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  • 1.
    Kalliokoski, Paul
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    20th Wonca Europe Conference 2015 Istanbul2016In: Distriktsläkaren, ISSN 0283-9830, no 1, p. 28-31Article in journal (Other (popular science, discussion, etc.))
  • 2.
    Kalliokoski, Paul
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Vitamin D, muscle strength, prolonged labour, Caesarean sections and lifestyle: Clinical and intervention studies in pregnant Somali and Swedish women and new mothers2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Long-term severe vitamin D deficiency may cause osteomalacia with muscle weakness, pain, soft bones, cramps and eventually death. In a pilot study, I found many Somali women to be vitamin D deficient and very weak. This raised my interest and resulted in the research questions regarding if and how this weakness was linked to vitamin D deficiency, if it could be treated with simple lifestyle advice and supplementation, and if pronounced deficiency could cause serious birth outcomes due to prolonged labour?

    Study I showed that 90% of pregnant Somali women (n = 52) and new mothers from primary antenatal care suffered from vitamin D deficiency with pronounced muscular weakness and signs of skeletal degradation, compared with 10% of the Swedish women (n = 71). Handgrip strength was predicted by vitamin D levels.

    Study II showed that vitamin D supplementation among those with insufficient levels at baseline reversed deficiency and skeletal degradation. Furthermore, increased strength in hands and legs was predicted by the amount of supplement intake.

    Study III aimed to investigate the vitamin D levels and the birth outcomes of cesarean sections and assisted birth for prolonged labour. A directed acyclic graph was established to adjust for covariates. A causal effect of critically low (unmeasurable) vitamin D levels on the outcomes of caesarean sections, emergency caesarean sections and assisted birth for prolonged labour was found with the increased odds of four, nine and six times to one for the birth outcomes, respectively.

    Lifestyle associated with vitamin D may concern many due to risk of low sun exposure, for example, when working long office hours, engaging in excessive computer gaming, using sunscreen, wearing veiled clothes, or when having special diets like vegan food.

    It is important to monitor individuals in primary- and antenatal care with muscle weakness and risk factors for vitamin D deficiency, especially in the high-risk group of Somali pregnant women and new mothers.         

    List of papers
    1. Physical performance and 25-hydroxyvitamin D: a cross-sectional study of pregnant Swedish and Somali immigrant women and new mothers
    Open this publication in new window or tab >>Physical performance and 25-hydroxyvitamin D: a cross-sectional study of pregnant Swedish and Somali immigrant women and new mothers
    2013 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 13, article id 237Article in journal (Refereed) Published
    Abstract [en]

    Background:

    Severe vitamin D deficiency can impair muscle strength. The study aims were to examine physical performance in the hands and upper legs, and analyze plasma 25-hydroxyvitamin D (25(OH) D) concentrations in women with presumably low (veiled, Somali-born) and high levels (unveiled, Swedish-born).

    Methods:

    Women (n = 123, 58% Swedish) enrolled at a Swedish antenatal clinic, latitude 60 degrees N, were recruited. Plasma 25(OH) D was analyzed, measured as nmol/L, then categorized as <10 = undetectable, 10-24, 25-49, 50-74 or >75. Muscle strength was tested: maximal hand grip strength (in Newtons, N), and upper leg performance (categorized as able/unable to perform squatting, standing on one leg, standing from a chair, and lifting their hips). Social and anthropometric data were collected. Non-parametric statistics tested the data for differences in their ability to perform the tests across 25(OH) D categories. Undetectable values (< 10 nmol/L) were replaced with '9' in the linear correlation statistics. A final main effect model for grip strength (in N) was calculated using stepwise linear regression for independent variables: country of birth, 25(OH) D levels, age, height, weight, physical activity, lactation status, parity, and gestational age.

    Results:

    Somali participants (35%) had 25(OH) D levels of < 10 nmol/L, and 90% had < 25 nmol/L; 10% of Swedish participants had < 25 nmol/L of 25(OH) D, and 54% had < 50 nmol/L. Somali women had a relatively weak grip strength compared with Swedish women: median 202 N (inter-quartile range 167-246) vs. median 316 N (inter-quartile range 278-359), respectively. Somali women were also weak in upper leg performance: 73% were unable to squat, 29% unable to stand on one leg, and 21% could not lift their hips (not significant across 25(OH) D categories); most Swedish women could perform these tests. In the final model, grip strength (N) was significantly associated with 25(OH) D levels (B 0.94, p=0.013) together with Somali birth (B -63.9, p<0.001), age (B 2.5, p=0.02) and height (B 2.6, p=0.01).

    Conclusions:

    Many Somali women had undetectable/severely low 25(OH) D concentrations and pronounced hand and upper leg weakness; grip strength was strongly associated with 25(OH) D. Maternity health care personnel should be aware of this increased frequency and manage care accordingly.

    Keywords
    Vitamin D, 25(OH)D, Ultraviolet B radiation, Grip strength, Clinical observation, Physical performance, Primary care, Somalia, Pregnancy
    National Category
    General Practice
    Identifiers
    urn:nbn:se:uu:diva-217631 (URN)10.1186/1471-2393-13-237 (DOI)000329252000003 ()
    Available from: 2014-02-06 Created: 2014-02-04 Last updated: 2019-09-05Bibliographically approved
    2. Critically low vitamin D may cause emergency caesarean sections:a cohort study of Somali and Swedish women in antenatal primary care
    Open this publication in new window or tab >>Critically low vitamin D may cause emergency caesarean sections:a cohort study of Somali and Swedish women in antenatal primary care
    (English)Manuscript (preprint) (Other academic)
    Keywords
    Caesarean section, dystocia, immigrant, muscle strength, obstetric labour 70 complications, osteomalacia, Somalia, vitamin D
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Research subject
    Obstetrics and Gynaecology
    Identifiers
    urn:nbn:se:uu:diva-392423 (URN)
    Available from: 2019-09-03 Created: 2019-09-03 Last updated: 2019-09-05
    3. Long-term adherence and effects on grip strength and upper leg performance of prescribed supplemental vitamin D in pregnant and recently pregnant women of Somali and Swedish birth with 25-hydroxyvitamin D deficiency: a before-and-after treatment study
    Open this publication in new window or tab >>Long-term adherence and effects on grip strength and upper leg performance of prescribed supplemental vitamin D in pregnant and recently pregnant women of Somali and Swedish birth with 25-hydroxyvitamin D deficiency: a before-and-after treatment study
    2016 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 353Article in journal (Refereed) Published
    Abstract [en]

    Background: Muscular weakness and severe vitamin D deficiency is prevalent in Somali (veiled) pregnant women, Sweden. The study aims here were to explore adherence to prescribed supplemental vitamin D in new mothers with vitamin D deficiency and its effects on grip strength and upper leg performance in Somali (target group TG) and Swedish women (reference group RG) from spring through winter.

    Methods: A before-and after study was designed. A cross-sectional sample of women in antenatal care with serum 25-OHD <= 50 nmol/L were prescribed one or two tablets daily (800 or 1600 IU vitamin D3 with calcium) for 10 months. Reminders were made by Somali nurses (TG) or Swedish doctors (RG). Baseline and 10 month measurements of plasma nmol/L 25-OHD, maximal grip strength held for 10 s (Newton, N) and ability to squat (yes; no) were done. Total tablet intake (n) was calculated. Outcome variables were changes from baseline in grip strength and ability to squat. Predicting variables for change in grip strength and ability to squat were calculated using linear and binary regression in final models. Undetectable 25-OHD values (< 10 nmol/L) were replaced with '9' in statistic calculations.

    Results: Seventy-one women (46 TG, 1/3 with undetectable baseline 25-OHD; 25 RG) participated. At the 10-month follow up, 17% TG and 8% RG women reported having refrained from supplement. Mean 25-OHD increased 16 to 49 nmol/L (TG) and 39 nmol/L to 67 nmol/L (RG), (both p < 0.001). Grip strength had improved from 153 to 188 N (TG) (p < 0.001) and from 257 to 297 N (RG) (p = 0.003) and inability to squat had decreased in TG (35 to 9, p < 0. 001). Intake of number of tablets predicted increased grip strength (B 0.067, 95% CI 0.008-0.127, p = 0.027). One tablet daily (> 300 in total) predicted improved ability to squat (OR 16; 95% CI 1.8-144.6).

    Conclusions: Adherence to supplemental vitamin D and calcium should be encouraged as an even moderate intake was associated to improved grip strength and upper leg performance, which was particularly useful for the women with severe 25-OHD deficiency and poor physical performance at baseline.

    Keywords
    Adherence, Multicultural care, Vitamin D, Physical performance, Grip strength, Pregnancy, Somalia
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-309795 (URN)10.1186/s12884-016-1117-3 (DOI)000387608700001 ()27846821 (PubMedID)
    Available from: 2016-12-21 Created: 2016-12-07 Last updated: 2019-09-05Bibliographically approved
    4. Impact on Vitamin D related lifestyle in Somali women with severe deficiency following medical advice by doctor: A mixed method study of before and after treatment
    Open this publication in new window or tab >>Impact on Vitamin D related lifestyle in Somali women with severe deficiency following medical advice by doctor: A mixed method study of before and after treatment
    (English)Manuscript (preprint) (Other academic)
    Keywords
    Clinical trial, Food, Lifestyle, Somalia, Vitamin D, Pregnant
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Family Medicine
    Identifiers
    urn:nbn:se:uu:diva-392424 (URN)
    Available from: 2019-09-03 Created: 2019-09-03 Last updated: 2019-09-05
  • 3.
    Kalliokoski, Paul
    et al.
    Primary Care Center Jakobsgårdarna, Jaxtorget 7A, Box 100 33 Borlänge S-781 10, Sweden.
    Bergqvist, Yngve
    Löfvander, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Physical performance and 25-hydroxyvitamin D: a cross-sectional study of pregnant Swedish and Somali immigrant women and new mothers2013In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 13, article id 237Article in journal (Refereed)
    Abstract [en]

    Background:

    Severe vitamin D deficiency can impair muscle strength. The study aims were to examine physical performance in the hands and upper legs, and analyze plasma 25-hydroxyvitamin D (25(OH) D) concentrations in women with presumably low (veiled, Somali-born) and high levels (unveiled, Swedish-born).

    Methods:

    Women (n = 123, 58% Swedish) enrolled at a Swedish antenatal clinic, latitude 60 degrees N, were recruited. Plasma 25(OH) D was analyzed, measured as nmol/L, then categorized as <10 = undetectable, 10-24, 25-49, 50-74 or >75. Muscle strength was tested: maximal hand grip strength (in Newtons, N), and upper leg performance (categorized as able/unable to perform squatting, standing on one leg, standing from a chair, and lifting their hips). Social and anthropometric data were collected. Non-parametric statistics tested the data for differences in their ability to perform the tests across 25(OH) D categories. Undetectable values (< 10 nmol/L) were replaced with '9' in the linear correlation statistics. A final main effect model for grip strength (in N) was calculated using stepwise linear regression for independent variables: country of birth, 25(OH) D levels, age, height, weight, physical activity, lactation status, parity, and gestational age.

    Results:

    Somali participants (35%) had 25(OH) D levels of < 10 nmol/L, and 90% had < 25 nmol/L; 10% of Swedish participants had < 25 nmol/L of 25(OH) D, and 54% had < 50 nmol/L. Somali women had a relatively weak grip strength compared with Swedish women: median 202 N (inter-quartile range 167-246) vs. median 316 N (inter-quartile range 278-359), respectively. Somali women were also weak in upper leg performance: 73% were unable to squat, 29% unable to stand on one leg, and 21% could not lift their hips (not significant across 25(OH) D categories); most Swedish women could perform these tests. In the final model, grip strength (N) was significantly associated with 25(OH) D levels (B 0.94, p=0.013) together with Somali birth (B -63.9, p<0.001), age (B 2.5, p=0.02) and height (B 2.6, p=0.01).

    Conclusions:

    Many Somali women had undetectable/severely low 25(OH) D concentrations and pronounced hand and upper leg weakness; grip strength was strongly associated with 25(OH) D. Maternity health care personnel should be aware of this increased frequency and manage care accordingly.

  • 4.
    Kalliokoski, Paul
    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.
    Nohlert, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. 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, Centre for Clinical Research, County of Västmanland.
    Rodhe, Nils
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Löfvander, Monica
    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, Centre for Clinical Research, County of Västmanland.
    Critically low vitamin D may cause emergency caesarean sections:a cohort study of Somali and Swedish women in antenatal primary careManuscript (preprint) (Other academic)
  • 5.
    Kalliokoski, Paul
    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.
    Widarsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Rodhe, Nils
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Löfvander, Monica
    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, Centre for Clinical Research, County of Västmanland.
    Impact on Vitamin D related lifestyle in Somali women with severe deficiency following medical advice by doctor: A mixed method study of before and after treatmentManuscript (preprint) (Other academic)
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