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Bröms, Kristina
Alternative names
Publications (10 of 21) Show all publications
Högman, M., Sulku, J., Ställberg, B., Janson, C., Bröms, K., Hedenström, H., . . . Malinovschi, A. (2018). 2017 Global Initiative for Chronic Obstructive Lung Disease reclassifies half of COPD subjects to lower risk group. The International Journal of Chronic Obstructive Pulmonary Disease, 13(`), 165-173
Open this publication in new window or tab >>2017 Global Initiative for Chronic Obstructive Lung Disease reclassifies half of COPD subjects to lower risk group
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2018 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 13, no `, p. 165-173Article in journal (Refereed) Published
Abstract [en]

Background: Unlike the 2014 guidelines, the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have removed lung function from the risk assessment algorithm of patients with COPD. The aim of this investigation was to analyze the proportion of subjects who would change to a lower risk group when applying GOLD(2017) and determine if they exhibit different characteristics in terms of inflammation, symptoms and comorbidity compared to the subjects who would remain in a high-risk group.

Subjects and methods: A total of 571 subjects with physician-diagnosed and spirometry-verified COPD were included in the present study. The data consisted of measurements of lung function, inflammatory markers, together with questionnaires that covered comorbidities, COPD symptoms and medication.

Results: From group C, 53% of the subjects would be reclassified to the lower risk group A, and from group D, 47% of the subjects would be reclassified to the lower risk group B when using GOLD(2017) instead of GOLD(2014). Compared to the subjects who would remain in group D, those who would change to group B were more often men (56% vs 72%); of an older age, mean (SD), 71 (8) years vs 68 (7) years; had more primary care contact (54% vs 33%); had lower levels of blood neutrophils, geometrical mean (95% CI), 5.3 (5.0, 5.7) vs 4.6 (4.3, 4.9); reported less anxiety/depression (20% vs 34%); experienced less asthma (29% vs 46%) and had fewer symptoms according to the COPD assessment test, 16 (5) vs 21 (7). All p-values were <0.05.

Conclusion: The removal of spirometry from risk assessment in GOLD(2017) would lead to the reclassification of approximately half of the subjects in the risk groups C and D to the lower risk groups A and B. There are differences in age, gender, health care contacts, inflammation, comorbidity and symptom burden among those changing from group D to group B. The effects of reclassification and changes in eventual treatment for disease control and symptom burden need further investigation.

Place, publisher, year, edition, pages
DOVE MEDICAL PRESS LTD, 2018
Keywords
COPD, lung function test, eosinophils, neutrophils, comorbidity, GOLD
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-341327 (URN)10.2147/COPD.S151016 (DOI)000419105400001 ()29379281 (PubMedID)
Funder
Swedish Heart Lung Foundation
Available from: 2018-02-07 Created: 2018-02-07 Last updated: 2018-02-07Bibliographically approved
Gustavsson, C., Nordqvist, M., Bröms, K., Jerdén, L., Kallings, L. V. & Wallin, L. (2018). What is required to facilitate implementation of Swedish physical activity on prescription?: - interview study with primary healthcare staff and management. BMC Health Services Research, 18, Article ID 196.
Open this publication in new window or tab >>What is required to facilitate implementation of Swedish physical activity on prescription?: - interview study with primary healthcare staff and management
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2018 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, article id 196Article in journal (Refereed) Published
Abstract [en]

Background: The method, Swedish Physical Activity on Prescription (SPAP), has been launched in Swedish healthcare to promote physical activity for prevention and treatment of lifestyle related health disorders. Despite scientific support for the method, and education campaigns, it is used to a limited extent by health professionals. The aim of the study was to describe the views of health professionals on perceived facilitators, barriers and requirements for successful implementation of SPAP in primary healthcare. Methods: Eighteen semi-structured interviews with stakeholders in SPAP, i.e. ten people working in local or central management and eight primary healthcare professionals in two regional healthcare organisations, were analysed using qualitative content analysis. Results: We identified an overarching theme regarding requirements for successful implementation of SPAP: Need for knowledge and organisational support, comprising four main categories: Need for increased knowledge and affirmative attitude among health professionals; Need for clear and supportive management; Need for central supporting structures; Need for local supporting structures. Knowledge of the SPAP method content and core components was limited. Confidence in the method varied among health professionals. There was a discrepancy between the central organisation policy documents declaring that disease preventive methods were prioritised and a mandatory assignment, while the health professionals asked for increased interest, support and resources from management, primarily time and supporting structures. There were somewhat conflicting views between primary healthcare professionals and managers concerning perceived barriers and requirements. In contrast to some of the management's beliefs, all primary healthcare professionals undisputedly acknowledged the importance of promoting physical activity, but they lacked time, written routines and in some cases competence for SPAP counselling. Conclusion: The study provides knowledge regarding requirements to facilitate the implementation of SPAP in healthcare. There was limited knowledge among health professionals regarding core components of SPAP and how to practise the method, which speaks for in-depth training in the SPAP method. The findings highlight the importance of forming policies and guidelines and establishing organisational supporting structures, and ensuring that these are well known and approved in all parts of the healthcare organisation.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Disease prevention, Health professionals, Health promotion, Implementation, Non-communicable disease prevention, Physical activity, Primary healthcare, Qualitative research method, Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-354361 (URN)10.1186/s12913-018-3021-1 (DOI)000428198500005 ()29562922 (PubMedID)
Available from: 2018-06-26 Created: 2018-06-26 Last updated: 2018-06-26Bibliographically approved
Gonzalez Lindh, M., Koyi, H., Blom Johansson, M., Malinovschi, A., Högman, M., Ställberg, B. & Bröms, K. (2017). Swallowing dysfunction in COPD: Is it more related to burden of disease than lung function: Results from the TIE-study. In: : . Paper presented at European society for swallowing disorders, ESSD-Conference, Barcelona.
Open this publication in new window or tab >>Swallowing dysfunction in COPD: Is it more related to burden of disease than lung function: Results from the TIE-study
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2017 (English)Conference paper, Oral presentation only (Other academic)
National Category
Medical and Health Sciences
Research subject
Lung Medicine
Identifiers
urn:nbn:se:uu:diva-337857 (URN)
Conference
European society for swallowing disorders, ESSD-Conference, Barcelona
Available from: 2018-01-05 Created: 2018-01-05 Last updated: 2018-01-05
Bröms, K., Norbäck, D., Eriksson, M., Sundelin, C. & Svärdsudd, K. (2013). Prevalence and co-occurrence of parentally reported possible asthma and allergic manifestations in pre-school children. BMC Public Health, 13, 764
Open this publication in new window or tab >>Prevalence and co-occurrence of parentally reported possible asthma and allergic manifestations in pre-school children
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2013 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. 764-Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this study was to make an in-depth analysis of the prevalence and co-occurrence in pre-school children of possible asthma and atopic manifestations. Methods: In Sweden 74%-84% of preschool children, depending on age, attend municipality organised day-care centres. Parents of 5,886 children 1-6 years of age, sampled from day-care centres in 62 municipalities all over Sweden, responded to a postal questionnaire regarding symptoms indicating prevalent possible asthma, allergic rhinitis, eczema, and food, furred pet and pollen allergy and other data in their children. Possible asthma was defined as any of the four criteria wheezing four times or more during the last year, physician diagnosis and current wheezing, ever had asthma and current wheezing, and current use of inhalation steroids, all based on questionnaire responses. Results: The overall prevalence of possible asthma was 8.9%, of eczema 21.7%, of rhinitis 8.1%, and of food allergy 6.6%. There was a highly significant co-occurrence between possible asthma and all atopic manifestations, 35.7% having any of the manifestations. Presence of pet allergy was the manifestation showing the closest co-occurrence with presence of possible asthma, presence of pollen allergy with presence of rhinitis, and presence of food allergy with presence of eczema. Assessed from plots of age-specific prevalence of possible asthma, rhinitis, eczema and food allergy, the prevalence of all manifestations increased from one to three years of age and then decreased, except for rhinitis where the prevalence increased until six years of age, indicating no specific ordered sequence. Conclusions: Parentally reported possible asthma, eczema and food allergy had a curvilinear prevalence course across age with a maximum at age 3, while rhinitis prevalence increased consistently with age. Co-occurrence between possible asthma and atopic manifestations was common, and some combinations were more common than others, but there was no evidence of a specific ordered onset sequence.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-208084 (URN)10.1186/1471-2458-13-764 (DOI)000323753900001 ()
Available from: 2013-09-23 Created: 2013-09-23 Last updated: 2017-12-06Bibliographically approved
Bröms, K., Norbäck, D., Sundelin, C., Eriksson, M. & Svärdsudd, K. (2012). A nationwide study of asthma incidence rate and its determinants in Swedish pre-school children. European Journal of Epidemiology, 27(9), 695-703
Open this publication in new window or tab >>A nationwide study of asthma incidence rate and its determinants in Swedish pre-school children
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2012 (English)In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 27, no 9, p. 695-703Article in journal (Refereed) Published
Abstract [en]

While many studies on asthma prevalence have been published, the number of studies on asthma incidence in pre-school children is limited. In this project, a nationwide sample of pre-school children was followed with the aim of estimating cumulative 5-year asthma incidence and its determinants. Parents of 5,886 children 1-6 years of age, sampled from day-care centres in 62 municipalities all over Sweden, responded in 2002 to a baseline postal questionnaire with questions regarding symptoms indicating possible asthma or atopic conditions, and a number of other variables. In 2007, parents of 4,255 children responded to an almost identical follow-up questionnaire. Of these, the 3,715 children who were free from asthma at baseline constitute the study population for this report. A large number of potential baseline determinants for cumulative 5-year asthma incidence were identified. Of these, food allergy, rhinitis, incomplete asthma diagnosis criteria (wheezing last 12 months, and ever had asthma but no current symptoms), parental rhinitis, parental asthma, age, and eczema, in ranking order of importance, remained significant in multivariate logistic regression analysis. The asthma incidence rate was highly dependent on presence or absence of these variables, the average annual rate ranging from 2/1,000/year in 6-year-olds with no determinants to154/1,000/year in 1-year-olds with all determinants, corresponding to 11/1,000/year based on the whole study population.

National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:uu:diva-185282 (URN)10.1007/s10654-012-9725-3 (DOI)000310589700004 ()22911025 (PubMedID)
Available from: 2012-11-21 Created: 2012-11-21 Last updated: 2017-12-07Bibliographically approved
Bröms, K. (2010). A Nationwide Study of Asthma and Allergy in Swedish Preschool Children: with Special Reference to Environment, Daycare, Prevalence, Co-ocurrence and Incidence. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>A Nationwide Study of Asthma and Allergy in Swedish Preschool Children: with Special Reference to Environment, Daycare, Prevalence, Co-ocurrence and Incidence
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The aim of this project was to study the age and sex specific occurrence of atopic and non-atopic asthma and other atopic manifestations in a nationwide sample of Swedish pre-school children.

Methods: All 70 allergen avoidance day-care centres (AADC) with 84 sections and 140 matched ordinary day-care centres with 440 sections in 62 municipalities across Sweden were sampled. In 2000 the staff at each section responded to a questionnaire on indoor and outdoor environment at the section. In 2002 parents of 5,886 children attending the AADCs and ODCs responded to a postal questionnaire regarding symptoms indicating prevalent asthma, allergic rhinitis, eczema, and food, furred pet and pollen allergy and other data in their children. In 2007, parents of 4255 children responded to an almost identical follow-up questionnaire.

Results: The AADCs had far more strict rules than ODCs on furred pets and smoking at home and on perfume use, and the indoor environment was better, owing to better cleaning. The age specific asthma prevalence was curvilinear with a peak at age 3 of 11.4% among boys and 9.8% among girls. In addition the prevalence increased by municipality population density, a proxy for degree of urbanisation. There was a highly significant co-occurrence between all asthma-atopic manifestations, but there was no evidence of ordered sequence of manifestation onset. The asthma incidence was highly dependent on presence or absence of co-occurrence variables. Given the variable mix in the present study population, the annual asthma incidence ranged from 0.6% to 1.2%.

Conclusions: AADCs had more strict rules and a better indoor environment than ODCs. The asthma prevalence was affected by age, sex and degree of urbanisation. There was close co-occurrence between all asthma and atopic manifestations but no evidence of ordered sequence of onsets. The annual asthma incidence was strongly dependent of co-occurrence conditions.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. p. 69
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 542
Keywords
Asthma, rhinitis, eczema, allergy, indoor environment, daycare centre, prevalence, incidence epidemiology
National Category
General Practice
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-121426 (URN)978-91-554-7759-2 (ISBN)
Public defence
2010-05-07, Brömssalen, ingång 11, Länssjukhuset, Gävle, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2010-04-16 Created: 2010-03-23 Last updated: 2018-01-12
Bröms, K., Norbäck, D., Eriksson, M., Sundelin, C. & Svärdsudd, K. F. (2009). Effect of degree of urbanisation on age and sex-specific asthmaprevalence in Swedish preschool children. BMC Public Health, 9, 303
Open this publication in new window or tab >>Effect of degree of urbanisation on age and sex-specific asthmaprevalence in Swedish preschool children
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2009 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, p. 303-Article in journal (Refereed) Published
Abstract [en]

Background: There are few studies on age and sex-specific asthma   prevalence in the age range 1-6 years. The purpose of this report was   to estimate age and sex specific asthma prevalence in preschool   children and to analyse the influence of possible demographic and   geographic determinants.   Methods: All 70 allergen avoidance day-care centres and 140 matched   ordinary day-care centres across Sweden were sampled. The parents of   all 8,757 children attending these day-care centres received the   International Study of Asthma and Allergies in Childhood (ISAAC)   written questionnaire, supplemented with questions on medical   treatment, physician assessed asthma diagnosis, and other asthma   related questions. The response rate was 68%.   Results: The age specific asthma prevalence, adjusted for the   underlying municipality population size, was among boys 9.7% at age 1,   11.1% at age 2, 11.4 at age 3, 10.5 at age 4, 8.7 at age 5, and 6.4 at   age 6. The corresponding proportions among girls were 8.9%, 9.9%, 9.8%,   8.8%, 7.0%, and 5.0%, on average 9.6% for boys and 8.2% for girls,   altogether 8.9%. In addition to age and sex the prevalence increased by   municipality population density, a proxy for degree of urbanisation.   Moreover, there was a remaining weak geographical gradient with   increasing prevalence towards the north and the west.   Conclusion: The age-specific asthma prevalence was curvilinear with a   peak around age 3 and somewhat higher for boys than for girls. The   asthma prevalence increased in a slowly accelerating pace by   municipality population density as a proxy for degree of urbanisation.

National Category
Medical and Health Sciences
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-120578 (URN)10.1186/1471-2458-9-303 (DOI)000270673700001 ()19695101 (PubMedID)
Available from: 2010-03-15 Created: 2010-03-15 Last updated: 2017-12-12Bibliographically approved
Högman, M., Lafih, J., Meriläinen, P., Bröms, K., Malinovschi, A. & Janson, C. (2009). Extended NO analysis in a healthy subgroup of a random sample from a Swedish population. Clinical Physiology and Functional Imaging, 29(1), 18-23
Open this publication in new window or tab >>Extended NO analysis in a healthy subgroup of a random sample from a Swedish population
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2009 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 29, no 1, p. 18-23Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: There is an interest in modelling exhaled nitric oxide (NO). Studies have shown that flow-independent NO parameters i.e. NO of the alveolar region (C(A)NO), airway wall (C(aw)NO), diffusing capacity (D(aw)NO) and flux (J(aw)NO), are altered in several disease states such as asthma, cystic fibrosis, alveolitis and chronic obsmuctive pulmonary disease (COPD). However, values from a healthy population are missing. OBJECTIVES: To calculate NO parameters in a healthy population by collecting NO values at different exhalation flow rates. METHODS: A random sample from the ECRHS II study was investigated. Among the 281 subjects that had performed a bronchial hyperreactivity (BHR)-test, FEV(1.0), IgE and NO-analyses 89 were found to be healthy. RESULTS: There were no differences in F(E)NO(0.05) or NO parameters between men and women. There were weak correlations between height and both F(E)NO(0.05) (r = 0.23, P = 0.03) and C(aw)NO (r = 0.22, P = 0.04). There was also a correlation between age and C(A)NO (r = 0.28, P = 0.007). When controlled for gender, this correlation was more powerful in women (r = 0.51, P = 0.001) but did not remain for male subjects. CONCLUSION: Extended NO analysis is a simple non-invasive tool that gives by far more information than F(E)NO(0.05). Based on our results, we suggest that the values for healthy subjects should be considered to fall between the following ranges: F(E)NO(0.05), 10-30 ppb; C(aw)NO, 50-250 ppb; D(aw)NO, 5-15 ml s(-1); J(aw)NO, 0.8-1.6 nl s(-1); and C(A)NO, 0-4 ppb. Values outside these intervals indicate the need for further investigation to exclude a state of disease.

Keywords
adults, exhaled nitric oxide, extended nitric oxide analysis, flow rate, gender, health, humans
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-123631 (URN)10.1111/j.1475-097X.2008.00831.x (DOI)000262047300003 ()18803639 (PubMedID)
Available from: 2010-04-28 Created: 2010-04-28 Last updated: 2017-12-12Bibliographically approved
Cai, G.-H., Bröms, K., Mälarstig, B., Zhao, Z.-H., Kim, J. L., Svärdsudd, K., . . . Norbäck, D. (2009). Quantitative PCR analysis of fungal DNA in Swedish day care centers and comparison with building characteristics and allergen levels. Indoor Air, 19(5), 392-400
Open this publication in new window or tab >>Quantitative PCR analysis of fungal DNA in Swedish day care centers and comparison with building characteristics and allergen levels
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2009 (English)In: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 19, no 5, p. 392-400Article in journal (Refereed) Published
Abstract [en]

 Sweden has had allergen-avoidance day care centers (AADCs) since 1979. The aim of this study was to measure fungal DNA by quantitative polymerase chain reaction (qPCR), a new method, in AADCs and ordinary day care centers (ODCs) and examine associations between allergen levels and building characteristics. Dust samples were collected by swabbing doorframes, vacuum-cleaning, and using Petri dishes. In total, 11 AADCs and 11 ODCs were studied (70 rooms). Total fungal DNA, measured by qPCR in the swab dust, was detected in 89%, Aspergillus or Penicillium (Asp/Pen) DNA in 34%, and Stachybotrys chartarum DNA in 6% of the rooms. Total fungal DNA was significantly higher in rooms with linoleum floor (P = 0.02), textile carpets (P = 0.03), reported dampness/molds (P = 0.02) and reported odor (P < 0.001) in the buildings, and significantly lower in wooden facade buildings (P = 0.003). Reported odor was related to the amount of sieved fine dust, reported dampness/molds and type of building construction. Total fungal DNA was related to cat, dog, horse and total allergen levels (P = 0.003) in the day care centers. In conclusion, total fungal DNA is related to reported dampness/molds, reported odor, and type of wall construction. The association between fungal and allergen contamination indicated a general 'hygiene factor' related to biological contaminants. Practical Implications The associations between fungal DNA, reported dampness/molds, and odor support the view that buildings with odor problems should be investigated for possible hidden fungal growth. There is a need to measure fungal biomass in different types of building constructions by monitoring fungal DNA. Analysis of fungal DNA with quantitative PCR can be a fast and practical way to study indoor fungal contamination. Swabbing dust from the doorframe of the main entrance to the room can be a convenient method of sampling dust for fungal DNA analysis. The high prevalence of reported dampness/molds and the common occurrence of fungal DNA indicate the need to improve the indoor environment of Swedish day care centers.

Keywords
Day care centers, Quantitative PCR, Fungal DNA, Allergen levels, Indoor environment, Building dampness
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-122932 (URN)10.1111/j.1600-0668.2009.00600.x (DOI)000269874800003 ()19500176 (PubMedID)
Available from: 2010-04-21 Created: 2010-04-21 Last updated: 2017-12-12Bibliographically approved
Bröms, K. (2008). En nationell studie av allergibarns hälsa i allergiförskolor och konventionella förskolor: [Halvtidskontroll].
Open this publication in new window or tab >>En nationell studie av allergibarns hälsa i allergiförskolor och konventionella förskolor: [Halvtidskontroll]
2008 (Swedish)Report (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-156865 (URN)
Available from: 2011-08-10 Created: 2011-08-10 Last updated: 2012-06-01Bibliographically approved
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