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Bixby, H., Lind, L., Lytsy, P., Sundström, J., Yngve, A. & Ezzati, M. (2019). Rising rural body-mass index is the main driver of the global obesity epidemic in adults [Letter to the editor]. Nature, 569(7755), 260-264
Open this publication in new window or tab >>Rising rural body-mass index is the main driver of the global obesity epidemic in adults
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2019 (English)In: Nature, ISSN 0028-0836, E-ISSN 1476-4687, Vol. 569, no 7755, p. 260-264Article in journal, Letter (Other academic) Published
Abstract [en]

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3,4,5,6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
International Health; Nutrition
Identifiers
urn:nbn:se:uu:diva-383181 (URN)10.1038/s41586-019-1171-x (DOI)000467473600049 ()31068725 (PubMedID)
Funder
Wellcome trust
Note

NCD Risk Factor Collaboration (NCD-RisC)

For a complete list of all 1155 authors see https://doi.org/10.1038/s41586-019-1171-x

Available from: 2019-05-10 Created: 2019-05-10 Last updated: 2019-06-19Bibliographically approved
Sundström, J., Lind, L., Nowrouzi, S., Lytsy, P., Marttala, K., Ekman, I., . . . Östlund, O. (2019). The Precision HYpertenSIon Care (PHYSIC) study: a double-blind, randomized, repeated cross-over study. Upsala Journal of Medical Sciences, 124(1), 51-58
Open this publication in new window or tab >>The Precision HYpertenSIon Care (PHYSIC) study: a double-blind, randomized, repeated cross-over study
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2019 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, no 1, p. 51-58Article in journal (Refereed) Published
Abstract [en]

High blood pressure is the leading risk factor for premature deaths and a major cost to societies worldwide. Effective blood pressure-lowering drugs are available, but patient adherence to them is low, likely partly due to side effects. To identify patient-specific differences in treatment effects, a repeated cross-over design, where the same treatment contrasts are repeated within each patient, is needed. Such designs have been surprisingly rarely used, given the current focus on precision medicine. The Precision HYpertenSIon Care (PHYSIC) study aims to investigate if there is a consistent between-person variation in blood pressure response to the common blood pressure-lowering drug classes of a clinically relevant magnitude, given the within-person variation in blood pressure. The study will also investigate the between-person variation in side effects of the drugs. In a double-blind, randomized, repeated cross-over trial, 300 patients with mild hypertension will be treated with four blood pressure-lowering drugs (candesartan, lisinopril, amlodipine, and hydrochlorothiazide) in monotherapy, with two of the drugs repeated for each patient. If the study indicates that there is a potential for precision hypertension care, the most promising predictors of blood pressure and side effect response to the drugs will be explored, as will the potential for development of a biomarker panel to rank the suitability of blood pressure-lowering drug classes for individual patients in terms of anticipated blood pressure effects and side effects, with the ultimate goal to maximize adherence. The study follows a protocol pre-registered at ClinicalTrials.gov with the identifier NCT02774460.

Keywords
Hypertension; blood pressure; randomised clinical trial; precision medicine
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-374958 (URN)10.1080/03009734.2018.1498958 (DOI)000461811100012 ()30265168 (PubMedID)
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-04-10Bibliographically approved
Wångdahl, J., Lytsy, P., Mårtensson, L. & Westerling, R. (2018). Comprehensive health literacy is associated with experiences of the health examination for asylum seekers - A Swedish cross-sectional study. Paper presented at 1st World Congress on Migration, Ethnicity, Race and Health, 17-19 May 2018, Edinburgh.. European Journal of Public Health, 28, 136-136
Open this publication in new window or tab >>Comprehensive health literacy is associated with experiences of the health examination for asylum seekers - A Swedish cross-sectional study
2018 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 136-136Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-358417 (URN)10.1093/eurpub/cky048.075 (DOI)000432430700391 ()
Conference
1st World Congress on Migration, Ethnicity, Race and Health, 17-19 May 2018, Edinburgh.
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-08-31Bibliographically approved
Zhou, B., Bentham, J., Di Cesare, M., Bixby, H., Danaei, G., Hajifathalian, K., . . . Cisneros, J. Z. (2018). Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: a pooled analysis of 1018 population-based measurement studies with 88.6 million participants. International Journal of Epidemiology, 47(3), 872-883i
Open this publication in new window or tab >>Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: a pooled analysis of 1018 population-based measurement studies with 88.6 million participants
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2018 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, no 3, p. 872-883iArticle in journal (Refereed) Published
Abstract [en]

Background

Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure.

Methods

We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20–29 years to 70–79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure.

Results

In 2005–16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association.

Conclusions

Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2018
Keywords
Blood pressure, hypertension, population health, global health, non-communicable disease
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-361286 (URN)10.1093/ije/dyy016 (DOI)000438342200023 ()29579276 (PubMedID)
Funder
Wellcome trust, 101506/Z/13/Z
Note

NCD Risk Factor Collaboration (NCD-RisC) Members are listed at the end of the paper

Available from: 2018-09-27 Created: 2018-09-27 Last updated: 2018-11-15Bibliographically approved
Wångdahl, J., Westerling, R., Lytsy, P. & Mårtensson, L. (2018). Experiences of the health examination for asylum seekers - focus group discussions with Arabic and Somali speaking refugees in Sweden. European Journal of Public Health, 28, 135-136
Open this publication in new window or tab >>Experiences of the health examination for asylum seekers - focus group discussions with Arabic and Somali speaking refugees in Sweden
2018 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 135-136Article in journal, Meeting abstract (Other academic) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-358415 (URN)000432430700389 ()
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-08-31Bibliographically approved
Berglund, E., Westerling, R., Sundström, J. & Lytsy, P. (2018). Length of time periods in treatment effect descriptions and willingness to initiate preventive therapy: a randomised survey experiment. BMC Medical Informatics and Decision Making, 18, Article ID 106.
Open this publication in new window or tab >>Length of time periods in treatment effect descriptions and willingness to initiate preventive therapy: a randomised survey experiment
2018 (English)In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 18, article id 106Article in journal (Refereed) Published
Abstract [en]

Background Common measures used to describe preventive treatment effects today are proportional, i.e. they compare the proportions of events in relative or absolute terms, however they are not easily interpreted from the patient's perspective and different magnitudes do not seem to clearly discriminate between levels of effect presented to people. Methods In this randomised cross-sectional survey experiment, performed in a Swedish population-based sample (n=1041, response rate 58.6%), the respondents, aged between 40 and 75years were given information on a hypothetical preventive cardiovascular treatment. Respondents were randomised into groups in which the treatment was described as having the effect of delaying a heart attack for different periods of time (Delay of Event,DoE): 1month, 6months or 18months. Respondents were thereafter asked about their willingness to initiate such therapy, as well as questions about how they valued the proposed therapy. ResultsLonger DoE:s were associated with comparatively greater willingness to initiate treatment. The proportions accepting treatment were 81, 71 and 46% when postponement was 18months, 6months and 1month respectively. In adjusted binary logistic regression models the odds ratio for being willing to take therapy was 4.45 (95% CI 2.72-7.30) for a DoE of 6months, and 6.08 (95% CI 3.61-10.23) for a DoE of 18months compared with a DoE of 1month. Greater belief in the necessity of medical treatment increased the odds of being willing to initiate therapy. ConclusionsLay people's willingness to initiate preventive therapy was sensitive to the magnitude of the effect presented as DoE. The results indicate that DoE is a comprehensible effect measure, of potential value in shared clinical decision-making.

Place, publisher, year, edition, pages
BMC, 2018
Keywords
Medical decision-making, Risk communication, Risk perception, Necessity-concern framework
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-371868 (URN)10.1186/s12911-018-0662-2 (DOI)000450786000002 ()30458757 (PubMedID)
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-03-11Bibliographically approved
Carlsson, L., Lytsy, P. & Anderzén, I. (2018). Motivationfor return to work and actual return to work among people on long-term sickleave due to pain syndrome or mental health conditions. Disability and Rehabilitation
Open this publication in new window or tab >>Motivationfor return to work and actual return to work among people on long-term sickleave due to pain syndrome or mental health conditions
2018 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed) Published
Abstract [en]

ABSTRACTPurpose:The purpose of this study was to investigate associations between motivation for return towork and actual return to work, or increased employability among people on long-term sick leave.Materials and methods:Data by responses to questionnaires was collected from 227 people on long-term sick leave (mean¼7.9years) due to pain syndrome or mild to moderate mental health conditionswho had participated in a vocational rehabilitation intervention. The participants’motivation for return towork was measured at baseline. At 12-month follow-up, change in the type of reimbursement betweenbaseline and at present was assessed and used to categorise outcomes as:“decreased work and employ-ability”,“unchanged”,“increased employability”,and“increased work”. Associations between baselinemotivation and return to work outcome were analysed using logistic and multinomial regression models.Results:Motivation for return to work at baseline was associated with return to work or increasedemployability at 12-month follow-up in the logistic regression model adjusting for potential confounders(OR 2.44, 95% CI 1.25–4.78).Conclusions:The results suggest that motivation for return to work at baseline was associated withactual chances of return to work or increased employability in people on long-term sick leave due topain syndrome or mild to moderate mental health conditions.

National Category
Other Medical Sciences not elsewhere specified Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-364565 (URN)10.1080/09638288.2018.1490462 (DOI)
Projects
vitalis
Available from: 2018-10-29 Created: 2018-10-29 Last updated: 2019-02-07Bibliographically approved
Berglund, E., Anderzén, I., Andersén, Å., Carlsson, L., Gustavsson, C., Wallman, T. & Lytsy, P. (2018). Multidisciplinary Intervention and Acceptance and Commitment Therapy for Return-to-Work and Increased Employability among Patients with Mental Illness and/or Chronic Pain: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health, 15(11), Article ID 2424.
Open this publication in new window or tab >>Multidisciplinary Intervention and Acceptance and Commitment Therapy for Return-to-Work and Increased Employability among Patients with Mental Illness and/or Chronic Pain: A Randomized Controlled Trial
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2018 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 11, article id 2424Article in journal (Refereed) Published
Abstract [en]

Background: People on long-term sick leave often have a long-lasting process back to work, where the individuals may be in multiple and recurrent states; i.e., receiving different social security benefits or working, and over time they may shift between these states. The purpose of this study was to evaluate the effects of two vocational rehabilitation programs, compared to a control, on return-to-work (RTW) or increased employability in patients on long-term sick leave due to mental illness and/or chronic pain. Methods: In this randomized controlled study, 427 women and men were allocated to either (1) multidisciplinary team management, i.e., multidisciplinary assessments and individual rehabilitation management, (2) acceptance and commitment therapy (ACT), or (3) control. A positive outcome was defined as RTW or increased employability. The outcome was considered negative if the (part-time) wage was reduced or ceased, or if there was an indication of decreased employability. The outcome was measured one year after entry in the project and analyzed using binary and multinomial logistic regressions. Results: Participants in the multidisciplinary team group reported having RTW odds ratio (OR) 3.31 (95% CI 1.39-7.87) compared to the control group in adjusted models. Participants in the ACT group reported having increased employability OR 3.22 (95% CI 1.13-9.15) compared to the control group in adjusted models. Conclusions: This study of vocational rehabilitation in mainly female patients on long-term sick leave due to mental illness and/or chronic pain suggests that multidisciplinary team assessments and individually adapted rehabilitation interventions increased RTW and employability. Solely receiving the ACT intervention also increased employability.

Keywords
return-to-work, vocational rehabilitation, multidisciplinary rehabilitation, chronic pain, mental illness, sick leave
National Category
Occupational Health and Environmental Health Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-372458 (URN)10.3390/ijerph15112424 (DOI)000451640500098 ()30384498 (PubMedID)
Funder
Swedish Social Insurance Agency
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-07Bibliographically approved
Wångdahl, J., Lytsy, P., Mårtensson, L. & Westerling, R. (2018). Poor health and refraining from seeking healthcare are associated with limited comprehensive health literacy among refugees: a Swedish cross-sectional study. International Journal of Public Health, 63(3), 409-419
Open this publication in new window or tab >>Poor health and refraining from seeking healthcare are associated with limited comprehensive health literacy among refugees: a Swedish cross-sectional study
2018 (English)In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 63, no 3, p. 409-419Article in journal (Refereed) Published
Abstract [en]

Objectives: The objectives of the study were to explore the distributions of comprehensive health literacy (CHL), general health, psychological well-being and having refrained from seeking healthcare among refugees in Sweden. Further objectives were to examine associations between CHL and the above mentioned factors.

Methods: A cross-sectional study was conducted among 513 refugees speaking Arabic, Dari and Somali. Participants in the civic orientation course in Sweden responded to a questionnaire. CHL was measured using the HLS-EU-Q16 questionnaire. Uni- and multivariate logistic regression was used to investigate potential associations.

Results: The majority of the respondents had limited CHL, and about four of ten had reported poor health and/or having refrained from seeking healthcare. Limited CHL was associated with having reported poor health and having refrained from seeking healthcare. 

Conclusions: A considerable proportion of the refugees in Sweden have limited CHL, and report less than good health and impaired well-being, or that they have refrained from seeking healthcare. Further, CHL is associated with the above mentioned factors. Efforts are needed to promote refugees' CHL, optimal health seeking behavior, and health.

Keywords
health literacy, general health, psychological well-being, refrained from healthcare, refugees
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-333397 (URN)10.1007/s00038-017-1074-2 (DOI)000428236500012 ()29480325 (PubMedID)
Note

The study was co-financed by the County Administrative Board in Stockholm.

Available from: 2017-11-13 Created: 2017-11-13 Last updated: 2018-06-20Bibliographically approved
Andersén, Å., Larsson, K., Lytsy, P., Berglund, E., Kristiansson, P. & Anderzén, I. (2018). Strengthened General Self-Efficacy with Multidisciplinary Vocational Rehabilitation in Women on Long-Term Sick Leave: A Randomised Controlled Trial. Journal of occupational rehabilitation, 28(4), 691-700
Open this publication in new window or tab >>Strengthened General Self-Efficacy with Multidisciplinary Vocational Rehabilitation in Women on Long-Term Sick Leave: A Randomised Controlled Trial
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2018 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 28, no 4, p. 691-700Article in journal (Refereed) Published
Abstract [en]

Purpose To investigate the effects of two vocational rehabilitation interventions on self-efficacy, for women on long-term sick leave ≥ 1 year due to chronic pain and/or mental illness. Methods This study uses data from a randomised controlled trial consisting of two phases and comprising 401 women on long-term sick leave. They were allocated to either (1) a multidisciplinary team assessment and multimodal intervention (TEAM), (2) acceptance and commitment therapy (ACT), or (3) control group. Data were collected through repeated measurements from self-reported questionnaires before intervention, 6 and 12 months later and registry data. Data from measurements of general self-efficacy, sociodemographics, anxiety and depression were analysed with linear regression analyses. Results During the intervention period, the women in the TEAM group’s self-efficacy mean increased from 2.29 to 2.74. The adjusted linear regression model, which included group allocation, sociodemographics, self-efficacy pre-treatment, anxiety and depression showed increased self-efficacy for those in the TEAM intervention at 12 months (B = 0.25, 95% CI 0.10–0.41). ACT intervention had no effect on self-efficacy at 12 months (B = 0.02, 95% CI − 0.16 to 0.19). The results in the adjusted model also showed that higher self-efficacy at pre-treatment was associated with a higher level of self-efficacy at 12 months (B = 0.68, 95% CI 0.54–0.81). Conclusion A multidisciplinary team assessment and multimodal intervention increased self-efficacy in women on sick leave for an extremely long time (mean 7.8 years) who had a low mean level of self-efficacy prior to inclusion. Thus, self-efficacy needs to be addressed in vocational rehabilitation.

Keywords
Chronic pain, Mental illness, Multidisciplinary rehabilitation, Self-efficacy, Sick leave, Vocational rehabilitation, Women
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-339109 (URN)10.1007/s10926-017-9752-8 (DOI)000450856600011 ()29318421 (PubMedID)
Funder
Swedish Social Insurance AgencySwedish Association of Local Authorities and RegionsVårdal Foundation
Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2019-01-22Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1949-6299

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