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Westerholm, Peter
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Publications (10 of 48) Show all publications
Kivimäki, M., Luukkonen, R., Batty, G. D., Ferrie, J. E., Pentti, J., Nyberg, S. T., . . . Jokela, M. (2018). Body mass index and risk of dementia: Analysis of individual-level data from 1.3 million individuals. Alzheimer's & Dementia, 14(5), 601-609
Open this publication in new window or tab >>Body mass index and risk of dementia: Analysis of individual-level data from 1.3 million individuals
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2018 (English)In: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 14, no 5, p. 601-609Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects.

METHODS: We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis.

RESULTS: Hazard ratios per 5-kg/m2 increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis.

CONCLUSIONS: The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short.

Keywords
Bias, Body mass index, Cohort study, Dementia, Obesity
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-336135 (URN)10.1016/j.jalz.2017.09.016 (DOI)000432438800003 ()29169013 (PubMedID)
Funder
NordForsk
Available from: 2017-12-12 Created: 2017-12-12 Last updated: 2018-08-01Bibliographically approved
Nyberg, S., Batty, D., Pentti, J., Virtanen, M., Alfredsson, L., Fransson, E., . . . Kivimäki, M. (2018). Obesity and loss of disease-free years owing to major non-communicable diseases: a multicohort study. Lancet Public Health, 3(10), e490-e497
Open this publication in new window or tab >>Obesity and loss of disease-free years owing to major non-communicable diseases: a multicohort study
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2018 (English)In: Lancet Public Health, Vol. 3, no 10, p. e490-e497Article in journal (Refereed) Published
Abstract [en]

Background

Obesity increases the risk of several chronic diseases, but the extent to which the obesity-related loss of disease-free years varies by lifestyle category and across socioeconomic groups is unclear. We estimated the number of years free from major non-communicable diseases in adults who are overweight and obese, compared with those who are normal weight.

Methods

We pooled individual-level data on body-mass index (BMI) and non-communicable diseases from men and women with no initial evidence of these diseases in European cohort studies from the Individual-Participant-Data Meta-Analysis in Working Populations consortium. BMI was assessed at baseline (1991–2008) and non-communicable diseases (incident type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease) were ascertained via linkage to records from national health registries, repeated medical examinations, or self-report. Disease-free years from age 40 years to 75 years associated with underweight (BMI <18·5 kg/m2), overweight (≥25 kg/m2 to <30 kg/m2), and obesity (class I [mild] ≥30 kg/m2 to <35 kg/m2; class II–III [severe] ≥35 kg/m2) compared with normal weight (≥18·5 kg/m2 to <25 kg/m2) were estimated.

Findings

Of 137 503 participants from ten studies, we excluded 6973 owing to missing data and 10 349 with prevalent disease at baseline, resulting in an analytic sample of 120 181 participants. Of 47 127 men, 211 (0·4%) were underweight, 21 468 (45·6%) normal weight, 20 738 (44·0%) overweight, 3982 (8·4%) class I obese, and 728 (1·5%) class II–III obese. The corresponding numbers among the 73 054 women were 1493 (2·0%), 44 760 (61·3%), 19 553 (26·8%), 5670 (7·8%), and 1578 (2·2%), respectively. During 1 328 873 person-years at risk (mean follow-up 11·5 years [range 6·3–18·6]), 8159 men and 8100 women developed at least one non-communicable disease. Between 40 years and 75 years, the estimated number of disease-free years was 29·3 (95% CI 28·8–29·8) in normal-weight men and 29·4 (28·7–30·0) in normal-weight women. Compared with normal weight, the loss of disease-free years in men was 1·8 (95% CI −1·3 to 4·9) for underweight, 1·1 (0·7 to 1·5) for overweight, 3·9 (2·9 to 4·9) for class I obese, and 8·5 (7·1 to 9·8) for class II–III obese. The corresponding estimates for women were 0·0 (−1·4 to 1·4) for underweight, 1·1 (0·6 to 1·5) for overweight, 2·7 (1·5 to 3·9) for class I obese, and 7·3 (6·1 to 8·6) for class II–III obese. The loss of disease-free years associated with class II–III obesity varied between 7·1 and 10·0 years in subgroups of participants of different socioeconomic level, physical activity level, and smoking habit.

Interpretation

Mild obesity was associated with the loss of one in ten, and severe obesity the loss of one in four potential disease-free years during middle and later adulthood. This increasing loss of disease-free years as obesity becomes more severe occurred in both sexes, among smokers and non-smokers, the physically active and inactive, and across the socioeconomic hierarchy.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-362394 (URN)10.1016/S2468-2667(18)30139-7 (DOI)
Available from: 2018-10-04 Created: 2018-10-04 Last updated: 2018-11-29Bibliographically approved
du Prel, J.-B., Runeson-Broberg, R., Westerholm, P., Alfredsson, L., Fahlén, G., Knutsson, A., . . . Peter, R. (2018). Work overcommitment: Is it a trait or a state?. International Archives of Occupational and Environmental Health, 91(1), 1-11
Open this publication in new window or tab >>Work overcommitment: Is it a trait or a state?
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2018 (English)In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 91, no 1, p. 1-11Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Effort-reward imbalance (ERI) is a well-tested work-related stress model with three components, the two extrinsic components "efforts" and "rewards" and the one intrinsic component "overcommitment". While an imbalance between "efforts" and "rewards" leads to strain reactions, "work-related overcommitment" (OC) has been described as a personal characteristic with a set of attitudes, behaviours, and emotions reflecting excessive striving combined with a strong desire for approval. However, the question whether OC is a personality trait or a response pattern sensitive to changes in the work context (state) is still open.

METHODS: 2940 Swedish industrial employees were included in this longitudinal analysis of the WOLF-Norrland data over 5 years. A change of OC index or its subscales were regressed against a change of freedom of choice at work, extra work, and ERI adjusted for age, sex, and education.

RESULTS: While OC was insensitive to changes in freedom of choice at work and extra work, it was clearly associated with changes of work-related stress over time. Three of four OC subscales exhibited statistically significant associations with ERI.

CONCLUSIONS: For the first time, we studied fundamental characteristics of OC as an independent personality variable (trait) or an outcome variable subject to changes in the work environment (state). The association between external ERI and OC over time supports our hypothesis of OC being a state. Further investigations are needed to establish OC as a trait or a state.

Keywords
Coping, Organisational change, Work organisation, Work stress models
National Category
Health Sciences
Identifiers
urn:nbn:se:uu:diva-335515 (URN)10.1007/s00420-017-1253-8 (DOI)000419350600001 ()28801694 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 20122022
Available from: 2017-12-06 Created: 2017-12-06 Last updated: 2018-02-07Bibliographically approved
Kivimäki, M., Pentti, J., Ferrie, J. E., Batty, G. D., Nyberg, S. T., Jokela, M., . . . Deanfield, J. (2018). Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study. The Lancet Diabetes and Endocrinology, 6(9), 705-713
Open this publication in new window or tab >>Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study
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2018 (English)In: The Lancet Diabetes and Endocrinology, ISSN 2213-8587, E-ISSN 2213-8595, Vol. 6, no 9, p. 705-713Article in journal (Refereed) Published
Abstract [en]

Background: Although some cardiovascular disease prevention guidelines suggest a need to manage work stress in patients with established cardiometabolic disease, the evidence base for this recommendation is weak. We sought to clarify the status of stress as a risk factor in cardiometabolic disease by investigating the associations between work stress and mortality in men and women with and without pre-existing cardiometabolic disease.

Methods: In this multicohort study, we used data from seven cohort studies in the IPD-Work consortium, initiated between 1985 and 2002 in Finland, France, Sweden, and the UK, to examine the association between work stress and mortality. Work stress was denoted as job strain or effort-reward imbalance at work. We extracted individual-level data on prevalent cardiometabolic diseases (coronary heart disease, stroke, or diabetes [without differentiation by diabetes type]) at baseline. Work stressors, socioeconomic status, and conventional and lifestyle risk factors (systolic and diastolic blood pressure, total cholesterol, smoking status, BMI, physical activity, and alcohol consumption) were also assessed at baseline. Mortality data, including date and cause of death, were obtained from national death registries. We used Cox proportional hazards regression to study the associations of work stressors with mortality in men and women with and without cardiometabolic disease.

Results: We identified 102 633 individuals with 1 423 753 person-years at risk (mean follow-up 13.9 years [SD 3.9]), of whom 3441 had prevalent cardiometabolic disease at baseline and 3841 died during follow-up. In men with cardiometabolic disease, age-standardised mortality rates were substantially higher in people with job strain (149.8 per 10 000 person-years) than in those without (97.7 per 10 000 person-years; mortality difference 52.1 per 10 000 person-years; multivariable-adjusted hazard ratio [HR] 1.68, 95% CI 1.19-2.35). This mortality difference for job strain was almost as great as that for current smoking versus former smoking (78.1 per 10 000 person-years) and greater than those due to hypertension, high total cholesterol concentration, obesity, physical inactivity, and high alcohol consumption relative to the corresponding lower risk groups (mortality difference 5.9-44.0 per 10 000 person-years). Excess mortality associated with job strain was also noted in men with cardiometabolic disease who had achieved treatment targets, including groups with a healthy lifestyle (HR 2.01, 95% CI 1.18-3.43) and those with normal blood pressure and no dyslipidaemia (6.17, 1.74-21.9). In all women and in men without cardiometabolic disease, relative risk estimates for the work stress-mortality association were not significant, apart from effort-reward imbalance in men without cardiometabolic disease (mortality difference 6.6 per 10 000 person-years; multivariable-adjusted HR 1.22, 1.06-1.41).

Interpretation: In men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and independent of conventional risk factors and their treatment, and measured lifestyle factors. Standard care targeting conventional risk factors is therefore unlikely to mitigate the mortality risk associated with job strain in this population.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-362475 (URN)10.1016/S2213-8587(18)30140-2 (DOI)000442438000017 ()29884468 (PubMedID)
Funder
NordForsk
Available from: 2018-10-05 Created: 2018-10-05 Last updated: 2018-10-05Bibliographically approved
Runeson, R., du Prel, J.-B., Westerholm, P., Nordin, M., Knutsson, A., Alfredsson, L., . . . Peter, R. (2017). Age-related associations between work over-commitment and zest for work among Swedish employees from a cross-sectional and longitudinal perspective. Work: A journal of Prevention, Assesment and rehabilitation, 57(2), 269-279
Open this publication in new window or tab >>Age-related associations between work over-commitment and zest for work among Swedish employees from a cross-sectional and longitudinal perspective
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2017 (English)In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 57, no 2, p. 269-279Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In aging societies, zest for work may be pivotal when deciding to stay occupationally active longer. Psychosocial work stress is a prevalent public health problem and may have an impact on zest for work. Work over-commitment (WOC) is a personal coping strategy for work stress with excessive striving and a health risk. However, the long-term effect of WOC on zest for work is poorly understood. OBJECTIVE: To investigate the age-related associations of work over-commitment with zest for work. METHODS: During 1996-1998 and 2000-2003, predominantly industrial workers (n = 2940) participated in the WOLF-Norrland study and responded to a questionnaire referring to socio-demographics, WOC, zest for work, effort-reward imbalance proxies, and mental health. Age-adjusted multiple logistic regressions were performed with original and imputed datasets. RESULTS: Cross-sectionally, work overcommitted middle-aged employees had an increased prevalence of poor zest for work compared to their contemporaries without WOC (OR: 3.74 [95%-CI 2.19; 6.40]). However, in a longitudinal analysis associations between onset of 'poor zest for work' and the WOC subscales 'need for approval' (OR: 3.29 [95%-CI 1.04; 10.37]) and 'inability to withdraw from work' (OR: 5.14 [95%-CI 1.32; 20.03]) were observed. CONCLUSION: The longitudinal findings among older employees could be relevant regarding the expected need to remain occupationally active longer.

Place, publisher, year, edition, pages
IOS Press, 2017
Keywords
Work stress, WOC, ERI, coping
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:uu:diva-330084 (URN)10.3233/WOR-172555 (DOI)000404774400013 ()
Available from: 2017-10-19 Created: 2017-10-19 Last updated: 2018-01-13Bibliographically approved
Westerholm, P. (2017). Depression eller depressiva symtom - orsakade av arbete?. Best Practice Psykiatri/Neurologi (31), 8-11
Open this publication in new window or tab >>Depression eller depressiva symtom - orsakade av arbete?
2017 (Swedish)In: Best Practice Psykiatri/Neurologi, no 31, p. 8-11Article in journal (Other academic) Published
Identifiers
urn:nbn:se:uu:diva-335592 (URN)
Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2017-12-07
Wagman, P., Nordin, M., Alfredsson, L., Westerholm, P. J. M. & Fransson, E. I. (2017). Domestic work division and satisfaction in cohabiting adults: Associations with life satisfaction and self-rated health. Scandinavian Journal of Occupational Therapy, 24(1), 24-31
Open this publication in new window or tab >>Domestic work division and satisfaction in cohabiting adults: Associations with life satisfaction and self-rated health
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2017 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 24, no 1, p. 24-31Article in journal (Refereed) Published
Abstract [en]

Background: The amount and perception of domestic work may affect satisfaction with everyday life, but further knowledge is needed about the relationship between domestic work division and health and well-being. Aim: To describe the division of, and satisfaction with, domestic work and responsibility for home/family in adults living with a partner. A further aim was to investigate the associations between these aspects and self-rated life satisfaction and health. Method: Data from the Work, Lipids and Fibrinogen survey collected 2009 were used, comprising 4924 participants living with a partner. Data were analyzed using logistic regression. Results: The majority shared domestic work and responsibility for home/family equally with their partner. However, more women conducted the majority of the domestic work and were less satisfied with its division. When both division and satisfaction with division was included in the analysis, solely satisfaction with the division and the responsibility were associated with higher odds for good life satisfaction. Regarding health, higher odds for good self-rated health were seen in those who were satisfied with their division of responsibility. Conclusion and significance: The results highlight the importance of taking into account not solely the actual division of domestic work but also the satisfaction with it.

Keywords
Activities in everyday life, gender differences, occupational balance
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-316965 (URN)10.1080/11038128.2016.1217926 (DOI)000392839900004 ()27686578 (PubMedID)
Funder
Swedish Research Council Formas, 2007-0740
Available from: 2017-03-08 Created: 2017-03-08 Last updated: 2017-11-29Bibliographically approved
Dragano, N., Siegrist, J., Nyberg, S. T., Lunau, T., Fransson, E. I., Alfredsson, L., . . . Kivimäki, M. (2017). Effort-Reward Imbalance at Work and Incident Coronary Heart Disease: A Multicohort Study of 90,164 Individuals.. Epidemiology, 28(4), 619-626
Open this publication in new window or tab >>Effort-Reward Imbalance at Work and Incident Coronary Heart Disease: A Multicohort Study of 90,164 Individuals.
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2017 (English)In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 28, no 4, p. 619-626Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Epidemiologic evidence for work stress as a risk factor for coronary heart disease is mostly based on a single measure of stressful work known as job strain, a combination of high demands and low job control. We examined whether a complementary stress measure that assesses an imbalance between efforts spent at work and rewards received predicted coronary heart disease.

METHODS: This multicohort study (the "IPD-Work" consortium) was based on harmonized individual-level data from 11 European prospective cohort studies. Stressful work in 90,164 men and women without coronary heart disease at baseline was assessed by validated effort-reward imbalance and job strain questionnaires. We defined incident coronary heart disease as the first nonfatal myocardial infarction or coronary death. Study-specific estimates were pooled by random effects meta-analysis.

RESULTS: At baseline, 31.7% of study members reported effort-reward imbalance at work and 15.9% reported job strain. During a mean follow-up of 9.8 years, 1,078 coronary events were recorded. After adjustment for potential confounders, a hazard ratio of 1.16 (95% confidence interval, 1.00-1.35) was observed for effort-reward imbalance compared with no imbalance. The hazard ratio was 1.16 (1.01-1.34) for having either effort-reward imbalance or job strain and 1.41 (1.12-1.76) for having both these stressors compared to having neither effort-reward imbalance nor job strain.

CONCLUSIONS: Individuals with effort-reward imbalance at work have an increased risk of coronary heart disease, and this appears to be independent of job strain experienced. These findings support expanding focus beyond just job strain in future research on work stress.

National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:uu:diva-336141 (URN)10.1097/EDE.0000000000000666 (DOI)000402541400028 ()28570388 (PubMedID)
Available from: 2017-12-12 Created: 2017-12-12 Last updated: 2018-09-06Bibliographically approved
Madsen, I. E., Nyberg, S. T., Magnusson Hanson, L. L., Ferrie, J. E., Ahola, K., Alfredsson, L., . . . Kivimäki, M. (2017). Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data.. Psychological Medicine, 47(8), 1342-1356
Open this publication in new window or tab >>Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data.
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2017 (English)In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 47, no 8, p. 1342-1356Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression.

METHOD: We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol.

RESULTS: We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47-2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04-1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94-1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81-1.32).

CONCLUSIONS: Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.

Keywords
Observational studies, occupational health, work stress
Identifiers
urn:nbn:se:uu:diva-335520 (URN)10.1017/S003329171600355X (DOI)28122650 (PubMedID)
Available from: 2017-12-06 Created: 2017-12-06 Last updated: 2017-12-06
Kivimaki, M., Nyberg, S. T., Batty, G. D., Kawachi, I., Jokela, M., Alfredsson, L., . . . Tabak, A. G. (2017). Long working hours as a risk factor for atrial fibrillation: a multi-cohort study. European Heart Journal, 38(34), 2621-2628
Open this publication in new window or tab >>Long working hours as a risk factor for atrial fibrillation: a multi-cohort study
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2017 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 38, no 34, p. 2621-2628Article in journal (Refereed) Published
Abstract [en]

Aims: Studies suggest that people who work long hours are at increased risk of stroke, but the association of long working hours with atrial fibrillation, the most common cardiac arrhythmia and a risk factor for stroke, is unknown. We examined the risk of atrial fibrillation in individuals working long hours (>= 55 per week) and those working standard 35-40 h/week.

Methods and results: In this prospective multi-cohort study from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium, the study population was 85 494 working men and women (mean age 43.4 years) with no recorded atrial fibrillation. Working hours were assessed at study baseline (1991-2004). Mean follow-up for incident atrial fibrillation was 10 years and cases were defined using data on electrocardiograms, hospital records, drug reimbursement registers, and death certificates. We identified 1061 new cases of atrial fibrillation (10-year cumulative incidence 12.4 per 1000). After adjustment for age, sex and socioeconomic status, individuals working long hours had a 1.4-fold increased risk of atrial fibrillation compared with those working standard hours (hazard ratio = 1.42, 95% CI= 1.13-1.80, P= 0.003). There was no significant heterogeneity between the cohort-specific effect estimates (I-2= 0%, P = 0.66) and the finding remained after excluding participants with coronary heart disease or stroke at baseline or during the follow-up (N= 2006, hazard ratio= 1.36, 95% CI= 1.05-1.76, P = 0.0180). Adjustment for potential confounding factors, such as obesity, risky alcohol use and high blood pressure, had little impact on this association.

Conclusion: Individuals who worked long hours were more likely to develop atrial fibrillation than those working standard hours.

Keywords
Atrial fibrillation, Life stress, Risk factors, Cohort study
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-335207 (URN)10.1093/eurheartj/ehx324 (DOI)000409542800012 ()28911189 (PubMedID)
Available from: 2017-12-04 Created: 2017-12-04 Last updated: 2017-12-04Bibliographically approved
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