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  • 151.
    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
    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.
    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.
    Psychosocial factors and low back pain, consultations, and sick leave among farmers and rural referents: A population-based study2004In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 46, no 9, p. 993-998Article in journal (Refereed)
    Abstract [en]

    Farmers have more low back pain (LBP) than nonfarmers. In a previous report, we found that differences between farmers and nonfarmers in physical work exposure did not explain the LBP differences. In this report, we tested the hypothesis that psychosocial factors might explain the differences in LBP reporting, medical consultation, and sick leave. A cross-sectional population-based survey of 1,013 middle-aged farmers and 769 matched referents was performed. Data on LBP, consultations, and sick leave during lifetime was obtained along with information on psychosocial, social network, and lifestyle variables. Several of the psychosocial variables were associated with LBP but the difference in LBP prevalence between farmers and nonfarmers could be explained only marginally. Farmers and self-employed referents tended to have lower odds of sick leave because of LBP than employed referents after adjustment for psychosocial factors.

  • 152. Huerta, C
    et al.
    Garcia Rodriguez, LA
    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
    Users of oral steroids are at a reduced risk of developing irritable bowelsyndrome2003In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 12, no 7, p. 583-588Article in journal (Refereed)
    Abstract [en]

    Purpose

    To study whether irritable bowel syndrome (IBS) is associated with the use of oral steroids and whether there is a dose- or duration-response.

    Methods

    We followed up a cohort of 65 270 patients aged 20–74 years old enrolled in the General Practice Research Database in the UK with at least one prescription for steroids between 1994 and 1999. We performed a nested case-control analysis to estimate the adjusted relative risk (RR) associated with the use of steroids using unconditional logistic regression. Cases were 466 patients with a first episode of IBS during follow-up and controls were 5000 individuals randomly selected from the study cohort.

    Results

    Current users of oral steroids presented an RR of 0.6 (95%CI: 0.4–0.9) compared to non-users. Doses greater than 10 mg of prednisolone daily were associated with an RR of 0.4 (95%CI: 0.2–0.9). When we stratified by age, no reduced risk of IBS was apparent under the age of 40 years. The reduced risk of IBS was greater among females than males.

    Conclusions

    Our results suggest that oral steroids can reduce the risk of a diagnosis of IBS. The apparent effect modification of age and sex deserves further research.

  • 153. Huerta, C
    et al.
    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.
    García Rodríguez, LA
    Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom2007In: Archives of Internal Medicine, ISSN 0003-9926, E-ISSN 1538-3679, Vol. 167, no 9, p. 935-943Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Venous thromboembolism (VTE) manifesting as deep vein thrombosis (DVT) and pulmonary embolism (PE) remains a common vascular disease with high mortality and morbidity. Our aim was to study the clinical spectrum of VTE, assess its incidence in the general population, and evaluate potential risk factors. METHODS: Prospective cohort study with nested case-control analysis using the General Practice Research Database (1994-2000). Venous thromboembolism was newly diagnosed in 6550 patients. Cases were compared with a random sample of 10,000 controls and frequency-matched by age, sex, and year. RESULTS: The incidence rate of VTE was 74.5 per 100,000 person-years. Overweight, varicose veins, inflammatory bowel disease, cancer, and oral corticosteroid use were associated with a greater risk of VTE. Ischemic heart disease, heart failure, and cerebrovascular diseases were associated with an increased risk of PE but not with DVT. Venous thromboembolism was strongly associated with fractures (odds ratio [OR], 21.3; 95% confidence interval [CI], 15.7-28.9) and surgery (OR, 25.0; 95% CI, 14.4-43.5). In women, the risk of VTE was 1.9 (95% CI, 1.5-2.3) among those receiving opposed hormone therapy (in which the woman takes estrogen throughout the month and progesterone for 10-14 days later in the month) and 1.9 (95% CI, 1.4-2.5) among those taking oral contraceptives. Cancer and cerebrovascular diseases presented a greater relative risk of fatal PE compared with nonfatal PE. CONCLUSIONS: Overweight, varicose veins, cancer, inflammatory bowel disease, fractures, surgery, and use of oral corticosteroids, oral contraceptives, and opposed hormone therapy were independent risk factors for both DVT and PE. The magnitude of the association with some risk factors varied between DVT and PE, as well as between fatal and nonfatal PE.

  • 154. Huerta, Consuelo
    et al.
    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.
    Rodríguez, Luis A. García
    Risk of myocardial infarction and overall mortality in survivors of venous thromboembolism.2008In: Thrombosis Journal, ISSN 1477-9560, E-ISSN 1477-9560, Vol. 6, p. 10-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Venous thromboembolism (VTE) and thromboembolic arterial diseases are usually considered to be distinct entities, but there is evidence to suggest that these disorders may be linked. The aim of this study was to determine whether a diagnosis of VTE increases the long-term risk of myocardial infarction (MI).

    METHODS

    The incidence rate (IR) and relative risk (RR) of MI in a cohort of patients with a diagnosis of VTE (n = 4890) compared with that of a control cohort without prior VTE (n = 43 382) were evaluated in the UK General Practice Research Database (GPRD). Death during follow-up was also determined. Patients were followed for up to 8 years (mean of 3 years).

    RESULTS

    The IR of MI per 1000 person-years was 4.1 (95% CI: 3.1-5.3) for the VTE cohort and 3.5 (95% CI: 3.2-3.8) for the control cohort. The IR of MI was highest in the first year after the VTE episode, but overall differences between the two cohorts were not significant (RR of MI associated with VTE: 1.2; 95% CI: 0.9-1.6). The risk of death was higher in the VTE cohort than the control cohort, even after adjustment for cancer, heart failure and ischaemic heart disease (RR: 2.4; 95% CI: 2.2-2.6), particularly during the first year after VTE (RR: 3.8; 95% CI: 3.4-4.3).

    CONCLUSION

    A VTE episode does not significantly increase the risk of MI, but does increase the risk of death, particularly in the first year following VTE diagnosis.

  • 155.
    Hägglund, Doris
    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.
    Ahlström, Gerd
    The meaning of women's experience of living with long term urinary incontinence is powerlessness2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 10, p. 1946-1954Article in journal (Refereed)
    Abstract [en]

    AIM: The aim was to illuminate the meaning of women's experiences of living with urinary incontinence (UI). BACKGROUND: Living with long-term UI means a variety of consequences for everyday life. Women's narratives about their lived experiences are important in enabling nurses to better understand and to help women achieve symptom control. No previous study could be found that has focused on the meaning of women's experience of living with UI from a symptom management perspective. METHOD: Fourteen women with UI (range: 34-52 years) who had sought professional help were interviewed. A phenomenological hermeneutic method was used to analyse and interpret the interview texts. FINDINGS: The women's experiences of living with UI are presented in terms of two interlaced themes of being in a vulnerable situation and striving for adjustment. Being in a vulnerable situation means that the women had no control over UI and experienced powerlessness. The sub-themes in this case were living with an uncontrolled body, living with incontinence as taboo and experiencing a less satisfying encounter. Striving for adjustment means that the women tried to handle their incontinence in different ways to regain power and continue to live as normal. The sub-themes here were living in readiness, making urine leakage comprehensible, accepting living with UI and being familiar with the situation. Conclusion. The meaning of women's experience of living with UI is powerlessness. RELEVANCE TO CLINICAL PRACTICE: Nurses should supervise women in pelvic floor muscle training to achieve control over incontinence, thereby helping them regain power. Additionally, Integrated Approach to Symptom Management can help nurses enhance women's self-care abilities.

  • 156.
    Hägglund, Doris
    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.
    Olsson, Henny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Leppert, Jerzy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Urinary incontinence: an unexpected large problem among young females. Results from a population-based study1999In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 16, no 5, p. 506-509Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The International Continence Society has defined urinary incontinence as a condition in which involuntary loss of urine is objectively demonstrable and is a social or hygiene problem. Urinary incontinence is presumably a common health problem among women even in younger ages.

    OBJECTIVES:

    The primary aim was to investigate the prevalence of urinary incontinence (UI) in a female population with a special focus on younger women (18-30 years old). The secondary aim was to investigate the association between UI and number of deliveries, use of contraceptives or oestrogen substitutions, and urinary tract infections (UTIs).

    METHODS:

    A population-based study with a self-administered questionnaire was set in the community of Surahammar, Sweden. Subjects were all women (3493) aged 18-70 years living in Surahammar during 1995. The main outcome measures were the prevalence of UI and variables such as number of deliveries, use of contraceptives or oestrogen substitutions, and UTIs.

    RESULTS:

    Twenty-six per cent of the women reported problems of UI. The prevalence of UI in younger women was 12%. The number of reported complaints of UTIs was significantly higher in the women with UI compared with women without urinary incontinence (wUI). In the younger women UTI, nulliparous or having given birth to one or two children were most frequent in those with UI. The use of contraceptives was more common in younger women without UI (P < 0.05). However, the use of oestrogen was more common in older women in the age group 51-70 years with UI (P < 0.01).

    CONCLUSION:

    Our findings have shown that 26% of the women who took part in the survey reported problems of UI. Among women below 30 years of age, 12% reported complaints of UI. We found a high prevalence of UI in younger women with a UTI, not taking oestrogen, nulliparous or having given birth to one or two children. There are needs for further investigations with a special focus on younger women.

  • 157.
    Häggström, Elisabeth
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    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.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Nurses' options about a web-based distance course in a specialist education programme for the care of older people: a questionnaire study2009In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 4, no 3, p. 177-184Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to investigate students' opinions about a web-based distance learning course that was part of a specialist education programme.

    Background

    Most registered nurses (RNs) who work with older people in Sweden do not have a specialist education in caring for older people. Design.?Survey.

    Method

    The study was a descriptive survey with both qualitative and quantitative questions.

    Results

    The students found the web-based course very useful for their theoretical and professional development. New perspectives on ageing, increased knowledge about analysing and describing theories as well as practising interviews and qualitative analysis as methods were appreciated by the students.

    Conclusions

    One way for RNs in Sweden to get a university specialist education in the care of older people is to have a distance web-based course, as it allows flexibility and improves the students' theoretical and professional knowledge and communication skills. Relevance for clinical practice.?Managers working in care for older people settings and educators will be interested in this study's finding that distance learning is a useful strategy for providing education for RNs who work with older people.

  • 158. Håkansson, Anders
    et al.
    André, Malin
    Björkelund, Cecilia
    Borgquist, Lars
    Holmberg, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Kristiansson, Robert
    Allmänmedicinsk forskning växer: men tillräckligt snabbt?2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, no 24-25, p. 1968-1971Article in journal (Other academic)
  • 159.
    Högman, Marieann
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Lafih, Jaroslava
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Meriläinen, Pekka
    Bröms, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Extended NO analysis in a healthy subgroup of a random sample from a Swedish population2009In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 29, no 1, p. 18-23Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: There is an interest in modelling exhaled nitric oxide (NO). Studies have shown that flow-independent NO parameters i.e. NO of the alveolar region (C(A)NO), airway wall (C(aw)NO), diffusing capacity (D(aw)NO) and flux (J(aw)NO), are altered in several disease states such as asthma, cystic fibrosis, alveolitis and chronic obsmuctive pulmonary disease (COPD). However, values from a healthy population are missing. OBJECTIVES: To calculate NO parameters in a healthy population by collecting NO values at different exhalation flow rates. METHODS: A random sample from the ECRHS II study was investigated. Among the 281 subjects that had performed a bronchial hyperreactivity (BHR)-test, FEV(1.0), IgE and NO-analyses 89 were found to be healthy. RESULTS: There were no differences in F(E)NO(0.05) or NO parameters between men and women. There were weak correlations between height and both F(E)NO(0.05) (r = 0.23, P = 0.03) and C(aw)NO (r = 0.22, P = 0.04). There was also a correlation between age and C(A)NO (r = 0.28, P = 0.007). When controlled for gender, this correlation was more powerful in women (r = 0.51, P = 0.001) but did not remain for male subjects. CONCLUSION: Extended NO analysis is a simple non-invasive tool that gives by far more information than F(E)NO(0.05). Based on our results, we suggest that the values for healthy subjects should be considered to fall between the following ranges: F(E)NO(0.05), 10-30 ppb; C(aw)NO, 50-250 ppb; D(aw)NO, 5-15 ml s(-1); J(aw)NO, 0.8-1.6 nl s(-1); and C(A)NO, 0-4 ppb. Values outside these intervals indicate the need for further investigation to exclude a state of disease.

  • 160. Ind, PW
    et al.
    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.
    Willich, SN
    Adjustable maintenance dosing with budesonide/formoterol (Symbicort) reduces treatment costs in asthma2004In: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 58, no s141, p. 33-41Article in journal (Refereed)
    Abstract [en]

    Adjustable maintenance dosing permits patients to increase or decrease their medication, according to a management plan, in response to daily variations in asthma. Adjustable maintenance dosing with budesonide/formoterol in a single inhaler was compared with fixed dosing bid in eight randomised, open-label studies. Data on resource utilisation were collected prospectively in six of the studies. Duration of randomised treatment was 3 months (UK, Italy, Germany), 4 months (Belgium), 5 months (Canada) or 6 months (Sweden). Mean number of budesonide/formoterol inhalations/day was significantly lower for adjustable maintenance dosing vs. fixed dosing, which resulted in significantly lower drug and total costs with adjustable maintenance dosing vs. fixed-dosing group. In the 3- and 4-month studies, both regimens had similar effectiveness. In the Canadian and Swedish studies, a significantly lower percentage of adjustable maintenance dosing patients had asthma exacerbations compared with fixed dosing. Adjustable maintenance dosing reduced treatment costs, providing similar or better asthma control at a lower overall dose, compared with fixed dosing.

  • 161.
    Janson, Christer
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    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).
    Hesselmar, Bill
    Astma och KOL2009In: Läkemedelsboken 2009-2010, Stockholm: Apoteket , 2009, p. 645-669Chapter in book (Other (popular science, discussion, etc.))
  • 162. Jansson, C
    et al.
    Nordenstedt, H
    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.
    Johnsen, R
    Hveem, K
    Lagergren, J
    Relation between gastroesophageal reflux symptoms and socioeconomic factors: a population-based study (the HUNT Study)2007In: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 5, no 9, p. 1029-1034Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Gastroesophageal reflux constitutes a major public health problem in the Western world. Few population-based studies have addressed socioeconomic factors in relation to reflux. METHODS: We conducted a case-control study based on 2 health surveys performed in the Norwegian county of Nord-Trondelag in 1984-1986 and 1995-1997, respectively. Reflux was assessed in the second survey, comprising 65,333 participants representing 70% of the county's adult population. Among 58,596 persons responding to questions regarding reflux symptoms, 3153 persons reporting severe symptoms represented the cases, and 40,210 persons without symptoms represented the controls. Data collected in questionnaires included socioeconomic status (SES) based on occupation, education, and material deprivation; family situation; and potential confounders. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated from unconditional logistic regression in crude models and models adjusted for age, sex, smoking, and body mass. RESULTS: The risk of reflux increased with decreasing levels of SES based on occupation, education, and material deprivation. Increased risks of reflux were seen among unskilled laborers (OR, 1.6; 95% CI, 1.3-2.0), skilled laborers (OR, 1.4; 95% CI, 1.1-1.7), and self-employed and farmers (OR, 1.3; 95% CI, 1.1-1.6). A 1.9-fold (95% CI, 1.7-2.2) increased risk of reflux was observed among persons with low education, compared with highly educated persons. Reflux was more common among materially deprived persons (OR, 3.4; 95% CI, 2.9-4.1). The results were similar in crude and adjusted models. CONCLUSIONS: This large population-based study reveals a link between low SES and reflux symptoms that is not explained by the known risk factors of smoking or obesity. This finding deserves further research.

  • 163. Jansson, C
    et al.
    Nordenstedt, H
    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
    Johnsen, R
    Hveem, K
    Lagergren, J
    Severe gastro-oesophageal reflux symptoms in relation to anxiety, depression and coping in a population-based study2007In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 26, no 5, p. 683-691Article in journal (Refereed)
    Abstract [en]

    Background The association between psychiatric disorders and gastro-oesophageal reflux symptoms is uncertain, and few population-based studies are available. Aim To examine the association between psychiatric and psychological factors and reflux symptoms. Methods Population-based, cross-sectional, case-control study based on two health surveys conducted in the Norwegian county Nord-Trondelag in 1984-1986 and 1995-1997. Reflux symptoms were assessed in the second survey, including 65 333 participants (70% of the county's adult population). 3153 subjects reporting severe reflux symptoms were defined as cases and 40 210 subjects without symptoms were defined as controls. Data were collected in questionnaires. Odds ratio with 95% confidence intervals were estimated using unconditional logistic regression, in adjusted models. Results Subjects reporting anxiety without depression had a 3.2-fold (95% CI: 2.7-3.8) increased risk of reflux, subjects with depression without anxiety had a 1.7-fold (95% CI: 1.4-2.1) increased risk and subjects with both anxiety and depression had a 2.8-fold (95% CI: 2.4-3.2) increased risk, compared to subjects without anxiety/depression. We observed a weak inverse association between one measure of covert coping and risk of reflux and a weak positive association between another coping measure and risk of reflux. Conclusions This population-based study indicates that anxiety and depression are strongly associated with reflux symptoms, while no consistent association regarding coping and reflux was found.

  • 164. Jansson, C
    et al.
    Nordenstedt, H
    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
    Johnsen, R
    Hveem, K
    Lagergren, J
    Severe symptoms of gastro-oesophageal reflux disease are associated with cardiovascular disease and other gastrointestinal symptoms, but not diabetes: a population-based study2008In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 27, no 1, p. 58-65Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Few population-based studies have examined comorbidity in relation to gastro-oesophageal reflux disease (GERD).

    AIM

    To study the association between cardiovascular disease, diabetes, gastrointestinal symptoms and GERD.

    METHODS

    Population-based, cross-sectional, case-control study based on a large Norwegian health survey conducted in 1995-97. Among 65,333 participants, 3153 persons reporting severe reflux symptoms were defined as cases, and 40,210 persons without such symptoms were defined as controls. Data on cardiovascular disease, diabetes, gastrointestinal symptoms and potential confounders were collected through questionnaires. Odds ratios (OR) with 95% confidence intervals (CI) were estimated using unconditional logistic regression, in crude and adjusted models. RESULTS: In the crude models, positive associations were observed between myocardial infarction (OR 1.7, 95% CI 1.4-2.1), angina pectoris (OR 2.5, 95% CI 2.1-2.9) and stroke (OR 1.6, 95% CI 1.2-2.1) and risk of GERD. The associations were attenuated in the adjusted models, but remained significant for angina pectoris (OR 1.9, 95% CI 1.6-2.2). No association was observed between diabetes and GERD. Strong positive associations were seen between all studied gastrointestinal symptoms, i.e. nausea, diarrhoea and constipation, and risk of GERD.

    CONCLUSIONS

    This population-based study indicates that myocardial infarction, angina pectoris, stroke and symptoms of nausea, diarrhoea and constipation are associated with GERD.

  • 165. Jansson, C
    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
    Johnsen, R
    Hveem, K
    Stressful psychosocial factors and symptoms of gastroesophageal reflux disease: a population-based study in Norway2010In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 45, no 1, p. 21-29Article in journal (Refereed)
    Abstract [en]

    Objective. Adverse psychosocial factors, including work-related stress, are, like gastroesophageal reflux disease (GERD), increasing health problems in industrialized countries. The importance of clarifying the relation between psychosocial factors and GERD has been stressed, but there are few population-based studies. Material and methods. This was a population-based, cross-sectional, case-control study based on two health surveys conducted in the Norwegian county Nord-Trondelag in 1984-86 and 1995-97. GERD symptoms were assessed in the second survey, which included 65,333 participants, representing 70% of the county's adult population. The 3153 persons reporting severe GERD symptoms were defined as cases and the 40,2 10 persons without such symptoms were defined as controls. Data on psychosocial factors and potential confounders were collected using questionnaires. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using unconditional logistic regression. Results. In models adjusted for age, sex, smoking, obesity and socioeconomic status, positive associations were observed between high job demands (OR 1.9, 95% CI 1.6-2.2), low job control (OR 1.1, 95% CI 1.0-1.2) and job strain (OR 1.9, 95% CI 1.6-2.4) and risk of GERD symptoms. Persons reporting low job satisfaction had a twofold (95% CI 1.6-2.5) increased risk of GERD compared to persons reporting high job satisfaction. Self pressure (OR 1.8, 95% CI 1.6-2.1) and time pressure (OR 2.0, 95% CI 1.7-2.4) were positively associated with GERD symptoms. These associations were attenuated after further adjustment for anxiety, depression, myocardial infarction, angina pectoris, stroke and insomnia, but remained statistically significant. Conclusions. This population-based study reveals a link between stressful psychosocial factors, including job strain, and GERD symptoms.

  • 166. Jansson, Catarina
    et al.
    Nordenstedt, Helena
    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
    Johnsen, Roar
    Hveem, Kristian
    Lagergren, Jesper
    A population-based study showing an association between gastroesophageal reflux disease and sleep problems2009In: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 7, no 9, p. 960-965Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Gastroesophageal reflux disease and sleep problems are common health problems in Western nations. It is important to clarify the association between sleep and gastroesophageal reflux disease, but only a few population-based studies have been conducted. METHODS: A population-based, cross-sectional, case-control study was based on 2 large health surveys performed in the Norwegian county Nord-Trondelag in 1984-1986 and 1995-1997. Gastroesophageal reflux disease was assessed in the second survey, which included 65,333 participants (70% of the county's adult population). The 3153 persons who reported severe reflux symptoms constituted the cases, and the 40,210 persons without reflux symptoms constituted the controls. Data on insomnia, sleep problems, and several potential confounders were collected in questionnaires. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by using unconditional logistic regression in crude and multivariable models. RESULTS: In models adjusted for age, sex, tobacco smoking, obesity, and socioeconomic status, positive associations were observed between presence of insomnia (OR, 3.2; 95% CI, 2.7-3.7), sleeplessness (OR, 3.3; 95% CI, 2.9-3.8), problems falling asleep (OR, 3.1; 95% CI, 2.5-3.8), and risk of gastroesophageal reflux disease. These associations were attenuated after further adjustments for anxiety, depression, myocardial infarction, angina pectoris, stroke, and gastrointestinal symptoms, but they remained statistically significant. CONCLUSIONS: A large population-based study indicated a link between sleep problems and gastroesophageal reflux disease that might be bidirectional.

  • 167. Jansson, Christer
    et al.
    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.
    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.
    Regionala skillnader i rökslutarstöd för KOL-patienter: resultat från Praxisstudien2006Conference paper (Other academic)
  • 168.
    Jansson, Stefan
    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.
    Andersson, Dan
    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.
    Prevalence and incidence rate of diabetes mellitus in a Swedish community during 30 years of follow-up2007In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 50, no 4, p. 703-710Article in journal (Refereed)
    Abstract [en]

    Aims/hypothesis: Increasing diabetes prevalence has been reported in most European countries in the last 20 years. In this study we report on the development of prevalence and incidence of diabetes from 1972 to 2001 in Laxå, a rural community in central Sweden. Materials and methods: A diabetes register was established at the primary healthcare centre (PHCC) in Laxå, beginning in 1972 and based on data from clinical records at the PHCC, nearby hospitals and private practitioners in the area. In addition, case-finding procedures involving 85% of the residents aged 35 to 79 years old was performed from 1983 onwards. Results: During the study period a total of 776 new diabetes cases was found, 36 type 1 diabetes mellitus and 740 type 2 diabetes mellitus. The age-standardised incidence rates for type 1 diabetes mellitus and type 2 diabetes mellitus were 0.15 and 3.03 cases per 1,000 population, respectively. No increase in incidence over time was detected for either forms of diabetes. Age-standardised prevalence for women and men increased from 28.3 and 25.9, respectively, per 1,000 in 1972 to 45 and 46.3 per 1,000 in 1988 (p<0.0001), thereafter falling to a mean of 43.5 per 1,000 for women, while men had a mean of 44.9 per 1,000 for the rest of the study period. Conclusions/interpretation: The prevalence of diabetes mellitus in Laxå is high, but has not increased during the last 13 years. The incidence rate was relatively stable over the whole 30-year period.

  • 169.
    Jansson, Stefan P. O.
    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.
    Andersson, Dan K. G.
    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.
    Mortality Trends in Subjects With and Without Diabetes During 33 Years of Follow-up2010In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 33, no 3, p. 551-556Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE - Mortality rates have declined substantially over the Past decades in the general population, but the situation among diabetic subjects is less clear. The aim of this study was to analyze mortality trends in diabetic and nondiabetic subjects during 1972-2004. RESEARCH DESIGN AND METHODS - Since 1972, all patients With diabetes are entered in a diabetes register at Laxa Primary Health Care Center; 776 incident cases were recorded Up to 2001. The register has been supplemented with a nondiabetic population of 3,880 subjects and with data from the National Cause of Death Register during 1972 to 2004. RESULTS - During the 33-year follow-up period, 233 (62.0%) diabetic women and 240 (60.0%) diabetic men and 995 (52.9%) nondiabetic women and 1,082 (54.1%) nondiabetic men died. The age-adjusted hazard ratio (HR) for all-cause mortality among diabetic and nondiabetic subjects was 1.17 (P < 0.0021) for all, 1.22 (P < 0.007) for women, and 1.13 (P = 0.095) for men. The corresponding cardiovascular disease (CVD) mortality HRs were 1.33 (P < 0.0001), 1.41 (P < 0.0003), and 1.27 (P < 0.0093), respectively. The CVD Mortality reduction across time was significant in nondiabetic subjects (P < 0.0001) and in men with diabetes (P = 0.014) but not in diabetic women (P = 0.69). The results regarding coronary heart disease (CHD) were similar (P < 0,0001, P < 0.006, and P = 0.17, respectively). The CVD and CHD mortality rate change across time was fairly linear in all groups. CONCLUSIONS - Diabetic subjects had less mortality rate reduction during follow-up than nondiabetic subjects. However the excess mortality risk for diabetic subjects was smaller than that found in Other Studies.

  • 170.
    Johannesson, Marie
    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.
    Askling, Johan
    Montgomery, Scott M
    Ekbom, Anders
    Bahmanyar, Shahram
    Cancer risk among patients with cystic fibrosis and their first-degree relatives2009In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 125, no 12, p. 2953-2956Article in journal (Refereed)
    Abstract [en]

    Patients with cystic fibrosis (CF) are at increased risk of some cancers. Little is known about the cancer risks among carriers heterozygous for the CF mutation and it is hypothesized this may be associated with reduced cancer risk. Using Swedish general population-based registers, we identified 884 patients with CF from 1968 to 2003 and 3,033 of their first-degree relatives The subjects were followed from birth of index persons or 1958, whichever came later, until death, emigration or 2003, whichever came first. Cancer risks were compared with the general Swedish population using standardized incidence ratios (SIR) with 95% confidence intervals (CI). Patients, followed for an average of 21 years, were at a higher overall risk of cancer. Some 26 cancer diagnoses, after excluding multiple diagnoses of nonmelanoma skin cancer in one man, produced an overall SIR of 3.2 (95% CI 2.1-4.6). We found statistically significantly increased risks for kidney, thyroid, endocrine, lymphoma and nonmelanoma skin cancer. There was no modification of cancer risk among parents and siblings, with an average of 21 years of follow-up. This study did not identify a heterozygote advantage for CF gene mutations in relation to cancer risk.

  • 171.
    Johansson, G
    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.
    Ställberg, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Tornling, G
    Andersson, S
    Karlsson, G
    Fält, K
    Berggren, F
    Asthma treatment preference study: a conjoint analysis of preferred drug treatments2004In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 125, p. 916-923Article in journal (Refereed)
  • 172.
    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.
    Screening upptäcker fler patienter med KOL2006In: Nordisk Medicine, Vol. 2, p. 27-30Article in journal (Other academic)
  • 173.
    Johansson, Gunnar
    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.
    Andreasson, Emma B.
    Larsson, Per E.
    Vogelmeier, Claus F.
    Cost effectiveness of budesonide/formoterol for maintenance and reliever therapy versus salmeterol/fluticasone plus salbutamol in the treatment of asthma2006In: PharmacoEconomics (Auckland), ISSN 1170-7690, E-ISSN 1179-2027, Vol. 24, no 7, p. 695-708Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Budesonide/formoterol (Symbicort) Maintenance And Reliever Therapy (SMART) is an effective and well tolerated treatment option for patients with asthma. We compared the cost effectiveness from a societal perspective of this one-inhaler regimen with that of maintenance salmeterol/fluticasone propionate (Seretide) plus salbutamol (albuterol) as needed (Seretide) Fixed Combination [SFC]). STUDY DESIGN: A cost-effectiveness analysis was performed based on effectiveness and resource-utilisation data collected prospectively in a randomised, 12-month study performed in 2143 patients in 16 countries. Resource utilisation data were pooled and unit costs (euro, year 2003 values) from Italy, France, the UK and Germany were used to generate estimates of direct and total costs per patient per year and cost per severe exacerbation avoided. METHODS: Adolescents and adults with asthma (n = 2143; mean forced expiratory volume in 1 second [FEV(1)] 73% predicted; mean inhaled corticosteroid [ICS] dose 884 microg/day) were randomised to SMART or SFC. The effectiveness measure used was the number of severe exacerbations per patient per year. Direct costs included medication use (budesonide/formoterol 160microg/4.5microg or salmeterol/fluticasone 50microg/100microg, 50microg/250microg or 50microg/500microg plus salbutamol) and nonmedication-related resource use, including days in hospital, emergency room visits, specialist or primary care physician visits and other healthcare provider contacts. Indirect costs, including the number of days when the patient or their carer was unable to attend to their normal daily activities, were also assessed. The study assumed a European societal perspective (i.e. including direct and indirect costs). RESULTS: Treatment with SMART resulted in significantly fewer severe exacerbations per patient per year compared with SFC (0.24 vs 0.31 events per patient per year; p = 0.0025). Resource use was low in both groups. Medication costs accounted for the majority of the total costs. The increased effectiveness of SMART was achieved at a reduced or similar cost compared with SFC. SMART dominated when German unit costs were applied (i.e. there was a statistically significant reduction in both costs and number of exacerbations). In all other countries, the incremental cost-effectiveness ratios showed that there was a reduction in mean total cost per exacerbation avoided; however, this difference was not statistically significant. CONCLUSION: This analysis demonstrates that, compared with SFC, SMART may be cost effective from a societal perspective for the treatment of patients with asthma in Italy, Germany, France and the UK. SMART provided a reduction in the number of severe exacerbations per patient per year, at no statistically significant increase in cost - or even at a lower cost - compared with SFC plus as-needed reliever salbutamol.

  • 174.
    Johansson, Gunnar
    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.
    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.
    Tornling, Göran
    Andersson, Stina
    Karlsson, Göran S
    Fält, Krister
    Berggren, Fredrik
    Asthma treatment preference study: a conjoint analysis of preferred drug treatments2004In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 125, no 3, p. 916-923Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    Assessment of patient preferences for attributes of asthma treatments.

    METHODS:

    Two hundred ninety-eight patients (age range, 18 to 60 years) from 15 centers in Sweden completed a questionnaire concerning their asthma, and ranked 18 alternative treatments using conjoint analysis. Patients were receiving treatment with either inhaled corticosteroids (ICS) and short-acting bronchodilator (n = 123) or ICS and long-acting bronchodilator (separate inhalers, n = 87; combination inhaler, n = 88). Attributes analyzed were maintenance treatment, additional reliever, time to onset and duration of reliever, number of symptom-free days (SFDs) per month, and out-of-pocket cost per month.

    RESULTS:

    Conjoint analysis showed that the most important aspect of treatment was SFD. Forty percent of the patients had <or= 15 SFDs per month. Eighty-five percent of the patients preferred another treatment over their current treatment. Treatment preferences were heterogeneous, and in 78% were not covered by current treatment guidelines. A total of 148 patients (50%) preferred a combination inhaler to separate inhalers, and 233 patients (78%) preferred a reliever that is both rapid and long acting. The most preferred treatment was a combination inhaler for maintenance and reliever use. On average, the patients were willing to pay an additional 328 Swedish krona [36 US dollars] per month for the change to the preferred treatment.

    CONCLUSION:

    SFDs were the most important attribute in asthma treatment. Patients were willing to pay for a switch to their preferred treatment. The most favored treatments were a reliever therapy that is both rapid and long acting and a combination inhaler for both maintenance and as-needed use.

  • 175. Johansson, S
    et al.
    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.
    Greén, Y
    Screening with spirometry reduces smoking2006In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 15, no 3, p. 213-213Article in journal (Refereed)
  • 176. Johansson, Saga
    et al.
    Ming, Eileen E
    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.
    García Rodríguez, Luis A.
    Herings, Ron M. C.
    Goettsch, Wim G.
    González-Pérez, Antonio
    McAfee, Andrew T.
    Walker, Alexander M.
    Rosuvastatin safety: a comprehensive, international pharmacoepidemiology programme2006In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 15, no 7, p. 454-461Article in journal (Refereed)
    Abstract [en]

    Results from clinical trials and clinical practice have shown statins to be generally well tolerated with a low frequency of clinically relevant side effects. Nevertheless, there are rare occasions when adverse events (AEs), sometimes serious, may occur. Rosuvastatin is the newest statin to be approved in the USA and many other countries. As part of the continued assessment of the benefit-risk profile of rosuvastatin, AstraZeneca has developed a progressive, comprehensive pharmacoepidentiology programme to complement safety data obtained from randomised clinical trials and spontaneous reporting systems, which have demonstrated that rosuvastatin has a safety profile in line with comparator statins. This programme comprises nine studies conducted in recognised centres of excellence assessing over 50000 patients treated with rosuvastatin. It consists of three components: patient characteristics studies (four studies), safety evaluation studies (four studies); and review of data generated from the Prescription-Event Monitoring (PEM) study, designed and run by an independent third party. Patient characteristics studies are designed to describe the characteristics and drug utilisation patterns of new users of rosuvastatin compared with new users of other statins in automated databases. Safety evaluation studies will examine the rates of specific AEs in different cohorts of statin users and determine risk factors for these events using data recorded prospectively in automated databases with case adjudication via medical record review. The independent PEM study will monitor any significant events recorded by general practitioners since starting rosuvastatin treatment. This article is an overview of the rationale and methodology of the rosuvastatin pharmacoepiderniology programme.

  • 177. Johansson, Saga
    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.
    de Abajo, Francisco J
    Garcia Rodriguez, Luis Alberto
    Prospective Drug Safety Monitoring Using the UK Primary-Care General Practice Research Database Theoretical Framework, Feasibility Analysis and Extrapolation to Future Scenarios2010In: Drug Safety, ISSN 0114-5916, E-ISSN 1179-1942, Vol. 33, no 3, p. 223-232Article in journal (Refereed)
    Abstract [en]

    Background: Post-launch drug safety monitoring is essential for the detection of adverse drug signals that may be missed during preclinical trials. Traditional methods of postmarketing surveillance such as spontaneous reporting have intrinsic limitations, many of which can be overcome by the additional application of structured pharmacoepidemiological approaches. However, further improvement in drug safety monitoring requires a shift towards more proactive pharmacoepidemiological methods that can detect adverse drug signals as they occur in the population. Objective: To assess the feasibility of using proactive monitoring of an electronic medical record system, in combination with an independent endpoint adjudication committee, to detect adverse events among users of selected drugs. Methods: UK General Practice Research Database (GPRD) information was used to detect acute liver disorder associated with the use of amoxicillin/clavulanic acid (hepatotoxic) or low-dose aspirin (acetylsalicylic acid [non-hepatotoxic]). Individuals newly prescribed these drugs between 1 October 2005 and 31 March 2006 were identified. Acute liver disorder cases were assessed using GPRD computer records in combination with case validation by an independent endpoint adjudication committee. Signal generation thresholds were based on the background rate of acute liver disorder in the general population. Results: Over a 6-month period, 8148 patients newly prescribed amoxicillin/clavulanic acid and 5577 patients newly prescribed low-dose aspirin were identified. Within this cohort, searches identified 11 potential liver disorder cases from computerized records: six for amoxicillin/clavulanic acid and five for low-dose aspirin. The independent endpoint adjudication committee refined this to four potential acute liver disorder cases for whom paper-based information was requested for final case assessment. Final case assessments confirmed no cases of acute liver disorder. The time taken for this study was 18 months (6 months for recruitment and 12 months for data management and case validation). To reach the estimated target exposure necessary to raise or rule out a signal of concern to public health, we determined that a recruitment period 2-3 times longer than that used in this study would be required. Based on the real market uptake of six commonly used medicinal products launched between 2001 and 2006 in the UK (budesonide/eformoterol [fixed-dose combination], duloxetine, ezetimibe, metformin/rosiglitazone [fixed-dose combination], tiotropium bromide and tadalafil) the target exposure would not have been reached until the fifth year of marketing using a single database. Conclusions: It is feasible to set Lip a system that actively monitors drug safety using a healthcare database and an independent endpoint adjudication committee. However, future successful implementation will require multiple databases to be queried so that larger study populations are included. This requires further development and harmonization of international healthcare databases.

  • 178.
    Johansson, Stefan
    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.
    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.
    Green, Yvonne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Epidemiology.
    Screening with spirometry reduces smoking2006In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 15, no 3, p. 213-213Article in journal (Other academic)
  • 179.
    Kallings, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Fysisk aktivitet på recept (FaR) en fungerande metod!2009In: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, Vol. 18, no 4, p. 42-45Article in journal (Other academic)
  • 180.
    Kallings, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Fysisk aktivitet på recept i Norden: ‐ erfarenheter och rekommendationer2010Report (Other academic)
    Abstract [sv]

    Bakgrund

    Otillräcklig fysisk aktivitetsnivå i befolkningen är en gemensam utmaning i de nordiska länderna. För att utbyta erfarenheter och samarbeta för att öka kunskapen och utveckla området livsstil på recept bildades ”Nordisk nettverk for fysisk aktivitet, mat og sunnhet”. I Danmark, Finland, Norge och Sverige har man under det senaste decenniet utvecklat olika modeller av ordination av fysisk aktivitet inom hälso- och sjukvården. Syftet med denna rapport är att beskriva de olika modellerna. Genom att sammanfatta erfarenheter och analysera de olika modellernas för och nackdelar är avsikten att ge rekommendationer för det framtida arbetet i Norden – att finna en nordisk ”best practice” av skriftlig ordination av fysisk aktivitet, med lokala anpassningsmöjligheter.

    Metod

    Material har sammanställts utifrån rapporter, vetenskapliga studier, hemsidor och kontakter med experter inom området i respektive land. Då förutsättningarna skiljer sig mellan länderna beskrivs kontexten för det hälsofrämjande arbetet med fysisk aktivitet och en kort historisk tillbakablick ges på det utvecklingsarbete som gjorts kring ordination av fysisk aktivitet. Skillnader respektive likheter identifieras mellan ländernas upplägg av förskrivning av fysisk aktivitet och gemensamma utvecklingsfrågor identifieras. En sammantagen analys leder till rekommendationer för det framtida arbetet i Norden.

    Resultat

    Den gemensamma nämnaren i de olika modellerna för fysisk aktivitet på recept är att läkare eller annan legitimerad hälso- och sjukvårdspersonal har ett samtal med patienten och gör en skriftlig ordination på fysisk aktivitet. Gemensamt tankesätt är även att i respektive land finns en eller ett par modeller som sedan anpassas utifrån lokala förutsättningar i varje region, landsting eller kommun. Olikheter mellan modellerna gäller framför allt vem som förskriver, vem som har det motiverande samtalet och följer upp den ordinerade aktiviteten samt vilka patienter som kan komma ifråga. Det är stor variation i hur intensiva interventionerna är, vilka delar som utförs inom hälso- och sjukvården respektive i  samverkan med andra aktörer i samhället, om man fokuserar på att främja fysisk aktivitet på egen hand eller gruppaktivitet. Vissa modeller utnyttjar befintliga strukturer i samhället medan andra har utvecklat nya. Alla modeller har sina för- och nackdelar och olika modeller passar under olika förutsättningar. De modeller som har studerats vetenskapligt, har i samtliga fall lett till en ökad fysisk aktivitetsnivå.

    Slutsats

    Det är viktigt med en individuell anpassning av såväl ordinerad aktivitet som vilket stöd patienten är i behov av. Grovt indelat bör hälso- och sjukvårdspersonal använda två nivåer av insatser till patienter som behöver öka sin fysiska aktivitet i förebyggande eller behandlande syfte. I första hand erbjuds motiverande samtal med en individanpassad skriftlig ordination av fysisk aktivitet som patientens bedriver på egen hand (vardagsaktivitet och/eller organiserad aktivitet). För de patienter som behöver utökat stöd för att komma igång med fysisk aktivitet, erbjuds träningsgrupper inom vården som ett första steg. En individanpassad skriftlig ordination kan därefter underlätta övergången från strukturerad träning inom vården, till att individen blir varaktigt fysiskt aktiv på egen hand. Det är dock inte möjligt att föreslå en enda modell för fysisk aktivitet på recept i Norden som passar alla patienter, förskrivare och olika lokala villkor. Arbetet måste därför anpassas utifrån de aktuella förutsättningarna.

  • 181.
    Kallings, Lena
    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.
    Hellénius, Mai-Lis
    Karolinska Institutet.
    Mindre stillasittande och mer fysisk aktivitet bra för hälsan: [Less inactivity and more physical activity good for health]2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 36, p. 2090-2095Article in journal (Refereed)
    Abstract [en]

    Strong evidence links higher levels of physical activity to improved health. However, even low intense activities are important, mainly for energy expenditure. Physical activity can be used in prevention and treatment of many disorders and diseases. Inactivity (sitting) and low non-exercise activity is an independent risk factor and may produce serious health problems regarding mortality, coronary heart disease, diabetes, and specific metabolic risk factors, and this cannot simply be explained by exercise deficiency. Breaks in sedentary periods of time should be encouraged to promote health. An individualized prescription of physical activity has been shown to be suitable as regular treatment in ordinary primary health care setting in Sweden. It positively influences physical activity level, quality of life and several cardiometabolic risk factors. Physical activity on prescription including a patient-centred counselling is a useful tool for practicing physicians as well as other health care workers.

  • 182.
    Kallings, Lena Viktoria
    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.
    Leijon, Matti E
    Kowalski, Jan
    Hellénius, Mai-Lis
    Ståhle, Agneta
    Self-reported adherence: a method for evaluating prescribed physical activity in primary health care patients2009In: Journal of Physical Activity and Health, ISSN 1543-3080, E-ISSN 1543-5474, Vol. 6, no 4, p. 483-492Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Physical activity on prescription, as a method for increasing physical activity, has attracted attention in recent years. However, few studies have examined adherence as a primary outcome variable. The aim of this article was to examine self-reported adherence to individualized prescribed physical activity in a routine primary health care setting.

    METHODS:

    Patients receiving an individualized physical activity on prescription (FaR) for prevention or treatment of disease were recruited from 13 Swedish primary health care units. Self-reported adherence, physical activity level, readiness to change to a more physically active lifestyle, and well-being were measured with questions at baseline and after 6 months in 240 patients (mean age 51, range 12 to 80, 75% women).

    RESULTS:

    At the 6-month follow-up a majority (65%) of the patients reported adherence to the prescription. Partial adherence was reported by 19% and nonadherence by 16%. There was a relationship between adherence and well-being and stages of action or maintenance.

    CONCLUSIONS:

    The results demonstrate that adherence to physical activity on prescription is as good as adherence to other treatments for chronic diseases. This is significant because even a small increase in physical activity is important both on an individual level and for public health.

  • 183. Kiotseridis, Hampus
    et al.
    Bjermer, Leif
    Pilman, Eva
    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.
    Romberg, Kerstin
    Tunsäter, Alf
    ALMA, a new tool for the management of asthma patients in clinical practice: development, validation and initial clinical findings2012In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 21, no 2, p. 139-144Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Several instruments have been developed for measuring asthma control, but there is still a need to provide a structure for primary care asthma reviews.

    AIMS:

    The Active Life with Asthma (ALMA) tool was developed with the aim of structuring patient visits and assessing asthma treatment in primary care. The ability of ALMA to map out the care of asthma patients was evaluated and validated.

    METHODS:

    ALMA was developed with patient and clinical expert input. Questions were generated in focus groups and the resulting tool was subsequently validated by factor analysis in 1779 patients (1116 females) of mean age 51 years (range 18-89) in primary care.

    RESULTS:

    The ALMA tool includes 19 questions, 14 of which belong to a subset assessing asthma control. In this subset, factor analysis revealed three domains (factors): physical, psychological, and environmental triggers. Correlation with the Asthma Control Questionnaire was 0.72 and the Cronbach's alpha was 0.88. The test-retest reliability was 0.93. Of the 1779 patients tested with ALMA in primary care, 62% reported chest tightness, 30% nightly awakenings and 45% asthma breakthrough despite medication.

    CONCLUSIONS:

    The ALMA tool is useful as a follow-up instrument in clinical practice to structure patient visits and assess asthma treatment in primary care. The breadth of the questions and the pragmatic use in clinical practice also make it useful as an outcome measure.

  • 184. Kjeldsen, S. E.
    et al.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Hasvold, P.
    Bodegard, J.
    Olsson, U.
    Russell, D.
    Effects of losartan vs candesartan in reducing cardiovascular events in the primary treatment of hypertension2010In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 24, no 4, p. 263-273Article in journal (Refereed)
    Abstract [en]

    Although angiotensin receptor blockers have different receptor binding properties no comparative studies with cardiovascular disease (CVD) end points have been performed within this class of drugs. The aim of this study was to test the hypothesis that there are blood pressure independent CVD-risk differences between losartan and candesartan treatment in patients with hypertension without known CVD. Seventy-two primary care centres in Sweden were screened for patients who had been prescribed losartan or candesartan between the years 1999 and 2007. Among the 24 943 eligible patients, 14 100 patients were diagnosed with hypertension and prescribed losartan (n = 6771) or candesartan (n = 7329). Patients were linked to Swedish national hospitalizations and death cause register. There was no difference in blood pressure reduction when comparing the losartan and candesartan groups during follow-up. Compared with the losartan group, the candesartan group had a lower adjusted hazard ratio for total CVD (0.86, 95% confidence interval (CI) 0.77-0.96, P = 0.0062), heart failure (0.64, 95% CI 0.50-0.82, P = 0.0004), cardiac arrhythmias (0.80, 95% CI 0.65-0.92, P = 0.0330), and peripheral artery disease (0.61, 95% CI 0.41-0.91, P = 0.0140). No difference in blood pressure reduction was observed suggesting that other mechanisms related to different pharmacological properties of the drugs may explain the divergent clinical outcomes.

  • 185. Krakau, Ingvar
    et al.
    Werkö, Lars
    Fabian, Christina
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Kreativiteten inom svensk allmänmedicin: Gösta Tibblin-symposium vid Allmänmedicinskt Forum 19981998Conference paper (Other (popular science, discussion, etc.))
  • 186.
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Back pain and symphyseal pain during pregnancy: a prospective study with special reference to occurrance, diagnosis and possible causes1996Book (Other academic)
  • 187.
    Kristiansson, Per
    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.
    Björ, O
    Wramsby, H
    Tumour incidence in Swedish women who gave birth following IVF treatment2007In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 22, no 2, p. 421-426Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Possible effects on maternal tumour incidence of a full-term pregnancy following IVF treatment with indicated supraphysiologic steroid and peptide hormonal levels in pregnancy remain uncertain. METHODS: National registries were used to compare incidence of non-invasive and invasive tumour disease in Swedish women with live birth following IVF treatment with women with live birth without IVF. RESULTS: The study had a mean follow-up period of 6.2 years in the IVF group and 7.8 years in the non-IVF group, and the mean gestation period (s.d.) for IVF and non-IVF group was 271.0 (21.1) days and 278.5 (14.1) days, respectively. In a multivariate Poisson regression analysis, adjusted rate ratios of 0.70 (0.52-0.92) and 0.93 (0.58-1.43) among IVF women were found for the risk of carcinoma in situ (CIS) of the cervix and breast cancer, respectively. When date of conception plus 1 and 3 years were used as start of follow-up, the rate ratios of CIS of the cervix increased to 0.77 (0.57-1.03) and 0.86 (0.60-1.19), respectively, and the corresponding figures for breast cancer decreased to 0.91 (0.58-1.42) and 0.74 (0.40-1.26). CONCLUSION: Following a relatively short follow-up period, there is little if any increased risk of premenopausal cancer development in women who gave birth after IVF treatment. The women who gave birth after IVF treatment had a decreased incidence of CIS of the cervix and breast cancer, but only the former was statistically significant. However, further studies are necessary to include longer follow-up times.

  • 188.
    Kristiansson, Per
    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.
    Björholt, Ingela
    Siewert-Delle, Annika
    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.
    To what extent do patients in general practice reach guideline lipid-lowering treatment goals?2007In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 14, no 1, p. 149-151Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We assessed the extent to which the 1998 European guideline goals were reached among patients on statin treatment. DESIGN: A cross-sectional study. METHODS: A total of 683 consecutive patients on statin treatment were recruited from 48 primary healthcare centres all over Sweden. Serum lipid levels and possible goal-reaching determinants were registered. RESULTS: The treatment goal for total cholesterol was met in 55% of patients and for low-density lipoprotein cholesterol in 60% of patients. Male sex and a history of diabetes mellitus or cardiovascular disease increased the likelihood of meeting treatment goals. CONCLUSIONS: More than half of statin-treated Swedish primary care patients reached the treatment goals.

  • 189.
    Kristiansson, Per
    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.
    Holding, C
    Hughes, S
    Haynes, D
    Does human relaxin-2 affect peripheral blood mononuclear cells to increase inflammatory mediators in pathologic bone loss?2005In: Annals of the New York Academy of Sciences, ISSN 0077-8923, E-ISSN 1749-6632, Vol. 1041, p. 317-9Article in journal (Refereed)
    Abstract [en]

    This study was designed to test the hypothesis that relaxin stimulates bone resorption by regulating the production of several mediators that stimulate osteoclast formation. The levels of mediators were measured in response to differing relaxin concentrations in supernatants from peripheral blood mononuclear cells (PBMCs), MCF-7 breast cancer cells, and normal human osteoblasts. Although all cell types expressed mRNA for the relaxin receptor (LGR7), only PBMCs responded to relaxin at physiologic levels by increasing tumor necrosis factor-α and interleukin-1β secretion. The findings indicate that PBMCs should be studied in relation to the effect of relaxin on inflammation and bone destruction caused by osteoclasts.

  • 190.
    Kristiansson, Per
    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.
    Nilsson-Wikman, L
    von Schoultz, Bo
    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.
    Wramsby, H
    Back pain in in-vitro fertilized and spontaneous pregnancies.1998In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 13, no 11, p. 3233-3238Article in journal (Refereed)
    Abstract [en]

    The influence of ovarian stimulation in in-vitro fertilization (IVF) on the prevalence of back pain with onset during pregnancy was studied in 31 women who became pregnant after IVF treatment and compared with that of 200 spontaneously pregnant women. A two times higher prevalence rate of sacral pain in late pregnancy was reported among IVF pregnant women (P < 0.0001), as well as a significantly higher prevalence rate of positive results of pelvic pain provocation tests performed in late pregnancy (0.0001 < or = P < or = 0.015), as compared with that of the spontaneously pregnant women. Among the IVF pregnant women, there was a significant positive correlation between relaxin concentrations in early pregnancy and the outcome of pelvic pain provocation tests (0.44 < or = r < or = 0.51, P < 0.05). In addition, the serum relaxin concentration was the factor that best explained differences in sacral pain prevalence. When the influence of serum relaxin concentration on back pain prevalence was taken into account, women carrying multiple pregnancies had no more pain than women carrying singletons, and IVF pregnant women had no more pain than spontaneously pregnant women. These results support the hypothesis that relaxin is involved in the generation of pelvic pain in pregnant women.

  • 191.
    Kristiansson, Per
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Discriminatory power of tests applied in back pain during pregnancy1996In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 21, no 20, p. 2337-2344Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN

    A longitudinal, prospective, observational cohort study.

    OBJECTIVES

    To assess the relationship between clinical back status and reported pain locations during and after pregnancy.

    SUMMARY OF BACKGROUND DATA

    Back pain during pregnancy is a frequent clinical occurrence, even during the early stages of pregnancy. The cause is unclear. There are few data describing the results of a general physical examination of the back during pregnancy and there are no data on serial examinations. Such data could provide information about what structures cause the pain, which might have implications for the choice of treatment.

    METHODS

    A cohort of 200 consecutive women attending an antenatal clinic was observed throughout the pregnancy terms, and repeated measurements of back pain and its possible determinants were taken using questionnaires and physical examinations in a standardized way, including a series of tests of configuration, mobility, and pain provocation.

    RESULTS

    Pain provocation tests were better at discriminating among women who reported back pain from women who reported no back pain from tests of configuration or mobility. The discriminatory power of the tests was better in the lower part of the spine than in the upper part. The best discrimination was achieved by combining some of the tests.

    CONCLUSIONS

    The results indicate that not one but several pain-releasing structures may be involved. These are probably the various pelvic ligaments, which may form a functional unit. These findings may have therapeutic implications.

  • 192.
    Kristiansson, Per
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    von Schoultz, Bo
    Back pain during pregnancy: a prospective study1996In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 21, no 6, p. 702-709Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN:

    A longitudinal, prospective, observational, cohort study.

    OBJECTIVES:

    To describe the natural history of back pain occurring during pregnancy and immediately after delivery.

    SUMMARY OF BACKGROUND DATA:

    Back pain during pregnancy is a frequent clinical problem even during the early stages of pregnancy. The cause is unclear.

    METHODS:

    A cohort of 200 consecutive women attending an antenatal clinic were followed throughout pregnancy with repeated measurements of back pain and possible determinants by questionnaires and physical examinations.

    RESULTS:

    Seventy-six percent reported back pain at some time during pregnancy. Sixty-one percent reported onset during the present pregnancy. In this group, the prevalence rate increased to 48% until the 24th week and then remained stable and declined to 9.4% after delivery. The reported pain intensity increased by pain duration. The pain score correlated closely to self-rated disability and days of sickness benefit.

    CONCLUSIONS:

    Back pain during pregnancy is a common complaint. The 30% with the highest pain score reported great difficulties with normal activities. The back pain started early in pregnancy and increased over time. Young women had more pain than older women. Back pain starting during pregnancy may be a special entity and may have another origin than back pain not related to pregnancy.

  • 193.
    Kristiansson, Per
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    von Schoultz, Bo
    Reproductive hormones and aminoterminal propeptide of type III procollagen in serum as early markers of pelvic pain during late pregnancy1999In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 180, no 1, p. 128-134Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE

    The object was to study serum concentrations of reproductive hormones and aminoterminal propeptide of type III procollagen in early pregnancy as markers of pelvic pain (sacral pain or symphyseal pain) during later pregnancy.

    STUDY DESIGN

    A prospective, clinical cohort study was performed, with repeated examinations of 200 women.

    RESULTS

    Serum concentrations of relaxin and serum concentrations of propeptide of type III procollagen (a collagen turnover marker) measured in early pregnancy were significantly correlated with pelvic pain with onset during pregnancy and reported in late pregnancy (positively and negatively, respectively). In a multivariate analysis, relaxin and propeptide of type III procollagen concentrations remained independently and significantly correlated with pelvic pain.

    CONCLUSION

    Serum concentrations of relaxin and propeptide of type III procollagen measured in early pregnancy may reflect the cause of and indicate an increased risk of pelvic pain (back pain or symphyseal pain) during late pregnancy. The mechanism is unclear.

  • 194.
    Kristiansson, Per
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    von Schoultz, Bo
    Reproductive hormones and aminoterminal propeptide of type III procollagen in serum as early markers of pelvic pain during late pregnancy1999In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 180, no 1, p. 128-34Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE

    The object was to study serum concentrations of reproductive hormones and aminoterminal propeptide of type III procollagen in early pregnancy as markers of pelvic pain (sacral pain or symphyseal pain) during later pregnancy.

    STUDY DESIGN

    A prospective, clinical cohort study was performed, with repeated examinations of 200 women.

    RESULTS

    Serum concentrations of relaxin and serum concentrations of propeptide of type III procollagen (a collagen turnover marker) measured in early pregnancy were significantly correlated with pelvic pain with onset during pregnancy and reported in late pregnancy (positively and negatively, respectively). In a multivariate analysis, relaxin and propeptide of type III procollagen concentrations remained independently and significantly correlated with pelvic pain.

    CONCLUSION

    Serum concentrations of relaxin and propeptide of type III procollagen measured in early pregnancy may reflect the cause of and indicate an increased risk of pelvic pain (back pain or symphyseal pain) during late pregnancy. The mechanism is unclear.

  • 195.
    Kristiansson, Per
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    von Schoultz, Bo
    Serum relaxin, symphyseal pain, and back pain during pregnancy1996In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 175, no 5, p. 1342-1347Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE

     Our purpose was to study the relationship between serum relaxin levels and back pain during pregnancy.

    STUDY DESIGN

     A prospective clinical cohort study with repeated examinations was performed.

    RESULTS

    There was an initial increase of relaxin levels until a peak value at the twelfth week followed by a decline until the seventeenth week. Thereafter stable serum levels around 50% of the peak value were recorded. Three months after delivery serum relaxin was not detectable. There was a significant correlation between mean serum relaxin levels during the pregnancy and symphyseal pain or low back pain occurring during late pregnancy as measured by medical history or pain-provoking test.

    CONCLUSION

     Relaxin is known to remodel pelvic connective tissue in several mammalian species during pregnancy. The current data suggest that relaxin might be involved in the development of pelvic pain in pregnant women.

  • 196.
    Kristiansson, Per
    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.
    Wang, J X
    Reproductive hormones and blood pressure during pregnancy2001In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 16, no 1, p. 13-17Article in journal (Refereed)
    Abstract [en]

    The mechanisms involved in cardiovasular changes during human pregnancy and the complicated aetiology of gestational hypertension are unclear. Reproductive hormones have known effects on the cardiovascular system in the non-pregnant state and in animal systems, but their effects in human pregnancy are uncertain. In this study of pregnant women, the effects of serum concentrations of relaxin, progesterone and oestradiol on arterial blood pressure were studied. Higher serum concentrations of progesterone and relaxin, but not oestradiol, in early pregnancy were related to lower mean systolic blood pressures in the second and third trimesters. No relationship was found between hormonal concentrations and diastolic blood pressures. However, women with a diastolic blood pressure of >90 mmHg in late pregnancy showed statistically significant lower relaxin concentrations in early pregnancy in comparison with women whose diastolic blood pressure was </=90 mmHg. In a multivariate analysis, the mean systolic blood pressure (P: < 0.0001) and serum relaxin (P: < 0.01) in early pregnancy, but not progesterone, were independently related to systolic blood pressure in late pregnancy. The results support previous experimental and clinical studies. The effect of relaxin may be explained by a possible vasodilatatory action seen in animal studies and appears to be moderate.

  • 197.
    Kristiansson, Per
    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.
    Wang, J.X.
    Reproductive hormones and blood pressure during pregnancy2001In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 16, no 1, p. 13-17Article in journal (Refereed)
    Abstract [en]

    The mechanisms involved in cardiovasular changes during human pregnancy and the complicated aetiology of gestational hypertension are unclear. Reproductive hormones have known effects on the cardiovascular system in the non-pregnant state and in animal systems, but their effects in human pregnancy are uncertain. In this study of pregnant women, the effects of serum concentrations of relaxin, progesterone and oestradiol on arterial blood pressure were studied. Higher serum concentrations of progesterone and relaxin, but not oestradiol, in early pregnancy were related to lower mean systolic blood pressures in the second and third trimesters. No relationship was found between hormonal concentrations and diastolic blood pressures. However, women with a diastolic blood pressure of >90 mmHg in late pregnancy showed statistically significant lower relaxin concentrations in early pregnancy in comparison with women whose diastolic blood pressure was ≤90 mmHg. In a multivariate analysis, the mean systolic blood pressure (P < 0.0001) and serum relaxin (P < 0.01) in early pregnancy, but not progesterone, were independently related to systolic blood pressure in late pregnancy. The results support previous experimental and clinical studies. The effect of relaxin may be explained by a possible vasodilatatory action seen in animal studies and appears to be moderate.

  • 198. Kull, Inger
    et al.
    Johansson, Gunnar S.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    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.
    Jagorstrand, Birgitta
    Romberg, Kerstin
    Tilling, Björn
    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/KOL-mottagningar i primärvård ger effektivt omhändertagande2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 42, p. 2937-2940Article in journal (Refereed)