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  • 101. Faresjö, Å
    et al.
    Grodzinsky, E
    Johansson, Saga
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Timpka, T
    Åkerlind, I
    A population-based case-control study of work and psychosocial problems in patients with irritable bowel syndrome: women are more seriously affected than men2007In: American Journal of Gastroenterology, ISSN 0002-9270, E-ISSN 1572-0241, Vol. 102, no 2, p. 371-379Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Everyday psychosocial functioning and quality of life are known to be reduced for patients with irritable bowel syndrome (IBS), but few previous studies have analyzed associations with functioning in working life. Accordingly, we examined perceptions of working conditions, functioning in the workplace, quality of life, and psychological complaints among IBS patients compared with age- and sex-matched controls. METHODS: A case-control study design was used based on 347 IBS patients from Swedish general practice who were compared with age- and sex-matched controls (N = 1,041) randomly selected from the general population. A survey was performed including validated questions concerning job strain, quality of life (SF-36 [Short Form 36]), absence because of illness, depression, anxiety, and sleeping habits. RESULTS: The IBS patients reported considerably more often that their daily performance in working life was affected by their gastrointestinal problems (OR [odds ratio] 7.14, 95% CI 5.45-9.36). Male IBS cases only reported less authority regarding decisions on their working pace (OR 5.44, 95% CI 1.28-23.18), while female IBS patients reported less decision authority regarding planning their work (OR 2.29, 95% CI 1.13-4.64), fewer learning opportunities at work (OR 2.12, 95% CI 1.26-3.57), and more long-term sick leave than their controls (OR 3.70, 95% CI 1.94-7.07). The female IBS cases also reported lower quality of life in all dimensions than their controls. CONCLUSION: In particular, female IBS patients reported lower authority over decisions at work and problems in their daily functioning in the workplace. These associations persisted after adjustments for possible confounders such as mood, sleeping problems, and perceived health.

  • 102. Faresjö, Å
    et al.
    Grodzinsky, E
    Johansson, Saga
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Timpka, T
    Åkerlind, I
    Psychosocial factors at work and in every day life are associated with irritable bowel syndrome2007In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 22, no 7, p. 473-480Article in journal (Refereed)
    Abstract [en]

    The etiology of irritable bowel syndrome (IBS) tends to be complex and multi-factorial and there is still a lack of understanding of how different psychosocial factors are associated with the syndrome. Our aim was to examine the occurrence of psychosocial and behavioural factors among patients diagnosed with IBS in primary care. The study had an epidemiological population-based case-control design comparing 347 IBS cases to 1041 age and sex matched controls from the general population. A survey was directed to cases and controls based on validated questions asking for mood status, job strain, family history of IBS, and sleeping habits as well as education, nutritional and exercise habits and medication. In multivariate analyses, independent associations were found between IBS and lack of influence on work planning, a family history of IBS, anxiety, and sleeping disturbances. Important factors associated with IBS diagnosis among females were anxiety as well as family history of IBS and lack of co-determination at work. For males, only lack of influence on working pace and family history of IBS remained independently associated with an IBS diagnosis. The causal associations of the complex risk factor panorama for IBS warrants further study. This study indicates that there should be a special focus on investigating the psychosocial working conditions and their associations to IBS.

  • 103. Faresjö, Åshild
    et al.
    Grodzinsky, Ewa
    Johansson, Saga
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Foldevi, Mats
    Patients with irritable bowel syndrome in Swedish primary care2006In: European Journal of General Practice, ISSN 1381-4788, E-ISSN 1751-1402, Vol. 12, no 2, p. 88-90Article in journal (Refereed)
  • 104. Garcia Rodriguez, LA
    et al.
    Ruigomez, A
    Hasselgren, G
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johanson, Saga
    Comparison of mortality from peptic ulcer bleed between patients with or without peptic ulcer antecedents.1998In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 9, no 4, p. 452-456Article in journal (Refereed)
    Abstract [en]

    We studied mortality related to peptic ulcer bleed in a well defined cohort of patients in the month after the episode of peptic ulcer bleed. Our objective was to assess the contribution of peptic ulcer antecedents and other predictive factors on the risk of dying. The study cohort comprised 1,020 patients hospitalized for an episode of peptic ulcer bleed between January 1991 and March 1994 and identified in the General Practice Research Database in the United Kingdom. Six hundred twenty-three patients had no prior episode of peptic ulcer disease, and 384 had peptic ulcer antecedents; for 13 patients, information was not available. Forty-five patients died (mortality rate = 4.4 per 100 person-months; 95% confidence interval = 3.3-5.9) within 1 month of the peptic ulcer bleed. Patients with no peptic ulcer antecedent faced a greater risk of dying than patients with antecedents (relative risk = 3.0; 95% confidence interval = 1.2-7.1). Elderly patients, those undergoing surgery, and current users of acid-suppressing drugs or nonsteroidal antiinflammatory drugs all had an increased mortality risk. Patients presenting with their first-ever episode of peptic ulcer bleed have a higher case fatality rate than those with previous episodes of peptic ulcer.

  • 105. Garcia Rodriguez, LA
    et al.
    Ruigomez, A
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Saga
    Olbe, L
    Detection of colorectal tumor and inflammatory bowel disease duringfollow-up of patients with initial diagnosis of irritable bowel syndrome.2000In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 35, no 3, p. 306-311Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    We wanted to estimate the incidence of irritable bowel syndrome (IBS) and functional dyspepsia (FD) in the general population, and the detection of colorectal tumor (CRT) and inflammatory bowel disease (IBD) after the diagnosis of IBS and FD.

    METHODS

    Patients aged 20-79 years newly diagnosed with IBS (N = 2956) or FD (N = 9900), together with a comparison cohort randomly sampled from the general source population, were followed-up during a mean time of 3 years.

    RESULTS

    We found an overall incidence of 10.3 per 1000 person-years for FD and 2.6 per 1000 person-years for IBS. There was a greater prevalence of depression, stress, fatigue, and pain disorders among IBS and FD patients than in the general population. During the 1st year after a diagnosis of IBS the cumulative risk of detecting CRT was close to 1% in IBS patients. After the 1st year the risk of CRT in IBS patients was close to that in the general population. We found a significantly increased risk of detecting IBD among patients initially diagnosed as having IBS (relative risk (RR), 16.3; 95% confidence interval (CI), 6.6-40.7), which was constant during all the follow-up period. No association was found between dyspepsia and CRT, or IBD.

    CONCLUSION

    IBS and FD shared some comorbidity features, yet demographics and incidence rates were different. Unlike the detection of colorectal tumor, the excess risk of IBD after an initial diagnosis of IBS was cumulatively increased during all the follow-up period. The continuously increased risk of IBD detection in IBS patients favors a true association between IBS and IBD.

  • 106. Garcia Rodriguez, Luis A.
    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 Clinical Epidemiology.
    Martin-Merino, Elisa
    Johansson, Saga
    Heart failure, myocardial infarction, lung cancer and death in COPD patients: A UK primary care study2010In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 104, no 11, p. 1691-1699Article in journal (Refereed)
    Abstract [en]

    Background: The leading comorbidities and causes of death in patients with chronic obstructive pulmonary disease (COPD) are lung cancer and cardiovascular disease. The aim of this study was to establish the incidence of lung cancer, myocardial infarction and heart failure in patients with COPD in UK primary care. Methods: The General Practice Research Database (GPRD) was used to identify a cohort of 1927 patients with a first recorded diagnosis of COPD. This cohort was followed for up to 5 years to identify new diagnoses of lung cancer, myocardial infarction and heart failure. Mortality was also assessed. The relative risk (RR) of each outcome in the COPD cohort was compared with that in a control cohort with no diagnosis of COPD. Results: The risk of lung cancer was significantly increased in individuals with a diagnosis of COPD compared with those with no COPD diagnosis (RR: 3.33; 95% confidence interval [Cl]: 2.33-4.75; adjusted for age, sex and smoking status). A diagnosis of COPD was also associated with a significant increase in the risk of heart failure (age- and sex-adjusted RR: 2.94; 95% CI: 2.46-3.51) and death (age- and sex-adjusted RR: 2.76; 95% Cl: 2.45-3.12), but not myocardial infarction (age- and sex-adjusted RR: 1.18; 95% Cl: 0.81-1.71). Conclusions: Patients with a diagnosis of COPD are at significantly increased risk of lung cancer, heart failure and death compared with the general population. They do not appear to be at increased risk of myocardial infarction.

  • 107. Garcia-Rodriguez, Luis Alberto
    et al.
    Gonzalez-Perez, Antonio
    Stang, Mary Rose
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Saga
    The safety of rosuvastatin in comparison with other statins in over 25 000 statin users in the Saskatchewan Health Databases2008In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 17, no 10, p. 953-961Article in journal (Refereed)
    Abstract [en]

    Purpose To compare mortality and the incidence of hospitalization for myopathy, rhabdomyolysis, acute renal failure and acute liver injury in patients receiving rosuvastatin and those taking other statins. Methods Patients prescribed a statin that they had not used before were selected from the Saskatchewan Health Databases (SHD) and followed up from 1 July 2003 until 31 March 2005. Results We studied 10 384 patients on rosuvastatin and 14 854 taking other statins. Two cases of myopathy were identified (one on rosuvastatin, one on another statin). The relative risk (RR) of myopathy in patients currently taking rosuvastatin compared with other statins was 1.31 (95% confidence interval [CI]: 0.13-13.41). Two cases of rhabdomyolysis were detected among current rosuvastatin users (incidence: 2.9 [95% CI: 0.8-10.71 per 10 000 person-years). No cases of acute liver injury occurred among rosuvastatin patients. Seventeen cases of acute renal failure were identified (five among rosuvastatin users, 12 taking other statins). The RR of acute renal failure in current rosuvastatin users compared with other statins was 0.49 (95% CI: 0.16-1.50). We identified 285 deaths during the study period (87 among rosuvastatin users, 198 taking other statins). The RR of death in current rosuvastatin users compared with other statins was 0.42 (95% CI: 0.32-0.57). Conclusions We found no evidence that patients prescribed rosuvastatin were at greater risk of the study outcomes than patients prescribed other statins. There was no evidence of increased mortality among patients taking rosuvastatin, even after allowing for age, sex and prior statin use.

  • 108. García Rodrígues, LA
    et al.
    Mannino, S
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Ocular safety of antiulcer drugs.1995In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 345, no 8956, p. 1059-1060Article in journal (Refereed)
  • 109. García Rodríguez, LA
    et al.
    González-Pérez, A
    Johansson, Saga
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Risk factors for inflammatory bowel disease in the general population2005In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 22, no 4, p. 309-315Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    The aetiology of inflammatory bowel disease remains largely unknown.

    AIM

    We performed a comprehensive assessment of potential risk factors associated with the occurrence of inflammatory bowel disease.

    METHODS

    We identified a cohort of patients 20-84 years old between 1995 and 1997 registered in the General Practitioner Research Database in the UK. A total of 444 incident cases of IBD were ascertained and validated with the general practitioner. We performed a nested case-control analysis using all cases and a random sample of 10 000 frequency-matched controls.

    RESULTS

    Incidence rates for ulcerative colitis, Crohn's disease, and indeterminate colitis were 11, 8, and 2 cases per 100 000 person-years, respectively. Among women, we found that long-term users of oral contraceptives were at increased risk of developing UC (OR: 2.35; 95% CI: 0.89-6.22) and CD (OR: 3.15; 95% CI: 1.24-7.99). Similarly, long-term users of HRT had an increased risk of CD (OR: 2.60; 95% CI: 1.04-6.49) but not UC. Current smokers experienced a reduced risk of UC along with an increased risk of CD. Prior appendectomy was associated with a decreased the risk of UC (OR: 0.37; 95% CI: 0.14-1.00).

    CONCLUSIONS

    Our results support the hypothesis of an increased risk of inflammatory bowel disease associated with oral contraceptives use and suggest a similar effect of hormone replacement therapy on CD. We also confirmed the effects of smoking and appendectomy on inflammatory bowel disease.

  • 110. García Rodríguez, LA
    et al.
    Mannino, S
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Lindblom, B
    A cohort study of the ocular safety of anti-ulcer drugs.1996In: British Journal of Clinical Pharmacology, ISSN 0306-5251, E-ISSN 1365-2125, Vol. 42, no 2, p. 213-216Article in journal (Refereed)
    Abstract [en]

    1. Recently, some cases have been reported where intravenous use of omeprazole was followed by loss of vision. We followed up a cohort of close to 140,000 persons during periods of treatment and non-treatment with five anti-ulcer drugs.

    2. The relative risk of vascular disorders of the eye during use of omeprazole compared with non-use was 1.8 (95% CI 0.5-6.0). Use of other anti-ulcer drugs was associated with a similar risk of vascular disorders. The relative risk associated with current use of any anti-ulcer drug was 1.9 (95% CI 1.1-3.4). We did not find a single case of optic inflammatory disorder during treatment with any of the five anti-ulcer drugs.

    3. These results do not suggest a major increased risk for vascular or inflammatory disorders of the eye associated with use of omeprazole or other anti-ulcer drugs.

  • 111. García Rodríguez, LA
    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 Clinical Epidemiology.
    Johansson, Saga
    Bjorck, S
    Renal disease and acid-suppressing drugs.1997In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 6, no 4, p. 247-251Article in journal (Refereed)
    Abstract [en]

    No comparative epidemiological data can be found in the literature on the renal safety of acid-suppressing drugs. We followed-up a cohort of close to 180,000 persons during periods of treatment and non-treatment with five anti-ulcer drugs to evaluate the risk of idiopathic acute renal failure and/or nephrotic syndrome. After reviewing medical records, five patients were found to be cases. Two presented with acute renal failure and three had nephrotic syndrome. Three cases occurred during periods of non-exposure to anti-ulcer drugs. Two cases occurred during current use of ranitidine: one of acute renal failure and one of nephrotic syndrome. No case was encountered during treatment with cimetidine, famotidine, nizatidine or omeprazole. The incidence of idiopathic renal disease in the general population was 1 per 100,000 person-years. The relative risk associated with use of acid-suppressing drugs was 1.8 (95% CI, 0.3-10.7) compared to non-use. These results do not suggest a major increased risk for acute renal injury and/or nephrotic syndrome associated with use of anti-ulcer drugs.

  • 112. García Rodríguez, LA
    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 Clinical Epidemiology.
    Stricker, BHC
    The risk of acute liver injury associated with cimetidine and other acid-suppressing anti-ulcer drugs.1997In: British Journal of Clinical Pharmacology, ISSN 0306-5251, E-ISSN 1365-2125, Vol. 43, no 2, p. 183-188Article in journal (Refereed)
    Abstract [en]

    AIMS

    The objective of this study was to estimate the risk of acute liver injury associated with individual acid-suppressing drugs and assess the role of dose and duration of treatment.

    METHODS

    We used a nested case-control study design within a cohort of over 100,000 users of cimetidine, famotidine, omeprazole and ranitidine. The primary source of information was the General Practitioners Research Database. We identified 108,981 persons aged 20-74 years who received at least one prescription for cimetidine, famotidine, omeprazole, or ranitidine during 1990-93, and we ascertained the first occurrence of clinically acute liver injury referred to a specialist or admitted to a hospital.

    RESULTS

    After review of medical records, 33 patients were considered eligible cases of idiopathic acute liver injury with no fatal cases. The type of liver injury was hepatocellular in almost half of the cases, and 80% of all cases presented with jaundice. Twelve cases occurred among current users of cimetidine, five among ranitidine users and one in an omeprazole user. The absolute risk of acute liver injury associated with cimetidine was estimated to be slightly greater than one per 5000 users of cimetidine. The adjusted relative risk (RRs) and 95% CI of developing acute liver injury associated with current use of cimetidine compared to non-use was 5.5 (1.9-15.9), with omeprazole 2.1 (0.2-19.2) and with ranitidine 1.7 (0.5-5.8). In the absence of concomitant use of other hepatotoxic drugs, the RR with cimetidine was 14.4 (2.9-73.7). Among users of cimetidine, the risk was especially high in the first 2 months of starting therapy (RR: 11.3, 3.7-35.1) and at daily doses of 800 mg or greater (RR: 8.8, 3.0-26.0).

    CONCLUSIONS

    Cimetidine was the individual anti-ulcer drug with the highest risk of developing symptomatic acute liver disease. Further data are required to confirm this finding. Our study indicates that there is a dose relationship and a short latent period between cimetidine treatment and acute liver injury.

  • 113. García Rodríguez, Luis A
    et al.
    Ruigómez, Ana
    Martín-Merino, Elisa
    Johansson, Saga
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Relationship between gastroesophageal reflux disease and COPD in UK primary care2008In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 134, no 6, p. 1223-1230Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Gastroesophageal reflux symptoms may be more common in patients with COPD than in control subjects. The aim of this study was to investigate the relationship between diagnoses of COPD and gastroesophageal reflux disease (GERD) in primary care. METHODS: We used the UK General Practice Research Database to identify a cohort of patients with a first diagnosis of GERD (n = 4,391) and another cohort of patients with a first diagnosis of COPD (n = 1,628) during 1996, which we compared with age-matched and sex-matched comparison cohorts without either diagnosis. We calculated the incidence of a GERD diagnosis among the patients with COPD and control subjects, and of a COPD diagnosis among the patients with GERD and control subjects. We also calculated the relative risk (RR) estimates of these diagnoses using the Mantel-Haenszel test. Risks associated with medication use, comorbidities, and demographic and lifestyle factors were examined using a nested case-control analysis. RESULTS: During the 5-year follow-up, the RR of an incident COPD diagnosis in patients with a diagnosis of GERD was 1.17 (95% confidence interval [CI], 0.91 to 1.49), while the RR of an incident GERD diagnosis among patients with a diagnosis of COPD was 1.46 (95% CI, 1.19 to 1.78). A COPD diagnosis was associated with current or former smoking, prior diagnosis of asthma, or the use of asthma medication. A GERD diagnosis was associated with a prior diagnosis of ischemic heart disease. CONCLUSIONS: Patients with a diagnosis of COPD are at a significantly increased risk of a diagnosis of GERD compared with individuals with no COPD diagnosis.

  • 114. García-Rodríguez, Luis Alberto
    et al.
    Massó-González, Elvira Luján
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Saga
    The safety of rosuvastatin in comparison with other statins in over 100,000 statin users in UK primary care2008In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 17, no 10, p. 943-52Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To compare mortality and the incidence of hospitalization for myopathy, rhabdomyolysis, acute renal failure and acute liver injury in patients receiving rosuvastatin and those taking other statins. METHODS: Patients prescribed a statin that they had not used before were selected from the UK General Practice Research Database (GPRD) and followed up from 1 April 2003 to 31 December 2005. RESULTS: We studied 10 289 patients on rosuvastatin and 117 102 taking other statins. No cases of myopathy, rhabdomyolysis or acute liver injury occurred among rosuvastatin users. In those taking statins other than rosuvastatin, the incidence of myopathy was 0.4 (95% confidence interval (CI): 0.1-0.9), of rhabdomyolysis was 0.4 (95%CI: 0.1-0.9) and of acute liver injury was 0.4 (95%CI: 0.2-1.0), per 10 000 person-years. Fourteen cases of acute renal failure were identified (two among rosuvastatin users and 12 among other statin users). Among current users, the relative risk (RR) of acute renal failure in rosuvastatin users compared with other statin users was 1.16 (95%CI: 0.15-9.03).We identified 3232 deaths during the study period (173 in the rosuvastatin-treated group and 3059 in the other statin group). The RR of death associated with current use of rosuvastatin compared with other statins was 0.55 (95%CI: 0.44-0.68). CONCLUSIONS: We found no evidence that patients prescribed rosuvastatin were at greater risk of these outcomes than patients prescribed other statins. There was no evidence of increased mortality among patients taking rosuvastatin, even after allowing for age, sex and prior statin use.

  • 115.
    Grunnesjö, Marie
    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 Manual Therapy, Outcome and its Prognosis2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Objectives. To assess outcome of manual therapy in addition to stay-active care in sub-acute low back pain patients and to investigate the predictive power of pain drawing sketch variables for return to work.

    Materials and methods. The study was designed as a randomised controlled trial with a factorial design, and included 160 patients with acute or sub-acute low back pain allocated to one of the four treatment groups during 10 weeks. Group 1 received stay-active care only, Group 2 the same treatment as in Group 1 + muscle stretching, Group 3 the same treatment as in Group 2 plus manual therapy, and Group 4 the same treatment as Group 3 plus steroid injections. Outcome included pain intensity, pain extension, functional and health related quality of life variables and return to work.

    Results. Pain intensity and disability rating improved faster in Groups 3 and 4 than in Groups 1 and 2 (p<0.05 and p<0.05). Also health related quality of life was affected by the treatments given; the more treatment options the better the effect (trend across the groups p<0.05). Pain extension as described on a pain drawing sketch decreased in all groups across the study period. The pain modality ‘numbness’ was the most painful one among patients with no pain radiation. Pain radiation according to the pain drawing sketch was the strongest predictor for return to work (p=0.03, Wald χ2=4.56).

    Conclusions. The manual therapy concept used in this study reduced pain intensity and disability rating better than the stay active concept. The effects on health related quality of life were greater the larger the number of treatment modalities available. Pain drawing information was significantly correlated with pain and functional variables. Pain radiation according to the pain drawing adds significant information to the prediction of return to work.

    List of papers
    1. The course of pain drawings during a 10-week treatment period in patients with acute and sub-acute low back pain
    Open this publication in new window or tab >>The course of pain drawings during a 10-week treatment period in patients with acute and sub-acute low back pain
    Show others...
    2006 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 7, p. 65-Article in journal (Refereed) Published
    Abstract [en]

    Background: Pain drawings are widely used as an assessment of patients' subjective pain in lowback pain patients being considered for surgery. Less work has been done on primary health carepatients. Moreover, the possible correlation between pain drawing modalities and other painassessment methods, such as pain score and functional variables needs to be described. Thus, theobjectives were to describe the course of pain drawings during treatment in primary health carefor low back pain patients.Methods: 160 primary health care outpatients with acute or sub-acute low back pain were studiedduring 10 weeks of a stay active concept versus manual therapy in addition to the stay activeconcept. The patients filled out 3 pain drawings each, at baseline and after 5 and 10 weeks oftreatment. In addition the patients also reported pain and functional variables during the 3measurement periods.Results: The proportion of areas marked, the mean number of areas marked (pain drawing score),mean number of modalities used (area score), and the proportion of patients with pain radiationall decreased during the 10-week treatment period. Most of the improvement occurred during thefirst half of the period. The seven different pain modalities in the pain drawing were correlated topain and functional variables. In case of no radiation some modalities were associated with morepain and disability than others, a finding that grew stronger over time. For patients with painradiation, the modality differences were smaller and inconsistent.Conclusion: Pain modalities are significantly correlated with pain and functional variables. Thereis a shift from painful modalities to less painful ones over time.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-83627 (URN)10.1186/1471-2474-7-65 (DOI)000240737600001 ()16901354 (PubMedID)
    Available from: 2007-03-21 Created: 2007-03-21 Last updated: 2017-12-14Bibliographically approved
    2. A randomized controlled clinical trial of stay-active care versus manual therapy in addition to stay-active care: functional variables and pain.
    Open this publication in new window or tab >>A randomized controlled clinical trial of stay-active care versus manual therapy in addition to stay-active care: functional variables and pain.
    2004 (English)In: Journal of Manipulative and Physiological Therapeutics, ISSN 0161-4754, E-ISSN 1532-6586, Vol. 27, no 7, p. 431-441Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVES

    To compare the effect of manual therapy in addition to the stay-active concept versus the stay-active concept only in low back pain patients.

    STUDY DESIGN

    A randomized, controlled trial during 10 weeks.

    METHODS

    One hundred sixty outpatients with acute or subacute low back pain were recruited from a geographically defined area. They were randomly allocated to a reference group treated with the stay-active concept and, in some cases, muscle stretching and an experimental group receiving manual therapy and, in some cases, steroid injections in addition to the stay-active concept. Pain and disability rating index were used as outcome measures.

    RESULTS

    At baseline, the experimental group had somewhat more pain, a higher disability rating index, and more herniated disks than the reference group. After 5 and 10 weeks, the experimental group had less pain and a lower disability rating index than the reference group.

    CONCLUSIONS

    The manual treatment concept used in this study in low back pain patients appears to reduce pain and disability rating better than the traditional stay-active concept.

    Keywords
    Low back pain, disability rating, manipulation, mobilization, stay-active care
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-79639 (URN)10.1016/j.jmpt.2004.06.001 (DOI)000224327300001 ()15389174 (PubMedID)
    Available from: 2007-03-21 Created: 2007-03-21 Last updated: 2017-12-14Bibliographically approved
    3. A randomized controlled trial of the effects of muscle stretching, manual therapy and steroid injections in addition to 'stay-active' care on health-related quality of life in acute and sub-acute low back pain
    Open this publication in new window or tab >>A randomized controlled trial of the effects of muscle stretching, manual therapy and steroid injections in addition to 'stay-active' care on health-related quality of life in acute and sub-acute low back pain
    Show others...
    2011 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 25, no 11, p. 999-1010Article in journal (Refereed) Published
    Abstract [en]

    Objective: To evaluate the health-related quality of life effects of muscle stretching, manual therapy and steroid injections in addition to 'stay active' care in acute or subacute low back pain patients.

    Study design: A randomized, controlled trial during 10 weeks with four treatment groups.

    Setting: Nine primary health care and one outpatient orthopaedic hospital department.

    Subjects: One hundred and sixty patients with acute or subacute low back pain.

    Interventions: Ten weeks of 'stay active' care only (group 1), or 'stay active' and muscle stretching (group 2), or 'stay active', muscle stretching and manual therapy (group 3), or 'stay active', muscle stretching, manual therapy and steroid injections (group 4).

    Main measures: The Gothenburg Quality of Life instrument subscales Well-being score and Complaint score.

    Results: In a multivariate analysis adjusted for possible outcome affecting variables other than the treatment given Well-being score was 68.4 (12.5), 72.1 (12.4), 72,3 (12.4) and 72.7 (12.5) in groups 1-4, respectively (P for trend <0.05). There were significant trends for the well-being components patience (P < 0.005), energy (P < 0.05), mood (P < 0.05) and family situation (P < 0.05). The remaining two components and Complaint score showed a non-significant trend towards improvement.

    Conclusion: The effects on health-related quality of life were greater the larger the number of treatment modalities available. The 'stay active' treatment group, with the most restricted number of modalities, had the most modest health-related quality of life improvement, while group 4 with the most generous choice of treatment modalities, had the greatest improvement.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-156551 (URN)10.1177/0269215511403512 (DOI)000296747400005 ()21831926 (PubMedID)
    Available from: 2011-08-08 Created: 2011-08-02 Last updated: 2017-12-08Bibliographically approved
    4. The contribution of pain drawings in the prediction of return to work in patients with acute or sub-acute low back pain
    Open this publication in new window or tab >>The contribution of pain drawings in the prediction of return to work in patients with acute or sub-acute low back pain
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    General Practice
    Identifiers
    urn:nbn:se:uu:diva-156552 (URN)
    Available from: 2011-08-08 Created: 2011-08-02 Last updated: 2018-01-12
  • 116.
    Grunnesjö, Marie I
    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.
    Bogefeldt, Johan P
    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.
    Delaney, Heléne
    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.
    The course of pain drawings during a 10-week treatment period in patients with acute and sub-acute low back pain2006In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 7, p. 65-Article in journal (Refereed)
    Abstract [en]

    Background: Pain drawings are widely used as an assessment of patients' subjective pain in lowback pain patients being considered for surgery. Less work has been done on primary health carepatients. Moreover, the possible correlation between pain drawing modalities and other painassessment methods, such as pain score and functional variables needs to be described. Thus, theobjectives were to describe the course of pain drawings during treatment in primary health carefor low back pain patients.Methods: 160 primary health care outpatients with acute or sub-acute low back pain were studiedduring 10 weeks of a stay active concept versus manual therapy in addition to the stay activeconcept. The patients filled out 3 pain drawings each, at baseline and after 5 and 10 weeks oftreatment. In addition the patients also reported pain and functional variables during the 3measurement periods.Results: The proportion of areas marked, the mean number of areas marked (pain drawing score),mean number of modalities used (area score), and the proportion of patients with pain radiationall decreased during the 10-week treatment period. Most of the improvement occurred during thefirst half of the period. The seven different pain modalities in the pain drawing were correlated topain and functional variables. In case of no radiation some modalities were associated with morepain and disability than others, a finding that grew stronger over time. For patients with painradiation, the modality differences were smaller and inconsistent.Conclusion: Pain modalities are significantly correlated with pain and functional variables. Thereis a shift from painful modalities to less painful ones over time.

  • 117.
    Grunnesjö, Marie I
    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.
    Bogefeldt, Johan P
    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.
    Strender, Lars-Erik
    Karolinska Institutet, Institutionen för neurobiologi, vårdvetenskap och samhälle, Department of Neurobiology, Care Science and Society.
    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.
    The contribution of pain drawings in the prediction of return to work in patients with acute or sub-acute low back painManuscript (preprint) (Other academic)
  • 118. Gudbjörnsdottir, S
    et al.
    Cederholm, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Nilsson, P M
    Eliasson, B
    The National Diabetes Register in Sweden: an implementation of the St. Vincent Declaration for Quality Improvement in Diabetes Care2003In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 26, no 4, p. 1270-1276Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:To monitor glycemic control, treatable risk factors, and treatment profile for quality assessment of diabetes care on a national scale.

    RESEARCH DESIGN AND METHODS:Four samples of 23,546, 32,903, 30,311, and 29,769 patients with diabetes (1996-1999) were studied based on a repeated national screening and quality assessment of diabetes care by the National Diabetes Register, Sweden, with participation of both hospitals and primary health care. Clinical characteristics included were age, sex, diabetes duration and treatment, glycemic control (HbA(1c)), office blood pressure (BP), BMI, smoking habits, and use of lipid-lowering drugs in patients with type 1 or type 2 diabetes.

    RESULTS:Favorable decreases of mean HbA(1c) and BP values were registered during the 4-year study period for both type 1 (HbA(1c) 7.5-7.3% and BP 130/75-130/74 mmHg) and type 2 diabetic patients (HbA(1c) 7.0-6.7% and BP 151/82-147/80 mmHg). Treatment aims of HbA(1c) and BP levels were also achieved in increasing proportions for type 1 (HbA(1c) <7.5%: 50-58% and BP </=140/85 mmHg: 77-79%), and type 2 diabetic patients (HbA(1c) <7.5%: 66-73% and BP </=140/85 mmHg: 32-42%). The use of lipid-lowering drugs increased for type 1 (4-11%) and type 2 diabetic patients (10-22%). In type 2 diabetic patients, treatment with oral agents alone decreased, but combination therapy (insulin and oral agents) increased during the study period. Mean BMI increased during 1996-1999 in type 2 diabetic patients. High HbA(1c) and BP values in 1999 were predicted by high BMI values 1996 and by high increase of BMI during the period, independent of diabetes duration, age, and sex.

    CONCLUSIONS:Decreasing mean HbA(1c) and BP levels and the wider use of lipid-lowering drugs during the late 1990s in patients with diabetes in a national sample from Sweden should translate into clinical benefits regarding micro- and macrovascular complications as well as diabetes-related mortality.

  • 119. Gudbjörnsdottir, S
    et al.
    Eeg-Olofsson, K
    Cederholm, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Eliasson, B
    Nilsson, P. M.
    Risk factor control in patients with Type 2 diabetes and coronary heart disease: findings from the Swedish National Diabetes Register (NDR)2009In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 26, no 1, p. 53-60Article in journal (Refereed)
    Abstract [en]

    AIMS: Patients with Type 2 diabetes and coronary heart disease (CHD) are infrequently treated to risk factor targets in current guidelines. We aimed to examine risk factor management and control levels in a large sample of patients with Type 2 diabetes with CHD. METHODS: This was an observational study of 1612 patients with first incidence of CHD before 2002, and of 4570 patients with first incidence of CHD before 2005, from the Swedish National Diabetes Register (NDR). RESULTS: In patients with CHD 1-2 years before follow-up, the achievement of cardiovascular risk factor targets (follow-up 2002/follow-up 2005) was: HbA(1c) < 7%, 47%/54% (P < 0.01); blood pressure < or = 130/80 mmHg, 31%/40% (P < 0.001); total cholesterol < 4.5 mmol/l, 47%/60% (P < 0.001); and low-density lipoprotein-cholesterol < 2.5 mmol/l, 49%/65% (P < 0.001). Use of medication: antihypertensives, 90%/94% (P < 0.01); lipid-lowering drugs, 75%/86% (P < 0.001); and aspirin, 85%/89% (P < 0.05). A high prevalence of adverse lifestyle characteristics prevailed (2002/2005): overweight [body mass index (BMI) > or = 25 kg/m(2)], 86%/85%; obesity (BMI > or = 30 kg/m(2)), 41%/42%; smokers in age group < 65 years, 16-23%/18-19%; as well as waist circumference > or = 102 cm (men) or > or = 88 cm (women), 68% in 2005. CONCLUSIONS: Patients with a combination of Type 2 diabetes and CHD showed an increased use of lipid-lowering drugs over time, corresponding to improving blood lipid levels. A discrepancy existed between the prevalent use of antihypertensive drugs and the low proportion reaching blood pressure targets. Regretfully, a high prevalence of adverse lifestyle characteristics prevailed. Evidence-based therapy with professional lifestyle intervention and drugs seems urgent for improved quality of secondary prevention in these patients.

  • 120. Gudbjörnsdottir, Soffia
    et al.
    Cederholm, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Nilsson, Peter M
    Eliasson, Björn
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Adamson, Ulf
    Nationella diabetesregistret 1996-2003: Kvalitetsvärdering visar att diabetesvården har förbättrats2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, no 47, p. 3790-3797Article in journal (Other academic)
    Abstract [en]

    The Swedish National Diabetes Register presents results during the period 1996- 2003. Quality of care data from more than 75,000 diabetic patients (2003) treated at medical departments and primary health care centres are evaluated concerning national goals of HbA1c <6,5% and BP <140/85 mm Hg, the prevalence of lipid treatment, smoking etc. The national goals of HbA1c and BP were reached with increasing degree in cross-sectional analysis during the period, and were achieved by 33% and 71% at medical departments, and by 61% and 48% in primary health care in 2003. A similar tendency was also seen in longitudinal analysis of subgroups 1996-2003. The use of antihypertensive and lipid-lowering drugs was also considerably increased. This should imply a reduction of the risk for diabetic complications. As the national goals are still difficult to reach, individual goals should be set for the treatment.

  • 121.
    Gulliksson, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Studies of Secondary Prevention after Coronary Heart Disease with Special Reference to Determinants of Recurrent Event Rate2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Objectives. The first aim was to examine the effects of secondary prevention with a focus on determinants in the risk of recurrent coronary heart disease (CHD). The second aim was to analyse the effects of a cognitive behavioural therapy (CBT) intervention on the risk of recurrent cardiovascular disease (CVD) and to investigate the psychosocial situation of CHD patients.

    Material and methods. Papers I and II were based on the Swedish Acute Myocardial Infarction Statistics Register, 1969 to 2001: 775,901 events in 589,341 subjects. Papers III and IV were based on The Secondary Prevention in Uppsala Primary Care project (SUPRIM), a randomized controlled clinical trial in 362 CHD patients.

    Results. The risk of a recurrent acute myocardial infarction (AMI) event was highly dependent on time from the previous event, with the greatest risk immediately after an AMI event. In addition, sex, age, and AMI number influenced the general risk level. Furthermore, there has been a major decline in recurrence risk over 30 years, and there were considerable geographical differences in risk, best explained by residential area population density, with a high recurrent AMI risk in areas with the lowest and the highest population densities, and the lowest risk in areas with moderate population density. Disease status and sex were determinants of psychological well-being the first year after a CHD event. Sex seemed to be the stronger determinant. The CBT intervention focused on stress management during one year in patients with CHD.  There was significantly improved outcome in the intervention group on recurrent CVD and recurrent AMI during a 9 year follow up. A dose-response relationship was demonstrated between attendance rate at intervention group meetings and outcome, the higher the attendance rate the better the outcome.

    Conclusions. The risk of a recurrent AMI event was dependent on time from the previous event, with major improvement seen in recent decades. Regional differences were best explained by population density. Female CHD patients were at high risk concerning well-being after a coronary event, which deserves special attention. The CBT intervention for CHD patients improved outcomes concerning the risk of recurrent CVD and AMI events.

    List of papers
    1. Hazard Function and Secular Trends in the Risk of Recurrent Acute Myocardial Infarction: 30 Years of Follow-Up of More Than 775 000 Incidents
    Open this publication in new window or tab >>Hazard Function and Secular Trends in the Risk of Recurrent Acute Myocardial Infarction: 30 Years of Follow-Up of More Than 775 000 Incidents
    2009 (English)In: Circulation: Cardiovascular Quality and Outcomes, ISSN 1941-7713, Vol. 2, no 3, p. 175-185Article in journal (Refereed) Published
    Abstract [en]

    Background—The incidence of a first acute myocardial infarction (AMI) has fallen considerably during the last decades. However, no previous studies have analyzed the underlying hazards function of experiencing a recurrent AMI, and none has analyzed the change of risk for a recurrent AMI over the last 3 decades.

    Methods and Results—The study was based on the Swedish national myocardial infarction register. The register contained more than 1 million AMI events. After exclusion of events occurring in subjects younger than 20 or older than 84 years and events with uncertain first AMI status, 775 901 events occurring between 1972 and 2001 remained for analysis.

    During the study period, the risk of a new event among survivors of a previous AMI decreased sharply during the first 2 years after the previous event, had its minimum after 5 years, and then increased slowly again. The risk for a recurrent AMI during the first year after a previous event was fairly stable over the years until the late 1970s and then decreased by 36% in women and 40% in men until the late 1990s, irrespective of age and AMI number, mirroring the incidence decrease over the years for primary events.

    Conclusions—The risk of a recurrent AMI event was highly dependent on time from the previous event, a novel finding which may affect risk scoring. There were strong secular trends toward diminishing risk for a recurrent AMI in recent years, even when other outcome affecting variables were taken into account.

     

     

     

    Keywords
    myocardial infarction, epidemiology, population, prevention
    National Category
    General Practice
    Research subject
    Family Medicine
    Identifiers
    urn:nbn:se:uu:diva-107364 (URN)10.1161/CIRCOUTCOMES.108.802397 (DOI)000276074000008 ()
    Note
    Pek 1Available from: 2009-08-07 Created: 2009-08-07 Last updated: 2018-01-13Bibliographically approved
    2. Effects of degree of urbanisation in the risk of recurrent acute myocardial infarction: more than 775,000 incidents followed for 30 years
    Open this publication in new window or tab >>Effects of degree of urbanisation in the risk of recurrent acute myocardial infarction: more than 775,000 incidents followed for 30 years
    (English)Manuscript (preprint) (Other academic)
    Keywords
    acute myocardial infarction, recurrence, regional variation, co-morbidity epidemiology
    National Category
    General Practice
    Research subject
    Family Medicine
    Identifiers
    urn:nbn:se:uu:diva-107360 (URN)
    Note
    Pek 2Available from: 2009-08-07 Created: 2009-08-07 Last updated: 2018-01-13Bibliographically approved
    3. Psychosocial factors during the first year after a coronary heart disease event in cases and referents: Secondary Prevention in Uppsala Primary Health Care Project (SUPRIM)
    Open this publication in new window or tab >>Psychosocial factors during the first year after a coronary heart disease event in cases and referents: Secondary Prevention in Uppsala Primary Health Care Project (SUPRIM)
    Show others...
    2007 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 7, p. 36-Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: A large number of studies have reported on the psychosocial risk factor pattern prior to coronary heart disease events, but few have investigated the situation during the first year after an event, and none has been controlled. We therefore performed a case-referent study in which the prevalence of a number of psychosocial factors was evaluated. METHODS: Three hundred and forty-six coronary heart disease male and female cases no more than 75 years of age, discharged from hospital within the past 12 months, and 1038 referents from the general population, matched to the cases by age, sex and place of living, received a postal questionnaire in which information on lifestyle, psychosocial and quality of life measures were sought. RESULTS: The cases were, as expected, on sick leave to a larger extent than the referents, reported poorer fitness, poorer perceived health, fewer leisure time activities, but unexpectedly reported better social support, and more optimistic views of the future than the referents. There were no significant case-referent differences in everyday life stress, stressful life events, vital exhaustion, depressive mood, coping or life orientation test. However, women reported less favourable situations than men regarding stressful life events affecting others, vital exhaustion, depressive mood, coping, self-esteem, sleep, and symptom reporting, and female cases reported the most unfavourable situation of all groups. CONCLUSION: In this first controlled study of the situation during the first year after a CHD event disease and gender status both appeared to be determinants of psychological well-being, with gender status apparently the strongest. This may have implications for cardiac rehabilitation programmes.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-13892 (URN)10.1186/1471-2261-7-36 (DOI)18031575 (PubMedID)
    Available from: 2008-01-28 Created: 2008-01-28 Last updated: 2017-12-11Bibliographically approved
    4. A randomized controlled trial of cognitive behavioral therapy versus standard treatment on recurrent cardiovascular events in coronary heart disease
    Open this publication in new window or tab >>A randomized controlled trial of cognitive behavioral therapy versus standard treatment on recurrent cardiovascular events in coronary heart disease
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Keywords
    coronary heart disease, randomized controlled trial, cognitive behavioral therapy, epidemiology, secondary prevention
    National Category
    General Practice
    Research subject
    Family Medicine
    Identifiers
    urn:nbn:se:uu:diva-107361 (URN)
    Available from: 2009-08-07 Created: 2009-08-07 Last updated: 2018-01-13Bibliographically approved
  • 122.
    Gulliksson, Mats
    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.
    Burell, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Lundin, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Toss, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    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.
    Psychosocial factors during the first year after a coronary heart disease event in cases and referents: Secondary Prevention in Uppsala Primary Health Care Project (SUPRIM)2007In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 7, p. 36-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A large number of studies have reported on the psychosocial risk factor pattern prior to coronary heart disease events, but few have investigated the situation during the first year after an event, and none has been controlled. We therefore performed a case-referent study in which the prevalence of a number of psychosocial factors was evaluated. METHODS: Three hundred and forty-six coronary heart disease male and female cases no more than 75 years of age, discharged from hospital within the past 12 months, and 1038 referents from the general population, matched to the cases by age, sex and place of living, received a postal questionnaire in which information on lifestyle, psychosocial and quality of life measures were sought. RESULTS: The cases were, as expected, on sick leave to a larger extent than the referents, reported poorer fitness, poorer perceived health, fewer leisure time activities, but unexpectedly reported better social support, and more optimistic views of the future than the referents. There were no significant case-referent differences in everyday life stress, stressful life events, vital exhaustion, depressive mood, coping or life orientation test. However, women reported less favourable situations than men regarding stressful life events affecting others, vital exhaustion, depressive mood, coping, self-esteem, sleep, and symptom reporting, and female cases reported the most unfavourable situation of all groups. CONCLUSION: In this first controlled study of the situation during the first year after a CHD event disease and gender status both appeared to be determinants of psychological well-being, with gender status apparently the strongest. This may have implications for cardiac rehabilitation programmes.

  • 123.
    Gulliksson, Mats
    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.
    Burell, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Vessby, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition Research.
    Lundin, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Toss, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    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.
    A randomized controlled trial of cognitive behavioral therapy versus standard treatment on recurrent cardiovascular events in coronary heart diseaseManuscript (preprint) (Other academic)
  • 124.
    Gulliksson, Mats
    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.
    Wedel, Hans
    Nordic School of Public Health, Gothenburg, Sweden.
    Köster, Max
    National Board of Health and Welfare, Centre for Epidemiology, Stockholm, Sweden.
    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.
    Effects of degree of urbanisation in the risk of recurrent acute myocardial infarction: more than 775,000 incidents followed for 30 yearsManuscript (preprint) (Other academic)
  • 125.
    Gulliksson, Mats
    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.
    Wedel, Hans
    The Nordic School of Public Health, Gothenburg, Sweden.
    Köster, Max
    The National Board of Health and Welfare, Centre for Epidemiology, Stockholm, Sweden .
    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.
    Hazard Function and Secular Trends in the Risk of Recurrent Acute Myocardial Infarction: 30 Years of Follow-Up of More Than 775 000 Incidents2009In: Circulation: Cardiovascular Quality and Outcomes, ISSN 1941-7713, Vol. 2, no 3, p. 175-185Article in journal (Refereed)
    Abstract [en]

    Background—The incidence of a first acute myocardial infarction (AMI) has fallen considerably during the last decades. However, no previous studies have analyzed the underlying hazards function of experiencing a recurrent AMI, and none has analyzed the change of risk for a recurrent AMI over the last 3 decades.

    Methods and Results—The study was based on the Swedish national myocardial infarction register. The register contained more than 1 million AMI events. After exclusion of events occurring in subjects younger than 20 or older than 84 years and events with uncertain first AMI status, 775 901 events occurring between 1972 and 2001 remained for analysis.

    During the study period, the risk of a new event among survivors of a previous AMI decreased sharply during the first 2 years after the previous event, had its minimum after 5 years, and then increased slowly again. The risk for a recurrent AMI during the first year after a previous event was fairly stable over the years until the late 1970s and then decreased by 36% in women and 40% in men until the late 1990s, irrespective of age and AMI number, mirroring the incidence decrease over the years for primary events.

    Conclusions—The risk of a recurrent AMI event was highly dependent on time from the previous event, a novel finding which may affect risk scoring. There were strong secular trends toward diminishing risk for a recurrent AMI in recent years, even when other outcome affecting variables were taken into account.

     

     

     

  • 126.
    Halford, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Self-rated Health with special reference to Prevalence, Determinants and Consequences2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Objectives: The overall aim was to investigate determinants and consequences of global non-comparative self-ratings of health (SRH). Concerning determinants, the aim was more specifically to investigate the association between age, year of investigation, stress-theory based psychobiological variables, and SRH.

    Materials and methods: Papers I and IV were based on eight ongoing population-based cohort studies, with sampling performed 1973-2003. The study-population consisted of 11,880 men and women, aged 25-99 years, providing 14,470 observations. Papers II and III were based on a longitudinal study of 212 adult, healthy, women and men.

    Results: In women, SRH declined linearly with age and year of investigation, after adjustment for influence of covariates, while in men the association was based on a third degree polynomial function. The most important covariates were complaint score, sick-leave or disability pension, and leisure time physical activity. The final model explained 76.2% of the variance in women and 74.5% in men. SRH was directly associated with psychological resources and inversely associated with psychological strain, in healthy, adult, women and men. In men with SRH which decreased to fair or poor, higher levels of prolactin and lower levels of testosterone were observed at follow-up as compared to baseline. There were no associations between endocrine variables and SRH in women. There was a significant inverse association between SRH and mortality, disability pension, and sick-leave during follow-up, in women and men, adjusted for covariates. Associations between SRH and mortality were robust during the follow-up period.

    Conclusions: Age and year of investigation were associated with SRH, but differently in women and men. Psychological resources and psychological strain were consistently associated with SRH, but there were no robust associations between endocrine measures and SRH. SRH was associated with mortality, disability pension, and sick-leave, during follow-up. The association between SRH and mortality was robust during the follow-up period

    List of papers
    1. Effects of age and secular trends on self-rated health: a population-based study of nearly 15,000 observations among Swedish women and men during 1973-2003
    Open this publication in new window or tab >>Effects of age and secular trends on self-rated health: a population-based study of nearly 15,000 observations among Swedish women and men during 1973-2003
    Show others...
    2010 (English)Article in journal (Other academic) Submitted
    Identifiers
    urn:nbn:se:uu:diva-132360 (URN)
    Available from: 2010-10-26 Created: 2010-10-19 Last updated: 2012-10-30Bibliographically approved
    2. Endocrine measures of stress and self-rated health: A longitudinal study
    Open this publication in new window or tab >>Endocrine measures of stress and self-rated health: A longitudinal study
    2003 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 55, no 4, p. 317-320Article in journal (Refereed) Published
    Abstract [en]

    Objective: Simple global self-ratings of health have been found to hold considerable predictive validity in relation to morbidity and mortality. Inverse associations between chronic stress and self-rated health (SRH) have been found and suggested to explain part of the predictive validity of SRH. Studies including biological data are, however, few. The purpose of this paper is to study the relationship between endocrine measures of stress and SRH.

    Methods: A longitudinal study of 102 healthy middle-aged men. Written questionnaires and blood samples were collected at baseline and at follow-up 1 year later.

    Results: A decrease in SRH below the level of good was associated with significantly increased s-prolactin and decreased s-testosterone. Poorer SRH and increased levels of s-prolactin were significantly associated with increased vital exhaustion at follow-up.

    Conclusion: Our study identifies a possible biological pathway, which might be of relevance in understanding the well-established association between SRH and health.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-64718 (URN)10.1016/S0022-3999(02)00634-7 (DOI)
    Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2017-11-30Bibliographically approved
    3. Self-rated health, life-style, and psychoendocrine measures of stress in healthy adult women
    Open this publication in new window or tab >>Self-rated health, life-style, and psychoendocrine measures of stress in healthy adult women
    Show others...
    2010 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 115, no 4, p. 266-274Article in journal (Refereed) Published
    Abstract [en]

    Background. Self-rated health (SRH) is a robust predictor of subsequent health outcome, independent of objective health measures and life-style-related health risk factors. However, the determinants of SRH are as yet largely unknown. In accordance with the prevailing stress theory, we hypothesized that SRH is associated with personal coping resources, psychological strain, life-style variables, and endocrine variables.

    Methods. A total of 106 healthy women, 22-59 years of age, were followed for up to 3 years with annual blood sampling (cortisol, prolactin, testosterone) and written questionnaires in which information on SRH, psychological strain, coping resources, socio-economic and life-style variables was sought.

    Results. In bivariate, screening logistic regression analyses, intended to find candidate variables for a final analysis model, all coping resource variables (sense of coherence, mastery, and self-esteem) were significantly related to SRH, and so were two psychological strain variables (vital exhaustion, and sleep disturbances), one life-style variable (fitness), but none of the endocrine variables. In the final multivariate analysis model, including all candidate variables, only vital exhaustion (P < 0.0001), fitness (P = 0.0002), and sense of coherence (P = 0.0006) were independently associated with SRH, together explaining 74% of the SRH variance.

    Conclusion. Some elements of the hypothesis, i.e. the effects of coping resources, psychological strain, and life-style variables on SRH, were supported by the results, while others, i.e. effects of endocrine measures on SRH, were not, indicating a possible gender difference.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2010
    Keywords
    Cortisol, prolactin, self-rated health, sense of coherence, testosterone, vital exhaustion
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-132358 (URN)10.3109/03009734.2010.496910 (DOI)000283555900008 ()
    Available from: 2010-10-26 Created: 2010-10-19 Last updated: 2018-05-24Bibliographically approved
    4. Effects of self-rated health on sick-leave, disability-pension, hospital admissions and mortality: a population-based study of nearly 15,000 observations among Swedish women and men followed 1973-2003
    Open this publication in new window or tab >>Effects of self-rated health on sick-leave, disability-pension, hospital admissions and mortality: a population-based study of nearly 15,000 observations among Swedish women and men followed 1973-2003
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-132361 (URN)
    Available from: 2010-10-26 Created: 2010-10-19 Last updated: 2012-10-30Bibliographically approved
  • 127.
    Halford, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Anderzén, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Arnetz, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social 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.
    Self-rated health, life-style, and psychoendocrine measures of stress in healthy adult women2010In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 115, no 4, p. 266-274Article in journal (Refereed)
    Abstract [en]

    Background. Self-rated health (SRH) is a robust predictor of subsequent health outcome, independent of objective health measures and life-style-related health risk factors. However, the determinants of SRH are as yet largely unknown. In accordance with the prevailing stress theory, we hypothesized that SRH is associated with personal coping resources, psychological strain, life-style variables, and endocrine variables.

    Methods. A total of 106 healthy women, 22-59 years of age, were followed for up to 3 years with annual blood sampling (cortisol, prolactin, testosterone) and written questionnaires in which information on SRH, psychological strain, coping resources, socio-economic and life-style variables was sought.

    Results. In bivariate, screening logistic regression analyses, intended to find candidate variables for a final analysis model, all coping resource variables (sense of coherence, mastery, and self-esteem) were significantly related to SRH, and so were two psychological strain variables (vital exhaustion, and sleep disturbances), one life-style variable (fitness), but none of the endocrine variables. In the final multivariate analysis model, including all candidate variables, only vital exhaustion (P < 0.0001), fitness (P = 0.0002), and sense of coherence (P = 0.0006) were independently associated with SRH, together explaining 74% of the SRH variance.

    Conclusion. Some elements of the hypothesis, i.e. the effects of coping resources, psychological strain, and life-style variables on SRH, were supported by the results, while others, i.e. effects of endocrine measures on SRH, were not, indicating a possible gender difference.

  • 128.
    Halford, Christina
    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).
    Bogefeldt, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Welin, Catharina
    Department of Heart and Lung Diseases, Sahlgrenska Academy, Gothenburg.
    Welin, Lennart
    Department of Heart and Lung Diseases, Sahlgrenska Academy, Gothenburg, Sweden.
    Rosengren, Annika
    Department of Heart and Lung Diseases, Sahlgrenska Academy, Gothenburg.
    Bardel, Annika
    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).
    Johansson, Saga
    Department of Heart and Lung Diseases, Sahlgrenska Academy, Gothenburg, Sweden.
    Eriksson, Henry
    Department of Heart and Lung Diseases, Sahlgrenska Academy, Gothenburg, Sweden.
    Palmer, Ed
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Economics.
    Wilhelmsen, Lars
    Department of Heart and Lung Diseases, Sahlgrenska Academy, Gothenburg, Sweden.
    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.
    Effects of self-rated health on sick-leave, disability-pension, hospital admissions and mortality: a population-based study of nearly 15,000 observations among Swedish women and men followed 1973-2003Manuscript (preprint) (Other academic)
  • 129.
    Halford, Christina
    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. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Welin, Catharina
    Department of Heart and Lung Diseases, Sahlgrenska Academy, Gothenburg.
    Bogefeldt, Johan P
    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).
    Rosengren, Annika
    Department of Heart and Lung Diseases, Sahlgrenska Academy, Gothenburg.
    Bardel, Annika
    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).
    Johansson, Saga
    Department of Heart and Lung Diseases, Sahlgrenska Academy, Gothenburg, Sweden.
    Eriksson, Henry
    Department of Heart and Lung Diseases, Sahlgrenska Academy, Gothenburg, Sweden.
    Wilhelmsen, Lars
    Department of Heart and Lung Diseases, Sahlgrenska Academy, Gothenburg, Sweden.
    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.
    Effects of age and secular trends on self-rated health: a population-based study of nearly 15,000 observations among Swedish women and men during 1973-20032010Article in journal (Other academic)
  • 130.
    Hasselgren, Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Epidemiological Aspects of Asthma in Primary Care: Special Reference to Prevalence, Clinical Detection and Validation2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Objectives. To describe the prevalence of asthma in a mid-Swedish region and measure the detection rate of asthma in primary care. To compare clinical outcomes for adolescents with asthma in primary care or in paediatric care and to perform a clinical validation in children with airway, nose and skin symptoms.

    Material and methods. A questionnaire survey of respiratory symptoms and disease in an adult population and an investigation of the occurrence of clinically detected asthma in primary care. A cross-sectional study comparing management, asthma control and quality of life in adolescents. The last study was a nested case-control study with a clinical validation of reported allergic symptoms in children.

    Results. The prevalence of asthma in the adult population was 8%. The clinical prevalence of asthma in primary care was 2%. The detection rate was higher in primary health care centres with asthma clinics, as compared to primary care without such clinics. In adolescents with asthma there was no difference in clinical outcomes between primary care and paediatric care. The validation study showed a high correlation between assigned cases and disease.

    Conclusions. Asthma is a common disease where the majority of cases are managed in primary care. Many cases are, however, not diagnosed and the detection rate becomes a quality care indicator. The study of adolescents confirms that proactive care can be further improved regardless of whether their management is in primary or paediatric care. The nested case-control design is suitable to suggest causational risk factors for asthma and for prediction of allergic disease development.

    List of papers
    1. Estimated prevalences of respiratory symtoms, asthma and chronic obstructive pulmonary disease related to detection rate in primary health care
    Open this publication in new window or tab >>Estimated prevalences of respiratory symtoms, asthma and chronic obstructive pulmonary disease related to detection rate in primary health care
    Show others...
    2001 In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, Vol. 19, no 1, p. 54-7Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-93777 (URN)
    Available from: 2005-11-17 Created: 2005-11-17Bibliographically approved
    2. Primary care based asthma clinics improves detection of asthma and COPD in the population
    Open this publication in new window or tab >>Primary care based asthma clinics improves detection of asthma and COPD in the population
    Article in journal (Refereed) Submitted
    Identifiers
    urn:nbn:se:uu:diva-93778 (URN)
    Available from: 2005-11-17 Created: 2005-11-17Bibliographically approved
    3. Management, asthma control and quality of life in Swedish adolescents with asthma
    Open this publication in new window or tab >>Management, asthma control and quality of life in Swedish adolescents with asthma
    Show others...
    2005 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 6, p. 682-688Article in journal (Refereed) Published
    Abstract [en]

    Aim: In Sweden, paediatricians or general practitioners treat most adolescents with asthma. This study compares management, treatment goals and quality of life for adolescents aged 15-18 y in paediatric or primary care. Material and methods: A random sample of patients answered a disease-specific and a quality-of-life (MiniAQLQ) questionnaire. Results: The 146 adolescents in paediatric care had more years with asthma, better continuity of annual surveillance, higher use of inhaled steroids and a stated better knowledge of their asthma than the 174 patients in primary care. No difference could be detected in asthma control or quality of life. Of all 320 adolescents, approximately 20% had woken at night due to asthma symptoms during the last week. About 15% had made unscheduled, urgent care visits and a third had used short-acting beta-agonist relievers more than twice a week. Quality-of-life scores were high and similar in both settings. Conclusions: Swedish adolescents with asthma are managed and treated somewhat differently in paediatric and primary care but with equal and, for the most part, satisfying results. The difference between the two settings probably reflects both differences in severity of asthma and different treatment traditions. For all adolescents, better fulfilment of goals regarding symptoms and exacerbations would be desirable, whereas a good quality of life including normal physical activity seems to have been achieved.

    Keywords
    Adolescent, Asthma/psychology/*therapy, Child, Child Health Services, Comparative Study, Cross-Sectional Studies, Humans, Primary Health Care, Quality of Life, Research Support; Non-U.S. Gov't, Sweden
    National Category
    Respiratory Medicine and Allergy
    Identifiers
    urn:nbn:se:uu:diva-93779 (URN)10.1080/08035250510025851 (DOI)000229836900008 ()16188769 (PubMedID)
    Available from: 2005-11-17 Created: 2005-11-17 Last updated: 2017-12-14Bibliographically approved
    4. Clinical validation in a nested case-control study of self-reported airway, nose and skin symptoms in children
    Open this publication in new window or tab >>Clinical validation in a nested case-control study of self-reported airway, nose and skin symptoms in children
    Show others...
    Article in journal (Refereed) Submitted
    Identifiers
    urn:nbn:se:uu:diva-93780 (URN)
    Available from: 2005-11-17 Created: 2005-11-17Bibliographically approved
  • 131.
    Hasselgren, Mikael
    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.
    Arne, Mats
    Johansson, Gunnar
    Primary care based asthma clinics improves detection of asthma and COPD in the populationArticle in journal (Refereed)
  • 132.
    Hasselgren, Mikael
    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.
    Arne, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Primary care-based asthma clinics improve detection of asthma and COPD in the population2006In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 15, no 3, p. 203-203Article in journal (Refereed)
  • 133.
    Hasselgren, Mikael
    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.
    Arne, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Primary care-based asthma clinics improve detection of asthma and COPD in the population2006In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 15, no 3, p. 203-203Article in journal (Other academic)
  • 134.
    Hasselgren, Mikael
    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.
    Arne, Mats
    Lindahl, Anders
    Janson, Staffan
    Lundbäck, Bo
    Estimated prevalences of respiratory symtoms, asthma and chronic obstructive pulmonary disease related to detection rate in primary health care2001In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, Vol. 19, no 1, p. 54-7Article in journal (Refereed)
  • 135.
    Hasselgren, Mikael
    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.
    Gustafsson, Dan
    Ställberg, Björn
    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).
    Lisspers, Karin
    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 , Center for Clinical Research Dalarna.
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Management, asthma control and quality of life in Swedish adolescents with asthma2005In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 6, p. 682-688Article in journal (Refereed)
    Abstract [en]

    Aim: In Sweden, paediatricians or general practitioners treat most adolescents with asthma. This study compares management, treatment goals and quality of life for adolescents aged 15-18 y in paediatric or primary care. Material and methods: A random sample of patients answered a disease-specific and a quality-of-life (MiniAQLQ) questionnaire. Results: The 146 adolescents in paediatric care had more years with asthma, better continuity of annual surveillance, higher use of inhaled steroids and a stated better knowledge of their asthma than the 174 patients in primary care. No difference could be detected in asthma control or quality of life. Of all 320 adolescents, approximately 20% had woken at night due to asthma symptoms during the last week. About 15% had made unscheduled, urgent care visits and a third had used short-acting beta-agonist relievers more than twice a week. Quality-of-life scores were high and similar in both settings. Conclusions: Swedish adolescents with asthma are managed and treated somewhat differently in paediatric and primary care but with equal and, for the most part, satisfying results. The difference between the two settings probably reflects both differences in severity of asthma and different treatment traditions. For all adolescents, better fulfilment of goals regarding symptoms and exacerbations would be desirable, whereas a good quality of life including normal physical activity seems to have been achieved.

  • 136.
    Hasselgren, Mikael
    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.
    Hederos, Carl-Axel
    Bornehag, Carl-Gustaf
    Andersson, Sofia
    Janson, Staffan
    Åberg, Nils
    Sigsgaard, Torben
    Clinical validation in a nested case-control study of self-reported airway, nose and skin symptoms in childrenArticle in journal (Refereed)
  • 137. He, Jia
    et al.
    Ma, Xiuqiang
    Zhao, Yanfang
    Wang, Rui
    Yan, Xiaoyan
    Yan, Hong
    Yin, Ping
    Kang, Xiaoping
    Fang, Jiqian
    Hao, Yuantao
    Li, Qiang
    Dent, John
    Sung, Joseph J. Y.
    Zou, Duowu
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Saga
    Liu, Wenbin
    Li, Zhaoshen
    A population-based survey of the epidemiology of symptom-defined gastroesophageal reflux disease: the Systematic Investigation of Gastrointestinal Diseases in China2010In: BMC Gastroenterology, ISSN 1471-230X, E-ISSN 1471-230X, Vol. 10, p. 94-Article in journal (Refereed)
    Abstract [en]

    Background: The epidemiology of gastroesophageal reflux disease (GERD) has yet to be investigated using the symptomatic threshold criteria recommended by the Montreal Definition. This study aimed to determine the prevalence of symptom-defined GERD across five regions of China, and to investigate variables associated with GERD. Methods: A representative sample of 18 000 adults (aged 18-80 years) were selected equally from rural and urban areas in each region (n = 1800). According to the Montreal Definition, GERD is present when mild symptoms of heartburn and/ or regurgitation occur on >= 2 days a week, or moderate-to-severe symptoms of heartburn and/or regurgitation occur on >= 1 day a week. Results: In total, 16 091 participants completed the survey (response rate: 89.4%) and 16 078 responses were suitable for analysis. Applying the Montreal criteria, the prevalence of symptom-defined GERD was 3.1% and varied significantly (p < 0.001) among the five regions (from 1.7% in Guangzhou to 5.1% in Wuhan) and between rural and urban populations (3.8% vs 2.4%). Factors significantly associated with GERD included living in a rural area and a family history of gastrointestinal diseases. Conclusions: This population-based survey found that the prevalence of symptom-defined GERD in China was 3.1%, which is lower than that found in Western countries.

  • 138.
    Hedenström, Hans
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ställberg, Björn
    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).
    Kvickbok om att ställa KOL-diagnos2007Book (Other (popular science, discussion, etc.))
  • 139. Hederos, Carl-Axel
    et al.
    Hasselgren, Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Hedin, Gunilla
    Bornehag, Carl-Gustaf
    Comparison of clinically diagnosed asthma with parental assessment of children's asthma in a questionnaire2007In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 18, no 2, p. 135-141Article in journal (Refereed)
    Abstract [en]

    Epidemiological evaluations of the prevalence of asthma are usually based on written questionnaires (WQs) in combination with validation by clinical investigation. In the present investigation, we compared parental assessment of asthma among their preschool children in response to a WQ with the corresponding medical records in the same region. An International Study of Asthma and Allergies in Childhood (ISAAC)-based WQ was answered by 75% of the parents of 6295 children aged 1–6 yr. Clinically diagnosed asthma, recorded in connection with admissions to the hospital or a visit to any of the outpatient clinics in the same region, were analysed in parallel. Finally, a complementary WQ was sent to the parents of children identified as asthmatic by either or both of this approaches. In response to the WQ 5.9% were claimed to suffer from asthma diagnosed by a doctor. According to the medical records, the prevalence of clinically diagnosed asthma was 4.9%. The estimated prevalence among children requiring treatment for their asthma was 4.4%. The sensitivity of the WQ was 77%, the specificity 97.5%. In the 1–2 yr age group the sensitivity was only 22%. This WQ was able to identify 54% of the children with a medical record of asthma. Forty percent of the children claimed by their parents to be asthmatic had no medical record of asthma. An ISAAC-based parentally completed WQ provided an acceptable estimation of the prevalence of asthma in children 2–6 yr of age, although only half of the individual patients identified in this manner are the same as those identified clinically.

  • 140. Hedin, Katarina
    et al.
    Andre, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
    Håkansson, Anders
    Mölstad, Sigvard
    Rodhe, Nils
    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 , Center for Clinical Research Dalarna.
    Petersson, Christer
    Infectious morbidity in 18-month-old children with and without older siblings2010In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 27, no 5, p. 507-512Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Infections are the most commonly reported health problems in children. Younger age and day care outside the home are two factors of importance for infectious morbidity. The influence of siblings on infectious symptoms is not clear.

    OBJECTIVES:

    To compare families with one child and families with more than one child in terms of reported infectious symptoms, physician consultations and antibiotic prescriptions.

    METHODS:

    A prospective population-based survey was performed. During 1 month, all infectious symptoms, physician consultations and antibiotic prescriptions for 18-month-old children were noted by the parents. The 789 families also answered questions about socio-economic factors, numbers of siblings in the family and type of day care.

    RESULTS:

    No difference in number of symptom days was found between children with and without older siblings. Neither could we find any significance in terms of having older siblings in relation to physician consultations and antibiotic prescriptions.

    CONCLUSIONS:

    The results of our study indicate that having older siblings not was important in relation to number of symptoms days, physician consultations or antibiotic prescriptions for 18-month-old children in Sweden today. Changes in social activities and attitudes towards antibiotic prescription may explain our different findings as compared with previous Swedish studies and studies from other countries.

  • 141. Hedin, Katarina
    et al.
    Andre, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
    Håkansson, Anders
    Mölstad, Sigvard
    Rodhe, Nils
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Petersson, Christer
    Physician consultation and antibiotic prescription in Swedish infants: population-based comparison of group daycare and home care.2007In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 7, p. 1059-1063Article in journal (Refereed)
    Abstract [en]

    Background: Daycare infants have more infectious episodes, see a physician more often, and are prescribed antibiotics more often than home care infants.

    Aim: To compare physician consultations and antibiotic prescription in daycare children and home care children taking number of symptom days, sociodemographic factors, concern about infectious illness and antibiotic knowledge into account.

    Methods: For a cohort of Swedish 18-month-old children all infectious symptoms, physician consultation and antibiotic prescriptions were registered during 1 month.

    Results: 561 infants with daycare outside the home and 278 with daycare at home were included. Of the daycare infants, 23.2% saw a physician and 11.4% were prescribed antibiotics, as compared with 10.8% physician consultations and 5.0% antibiotic prescription for the home care infants. For daycare infants the crude odds ratio for physician consultation were 2.49 (1.63–3.82) and for antibiotic prescription 2.43 (1.34–4.41) compared with home care infants. However, these differences were no longer statistically significant when background data, concern about infectious illness and reported symptoms were taken into account.

    Conclusion: When background data, concern about infectious illness and reported infectious symptoms were taken into account daycare infants saw a physician and was prescribed antibiotics in the same way as home care infants.

  • 142. Hedlin, Gunilla
    et al.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ställberg, Björn
    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).
    Astma och KOL2005In: Läkemedelsboken, Stockholm: Apoteket AB , 2005, p. 543-565Chapter in book (Other (popular science, discussion, etc.))
  • 143.
    Hofsten, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Influence of age, hypertension or myocardial infarction on cardiovascular responses to changes in body position: a population-based study in 30-, 50- and 60-year-old men2000Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    An age-related attenuation of the normal increase in diastolic blood pressure and heart rate upon standing has previously been observed in man. Whether this is due to aging as such or is a consequence of a higher prevalence of cardiovascular disease in older compared to younger subjects is unclear. This population-based study addresses this question and presents the blood pressure and heart rate responses to sudden changes in body position in representative groups of men aged 30 (n=50), 50 (n=44) and 60 (n=69) years, as well as in 60-year-old men with hypertension (n=75) or previous myocardial infarction (n=39) and in a control group (n=41) free from these diseases.

    Blood pressure and heart rate were measured during three seven-minute periods (supinestanding-supine), using an unbiased non-invasive method. Whereas there was an initial decrease in systolic blood pressure upon standing in men aged 50 and 60 years, an increase was seen in the 30-year-olds. The diastolic blood pressure increased in all age groups, but less in the older compared to the younger men. In all age groups, the change in systolic blood pressure upon standing was transient, while the changes in the diastolic blood pressure lasted during the entire observation period. The heart rate increased to a similar extent upon standing in all age groups. After resuming the supine position, both blood pressure and heart rate returned to the levels initially recorded. The cardiovascular responses were both qualitatively and quantitatively similar in all three groups of 60-year-old men (with or without hypertension or previous myocardial infarction).

    In conclusion, this population-based study confirmed previous observations of an age-related attenuation of the blood pressure response to change in body position. However, 60-year-old men with hypertension or previous myocardial infarction had blood pressure responses similar to those of men of the same age and free from these diseases. This indicates that the attenuated response in older compared to younger subjects is not explained by the higher prevalence of these cardiovascular diseases in the elderly, but appears to be the result of normal aging.

    List of papers
    1. Age-related differences in blood pressure and heart rate responses to changes in body position: results from a study with serial measurements in the supine and standing positions in 30-, 50- and 60-year-old men
    Open this publication in new window or tab >>Age-related differences in blood pressure and heart rate responses to changes in body position: results from a study with serial measurements in the supine and standing positions in 30-, 50- and 60-year-old men
    1999 (English)In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 8, no 4, p. 220-226Article in journal (Refereed) Published
    Abstract [en]

    This population-based study presents the blood pressure and heart rate responses to sudden changes in body position in representative groups of men aged 30 (n = 50), 50 (n = 44) and 60 (n = 69) years, using an unbiased method for non-invasive blood pressure measurements. Blood pressure and heart rate were measured every minute during three 7-min periods in the supine, standing and again supine positions. Whereas there was an initial decrease in systolic blood pressure upon standing in men aged 50 and 60 years, an increase was seen in the 30-year-olds. The diastolic blood pressure increased in all age groups, but less in the older compared to the younger men. In all age groups, the changes in systolic blood pressure upon standing were transient, while the changes in the diastolic blood pressure lasted during the entire observation period. The heart rate increased to a similar extent upon standing in all age groups. No symptomatic hypotension was observed. After resuming the supine position, both blood pressure and heart rate returned towards the levels initially recorded. This population-based study confirms previous observations in selected subjects of age-related attenuation in blood pressure response to change in body position. The study also shows that blood pressure and heart rate are rapidly stabilized upon standing up.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-53179 (URN)10697302 (PubMedID)
    Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2018-06-20Bibliographically approved
    2. Does hypertension or a previous myocardial infarction influence the bloodpressure and heart rate responses to changes in body position?: results from a study with serial measurements in the supine and standing positions in 60-year-old-men
    Open this publication in new window or tab >>Does hypertension or a previous myocardial infarction influence the bloodpressure and heart rate responses to changes in body position?: results from a study with serial measurements in the supine and standing positions in 60-year-old-men
    2000 (English)In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 9, no 6, p. 315-322Article in journal (Refereed) Published
    Abstract [en]

    An age-related attenuation of the normal increase in diastolic blood pressure and heart rate upon standing has previously been observed in man. Whether this is due to ageing as such, or a consequence of a higher prevalence of cardiovascular disease in older compared to younger subjects, is unclear. This population-based study was conducted to address this question. It was carried out in three groups of 60-year-old men: (i) with hypertension (n = 75), (ii) with a previous myocardial infarction (n = 39), and (iii) without any of these diseases, thus constituting a control group (n = 41). Blood pressure and heart rate were assessed during three 7-min periods (supine-standing-supine), using an unbiased non-invasive method. The cardiovascular responses were both qualitatively and quantitatively similar in all three groups, i.e. the increases in diastolic blood pressure and heart rate upon standing, and decreases upon laying down, were of a similar magnitude. In conclusion, 60-year-old men with hypertension or a previous myocardial infarction had blood pressure and heart rate responses similar to those of men of the same age who did not have these diseases. This indicates that the attenuated response previously reported in older compared to younger people is not explained by the higher prevalence of these cardiovascular diseases in the elderly, but is merely an age-dependent characteristic.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-53585 (URN)11212059 (PubMedID)
    Available from: 2007-03-21 Created: 2007-03-21 Last updated: 2018-06-20Bibliographically approved
  • 144.
    Hofsten, Anna
    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.
    Elmfeldt, Dag
    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
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Age-related differences in blood pressure and heart rate responses to changes in body position: results from a study with serial measurements in the supine and standing positions in 30-, 50- and 60-year-old men1999In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 8, no 4, p. 220-226Article in journal (Refereed)
    Abstract [en]

    This population-based study presents the blood pressure and heart rate responses to sudden changes in body position in representative groups of men aged 30 (n = 50), 50 (n = 44) and 60 (n = 69) years, using an unbiased method for non-invasive blood pressure measurements. Blood pressure and heart rate were measured every minute during three 7-min periods in the supine, standing and again supine positions. Whereas there was an initial decrease in systolic blood pressure upon standing in men aged 50 and 60 years, an increase was seen in the 30-year-olds. The diastolic blood pressure increased in all age groups, but less in the older compared to the younger men. In all age groups, the changes in systolic blood pressure upon standing were transient, while the changes in the diastolic blood pressure lasted during the entire observation period. The heart rate increased to a similar extent upon standing in all age groups. No symptomatic hypotension was observed. After resuming the supine position, both blood pressure and heart rate returned towards the levels initially recorded. This population-based study confirms previous observations in selected subjects of age-related attenuation in blood pressure response to change in body position. The study also shows that blood pressure and heart rate are rapidly stabilized upon standing up.

  • 145.
    Hofsten, Anna
    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.
    Elmfeldt, Dag
    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
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Does hypertension or a previous myocardial infarction influence the bloodpressure and heart rate responses to changes in body position?: results from a study with serial measurements in the supine and standing positions in 60-year-old-men2000In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 9, no 6, p. 315-322Article in journal (Refereed)
    Abstract [en]

    An age-related attenuation of the normal increase in diastolic blood pressure and heart rate upon standing has previously been observed in man. Whether this is due to ageing as such, or a consequence of a higher prevalence of cardiovascular disease in older compared to younger subjects, is unclear. This population-based study was conducted to address this question. It was carried out in three groups of 60-year-old men: (i) with hypertension (n = 75), (ii) with a previous myocardial infarction (n = 39), and (iii) without any of these diseases, thus constituting a control group (n = 41). Blood pressure and heart rate were assessed during three 7-min periods (supine-standing-supine), using an unbiased non-invasive method. The cardiovascular responses were both qualitatively and quantitatively similar in all three groups, i.e. the increases in diastolic blood pressure and heart rate upon standing, and decreases upon laying down, were of a similar magnitude. In conclusion, 60-year-old men with hypertension or a previous myocardial infarction had blood pressure and heart rate responses similar to those of men of the same age who did not have these diseases. This indicates that the attenuated response previously reported in older compared to younger people is not explained by the higher prevalence of these cardiovascular diseases in the elderly, but is merely an age-dependent characteristic.

  • 146.
    Hofsten, Anna
    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.
    Gustafsson, Christina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Educational Sciences, Department of Education.
    Häggström, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Case seminars open doors to deeper understanding: nursing students' experiences of learning2010In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 30, no 6, p. 533-538Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The Case Method is a teaching method in which cases from real life inspire students to actively seek knowledge that they discuss in structured seminars. Case seminars in health education have been evaluated, compared and discussed, but descriptions that can help us understand how students learn in the seminars have not previously been published. In a Swedish nursing programme, where case seminars have been used for several years, students were asked to write about their experiences of learning in the seminars. The aim of the present study was to describe this learning process from the students' point of view.

    METHOD:

    Written data were analysed using content analysis.

    FINDINGS:

    A theme concerning how the Case Method opens doors to deeper understanding was identified as a thread running through different codes and categories. Students described the importance of new perspectives and their wish to participate in discussions with other students. The students indicated that the structure, which involved pre-prepared cases and writing on the white board, positioned their own knowledge in a wider context and that the learning atmosphere enabled everyone to participate.

    CONCLUSIONS:

    The Case Method seems to involve students in a way that deepens their understanding and critical thinking.

  • 147.
    Holmberg, Sara A. C.
    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.
    Thelin, Anders G.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Predictors of sick leave owing to neck or low back pain: a 12-year longitudinal cohort study in a rural male population2010In: AAEM: Annals of Agricultural and Environmental Medicine, ISSN 1232-1966, E-ISSN 1898-2263, Vol. 17, no 2, p. 251-257Article in journal (Refereed)
    Abstract [en]

    Back pain is a common cause of sick leave. We analyzed how individual, work-related and lifestyle factors predicted sick leave owing to neck or low back pain over a 12-year period. In this prospective cohort study, 1,405 rural middle-aged farmers and non-farmers were surveyed in 1990-1991 (participation rate 76%) and followed up 12 years later (participation rate 68%). The 836 men who reported having experienced unspecific neck or low back pain the year prior to survey I were followed up for self-reported sick leave owing to neck or low back problems. Individual, occupational and lifestyle factors and data on acquired specific neck or back diagnosis were included in multiple logistic regression models. Seven percent reported neck or low back related sick leave during the 12 year period. Self-employment was associated with a lower risk of sick leave while sedentary leisure time, snuff use and a specific neck or back diagnosis was associated with a higher risk. Age, education, physical workload, marital status, sense of coherence, smoking, and alcohol consumption were not independently associated with sick leave. The low risk of sick leave among the self-employed is notable from a societal and public health perspective.

  • 148.
    Holmberg, Sara A. C.
    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.
    Thelin, Anders G.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Primary care consultation, hospital admission, sick leave and disability pension owing to neck and low back pain: a 12-year prospective cohort study in a rural population2006In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 7, p. 66-Article in journal (Refereed)
    Abstract [en]

    Background: Neck and low back pain are common musculoskeletal complaints generating large societal costs in Western populations. In this study we evaluate the magnitude of long-term health outcomes for neck and low back pain, taking possible confounders into account.

    Method: A cohort of 2,351 Swedish male farmers and rural non-farmers (40-60 years old) was established in 1989. In the first survey, conducted in 1990-91, 1,782 men participated. A 12-year follow-up survey was made in 2002-03 and 1,405 men participated at both times. After exclusion of 58 individuals reporting a specific back diagnosis in 1990-91, the study cohort encompassed 1,347 men. The health outcomes primary care consultation, hospital admission, sick leave and disability pension were assessed in structured interviews in 2002-03 (survey 2). Symptoms and potential confounders were assessed at survey 1, with the exception of rating of depression and anxiety, which was assessed at survey 2. Multiple logistic regression generating odds ratios (OR) with 95% confidence intervals (95% CI) was performed to adjust the associations between reported symptoms and health outcomes for potential confounders (age, farming, workload, education, demand and control at work, body mass index, smoking, snuff use, alcohol consumption, psychiatric symptoms and specific back diagnoses during follow up).

    Results: Of the 836 men reporting current neck and/or low back pain at survey 1, 21% had had at least one primary care consultation for neck or low back problems, 7% had been on sick leave and 4% had disability pension owing to the condition during the 12 year follow up. Current neck and/or low back pain at survey 1 predicted primary care consultations (OR = 4.10, 95% CI 2.24-7.49) and sick leave (OR = 3.22, 95% CI 1.13-9.22) after potential confounders were considered. Lower education and more psychiatric symptoms were independently related to sick leave. Lower education and snuff use independently predicted disability pension.

    Conclusion: Few individuals with neck or low back pain were on sick leave or were granted a disability pension owing to neck or low back problems during 12 years of follow up. Symptoms at baseline independently predicted health outcomes. Educational level and symptoms of depression/anxiety were important modifiers.

  • 149.
    Holmberg, Sara
    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.
    Thelin, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Blir man fet av snus? [Does snuff make you fat?]2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 3, p. 118-20Article in journal (Other academic)
  • 150.
    Holmberg, Sara
    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.
    Thelin, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Stiernström, Eva-Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Food choices and coronary heart disease: a population based cohort study of rural Swedish men with 12 years of follow-up2009In: International journal of environmental research and public health, ISSN 1661-7827, Vol. 6, no 10, p. 2626-2638Article in journal (Refereed)
    Abstract [en]

    Coronary heart disease is associated with diet. Nutritional recommendations are frequently provided, but few long term studies on the effect of food choices on heart disease are available. We followed coronary heart disease morbidity and mortality in a cohort of rural men (N = 1,752) participating in a prospective observational study. Dietary choices were assessed at baseline with a 15-item food questionnaire. 138 men were hospitalized or deceased owing to coronary heart disease during the 12 year follow-up. Daily intake of fruit and vegetables was associated with a lower risk of coronary heart disease when combined with a high dairy fat consumption (odds ratio 0.39, 95% CI 0.21-0.73), but not when combined with a low dairy fat consumption (odds ratio 1.70, 95% CI 0.97-2.98). Choosing wholemeal bread or eating fish at least twice a week showed no association with the outcome.

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