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  • 1. Adami, Hans-Olov
    et al.
    Bill-Axelson, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Urology.
    Johansson, Jan-Erik
    Management of Early Prostate Cancer REPLY2014In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 370, no 22, p. 2151-2151Article in journal (Refereed)
  • 2.
    Adamski, Jan
    et al.
    via media, S-75655 Uppsala, Sweden..
    Goraj, Radoslaw
    Reg Specialist Hosp Olsztyn, Dept Anaesthesiol & Intens Care, Olsztyn, Poland..
    Onichimowski, Dariusz
    Reg Specialist Hosp Olsztyn, Dept Anaesthesiol & Intens Care, Olsztyn, Poland..
    Gawlikowska, Ewa
    Reg Specialist Hosp Olsztyn, Dept Anaesthesiol & Intens Care, Olsztyn, Poland..
    Weigl, Wojciech
    Uppsala Univ, Univ Uppsala Hosp, Dept Surg Sci Anaesthesiol & Intens Care, Uppsala, Sweden..
    The differences between two selected intensive care units located in central and northern Europe: preliminary observation2015In: ANAESTHESIOLOGY INTENSIVE THERAPY, ISSN 1642-5758, Vol. 47, no 2, p. 117-124Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to evaluate possible differences in the functioning of two selected intensive care units in Poland and Finland. The activity of the units was analysed over a period of one year. Methods: The following parameters were compared: demography of treated populations, site of admission, category of illness, severity of illness (APACHE-II scale), mean length of stay, demanded workload (TISS-28 scale), mortality (both ICU and hospital) and standardized mortality ratio (SMR). Results: The results of this study indicated that most of the patients in the Polish ICU, regardless of age, diagnosis and APACHE II score, presented significantly longer lengths of stay (14.65 +/- 13.6 vs 4.1 +/- 4.7 days, P = 0.0001), higher mean TISS-28 score (38.9 +/- 9.1 vs 31.2 +/- 6.1, P = 0.0001) and higher ICU and hospital mortality (41.5% vs 10.2% and 44.7% vs 21.8%, respectively, P = 0.0001). The values of SMR were 0.9 and 0.85 for the Finnish and Polish ICUs, respectively. Conclusion: The collected data indicate huge differences in the utilisation of critical care resources. Treatment in Polish ICU is concentrated on much more severely ill patients which might be sometimes accompanied by futility of care. In order to verify and correctly interpret the presented phenomena, further studies are needed.

  • 3.
    Alander, Ture
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Agréus, L
    Functional gastrointestinal disorder is associated with increased non-gastrointestinal healthcare consumption in the general population2008In: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 62, no 2, p. 234-240Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Comparison of comorbidity and healthcare consumption in primary healthcare subjects with persistent functional gastrointestinal disorder (FGID) and a strictly gastrointestinal (GI) symptom-free group (SSF). METHODS: A stratified sample (n=1428, 21-86 years) of subjects living in the Osthammar community, Sweden, was limited to half of the community and classified through the Abdominal Symptom Questionnaire (ASQ) into two study groups, one with persistent FGID (n=71), another SSF (n=48). Symptoms were re-evaluated by means of the ASQ at a surgery visit, as was healthcare consumption during 2 years, and the levels of anxiety and depression, as measured with the Hospital Anxiety and Depression Scale. Diagnoses were set according to The International Classification of Diseases (ICD)-9 and the 14 diagnostic groups. RESULTS: Of the FGID patients, 97% had a non-GI diagnosis, compared with 100% of SSF (ns). The mean number of doctors' consultations (OR=3.5), phone calls to doctors (OR=3.4), number of prescriptions (OR=2.4) and number of set diagnoses (OR=3.9), anxiety level (OR=11.5) and depression (OR=5.2) were all statistically significantly higher (p<0.05) for FGID than for SSF, while the number of referrals and sick leave were not. Besides a GI diagnosis, there was no significant difference (p>0.05) in the spectrum of morbidity in terms of ICD-9 subgroup classification, except an increased proportion of older SSF subjects with circulatory disorders and hypertension. CONCLUSIONS: Functional gastrointestinal disorders are related to an increased demand on primary healthcare because of an increased overall comorbidity, which signifies a need for a holistic healthcare approach.

  • 4.
    Andersson, Dan
    Socialstyrelsens regionala tillsynsenhet i Örebro.
    Fick ingen akuttid - drabbades av diabeteskoma: Distriktsläkare gav 10-åring besökstid om två veckor [The patient didn't get an emergency appointment--suffered from diabetic coma. The family practitioner scheduled 10-year old for a visit in two weeks]2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 4, p. 240-241Article in journal (Other academic)
  • 5.
    Andersson, Dan
    Socialstyrelsens regionala tillsynsenhet i Örebro.
    Högst angeläget fokusera på tre områden: rådgivning, diagnostiska åtgärder och läkemedelsordination [Important to focus on three issues. Counseling, diagnostic measures and drug prescription]2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 4, p. 238-239Article in journal (Refereed)
  • 6. Andersson, Sven-Olof
    et al.
    Björkegren, KarinUppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.Foldevi, MatsLindgren, StefanRödjer, StigTroein Töllborn, MargaretaWahlqvist, MatsSeeberger, Astrid
    Professionell utveckling inom läkaryrket2012Collection (editor) (Other academic)
  • 7.
    Ankarcrona, M.
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Neurogeriatr, Ctr Alzheimer Res, Huddinge, Sweden..
    Winblad, B.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Neurogeriatr, Ctr Alzheimer Res, Huddinge, Sweden..
    Monteiro, C.
    Skaggs Inst Chem Biol, Dept Chem, La Jolla, CA 92037 USA.;Scripps Res Inst, Dept Mol & Expt Med, 10666 N Torrey Pines Rd, La Jolla, CA 92037 USA..
    Fearns, C.
    Skaggs Inst Chem Biol, Dept Chem, La Jolla, CA 92037 USA.;Scripps Res Inst, Dept Mol & Expt Med, 10666 N Torrey Pines Rd, La Jolla, CA 92037 USA..
    Powers, E. T.
    Skaggs Inst Chem Biol, Dept Chem, La Jolla, CA 92037 USA..
    Johansson, J.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Neurogeriatr, Ctr Alzheimer Res, Huddinge, Sweden..
    Westermark, Gunilla T.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Presto, J.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Neurogeriatr, Ctr Alzheimer Res, Huddinge, Sweden..
    Ericzon, B. -G
    Karolinska Univ Hosp, Div Transplantat Surg, Stockholm, Sweden.
    Kelly, J. W.
    Skaggs Inst Chem Biol, Dept Chem, La Jolla, CA 92037 USA.;Scripps Res Inst, Dept Mol & Expt Med, 10666 N Torrey Pines Rd, La Jolla, CA 92037 USA..
    Current and future treatment of amyloid diseases2016In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 280, no 2, p. 177-202Article, review/survey (Refereed)
    Abstract [en]

    There are more than 30 human proteins whose aggregation appears to cause degenerative maladies referred to as amyloid diseases or amyloidoses. These disorders are named after the characteristic cross--sheet amyloid fibrils that accumulate systemically or are localized to specific organs. In most cases, current treatment is limited to symptomatic approaches and thus disease-modifying therapies are needed. Alzheimer's disease is a neurodegenerative disorder with extracellular amyloid -peptide (A) fibrils and intracellular tau neurofibrillary tangles as pathological hallmarks. Numerous clinical trials have been conducted with passive and active immunotherapy, and small molecules to inhibit A formation and aggregation or to enhance A clearance; so far such clinical trials have been unsuccessful. Novel strategies are therefore required and here we will discuss the possibility of utilizing the chaperone BRICHOS to prevent A aggregation and toxicity. Type 2 diabetes mellitus is symptomatically treated with insulin. However, the underlying pathology is linked to the aggregation and progressive accumulation of islet amyloid polypeptide as fibrils and oligomers, which are cytotoxic. Several compounds have been shown to inhibit islet amyloid aggregation and cytotoxicity in vitro. Future animal studies and clinical trials have to be conducted to determine their efficacy in vivo. The transthyretin (TTR) amyloidoses are a group of systemic degenerative diseases compromising multiple organ systems, caused by TTR aggregation. Liver transplantation decreases the generation of misfolded TTR and improves the quality of life for a subgroup of this patient population. Compounds that stabilize the natively folded, nonamyloidogenic, tetrameric conformation of TTR have been developed and the drug tafamidis is available as a promising treatment. Read more articles from the symposium: Amyloid - a multifaceted player in human health and disease.

  • 8.
    Arne, Mats
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Primary Care Res Unit, Karlstad, Sweden.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lisspers, Karin H.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Wadell, Karin
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Availability of pulmonary rehabilitation in primary care for patients with COPD: a cross-sectional study in Sweden2016In: European clinical respiratory journal, E-ISSN 2001-8525, Vol. 3, article id 31601Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pulmonary rehabilitation (PR) is an important, evidence-based component for the management of individuals with chronic obstructive pulmonary disease (COPD). In daily practice, the majority of COPD patients are treated in primary care. However, information about the availability of PR in primary care in Sweden is lacking. The aim was to investigate the availability of rehabilitation resources in primary care settings for patients with COPD in Sweden.

    METHODS: A cross-sectional descriptive design was applied, using web-based questionnaires sent to all primary care centres in four regions, comprising more than half of the 9.6 million inhabitants of Sweden. The main questionnaire included questions about the content and availability of rehabilitation resources for COPD patients. PR was defined as exercise training and one or more of the following activities: education, nutritional intervention, energy conservation techniques or psychosocial support.

    RESULTS: A total of 381 (55.9%) of the 682 primary care centres answered the main questionnaire. In addition to physicians and nurses, availability of healthcare professionals for rehabilitation in primary care settings was physiotherapists 92.0%, occupational therapists 91.9%, dieticians 83.9% and social workers or psychologists 98.4%. At 23.7% of all centres, PR was not available to COPD patients - neither in primary care nor at hospitals.

    CONCLUSION: Despite high availability of professionals for rehabilitation in primary care settings, about one-quarter of managers at primary care centres stated that their COPD patients had no access to PR. This indicates a need to structure resources for rehabilitation and to present and communicate the available resources within the healthcare system.

  • 9.
    Arnetz, Bengt
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Drutchas, Alexis
    Sokol, Robert
    Kruger, Michael
    Jamil, Hikmet
    1991 Gulf War exposures and adverse birth outcomes2013In: U.S. Army Medical Department journal, ISSN 1524-0436, p. 58-65Article in journal (Refereed)
    Abstract [en]

    We studied 1991 Gulf War (GW)-related environmental exposures and adverse birth outcomes in Iraqis. A random cross-sectional sample of 307 Iraqi families that immigrated to the United States responded to a structured interview covering socioeconomics, lifestyle, environmental exposures, and birth outcome. Data per each family was collected either from the man or the woman in the respective family. The respondents were divided into those that resided in Iraq during and following the GW (post-GW, n=185) and those that had left before (pre-GW, n=122). The primary outcome was lifetime prevalence of adverse birth outcomes, ie, congenital anomalies, stillbirth, low birth weight, and preterm delivery and its relationship to GW exposures. Mean number of adverse birth outcomes increased from 3.43 (SD=2.11) in the pre-GW to 4.63 (SD=2.63) in the post-GW group (P<.001). Mean chemical (Ch) and nonchemical (NCh) environmental exposure scores increased from pre-GW scores of 0.38 units (SD=1.76) and 0.43 (SD=1.86), respectively, to post-GW scores of 5.65 units (SD=6.23) and 7.26 (SD=5.67), P<.001 between groups for both exposures. There was a significant dose-response relationship between Ch environmental exposure (P=.001), but not NCh exposure, and number of adverse birth outcomes. Exposure to burning oil pits and mustard gas increased the risks for specific adverse birth outcomes by 2 to 4 times. Results indicate that Gulf War Ch, but not NCh exposures are related to adverse birth outcomes. Pregnancies in women with a history of war exposures might benefit from more intensive observation.

  • 10.
    Askelöf, Ulrica
    et al.
    Karolinska Inst, Div Obstet & Gynecol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden..
    Andersson, Ola
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Domellöf, Magnus
    Umea Univ, Dept Clin Sci, Unit Pediat, Umea, Sweden..
    Fasth, Anders
    Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden.;Univ Gothenburg, Inst Clin Sci, Dept Pediat, Gothenburg, Sweden..
    Hallberg, Boubou
    Karolinska Inst, CLINTEC, Dept Neonatol, Stockholm, Sweden.;Univ Hosp, Stockholm, Sweden..
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
    Pettersson, Karin
    Karolinska Inst, Div Obstet & Gynecol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden..
    Westgren, Magnus
    Karolinska Inst, Div Obstet & Gynecol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden..
    Wiklund, Ingela E.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Gotherstrom, Cecilia
    Karolinska Inst, Div Obstet & Gynecol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden.;Karolinska Inst, Ctr Hematol & Regenerat Med, Stockholm, Sweden..
    Wait a minute?: An observational cohort study comparing iron stores in healthy Swedish infants at 4 months of age after 10-, 60-and 180-second umbilical cord clamping2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 12, article id e017215Article in journal (Refereed)
    Abstract [en]

    Background and objective: Umbilical cord blood (UCB) is a valuable stem cell source used for transplantation. Immediate umbilical cord (UC) clamping is widely practised, but delayed UC clamping is increasingly advocated to reduce possible infant anaemia. The aim of this study was to investigate an intermediate UC clamping time point and to evaluate iron status at the age of 4 months in infants who had the UC clamped after 60 s and compare the results with immediate and late UC clamping.

    Design: Prospective observational study with two historical controls.

    Setting: A university hospital in Stockholm, Sweden, and a county hospital in Halland, Sweden.

    Methods: Iron status was assessed at 4 months in 200 prospectively recruited term infants whose UC was clamped 60 s after birth. The newborn baby was held below the uterine level for the first 30 s before placing the infant on the mother’s abdomen for additional 30 s. The results were compared with data from a previously conducted randomised controlled trial including infants subjected to UC clamping at ≤10 s (n=200) or ≥180 s (n=200) after delivery.

    Results: After adjustment for age differences at the time of follow-up, serum ferritin concentrations were 77, 103 and 114 µg/L in the 10, 60 and 180 s groups, respectively. The adjusted ferritin concentration was significantly higher in the 60 s group compared with the 10 s group (P=0.002), while the difference between the 60 and 180 s groups was not significant (P=0.29).

    Conclusion: In this study of healthy term infants, 60 s UC clamping with 30 s lowering of the baby below the uterine level resulted in higher serum ferritin concentrations at 4 months compared with 10 s UC clamping. The results suggest that delaying the UC clamping for 60 s reduces the risk for iron deficiency.

  • 11.
    Athlin, Åsa Muntlin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Univ Adelaide, Sch Nursing, Adelaide, SA, Australia..
    Juhlin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Jangland, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Education in Nursing.
    Lack of existing guidelines for a large group of patients in Sweden: a national survey across the acute surgical care delivery chain2017In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, no 1, p. 89-95Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectivesEvidence-informed healthcare is the fundament for prac-tice, whereby guidelines based on the best available evidence should assist health profes-sionals in managing patients. Patients seeking care for acute abdominal pain form acommon group in acute care settings worldwide, for whom decision-making and timelytreatment are of paramount importance. There is ambiguity about the existence, use andcontent of guidelines for patients with acute abdomen. The objective was to describe andcompare guidelines and management of patients with acute abdomen in different settingsacross the acute care delivery chain in Sweden.MethodA national cross-sectional design was used. Twenty-nine ambulance stations, 17emergency departments and 33 surgical wards covering all six Swedish health regions wereincluded, and 23 guidelines were quality appraised using the validated Appraisal of Guide-lines for Research & Evaluation II tool.ResultsThere is a lack of guidelines in use for the management of this large group of pa-tients between and within different healthcare areas across the acute care delivery chain.The quality appraisal identified that several guidelines were of poor quality, especiallythe in-hospital ones. Further, range orders for analgesics are common in the ambulance ser-vices and the surgical wards, but are seldom present in the emergency departments. Also,education in pain management is more common in the ambulance services. Thesefindingsare noteworthy as, hypothetically, the same patient could be treated in three different waysduring the same care episode.ConclusionsThere is an urgent need to develop high-quality evidence-based clinicalguidelines for this patient group, with the entire care process in focus

  • 12.
    Bardel, Annika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Women's Health and Drug Utilization2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Objectives. To study medication utilization and adherence to prescribed therapy in a female population in central Sweden. To study usage of hormone replacement therapy (HRT) in this population and to assess how HRT users compare to non-users regarding symptom reporting, general health and other variables. To evaluate symptom prevalence adjusted for potential symptom affecting variables.

    Material and methods. A cross-sectional postal questionnaire study was performed in 1995 in seven counties in central Sweden. A questionnaire was sent to a random sample of 4,200 women aged 35-64, of whom 2,991 responded (71.2%). The questionnaire contained questions on psycho-socio-economic background, quality of life, self-reported health, height and weight, climacteric symptom prevalence, and menopausal status and symptoms. It also comprised questions on medication prescribed during the past year.

    Results. 40% used prescribed medication and 12% took four drugs or more. Age, educational level, self-rated health, and BMI remained significantly correlated to drug use in multivariate analysis. Adherence ranged from 15%-98% depending on age, a scheduled check-up, perceived importance of medication, concern about medication, taking cardiovascular and respiratory disease drugs. The highest adherence was found for hormonal medication the lowest for musculoskeletal medication.

    HRT was used by 15% of the women. 13 % used other symptom relieving therapy. HRT users reported higher score of vasomotor symptoms, except for sweating during the daytime.

    Prevalence of general symptoms did not necessarily increase with age. Especially symptoms related to stress-tension-depression decreased with age. Four different symptom prevalence patterns were found.

    Conclusions. Age, health status, educational level and body mass index (BMI) appear to affect drug use. Adherence to therapy is highest among elderly women who regard their medication as important and have a scheduled check-up. HRT relieves some vasomotor symptoms but does not affect other symptoms or self-rated health. Prevalence of symptoms related to Stress-tension-depression appears to decrease with age.

    List of papers
    1. Reported current use of prescription drugs and some of its determinants among 35-65-year-old women in mid-Sweden: A population-based study
    Open this publication in new window or tab >>Reported current use of prescription drugs and some of its determinants among 35-65-year-old women in mid-Sweden: A population-based study
    2000 (English)In: Journal of Clinical Epidemiology, Vol. 53, p. 647-653Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-96254 (URN)
    Available from: 2007-10-03 Created: 2007-10-03 Last updated: 2011-08-15Bibliographically approved
    2. Factors associated with adherence to drug therapy: a population-based study
    Open this publication in new window or tab >>Factors associated with adherence to drug therapy: a population-based study
    2007 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 63, no 3, p. 307-314Article in journal (Refereed) Published
    Abstract [en]

    Objective  To investigate adherence to prescription in a female population aged 35–65 years.

    Design  Postal questionnaire study of 2991 randomly sampled 35- to 64-year-old women in seven provinces of central Sweden. Methods  The study was performed in 1995 as a cross-sectional postal questionnaire study in seven counties in central Sweden. The questionnaire was sent to a random sample of 4200 women between the ages of 35 and 64, of whom 2991 (71.2%) responded. The questionnaire asked about drugs prescribed during the past year and about factors potentially affecting adherence. Results  The same women had different degrees of adherence to different medications. A large number of factors were associated with adherence. Multivariate analysis revealed that age, scheduled check-up, perceived importance of medication, concerns about medication safety and taking medication for a respiratory or a cardiovascular disease were significantly related to adherence. Adherence ranged from 15–98% depending on these factors, and was the lowest among young women who regarded their medication as unimportant and who had no scheduled check-up; the highest reported adherence was found among elderly women who regarded their medication as important and who had a scheduled check-up. Conclusion  Factors that were associated with the perceived importance of medication had a positive effect on adherence, while concerns about medication safety had a negative effect.

    Keywords
    Adherence, Communication skills, Epidemiology, Prescription, Women
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-96255 (URN)10.1007/s00228-006-0246-4 (DOI)000244091900012 ()17211620 (PubMedID)
    Available from: 2007-10-03 Created: 2007-10-03 Last updated: 2017-12-14Bibliographically approved
    3. Hormone replacement therapy and symptom reporting in menopausal women: A population-based study of 35-65-year-old women in mid-Sweden
    Open this publication in new window or tab >>Hormone replacement therapy and symptom reporting in menopausal women: A population-based study of 35-65-year-old women in mid-Sweden
    2002 (English)In: Maturitas, Vol. 41, p. 7-15Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-96256 (URN)
    Available from: 2007-10-03 Created: 2007-10-03 Last updated: 2011-08-15Bibliographically approved
    4. Age-specific symptom prevalence in women 35-64 years old: A population-based study
    Open this publication in new window or tab >>Age-specific symptom prevalence in women 35-64 years old: A population-based study
    2009 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, p. 37-Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Symptom prevalence is generally believed to increase with age. The aim of this study was to evaluate the age specific prevalence of 30 general symptoms among Swedish middle-aged women. METHODS: A cross-sectional postal questionnaire study in seven Swedish counties in a random sample of 4,200 women 35-64 years old, with 2,991 responders. Thirty general symptoms included in the Complaint Score subscale of the Gothenburg Quality of Life Instrument were used. RESULTS: Four groups of age specific prevalence patterns were identified after adjustment for the influence of educational level, perceived health and mood, body mass index, smoking habits, use of hormone replacement therapy, and use of other symptom relieving therapy. Only five symptoms (insomnia, leg pain, joint pain, eye problems and impaired hearing) increased significantly with age. Eleven symptoms (general fatigue, headache, irritability, melancholy, backache, exhaustion, feels cold, cries easily, abdominal pain, dizziness, and nausea) decreased significantly with age. Two symptoms (sweating and impaired concentration) had a biphasic course with a significant increase followed by a significant decrease. The remaining twelve symptoms (difficulty in relaxing, restlessness, overweight, coughing, breathlessness, diarrhoea, chest pain, constipation, nervousness, poor appetite, weight loss, and difficulty in urinating) had stable prevalence with age. CONCLUSION: Symptoms did not necessarily increase with age instead symptoms related to stress-tension-depression decreased.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-96257 (URN)10.1186/1471-2458-9-37 (DOI)000264288600001 ()19171031 (PubMedID)
    Available from: 2007-10-03 Created: 2007-10-03 Last updated: 2017-12-14Bibliographically approved
  • 13.
    Bardel, Annika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala universitet.
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Factors associated with adherence to drug therapy2015In: The world book of family medicine: European edition published on the ocction of the 20th Anniversary of WONCA Europe, Istanbul, October 2015 / [ed] Mehmet Ungen & Carl Steylaerts, Ljubljana: Narodna in univerzitetna , 2015, p. 100-102Chapter in book (Other academic)
  • 14.
    Bellomo, Claudia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Ludwig Institute for Cancer Research.
    Gahman, T. C.
    Ludwig Canc Res, La Jolla, CA USA..
    Shiau, A. K.
    Ludwig Canc Res, La Jolla, CA USA..
    Heldin, Carl-Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Ludwig Institute for Cancer Research.
    Moustakas, Aristidis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Ludwig Institute for Cancer Research.
    TGF beta and the nuclear receptor LXR alpha crosstalk on lipid metabolism and epithelial to mesenchymal transition in hepatocellular carcinoma2016In: European Journal of Clinical Investigation, ISSN 0014-2972, E-ISSN 1365-2362, Vol. 46, p. 36-36Article in journal (Other academic)
  • 15.
    Berglund, Britta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Födoämnesöverkänslighet hos personer med Ehlers-Danlos syndrom: ett vanligt problem2015In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 35, no 1Article in journal (Refereed)
    Abstract [en]

    Ehlers-Danlos syndrome (EDS) is a hereditary connective tissue disorder with generalized joint hypermobility, complications of instability, chronic musculoskeletal pain, a bleeding tendency, oral health problems and food hypersensitivity. A connection between hypermobility of joints and gastrointestinal problems is described. This study shows that indigestion is common in this group of 250 respondents from the Swedish EDS group. In total, 30% of the respondents reported no sensitivity to food at all, but 47% reported hypersensitivity for more than four food items. Most frequent reported food items were carbohydrates, histamine- and birch-related foods. Indigestion, itching and diarrhoea were most common problems related to food hypersensitivity.

  • 16.
    Berglund, Britta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    The diagnostic gap -  an expert opinion: Editorial2014In: Expert Opinion on Orphan Drugs, ISSN 2167-8707, Vol. 2, no 11, p. 1131-1133Article in journal (Refereed)
    Abstract [en]

    Many individuals with rare diseases of different types experience gaps between symptoms, diagnosis and treatment when in need of care. This is known in patient groups but not always known in society. A common experience is that no one is knowledgeable about the rare disease so the patient must, at every visit to healthcare, describe the disease and its consequences, which is not easy if you are in need of care.

  • 17. Bergström, G
    et al.
    Berglund, G
    Blomberg, A
    Brandberg, J
    Engström, G
    Engvall, J
    Eriksson, M
    de Faire, U
    Flinck, A
    Hansson, Mats G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Hedblad, B
    Hjelmgren, O
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Jernberg, T
    Johnsson, Å
    Johansson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Löfdahl, C-G
    Melander, O
    Östgren, C J
    Persson, A
    Persson, M
    Sandström, A
    Schmidt, C
    Söderberg, S
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Toren, K
    Waldenström, A
    Wedel, H
    Vikgren, J
    Fagerberg, B
    Rosengren, A
    The Swedish CArdioPulmonary BioImage Study: objectives and design2015In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 278, no 6, p. 645-659Article in journal (Refereed)
    Abstract [en]

    Cardiopulmonary diseases are major causes of death worldwide, but currently recommended strategies for diagnosis and prevention may be outdated because of recent changes in risk factor patterns. The Swedish CArdioPulmonarybioImage Study (SCAPIS) combines the use of new imaging technologies, advances in large-scale 'omics' and epidemiological analyses to extensively characterize a Swedish cohort of 30 000 men and women aged between 50 and 64 years. The information obtained will be used to improve risk prediction of cardiopulmonary diseases and optimize the ability to study disease mechanisms. A comprehensive pilot study in 1111 individuals, which was completed in 2012, demonstrated the feasibility and financial and ethical consequences of SCAPIS. Recruitment to the national, multicentre study has recently started.

  • 18. Bischoff, Stephan C
    et al.
    Boirie, Yves
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Chourdakis, Michael
    Cuerda, Cristina
    Delzenne, Nathalie M
    Deutz, Nicolaas E
    Fouque, Denis
    Genton, Laurence
    Gil, Carmen
    Koletzko, Berthold
    Leon-Sanz, Miguel
    Shamir, Raanan
    Singer, Joelle
    Singer, Pierre
    Stroebele-Benschop, Nanette
    Thorell, Anders
    Weimann, Arved
    Barazzoni, Rocco
    Towards a multidisciplinary approach to understand and manage obesity and related diseases2017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 4, p. 917-938, article id S0261-5614(16)31323-1Article, review/survey (Refereed)
    Abstract [en]

    Overnutrition and sedentary lifestyle result in overweight or obesity defined as abnormal or excessive fat accumulation that may impair health. According to the WHO, the worldwide prevalence of obesity nearly doubled between 1980 and 2008. In 2008, over 50% of both men and women in the WHO European Region were overweight, and approximately 23% of women and 20% of men were obese. Comprehensive diagnostic and therapeutic approaches should include nutritional treatment to favor the best metabolic and nutritional outcome, as well as to induce potential disease-specific benefits from selected nutritional regimens. Obesity is usually accompanied by an increased muscle mass. This might explain why obesity, under particular circumstances such as cancer or high age, might have protective effects, a phenomenon named the 'obesity paradox'. However, loss of muscle mass or function can also occur, which is associated with poor prognosis and termed 'sarcopenic obesity'. Therefore, treatment recommendations may need to be individualized and adapted to co-morbidities. Since obesity is a chronic systemic disease it requires a multidisciplinary approach, both at the level of prevention and therapy including weight loss and maintenance. In the present personal review and position paper, authors from different disciplines including endocrinology, gastroenterology, nephrology, pediatrics, surgery, geriatrics, intensive care medicine, psychology and psychiatry, sports medicine and rheumatology, both at the basic science and clinical level, present their view on the topic and underline the necessity to provide a multidisciplinary approach, to address this epidemic.

  • 19.
    Bjelland, Elisabeth Krefting
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Owe, Katrine Mari
    Pingel, Ronnie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Vangen, Siri
    Eberhard-Gran, Malin
    Pelvic pain after childbirth: a longitudinal population study2016In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 157, no 3, p. 710-716Article in journal (Refereed)
    Abstract [en]

    In this longitudinal population study, the aims were to study associations of mode of delivery with new onset of pelvic pain and changes in pelvic pain scores up to 7-18 months after childbirth. We included 20,248 participants enrolled in the Norwegian Mother and Child Cohort Study (1999-2008) without preexisting pelvic pain in pregnancy. Data were obtained by four self-administered questionnaires and linked to the Medical Birth Registry of Norway. A total of 4.5% of the women reported new onset of pelvic pain 0-3 months postpartum. Compared to unassisted vaginal delivery, operative vaginal delivery was associated with increased odds of pelvic pain (adjusted odds ratio 1.30; 95% confidence interval: 1.06-1.59). Planned and emergency cesarean deliveries were associated with reduced odds of pelvic pain (adjusted odds ratio 0.48; 95% confidence interval: 0.31-0.74 and adjusted odds ratio 0.65; 95% confidence interval: 0.49-0.87, respectively). Planned cesarean delivery, young maternal age, and low Symptom Checklist-8 scores were associated with low pelvic pain scores after childbirth. A history of pain was the only factor associated with increased pelvic pain scores over time (P=0.047). We conclude that new onset of pelvic pain after childbirth was not commonly reported, particularly following cesarean delivery. Overall, pelvic pain scores were rather low at all time points and women with a history of pain reported increased pelvic pain scores over time. Hence, clinicians should follow up women with pelvic pain after a difficult childbirth experience, particularly if they have a history of pain.

  • 20.
    Björk, A
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Andersson, K
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Björkegren, K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Johansson, G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Löfvander, M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Treatment of vitamin D insufficiency in female primary health care patients in Sweden: results from a study at 60N2012Conference paper (Other academic)
  • 21.
    Björk, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Aspects of Vitamin D: Prevalence of deficiency and impact on musculoskeletal parameters2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Vitamin D is central in calcium turnover, and adequate levels are important for skeletal health. It is not clear how large contributions from food and sunlight are in Swedish primary care patients, considering the low radiation of UVB in Sweden and fortification of some foods, and whether differences exist between patients of immigrant and Swedish origin. Increasing incidence of osteoporosis-related fractures is a major global health problem. Genetic variations in metabolising enzymes and in the Vitamin D receptor (VDR) have also been shown to be of importance to the overall effect of vitamin D. Polymorphic variation in the gene CYP2R1 encoding the 25-hydroxylase has previously been reported to correlate with circulating levels of 25(OH)D3. Results of association studies between genetic variants of the VDR and muscle strength, as well as falls have been contradictory.

    The purposes of this thesis were to examine possible differences in plasma-25(OH)D3 levels and intake of vitamin D between Swedish and immigrant female primary care patients, to estimate what foods contribute the most, and to identify contributors to vitamin D status (Paper I-II). Furthermore, the relationship between polymorphisms in the CYP2R1 gene and levels of 25(OH)D3 as well as other biochemical parameters (parathyroid hormone, calcium, phosphate and fibroblast growth factor 23) of skeletal homeostasis, bone mineral density and incidence of fractures was investigated (Paper III). Also, the association between genetic variations in the gene for the vitamin D receptor and measures of muscle strength, physical performance and falls (Paper IV), was investigated by using data from a Swedish multicenter study of elderly men (MrOS).

    Most important results: Vitamin D deficiency was common, with significant difference between Swedish born and immigrant patients (Paper I). Food intake of vitamin D is associated with circulating vitamin D, but the factors most strongly affecting vitamin D levels were reported sun holiday and origin (Paper II). CYP2R1 polymorphisms are associated with circulating levels of 25(OH)D3 and bone mineral density (Paper III). VDR genetic variants do not appear to have a direct effect on muscle strength or physical performance and incidence of falls in elderly Swedish men (Paper IV).

    List of papers
    1. Vitamin D intake and status in immigrant and native Swedish women: a study at a primary health care centre located at 60 degrees N in Sweden
    Open this publication in new window or tab >>Vitamin D intake and status in immigrant and native Swedish women: a study at a primary health care centre located at 60 degrees N in Sweden
    2013 (English)In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 57, p. UNSP 20089-Article in journal (Refereed) Published
    Abstract [en]

    Background: Immigration to Sweden from lower latitude countries has increased in recent years. Studies in the general population in other Nordic countries have demonstrated that these groups are at risk of developing vitamin D deficiency, but studies in primary health care patients are rare. Objectives: The aim of this study is to examine possible differences in plasma-25(OH)-vitamin D levels and intake of vitamin D between Swedish and immigrant female patients in a primary health care centre located at 60 degrees N, where half of the inhabitants have an immigrant background. Another objective was to estimate what foods contribute with most vitamin D. Design: Thirty-one female patients from the Middle East and Africa and 30 from Sweden were recruited. P-25(OH)D was measured and intake of vitamin D was estimated with a modified food frequency questionnaire (FFQ). Results: Vitamin D deficiency (plasma-25(OH)D<25 nmol/L) was common among immigrant women (61%). One immigrant woman and half of the Swedish women had optimal levels (plasma-25(OH)D>50 nmol/L). There was a positive correlation between the intake of vitamin D from food and plasma-25(OH) D. Only three women, all Swedish, reached the recommended intake of vitamin D from food. The immigrant women had lower intake compared to Swedish women (median: 3.1 vs. 5.1 mu g/day). The foods that contributed with most vitamin D were fatty fish, fortified milk and margarine. Immigrant women consumed less fortified milk and margarine but more meat. Irrespective of origin, patients with plasma-25(OH)D<25 nmol/L consumed less margarine but more meat. Conclusion: Vitamin D deficiency was common in the immigrant patients and their intake of vitamin D was lower. This highlights the need to target information about vitamin D to immigrant women in order to decrease the risk for vitamin D deficiency. The FFQ was well adapted to its purpose to estimate intake of vitamin D.

    Keywords
    immigrants, vitamin D deficiency, primary health care, food, nutrition requirements
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-203368 (URN)10.3402/fnr.v57i0.20089 (DOI)000319261600001 ()
    Available from: 2013-07-09 Created: 2013-07-09 Last updated: 2018-01-19Bibliographically approved
    2. Evaluation of sun holiday, diet habits, origin and other factors as determinants of vitamin D status in Swedish primary health care patients: a cross-sectional study with regression analysis of ethnic Swedish and immigrant women
    Open this publication in new window or tab >>Evaluation of sun holiday, diet habits, origin and other factors as determinants of vitamin D status in Swedish primary health care patients: a cross-sectional study with regression analysis of ethnic Swedish and immigrant women
    Show others...
    2013 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 14, p. 129-Article in journal (Refereed) Published
    Abstract [en]

    Background

    Determinants of vitamin D status measured as 25-OH-vitamin D in blood are exposure to sunlight and intake of vitamin D through food and supplements. It is unclear how large the contributions are from these determinants in Swedish primary care patients, considering the low radiation of UVB in Sweden and the fortification of some foods. Asian and African immigrants in Norway and Denmark have been found to have very low levels, but it is not clear whether the same applies to Swedish patients. The purpose of our study was to identify contributors to vitamin D status in Swedish women attending a primary health care centre at latitude 60°N in Sweden.

    Methods

    In this cross-sectional, observational study, 61 female patients were consecutively recruited between January and March 2009, irrespective of reason for attending the clinic. The women were interviewed about their sun habits, smoking, education and food intake at a personal appointment and blood samples were drawn for measurements of vitamin D and calcium concentrations.

    Results

    Plasma concentration of 25-OH-vitamin D below 25 nmol/L was found in 61% (19/31) of immigrant and 7% (2/30) of native women. Multivariate analysis showed that reported sun holiday of one week during the last year at latitude below 40°N with the purpose of sun-bathing and native origin, were significantly, independently and positively associated with 25-OH-vitamin D concentrations in plasma with the strongest association for sun holiday during the past year.

    Conclusions

    Vitamin D deficiency was common among the women in the present study, with sun holiday and origin as main determinants of 25-OH-vitamin D concentrations in plasma. Given a negative effect on health this would imply needs for vitamin D treatment particularly in women with immigrant background who have moved from lower to higher latitudes.

    Keywords: Vitamin D; Sun habits; Immigrant; Women; Primary health care

    National Category
    General Practice
    Identifiers
    urn:nbn:se:uu:diva-208596 (URN)10.1186/1471-2296-14-129 (DOI)000324297400001 ()
    Available from: 2013-10-04 Created: 2013-10-04 Last updated: 2018-01-19Bibliographically approved
    3. Polymorphisms in the CYP2R1 gene are associated with 25OHD3 and bone mineral density, but not with calcium and phosphate concentrations (MrOS Sweden).
    Open this publication in new window or tab >>Polymorphisms in the CYP2R1 gene are associated with 25OHD3 and bone mineral density, but not with calcium and phosphate concentrations (MrOS Sweden).
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Clinical Medicine
    Research subject
    Endocrinology and Diabetology
    Identifiers
    urn:nbn:se:uu:diva-317312 (URN)
    Available from: 2017-03-13 Created: 2017-03-13 Last updated: 2017-03-13
    4. Genetic variation in the vitamin D receptor gene is not associated with measures of muscle strength, physical performance, or falls in elderly men. Data from MrOS Sweden.
    Open this publication in new window or tab >>Genetic variation in the vitamin D receptor gene is not associated with measures of muscle strength, physical performance, or falls in elderly men. Data from MrOS Sweden.
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Endocrinology and Diabetes
    Identifiers
    urn:nbn:se:uu:diva-315701 (URN)
    Available from: 2017-02-19 Created: 2017-02-19 Last updated: 2017-03-30
  • 22.
    Björk, Anne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Andersson, Åsa
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Björkegren, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Bardel, Annika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Evaluation of sun holiday, diet habits, origin and other factors as determinants of vitamin D status in Swedish primary health care patients: a cross-sectional study with regression analysis of ethnic Swedish and immigrant women2013In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 14, p. 129-Article in journal (Refereed)
    Abstract [en]

    Background

    Determinants of vitamin D status measured as 25-OH-vitamin D in blood are exposure to sunlight and intake of vitamin D through food and supplements. It is unclear how large the contributions are from these determinants in Swedish primary care patients, considering the low radiation of UVB in Sweden and the fortification of some foods. Asian and African immigrants in Norway and Denmark have been found to have very low levels, but it is not clear whether the same applies to Swedish patients. The purpose of our study was to identify contributors to vitamin D status in Swedish women attending a primary health care centre at latitude 60°N in Sweden.

    Methods

    In this cross-sectional, observational study, 61 female patients were consecutively recruited between January and March 2009, irrespective of reason for attending the clinic. The women were interviewed about their sun habits, smoking, education and food intake at a personal appointment and blood samples were drawn for measurements of vitamin D and calcium concentrations.

    Results

    Plasma concentration of 25-OH-vitamin D below 25 nmol/L was found in 61% (19/31) of immigrant and 7% (2/30) of native women. Multivariate analysis showed that reported sun holiday of one week during the last year at latitude below 40°N with the purpose of sun-bathing and native origin, were significantly, independently and positively associated with 25-OH-vitamin D concentrations in plasma with the strongest association for sun holiday during the past year.

    Conclusions

    Vitamin D deficiency was common among the women in the present study, with sun holiday and origin as main determinants of 25-OH-vitamin D concentrations in plasma. Given a negative effect on health this would imply needs for vitamin D treatment particularly in women with immigrant background who have moved from lower to higher latitudes.

    Keywords: Vitamin D; Sun habits; Immigrant; Women; Primary health care

  • 23.
    Björkelund, Cecilia
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Primary Hlth Care, Gothenburg, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Primary Hlth Care, Box 454, S-40530 Gothenburg, Sweden..
    Svenningsson, Irene
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Primary Hlth Care, Gothenburg, Sweden..
    Hange, Dominique
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Primary Hlth Care, Gothenburg, Sweden..
    Udo, Camilla
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
    Petersson, Eva-Lisa
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Primary Hlth Care, Gothenburg, Sweden.;Narhalsan Res & Dev Primary Hlth Care, Reg Vastra Gotaland, Gothenburg, Sweden..
    Ariai, Nashmil
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Primary Hlth Care, Gothenburg, Sweden..
    Nejati, Shabnam
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Primary Hlth Care, Gothenburg, Sweden..
    Wessman, Catrin
    Univ Gothenburg, Sahlgrenska Acad, Hlth Metr Unit, Gothenburg, Sweden..
    Wikberg, Carl
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Primary Hlth Care, Gothenburg, Sweden..
    André, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Wallin, Lars
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Dept Hlth & Care Sci, Gothenburg, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Stockholm, Sweden..
    Westman, Jeanette
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med, Stockholm, Sweden..
    Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial2018In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 19, article id 28Article in journal (Refereed)
    Abstract [en]

    Background: Depression is one of the leading causes of disability and affects 10-15% of the population. The majority of people with depressive symptoms seek care and are treated in primary care. Evidence internationally for high quality care supports collaborative care with a care manager. Our aim was to study clinical effectiveness of a care manager intervention in management of primary care patients with depression in Sweden.

    Methods: In a pragmatic cluster randomized controlled trial 23 primary care centers (PCCs), urban and rural, included patients aged >= 18 years with a new (< 1 month) depression diagnosis. Intervention consisted of Care management including continuous contact between care manager and patient, a structured management plan, and behavioral activation, altogether around 6-7 contacts over 12 weeks. Control condition was care as usual (CAU). Outcome measures: Depression symptoms (measured by Mongomery-Asberg depression score-self (MADRS-S) and BDI-II), quality of life (QoL) (EQ-5D), return to work and sick leave, service satisfaction, and antidepressant medication. Data were analyzed with the intention-to-treat principle.

    Results: One hundred ninety two patients with depression at PCCs with care managers were allocated to the intervention group, and 184 patients at control PCCs were allocated to the control group. Mean depression score measured by MADRS-S was 2.17 lower in the intervention vs. the control group (95% CI [0.56; 3.79], p = 0.009) at 3 months and 2.27 lower (95% CI [0.59; 3.95], p = 0.008) at 6 months; corresponding BDI-II scores were 1.96 lower (95% CI [-0.19; 4.11], p = 0.07) in the intervention vs. control group at 6 months. Remission was significantly higher in the intervention group at 6 months (61% vs. 47%, p = 0.006). QoL showed a steeper increase in the intervention group at 3 months (p = 0.01). During the first 3 months, return to work was significantly higher in the intervention vs. the control group. Patients in the intervention group were more consistently on antidepressant medication than patients in the control group.

    Conclusions: Care managers for depression treatment have positive effects on depression course, return to work, remission frequency, antidepressant frequency, and quality of life compared to usual care and is valued by the patients.

  • 24.
    Bogefeldt, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Low Back Pain: With Special Reference to Prevalence, Diagnosis, Treatment and Prognosis2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Objectives. Ascertain if there has been a secular trend in 3-months prevalence of casually reported back pain. Evaluate if such back pain predicts concurrent health as well as future sick leave, disability pension, hospitalization and survival. Study differences in diagnostic assessment and labelling between physicians. Evaluate if a comprehensive manual therapy programme reduces sickness absence.

    Materials and methods. Combined population samples from 1973 to 2003 with a total of 12,891 observations with self-reported back pain and covariates. 7,074 of these individuals were followed for an average of 8.5 years and outcomes were self-reported health as well as official register data on sick leave, disability pension, hospitalisation and mortality. The Gotland Low Back Pain Study, a randomised controlled trial with participation of two general practitioners and two orthopaedic surgeons treating 160 patients with acute/subacute low back pain, with 10 weeks diagnostic evaluation and treatment and a two-year follow up.

    Results. Back pain prevalence increased 16% per ten years (OR 1.16, 95%CI 1.11-1.22). Back pain was negatively associated with self-rated health (p<0.0001), increased the risk of disability pension (p<0.002), and hospital admissions (p<0.0005), but not number of days in hospital, sick leave or mortality. General practitioners used terms from manual medicine and reported more pseudoradicular pain, while orthopaedic surgeons used non-specific pain labels, reported more true radicular pain and used more x-ray examinations. Among those on sick leave at baseline, manual therapy patients showed faster return to work (HR 1.62, 95%CI 1.006–2.60) and a lower point-prevalence of sick leave than reference patients at end of treatment period (ratio 0.35, 95% CI 0.13–0.97) but not after two years.

    Conclusions. There was a strong secular trend towards increase in self-reported back pain from 1973 to 2003. Such pain had a negative effect on some of the health outcomes and does not appear to be harmless. Physicians from different specialities labelled the condition differently. The manual therapy programme proved to be more effective than the established treatment regarding return to work.

    List of papers
    1. Medical and social consequences of back pain: a longitudinal study of 7,074 men and women sampled from the general population
    Open this publication in new window or tab >>Medical and social consequences of back pain: a longitudinal study of 7,074 men and women sampled from the general population
    Show others...
    (Swedish)Manuscript (preprint) (Other (popular science, discussion, etc.))
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-108069 (URN)
    Available from: 2009-09-06 Created: 2009-09-06 Last updated: 2012-08-24Bibliographically approved
    2. Diagnostic differences between general practitioners and orthopaedic surgeons in low back pain patients
    Open this publication in new window or tab >>Diagnostic differences between general practitioners and orthopaedic surgeons in low back pain patients
    2007 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 112, no 2, p. 199-212Article in journal (Refereed) Published
    Abstract [en]

    Background. There is a growing consensus on low back pain treatment. However, whether this extends to diagnostic labelling is still largely unknown. The aim of this report was to compare the diagnostic assessment of low back pain patients between general practitioners trained in manual therapy and orthopaedic surgeons. Methods. Population-based randomized controlled trial in which 160 patients with acute or sub-acute low back pain were assessed and treated by general practitioners or orthopaedic surgeons. Information on diagnoses and use of diagnostic imaging was obtained from medical records and physician questionnaires covering the ten-week treatment period. The Quebec Task Force classification and free text analysis were used to group diagnostic labels. Results: At baseline there were no significant differences in medical history, findings at physical examination and distribution of the Quebec Task Force diagnostic classification between the patient groups, indicating that they were similar. However, there were significant differences in physicians' use of diagnostic labels for local pain and their characterisation of radiating pain. General practitioners used more terms from manual medicine and reported more pseudoradicular pain than orthopaedic surgeons, who used non-specific pain labels, reported more true radicular pain and used more x-ray examinations. Differences were found at all times from first visit to ten week follow-up. Conclusions: There were significant differences in diagnostic assessment and use of diagnostic radiology between general practitioners and orthopaedic surgeons.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-11765 (URN)000253452000007 ()17578820 (PubMedID)
    Available from: 2007-10-17 Created: 2007-10-17 Last updated: 2017-12-11Bibliographically approved
    3. Sick leave reductions from a comprehensive manual therapy programme for low back pain: the Gotland Low Back Pain Study
    Open this publication in new window or tab >>Sick leave reductions from a comprehensive manual therapy programme for low back pain: the Gotland Low Back Pain Study
    2008 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 22, no 6, p. 529-41Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To evaluate if a comprehensive manual therapy programme reduces sick leave due low back pain and facilitates return to work more than the conventional optimized activating care. DESIGN: A randomized controlled trial over a 10-week period with a two-year follow-up. SETTING: Primary health care and Visby Hospital, Municipality of Gotland, Sweden. SUBJECTS: One hundred and sixty patients (70 women, 90 men, ages 20-55 years) with acute or subacute low back pain with or without pain radiation into the legs. INTERVENTIONS: Standardized optimized activating care (n = 71) versus a comprehensive pragmatic manual therapy programme including specific corticosteroid injections (n = 89). MAIN MEASURES: Sick leave measured as net sick leave volume, point prevalence and return to work. RESULTS: After 10 weeks, significantly more manual therapy patients than reference patients had returned to work (hazards ratio 1.62, 95% confidence interval (CI) 1.006-2.60, P<0.05), and among those on sick leave at baseline, significantly fewer were still on sick leave (8/58 versus 13/40, ratio 0.35, 95% CI 0.13-0.97, P<0.05). For all other measures there were inconclusive differences in favour of the manual therapy group. No significant differences remained after two years. CONCLUSIONS: The manual therapy programme used in this study decreased sick leave and increased return to work more than the standardized optimized activating care only up to 10 weeks but not up to two years.

    National Category
    General Practice
    Identifiers
    urn:nbn:se:uu:diva-17529 (URN)10.1177/0269215507087294 (DOI)000257151400006 ()18511533 (PubMedID)
    Available from: 2008-06-27 Created: 2008-06-27 Last updated: 2018-01-12Bibliographically approved
    4. Age and time trends in back pain prevalence among men and women sampled from the general population
    Open this publication in new window or tab >>Age and time trends in back pain prevalence among men and women sampled from the general population
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    General Practice
    Research subject
    Family Medicine
    Identifiers
    urn:nbn:se:uu:diva-108068 (URN)
    Available from: 2009-09-06 Created: 2009-09-06 Last updated: 2018-01-13Bibliographically approved
  • 25.
    Bogefeldt, Johan P
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Grunnesjö, Marie I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt F
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Blomberg, Stefan I E
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Sick leave reductions from a comprehensive manual therapy programme for low back pain: the Gotland Low Back Pain Study2008In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 22, no 6, p. 529-41Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate if a comprehensive manual therapy programme reduces sick leave due low back pain and facilitates return to work more than the conventional optimized activating care. DESIGN: A randomized controlled trial over a 10-week period with a two-year follow-up. SETTING: Primary health care and Visby Hospital, Municipality of Gotland, Sweden. SUBJECTS: One hundred and sixty patients (70 women, 90 men, ages 20-55 years) with acute or subacute low back pain with or without pain radiation into the legs. INTERVENTIONS: Standardized optimized activating care (n = 71) versus a comprehensive pragmatic manual therapy programme including specific corticosteroid injections (n = 89). MAIN MEASURES: Sick leave measured as net sick leave volume, point prevalence and return to work. RESULTS: After 10 weeks, significantly more manual therapy patients than reference patients had returned to work (hazards ratio 1.62, 95% confidence interval (CI) 1.006-2.60, P<0.05), and among those on sick leave at baseline, significantly fewer were still on sick leave (8/58 versus 13/40, ratio 0.35, 95% CI 0.13-0.97, P<0.05). For all other measures there were inconclusive differences in favour of the manual therapy group. No significant differences remained after two years. CONCLUSIONS: The manual therapy programme used in this study decreased sick leave and increased return to work more than the standardized optimized activating care only up to 10 weeks but not up to two years.

  • 26.
    Bogefeldt, Johan P
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Welin, Lennart
    Department of Heart and Lung Diseases, Sahlgren Academy.
    Eriksson, Henry
    Department of Heart and Lung Diseases, Sahlgren Academy.
    Johansson, Saga
    Department of Heart and Lung Diseases, Sahlgren Academy OCH Department of Epidemiology, AstraZeneca R6D, Mölndal , Sweden.
    Grunnesjö, Marie I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt F
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Age and time trends in back pain prevalence among men and women sampled from the general populationManuscript (preprint) (Other academic)
  • 27. Bomba, David
    et al.
    Svärdsudd, Kurt
    Kristiansson, Per
    A comparison of patient attitudes towards the use of computerized medical records and unique identifiers in Australia and Sweden2004In: Australian Journal of Primary Health, ISSN 1448-7527, E-ISSN 1836-7399, Vol. 10, p. 36-41Article in journal (Refereed)
  • 28.
    Brochard, Laurent
    et al.
    St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr, 30 Bond St, Toronto, ON M5B 1W8, Canada.;Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada..
    Hedenstierna, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.
    Ten physiologic advances that improved treatment for ARDS2016In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 42, no 5, p. 814-816Article in journal (Other academic)
  • 29. Bränström, R
    et al.
    Arrelöv, B
    Gustavsson, Catharina
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
    Kjeldgård, L
    Ljungquist, T
    Nilsson, G H
    Alexanderson, K
    Sickness certification at oncology clinics: perceived problems, support, need for education and reasons for certifying unnecessarily long sickness absences2014In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 23, no 1, p. 89-97Article in journal (Refereed)
    Abstract [en]

    Physicians' work with sickness certifications is an understudied field. The aims of this study were to gain knowledge of experiences concerning the sickness certification process among physicians working at oncology clinics. In 2008, all physicians working in Sweden (n = 36 898) were sent a questionnaire concerning sick-listing practices. All respondents working at an oncology clinic (n = 428) were included in the current study. Most of the physicians had sickness certification consultations at least weekly (91.3%). More than one fifth (22.3%) reported that they worked at a clinic with a workplace policy regarding the handling of sickness certification and 61.1% reported receiving at least some support in such cases from their immediate manager. Issuing unnecessary long sickness certificates were related to experiencing delicate interactions with patients and to lack of time. To a moderate degree, further competence was requested regarding: different types of compensation in the social insurance system, responsibilities of the Social Insurance Agency and employers, and sickness insurance rules. The large majority of physicians working in oncology reported regularly having consultations involving sickness certification. Overall, they reported few problems, low level of need for more competence regarding sickness certification, and low frequency of issuing sickness absences for longer periods than necessary.

  • 30. Bränström, Richard
    et al.
    Arrelöv, Britt
    Gustavsson, Catharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Kjeldgård, Linnea
    Ljungquist, Therese
    Nilsson, Gunnar H
    Alexanderson, Kristina
    Reasons for and factors associated with issuing sickness certificates for longer periods than necessary: results from a nationwide survey of physicians.2013In: BMC public health, ISSN 1471-2458, Vol. 13, p. 478-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Physicians' work with sickness certifications is an understudied field. Physicians' experience of sickness certifying for longer periods than necessary has been previous reported. However, the extent and frequency of such sickness certification is largely unknown. The aims of this study were: a) to explore the frequency of sickness certifying for longer periods than necessary among physicians working in different clinical settings; b) to examine main reasons for issuing sickness certificates for longer periods than necessary; and c) to examine factors associated with unnecessary issued sickness certificates.

    METHODS: In 2008, all physicians living and working in Sweden (a total of 36,898) were sent an invitation to participate in a questionnaire study concerning their sick-listing practices. A total of 22,349 (60.6%) returned the questionnaire. In the current study, physicians reporting handling sickness certification consultations at least weekly were included in the analyses, a total of 12,348.

    RESULTS: The proportion of physicians reporting issuing sickness certificates for longer periods than actually necessary varied greatly between different types of clinics, with the highest frequency among those working at: occupational medicine, orthopedic, primary health care, and psychiatry clinics; and lowest among those working in: eye, dermatology, ear/nose/throat, oncology, surgery, and infection clinics. Logistic analyses showed that sickness certifying for longer periods than necessary due to limitations in the health care system was particularly common among physicians working at occupational medicine, orthopedic, and primary health care clinics. Sickness certifying for longer periods than necessary due to patient-related factors was much more common among physicians working at psychiatric clinics. In addition to differences between clinics, frequency of sickness certificates issued for longer periods than necessary varied by age, physicians' experiences of different situations, and perceived problems.

    CONCLUSIONS: This study showed that physicians issued sickness certificates for longer periods than actually necessary quite frequently at some types of clinics. Differences between clinics were to a large extent associated with frequency of problems, lack of time, delicate interactions with patients, and need for more competence.

  • 31.
    Bröms, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    A Nationwide Study of Asthma and Allergy in Swedish Preschool Children: with Special Reference to Environment, Daycare, Prevalence, Co-ocurrence and Incidence2010Doctoral 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.

    List of papers
    1. A nationwide study of indoor and outdoor environments in allergen avoidance and conventional daycare centers in Sweden
    Open this publication in new window or tab >>A nationwide study of indoor and outdoor environments in allergen avoidance and conventional daycare centers in Sweden
    2006 (English)In: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 16, no 3, p. 227-35Article in journal (Refereed) Published
    Abstract [en]

    Sweden has had specialized 'allergen avoidance daycare centers' (AADC) since 1979. The aim was to compare AADC with ordinary daycare centers (ODC). Through contacts with municipalities and hospitals, 72 AADC were identified. For each AADC, the two nearest ODCs served as controls. A questionnaire was sent to the local directors of the 216 daycare centers (531 sections), 83% responded. A total of 39% of the ODCs had ever had dampness/molds, 12% were near (<500 m) stables/farms, 23% were closer than 50 m to a heavy trafficked road, and 13% were exposed to wood smoke in winter. Only 11% of the AADCs had any child with furred pets at home, while 97% of the ODCs had children with furred pets. Bans on smoking at home and on perfumes were more common at the AADCs (P = 0.001). Fewer AADCs had PVC floors (OR = 0.53; P = 0.01), dampness/molds (OR = 0.55; P = 0.04), shelves (OR 3.03; P = 0.001), curtains (OR = 1.67; P = 0.047), and flowers (OR = 0.03; P < 0.001), while more had daily floor cleaning (OR = 19.9; P = 0.004), weekly wiping of furniture (OR = 11.0; P = 0.001), and washing of pillows/mattresses (OR = 2.74; P = 0.005) and curtains (OR = 9.07; P = 0.001). In conclusion, allergy avoidance daycare centers differ from other daycare centers, and may have better indoor environments. PRACTICAL IMPLICATIONS: There is a need to improve the indoor environments of daycare centers, including reduction of building dampness and molds. Allergen avoidance daycare centers (AADC) in Sweden differ from ordinary daycare centers in many respects, with fewer indoor and building factors related to dust, allergens and irritants. This shows that the indoor environments of daycare centers can be improved. Data suggest that AADC may have lower levels of pet allergens, and this is beneficial for children with pet allergy. The effects of these improvements on indoor exposures and health of the children need to be further evaluated.

    Keywords
    Air Pollutants, Air Pollution; Indoor/*analysis, Allergens/*analysis, Animals, Antigens; Dermatophagoides/analysis, Cats, Child Day Care Centers, Child; Preschool, Cockroaches, Dogs, Dust/analysis, Environmental Monitoring, Facility Design and Construction, Humans, Questionnaires, Sick Building Syndrome, Sweden, Ventilation
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-81290 (URN)10.1111/j.1600-0668.2005.00420.x (DOI)16683941 (PubMedID)
    Available from: 2008-06-25 Created: 2008-06-25 Last updated: 2017-12-14Bibliographically approved
    2. Effect of degree of urbanisation on age and sex-specific asthmaprevalence in Swedish preschool children
    Open this publication in new window or tab >>Effect of degree of urbanisation on age and sex-specific asthmaprevalence in Swedish preschool children
    Show others...
    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
    3. Prevalence and co-occurrence of asthma and allergic manifestations in preschool children
    Open this publication in new window or tab >>Prevalence and co-occurrence of asthma and allergic manifestations in preschool children
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: It has been claimed that preschool children may embark on ‘the atopic march’, which means that atopic manifestations show up one after another in a certain order. The aim of this study was to make an in-depth analysis of the co-occurrence of asthma and atopic manifestations.

    Methods: Parents of 5886 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 asthma, allergic rhinitis, eczema, food allergy, furred pet and pollen allergy and other data in their children. Age specific prevalence of asthma, rhinitis, eczema, and food allergy was computed, adjusted for municipality population size.

    Results: The overall prevalence of 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 all asthma-atopic manifestations. Presence of pet allergy was the manifestation showing the closest co-occurrence with presence of 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 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. There was no evidence of a rank order of asthma and allergy manifestation onset.

    Conclusions: There was close co-occurrence between all asthma-atopic manifestations but no evidence of a rank order of onsets.

    Keywords
    asthma, rhinitis, eczema, food allergy, epidemiology
    National Category
    General Practice
    Research subject
    Family Medicine
    Identifiers
    urn:nbn:se:uu:diva-120585 (URN)
    Available from: 2010-03-15 Created: 2010-03-15 Last updated: 2018-01-12
    4. A nationwide study of asthma incidence and its determinants in preschool children during five years of follow up
    Open this publication in new window or tab >>A nationwide study of asthma incidence and its determinants in preschool children during five years of follow up
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Many studies on asthma prevalence have been published, but the number of studies on asthma incidence in preschool children is limited.

    A number of studies on asthma prevalence have been published, but there are few studies on asthma incidence in preschool children. In this project a nationwide sample of preschool children were followed with the aim to estimate 5-year asthma incidence and its determinants.

    Methods: Parents of 5886 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, 4255 of the parents responded to an almost identical questionnaire.

    Results: A large number of potential baseline determinants for 5-year asthma incidence were identified. Of these, food allergy, wheezing last 12 months, rhinitis, parental rhinitis, parental asthma, ever asthma, age, and eczema, on rank order of importance, remained significant in multivariate logistic regression analysis. The asthma incidence was highly dependent on presence or absence of these variables. Given the variable mix in the present study population, the incidence ranged from 2.9% in the oldest to 5.8% in the youngest children, corresponding to an annual asthma incidence of 0.6% to 1.2%.

    Conclusions: The incidence of asthma is highly dependent on the composition of the underlying population. However, an annual incidence in range a half to one percent in preschool children in the general population appears probable.

    Keywords
    asthma, incidence rate, preschool children, determinants, parental atopy
    National Category
    General Practice
    Research subject
    Family Medicine
    Identifiers
    urn:nbn:se:uu:diva-120591 (URN)
    Available from: 2010-03-15 Created: 2010-03-15 Last updated: 2018-01-12
  • 32.
    Bröms, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    A nationwide study of asthma incidence and its determinants in preschool children during five years of follow upManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Many studies on asthma prevalence have been published, but the number of studies on asthma incidence in preschool children is limited.

    A number of studies on asthma prevalence have been published, but there are few studies on asthma incidence in preschool children. In this project a nationwide sample of preschool children were followed with the aim to estimate 5-year asthma incidence and its determinants.

    Methods: Parents of 5886 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, 4255 of the parents responded to an almost identical questionnaire.

    Results: A large number of potential baseline determinants for 5-year asthma incidence were identified. Of these, food allergy, wheezing last 12 months, rhinitis, parental rhinitis, parental asthma, ever asthma, age, and eczema, on rank order of importance, remained significant in multivariate logistic regression analysis. The asthma incidence was highly dependent on presence or absence of these variables. Given the variable mix in the present study population, the incidence ranged from 2.9% in the oldest to 5.8% in the youngest children, corresponding to an annual asthma incidence of 0.6% to 1.2%.

    Conclusions: The incidence of asthma is highly dependent on the composition of the underlying population. However, an annual incidence in range a half to one percent in preschool children in the general population appears probable.

  • 33.
    Bröms, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Erikssson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Svärdsudd, Kurt F
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Prevalence and co-occurrence of asthma and allergic manifestations in preschool childrenManuscript (preprint) (Other academic)
    Abstract [en]

    Background: It has been claimed that preschool children may embark on ‘the atopic march’, which means that atopic manifestations show up one after another in a certain order. The aim of this study was to make an in-depth analysis of the co-occurrence of asthma and atopic manifestations.

    Methods: Parents of 5886 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 asthma, allergic rhinitis, eczema, food allergy, furred pet and pollen allergy and other data in their children. Age specific prevalence of asthma, rhinitis, eczema, and food allergy was computed, adjusted for municipality population size.

    Results: The overall prevalence of 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 all asthma-atopic manifestations. Presence of pet allergy was the manifestation showing the closest co-occurrence with presence of 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 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. There was no evidence of a rank order of asthma and allergy manifestation onset.

    Conclusions: There was close co-occurrence between all asthma-atopic manifestations but no evidence of a rank order of onsets.

  • 34. Bui, Christine L
    et al.
    Kaye, James A
    Castellsague, Jordi
    Calingaert, Brian
    McQuay, Lisa J
    Riera-Guardia, Nuria
    Saltus, Catherine W
    Quinlan, Scott C
    Holick, Crystal N
    Wahl, Peter M
    Suzart, Kiliana
    Rothman, Kenneth J
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Perez-Gutthann, Susana
    Validation of acute liver injury cases in a population-based cohort study of oral antimicrobial users2014In: Current Drug Safety, ISSN 1574-8863, E-ISSN 2212-3911, Vol. 9, no 1, p. 23-28Article in journal (Refereed)
    Abstract [en]

    We conducted a cohort study of acute, noninfectious liver injury among oral antimicrobial users. Potential cases were identified in the HealthCore Integrated Research Database (HIRD(SM)) population between July 1, 2001, and March 31, 2009, using ICD-9-CM codes primarily for acute and subacute necrosis of the liver, hepatic coma, and unspecified hepatitis.

    Liver test results were used to confirm case status according to published criteria. Two physician reviewers experienced in studying acute liver injury (blinded to study drug exposures) evaluated data abstracted from hospital and emergency department records to validate potential cases. Of 715 potential cases having claims associated with any of the primary screening codes, 312 (44%) were valid cases, 108 (15%) were not cases, and 295 (41%) were of uncertain status (records inadequate for validation). Among potential cases with adequate medical records, the PPV for presence of any of the primary codes was 74% (95% CI, 70%-78%). The highest PPV for a single code was for acute and subacute necrosis of the liver (84%; 95% CI, 77%-90%).

    Evaluation of cases of noninfectious liver injury using hospital and emergency department medical records continues to represent the preferred approach in studies using insurance claims data.

  • 35.
    Butler, Stephen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Acad Hosp, Ctr Multidisciplinary Pain, S-75185 Uppsala, Sweden.
    The triumvirate of co-morbid chronic pain, depression, and cognitive impairment: Attacking this "chicken-and-egg" in novel ways2017In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 15, p. 148-149Article in journal (Other academic)
  • 36.
    Butler, Stephen
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Norwegian Univ Sci & Technol, Fac Med, Dept Circulat & Med Imaging, N-7034 Trondheim, Norway; Univ Uppsala Hosp, Pain Ctr, ING 79,2 TR, S-75185 Uppsala, Sweden.
    Landmark, Tormod
    St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway.
    Glette, Mari
    Norwegian Univ Sci & Technol, Fac Med, Dept Circulat & Med Imaging, N-7034 Trondheim, Norway.
    Borchgrevink, Petter
    Norwegian Univ Sci & Technol, Fac Med, Dept Circulat & Med Imaging, N-7034 Trondheim, Norway; St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway.
    Woodhouse, Astrid
    St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway; Norwegian Univ Sci & Technol, Fac Med, Dept Publ Hlth & Gen Practice, N-7034 Trondheim, Norway.
    Chronic widespread pain - the need for a standard definition2016In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 157, no 3, p. 541-543Article, review/survey (Refereed)
  • 37.
    Carlsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Healthcare and patient factors affecting sick leave: From a primary health care perspective2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: For indeterminate reasons, there have been major variations in sick leave in Sweden, and many physicians have perceived sick leave assignments as burdensome.

    Aim: To gain more knowledge and understanding, from a perspective of primary health care, about factors in health care and patients that affect sick leave. Thereby help patients in the best way, facilitate the work of physicians and other health professionals involved in the rehabilitation process, and use the health care resources optimally.

    Methods: This thesis is based on a randomised controlled trial (RCT) in a primary health care centre with participants on short-term sick leave, due to pain and/or mental illness, who received a multidisciplinary assessment. Qualitative focus-group discussions with physicians in primary health care centres. A cohort of women on very long-term sick leave due to pain and/or mental illness, who lost sickness benefits due to a new time limit on sickness insurance, were randomised to multidisciplinary assessment and multimodal intervention (TEAM), or to Acceptance and Commitment Therapy (ACT). In an extended cohort, including some men on very long-term sick leave due to pain and/or mental illness, the importance of the motivation for return to work (RTW) was investigated.

    Results. Very early multidisciplinary assessment increased days on sick leave in the first three month period. Physicians at primary health care centres perceived sick leave assignments as burdensome, but clearer rules and cooperation with other professionals have made sick leave assignments less burdensome. TEAM intervention resulted in an increase in working hours per week as well as an increase in work-related engagements, compared to control in the RCT. Motivation for RTW was associated with RTW or increased employability in the rehabilitation of patients

    Conclusions: Continued studies are needed to find those who are at risk of long-term sick leave, the time when rehabilitation efforts should be started, and the content of rehabilitation. Collaboration in teams facilitates sick leave assignments for physicians at primary care health centres. Motivation for RTW might be a factor of importance for the effect of rehabilitation and needs to be studied further.

    List of papers
    1. Early multidisciplinary assessment was associated with longer periods of sick leave: A randomized controlled trial in a primary health care centre
    Open this publication in new window or tab >>Early multidisciplinary assessment was associated with longer periods of sick leave: A randomized controlled trial in a primary health care centre
    2013 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 31, no 3, p. 141-146Article in journal (Refereed) Published
    Abstract [en]

    Objective

    To study the effects on sick leave from an early multidisciplinary assessment at a primary health care centre. Design. Randomized controlled trial.

    Setting

    Patients who saw GPs at a primary health care centre in mid-Sweden and asked for a sickness certificate for psychiatric or musculoskeletal diagnoses were invited to participate. Patients included were sick-listed for less than four weeks; 33 patients were randomized either to an assessment within a week by a physiotherapist, a psychotherapist, and an occupational therapist or to "standard care". The therapists used methods and tools they normally use in their clinical work.

    Main outcome measure

    Proportion of patients still sick-listed three months after randomization, total and net days on sick leave, and proportion who were on part-time sick leave.

    Results

    At follow-up after three months, in contrast to the pre-trial hypothesis, there was a trend toward a higher proportion of patients still sick-listed in the intervention group (7/18) as compared with the control group (3/15). The intervention group also had significantly longer sick-listing periods (mean 58 days) than the control group (mean 36 days) (p = 0.038). The proportion of patients who were part time sick-listed was significantly higher in the intervention group (10/18) than in the control group (2/15) (p = 0.027).

    Conclusions

    In this study an early multidisciplinary assessment was associated with longer periods on sick leave and more individuals on part-time sick leave.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-205930 (URN)10.3109/02813432.2013.811943 (DOI)000323243900005 ()23909930 (PubMedID)
    Available from: 2013-08-26 Created: 2013-08-26 Last updated: 2017-08-17Bibliographically approved
    2. General practitioners' perceptions of working with the certification of sickness absences following changes in the Swedish social security system: a qualitative focus-group study
    Open this publication in new window or tab >>General practitioners' perceptions of working with the certification of sickness absences following changes in the Swedish social security system: a qualitative focus-group study
    2015 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 16, article id 21Article in journal (Refereed) Published
    Abstract [en]

    Background: Many physicians in Sweden, as well as in other countries, find the matter of certification of sickness absence (COSA) particularly burdensome. The issuing of COSAs has also been perceived as a work-environment problem among physicians. Among general practitioners (GPs) are the highest proportion of physicians in Sweden who experience difficulties with COSA. Swedish authorities have created several initiatives, by changing the social security system, to improve the rehabilitation of people who are ill and decrease the number of days of sick leave used. The aim of this study was to describe how GPs in Sweden perceive their work with COSA after these changes. Methods: A descriptive design with a qualitative, inductive focus-group discussion (FGD) approach was used. Results: Four categories emerged from the analysis of FGDs with GPs in Sweden: 1) Physicians' difficulties in their professional role; 2) Collaboration with other professionals facilitates the COSA; 3) Physicians' approach in relation to the patient; 4) An easier COSA process. Conclusions: Swedish GPs still perceived COSA to be a burdensome task. However, system changes in recent years have facilitated work related to COSA. Cooperation with other professionals on COSA was perceived positively.

    Keywords
    General practitioners, Primary health care, Focus group discussions, Sick leave, Certification of sickness absence, Social security system
    National Category
    Other Medical Sciences
    Identifiers
    urn:nbn:se:uu:diva-248186 (URN)10.1186/s12875-015-0238-5 (DOI)000350069200001 ()
    Available from: 2015-04-12 Created: 2015-03-30 Last updated: 2017-12-04Bibliographically approved
    3. Effectiveness of two vocational rehabilitation programmes in women with long-term sick leave due to pain syndrome or mental illness: 1-year follow-up of a randomized controlled trial
    Open this publication in new window or tab >>Effectiveness of two vocational rehabilitation programmes in women with long-term sick leave due to pain syndrome or mental illness: 1-year follow-up of a randomized controlled trial
    2017 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, no 2, p. 170-177Article in journal (Refereed) Published
    Abstract [en]

    Objective: Mental illness and chronic pain are common reasons for long-term sick leave, typically more so for women. This study investigated the effects on return to work of 2 vocational rehabilitation programmes. Methods: In this randomized controlled study, 308 women were allocated to treatment with acceptance and commitment therapy, to multidisciplinary assessment and individualized rehabilitation interventions, or to a control group. Return-to-work at 12 months was assessed as: (i) returning to health insurance; (ii) number of reimbursed health insurance days during follow-up; (iii) self-reported change in working hours; (iv) a composite measure of self-reported change in work-related engagement. Results: The mean age of the Swedish study population was 48.5 years (standard deviation (SD) 6.3 years) and the mean time on sick leave 7.5 years (SD 3.2 years). There were no significant differences in reimbursed days or returning to the health insurance at 12 months. The multidisciplinary assessment and individualized rehabilitation interventions group, compared with control, reported a significant increase in working hours per week, as well as a significant increase in work-related engagement. Conclusion: Multidisciplinary assessments and individual rehabilitation interventions may improve the chance of return-to-work in women with long-term sick leave due to pain condition or mental illness.

    Keywords
    return to work, vocational rehabilitation, multidisciplinary rehabilitation, acceptance and commitment therapy, chronic pain
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-317212 (URN)10.2340/16501977-2188 (DOI)000396799000010 ()28101560 (PubMedID)
    Funder
    Swedish Social Insurance Agency
    Available from: 2017-03-11 Created: 2017-03-11 Last updated: 2018-09-06Bibliographically approved
    4. Motivation for return to work and actual return to work among people on long-term sick leave due to pain syndrome or mental health conditions
    Open this publication in new window or tab >>Motivation for return to work and actual return to work among people on long-term sick leave due to pain syndrome or mental health conditions
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Keywords
    Sick leave, motivation, return to work, sickness insurance, insurance medicine, public employment service, self-determination theory
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Family Medicine
    Identifiers
    urn:nbn:se:uu:diva-327288 (URN)
    Available from: 2017-08-08 Created: 2017-08-08 Last updated: 2017-08-17Bibliographically approved
  • 38. Carrasquilla, Germán D
    et al.
    Berglund, Anita
    Gigante, Bruna
    Landgren, Britt-Marie
    de Faire, Ulf
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Leander, Karin
    Does menopausal hormone therapy reduce myocardial infarction risk if initiated early after menopause?: A population-based case-control study2014In: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 22, no 6, p. 598-606Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study aims to assess whether the timing of menopausal hormone therapy initiation in relation to onset of menopause and hormone therapy duration is associated with myocardial infarction risk.

    METHODS: This study was based on the Stockholm Heart Epidemiology Program, a population-based case-control study including 347 postmenopausal women who had experienced a nonfatal myocardial infarction and 499 female control individuals matched for age and residential area. Odds ratios (with 95% CIs) for myocardial infarction were calculated using logistic regression.

    RESULTS: Early initiation of hormone therapy (within 10 y of onset of menopause or before age 60 y), compared with never use, was associated with an odds ratio of 0.87 (95% CI, 0.58-1.30) after adjustments for lifestyle factors, body mass index, and socioeconomic status. For late initiation of hormone therapy, the corresponding odds ratio was 0.97 (95% CI, 0.53-1.76). For hormone therapy duration of 5 years or more, compared with never use, the adjusted odds ratio was 0.64 (95% CI, 0.35-1.18). For hormone therapy duration of less than 5 years, the odds ratio was 0.97 (95% CI, 0.63-1.48).

    CONCLUSIONS: Neither the timing of hormone therapy initiation nor the duration of therapy is significantly associated with myocardial infarction risk.

  • 39.
    Cars, Otto
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Securing access to effective antibiotics for current and future generations. Whose responsibility?2014In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 119, no 2, p. 209-214Article in journal (Other academic)
  • 40. Cea Soriano, Lucía
    et al.
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Andersson, Susan
    Filonenko, Anna
    García Rodríguez, Luis Alberto
    The continuation rates of long-acting reversible contraceptives in UK general practice using data from The Health Improvement Network2015In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 24, no 1, p. 52-58Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this study was to determine the continuation rates of new users of long-acting reversible contraceptive (LARC) methods in the UK, using data from general practice.

    METHODS: We conducted an observational study using a general practitioner (GP) database, The Health Improvement Network (THIN). The methods studied were copper intrauterine devices (Cu-IUDs), levonorgestrel-releasing intrauterine system (LNG-IUS), progestogen-only implants and progestogen-only injections. The study population comprised women in THIN aged 18-44 years during the period 2004-2009 who had been registered with their GP for at least 5 years, with a computerized prescription history of at least 1 year. Using computer algorithms, the database was searched for the Read and Multilex codes for each LARC method. New LARC users were identified and followed until there was a record indicating termination of use or the study period ended.

    RESULTS: The proportion of women who discontinued use during the same year of administration was 7.5% for Cu-IUDs, 10.6% for LNG-IUS, 13.2% for progestogen-only implants and 54.4% for progestogen-only injections. By the end of the study, a higher proportion of Cu-IUD and LNG-IUS users (21.1 and 18.6%, respectively) undertook consecutive use of the same method than progestogen-only implant users (10.7%). Manual review of computerized profiles demonstrated the validity of this approach.

    CONCLUSIONS: In the UK, the continuation rates of LARCs are high, and approximately one fifth of women chose to have a second intrauterine device fitted after expiry of the first device. A validation step demonstrated the reliability of the methodology and computer algorithms used.

  • 41. Cea Soriano, Lucía
    et al.
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Andersson, Susan
    Filonenko, Anna
    García Rodríguez, Luis Alberto
    Use of long-acting reversible contraceptives in the UK from 2004 to 2010: Analysis using The Health Improvement Network Database2014In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 19, no 6, p. 439-447Article in journal (Refereed)
    Abstract [en]

    Objectives To determine the use of long-acting reversible contraceptives (LARCs) in the UK over the period 2004 to 2010, using the general practice database The Health Improvement Network (THIN).

    Methods Women in THIN, aged 18 to 44 years during 2004 to 2010, who had been registered with their general practitioner for at least five years, with a prescription history of at least one year were included. THIN was searched using the Read and MULTILEX codes for: copper intrauterine devices (Cu-IUDs), the levonorgestrel releasing-intrauterine system (LNG-IUS), progestogen-only implants, and progestogen-only injections.

    Results The prevalence of progestogen-only implant use rose from 0.5 to 3.4%, and that of the LNG-IUS from 3.1 to 5.2%. The annual incidence and prevalence of progestogen-only implant use increased for all age groups but was most marked in younger women, whereas the use of the LNG-IUS augmented with increasing age. For all women, there was a small decrease in the prevalence of use of Cu-IUDs (from 5.4 to 4.8%) and progestogen-only injections (from 3.6 to 3.2%).

    Conclusions Uptake of progestogen-only implants and the LNG-IUS increased over the period 2004 to 2010 in the UK, but LARC use in young women remains low.

  • 42.
    Chiavaroli, Valentina
    et al.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.
    Hopkins, Sarah A.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.
    Derraik, Jose G. B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Univ Auckland, Liggins Inst, Auckland, New Zealand;Univ Auckland, A Better Start Natl Sci Challenge, Auckland, New Zealand.
    Biggs, Janene B.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.
    Rodrigues, Raquel O.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.
    Brennan, Christine H.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.
    Seneviratne, Sumudu N.
    Univ Auckland, Liggins Inst, Auckland, New Zealand;Univ Colombo, Dept Paediat, Fac Med, Colombo, Sri Lanka.
    Higgins, Chelsea
    Univ Auckland, Liggins Inst, Auckland, New Zealand.
    Baldi, James C.
    Univ Otago, Dunedin Sch Med, Dept Med, Dunedin, New Zealand.
    McCowan, Lesley M. E.
    Univ Auckland, Dept Obstet & Gynaecol, Fac Med & Hlth Sci, Auckland, New Zealand.
    Cutfield, Wayne S.
    Univ Auckland, Liggins Inst, Auckland, New Zealand;Univ Auckland, A Better Start Natl Sci Challenge, Auckland, New Zealand.
    Hofman, Paul L.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.
    Exercise in pregnancy: 1-year and 7-year follow-ups of mothers and offspring after a randomized controlled trial2018In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 12915Article in journal (Refereed)
    Abstract [en]

    There are limited data on long-term outcomes of mothers or their offspring following exercise interventions during pregnancy. We assessed long-term effects of an exercise intervention (home-based stationary cycling) between 20-36 weeks of gestation on anthropometry and body composition in mothers and offspring after 1 and 7 years. 84 women were randomised to intervention or usual activity, with follow-up data available for 61 mother-child pairs (38 exercisers) at 1 year and 57 (33 exercisers) at 7 years. At 1 year, there were no observed differences in measured outcomes between mothers and offspring in the two groups. At the 7-year follow-up, mothers were mostly similar, except that exercisers had lower systolic blood pressure (-6.2 mmHg; p = 0.049). However, offspring of mothers who exercised during pregnancy had increased total body fat (+3.2%; p = 0.034) and greater abdominal (+4.1% android fat; p = 0.040) and gynoid (+3.5% gynoid fat; p = 0.042) adiposity compared with controls. Exercise interventions beginning during pregnancy may be beneficial to long-term maternal health. However, the initiation of exercise during pregnancy amongst sedentary mothers may be associated with adverse effects in the offspring during childhood. Larger follow-up studies are required to investigate long-term effects of exercise in pregnancy.

  • 43.
    Cunningham, A. L.
    et al.
    Westmead Inst Med Res, Westmead, NSW, Australia.;Univ Sydney, Sydney, NSW, Australia..
    Lal, H.
    GSK Vaccines, King Of Prussia, PA USA..
    Kovac, M.
    GSK Vaccines, Wavre, Belgium..
    Chlibek, R.
    Univ Def, Fac Mil Hlth Sci, Hradec Kralove, Czech Republic..
    Hwang, S. -J
    Diez-Domingo, J.
    Fdn Fomento Invest Sanitaria & Biomed, Vaccine Res Unit, Valencia, Spain..
    Godeaux, O.
    GSK Vaccines, Wavre, Belgium..
    Levin, M. J.
    Univ Colorado, Dept Pediat, Anschutz Med Campus, Aurora, CO USA.;Univ Colorado, Dept Med, Anschutz Med Campus, Aurora, CO USA..
    McElhaney, J. E.
    Hlth Sci North Res Inst, Sudbury, ON, Canada..
    Puig-Barbera, J.
    Fdn Fomento Invest Sanitaria & Biomed, Vaccine Res Unit, Valencia, Spain..
    Abeele, C. Vanden
    GSK Vaccines, Wavre, Belgium..
    Vesikari, T.
    Univ Tampere, Vaccine Res Ctr, Tampere, Finland..
    Watanabe, D.
    Aichi Med Univ, Dept Dermatol, Nagakute, Aichi, Japan..
    Zahaf, T.
    GSK Vaccines, Wavre, Belgium..
    Ahonen, A.
    Univ Tampere, Vaccine Res Ctr, Tampere, Finland..
    Athan, E.
    Deakin Univ, Barwon Hlth, Dept Infect Dis, Geelong, Vic, Australia..
    Barba-Gomez, J. F.
    Inst Dermatol Jalisco Dr Jose Barba Rubio, Zapopan, Mexico..
    Campora, L.
    GSK Vaccines, Wavre, Belgium..
    de Looze, F.
    Univ Queensland, Sch Med, AusTrials, Brisbane, Qld, Australia.;Univ Queensland, Sch Med, Discipline Gen Practice, Brisbane, Qld, Australia..
    Downey, H. J.
    Jacksonville Ctr Clin Res, Jacksonville, FL USA..
    Ghesquiere, W.
    Univ British Columbia, Infect Dis Sect, Victoria, BC, Canada..
    Gorfinkel, I.
    PrimeHlth Clin Res, Toronto, ON, Canada..
    Korhonen, T.
    Univ Tampere, Vaccine Res Ctr, Tampere, Finland..
    Leung, E.
    United Christian Hosp, Dept Med & Geriatr, Div Geriatr Med, Hong Kong, Hong Kong, Peoples R China..
    McNeil, S. A.
    Dalhousie Univ, IWK Hlth Ctr, Canadian Ctr Vaccinol, Halifax, NS, Canada.;Dalhousie Univ, Nova Scotia Hlth Author, Halifax, NS, Canada..
    Oostvogels, L.
    GSK Vaccines, Wavre, Belgium..
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Sormland Cty Council, Clin Res Ctr, Eskilstuna, Sweden..
    Smetana, J.
    Univ Def, Fac Mil Hlth Sci, Hradec Kralove, Czech Republic..
    Weckx, L.
    Univ Fed Sao Paulo, Ctr Referencia Imunobiol Especiais, Sao Paulo, Brazil..
    Yeo, W.
    Univ Wollongong, Grad Sch Med, Illawarra Hlth & Med Res Inst, Wollongong, NSW, Australia..
    Heineman, T. C.
    GSK Vaccines, King Of Prussia, PA USA..
    Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older2016In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 375, no 11, p. 1019-1032Article in journal (Refereed)
    Abstract [en]

    BACKGROUND A trial involving adults 50 years of age or older (ZOE-50) showed that the herpes zoster subunit vaccine (HZ/su) containing recombinant varicella-zoster virus glycoprotein E and the AS01(B) adjuvant system was associated with a risk of herpes zoster that was 97.2% lower than that associated with placebo. A second trial was performed concurrently at the same sites and examined the safety and efficacy of HZ/su in adults 70 years of age or older (ZOE-70). METHODS This randomized, placebo-controlled, phase 3 trial was conducted in 18 countries and involved adults 70 years of age or older. Participants received two doses of HZ/su or placebo (assigned in a 1: 1 ratio) administered intramuscularly 2 months apart. Vaccine efficacy against herpes zoster and postherpetic neuralgia was assessed in participants from ZOE-70 and in participants pooled from ZOE-70 and ZOE-50. RESULTS In ZOE-70, 13,900 participants who could be evaluated (mean age, 75.6 years) received either HZ/su (6950 participants) or placebo (6950 participants). During a mean follow-up period of 3.7 years, herpes zoster occurred in 23 HZ/su recipients and in 223 placebo recipients (0.9 vs. 9.2 per 1000 person-years). Vaccine efficacy against herpes zoster was 89.8% (95% confidence interval [CI], 84.2 to 93.7; P<0.001) and was similar in participants 70 to 79 years of age (90.0%) and participants 80 years of age or older (89.1%). In pooled analyses of data from participants 70 years of age or older in ZOE-50 and ZOE-70 (16,596 participants), vaccine efficacy against herpes zoster was 91.3% (95% CI, 86.8 to 94.5; P<0.001), and vaccine efficacy against postherpetic neuralgia was 88.8% (95% CI, 68.7 to 97.1; P<0.001). Solicited reports of injection-site and systemic reactions within 7 days after injection were more frequent among HZ/su recipients than among placebo recipients (79.0% vs. 29.5%). Serious adverse events, potential immune-mediated diseases, and deaths occurred with similar frequencies in the two study groups. CONCLUSIONS In our trial, HZ/su was found to reduce the risks of herpes zoster and postherpetic neuralgia among adults 70 years of age or older. (Funded by GlaxoSmithKline Biologicals; ZOE-50 and ZOE-70 ClinicalTrials.govnumbers, NCT01165177 and NCT01165229.)

  • 44.
    Derraik, Jose G. B.
    et al.
    Univ Auckland, Liggins Inst, Auckland 1, New Zealand..
    Ahlsson, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Diderholm, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lundgren, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Obesity rates in two generations of Swedish women entering pregnancy, and associated obesity risk among adult daughters2015In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 5, article id 16692Article in journal (Refereed)
    Abstract [en]

    We examined changes in obesity rates in two generations of Swedish women entering pregnancy, and assessed the effects of maternal body mass index (BMI) on the risk of overweight or obesity among adult daughters. This study covered an intergenerational retrospective cohort of 26,561 Swedish mothers and their 26,561 first-born daughters. There was a 4-fold increase in obesity rates, which rose from 3.1% among women entering pregnancy in 1982-1988 to 12.3% among their daughters in 2000-2008 (p < 0.0001) when entering pregnancy. The greater the maternal BMI, the greater the odds of overweight and/or obesity among daughters. Underweight mothers had half the odds of having an overweight or obese daughter in comparison to mothers of normal BMI (p < 0.0001). In contrast, the odds ratio of obese mothers having obese daughters was 3.94 (p < 0.0001). This study showed a strong association between maternal obesity and the risk of obesity among their first-born daughters. In addition, we observed a considerable increase in obesity rates across generations in mother-daughter pairs of Swedish women entering pregnancy. Thus, it is important to have preventative strategies in place to halt the worsening intergenerational cycle of obesity.

  • 45.
    Edgren, Gustaf
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Box 281, SE-17177 Stockholm, Sweden..
    Hjalgrim, Henrik
    Statens Serum Inst, Dept Epidemiol Res, 5 Artillerivej, DK-2300 Copenhagen S, Denmark..
    Rostgaard, Klaus
    Statens Serum Inst, Dept Epidemiol Res, 5 Artillerivej, DK-2300 Copenhagen S, Denmark..
    Lambert, Paul
    Univ Leicester, Dept Hlth Sci, Adrian Bldg,Univ Rd, Leicester LE1 7RH, Leics, England. Uppsala Univ, Dept Immunol Genet & Pathol, Akad Sjukhuset, SE-75185 Uppsala, Sweden..
    Wikman, Agneta
    Karolinska Univ Hosp, Dept Clin Immunol & Transfus Med, C2 66 Huddinge, SE-17777 Stockholm, Sweden..
    Norda, Rut
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Titlestad, Kjell-Einar
    Odense Univ Hosp, Dept Clin Immunol, Sondre Blvd 29, DK-5000 Odense, Denmark..
    Erikstrup, Christian
    Aarhus Univ Hosp, Dept Clin Immunol, Palle Juul Jensens Blvd 99, DK-8000 Aarhus, Denmark. Stanford Univ, Sch Med, Stanford, CA 94305 USA..
    Ullum, Henrik
    Copenhagen Univ Hosp, Dept Clin Immunol, Blegdamsvej 9, DK-2100 Copenhagen, Denmark..
    Melbye, Mads
    Statens Serum Inst, Dept Epidemiol Res, 5 Artillerivej, DK-2300 Copenhagen S, Denmark..
    Busch, Michael P.
    Blood Syst Res Inst, 270 Masonic Ave, San Francisco, CA 94118 USA. Univ Calif San Francisco, San Francisco, CA USA..
    Nyren, Olof
    Karolinska Inst, Dept Med Epidemiol & Biostat, Box 281, SE-17177 Stockholm, Sweden..
    Transmission of Neurodegenerative Disorders Through Blood Transfusion A Cohort Study2016In: Annals of Internal Medicine, ISSN 0003-4819, E-ISSN 1539-3704, Vol. 165, no 5, p. 316-+Article in journal (Refereed)
    Abstract [en]

    Background: The aggregation of misfolded proteins in the brain occurs in several neurodegenerative disorders. Aberrant protein aggregation is inducible in rodents and primates by intracerebral inoculation. Possible transfusion transmission of neurodegenerative diseases has important public health implications. Objective: To investigate possible transfusion transmission of neurodegenerative disorders. Design: Retrospective cohort study. Setting: Nationwide registers of transfusions in Sweden and Denmark. Participants: 1 465 845 patients who received transfusions between 1968 and 2012. Measurements: Multivariable Cox regression models were used to estimate hazard ratios for dementia of any type, Alzheimer disease, and Parkinson disease in patients receiving blood transfusions from donors who were later diagnosed with any of these diseases versus patients who received blood from healthy donors. Whether excess occurrence of neurodegenerative disease occurred among recipients of blood from a subset of donors was also investigated. As a positive control, transmission of chronic hepatitis before and after implementation of hepatitis C virus screening was assessed. Results: Among included patients, 2.9% received a transfusion from a donor diagnosed with one of the studied neurodegenerative diseases. No evidence of transmission of any of these diseases was found, regardless of approach. The hazard ratio for dementia in recipients of blood from donors with dementia versus recipients of blood from healthy donors was 1.04 (95% CI, 0.99 to 1.09). Corresponding estimates for Alzheimer disease and Parkinson disease were 0.99 (CI, 0.85 to 1.15) and 0.94 (CI, 0.78 to 1.14), respectively. Hepatitis transmission was detected before but not after implementation of hepatitis C virus screening. Limitation: Observational study design, underascertainment of the outcome, and possible insufficient statistical power. Conclusion: The data provide no evidence for the transmission of neurodegenerative diseases and suggest that if transmission does occur, it is rare.

  • 46.
    Eldh, Ann Catrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Dalarna Univ, Sch Hlth & Social Sci, Falun, Sweden..
    Wallin, Lars
    Dalarna Univ, Sch Hlth & Social Sci, Falun, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Stockholm, Sweden..
    Fredriksson, Mio
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Vengberg, Sofie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Halford, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Dahlström, Tobias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Factors facilitating a national quality registry to aid clinical quality improvement: findings of a national survey2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 11, article id e011562Article in journal (Refereed)
    Abstract [en]

    Objectives: While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement. Methods: Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression. Results: A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R-2=0.76) with 'Colleagues' call for local results' (p=<0.001), 'Management Request of Registry data' (p=<0.001), and it was said to be 'Simple to explain the results to colleagues' (p=0.02). Using stepwise regression, 'Colleagues' call for local results' was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results. Conclusions: While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives.

  • 47.
    Elwer, Sofia
    et al.
    Umeå universitet, Allmänmedicin.
    Alex, Lena
    Umeå universitet, Institutionen för omvårdnad.
    Hammarström, Anne
    Umeå universitet, Allmänmedicin.
    Gender (in)equality among employees in elder care: implications for health2012In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 11, no 1Article in journal (Refereed)
    Abstract [en]

    Introduction: Gendered practices of working life create gender inequalities through horizontal and vertical gender segregation in work, which may lead to inequalities in health between women and men. Gender equality could therefore be a key element of health equity in working life. Our aim was to analyze what gender (in) equality means for the employees at a woman-dominated workplace and discuss possible implications for health experiences.

    Methods: All caregiving staff at two workplaces in elder care within a municipality in the north of Sweden were invited to participate in the study. Forty-five employees participated, 38 women and 7 men. Seven focus group discussions were performed and led by a moderator. Qualitative content analysis was used to analyze the focus groups.

    Results: We identified two themes. "Advocating gender equality in principle" showed how gender (in) equality was seen as a structural issue not connected to the individual health experiences. "Justifying inequality with individualism" showed how the caregivers focused on personalities and interests as a justification of gender inequalities in work division. The justification of gender inequality resulted in a gendered work division which may be related to health inequalities between women and men. Gender inequalities in work division were primarily understood in terms of personality and interests and not in terms of gender.

    Conclusion: The health experience of the participants was affected by gender (in) equality in terms of a gendered work division. However, the participants did not see the gendered work division as a gender equality issue. Gender perspectives are needed to improve the health of the employees at the workplaces through shifting from individual to structural solutions. A healthy-setting approach considering gender relations is needed to achieve gender equality and fairness in health status between women and men.

  • 48.
    Enroth, Stefan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Hallmans, Göran
    Umea Univ, Dept Biobank Res, SE-90187 Umea, Sweden..
    Grankvist, Kjell
    Umea Univ, Dept Med Biosci, Clin Chem, SE-90185 Umea, Sweden..
    Gyllensten, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Effects of Long-Term Storage Time and Original Sampling Month on Biobank Plasma Protein Concentrations2016In: EBioMedicine, ISSN 0360-0637, E-ISSN 2352-3964, Vol. 12, p. 309-314Article in journal (Refereed)
    Abstract [en]

    The quality of clinical biobank samples is crucial to their value for life sciences research. A number of factors related to the collection and storage of samples may affect the biomolecular composition. We have studied the effect of long-time freezer storage, chronological age at sampling, season and month of the year and on the abundance levels of 108 proteins in 380 plasma samples collected from 106 Swedish women. Storage time affected 18 proteins and explained 4.8-34.9% of the observed variance. Chronological age at sample collection after adjustment for storage-time affected 70 proteins and explained 1.1-33.5% of the variance. Seasonal variation had an effect on 15 proteins and month (number of sun hours) affected 36 proteins and explained up to 4.5% of the variance after adjustment for storage-time and age. The results show that freezer storage time and collection date (month and season) exerted similar effect sizes as age on the protein abundance levels. This implies that information on the sample handling history, in particular storage time, should be regarded as equally prominent covariates as age or gender and need to be included in epidemiological studies involving protein levels.

  • 49.
    Eriksson, D.
    et al.
    Karolinska Inst, Dept Med Solna, Ctr Mol Med, Stockholm, Sweden.;Metab & Diabet Karolinska Univ Hosp, Dept Endocrinol, Stockholm, Sweden..
    Bianchi, Matteo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Landegren, Nils
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Autoimmunity. Uppsala University, Science for Life Laboratory, SciLifeLab. Karolinska Inst, Dept Med Solna, Ctr Mol Med, Stockholm, Sweden..
    Nordin, Jessika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Dalin, Frida
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Dermatology and Venereology. Uppsala University, Science for Life Laboratory, SciLifeLab. Karolinska Inst, Dept Med Solna, Ctr Mol Med, Stockholm, Sweden..
    Mathioudaki, Argyri
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Eriksson, G. N.
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Hultin-Rosenberg, Lina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Dahlqvist, Johanna
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Zetterqvist, H.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Hallgren, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Science for Life Laboratory, SciLifeLab. Karolinska Inst, Dept Med Solna, Ctr Mol Med, Stockholm, Sweden..
    Farias, F. H. G.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Murén, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Ahlgren, Kerstin M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Autoimmunity. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Lobell, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Autoimmunity. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Andersson, G.
    Swedish Univ Agr Sci, Dept Anim Breeding & Genet, Uppsala, Sweden..
    Tandre, Karolina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Rheumatology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Dahlqvist, S. R.
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Soderkvist, P.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Rönnblom, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Rheumatology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Hulting, A. -L
    Wahlberg, J.
    Linkoping Univ, Dept Endocrinol, Dept Med & Hlth Sci, Dept Clin & Expt Med, Linkoping, Sweden..
    Ekwall, O.
    Univ Gothenburg, Sahlgrenska Acad, Dept Pediat, Inst Clin Sci, Gothenburg, Sweden.;Univ Gothenburg, Dept Rheumatol & Inflammat Res, Inst Med, Sahlgrenska Acad, Gothenburg, Sweden..
    Dahlqvist, P.
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Meadows, Jennifer R. S.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Bensing, S.
    Metab & Diabet Karolinska Univ Hosp, Dept Endocrinol, Stockholm, Sweden.;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Lindblad-Toh, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Science for Life Laboratory, SciLifeLab. Broad Inst MIT & Harvard, Cambridge, MA USA..
    Kämpe, Olle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Autoimmunity. Uppsala University, Science for Life Laboratory, SciLifeLab. Karolinska Inst, Dept Med Solna, Ctr Mol Med, Stockholm, Sweden.;Metab & Diabet Karolinska Univ Hosp, Dept Endocrinol, Stockholm, Sweden..
    Pielberg, Gerli R.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Genomics.
    Extended exome sequencing identifies BACH2 as a novel major risk locus for Addison's disease2016In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 286, no 6, p. 595-608Article in journal (Refereed)
    Abstract [en]

    BackgroundAutoimmune disease is one of the leading causes of morbidity and mortality worldwide. In Addison's disease, the adrenal glands are targeted by destructive autoimmunity. Despite being the most common cause of primary adrenal failure, little is known about its aetiology. MethodsTo understand the genetic background of Addison's disease, we utilized the extensively characterized patients of the Swedish Addison Registry. We developed an extended exome capture array comprising a selected set of 1853 genes and their potential regulatory elements, for the purpose of sequencing 479 patients with Addison's disease and 1394 controls. ResultsWe identified BACH2 (rs62408233-A, OR = 2.01 (1.71-2.37), P = 1.66 x 10(-15), MAF 0.46/0.29 in cases/controls) as a novel gene associated with Addison's disease development. We also confirmed the previously known associations with the HLA complex. ConclusionWhilst BACH2 has been previously reported to associate with organ-specific autoimmune diseases co-inherited with Addison's disease, we have identified BACH2 as a major risk locus in Addison's disease, independent of concomitant autoimmune diseases. Our results may enable future research towards preventive disease treatment.

  • 50.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Födelseviktens betydelse för utveckling av kardiovaskulära riskfaktorer, sjukdom och död: män födda 1913 och följda framgent2003Other (Other academic)
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