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Wallert, J., Olsson, E., Pingel, R., Norlund, F., Leosdottir, M., Burell, G. & Held, C. (2019). Attending Heart School and long-term outcome after myocardial infarction: A decennial SWEDEHEART registry study. European Journal of Preventive Cardiology
Open this publication in new window or tab >>Attending Heart School and long-term outcome after myocardial infarction: A decennial SWEDEHEART registry study
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2019 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Heart School is a standard component of cardiac rehabilitation after myocardial infarction in Sweden. The group-based educational intervention aims to improve modifiable risks, in turn reducing subsequent morbidity and mortality. However, an evaluation with respect to mortality is lacking.

AIMS: Using linked population registries, we estimated the association of attending Heart School with both all-cause and cardiovascular mortality, two and five years after admission for first-time myocardial infarction.

METHODS: Patients with first-time myocardial infarction (<75 years) were identified as consecutively registered in the nationwide heart registry, SWEDEHEART (2006-2015), with >99% complete follow-up in the Causes of Death registry for outcome events. Of 192,059 myocardial infarction admissions, 47,907 unique patients with first-time myocardial infarction surviving to the first cardiac rehabilitation visit constituted the study population. The exposure was attending Heart School at the first cardiac rehabilitation visit 6-10 weeks post-myocardial infarction. Data on socioeconomic status was acquired from Statistics Sweden. After multiple imputation, propensity score matching was performed. The association of exposure with mortality was estimated with Cox regression and survival curves.

RESULTS: After matching, attending Heart School was associated (hazard ratio (95% confidence interval)) with a markedly lower risk of both all-cause (two-year hazard ratio = 0.53 (0.44-0.64); five-year hazard ratio = 0.62 (0.55-0.69)) and cardiovascular (0.50 (0.38-0.65); 0.57 (0.47-0.69)) mortality. The results were robust in several sensitivity analyses.

CONCLUSIONS: Attending Heart School during cardiac rehabilitation is associated with almost halved all-cause and cardiovascular mortality after first-time myocardial infarction. The result warrants further investigation through adequately powered randomised trials.

Place, publisher, year, edition, pages
31514507: , 2019
Keywords
Patient education, cardiac rehabilitation, cardiovascular disease, prognosis, secondary prevention
National Category
Cardiac and Cardiovascular Systems Health Sciences
Research subject
Cardiology; Caring Sciences
Identifiers
urn:nbn:se:uu:diva-400114 (URN)10.1177/2047487319871714 (DOI)31514507 (PubMedID)
Funder
Swedish Heart Lung Foundation, 2016-0463U‐Care: Better Psychosocial Care at Lower Cost? Evidence-based assessment and Psychosocial Care via Internet, a Swedish Example, 2009-1093
Available from: 2019-12-19 Created: 2019-12-19 Last updated: 2019-12-19
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: 2020-01-18
Bean, C., Pingel, R., Hallqvist, J., Berg, N. & Hammarström, A. (2019). Poor peer relations in adolescence, social support in early adulthood, and depressive symptoms in later adulthood: evaluating mediation and interaction using four-way decomposition analysis. Annals of Epidemiology, 29, 52-59
Open this publication in new window or tab >>Poor peer relations in adolescence, social support in early adulthood, and depressive symptoms in later adulthood: evaluating mediation and interaction using four-way decomposition analysis
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2019 (English)In: Annals of Epidemiology, ISSN 1047-2797, E-ISSN 1873-2585, Vol. 29, p. 52-59Article in journal (Refereed) Published
Abstract [en]

Purpose: Supportive social relations are associated with good mental health, yet few studies have considered the prospective importance of adolescent peer relations for adult mental health and the potential mechanisms involved.

Methods: Participants (n=941) were sourced from the Northern Swedish Cohort, a prospective study comprising school students aged 16 in 1981. Integrating life course epidemiology with four-way decomposition analysis, this paper considers the controlled direct effect of poor peer relations at age 16 on depressive symptoms at age 43, the pure indirect effect mediated by the availability of social support at age 30, and potential interactions between the exposure and the mediator.

Results: After controlling for gender, baseline depressive symptoms and parental socioeconomic position, poor peer relations at age 16 were associated with depressive symptoms at age 43, largely irrespective of social support at age 30. Nonetheless, poor peer relations in adolescence were associated with poorer social support at age 30, and mediation accounted for a modest proportion (pure indirect effect 10%) of the association between poor peer relations and depressive symptoms at age 43.

Conclusions: Policies to foster constructive peer relations for adolescents at school are encouraged; such policies may promote both the availability of social support and better mental health across the life course.

Keywords
Adolescent, Adult, Mental health, Interpersonal relations, Peer group, Social support, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-364744 (URN)10.1016/j.annepidem.2018.10.007 (DOI)000457352500008 ()30578124 (PubMedID)
Funder
Swedish Research Council Formas, 259-2012-37
Available from: 2018-11-01 Created: 2018-11-01 Last updated: 2019-03-05Bibliographically approved
Pingel, R. (2018). Estimating the variance of a propensity score matching estimator for the average treatment effect. Observational Studies, 4, 71-96
Open this publication in new window or tab >>Estimating the variance of a propensity score matching estimator for the average treatment effect
2018 (English)In: Observational Studies, Vol. 4, p. 71-96Article in journal (Refereed) Published
Abstract [en]

This study considers variance estimation when estimating the asymptotic variance of a propensity score matching estimator for the average treatment effect.  We investigate the role of smoothing parameters in a variance estimator based on matching.   We also study the properties of estimators using local linear estimation. Simulations demonstrate that large gains can be made in terms of mean squared error, bias and coverage rate by properly selecting smoothing parameters.  Alternatively, a residual-based local linear estimator could be used as an estimator of the asymptotic variance.   The variance estimators are implemented in analysis to evaluate the effect of right heart catheterisation.

Keywords
average treatment effect, causal inference, kernel estimator
National Category
Probability Theory and Statistics
Research subject
Statistics
Identifiers
urn:nbn:se:uu:diva-347022 (URN)
Available from: 2018-03-23 Created: 2018-03-23 Last updated: 2018-03-26Bibliographically approved
Schlager, A., Ahlqvist, K., Rasmussen-Barr, E., Bjelland, E. K., Pingel, R., Olsson, C., . . . Kristiansson, P. (2018). Inter- and intra-rater reliability for measurement of range of motion in joints included in three hypermobility assessment methods. BMC Musculoskeletal Disorders, 19, Article ID 376.
Open this publication in new window or tab >>Inter- and intra-rater reliability for measurement of range of motion in joints included in three hypermobility assessment methods
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2018 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 19, article id 376Article in journal (Refereed) Published
Abstract [en]

Background: Comparisons across studies of generalized joint hypermobility are often difficult since there are several classification methods and methodological differences in the performance exist. The Beighton score is most commonly used and has been tested for inter- and intra-rater reliability. The Contompasis score and the Hospital del Mar criteria have not yet been evaluated for reliability. The aim of this study was to investigate the inter- and intra-rater reliability for measurements of range of motion in joints included in these three hypermobility assessment methods using a structured protocol.

Methods: The study was planned in accordance with guidelines for reporting reliability studies. Healthy adults were consecutively recruited (49 for inter-and 29 for intra-rater assessments). Intra-class correlations, two-way random effects model, (ICC 2.1) with 95% confidence intervals, standard error of measurement, percentage of agreement, Cohen's Kappa () and prevalence-adjusted bias-adjusted kappa were calculated for single-joint measured in degrees and for total scores.

Results: The inter- and intra-rater reliability in total scores were ICC 2.1: 0.72-0.82 and 0.76-0.86 and for single-joint measurements in degrees 0.44-0.91 and 0.44-0.90, respectively. The difference between ratings was within 5 degrees in all but one joint. Standard error of measurement ranged from 1.0 to 6.9 degrees. The inter- and intra-rater reliability for prevalence of positive hypermobility findings the Cohen's for total scores were 0.54-0.78 and 0.27-0.78 and in single joints 0.21-1.00 and 0.19-1.00, respectively. The prevalence- and bias adjusted Cohen's , increased all but two values.

Conclusions: Following a structured protocol, the inter- and intra-rater reliability was good-to-excellent for total scores and in all but two single joints, measured in degrees. The inter- and intra-rater reliability for prevalence of positive hypermobility findings was fair-to-almost perfect for total scores and slight-to-almost-perfect in single joints.By using a structured protocol, we attempted to standardize the assessment of range of motion in clinical and in research settings. This standardization could be helpful in the first part of the process of standardizing the tests thus avoiding that assessment of GJH is based on chance.

Place, publisher, year, edition, pages
BMC, 2018
Keywords
Generalized joint hypermobility, Inter-and intra- reliability, Beighton score, Contompasis score, Hospital del mar criteria, Joint mobility assessment, Standardized protocol, Goniometer, Range of motion
National Category
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-369097 (URN)10.1186/s12891-018-2290-5 (DOI)000447638900001 ()30326873 (PubMedID)
Available from: 2019-02-18 Created: 2019-02-18 Last updated: 2019-02-18Bibliographically approved
Isaksson, D., Blomqvist, P., Pingel, R. & Winblad, U. (2018). Risk selection in primary care: a cross-sectional fixed effect analysis of Swedish individual data. BMJ Open, 8(10), Article ID e020402.
Open this publication in new window or tab >>Risk selection in primary care: a cross-sectional fixed effect analysis of Swedish individual data
2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 10, article id e020402Article in journal (Refereed) Published
Abstract [en]

Objective To assess socioeconomic differences between patients registered with private and public primary healthcare centres.

Design Population-based cross-sectional study controlling for municipality and household.

Setting Swedish population-based socioeconomic data collected from Statistics Sweden linked with individual registration data from all 21 Swedish regions.

Participants All individuals residing in Sweden on 31 December 2015 (n=9 851 017) were included in the study.

Primary outcome measures Registration with private versus public primary healthcare centres.

Results After controlling for municipality and household, individuals with higher socioeconomic status were more likely to be registered with a private primary healthcare provider. Individuals in the highest income quantile were 4.9 percentage points (13.7%) more likely to be registered with a private primary healthcare provider compared with individuals in the lowest income quantile. Individuals with 1–3 years of higher education were 4.7 percentage points more likely to be registered with a private primary healthcare provider compared with those with an incomplete primary education.

Conclusions The results show that there are notable differences in registration patterns, indicating a skewed distribution of patients and health risks between private and public primary healthcare providers. This suggests that risk selection behaviour occurs in the reformed Swedish primary healthcare system, foremost through location patterns.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-354474 (URN)10.1136/bmjopen-2017-020402 (DOI)000454739500024 ()30355789 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2011-1137
Available from: 2018-06-20 Created: 2018-06-20 Last updated: 2019-01-18Bibliographically approved
Olsson, E., Norlund, F., Pingel, R., Burell, G., Gulliksson, M., Larsson, A., . . . Held, C. (2018). The effect of group-based cognitive behavioral therapy on inflammatory biomarkers in patients with coronary disease: results from the SUPRIM-trial. Upsala Journal of Medical Sciences, Supplement, 123(3), 167-173
Open this publication in new window or tab >>The effect of group-based cognitive behavioral therapy on inflammatory biomarkers in patients with coronary disease: results from the SUPRIM-trial
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2018 (English)In: Upsala Journal of Medical Sciences, Supplement, ISSN 0300-9726, Vol. 123, no 3, p. 167-173Article in journal (Refereed) Published
Abstract [en]

Background: The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) is a prospective randomized controlled trial of a group-based cognitive behavioral therapy (CBT) stress management program for coronary heart disease (CHD) patients. The intervention reduced the risk of fatal or non-fatal first recurrent cardiovascular (CV) events. The aim of the present study was to analyze if the positive effects of the CBT program on clinical outcomes could have been mediated by changes in biomarkers for inflammation.

Methods: Altogether 362 patients with CHD were randomly assigned to intervention or usual care. The inflammatory biomarkers (VCAM-1, TNF-R1, TNF-R2, PTX3, and hs-CRP) were serially assessed at five time points every six months from study start until 24 months later, and analyzed with linear mixed models.

Results: Baseline levels of the inflammatory markers were near normal, indicating a stable phase. The group-based CBT stress management program did not significantly affect the levels of inflammatory biomarkers in patients with CHD. Three out of five (VCAM-1, TNF-R2, and PTX3) inflammatory biomarkers showed a slight increase over time in both study groups, and all were positively associated with age.

Conclusion: Group-based CBT stress management did not affect biomarkers for inflammation in patients with CHD. It is therefore unlikely that inflammatory processes including these biomarkers were mediating the effect the CBT program had on the reduction in CV events. The close to normal baseline levels of the biomarkers and the lack of elevated psychological distress symptoms indicate a possible floor effect which may have influenced the results.

Keywords: Biomarkers, CBT, CHD, inflammation, stress management

National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-356841 (URN)10.1080/03009734.2018.1490829 (DOI)000446977000005 ()30086659 (PubMedID)
Funder
Vårdal Foundation, V96-160Vårdal Foundation, V98-403Vårdal Foundation, 2014-0114Swedish Heart Lung Foundation, E010-95Swedish Heart Lung Foundation, E019-96Swedish Heart Lung Foundation, E019-98Swedish Heart Lung Foundation, E010-00Swedish Heart Lung Foundation, E009-01Swedish Heart Lung Foundation, E45-04Swedish Heart Lung Foundation, K-97-21x-12256-01ASwedish Heart Lung Foundation, K98-21X-12256-02BSwedish Heart Lung Foundation, K99-21X-12256-03CSwedish Heart Lung Foundation, 2009-1093Swedish National Board of Health and Welfare, 1471-601:Var95-161Forte, Swedish Research Council for Health, Working Life and Welfare, F0196/99Forte, Swedish Research Council for Health, Working Life and Welfare, 2001-1049Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4947
Available from: 2018-08-08 Created: 2018-08-08 Last updated: 2018-12-10Bibliographically approved
Andersén, Å., Larsson, K., Pingel, R., Kristiansson, P. & Anderzén, I. (2018). The relationship between self-efficacy and transition to work or studies in young adults with disabilities. Scandinavian Journal of Public Health, 46(2), 272-278
Open this publication in new window or tab >>The relationship between self-efficacy and transition to work or studies in young adults with disabilities
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2018 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, no 2, p. 272-278Article in journal (Refereed) Published
Abstract [en]

Aim: To investigate perceived self-efficacy in unemployed young adults with disabilities and the association between self-efficacy and transition to work or studies.

Methods: This prospective cohort study collected data through self-report questionnaires and registry data from a vocational rehabilitation project with young adults, aged 19-29 years. The Swedish Social Insurance Agency, the Swedish Public Employment Service and the participating municipalities identified potential participants to the study. A total of 531 participants were included in the study, of which 249 (47%) were available for analysis. Multinomial logistic regression models were carried out to estimate the associations between self-efficacy, demographic, health and employment status. The latter was coded as: “no transition to work or studies”, “transition to studies”, and “transition to work”.

Results: A higher level of self-efficacy was associated with increased odds for “transition to work” (OR=2.37, p<0.05). This finding remained consistent when adjusting for possible confounders. The mean value of self-efficacy was low, and participants with lower self-efficacy reported worse self-rated health (p<0.001) compared with participants with higher self-efficacy.

Conclusions: The results from this study suggest that self-efficacy should be addressed in vocational rehabilitation of young adults with disabilities in order to support their transition and integration into the labour market.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
self-efficacy, young adults, disability, employment
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-328794 (URN)10.1177/1403494817717556 (DOI)000429934600015 ()29569532 (PubMedID)
Funder
European Social Fund (ESF)Swedish Social Insurance Agency
Available from: 2017-08-31 Created: 2017-08-31 Last updated: 2018-06-19Bibliographically approved
Bean, C., Pingel, R., Berg, N., Hallqvist, J. & Hammarström, A. (2017). A 4-way decomposition analysis of poor social relations and depressive symptoms over the life-course. In: European Journal of Public Health, Volume 27, Issue Suppl 3: . Paper presented at 10th European Public Health Conference.
Open this publication in new window or tab >>A 4-way decomposition analysis of poor social relations and depressive symptoms over the life-course
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2017 (English)In: European Journal of Public Health, Volume 27, Issue Suppl 3, 2017Conference paper, Oral presentation with published abstract (Refereed)
National Category
Social Sciences
Identifiers
urn:nbn:se:uu:diva-333174 (URN)10.1093/eurpub/ckx187.310 (DOI)000414389801080 ()
Conference
10th European Public Health Conference
Available from: 2017-11-07 Created: 2017-11-07 Last updated: 2018-09-28
Peterson, M., Pingel, R., Lagali, N., Dahlin, L. B. & Rolandsson, O. (2017). Association between HbA1c and peripheral neuropathy in a 10-year follow-up study of people with normal glucose tolerance, impaired glucose tolerance and Type 2 diabetes. Paper presented at 16th World Congress on Pain, SEP 26-30, 2016, Yokohama, JAPAN. Diabetic Medicine, 34(12), 1756-1764
Open this publication in new window or tab >>Association between HbA1c and peripheral neuropathy in a 10-year follow-up study of people with normal glucose tolerance, impaired glucose tolerance and Type 2 diabetes
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2017 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 34, no 12, p. 1756-1764Article in journal (Refereed) Published
Abstract [en]

Aims: To explore the association between HbA(1c) and sural nerve function in a group of people with normal glucose tolerance, impaired glucose tolerance or Type 2 diabetes.

Methods: We conducted a 10-year follow-up study in 87 out of an original 119 participants. At study commencement (2004), 64 men and 55 women (mean age 61.1 years) with normal glucose tolerance (n=39), impaired glucose tolerance (n=29), or Type 2 diabetes (n=51) were enrolled. At the 2014 follow-up (men, n=46, women, n=41; mean age 71.1 years), 36, nine and 42 participants in the normal glucose tolerance, impaired glucose tolerance and Type 2 diabetes categories, respectively, were re-tested. Biometric data and blood samples were collected, with an electrophysiological examination performed on both occasions.

Results: At follow-up, we measured the amplitude of the sural nerve in 74 of the 87 participants. The mean amplitude had decreased from 10.9 V (2004) to 7.0 mu V (2014; P<0.001). A 1% increase in HbA(1c) was associated with a similar to 1% average decrease in the amplitude of the sural nerve, irrespective of group classification. Crude and adjusted estimates ranged from -0.84 (95% CI -1.32, -0.37) to -1.25 (95% CI -2.31, -0.18). Although the mean conduction velocity of those measured at both occasions (n=73) decreased from 47.6 m/s to 45.8 m/s (P=0.009), any association with HbA(1c) level was weak. Results were robust with regard to potential confounders and missing data.

Conclusions: Our data suggest an association between sural nerve amplitude and HbA(1c) at all levels of HbA(1c). Decreased amplitude was more pronounced than was diminished conduction velocity, supporting the notion that axonal degeneration is an earlier and more prominent effect of hyperglycaemia than demyelination.

National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-342209 (URN)10.1111/dme.13514 (DOI)000415191800015 ()28929513 (PubMedID)
Conference
16th World Congress on Pain, SEP 26-30, 2016, Yokohama, JAPAN
Available from: 2018-02-20 Created: 2018-02-20 Last updated: 2018-02-20Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4140-1981

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