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Karlsson, Andreas, Fil. drORCID iD iconorcid.org/0000-0003-3691-8326
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Publications (10 of 86) Show all publications
Söderström, L. & Rosenblad, A. (2019). Association between separate items of the Mini Nutritional Assessment instrument and mortality among older adults: A prospective cohort study introducing a trimmed MNA version.. Clinical Nutrition, Article ID S0261-5614(19)33086-9.
Open this publication in new window or tab >>Association between separate items of the Mini Nutritional Assessment instrument and mortality among older adults: A prospective cohort study introducing a trimmed MNA version.
2019 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, article id S0261-5614(19)33086-9Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND & AIMS: The predictive ability of the separate items of the full Mini Nutritional Assessment (MNA-F) instrument in relation to all-cause mortality (ACM) in older adults is unclear. The present study aimed to examine the magnitudes of the independent associations between separate MNA-F items and ACM among people aged ≥65 years old admitted to hospital. A secondary aim was to construct a trimmed MNA instrument (MNA-T) consisting of MNA-F items that contributed independently to predicting ACM, and compare its predictive ability with that of MNA-F and MNA short forms (MNA-SF).

METHODS: This prospective cohort study included 1768 individuals aged ≥65 years old admitted to a Swedish hospital who answered MNA-F in 2008. They were followed-up for ACM after two years using national registers. Associations with ACM were calculated using Cox regression analysis. Predictive abilities for ACM were calculated using an R2-type measure.

RESULTS: After a mean follow-up time of 1.7 years (3006 person-years), 455 (25.7%) participants had died. In adjusted analyses, nine MNA-F items contributed independently to predicting ACM (P < 0.20) and were included in MNA-T. Five items (food intake, independent living, > 3 prescription drugs, fluid intake, self-assessed health status) had significant contributions (P < 0.05). MNA-T had a better predictive ability for ACM than MNA-F and MNA-SF.

CONCLUSIONS: MNA-F could possibly benefit from excluding less important and more time-consuming items when used for predicting the ultimate consequence of malnutrition, an early death. MNA-T should be a more reliable instrument to use for this purpose.

Keywords
All-cause mortality, Cox regression, Epidemiology, Malnutrition, Mini nutritional assessment, Predictive ability
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-402748 (URN)10.1016/j.clnu.2019.10.014 (DOI)31703950 (PubMedID)
Available from: 2020-01-19 Created: 2020-01-19 Last updated: 2020-02-04Bibliographically approved
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
Drevin, J., Hallqvist, J., Sonnander, K., Rosenblad, A., Pingel, R. & Bjelland, E. K. (2019). Childhood abuse and unplanned pregnancies: a cross-sectional study of women in the Norwegian Mother and Child Cohort Study.. British Journal of Obstetrics and Gynecology
Open this publication in new window or tab >>Childhood abuse and unplanned pregnancies: a cross-sectional study of women in the Norwegian Mother and Child Cohort Study.
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2019 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: To study if childhood emotional, physical and sexual abuse are determinants for having an unplanned pregnancy, if the categories of abuse interact, and if a potential bias due to the selection of the participants (collider stratification bias) could explain the effect of childhood abuse.

DESIGN: A cross-sectional study.

SETTING: The study is based on the Norwegian Mother and Child Cohort Study (MoBa) and uses data from the Medical Birth Registry of Norway.

SAMPLE: Women participating in the MoBa for the first time, ≥18 years of age who responded to questions regarding childhood abuse and pregnancy planning (n = 76 197).

METHODS: Data were collected using questionnaires. We conducted analyses using modified Poisson regressions and the relative excess risks due to interaction (RERI). Sensitivity analyses were performed.

MAIN OUTCOME MEASURE: An unplanned pregnancy (yes/no).

RESULTS: Exposure to childhood emotional (adjusted relative risk (RR) 1.14, 95% CI 1.10-1.19), physical (adjusted RR 1.11, 95% CI 1.04-1.18) and sexual (adjusted RR 1.20, 95% CI 1.14-1.27) abuse increased the risk of having an unplanned pregnancy. The effects could not be explained by the collider stratification bias. The different combinations of categories of abuse did not show any interaction effects.

CONCLUSIONS: Childhood emotional, physical and sexual abuses separately increase the risk of having an unplanned pregnancy. The results indicate that victims of childhood abuse are in greater need of support to achieve their reproductive goals.

TWEETABLE ABSTRACT: Childhood abuse increases the risk of having an unplanned pregnancy. #reproductivehealth #epitwitter.

Keywords
MoBa, The Norwegian Mother and Child Cohort Study, abortion, child abuse, family planning services, induced, preconception care, pregnancy, unplanned
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-402741 (URN)10.1111/1471-0528.16037 (DOI)31802594 (PubMedID)
Available from: 2020-01-18 Created: 2020-01-18 Last updated: 2020-03-02
Tiselius, C., Kindler, C., Rosenblad, 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: 2020-02-04Bibliographically approved
Löfvander, M. & Rosenblad, A. (2019). Mortality among immigrant patients 20-45 years of age with chronic back pain in primary care in Sweden: A 15-year follow-up cohort study.. Journal of Back and Musculoskeletal Rehabilitation
Open this publication in new window or tab >>Mortality among immigrant patients 20-45 years of age with chronic back pain in primary care in Sweden: A 15-year follow-up cohort study.
2019 (English)In: Journal of Back and Musculoskeletal Rehabilitation, ISSN 1053-8127, E-ISSN 1878-6324Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Mortality rates among immigrant patients undergoing rehabilitation for musculoskeletal backache are unknown.

OBJECTIVE: To study the association between marital status, severe psychosocial strain, receiving long-term time-limited sickness allowance (TLSA) and all-cause mortality (ACM) in a cohort of immigrants aged 20-45 years with long-standing backache in Sweden.

METHODS: We studied 318 patients (92% foreign-born, 76% non-European) of known marital status on sick-leave for musculoskeletal backache. They were followed up for ACM until 2015. Socio-demographic data, TLSA and psychosocial strain, including major depression, severe psychosocial stressors and pessimistic thoughts, were analysed using multiple-imputation Cox regression.

RESULTS: Over a mean (standard deviation) follow-up time of 15 (5.0) years, 11 (3.5%) participants died. At baseline, 34% were unmarried, 19% were receiving TLSA, and 71% had ⩾ 1 psychosocial strain component (38% depression; 47% severe stressors; 35% pessimistic thoughts). After concomitant risk factors were adjusted for, being unmarried and receiving TLSA were associated with higher mortality by factors of 6.2 (p= 0.005) and 5.8 (p= 0.006), respectively. Psychosocial strain was only significantly associated with higher mortality in the unadjusted analyses.

CONCLUSIONS: Being unmarried and receiving TLSA were associated with significantly higher ACM in this highly marginalized group of immigrant patients.

Keywords
Chronic pain, all-cause mortality, depression, illness attitudes, immigrants, primary care, psychosocial stressors, rehabilitation, sickness allowance
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-402740 (URN)10.3233/BMR-181273 (DOI)31903979 (PubMedID)
Available from: 2020-01-18 Created: 2020-01-18 Last updated: 2020-01-30Bibliographically 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: 2020-01-08Bibliographically approved
Sundström, J., Söderholm, M., Söderberg, S., Alfredsson, L., Andersson, M., Bellocco, R., . . . Wiberg, B. (2019). Risk factors for subarachnoid haemorrhage: a nationwide cohort of 950 000 adults.. International Journal of Epidemiology, 48(6), 2018-2025
Open this publication in new window or tab >>Risk factors for subarachnoid haemorrhage: a nationwide cohort of 950 000 adults.
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2019 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 48, no 6, p. 2018-2025Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium.

METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries.

RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH.

CONCLUSIONS: The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.

Keywords
Stroke, cohort study, epidemiology
National Category
Medical and Health Sciences
Research subject
Lung Medicine
Identifiers
urn:nbn:se:uu:diva-401342 (URN)10.1093/ije/dyz163 (DOI)31363756 (PubMedID)
Available from: 2020-01-07 Created: 2020-01-07 Last updated: 2020-03-25Bibliographically 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: 2020-01-23Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0003-3691-8326

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