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Publications (10 of 82) Show all publications
Husdal, R., Thors Adolfsson, E., Leksell, J., Eliasson, B., Jansson, S., Jerdén, L., . . . Rosenblad, A. (2019). Associations between quality of work features in primary health care and glycaemic control in people with Type 2 diabetes mellitus: A nationwide survey.. Primary Care Diabetes, 13(2), 176-186, Article ID S1751-9918(18)30277-8.
Open this publication in new window or tab >>Associations between quality of work features in primary health care and glycaemic control in people with Type 2 diabetes mellitus: A nationwide survey.
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2019 (English)In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 13, no 2, p. 176-186, article id S1751-9918(18)30277-8Article in journal (Refereed) Published
Abstract [en]

Aims: To describe and analyse the associations between primary health care centres’ (PHCCs’) quality of work (QOW) and individual HbA1c levels in people with Type 2 diabetes mellitus (T2DM).

Methods: This cross-sectional study invited all 1152 Swedish PHCCs to answer a questionnaire addressing QOW conditions. Clinical, socio-economic and comorbidity data for 230,958 people with T2DM were linked to data on QOW conditions for 846 (73.4%) PHCCs.

Results: Of the participants, 56% had controlled (≤52 mmol/mol), 31.9% intermediate (53–69 mmol/mol), and 12.1% uncontrolled (≥70 mmol/mol) HbA1c. An explanatory factor analysis identified seven QOW features. The features having a call-recall system, having individualized treatment plans, PHCCs’ results always on the agenda, and having a follow-up strategy combined with taking responsibility of outcomes/results were associated with lower HbA1c levels in the controlled group (all < 0.05). For people with intermediate or uncontrolled HbA1c, having individualized treatment plans was the only QOW feature that was significantly associated with a lower HbA1c level (< 0.05).

Conclusions: This nationwide study adds important knowledge regarding associations between QOW in real life clinical practice and HbA1c levels. PHCCs’ QOW may mainly only benefit people with controlled HbA1c and more effective QOW strategies are needed to support people with uncontrolled HbA1c.

Keywords
Diabetes mellitus, National survey, Primary health care, Quality of health care, Type 2
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-373949 (URN)10.1016/j.pcd.2018.11.005 (DOI)000462105300010 ()30545793 (PubMedID)
Available from: 2019-01-17 Created: 2019-01-17 Last updated: 2019-04-17Bibliographically approved
Tiselius, C., Kindler, C., Karlsson, A. & Smedh, K. (2019). Localization of mesenteric lymph node metastases in relation to the level of arterial ligation in rectal cancer surgery. European Journal of Surgical Oncology, 45(6), 989-994
Open this publication in new window or tab >>Localization of mesenteric lymph node metastases in relation to the level of arterial ligation in rectal cancer surgery
2019 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 45, no 6, p. 989-994Article in journal (Refereed) Published
Abstract [en]

Introduction: For oncological reasons, central arterial ligation of the inferior mesenteric artery (IMA) is suggested in rectal cancer surgery although no conclusive evidence support this. We have therefore investigated the localization of lymph node metastases and compared central ligation of the IMA versus peripheral arterial ligation, in rectal cancer specimens. Methods: This was a cross-sectional population-based study of consecutive recruited patients who underwent resection for rectal cancer in 2012-2015. Multiple linear regression analysis was used to explore the relationship between lymph node count and age, sex, body mass index, preoperative oncological treatment, type of surgery, tumour stage, and vessel and specimen length. Results: 151 patients (54 women) were included, with median (range) age 70 (45-87) years. The median (range) number of lymph nodes retrieved was 25 (3-70), which was associated with body mass index, type of surgery and vessel length. Vessel length, median (range) 9.6 (5-14) and 9.2 (5-15) cm for reported central and peripheral arterial ligation, respectively, was associated with body mass index. In 39 of 42 samples, metastatic lymph nodes were located in the mesorectum, and 13 of 42 samples also had metastatic lymph nodes in the sigmoid mesentery. None were found around the ligated artery. Conclusion: To recruit all metastatic lymph nodes in rectal cancer surgery, it is important to include the sigmoid mesentery in the specimen, but not to perform a central ligation of the IMA compared with ligation of the SRA close to the left colic artery (LCA). (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Lymph node, Arterial ligation, Rectal cancer
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-389814 (URN)10.1016/j.ejso.2019.01.183 (DOI)000470941000010 ()30744943 (PubMedID)
Available from: 2019-07-30 Created: 2019-07-30 Last updated: 2019-07-30Bibliographically approved
Sundström, J., Björkelund, C., Giedraitis, V., Hansson, P.-O., Högman, M., Janson, C., . . . Svennblad, B. (2019). Rationale for a Swedish cohort consortium. Upsala Journal of Medical Sciences, 124(1), 21-28
Open this publication in new window or tab >>Rationale for a Swedish cohort consortium
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2019 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, no 1, p. 21-28Article in journal (Refereed) Published
Abstract [en]

We herein outline the rationale for a Swedish cohort consortium, aiming to facilitate greater use of Swedish cohorts for world-class research. Coordination of all Swedish prospective population-based cohorts in a common infrastructure would enable more precise research findings and facilitate research on rare exposures and outcomes, leading to better utilization of study participants' data, better return of funders' investments, and higher benefit to patients and populations. We motivate the proposed infrastructure partly by lessons learned from a pilot study encompassing data from 21 cohorts. We envisage a standing Swedish cohort consortium that would drive development of epidemiological research methods and strengthen the Swedish as well as international epidemiological competence, community, and competitiveness.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2019
Keywords
Common infrastructure, epidemiological research, pilot study, rare outcomes, Swedish cohort consortium
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-381205 (URN)10.1080/03009734.2018.1556754 (DOI)000461811100006 ()30618330 (PubMedID)
Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2019-04-10Bibliographically approved
Karlsson, A. (2018). A comparison of blood pressure indices as predictors of all-cause mortality among middle-aged men and women during 701,707 person-years of follow-up. Journal of Human Hypertension, 32(10), 660-667
Open this publication in new window or tab >>A comparison of blood pressure indices as predictors of all-cause mortality among middle-aged men and women during 701,707 person-years of follow-up
2018 (English)In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 32, no 10, p. 660-667Article in journal (Refereed) Published
Abstract [en]

High systolic blood pressure (SBP) is often used as a measure of hypertension in epidemiological studies. Alternative blood pressure (BP) indices include diastolic blood pressure (DBP), pulse pressure (PP), mid-blood pressure (MBP) and mean arterial pressure (MAP). The present study compares the predictive ability for all-cause mortality (ACM) of these indices and the novel BP index mean proportional arterial pressure (MPAP), defined as the weighted mean of SBP and DBP where the weights are proportional to SBP's and DBP's contributions to the sum of SBP and DBP. Using a Swedish cohort of 32,238 middle-aged men and women, not being on antihypertensive treatment, examined in 1989-2000 and followed-up until March 9, 2017, the predictive abilities for ACM of SBP, DBP, PP, MBP, MAP and MPAP were compared using a likelihood-based R 2 -type measure for adjusted and unadjusted Cox regression models. Of the included participants (mean age 45.4 years, 48.2% men), 2936 (9.1%) died during a mean follow-up time of 21.8 years, equalling 701,707 person-years at risk. Higher BP were for all indices significantly associated with increased ACM. For all models, those including MPAP had the highest predictive ability, followed in turn by models including MBP, SBP, MAP, DBP and PP, respectively. The difference was significant for SBP, DBP and PP in unadjusted models and for PP in fully adjusted models. In conclusion, MPAP and MBP are the best predictors of ACM. Until the clinical usefulness of these indices has been evaluated, they may primarily be useful for epidemiological studies.

Place, publisher, year, edition, pages
NATURE PUBLISHING GROUP, 2018
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-368451 (URN)10.1038/s41371-018-0085-7 (DOI)000447268300004 ()29991703 (PubMedID)
Available from: 2018-12-07 Created: 2018-12-07 Last updated: 2018-12-07Bibliographically approved
Knutsson, J., Priwin, C., Hessen-Soderman, A.-C., Rosenblad, A. & von Unge, M. (2018). A randomized study of four different types of tympanostomy ventilation tubes: Full-term follow-up. International Journal of Pediatric Otorhinolaryngology, 107, 140-144
Open this publication in new window or tab >>A randomized study of four different types of tympanostomy ventilation tubes: Full-term follow-up
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2018 (English)In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 107, p. 140-144Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the impact of tympanostomy ventilation tube material (silicone vs fluoroplastic) and shape (short vs long) regarding time to extrusion, occurrence of otorrhea, occlusion, tube removal and occurrence of persistent perforation.

Methods and material: Four different types of ventilation tubes were used; Long Armstrong tubes, Donaldson tubes, Shepard tubes and straight tubes, representing four specific combinations of VT material (silicone or fluoroplastic) and shape (short, double flanged or long, single flanged). Four hundred children scheduled for bilateral tube insertion were included in a randomized trial. The patients received one type of tube in the right ear and another type in the left ear. The incidence of tube extrusion and complications were monitored post-operatively every third month by an otolaryngologist.

Results: Twenty-two children were excluded during surgery. Out of the studied 378 children the mean age was 35.3 months. 63.8% were boys. Short tubes extruded earlier than long tubes; hazard ratio (HR) 4.84 (95% CI 3.50-6.69, p < 0.001). Long Armstrong tubes were least prone to extrude. Silicone tubes resulted in significantly longer time to first infection in a VT ear, HR 1.68 (95% CI 1.03-2.76, p = 0.039). Donaldson tubes rendered the longest mean time to first infection (p = 0.025). Infections did not affect tube extrusion rates significantly (p = 0.879). No significant differences were found regarding tube occlusion, tube extraction or persistent perforation.

Conclusions: Long tubes are less prone to extrude early. Long Armstrong tubes have the least propensity to extrude early. Silicone tubes render significantly longer time to first infection. Donaldson tubes result in least infections. Infection does not affect extrusion rates significantly.

Keywords
Ventilation tubes, Tympanostomy tubes, Secretory otitis media, Extrusion, Otorrhea, Occlusion, Complications, Material, Tympanic membrane perforation
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-351643 (URN)10.1016/j.ijporl.2018.02.012 (DOI)000428492100027 ()29501296 (PubMedID)
Available from: 2018-05-31 Created: 2018-05-31 Last updated: 2018-05-31Bibliographically approved
Cloodt, E., Rosenblad, A. & Rodby-Bousquet, E. (2018). Demographic and modifiable factors associated with knee contracture in children with cerebral palsy. Developmental Medicine & Child Neurology, 60(4), 391-396
Open this publication in new window or tab >>Demographic and modifiable factors associated with knee contracture in children with cerebral palsy
2018 (English)In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 60, no 4, p. 391-396Article in journal (Refereed) Published
Abstract [en]

AimTo identify the prevalence of knee contracture and its association with gross motor function, age, sex, spasticity, and muscle length in children with cerebral palsy (CP). MethodCross-sectional data for passive knee extension were analysed in 3045 children with CP (1756 males, 1289 females; mean age 8y 1mo [SD 3.84]). CP was classified using the Gross Motor Function Classification System (GMFCS) levels I (n=1330), II (n=508), III (n=280), IV (n=449), and V (n=478). Pearson's chi(2) test and multiple binary logistic regression were applied to analyse the relationships between knee contracture and GMFCS level, sex, age, spasticity, hamstring length, and gastrocnemius length. ResultsKnee contracture greater than or equal to 5 degrees occurred in 685 children (22%). The prevalence of knee contracture was higher in older children and in those with higher GMFCS levels. Odds ratios (ORs) for knee contracture were significantly higher for children at GMFCS level V (OR=13.17), with short hamstring muscles (OR=9.86), and in the oldest age group, 13 years to 15 years (OR=6.80). InterpretationKnee contracture is associated with higher GMFCS level, older age, and shorter muscle length; spasticity has a small effect. Maintaining muscle length, especially of the hamstrings, is important for reducing the risk of knee contracture.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-351680 (URN)10.1111/dmcn.13659 (DOI)000428388000019 ()29318610 (PubMedID)
Available from: 2018-06-05 Created: 2018-06-05 Last updated: 2018-06-05Bibliographically approved
Rosenblad, A. (2018). Extending the Linear Model with R: Generalized Linear, Mixed Effects and Nonparametric Regression Models, 2nd edition [Review]. Psychometrika, 83(4), 1011-1013
Open this publication in new window or tab >>Extending the Linear Model with R: Generalized Linear, Mixed Effects and Nonparametric Regression Models, 2nd edition
2018 (English)In: Psychometrika, ISSN 0033-3123, E-ISSN 1860-0980, Vol. 83, no 4, p. 1011-1013Article, book review (Other academic) Published
Place, publisher, year, edition, pages
Springer, 2018
National Category
Pharmacology and Toxicology
Identifiers
urn:nbn:se:uu:diva-372950 (URN)10.1007/s11336-018-9628-7 (DOI)000450043100013 ()30421259 (PubMedID)
Available from: 2019-01-15 Created: 2019-01-15 Last updated: 2019-01-15Bibliographically approved
Calais, F., Ostman, M. E., Hedberg, P., Karlsson, A., Leppert, J. & Fröbert, O. (2018). Incremental prognostic value of coronary and systemic atherosclerosis after myocardial infarction. International Journal of Cardiology, 261, 6-11
Open this publication in new window or tab >>Incremental prognostic value of coronary and systemic atherosclerosis after myocardial infarction
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2018 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 261, p. 6-11Article in journal (Refereed) Published
Abstract [en]

Background: The role of systemic atherosclerosis in myocardial infarction (MI) patients is not fully understood. We investigated the incremental prognostic value of coronary and systemic atherosclerosis after acute MI by estimating extra-cardiac artery disease (ECAD) and extent of coronary atherosclerosis.

Methods and results: The study included 544 prospective MI patients undergoing coronary angiography. For all patients, the longitudinal coronary atherosclerotic extent, expressed as Sullivan extent score (SES) was calculated. In addition, the patients underwent non-invasive screening for ECAD in the carotid, aortic, renal and lower limb. SES was found to be associated with ECAD independent of baseline clinical parameters [adjusted odds ratio (OR) 1.04 95% confidence interval (CI) 1.02–1.06, P < 0.001]. Extensive systemic atherosclerosis, defined as the combination of extensive coronary disease (SES ≥ 17) and ECAD, was associated with higher risk for all-cause mortality compared to limited systemic atherosclerosis (SES < 17 and no ECAD) (hazard ratio [HR] 2.9 95% CI 1.9–4.5, P < 0.001, adjusted for Global Registry of Acute Coronary Events risk score parameters 1.8, 95% CI 1.1–3.0, P = 0.019). The risk for the composite endpoint of cardiovascular death or hospitalization was significantly higher in patients with extensive systemic atherosclerosis compared to patients with limited systemic atherosclerosis (HR 3.1, 95% CI 2.1–4.7, P < 0.001, adjusted HR 1.9, 95% CI 1.2–3.1, P < 0.004).

Conclusions: Visual estimation of the longitudinal coronary atherosclerotic extent at the time of MI predicts ECAD. Coexistence of extensive coronary disease and ECAD defines a group with particularly poor prognosis after MI.

Keywords
Atherosclerosis, Myocardial infarction, Coronary artery disease, Extra-cardiac artery disease, Prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-353355 (URN)10.1016/j.ijcard.2018.02.035 (DOI)000430081000002 ()29657058 (PubMedID)
Available from: 2018-06-12 Created: 2018-06-12 Last updated: 2018-06-12Bibliographically approved
Calais, F., Ostman, M. E., Hedberg, P., Karlsson, A., Leppert, J. & Fröbert, O. (2018). Reply to "Letter to editor, Assessing the effect of coronary and systemic atherosclerosis following myocardial infarction" by dr Su Yueqiu et al. [Letter to the editor]. International Journal of Cardiology, 271, 29-29
Open this publication in new window or tab >>Reply to "Letter to editor, Assessing the effect of coronary and systemic atherosclerosis following myocardial infarction" by dr Su Yueqiu et al.
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2018 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 271, p. 29-29Article in journal, Letter (Other academic) Published
Keywords
Atherosclerosis, Myocardial infarction, Coronary artery disease, Extra-cardiac artery disease, Prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-366381 (URN)10.1016/j.ijcard.2018.06.047 (DOI)000444611600012 ()30223358 (PubMedID)
Available from: 2018-11-21 Created: 2018-11-21 Last updated: 2018-11-21Bibliographically approved
Husdal, R., Karlsson, A., Leksell, J., Eliasson, B., Jansson, S., Jerden, L., . . . Thors Adolfsson, E. (2018). Resources and organisation in primary health care are associated with HbA1c level: A nationwide study of 230958 people with Type 2 diabetes mellitus.. Primary Care Diabetes, 12(1), 23-33
Open this publication in new window or tab >>Resources and organisation in primary health care are associated with HbA1c level: A nationwide study of 230958 people with Type 2 diabetes mellitus.
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2018 (English)In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 12, no 1, p. 23-33Article in journal (Refereed) Published
Abstract [en]

AIMS: To examine the association between personnel resources and organisational features of primary health care centres (PHCCs) and individual HbA1c level in people with Type 2 diabetes mellitus (T2DM).

METHODS: People with T2DM attending 846 PHCCs (n=230958) were included in this cross-sectional study based on PHCC-level data from a questionnaire sent to PHCCs in 2013 and individual-level clinical data from 2013 for people with T2DM reported in the Swedish National Diabetes Register, linked to individual-level data on socio-economic status and comorbidities. Data were analysed using a generalized estimating equations linear regression models.

RESULTS: After adjusting for PHCC- and individual-level confounding factors, personnel resources associated with lower individual HbA1c level were mean credits of diabetes-specific education among registered nurses (RNs) (-0.02mmol/mol for each additional credit; P<0.001) and length of regular visits to RNs (-0.19mmol/mol for each additional 15min; P<0.001). Organisational features associated with HbA1c level were having a diabetes team (-0.18mmol/mol; P<0.01) and providing group education (-0.20mmol/mol; P<0.01).

CONCLUSIONS: In this large sample, PHCC personnel resources and organisational features were associated with lower HbA1c level in people with T2DM.

Keywords
HbA(1c), Organisation, Personnel resources, Primary health care system, Type 2 diabetes mellitus
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-332689 (URN)10.1016/j.pcd.2017.09.003 (DOI)000423008800003 ()28964673 (PubMedID)
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2018-12-21Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3691-8326

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