or sufficient patients to detect rare adverse events, or sufficient follow-up time to detect late adverse events that require long exposure times to develop. It may therefore be relevant that post-marketing trials sometimes have more pragmatic characteristics, if there is a need for further efficacy and safety information. A pragmatic study design may reflect a situation close to clinical practice, but may also have greater potential methodological concerns, e.g. regarding the validity and completeness of data when using routinely collected information from registries and health records, the handling of intercurrent events, and misclassification of outcomes. In a regulatory evaluation it is important to be able to isolate the effect of a specific product or substance, and to have a defined population that the results can be referred to. A study feature such as having a wide and permissive inclusion of patients might therefore actually hamper the utility of the results for regulatory purposes. Randomization in a registry-based setting addresses confounding that could otherwise complicate a corresponding non-interventional design, but not any other methodological issues. Attention to methodological basics can help generate reliable study results, and is more important than labelling studies as 'pragmatic'.

Keywords
Drug approval, government regulation, methods, pharmaceutical preparations, pragmatic clinical trial
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-365149 (URN)10.1080/03009734.2018.1515280 (DOI)30251577 (PubMedID)
Available from: 2018-11-09 Created: 2018-11-09 Last updated: 2019-02-13Bibliographically approved
Gedeborg, R., Svennblad, B., Byberg, L., Michaëlsson, K. & Thiblin, I. (2017). Prediction of mortality risk in victims of violent crimes. Forensic Science International, 281, 92-97
Open this publication in new window or tab >>Prediction of mortality risk in victims of violent crimes
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2017 (English)In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 281, p. 92-97Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: To predict mortality risk in victims of violent crimes based on individual injury diagnoses and other information available in health care registries.

METHODS: Data from the Swedish hospital discharge registry and the cause of death registry were combined to identify 15,000 hospitalisations or prehospital deaths related to violent crimes. The ability of patient characteristics, injury type and severity, and cause of injury to predict death was modelled using conventional, Lasso, or Bayesian logistic regression in a development dataset and evaluated in a validation dataset.

RESULTS: Of 14,470 injury events severe enough to cause death or hospitalization 3.7% (556) died before hospital admission and 0.5% (71) during the hospital stay. The majority (76%) of hospital survivors had minor injury severity and most (67%) were discharged from hospital within 1day. A multivariable model with age, sex, the ICD-10 based injury severity score (ICISS), cause of injury, and major injury region provided predictions with very good discrimination (C-index=0.99) and calibration. Adding information on major injury interactions further improved model performance. Modeling individual injury diagnoses did not improve predictions over the combined ICISS score.

CONCLUSIONS: Mortality risk after violent crimes can be accurately estimated using administrative data. The use of Bayesian regression models provides meaningful risk assessment with more straightforward interpretation of uncertainty of the prediction, potentially also on the individual level. This can aid estimation of incidence trends over time and comparisons of outcome of violent crimes for injury surveillance and in forensic medicine.

Keywords
Bayesian inference, Forensic medicine, Mortality, Violent crime
National Category
Forensic Science
Identifiers
urn:nbn:se:uu:diva-334432 (URN)10.1016/j.forsciint.2017.10.015 (DOI)000417055800017 ()29125989 (PubMedID)
Available from: 2017-11-23 Created: 2017-11-23 Last updated: 2018-11-30
Thiblin, I., Garmo, H., Garle, M., Holmberg, L., Byberg, L., Michaëlsson, K. & Gedeborg, R. (2015). Anabolic steroids and cardiovascular risk: A national population-based cohort study. Drug And Alcohol Dependence, 152, 87-92
Open this publication in new window or tab >>Anabolic steroids and cardiovascular risk: A national population-based cohort study
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2015 (English)In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 152, p. 87-92Article in journal (Refereed) Published
Abstract [en]

Background: Non-therapeutic use of anabolic androgenic steroids (AAS) has been associated with various adverse effects; one of the most serious being direct cardiovascular effects with unknown long-term consequences. Therefore, large studies of the association between AAS and cardiovascular outcomes are warranted. We investigated cardiovascular morbidity and mortality in individuals who tested positive for AAS. Methods and results: Between 2002 and 2009, a total of 2013 men were enrolled in a cohort on the date of their first AAS test. Mortality and morbidity after cohort entry was retrieved from national registries. Of the 2013 individuals, 409(20%) tested positive for MS. These men had twice the cardiovascular morbidity and mortality rate as those with negative tests (adjusted hazard ratio (aHR) 2.0; 95% confidence interval (CI) 1.2-3.3). Compared to the Swedish population, all tested men had an increased risk of premature death from all causes (standardized mortality ratio for MS-positive: 19.3, 95% CI 12.4-30.0; for AAS-negative: 8.3,95% CI 6.1-11.0). Conclusion: Non-therapeutic exposure to MS appears to be an independent risk factor for cardiovascular morbidity and premature death.

Keywords
Anabolic androgenic steroids, Mortality, Morbidity, Cardiac disease, Psychiatric disease, Injury
National Category
Substance Abuse Psychiatry
Identifiers
urn:nbn:se:uu:diva-259103 (URN)10.1016/j.drugalcdep.2015.04.013 (DOI)000356738300012 ()26005042 (PubMedID)
Available from: 2015-07-28 Created: 2015-07-27 Last updated: 2018-08-24
Chung, S.-C., Gedeborg, R., Nicholas, O., James, S. K., Jeppsson, A., Wolfe, C., . . . Hemingway, H. (2014). Acute myocardial infarction: a comparison of short-term survival in national outcome registries in Sweden and the UK. The Lancet, 383(9925), 1305-1312
Open this publication in new window or tab >>Acute myocardial infarction: a comparison of short-term survival in national outcome registries in Sweden and the UK
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2014 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 383, no 9925, p. 1305-1312Article in journal (Refereed) Published
Abstract [en]

Background International research for acute myocardial infarction lacks comparisons of whole health systems. We assessed time trends for care and outcomes in Sweden and the UK. Methods We used data from national registries on consecutive patients registered between 2004 and 2010 in all hospitals providing care for acute coronary syndrome in Sweden and the UK. The primary outcome was all-cause mortality 30 days after admission. We compared effectiveness of treatment by indirect casemix standardisation. This study is registered with ClinicalTrials.gov, number NCT01359033. Findings We assessed data for 119 786 patients in Sweden and 391 077 in the UK. 30-day mortality was 7.6% (95% CI 7.4-7.7) in Sweden and 10.5% (10.4-10.6) in the UK. Mortality was higher in the UK in clinically relevant subgroups defined by troponin concentration, ST-segment elevation, age, sex, heart rate, systolic blood pressure, diabetes mellitus status, and smoking status. In Sweden, compared with the UK, there was earlier and more extensive uptake of primary percutaneous coronary intervention (59% vs 22%) and more frequent use of beta blockers at discharge (89% vs 78%). After casemix standardisation the 30-day mortality ratio for UK versus Sweden was 1.37 (95% CI 1.30-1.45), which corresponds to 11 263 (95% CI 9620-12 827) excess deaths, but did decline over time (from 1.47, 95% CI 1.38-1.58 in 2004 to 1.20, 1.12-1.29 in 2010; p=0.01). Interpretation We found clinically important differences between countries in acute myocardial infarction care and outcomes. International comparisons research might help to improve health systems and prevent deaths.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-224324 (URN)10.1016/S0140-6736(13)62070-X (DOI)000334104900029 ()
Available from: 2014-05-14 Created: 2014-05-09 Last updated: 2017-12-05Bibliographically approved
Gedeborg, R., Warner, M., Chen, L.-H., Gulliver, P., Cryer, C., Robitaille, Y., . . . Langley, J. (2014). Internationally comparable diagnosis-specific survival probabilities for calculation of the ICD-10-based Injury Severity Score. Journal of Trauma and Acute Care Surgery, 76(2), 358-365
Open this publication in new window or tab >>Internationally comparable diagnosis-specific survival probabilities for calculation of the ICD-10-based Injury Severity Score
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2014 (English)In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, Vol. 76, no 2, p. 358-365Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The International Statistical Classification of Diseases, 10th Revision (ICD-10) -based Injury Severity Score (ICISS) performs well but requires diagnosis-specific survival probabilities (DSPs), which are empirically derived, for its calculation. The objective was to examine if DSPs based on data pooled from several countries could increase accuracy, precision, utility, and international comparability of DSPs and ICISS. METHODS: Australia, Argentina, Austria, Canada, Denmark, New Zealand, and Sweden provided ICD-10-coded injury hospital discharge data, including in-hospital mortality status. Data from the seven countries were pooled using four different methods to create an international collaborative effort ICISS (ICE-ICISS). The ability of the ICISS to predict mortality using the country-specific DSPs and the pooled DSPs was estimated and compared. RESULTS: The pooled DSPs were based on a total of 3,966,550 observations of injury diagnoses from the seven countries. The proportion of injury diagnoses having at least 100 discharges to calculate the DSP varied from 12% to 48% in the country-specific data set and was 66% in the pooled data set. When compared with using a country's own DSPs for ICISS calculation, the pooled DSPs resulted in somewhat reduced discrimination in predicting mortality (difference in c statistic varied from 0.006 to 0.04). Calibration was generally good when the predicted mortality risk was less than 20%. When Danish and Swedish data were used, ICISS was combined with age and sex in a logistic regression model to predict in-hospital mortality. Including age and sex improved both discrimination and calibration substantially, and the differences from using country-specific or pooled DSPs were minor. CONCLUSION: Pooling data from seven countries generated empirically derived DSPs. These pooled DSPs facilitate international comparisons and enables the use of ICISS in all settings where ICD-10 hospital discharge diagnoses are available. The modest reduction in performance of the ICE-ICISS compared with the country-specific scores is unlikely to outweigh the benefit of internationally comparable Injury Severity Scores possible with pooled data.

Keywords
Trauma, injury, trauma severity indices, population surveillance, hospital mortality
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-227948 (URN)10.1097/TA.0b013e3182a9cd31 (DOI)000336386100015 ()
Available from: 2014-07-07 Created: 2014-07-02 Last updated: 2014-07-07Bibliographically approved
Snellman, G., Byberg, L., Lemming, E. W., Melhus, H., Gedeborg, R., Mallmin, H., . . . Michaelsson, K. (2014). Long-Term Dietary Vitamin D Intake and Risk of Fracture and Osteoporosis: A Longitudinal Cohort Study of Swedish Middle-aged and Elderly Women. Journal of Clinical Endocrinology and Metabolism, 99(3), 781-790
Open this publication in new window or tab >>Long-Term Dietary Vitamin D Intake and Risk of Fracture and Osteoporosis: A Longitudinal Cohort Study of Swedish Middle-aged and Elderly Women
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2014 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 99, no 3, p. 781-790Article in journal (Refereed) Published
Abstract [en]

Context: The importance of dietary vitamin D for osteoporotic fracture prevention is uncertain. Objective: Our objective was to investigate associations between dietary vitamin D intake with risk of fracture and osteoporosis. Design and Participants: In the population-based Swedish Mammography Cohort (including 61 433 women followed for 19 years), diet was assessed by repeated food frequency questionnaires. Setting: The study was conducted in 2 municipalities in central Sweden. Main Outcome Measure: Incident fractures were identified from registry data. In a subcohort (n = 5022), bone mineral density was determined by dual-energy x-ray absorptiometry and serum 25-hydroxyvitamin D was measured using HPLC-tandem mass spectrometry. Results: A total of 14 738 women experienced any type of first fracture during follow-up, and 3871 had a hip fracture. Multivariable-adjusted hazard ratio (HR) for any first fracture was 0.96 (95% confidence interval, 0.92-1.01) for the lowest (mean, 3.1 mu g/d) and 1.02 (0.96-1.07) for the highest (mean, 6.9 mu g/d) quintile compared with the third quintile of vitamin D intake. The corresponding HR for a first hip fracture was 1.02 (0.96-1.08) for the lowest and 1.14 (1.03-1.26) for the highest quintile. Intakes >10 mu g/d, compared with <5 mu g/d, conferred an HR of 1.02 (0.92-1.13) for any fracture and an HR of 1.27 (1.03-1.57) for hip fracture. The intake of vitamin D did not affect the odds for osteoporosis, although higher levels were associated with higher bone mineral density (0.3%-2%, P < .0001). A positive association was observed between vitamin D intake and serum 25-hydroxyvitamin D. Conclusions: Dietary intakes of vitamin D seem of minor importance for the occurrence of fractures and osteoporosis in community-dwelling Swedish women.

National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-224478 (URN)10.1210/jc.2013-1738 (DOI)000333461600038 ()
Available from: 2014-05-15 Created: 2014-05-13 Last updated: 2018-08-24Bibliographically approved
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