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  • 201.
    Engström, Sevek
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Berne, Christian
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Gahnberg, Lars
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Effectiveness of screening for diabetes mellitus in dental health care2013Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 30, nr 2, s. 239-245Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims:  The aim of the present study was to test the effectiveness of opportunistic blood glucose screening in a cooperational framework between dental and primary health care.

    Methods:  Altogether, 1568 subjects, age 20-75 years, with no previous history of diabetes, who came for a regular dental examination, had their non-fasting blood glucose measured with a portable blood glucose meter. Subjects with a concentration of ≥ 6.7 mmol/l (121 mg dl(-1) ) were referred to their primary healthcare centre for follow-up. The outcome, a diagnosis of diabetes mellitus, was obtained from primary healthcare centre and hospital patient records, during 3 years after screening.

     Results:  Of the 155 (9.9%) subjects who screened positive, 139 (89.7%) came to their primary healthcare centre within the 3-year follow-up period and nine (5.8%) were diagnosed as having diabetes mellitus according to the World Health Organization criteria. Of the 1413 subjects who screened negative, 1137 (80.5%) came to the primary healthcare centre and eight (0.6%) were found to have diabetes mellitus. Screening sensitivity was 52.9%, specificity 90.6% and positive predictive value 5.8%. The number of subjects needed to screen to find one case of diabetes was 196. Delineating the study population to those 40- to 75-year-olds with a BMI ≥ 25 kg/m(2) , and 30-to 75-year-olds with a BMI ≥ 30 kg/m(2) , the numbers needed to screen was reduced to 96.

    Conclusions:  Cooperation between dental and primary care for high blood glucose screening and follow-up appears to be a feasible method for early diagnosis of diabetes.

  • 202.
    Engström, Sevek
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Berne, Christian
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Gahnberg, Lars
    Svärdsudd, Kurt F
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Efficacy of screening for high blood pressure in dental health care2011Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, s. 194-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is consensus on the importance of early detection and treatment of high blood pressure. Dental care is one of few medical services to which a considerable proportion of the general population comes for regular check-ups. We tested the effects of blood pressure screening in dental care centres with subsequent workup of subjects screening positive in primary health care (PHCC). Methods: Altogether 1,149 subjects 40-65 years old or 20-39 years old with body mass index >25, and with no previously known hypertension, who came for a dental examination had their blood pressure measured with an Omron M4 (R) automatic blood pressure reading device. Subjects with systolic blood pressure readings above 160 mmHg or diastolic above 90 mmHg were referred to their PHCC for a check up. Outcome data were obtained by scrutiny of PHCC and hospital patient records for hypertension diagnoses during the three years following screening. Results: 237 (20.6%) subjects screened positive. Of these, 230 (97.1%) came to their PHCC within the 3-year follow-up period, as compared with 695 (76.2%) of those who screened negative (p < 0.0001). Of those who screened positive, 76 (32.1%) received a diagnosis of hypertension, as compared with 26 (2.9%) of those who screened negative. Sensitivity was 79.1%, specificity 84.8% and positive predictive value 30.1%. The number of subjects needed to screen to find one case of hypertension was 18. Conclusions: Co-operation between dental and primary care for blood pressure screening and work-up appears to be an effective way of detecting previously unknown hypertension.

  • 203.
    Engström, Sevek
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Borgquist, Lars
    Berne, Christian
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Gahnberg, Lars
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Can costs of screening for hypertension and diabetes in dental care and follow-up in primary health care be predicted?2013Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 118, nr 4, s. 256-262Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim. The purpose was to assess the direct costs of screening for high blood pressure and blood glucose in dental care and of follow-up in primary health care and, based on these data, arrive at a prediction function. Study population. All subjects coming for routine check-ups at three dental health clinics were invited to have blood pressure or blood glucose measurements; 1,623 agreed to participate. Subjects screening positive were referred to their primary health care centres for follow-up. Methods. Information on individual screening time was registered during the screening process, and information on accountable time, costs for the screening staff, overhead costs, and analysis costs for the screening was obtained from the participating dental clinics. The corresponding items in primary care, i.e. consultation time, number of follow-up appointments, accountable time, costs for the follow-up staff, overhead costs, and analysis costs during follow-up were obtained from the primary health care centres. Results. The total screening costs per screened subject ranged from (sic)7.4 to (sic)9.2 depending on subgroups, corresponding to 16.7-42.7 staff minutes. The corresponding follow-up costs were (sic)57-(sic)91. The total resource used for screening and follow-up per diagnosis was 563-3,137 staff minutes. There was a strong relationship between resource use and numbers needed to screen (NNS) to find one diagnosis (P < 0.0001, degree of explanation 99%). Conclusions. Screening and follow-up costs were moderate and appear to be lower for combined screening of blood pressure and blood glucose than for separate screening. There was a strong relationship between resource use and NNS.

  • 204.
    Engström, Sevek
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Borgquist, Lars
    Institutionen för medicin och hälsa, Linköpings universitet.
    Berne, Christian
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet.
    Gahnberg, Lars
    Institutionen för odontologi, Göteborgs universitet.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Cost of screening for hypertension and diabetes in dental care and follow up in primary health careManuskript (preprint) (Övrigt vetenskapligt)
  • 205.
    Engström, Sevek
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Holmlund, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Self-estimated oral and general health are related and associated with clinically investigated dental health2011Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 35, nr 4, s. 169-176Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim was to investigate whether the self-estimation of oral and general health is correlated and related to clinical parameters for dental health. Furthermore, to investigate the influence of socioeconomic factors on the self-assessment of oral and general health. During 2007 a dental health survey was performed in the Community of Gavle located in central Sweden.1,224 subjects randomized from the general population of Gavle (adult population 75, 000) were invited to participate. Seven hundred and forty-eight individuals answered a questionnaire regarding their health and 373 of these subjects participated in a dental examination. Self-estimated oral and general health was correlated (p<0.0001, r= 0.35) and individuals who perceived their oral health as bad had more decayed surfaces, surfaces with secondary caries,fewer teeth and more bleeding on probing than those with good estimated oral health (p<0.017 for all). In a logistic regression analysis with self-estimated oral health as the dependent variable was related to, the independent variables NT, DFT, self-estimated general health and age were related to self-estimated oral health, but not to income or educational level. However, subjects with low disposable income and low education level had significantly more clinical caries and fewer teeth than subjects with high income or a high educational level. Conclusions: In the present study, self-estimation of oral and general health was correlated and related to some clinical oral parameters. Subjects in the low socioeconomic group had worse dental health and a tendency to underestimate their need of dental care.

  • 206. Eriksson, Mats
    et al.
    Zethelius, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Eeg-Olofsson, Katarina
    Nilsson, Peter M.
    Gudbjörnsdottir, Soffia
    Cederholm, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Eliasson, Björn
    Blood lipids in 75,048 type 2 diabetic patients: a population-based survey from the Swedish National diabetes register2011Ingår i: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 18, nr 1, s. 97-105Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Type 2 diabetes and diabetic dyslipidemia are high-risk conditions for cardiovascular disease. However, the description of the distribution of blood lipids in diabetic patients has not been based on population-based surveys. The aim of this study was to describe diabetic dyslipidemia in a large unselected sample of patients from the Swedish National Diabetes Register. Methods: Blood lipid profiles and clinical characteristics in 75,048 type 2 diabetic patients (57% men) were studied. Results: Pronounced hypertriglyceridemia (triglycerides >4.0mmol/l) was seen in 3.4% of the patients. Total cholesterol (TC), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C) and non-HDL-C were generally higher, and LDL-C/HDL-C and Non-HDL-C/HDL-C ratios were lower in women. Mean TC, LDL-C as well as HDL-C values were lower in patients treated with lipid-lowering agents, whereas triglycerides was higher than in the untreated patients. In patients not treated with lipid-lowering agents all blood lipids increased in women and decreased in men (except HDL-C) at higher ages. Patients with LDL-C/HDL-C ratio >= 3 were slightly younger, less frequently used lipid-lowering drugs and had not so often a history of coronary heart disease or stroke. Conclusion: The distribution of blood lipids in this large sample of unselected type 2 diabetic patients challenges the previous conception of diabetic dyslipidemia, and calls for new studies to explain the roles of LDL-C and HDL-C as strong cardiovascular risk factors in type 2 diabetes.

  • 207.
    Espes, Daniel
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Martinell, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Carlsson, Per-Ola
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Increased Circulating Betatrophin Concentrations in Patients with Type 2 Diabetes2014Ingår i: International Journal of Endocrinology, ISSN 1687-8337, E-ISSN 1687-8345, Vol. 2014, s. 323407-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Betatrophin has recently been described as a key hormone to stimulate beta-cell mass expansion in response to insulin resistance and obesity in mice. The finding has generated an interest in the development of antidiabetic drugs with betatrophin as the active component. However, the circulating levels of betatrophin in patients with type 2 diabetes are not well known. Betatrophin concentrations in plasma of 27 type 2 diabetes patients and 18 gender-, age-, and BMI-matched controls were measured. Study participants were characterized with regard to BMI, waist and hip circumference, blood pressure, and fasting plasma blood lipids, creatinine, glucose, HbA1c, and C-peptide. HOMA2 indices were calculated. Betatrophin was 40% higher in patients with type 2 diabetes (893 +/- 80 versus 639 +/- 66 pg/mL). Betatrophin positively correlated with age in the controls and with HbA1c in the type 2 diabetes patients. All study participants were insulin resistant with mean HOMA2B IR in both groups exceeding 2 and HOMA2% S < 50%. Control individuals had impaired fasting glucose concentrations. In this report on betatrophin concentrations in type 2 diabetes and insulin resistance, elevated betatrophin levels were measured in the patients with type 2 diabetes. Future studies are clearly needed to delineate the exact role, if any, of betatrophin in regulating human beta-cell mass.

  • 208.
    Espes, Daniel
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Martinell, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Liljebäck, Hanna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Carlsson, Per-Ola
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Betatrophin in Diabetes Mellitus: the Epidemiological Evidence in Humans2015Ingår i: Current Diabetes Reports, ISSN 1534-4827, E-ISSN 1539-0829, Vol. 15, nr 12, artikel-id 104Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The prevalence of type 2 diabetes is increasing worldwide, and while numerous treatments exist, none of the current pharmacologic therapies is curative. Pharmacologic approaches that increase beta cell mass may present an avenue for actual cure. There have been numerous reports on factors that can induce beta cell proliferation in rodents, whereas there are still very limited data on the occurrence of beta cell proliferation in humans. The recent discovery of the hormone betatrophin, which in mice counteracted glucose intolerance induced by insulin resistance by potently stimulating beta cell proliferation, has boosted the hope for a new target for drug development for the treatment of diabetes mellitus in humans. With the encouraging preclinical findings as a background, this review presents the available clinical data on betatrophin and discusses its possible role in humans.

  • 209. Ferro, Alberto
    et al.
    Kristiansson, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Ecology of medical care in a publicly funded health care system: a registry study in Sweden2011Ingår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 29, nr 3, s. 187-192Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. To explore the influence of sociodemographic factors on access to appointments with physicians in primary, secondary, and tertiary health care in a publicly funded health care system. Design. A population-based registry study. Setting. Different health care settings in V sternorrland county, Sweden. Subjects. All residents in the county at the end of 2006. Main outcome measures. The number of people per 1000 residents who had at least one appointment with a physician in an average month in different health care settings. Results. A total of 87 people had appointments with a physician in primary health care, 44 in outpatient clinics at a regional hospital, 20 in an emergency department, 14 in home care, and two in a university hospital outpatient clinic. Twelve were hospitalized at a regional hospital and <1 at the university hospital. Being young or elderly, female, divorced, widowed, and having a contractor as usual source of care were all independently associated with higher odds of receiving primary care. Conclusions. The physician's office in primary care is the setting that has the potential to affect the largest number of people. The extent of the use of health care was independently influenced by all sociodemographic characteristics studied, which highlights the importance of individual factors in future resource allocation. Regarding availability the ecology model provides superior information as compared with the absolute number of physicians' appointments. The prerequisites in Sweden of high-quality registries and unique personal identification numbers encourage future research on the ecology model to optimize accessibility of health care.

  • 210. Fhärm, E
    et al.
    Cederholm, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Eliasson, B
    Gudbjörnsdottir, S
    Rolandsson, O
    Time trends in absolute and modifiable coronary heart disease risk in patients with Type 2 diabetes in the Swedish National Diabetes Register (NDR) 2003-20082012Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 29, nr 2, s. 198-206Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: 

    The aim was to evaluate treatment goal achievements early in the course of Type 2 diabetes, and their effect on 10-year risk of coronary heart disease in patients receiving usual care.

    Methods: 

    Assessment of risk factor control 3 years after diagnosis in patients with Type 2 diabetes with no previous coronary heart disease included from the Swedish National Diabetes Register; a total of 19 382 patients (mean age 58 years) in cross-sectional surveys from 2003 to 2008, and a subgroup of 4293 patients followed individually from year of diagnosis to follow-up after a mean 2.6 years. Estimation of absolute 10-year risk of coronary heart disease using the UK Prospective Diabetes Study risk engine, and modifiable 10-year risk defined as percentage excess risk above patients with 'normal' risk factor values.

    Results: 

    Treatment goals for HbA(1c) , blood pressure, total and LDL cholesterol were achieved in 78.4, 65.5, 55.6% and 61.0%, respectively, in the cross-sectional survey in 2008, following a trend of generally improved control. In the individually followed patients in the subgroup, mean absolute 10-year coronary heart disease risk increased from 13.7% (men/women 16.9/9.5%) to 14.2 (men/women 17.6/9.6%) (P < 0.001) from year of diagnosis to follow-up after 2.6 years, while mean modifiable risk decreased from 37.7% (men/women 28.6/49.9%) to 19.1% (13.2/26.9%) (P < 0.001 in all).

    Conclusions:

    A high achievement of treatment goals and a low mean modifiable 10-year coronary heart disease risk was found at the 3-year follow-up, both in the cross-sectional survey in 2008 and in patients individually followed since diagnosis. This indicates the feasibility and significance of early multifactorial risk factor treatment.

  • 211.
    Flink, Håkan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Publ Dent Hlth Vastmanland, Publ Dent Clin, Sala, Sweden..
    Tegelberg, Åke
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Malmo Univ, Fac Odontol, Malmo, Sweden.;Publ Dent Hlth Serv, Postgrad Dent Educ Ctr, Orebro, Sweden..
    Arnetz, Judith E
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Michigan State Univ, Coll Human Med, Dept Family Med, E Lansing, MI 48824 USA..
    Birkhed, Dowen
    Fersens Vag, Malmo, Sweden..
    Patient-reported negative experiences related to caries and its treatment among Swedish adult patients2017Ingår i: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 17, artikel-id 95Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: It has been suggested that dental caries should be regarded as a chronic disease as many individuals repeatedly develop new caries lesions. How this is perceived by caries active patients is unclear. The aim of this study was to measure patient-reported attitudes and negative experiences related to caries and dental treatment.

    Methods: A questionnaire was mailed to 134 caries active (CA) and 40 caries inactive (CI) adult patients treated at a Swedish public dental service clinic. The questionnaire included items regarding patient-reported oral health; attitudes towards caries and efforts to prevent them; and negative experiences related to caries and dental treatment. Questionnaire data were supplemented with data on caries and caries prophylaxis from patients' dental records. Exploratory factor analysis was conducted on items related to patients' perceptions of problems to see whether scales could be created. Experiences, perceptions and dental records of CA and CI patients were compared.

    Results: The overall response rate was 69%. Dental records confirmed that CA patients had significantly more decayed teeth per year and a longer period of caries-active time than CI patients. Factor analysis resulted in 3 distinct scales measuring problems related to caries; 1) caries-related information; 2) negative experiences; and 3) negative treatment/staff attitudes. A fourth scale measuring perceived problems related to caries was also created. The CA group reported significantly more problems related to caries and dental treatment, received significantly more caries-related information, and reported significantly more negative treatment experiences compared to CI patients.

    Conclusions: Caries prophylaxis methods need to be improved in order to better meet the needs of caries active patients and to create a more positive experience with dental care.

  • 212.
    Flink, Håkan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Tegelberg, Åke
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Arnetz, Judy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Birkhed, Dowen
    Correlation between perceived experience of caries disease and recorded caries activity among adult patients at a Swedish Public Dental Clinic: A longitudinal study2013Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 71, nr 6, s. 1486-1492Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. To compare patients' perceived experiences of caries activity with recorded longitudinal caries prevalence, consequences of caries and length of recall intervals. Materials and methods. A questionnaire was mailed to 134 caries active (CA) and 40 caries inactive (CI) adult patients at a Swedish Public Dental Clinic. The overall response rate was 69%. The questionnaire included items regarding perceived caries activity, general health, dietary and oral hygiene habits, level of education and socioeconomic status. Questionnaire responses were studied for their association to clinical data extracted from patient dental records. Results. There was a correlation between patient-perceived and documented caries activity for all respondents (rho = 0.65; p < 0.001). CA patients had significantly more perceived caries activity (p < 0.001), decayed teeth (p < 0.001), root fillings (p = 0.001) and extractions (p < 0.001) than CI patients. The mean recall interval was 1.5 years for CA and 2.1 years for CI (p < 0.001). In multiple logistic regression analysis, CA patients were at increased risk for xerostomia (OR = 22.66, p = 0.003), sleep disturbances (OR = 4.36, p = 0.04) and more frequent use of daily extra fluoride (OR = 3.58, p = 0.03). Conclusions. Patient-perceived experience of caries correlated well with recorded caries activity in this group of middle-aged Swedish adults. Individuals with active caries were aware of their disease and made more frequent attempts to reduce caries activity by use of daily extra fluoride. Individual risk-based recall intervals did not seem to eliminate consequences of disease activity such as root fillings and extractions during the follow-up period.

  • 213.
    Flink, Håkan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Publ Dent Hlth Vastmanland, Publ Dent Clin Sala, Vasteras, Sweden..
    Tegelberg, Åke
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Malmo Univ, Fac Odontol, Malmo, Sweden..
    Arnetz, Judy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Michigan State Univ, Dept Family Med, E Lansing, MI 48824 USA..
    Birkhed, Dowen
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Cariol, Gothenburg, Sweden..
    Patient-reported outcomes of caries prophylaxis among Swedish caries active adults in a long-term perspective2016Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 40, nr 1, s. 101-110Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Syftet med studien var att undersöka patientrapporterade utfallsmått för kariesprofylax och jämföra dem med tidigare dokumenterade journaldata. Ett frågeformulär skickades till 134 kariesaktiva (CA) och 40 kariesinaktiva (CI) vuxna patienter vid folktandvården i Sala, och besvarades av 69%. Frågorna gällde patientupplevelser relaterat till kariesprofylax avseende: 1) behandlingar och rekommendationer vid tandvårdsbesök, 2) genomförd egenvård, och 3) upp-levd effekt och förhoppningar om önskat resultat. Svaren analyserades i förhållande till kliniska data, som hämtades retrospektivt ur patienternas tandvårdsjournaler. Medelvärdet för upp-följningstiden var > 16 år. Information angående karies och profylax (p=0.01) samt rekommen-dationer om egenvård (p=0.04) hade oftare givits till CA än till CI-gruppen. Kompletterande undersökningar och rekommendation av extra riskprofylax var mer vanligt förekommande hos CA-gruppen (p<0.001). CA-patienterna hade även mer ofta gjort extra ansträngningar för att undvika karies genom att ändra matvanor (p<0.001), förbättra munhygien (p=0.04) och använt extra fluor (p=0.001). I CA-gruppen upplevde 60% att de trots sina extra profylaxinsatser inte blivit kariesfria, och 40% var inte nöjda med resultatet. De flesta patienter (>90%) satte dock stort värde till kariesprofylax som förväntades att kunna minska antalet kariesangrepp. Patientrapporterade utfallsmått för kariesprofylax överensstämde med journaldata. Både tandläkare och de kariesaktiva patienterna i denna studie var medvetna om behovet av extra profylax. De kariesaktiva patienterna hade genomfört mer extra profylax, men många hade ej upplevt att de blev kariesfria.

  • 214.
    Frank, Catharina
    et al.
    Karolinska Institutet.
    Takman, Christina
    Karolinska Institutet.
    Nordgren, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Mälardalens högskola.
    Social insurance administrative officers’ perceptions of their assignment and problematic issues in their work with heart failure clients in the sick-leave and rehabilitation process2015Ingår i: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588, Vol. 5, nr 2, s. 173-188Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This article explores social insurance administrative officers’ (AOs’) perceptions of the sick-leave process for heart failure clients. The work situation and the sick-leave process for people with heart failure tend to be complex and problematic. The problems are often caused by a lack of understanding from professionals, such as social insurance AOs. The study draws on two focus group interviews with social insurance AOs from two different social insurance agencies. The interviews were guided by an open approach, and analysis was performed on the interviews’ manifest content through a qualitative content analysis. The findings demonstrate that the AOs were concerned about the clients’ ability to return to work, but they were hindered in fulfilling their duties through insufficient collaboration with physicians and unclear sickness certificates. There seems to be a gap between the AOs’ assignment and their ability to make well-founded decisions about their clients’ ability to work. This can have consequences for the individual who lives with heart failure. In the sociopolitical agenda of Sweden, this can have consequences for the development of collaboration between AOs and the medical experts who provide the foundations for decisions about work ability of the client with heart failure.

  • 215.
    Franzen, Stefan
    et al.
    Register Centrum, Gothenburg, Sweden..
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Larsson, Kjell
    Karolinska Inst, Dept Environm Med, Solna, Sweden..
    Petzold, Max
    Univ Gothenburg, Ctr Appl Biostat, Gothenburg, Sweden..
    Olsson, Urban
    Statisticon AB, Uppsala, Sweden..
    Magnusson, Gunnar
    AstraZeneca, Gothenburg, Sweden..
    Telg, Gunilla
    AstraZeneca Nord Balt, Sodertalje, Sweden..
    Colice, Gene
    AstraZeneca, Gaithersburg, MD USA..
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Sundgren, Mats
    AstraZeneca, Gothenburg, Sweden.;AstraZeneca, Biometr & Informat Sci, SE-43183 Molndal, Sweden..
    Evaluation of the use of Swedish integrated electronic health records and register health care data as support clinical trials in severe asthma: the PACEHR study2016Ingår i: Respiratory Research, ISSN 1465-9921, E-ISSN 1465-993X, Vol. 17, artikel-id 152Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In the development of new drugs for severe asthma, it is a challenge from an ethical point of view to randomize severe asthma patients to placebo, and to obtain long-term safety data due to discontinuations. The aim of this study was to evaluate the feasibility of using electronic health record (EHR) data to create a real-world reference population of uncontrolled asthmatic patients to supplement the concurrent control/placebo group in long-term studies of asthma.

    Methods: EHR data from 36 primary care centres and a University hospital in Sweden were linked to Swedish mandatory health registers (2005-2013), creating a population covering 33 890 asthma patients, including data on co-morbidities, risk factors and laboratory/respiratory measurements. A severe asthma EHR reference cohort was established. We used logistic regression to estimate the propensity score (probability) of each RCT or EHR patient existing in the EHR cohort given their covariates.

    Results: We created an EHR-derived reference cohort of 240 patients, matching the placebo group (N = 151) in an RCT of severe asthma. The exacerbation rate during follow-up in the EHR study population was 1.24 (weighted) compared to 0.9 in the RCT placebo group. Patients in the EHR cohort were of similar age as in the RCT placebo group, 50.6 years versus 50.1 years; had slightly higher body mass index 27.0 kg/m(2) versus 27.3 kg/m(2); and consisted of 40% versus 34% males.

    Conclusions: The results indicate that EHRs provide an opportunity to supplement the control group in RCTs of severe diseases.

  • 216.
    Frimanson, Lars
    et al.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Företagsekonomiska institutionen.
    Anderzén, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Psychosocial and neurobiological responses to accounting2015Ingår i: 38th European Accounting Annual Congress 2015, 2015Konferensbidrag (Refereegranskat)
  • 217.
    Frimanson, Lars
    et al.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Företagsekonomiska institutionen.
    Anderzén, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    The impact of formal performance evaluation frequency on psychosocial and biological employee energy markers: An orgnizational experiment2013Konferensbidrag (Övrigt vetenskapligt)
  • 218.
    Frimanson, Lars
    et al.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Företagsekonomiska institutionen.
    Anderzén, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    The impact of formal performance evaluation on psychosocial and neurobiological energy mobilization: A randomized intervention study2014Konferensbidrag (Refereegranskat)
  • 219.
    Frimanson, Lars
    et al.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Företagsekonomiska institutionen.
    Anderzén, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Lekander, Mats
    Karolinska Institutet.
    Frequency of prolonged social-evaluative threat and cytokine activity: A field experiment2013Ingår i: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 32, nr Suppl., s. e13-Artikel i tidskrift (Refereegranskat)
  • 220.
    Frimanson, Lars
    et al.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Företagsekonomiska institutionen.
    Anderzén, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Lekander, Mats
    Stockholm universitet.
    Reduction in prolonged social-evaluative threat frequency reduces inflammation activity2015Ingår i: Proceedings MITSC Spring 2015 / [ed] Christina Keller, 2015Konferensbidrag (Övrigt vetenskapligt)
  • 221. Froberg, Frida
    et al.
    Modin, Bitte
    Rosendahl, Ingvar K.
    Tengstrom, Anders
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    The Association Between Compulsory School Achievement and Problem Gambling Among Swedish Young People2015Ingår i: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 56, nr 4, s. 420-428Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: We aimed to examine the association between school grades at the age of 16 years and problem gambling at the age of 17-25 years among Swedish females and males. Methods: In a cohort design, we followed the 16-to 24-year-old participants in the representative Swedish Longitudinal Gambling Study for 2 years, 2008/2009 and 2009/2010, generating 3,816 person-years of follow-up time. The outcome, incidence of mild and moderate/severe gambling problems, was measured by the Problem Gambling Severity Index in telephone interviews. The exposure was register-linked information about final grades in compulsory school. The association between school grades and problem gambling was estimated in multinomial logistic regressions. Results: Low and average school grades were associated with increased incidence of mild and moderate/severe problem gambling compared to high grades, adjusted for sociodemographic characteristics, psychological distress, and alcohol use. Low grades, compared to high grades, were associated with a higher risk of mild gambling problems for adolescent males, whereas the incidence proportion of moderate/severe problem gambling was high for males aged 20-25 years with low grades, among whom unemployment was also very high. Furthermore, we found a strong and graded association between school grades and moderate/severe problem gambling for women in both age groups, despite a low prevalence of gambling participation among females compared to males. Conclusions: Our findings show that Swedish youth with low school achievement have an increased risk of gambling problems up to 8 years after school graduation, after control for confounding from sociodemographic characteristics, psychological distress, and alcohol use, and that this association is stronger for females than males.

  • 222. Fröberg, Frida
    et al.
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Tengström, Anders
    Psychosocial health and gambling problems among men and women aged 16-24 years in the Swedish National Public Health Survey2013Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, nr 3, s. 427-433Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: This study aimed to explore the association between psychosocial health, gambling and gambling problems in a nationally representative sample of Swedish youth aged 16-24 years. Another aim was to examine whether these associations were different between young men and women. METHODS: Data were from the cross-sectional Swedish National Public Health Survey in 2004-07. With a response rate of 60.1%, the sample consisted of 19 016 youth. Using a sex-stratified multinomial logistic regression, we estimated associations between psychosocial health variables and gambling and gambling problems. RESULTS: Among males, we found that the higher the alcohol consumption, the higher the likelihood of gambling and gambling problems. Men with high alcohol consumption had an almost four times higher likelihood of gambling problems than men with no or low alcohol consumption (OR 3.94, 95% CI: 2.17-7.14). Moreover, young male victims of violence were more than twice as likely to have gambling problems than non-victims (OR 2.35, 95% CI: 1.39-3.99). Among young women, we found an inverse association between high alcohol consumption and gambling problems (OR 0.15, 95% CI: 0.05-0.44), opposite that of the young men. Furthermore, psychological distress (OR 6.15, 95% CI: 2.15-17.60) and suicidality (OR 2.88, 95% CI: 1.16-7.17) were associated with higher probabilities of gambling problems among young women. CONCLUSION: Alcohol use, violence victimization and poor mental health are associated with gambling problems among Swedish youth, however, with important sex differences. Prevention of youth gambling should consider sex differences and psychosocial health in addition to gambling.

  • 223. Fröberg, Frida
    et al.
    Rosendahl, Ingvar K
    Abbott, Max
    Romild, Ulla
    Tengström, Anders
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    The Incidence of Problem Gambling in a Representative Cohort of Swedish Female and Male 16-24 Year-Olds by Socio-demographic Characteristics, in Comparison with 25-44 Year-Olds2015Ingår i: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 31, nr 3, s. 621-641Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We aimed to estimate the incidence of a first episode of problem gambling among Swedish 16-24 year-olds by demographic and socio-economic characteristics, and to compare the incidence between 16-24 and 25-44 year-olds, and between young women and men. Other aims were to estimate the proportions of recovery and incidence in recurrent problem gambling, and prevalence of problem gambling among 16-44 year-olds in Sweden. We selected 4,358 participants aged 16-44 from the nationally representative Swedish Longitudinal Gambling Study in 2008/2009 and 2009/2010. The primary outcome measure was a first episode of problem gambling during 12 months before the follow-up as measured by the Problem Gambling Severity Index among participants without a history of problem gambling at baseline. The incidence proportion of a first episode of problem gambling among 16-24 year-olds was 2.26 % (95 % confidence interval 1.52-3.36); three times lower among females (1.14; 0.42-3.07 %) than males (3.32; 2.19-5.01 %). Young age and household financial problems were associated with first episode problem gambling among young women. Among 25-44 year-olds, the incidence proportion of a first episode of problem gambling was 0.81 % (0.41-1.56). Recovery from problem gambling was high, in particular among females. Individual transitions from problem gambling to recovery and to recurrent problem gambling, between baseline and follow-up, were common regardless of age. This study adds further evidence to research suggesting that there is a high mobility in and out of problem gambling over time on an individual level. The high incidence of first episode problem gambling among youth in Sweden stresses the importance of prevention of problem gambling at an early age.

  • 224.
    Fu, Michael
    et al.
    Univ Gothenburg, Dept Mol & Clin Med, Inst Med, Sahlgrenska Acad, Gothenburg, Sweden.
    Rosengren, Annika
    Univ Gothenburg, Dept Mol & Clin Med, Inst Med, Sahlgrenska Acad, Gothenburg, Sweden.
    Thunström, Erik
    Univ Gothenburg, Dept Mol & Clin Med, Inst Med, Sahlgrenska Acad, Gothenburg, Sweden.
    Mandalenakis, Zacharias
    Univ Gothenburg, Dept Mol & Clin Med, Inst Med, Sahlgrenska Acad, Gothenburg, Sweden.
    Welin, Lennart
    Lidkoping Hosp, Dept Med, Lidkoping, Sweden.
    Caidahl, Kenneth
    Univ Gothenburg, Dept Mol & Clin Med, Inst Med, Sahlgrenska Acad, Gothenburg, Sweden;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
    Pivodic, Aldina
    Stat Consulting, Gothenburg, Sweden.
    Zhong, You
    Beijing Hosp, Dept Cardiol, Beijing, Peoples R China.
    Ergatoudes, Constantinos
    Univ Gothenburg, Dept Mol & Clin Med, Inst Med, Sahlgrenska Acad, Gothenburg, Sweden.
    Morales, David
    Univ Gothenburg, Dept Mol & Clin Med, Inst Med, Sahlgrenska Acad, Gothenburg, Sweden.
    Welin, Catharina
    Univ Gothenburg, Dept Mol & Clin Med, Inst Med, Sahlgrenska Acad, Gothenburg, Sweden.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Dellborg, Mikael
    Univ Gothenburg, Dept Mol & Clin Med, Inst Med, Sahlgrenska Acad, Gothenburg, Sweden.
    Hansson, Per-Olof
    Univ Gothenburg, Dept Mol & Clin Med, Inst Med, Sahlgrenska Acad, Gothenburg, Sweden.
    Although Coronary Mortality Has Decreased, Rates of Cardiovascular Disease Remain High: 21 Years of Follow-Up Comparing Cohorts of Men Born in 1913 With Men Born in 19432018Ingår i: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, nr 9, artikel-id e008769Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background - Despite a decline in mortality rates from cardiovascular disease (CVD) in the past few decades, the burden of CVD in a contemporary population remains inadequately addressed. Therefore, this study was aimed to investigate secular trends in mortality from coronary artery disease and all-cause mortality over 2 decades, by comparing 2 cohorts of men born 30 years apart and evaluate the prediction of the risk of CVD and all-cause death in a contemporary random sample of Swedish men.

    Methods and Results - Two cohorts of randomly selected men born in 1913 (855 men) and 1943 (798 men) were first examined at age 50 in 1963 and 1993, respectively, and followed longitudinally over 21 years. All-cause mortality and coronary artery disease death were lower in 50-to 71-year-old men born in 1943 compared with those born in 1913, with unadjusted hazard ratios of 0.57 (0.45-0.71) and 0.34 (0.22-0.53), respectively. After adjustment for risk factors (smoking, serum cholesterol, hypertension, systolic blood pressure, diabetes mellitus, body mass index, and physical activity), the differences between the cohorts remained significant for coronary artery disease, hazard ratios 0.57 (0.34-0.94), P=0.029, but not for all-cause mortality hazard ratios 0.82 (0.62-1.07), P=0.14. However, the rate of CVD events during follow-up was still high (30.7%) for the men born in 1943. No statistically significant interaction by birth cohort in contribution of risk factors to death was found between 2 cohorts except physical inactivity.

    Conclusions - Despite a marked reduction in the rate of coronary artery disease death over the past 30 years, the burden of CVD events and all-cause mortality remains high. Therefore, intensified efforts to modify contributing risk factors are still required.

  • 225. Gaist, David
    et al.
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    González-Pérez, Antonio
    García-Rodríguez, Luis Alberto
    Incidence of hemorrhagic stroke in the general population: validation of data from The Health Improvement Network2013Ingår i: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, nr 2, s. 176-182Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The Health Improvement Network (THIN) is a UK healthcare database composed of computerized information from primary care physicians (PCPs). We analyzed the validity of our method for identifying cases of intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) within THIN and assessed the incidence of these events. METHODS: Patients aged 20-89 years were identified and followed until (i) ICH or SAH was detected, (ii) the patient reached 90 years old (iii) death, or (iv) the end of the study. Computerized patient profiles were reviewed manually; those not discarded became potential cases. A validation study was undertaken in 400 computer-detected cases (333 confirmed as potential cases; 67 discarded). PCPs completed a questionnaire to determine the actual incidence of ICH and SAH among these cases. We also assessed the incidence of ICH and SAH in the total cohort. RESULTS: A total of 4330 patients with a READ code suggesting hemorrhagic stroke were identified. Computerized profiles with free-text comments were reviewed manually to identify 3633 potential cases. Responses to the PCP questionnaire were received for 306 potential cases and 63 discarded cases (92% response rate); 82% of potential cases were confirmed. Finally, we identified 3137 cases of hemorrhagic stroke. Crude incidence was 15 per 100 000 person-years for ICH and 11 per 100 000 person-years for SAH; the overall incidence increased sharply with age. CONCLUSIONS: Computer detection of cases of hemorrhagic stroke in THIN followed by manual review of clinical profiles is a valid method. The incidence of hemorrhagic stroke increases sharply with age.

  • 226. Garcia Rodriguez, LA
    et al.
    Tolosa, LB
    Ruigómez, A
    Johansson, Saga
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Rheumatoid arthritis in UK primary care: incidence and prior morbidity2009Ingår i: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 38, nr 3, s. 173-177Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To estimate the incidence of rheumatoid arthritis (RA) in primary care and to investigate associations with consultation behaviour, risk factors, and comorbidities, using the UK General Practice Research Database (GPRD). METHODS: Subjects with a first-ever diagnosis of RA between 1 January 1996 and 31 December 1997 (n = 579) were identified from a cohort of 1 206 918 subjects aged 20-79 years without cancer. Controls from the same cohort were frequency-matched to the RA group by age, sex, and calendar year (n = 4234). Odds ratios (ORs) and 95% confidence intervals (CIs) of being diagnosed with RA in association with a range of factors were estimated using logistic regression analysis. RESULTS: RA incidence was 0.15 per 1000 person-years, was higher in women than in men, and increased with age in both sexes. Consultations and use of non-steroidal anti-inflammatory drugs (NSAIDs) prior to diagnosis were increased in subjects with RA. An increased risk of RA was observed in association with anaemia in the previous year (OR 2.63, 95% CI 1.54-4.48) and with smoking (1.33, 1.07-1.67). A decreased risk of RA was observed in association with infectious diseases (0.68, 0.50-0.94) and pregnancy in the previous year (0.22, 0.06-0.77), diabetes (0.45, 0.26-0.78), and hypertension (0.74, 0.57-0.94). We found no association with alcohol intake, obesity, or use of low-dose aspirin, oral contraceptives, or hormone replacement therapy (HRT). CONCLUSIONS: Smoking was identified as the only significant lifestyle-related risk factor for RA. Infection in the previous year was associated with a reduced likelihood of RA.

  • 227. Garcia Rodriguez, Luis
    et al.
    Garbe, Edeltraut
    Bezemer, Irene
    Layton, Deborah
    Suzart-Woischnik, Kiliana
    Brobert, Gunnar
    Alderson, Jesse
    Winchester, Christopher
    Herings, Ron
    Jobski, Kathrin
    Schink, Tania
    Shakir, Saad
    Soriano-Gabarro, Montse
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Development of a Collaborative European Post-Authorization Safety Study (PASS) Program Examining Rivaroxaban Use in Routine Clinical Practice2014Ingår i: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 23, nr S1, s. 459-460Artikel i tidskrift (Övrigt vetenskapligt)
  • 228. García Rodríguez, Luis A
    et al.
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Tolosa, Laura Barreales
    Johansson, Saga
    Chronic obstructive pulmonary disease in UK primary care: incidence and risk factors2009Ingår i: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, Vol. 6, nr 5, s. 369-379Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We evaluated the association of chronic obstructive pulmonary disease (COPD) with modifiable risk factors such as smoking and prescription medications, and investigated possible risk factors unique to patients who had never smoked. The UK General Practice Research Database was used to identify a cohort of patients with a first diagnosis of COPD (n = 1927) along with age- and sex-matched controls without COPD (n = 16 546). The incidence of COPD diagnoses and the risks associated with medication use, co-morbidities, and demographic factors, were estimated. The incidence of COPD was 2.6 per 1000 person-years (95% confidence interval [CI]: 2.5-2.7) among 40-89 year-olds. The risk significantly increased in current and former smokers (OR: 6.15 [95% CI: 5.41-7.00] and 3.45 [95% CI: 2.96-4.02]), respectively. The risk was significantly lower in former smokers than current smokers (OR: 0.61; 95% CI: 0.52-0.71). Current statin use was significantly associated with a reduced risk (OR: 0.45; 95% CI: 0.25-0.80). In never smokers, risk factors included advanced age and obesity. The risk in never smokers was more strongly related to paracetamol use (OR: 1.82; 95% CI: 1.33-2.49) than in current and former smokers (OR: 1.48; 95% CI: 1.18-1.86). In summary, COPD is associated with a range of cardiovascular and respiratory conditions and the risk is influenced by current and past medications. While the risk factors are similar in smokers and never smokers, some were unique to never smokers. Moreover, subjects who stopped smoking had a substantially lower COPD risk than those who continued smoking.

  • 229. Ghadimi, Hadi
    et al.
    Esmaily, Hamideh M.
    Wahlström, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    General practitioners' prescribing patterns for the elderly in a province of Iran2011Ingår i: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 20, nr 5, s. 482-487Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose To determine prescribing patterns by general physicians working in primary care (GPs) in Iran for the elderly and the prevalence of inappropriate prescribing. Methods We collected information about prescribed medicines for 10% of patients in primary care aged 65 years or above in six cities in one province during two separate months 1 year apart. Inappropriate prescribing was determined using Beers criteria, excluding diagnosis-related medications. The WHO indicators for appropriateness of prescribing in general practice and drug-drug interactions (DDIs) were also assessed. Results A total of 2041 patients were studied (mean age 73 years, 56% were women). Drugs for the alimentary system (20%), nervous system (15%), cardiovascular system (14%), and anti-infectives (12%) were most frequently prescribed. Almost all drugs (96%) were prescribed by generic names. Thirty percent of patients received at least one inappropriate drug (27% for men; 33% for women), whereof 94% were categorized as high risk for adverse effects. Indomethacin, diphenhydramine, and methocarbamol were the most common inappropriate medications. The average number of drugs per patient was 4.4 (4.2 for men; 4.5 for women). Forty-four percent of patients received five or more drugs. Antibiotics and injections were prescribed in 39 and 55% of all patients, respectively. Clinically relevant DDIs were observed for 14% of the patients. Conclusion Our findings call for further interventions aiming at educating GPs to reduce potential errors. National drug policies and prescribing guidelines should be implemented to address the problem of inappropriate drug usage among the elderly.

  • 230.
    Giezeman, Maaike
    et al.
    Orebro Univ, Sch Med Sci, Orebro, Sweden;Cty Council Varmland, Ctr Clin Res, Karlstad, Sweden.
    Hasselgren, Mikael
    Orebro Univ, Sch Med Sci, Orebro, Sweden.
    Lisspers, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Montgomery, Scott
    Orebro Univ, Clin Epidemiol & Biostat, Orebro, Sweden;Karolinska Inst, Dept Med, Clin Epidemiol Unit, Stockholm, Sweden;UCL, Dept Epidemiol & Publ Hlth, London, England.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Sundh, Josefin
    Orebro Univ, Sch Med Sci, Dept Resp Med, Orebro, Sweden.
    Influence of comorbid heart disease on dyspnea and health status in patients with COPD - a cohort study2018Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 13, s. 3857-3865Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The aim of this study was to examine the changing influence over time of comorbid heart disease on symptoms and health status in patients with COPD. Patients and methods: This is a prospective cohort study of 495 COPD patients with a baseline in 2005 and follow-up in 2012. The study population was divided into three groups: patients without heart disease (no-HD), those diagnosed with heart disease during the study period (new-HD) and those with heart disease at baseline (HD). Symptoms were measured using the mMRC. Health status was measured using the Clinical COPD Questionnaire (CCQ) and the COPD Assessment Test (CAT; only available in 2012). Logistic regression with mMRC $2 and linear regression with CCQ and CAT scores in 2012 as dependent variables were performed unadjusted, adjusted for potential confounders, and additionally adjusted for baseline mMRC, respectively, CCQ scores. Results: Mean mMRC worsened from 2005 to 2012 as follows: for the no-HD group from 1.8 (+/- 1.3) to 2.0 (+/- 1.4), (P=0.003), for new-HD from 2.2 (+/- 1.3) to 2.4 (+/- 1.4), (P=0.16), and for HD from 2.2 (+/- 1.3) to 2.5 (+/- 1.4), (P=0.03). In logistic regression adjusted for potential confounding factors, HD (OR 1.71; 95% CI: 1.03-2.86) was associated with mMRC $ 2. Health status worsened from mean CCQ as follows: for no-HD from 1.9 (+/- 1.2) to 2.1 (+/- 1.3) with (P=0.01), for new-HD from 2.3 (+/- 1.5) to 2.6 (+/- 1.6) with (P=0.07), and for HD from 2.4 (+/- 1.1) to 2.5 (+/- 1.2) with (P=0.57). In linear regression adjusted for potential confounders, HD (regression coefficient 0.12; 95% CI: 0.04-5.91) and new-HD (0.15; 0.89-5.92) were associated with higher CAT scores. In CCQ functional state domain, new-HD (0.14; 0.18-1.16) and HD (0.12; 0.04-0.92) were associated with higher scores. After additional correction for baseline mMRC and CCQ, no statistically significant associations were found. Conclusion: Heart disease contributes to lower health status and higher symptom burden in COPD but does not accelerate the worsening over time.

  • 231.
    Glette, Mari
    et al.
    Norwegian Univ Sci & Technol, Dept Circulat & Med Imaging, Trondheim, Norway;St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway.
    Landmark, Tormod
    St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway;Norwegian Univ Sci & Technol, Dept Psychol, Trondheim, Norway.
    Jensen, Mark P.
    Univ Washington, Sch Med, Dept Rehabil Med, Seattle, WA 98195 USA.
    Woodhouse, Astrid
    Norwegian Univ Sci & Technol, Dept Circulat & Med Imaging, Trondheim, Norway;St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway;Univ Hosp Uppsala, Pain Ctr, Uppsala, Sweden.
    Borchgrevink, Petter C.
    Norwegian Univ Sci & Technol, Dept Circulat & Med Imaging, Trondheim, Norway;St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway.
    Stiles, Tore C.
    St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway;Norwegian Univ Sci & Technol, Dept Psychol, Trondheim, Norway.
    Catastrophizing, Solicitous Responses From Significant Others, and Function in Individuals With Neuropathic Pain, Osteoarthritis, or Spinal Pain in the General Population2018Ingår i: Journal of Pain, ISSN 1526-5900, E-ISSN 1528-8447, Vol. 19, nr 9, s. 983-995Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    That certain psychological factors are negatively associated with function in patients with chronic pain is well established. However, few studies have evaluated these factors in individuals with chronic pain from the general population. The aims of this study were to: 1) evaluate the unique associations between catastrophizing and perceived solicitous responses and psychological function, physical function, and insomnia severity in individuals with neuropathic pain, osteoarthritis, or spinal pain in the general population; and 2) determine if diagnosis moderates the associations found. Five hundred fifty-one individuals from the general population underwent examinations with a physician and physiotherapist, and a total of 334 individuals were diagnosed with either neuropathic pain (n = 34), osteoarthritis (n = 78), or spinal pain (n = 222). Results showed that catastrophizing was significantly associated with reduced psychological and physical function, explaining 24% and 2% of the variance respectively, whereas catastrophizing as well as perceived solicitous responding were significantly and uniquely associated with insomnia severity, explaining 8% of the variance. Perceived solicitous responding was significantly negatively associated with insomnia severity. Moderator analyses indicated that: 1) the association between catastrophizing and psychological function was greater among individuals with spinal pain and neuropathic pain than those with osteoarthritis, and 2) the association between catastrophizing and insomnia was greater among individuals with spinal pain and osteoarthritis than those with neuropathic pain. No statistically significant interactions including perceived solicitous responses were found. The findings support earlier findings of an association between catastrophizing and function among individuals with chronic pain in the general population, and suggest that diagnosis may serve a moderating role in some of these associations. Perspective: When examining persons with pain in the general population, catastrophizing is associated with several aspects of function, and diagnosis serves as a moderator for these associations. The replication of these associations in the general population support their reliability and generalizability.

  • 232.
    Gonzalez Lindh, Margareta
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Logopedi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Koyi, Hirsh
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Blom Johansson, Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Forskning om funktionshinder och habilitering. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Logopedi.
    Högman, Marieann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi, Integrativ Fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Malinovschi, Andrei
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi, Integrativ Fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Bendrik, Regina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Lisspers, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Prevalence of subjective swallowing dysfunction in patients with stable COPD: Results from the TIE-study2017Konferensbidrag (Övrigt vetenskapligt)
  • 233.
    Gonzalez Lindh, Margareta
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Logopedi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Koyi, Hirsh
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Blom Johansson, Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Forskning om funktionshinder och habilitering. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Logopedi.
    Malinovschi, Andrei
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi, Integrativ Fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Högman, Marieann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi, Integrativ Fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Bröms, Kristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Swallowing dysfunction in COPD: Is it more related to burden of disease than lung function: Results from the TIE-study2017Konferensbidrag (Övrigt vetenskapligt)
  • 234.
    Gonzalez Lindh, Margareta
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Blom Johansson: Logopedi.
    Malinovschi, Andrei
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi, Integrativ Fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Brandén, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Jansson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna.
    Bröms, Kristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Blom Johansson, Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Forskning om funktionshinder och habilitering. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Blom Johansson: Logopedi.
    Lisspers, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Koyi, Hirsh
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Subjective swallowing symptoms and related risk factors in COPD2019Ingår i: ERJ Open Research, Vol. 5, nr 3Artikel i tidskrift (Refereegranskat)
  • 235. Gonzalez-Perez, Antonio
    et al.
    Gaist, David
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    McFeat, Gillian
    Garcia-Rodriguez, Luis A.
    Mortality after hemorrhagic stroke Data from general practice (The Health Improvement Network)2013Ingår i: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 81, nr 6, s. 559-565Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To investigate short-term case fatality and long-term mortality after intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) using data from The Health Improvement Network database. Methods: Thirty-day case fatality was stratified by age, sex, and calendar year after ICH and SAH using logistic regression. Cox proportional hazards regression analyses were used to estimate the risk of death during the first year of follow-up and survivors at 1 year. Results: Case fatality after ICH was 42.0%, compared with 28.7% after SAH. It increased with age (ICH: 29.7% for 20-49 years, 54.6% for 80-89 years; SAH: 20.3% for 20-49 years, 56.7% for 80-89 years; both p-trend < 0.001), and decreased over the period 2000-2001 to 2006-2008 (ICH: from 53.1% to 35.8%, p-trend < 0.001; SAH: from 33.3% to 24.7%, p-trend = 0.02). Risk of death was significantly higher among stroke patients during the first year of follow-up compared with controls (ICH: hazard ratio [HR] 2.60, 95% confidence interval [CI] 2.09-3.24, p < 0.01; SAH: HR 2.87,95% CI 2.07-3.97, p < 0.01) and remained elevated among survivors at 1 year (ICH: HR 2.02, 95% CI 1.75-2.32, p < 0.01; SAH: HR 1.32, 95% CI 1.02-1.69, p = 0.03). Conclusions: More than one-third of individuals die in the first month after hemorrhagic stroke, and patients younger than 50 years are more likely to die after ICH than SAH. Short-term case fatality has decreased over time. Patients who survive hemorrhagic stroke have a continuing elevated risk of death compared with matched individuals from the general population.

  • 236. Granstrom, O.
    et al.
    Kjeldsen, S. E.
    Russell, D.
    Thuresson, M.
    Stålhammar, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Bodegard, J.
    Hedegaard, M.
    Hospitalizations and primary care resource use: A real-life perspective2012Ingår i: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 15, nr 4, s. A130-A130Artikel i tidskrift (Övrigt vetenskapligt)
  • 237.
    Grape Viding, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Den sjungande kroppen2014Ingår i: Kulturhälsoboxen: Del 6 - Musikboken / [ed] Bojner Horwitz, Eva, Gothia Fortbildning , 2014Kapitel i bok, del av antologi (Övrig (populärvetenskap, debatt, mm))
  • 238.
    Grape Viding, Christina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Osika, Walter
    Bojner Horwitz, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    "You Can´t Feel Healthier than Your Caregiver": The Ripple Effect of Trust and Empathy for Patients and Health Care Staff, Cultivated through Cultural Activities2017Ingår i: Journal of Nursing & Care, ISSN 2167-1168, Vol. 6, nr 5, artikel-id 1000422Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Stress-related problems, including burnout, cause personal suffering, disability and result in costly sick leave. The use of different cultural activities within a health care system may help to prevent burnout, but very few studies have focused on what happens after such activities.

    Methods: Interventions with different cultural activities were conducted for burn out patients in four primary health care settings during three months. Focus group interviews were conducted with patients, cultural producers and health care nurses. The aim was to provide a description of the participant’s experiences after the activities.

    Results: The cultural activities were found to affect both participants' emotions and behaviour and created a sense of belonging and equality among them. Positive 'spill-over' effects were also seen on nurses of health care management.

    Conclusion: We find that the cultural activities help to create a trustful and empathic health care environment where the wellbeing of staff and that of patients have an impact on each other. We suggest the incorporation of arts into health care as a possible contributor to the development of a sustainable health care system.

  • 239.
    Grape Viding, Christina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Osika, Walter
    Theorell, Töres
    Kowalski, J
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Bojner Horwitz, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    The Culture palette: a randomized intervention study for women with burnout symptoms in Sweden2015Ingår i: British Journal of Medical Practitioners, ISSN 1757-8515, Vol. 8, nr 2, artikel-id a813Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Burnout is common among women in Sweden. Cultural activities, i.e. arts, have benefitted different patient populations and may have potential for treating this group as well. Aim: To evaluate possible health effects of regular cultural activities for women with burnout symptoms with focus on exhaustion level. Methods: 48 women (mean age 54) were randomly assigned either to a cultural activity group (intervention group) or to a control group. Four health care centers were the settings for a “Culture Palette” comprised of six different cultural activity packages: interactive theater, movie, vocal improvisation and drawing, dance, mindfulness training and musical show. The activity packages were offered once a week over a period of three months. Standardized questionnaires; the Karolinska Exhaustion Disorder Scale ( KEDS), Sense of Coherence (SOC), Toronto Alexithymia Scale (TAS) and Self-rated health were used at baseline, in month three and at follow-up in month six. Qualitative interviews with patients, cultural producers and health care staff were conducted at month three and month six. Results: Burnout symptoms/exhaustion (P< .001) and alexithymia (P=0.007) as well as self-rated health (P<0.001) improved more in the intervention group than in the control group with clinically relevant effect variances. There was no statistical evidence of any difference in the development of SOC between the intervention and the control group. The healthcare staff were also positively affected although they did not participate in the cultural activities. Conclusion: Regular cultural activities affected this group of women beneficially with enhanced health and decreased levels of exhaustion.

  • 240.
    Grape Viding, Christina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Sandgren, Maria
    Hansson, Lars-Olof
    Ericson, Mats
    Theorell, Töres
    Does Singing Promote Well-Being?: An Empirical Study of Professional and Amateur Singers during a  Singing Lesson2003Ingår i: Integrative Physiological & Behavioral Science, ISSN 1053-881X, E-ISSN 2168-7846, Vol. 38, nr 1, s. 65-74Artikel i tidskrift (Refereegranskat)
  • 241. Gray, Linsay
    et al.
    Merlo, Juan
    Mindell, Jennifer
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Tafforeau, Jean
    O'Reilly, Dermot
    Regidor, Enrique
    Næss, Oyvind
    Kelleher, Cecily
    Helakorpi, Satu
    Lange, Cornelia
    Leyland, Alastair H
    International differences in self-reported health measures in 33 major metropolitan areas in Europe2012Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, nr 1, s. 40-47Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    The increasing concentration of populations into large conurbations in recent decades has not been matched by international health assessments, which remain largely focused at the country level. We aimed to demonstrate the use of routine survey data to compare the health of large metropolitan centres across Europe and determine the extent to which differences are due to socio-economic factors.

    METHODS:

    Multilevel modelling of health survey data on 126 853 individuals from 33 metropolitan areas in the UK, Republic of Ireland, Sweden, Norway, Finland, Spain, Belgium and Germany compared general health, longstanding illness, acute sickness, psychological distress and obesity with the average for all areas, accounting for education and social class.

    RESULTS:

    We found some areas (Greater Glasgow; Greater Manchester, Cheshire and Merseyside; Northumberland, Tyne and Wear and South Yorkshire) had significantly higher levels of poor health. Other areas (West Flanders and Antwerp) had better than average health. Differences in individual socio-economic circumstances did not explain findings. With a few exceptions, acute sickness levels did not vary.

    CONCLUSION:

    Health tended to be worse in metropolitan areas in the north and west of the UK and the central belt and south east of Germany, and more favourable in Sweden and north west Belgium, even accounting for socio-economic composition of local populations. This study demonstrated that combining national health survey data covering different areas is viable but not without technical difficulties. Future comparisons between European regions should be made using standardized sampling, recruitment and data collection protocols, allowing proper monitoring of health inequalities.

  • 242. Grundvold, Irene
    et al.
    Bodegard, Johan
    Nilsson, Peter M.
    Svennblad, Bodil
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Ostgren, Carl Johan
    Sundström, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Body weight and risk of atrial fibrillation in 7,169 patients with newly diagnosed type 2 diabetes; an observational study2015Ingår i: Cardiovascular Diabetology, ISSN 1475-2840, E-ISSN 1475-2840, Vol. 14, s. 5-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Obesity, type 2 diabetes and atrial fibrillation (AF) are closely associated, but the underlying mechanisms are not fully understood. We aimed to explore associations between body mass index (BMI) or weight change with risk of AF in patients with type 2 diabetes. Methods: A total of 7,169 participations with newly diagnosed type 2 diabetes were stratified according to baseline BMI, and after a second BMI measurement within 18 months, further grouped according to relative weight change as "weight gain" (> 1 BMI unit), " stable weight" (+/- 1 BMI unit) and " weight loss" (< 1 BMI unit). The mean follow-up period was 4.6 years, and the risk of AF was estimated using adjusted Cox regression models. Results: Average age at diabetes diagnosis was 60 years and the patients were slightly obese (mean BMI 30.2 kg/m(2)). During follow-up, 287 patients developed incident AF, and those with overweight or obesity at baseline had 1.9 fold and 2.9-fold higher risk of AF, respectively, than those with normal BMI. The 14% of the patients with subsequent weight gain had 1.5-fold risk of AF compared with those with stable weight or weight loss. Conclusions: In patients with newly diagnosed type 2 diabetes, baseline overweight and obesity, as well as modest weight increase during the first 18 months after diagnosis, were associated with a substantially increased risk of incident AF. Patients with type 2 diabetes may benefit from efforts to prevent weight gain in order to reduce the risk of incident AF.

  • 243.
    Grunnesjö, Marie I
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Bogefeldt, Johan P
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Blomberg, Stefan I E
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Strender, Lars-Erik
    Karolinska Institutet, Institutionen för neurobiologi, vårdvetenskap och samhälle, Department of Neurobiology, Care Science and Society.
    Svärdsudd, Kurt F
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    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 pain2011Ingår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 25, nr 11, s. 999-1010Artikel i tidskrift (Refereegranskat)
    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.

  • 244.
    Gröndal, Hedvig
    et al.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Hedin, Katarina
    Strandberg, Eva Lena
    André, Malin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Brorsson, Annika
    Near-patient tests and the clinical gaze in decision-making of Swedish GPs not following current guidelines for sore throat - a qualitative interview study2015Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 16, artikel-id 81Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Excessive antibiotics use increases the risk of resistance. Previous studies have shown that the Centor score combined with Rapid Antigen Detection Test (RADT) for Group A Streptococci can reduce unnecessary antibiotic prescribing in patients with sore throat. According to the former Swedish guidelines RADT was recommended with 2-4 Centor criteria present and antibiotics were recommended if the test was positive. C-reactive protein (CRP) was not recommended for sore throats. Inappropriate use of RADT and CRP has been reported in several studies. Methods: From a larger project 16 general practitioners (GPs) who stated management of sore throats not according to the guidelines were identified. Half-hour long semi-structured interviews were conducted. The topics were the management of sore throats and the use of near-patient tests. Qualitative content analysis was used. Results: The use of the near-patient test interplayed with the clinical assessment and the perception that all infections caused by bacteria should be treated with antibiotics. The GPs expressed a belief that the clinical picture was sufficient for diagnosis in typical cases. RADT was not believed to be relevant since it detects only one bacterium, while CRP was considered as a reliable numerical measure of bacterial infection. Conclusions: Inappropriate use of near-patient test can partly be understood as remnants of outdated knowledge. When new guidelines are introduced the differences between them and the former need to be discussed more explicitly.

  • 245. Gudbjörnsdottir, S
    et al.
    Eliasson, B
    Eeg-Olofsson, K
    Zethelius, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Cederholm, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Additive effects of glycaemia and dyslipidaemia on risk of cardiovascular diseases in type 2 diabetes: an observational study from the Swedish National Diabetes Register2011Ingår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 54, nr 10, s. 2544-2551Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS/HYPOTHESIS:

    The study aimed to assess the relative importance of the control of HbA(1c) and total cholesterol/HDL-cholesterol ratio (TC/HDL) on risk of cardiovascular disease (CVD).

    METHODS:

    In 22,135 participants with type 2 diabetes (age 30-75 years, 15% with previous CVD) followed for 5 years, baseline and annually updated mean HbA(1c) and TC/HDL were analysed and also categorised in combinations of quartiles. Outcomes were fatal/non-fatal CHD, stroke, CVD and total mortality.

    RESULTS:

    In all participants, HRs per 1 SD increase in updated mean HbA(1c) or TC/HDL using Cox regression analysis were 1.13 (95% CI 1.07, 1.19) and 1.31 (1.25, 1.37) for CHD, 1.15 (1.06, 1.24) and 1.25 (1.17, 1.34) for stroke, 1.13 (1.08, 1.18) and 1.29 (1.24, 1.34) for CVD (all p < 0.001), and 1.07 (1.02, 1-13; p = 0.01) and 1.18 (1.12, 1.24; p < 0.001) for total mortality, respectively, adjusted for clinical characteristics and traditional risk factors. The p value for the interaction between HbA(1c) and TC/HDL was 0.02 for CHD, 0.6 for stroke and 0.1 for CVD. Adjusted mean 5-year event rates in a Cox model, in combinations of quartiles of updated mean TC/HDL and HbA(1c) (lowest <3.1 mmol/l and 5.0-6.4% [31-46 mmol/mol]; <3.1 mmol/l and ≥7.8% [≥62 mmol/mol]; ≥4.6 mmol/l and 5.0-6.4% 31-46 mmol/mol; and highest ≥4.6 mmol/l and ≥7.8% [≥62 mmol/mol]), were 4.8%, 7.0%, 9.1% and 14.5% for CHD, and 7.1%, 9.9%, 12.8% and 19.4% for CVD, respectively. Adjusted HRs for highest vs lowest combinations were 2.24 (1.58-3.18) for CHD and 2.43 (1.79-3.29) for CVD (p < 0.001).

    CONCLUSIONS/INTERPRETATION:

    Hyperglycaemia and hyperlipidaemia were less than additive for CHD and additive for other endpoints, with the lowest risk at lowest combination levels and a considerable increase in absolute risk at high combination levels.

  • 246.
    Gulliksson, Mats