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  • 251.
    Halford, Christina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Jonsdottír, Ingibjörg H.
    Eek, Frida
    Perceived stress, psychological resources and salivary cortisol2012Inngår i: The role of saliva cortisol measurement in health and disease / [ed] Kristenson M, Garvin P, Lundberg U, Bentham eBooks, 2012, s. 67-86Kapittel i bok, del av antologi (Fagfellevurdert)
    Abstract [en]

    The aim of this chapter was to analyze associations between measures of cortisol in saliva with measures of perceived stress, using the Perceived Stress Scale (PSS), and of psychological resources in terms of mastery, locus of control, self-esteem and sense of coherence. Only studies on healthy individuals were included and cortisol measures were grouped into single time point measures, deviation measures, Area Under the Curve (AUC), laboratory test responses, and dexamethasone suppression. For both Perceived Stress Scale (PSS) and for psychological resources, most results of associations with saliva cortisol were nonsignificant particularly for single measures and for cortisol awakening response. For PSS the largest proportion of significant findings (38%) was seen for morning AUC, however with conflicting results. For psychological resource constructs, mastery and sense of coherence were related to lower cortisol level at baseline in standardized rest and high mastery was related to steeper diurnal slope in two studies. For self-esteem, no associations showed significant results. Differences in findings may to a large extent be dependent on theoretical assumptions made and methods used.

  • 252.
    Halford, Christina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Wallman, Thorne
    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 i Sörmland (CKFD).
    Welin, Lennart
    Rosengren, Annika
    Bardel, Annika
    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 i Sörmland (CKFD).
    Johansson, Saga
    Eriksson, Henry
    Palmer, Ed
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Nationalekonomiska institutionen.
    Wilhelmsen, Lars
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Effects of self-rated health on sick leave, disability pension, hospital admissions and mortality: A population-based longitudinal study of nearly 15,000 observations among Swedish women and men2012Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, nr 1, s. 1103-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Simple global self-ratings of health (SRH) have become increasingly used in national and international public health monitoring, and in recent decades recommended as a standard part of health surveys. Monitoring developments in population health requires identification and use of health measures, valid in relation to targets for population health. The aim of the present study was to investigate associations between SRH and sick leave, disability pension, hospital admissions, and mortality, adjusted for effects of significant covariates, in a large population-based cohort.

    METHODS:

    The analyses were based on screening data from eight population-based cohorts in southern and central Sweden, and on official register data regarding sick-leave, disability pension, hospital admissions, and death, with little or no data loss. Sampling was performed 1973--2003. The study population consisted of 11,880 women and men, age 25--99 years, providing 14,470 observations. Information on SRH, socio-demographic data, lifestyle variables and somatic and psychological symptoms were obtained from questionnaires.

    RESULTS:

    There was a significant negative association between SRH and sick leave (Beta -13.2, p<0.0001, and -9.5, p<0.01, in women and men, respectively), disability pension (Hazard ratio 0.77, p<0.0001 and 0.76, p<0.0001, in women and men, respectively), and mortality, adjusted for covariates. SRH was also significantly associated with hospital admissions in men (Hazard ratio 0.87, p<0.0001), but not in women (Hazard ratio 0.96, p0.20). Associations between SRH on the one hand, and sick leave, disability pension, hospital admission, and mortality, on the other, were robust during the follow-up period.

    CONCLUSIONS:

    SRH had strong predictive validity in relation to use of social insurance facilities and health care services, and to mortality. Associations were strong and robust during follow-up.

  • 253.
    Halford, Christina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Welin, Catharina
    Bogefeldt, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Wallman, Thorne
    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 i Sörmland (CKFD).
    Rosengren, Annika
    Bardel, Annika
    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 i Sörmland (CKFD).
    Johansson, Saga
    Eriksson, Henry
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    A population-based study of nearly 15 000 observations among Swedish women and men during 1973-20032012Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, nr 6, s. e001353-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES:

    Global self-rated health (SRH) has become extensively used as an outcome measure in population health surveillance. The aim of this study was to analyse the effects of age and secular trend (year of investigation) on SRH.

    DESIGN:

    Prospective cohort study, using population-based data from eight ongoing cohort studies, with sampling performed between 1973 and 2003.

    SETTING:

    Sweden.

    PARTICIPANTS:

    11 880 women and men, aged 25-99 years, providing 14 470 observations.

    PRIMARY OUTCOME MEASURE:

    Global SRH.

    RESULTS:

    In multiple ordinal logistic regression analyses, adjusted for the effects of covariates, there were independent effects of age (p<0.0001) and of year of investigation (p<0.0001) on SRH. In women the association was linear, showing lower levels of SRH with increased age, and more recent year of investigation. In men the association was curvilinear, and thus more complex. The final model explained 76.2% of the SRH variance in women and 74.5% of the variance in men.

    CONCLUSIONS:

    SRH was strongly and inversely associated with age in both sexes, after adjustment for other outcome-affecting variables. There was a strongly significant effect of year of investigation indicating a change in SRH, in women towards lower levels over calendar time, in men with fluctuations across time.

  • 254.
    Hallberg, S.
    et al.
    Quantify Res, Hantverkargatan 8, S-11221 Stockholm, Sweden..
    Banefelt, J.
    Quantify Res, Hantverkargatan 8, S-11221 Stockholm, Sweden..
    Fox, K. M.
    Strateg Healthcare Solut LLC, Baltimore, MD USA..
    Mesterton, J.
    Quantify Res, Hantverkargatan 8, S-11221 Stockholm, Sweden.;Karolinska Inst, LIME Med Management Ctr, Stockholm, Sweden..
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Levin, L. -A
    Sobocki, P.
    Karolinska Inst, LIME Med Management Ctr, Stockholm, Sweden.;IMS Hlth, Stockholm, Sweden..
    Gandra, S. R.
    Amgen Inc, Thousand Oaks, CA 91320 USA..
    Lipid-lowering treatment patterns in patients with new cardiovascular events - estimates from population-based register data in Sweden2016Inngår i: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 70, nr 3, s. 222-228Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    ObjectivesThe aim of this study was to assess treatment patterns of lipid-lowering therapy (LLT) in patients with hyperlipidaemia or prior cardiovascular (CV) events who experience new CV events. MethodsA retrospective population-based cohort study was conducted using Swedish medical records and registers. Patients were included in the study based on a prescription of LLT or CV event history and followed up for up to 7 years for identification of new CV events and assessment of LLT treatment patterns. Patients were stratified into three cohorts based on CV risk level. All outcomes were assessed during the year following index (the date of first new CV event). Adherence was defined as medication possession ratio (MPR) > 0.80. Persistence was defined as no gaps > 60 days in supply of drug used at index. ResultsOf patients with major cardiovascular disease (CVD) history (n = 6881), 49% were not on LLT at index. Corresponding data for CV risk equivalent and low/unknown CV risk patients were 37% (n = 3226) and 38% (n = 2497) respectively. MPR for patients on LLT at index was similar across cohorts (0.74-0.75). The proportions of adherent (60-63%) and persistent patients (56-57%) were also similar across cohorts. Dose escalation from dose at index was seen within all cohorts and 2-3% of patients switched to a different LLT after index while 5-6% of patients augmented treatment by adding another LLT. ConclusionsAlmost 50% of patients with major CVD history were not on any LLT, indicating a potential therapeutic gap. Medication adherence and persistence among patients on LLT were suboptimal.

  • 255. Hallberg, S.
    et al.
    Banefelt, J.
    Fox, K. M.
    Mesterton, J.
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Levin, L. A.
    Sobocki, P.
    Gandra, S. R.
    Treatment Patterns In Hyperlipidemia Patients With New Cardiovascular Events - Estimates From Population-Based Register Data In Sweden2014Inngår i: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 17, nr 7, s. A501-A501, artikkel-id PCV162Artikkel i tidsskrift (Annet vitenskapelig)
  • 256. Hallberg, S.
    et al.
    Banefelt, J.
    Mesterton, J.
    Gandra, S. R.
    Fox, K. M.
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Levin, L. A.
    Sobocki, P.
    Health Care Costs Associated With Cardiovascular Events In Patients With Hyperlipidemia - Estimates From Population-Based Register Data In Sweden2014Inngår i: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 17, nr 7, s. A492-A492, artikkel-id PCV111Artikkel i tidsskrift (Annet vitenskapelig)
  • 257.
    Hallberg, S.
    et al.
    Quantify Res, Hantverkargatan 8, S-11221 Stockholm, Sweden..
    Gandra, S. R.
    Amgen Inc, Thousand Oaks, CA 91320 USA..
    Fox, K. M.
    Strateg Healthcare Solut LLC, Baltimore, MD USA..
    Mesterton, J.
    Quantify Res, Hantverkargatan 8, S-11221 Stockholm, Sweden.;Karolinska Inst, LIME Med Management Ctr, Stockholm, Sweden..
    Banefelt, J.
    Quantify Res, Hantverkargatan 8, S-11221 Stockholm, Sweden..
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Levin, L. -Å
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Sobocki, P.
    Karolinska Inst, LIME Med Management Ctr, Stockholm, Sweden.;IMS Hlth, Stockholm, Sweden..
    Healthcare costs associated with cardiovascular events in patients with hyperlipidemia or prior cardiovascular events: estimates from Swedish population-based register data2016Inngår i: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 17, nr 5, s. 591-601Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To estimate healthcare costs of new cardiovascular (CV) events (myocardial infarction, unstable angina, revascularization, ischemic stroke, transient ischemic attack, heart failure) in patients with hyperlipidemia or prior CV events. A retrospective population-based cohort study was conducted using Swedish national registers and electronic medical records. Patients with hyperlipidemia or prior CV events were stratified into three cohorts based on CV risk level: history of major cardiovascular disease (CVD), coronary heart disease (CHD) risk-equivalent, and low/unknown risk. Propensity score matching was applied to compare patients with new events to patients without new events for estimation of incremental costs of any event and by event type. A CV event resulted in increased costs over 3 years of follow-up, with the majority of costs occurring in the 1st year following the event. The mean incremental cost of patients with a history of major CVD (n = 6881) was a,not sign8588 during the 1st year following the event. This was similar to that of CHD risk-equivalent patients (n = 3226; a,not sign6663) and patients at low/unknown risk (n = 2497; a,not sign8346). Ischemic stroke resulted in the highest 1st-year cost for patients with a history of major CVD and CHD risk-equivalent patients (a,not sign10,194 and a,not sign9823, respectively); transient ischemic attack in the lowest (a,not sign3917 and a,not sign4140). Incremental costs remained elevated in all cohorts during all three follow-up years, with costs being highest in the major CVD history cohort. Healthcare costs of CV events are substantial and vary considerably by event type. Incremental costs remain elevated for several years after an event.

  • 258.
    Hallman, David M.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Lyskov, Eugene
    Centrum för belastningsskadeforskning, Högskolan i Gävle.
    Autonomic regulation, physical activity and perceived stress in subjects with musculoskeletal pain: 24-hour ambulatory monitoring2012Inngår i: International Journal of Psychophysiology, ISSN 0167-8760, E-ISSN 1872-7697, Vol. 86, nr 3, s. 276-282Artikkel i tidsskrift (Fagfellevurdert)
  • 259.
    Hallman, David M.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Olsson, Erik M. G.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Psykosocial onkologi och stödjande vård.
    von Schéele, Bo
    Melin, Lennart
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Lyskov, Eugene
    Effects of Heart Rate Variability Biofeedback in Subjects with Stress-Related Chronic Neck Pain: A Pilot Study2011Inngår i: Applied Psychophysiology and Biofeedback, ISSN 1090-0586, E-ISSN 1573-3270, Vol. 36, nr 2, s. 71-80Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Recent studies focusing on autonomic nervous system (ANS) dysfunctions, together with theoretical pathophysiological models of musculoskeletal disorders, indicate the involvement of ANS regulation in development and maintenance of chronic muscle pain. Research has demonstrated the effectiveness of heart rate variability (HRV) biofeedback (BF) in increasing HRV and reducing the symptoms of different disorders characterized by ANS aberration. The study investigated the effects of resonance frequency HRV BF on autonomic regulation and perceived health, pain, stress and disability in 24 subjects with stress-related chronic neck-shoulder pain. Twelve subjects participated in 10 weekly sessions of resonant HRV BF and were compared to a control group. Subjective reports and HRV measures during relaxation and in response to a standardized stress protocol were assessed for both groups pre- and post-intervention. Group × time interactions revealed a significantly stronger increase over time in perceived health (SF-36) for the treatment group, including vitality, bodily pain and social functioning. Interactions were also seen for HRV during relaxation and reactivity to stress. The present pilot study indicates improvement in perceived health over a 10 week intervention with HRV-biofeedback in subjects with chronic neck-pain. Increased resting HRV as well as enhanced reactivity to hand grip and cold pressor tests might reflect beneficial effects on ANS regulation, and suggest that this intervention protocol is suitable for a larger controlled trial.

  • 260.
    Hallqvist, Johan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    [Incidence and medical care of diabetes in a defined population]1981Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 78, nr 42, s. 3706-10Artikkel i tidsskrift (Fagfellevurdert)
  • 261.
    Hallqvist, Johan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Smedby, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Sjukvårdskonsumtion och sociala faktorer hos patienter som sökt distriktsläkare för icke-ulcus dyspepsi (stencil)1983Rapport (Annet vitenskapelig)
  • 262.
    Hamblin, Lydia E.
    et al.
    Wayne State Univ, Dept Family Med & Publ Hlth Sci, Detroit, MI 48201 USA.;Wayne State Univ, Ind & Org Psychol, Detroit, MI 48201 USA..
    Essenmacher, Lynnette
    Detroit Med Ctr, Occupat Hlth Serv, Detroit, MI USA..
    Ager, Joel
    Wayne State Univ, Dept Family Med & Publ Hlth Sci, Detroit, MI 48201 USA..
    Upfal, Mark
    Wayne State Univ, Sch Med, Dept Emergency Med, Detroit, MI 48201 USA.;Detroit Med Ctr, Detroit, MI USA..
    Luborsky, Mark
    Wayne State Univ, Dept Anthropol, Inst Gerontol, Detroit, MI 48201 USA.;Wayne State Univ, Dept Gerontol, Inst Gerontol, Detroit, MI 48201 USA.;Wayne State Univ, Aging & Hlth Dispar Res, Inst Gerontol, Detroit, MI 48201 USA.;Karolinska Inst, S-10401 Stockholm, Sweden..
    Russell, Jim
    Detroit Med Ctr, Occupat Hlth Serv, Detroit, MI USA..
    Arnetz, Judith
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Wayne State Univ, Detroit, MI 48201 USA.;Michigan State Univ, Coll Human Med, Dept Family Med, E Lansing, MI 48824 USA..
    Worker-to-Worker Violence in Hospitals Perpetrator Characteristics and Common Dyads2016Inngår i: Workplace Health & Safety, ISSN 2165-0799, Vol. 64, nr 2, s. 51-56Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Worker-to-worker (Type III) violence is prevalent in health care settings and has potential adverse consequences for employees and organizations. Little research has examined perpetrator characteristics of this type of violence. The current study is a descriptive examination of the common demographic and work-related characteristics of perpetrators of Type III workplace violence among hospital workers. Analysis was based on documented incidents of Type III violence reported within a large hospital system from 2010 to 2012. Nurses were involved as either the perpetrator or target in the five most common perpetrator-target dyads. Incidence rate ratios revealed that patient care associates and nurses were significantly more likely to be perpetrators than other job titles. By examining characteristics of perpetrators and common worker dyads involved in Type III workplace violence, hospital stakeholders and unit supervisors have a starting point to develop strategies for reducing conflict between workers.

  • 263.
    Hamblin, Lydia E.
    et al.
    Michigan State University, Department of Family Medicine.
    Essenmacher, Lynnette
    Detroit Medical Center, Occupational Health Services.
    Luborsky, Mark
    Wayne State University, Institute of Gerontology; Karolinska Institutet, Caring Sciences and Society, Department of Neurobiology.
    Russell, Jim
    Detroit Medical Center, Occupational Health Services.
    Janisse, James
    Wayne State University, Department of Family Medicine and Public Health Sciences.
    Upfal, Mark
    Detroit Medical Center, Occupational Health Services; Wayne State University, Department of Emergency Medicine.
    Arnetz, Judith
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Michigan State University, Department of Family Medicine; Umeå University, Department of Public Health and Clinical Medicine.
    Worksite Walkthrough Intervention: Data-driven Prevention of Workplace Violence on Hospital Units2017Inngår i: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 59, nr 9, s. 875-884Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this study was to describe the implementation of a data-driven, unit-based walkthrough intervention shown to be effective in reducing the risk of workplace violence in hospitals.

    Methods: A structured worksite walkthrough was conducted on 21 hospital units. Unit-level workplace violence data were reviewed and a checklist of possible prevention strategies and an Action Plan form guided development of unit-specific intervention. Unit supervisor perceptions of the walkthrough and implemented prevention strategies were reported via questionnaires. Prevention strategies were categorized as environmental, behavioral, or administrative.

    Results: A majority of units implemented strategies within 12 months' postintervention. Participants found the walkthrough useful, practical, and worthy of continued use.

    Conclusions: Structured worksite walkthroughs provide a feasible method for workplace violence reduction in hospitals. Core elements are standardized yet flexible, promoting fidelity and transferability of this intervention.

  • 264.
    Hamblin, Lydia E.
    et al.
    Wayne State Univ, Sch Med, Dept Family Med & Publ Hlth Sci, Detroit, MI 48201 USA.;Wayne State Univ, Dept Psychol, Detroit, MI 48201 USA..
    Essenmacher, Lynnette
    Wayne State Univ, Sch Med, Detroit Med Ctr Occupat Hlth Serv, Detroit, MI 48201 USA..
    Upfal, Mark J.
    Wayne State Univ, Sch Med, Detroit Med Ctr Occupat Hlth Serv, Detroit, MI 48201 USA.;Wayne State Univ, Sch Med, Dept Emergency Med, Occupat Med, Detroit, MI 48201 USA..
    Russell, Jim
    Detroit Med Ctr Occupat Hlth Serv, Occupat Hlth Serv, Detroit, MI USA..
    Luborsky, Mark
    Wayne State Univ, Inst Gerontol, Detroit, MI 48201 USA.;Karolinska Inst, Dept Neurobiol Caring Sci & Soc, Stockholm, Sweden..
    Ager, Joel
    Wayne State Univ, Sch Med, Dept Family Med & Publ Hlth Sci, Detroit, MI 48201 USA..
    Arnetz, Judith E.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Wayne State Univ, Sch Med, Dept Family Med & Publ Hlth Sci, Detroit, MI 48201 USA..
    Catalysts of worker-to-worker violence and incivility in hospitals2015Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, nr 17-18, s. 2458-2467Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims and objectivesTo identify common catalysts of worker-to-worker violence and incivility in hospital settings. BackgroundWorker-to-worker violence and incivility are prevalent forms of mistreatment in healthcare workplaces. These are forms of counterproductive work behaviour that can lead to negative outcomes for employees, patients and the organisation overall. Identifying the factors that lead to co-worker mistreatment is a critical first step in the development of interventions targeting these behaviours. DesignRetrospective descriptive study. MethodsQualitative content analysis was conducted on the total sample (n=141) of employee incident reports of worker-to-worker violence and incivility that were documented in 2011 at a large American hospital system. ResultsMore than 50% of the incidents involved nurses, and the majority of incidents did not involve physical violence. Two primary themes emerged from the analysis: Work Behaviour and Work Organisation. Incidents in the Work Behaviour category were often sparked by unprofessional behaviour, disagreement over responsibilities for work tasks or methods of patient care, and dissatisfaction with a co-worker's performance. Incidents in the Work Organisation category involved conflicts or aggression arising from failure to following protocol, patient assignments, limited resources and high workload. ConclusionIncidents of worker-to-worker violence and incivility stemmed from dissatisfaction with employee behaviour or from organisational practices or work constraints. These incident descriptions reflect worker dissatisfaction and frustration, resulting from poor communication and collaboration between employees, all of which threaten work productivity. Relevance to clinical practiceViolence and incivility between hospital employees can contribute to turnover of top performers, hinder effective teamwork and jeopardise the quality of patient care. Identification of common catalysts for worker-to-worker violence and incivility informs the development of mistreatment prevention programmes that can be used to educate hospital staff.

  • 265. Hambraeus, K.
    et al.
    Burell, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Johansson, P.
    Karlsson, R.
    Lisspers, J.
    Perk, J.
    Cardiac rehabilitation: demands from elderly patients after percutaneous coronary intervention2012Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, nr Suppl 1, s. 450-450Artikkel i tidsskrift (Annet vitenskapelig)
  • 266.
    Hammarberg, Sandra af Winklerfelt
    et al.
    Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Alfred Nobels Alle 23, S-14152 Stockholm, Sweden;Stockholm Cty Council, Acad Primary Hlth Care Ctr, Stockholm, Sweden.
    Hange, Dominique
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Primary Hlth Care,Dept Publ Hlth & Community Med, Gothenburg, Sweden.
    Andre, Malin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Udo, Camilla
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden;Ctr Clin Res Dalarna, CKF, Falun, Sweden.
    Svenningsson, Irene
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Primary Hlth Care,Dept Publ Hlth & Community Med, Gothenburg, Sweden;Narhalsan Res & Dev Primary Hlth Care, Gothenburg, Sweden.
    Bjorkelund, Cecilia
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Primary Hlth Care,Dept Publ Hlth & Community Med, Gothenburg, Sweden.
    Petersson, Eva-Lisa
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Primary Hlth Care,Dept Publ Hlth & Community Med, Gothenburg, Sweden;Narhalsan Res & Dev Primary Hlth Care, Gothenburg, Sweden.
    Westman, Jeanette
    Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Alfred Nobels Alle 23, S-14152 Stockholm, Sweden;Stockholm Cty Council, Acad Primary Hlth Care Ctr, Stockholm, Sweden;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Stockholm, Sweden.
    Care managers can be useful for patients with depression but their role must be clear: a qualitative study of GPs' experiences2019Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, nr 3, s. 273-282Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Explore general practitioners' (GPs') views on and experiences of working with care managers for patients treated for depression in primary care settings. Care managers are specially trained health care professionals, often specialist nurses, who coordinate care for patients with chronic diseases. Design: Qualitative content analysis of five focus-group discussions. Setting: Primary health care centers in the Region of Vastra Gotaland and Dalarna County, Sweden. Subjects: 29 GPs. Main outcome measures: GPs' views and experiences of care managers for patients with depression. Results: GPs expressed a broad variety of views and experiences. Care managers could ensure care quality while freeing GPs from case management by providing support for patients and security and relief for GPs and by coordinating patient care. GPs could also express concern about role overlap; specifically, that GPs are already care managers, that too many caregivers disrupt patient contact, and that the roles of care managers and psychotherapists seem to compete. GPs thought care managers should be assigned to patients who need them the most (e.g. patients with life difficulties or severe mental health problems). They also found that transition to a chronic care model required change, including alterations in the way GPs worked and changes that made depression treatment more like treatment for other chronic diseases. Conclusion: GPs have varied experiences of care managers. As a complementary part of the primary health care team, care managers can be useful for patients with depression, but team members' roles must be clear.

  • 267. Hansson, J.
    et al.
    Galanti, M. R.
    Hergens, M. -P
    Fredlund, P.
    Ahlbom, A.
    Alfredsson, L.
    Bellocco, R.
    Engstrom, G.
    Eriksson, M.
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Hedblad, B.
    Jansson, J. -H
    Pedersen, N. L.
    Lagerros, Y. Trolle
    Ostergren, P. -O
    Magnusson, C.
    Snus (Swedish smokeless tobacco) use and risk of stroke: pooled analyses of incidence and survival2014Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 276, nr 1, s. 87-95Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. Snus is a moist smokeless tobacco product with high nicotine content. Its use has a short-term effect on the cardiovascular system, but the relationship between snus use and stroke is unclear. Objective. The aim of this study was to assess the associations between use of snus and incidence of and survival after stroke, both overall and according to subtypes. Methods. Pooled analyses of eight Swedish prospective cohort studies were conducted, including 130 485 men who never smoked. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) of incidence and death after diagnosis using Cox proportional hazard regression models and case fatality and survival using logistic regression and Kaplan-Meier methods, respectively. Results. No associations were observed between the use of snus and the risk of overall stroke (HR 1.04, 95% CI 0.92-1.17) or of any of the stroke subtypes. The odds ratio (OR) of 28-day case fatality was 1.42 (95% CI 0.99-2.04) amongst users of snus who had experienced a stroke, and the HR of death during the follow-up period was 1.32 (95% CI 1.08-1.61). Conclusion. Use of snus was not associated with the risk of stroke. Hence, nicotine is unlikely to contribute importantly to the pathophysiology of stroke. However, case fatality was increased in snus users, compared with nonusers, but further studies are needed to determine any possible causal mechanisms.

  • 268. Hansson, J
    et al.
    Pedersen, N L
    Galanti, M R
    Andersson, T
    Ahlbom, A
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Magnusson, C
    Use of snus and risk for cardiovascular disease: results from the Swedish Twin Registry2009Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 265, nr 6, s. 717-724Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE

    To study the association between snus use and the risk for cardiovascular disease, i.e. ischemic heart disease and stroke.

     

    DESIGN

    Cohort study.

     

    SETTING

    Sweden.

     

    SUBJECTS

    Sixteen thousand six hundred and forty-two male Swedish twins participating in the Screening Across the Lifespan Twin Study, conducted in 1998- 2002, were followed for incident cardiovascular disease. Participants were without a history of cardiovascular disease at baseline and incident cases were identified via the Swedish Cause of Death Register and Hospital Discharge Register.

    RESULTS

    Overall, there was no association between use of snus and risk for cardiovascular disease. Current snus users, without a smoking history, had a relative risk of 1.00 (95% confidence interval 0.69-1.46) for cardiovascular disease as compared to non users. Corresponding relative risks for ischemic heart disease and stroke were 0.85 (95% confidence interval 0.51-1.41) and 1.18 (95% confidence interval 0.67-2.08), respectively. In smoking adjusted models, risk estimates for ischemic heart disease in relation to snus use were all close to unity regardless of timing or intensity of snus use. However, current heavy snus users (consuming more than four cans week(-1)) had a relative risk for stroke of 1.75 (95% confidence interval 0.95-3.21).

     

    CONCLUSION

    These data do not support any strong association between snus use and risk for cardiovascular disease.

  • 269. Hansson, Jenny
    et al.
    Galanti, Maria Rosaria
    Hergens, Maria-Pia
    Fredlund, Peeter
    Ahlbom, Anders
    Alfredsson, Lars
    Bellocco, Rino
    Eriksson, Marie
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Hedblad, Bo
    Jansson, Jan-Håkan
    Nilsson, Peter
    Pedersen, Nancy
    Lagerros, Ylva Trolle
    Östergren, Per-Olof
    Magnusson, Cecilia
    Use of snus and acute myocardial infarction: pooled analysis of eight prospective observational studies2012Inngår i: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 27, nr 10, s. 771-779Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The use of snus (also referred to as Scandinavian or Swedish moist smokeless tobacco), which is common in Sweden and increasing elsewhere, is receiving increasing attention since considered a tobacco smoke "potential reduction exposure product". Snus delivers a high dose of nicotine with possible hemodynamic effects, but its impact on cardiovascular morbidity and mortality is uncertain. The aim of this study was to investigate whether snus use is associated with risk of and survival after acute myocardial infarction (AMI). Data from eight prospective cohort studies set in Sweden was pooled and reanalysed. The relative risk of first time AMI and 28-day case-fatality was calculated for 130,361 men who never smoked. During 2,262,333 person-years of follow-up, 3,390 incident events of AMI were identified. Current snus use was not associated with risk of AMI (pooled multivariable hazard ratio 1.04, 95 % confidence interval 0.93 to 1.17). The short-term case fatality rate appeared increased in snus users (odds ratio 1.28, 95 % confidence interval 0.99 to 1.68). This study does not support any association between use of snus and development of AMI. Hence, toxic components other than nicotine appear implicated in the pathophysiology of smoking related ischemic heart disease. Case fatality after AMI is seemingly increased among snus users, but this relationship may be due to confounding by socioeconomic or life style factors.

  • 270. Hasvold, L. P.
    et al.
    Bodegard, J.
    Thuresson, M.
    Stålhammar, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Hammar, N.
    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).
    Russell, D.
    Kjeldsen, S. E.
    Diabetes and CVD risk during angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker treatment in hypertension: a study of 15 990 patients2014Inngår i: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 28, nr 11, s. 663-669Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Differences in clinical effectiveness between angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) in the primary treatment of hypertension are unknown. The aim of this retrospective cohort study was to assess the prevention of type 2 diabetes and cardiovascular disease (CVD) in patients treated with ARBs or ACEis. Patients initiated on enalapril or candesartan treatment in 71 Swedish primary care centers between 1999 and 2007 were included. Medical records data were extracted and linked with nationwide hospital discharge and cause of death registers. The 11 725 patients initiated on enalapril and 4265 on candesartan had similar baseline characteristics. During a mean follow-up of 1.84 years, 36 482 patient-years, the risk of new diabetes onset was lower in the candesartan group (hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.69-0.96, P = 0.01) compared with the enalapril group. No difference between the groups was observed in CVD risk (HR 0.99, 95% CI 0.87-1.13, P = 0.86). More patients discontinued treatment in the enalapril group (38.1%) vs the candesartan group (27.2%). In a clinical setting, patients initiated on candesartan treatment had a lower risk of new-onset type 2 diabetes and lower rates of drug discontinuation compared with patients initiated on enalapril. No differences in CVD risk were observed.

  • 271.
    Hasvold, Pal
    et al.
    AstraZeneca, S-15185 Sodertalje, Sweden.;Univ Oslo, Fac Med, N-0424 Oslo, Norway..
    Thuresson, Marcus
    Statisticon AB, S-75322 Uppsala, Sweden..
    Sundstrom, Johan
    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 medicinska vetenskaper.
    Hammar, Niklas
    Karolinska Inst, Inst Environm Med, S-17177 Stockholm, Sweden.;AZ R&D, Med Evidence & Observat Res, Molndal, Sweden..
    Kjeldsen, Sverre E.
    Univ Oslo, Fac Med, N-0424 Oslo, Norway.;Oslo Univ Hosp, Dept Cardiol, Oslo, Norway..
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Holme, Ingar
    Norwegian Sch Sport Sci, Dept Sports Med, POB 4014, N-0806 Oslo, Norway..
    Bodegard, Johan
    AstraZeneca, S-15185 Sodertalje, Sweden..
    Association Between Paradoxical HDL Cholesterol Decrease and Risk of Major Adverse Cardiovascular Events in Patients Initiated on Statin Treatment in a Primary Care Setting2016Inngår i: Clinical drug investigation, ISSN 1173-2563, E-ISSN 1179-1918, Vol. 36, nr 3, s. 225-233Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and Objectives Statin-induced changes in high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) are unrelated. Many patients initiated on statins experience a paradoxical decrease in HDL-C. The aim of this study was to evaluate the association between a decrease in HDL-C and risk of major adverse cardiovascular events (MACE). Methods Data from 15,357 primary care patients initiated on statins during 2004-2009 were linked with data from mandatory national hospital, drug-dispensing, and cause-of-death registers, and were grouped according to HDL-C change: decreased >= 0.1 mmol/L, unchanged +/- 0.1 or >= 0.1 mmol/L increased. To evaluate the association between decrease in HDL-C and risk of MACE, a sample of propensity score-matched patients from the decreased and unchanged groups was created, using the latter group as reference. MACE was defined as myocardial infarction, unstable angina pectoris, ischaemic stroke, or cardiovascular mortality. Cox proportional hazards models were used to estimate relative risks. Results HDL-C decreased in 20 %, was unchanged in 58%, and increased in 22 % of patients initiated on statin treatment (96 % treated with simvastatin). The propensity score-matched sample comprised 5950 patients with mean baseline HDL-C and LDL-C of 1.69 and 4.53 mmol/L, respectively. HDL-C decrease was associated with 56 % higher MACE risk (hazard ratio 1.56; 95 % confidence interval 1.12-2.16; p < 0.01) compared with the unchanged HDL-C group. Conclusions Paradoxical statin-induced reduction in HDL-C was relatively common and was associated with increased risk of MACE.

  • 272. Hedegaard, M.
    et al.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    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.
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Jorgensen, L.
    Larsson, K.
    Cost Effectiveness Of Budesonide/Formoterol Versus Fluticasone/Salmeterol From A Swedish Health Care Perspective Based On Real-World Effectiveness And Safety In Patients With Copd2013Inngår i: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 16, nr 3, s. A235-A235Artikkel i tidsskrift (Annet vitenskapelig)
  • 273. Hedegaard, M.
    et al.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    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.
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Jorgensen, L.
    Larsson, K.
    Cost-effectiveness of budesonide/formoterol versus fluticasone/salmeterol based on real-world effectiveness in patients with copd2012Inngår i: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 15, nr 7, s. A563-A563Artikkel i tidsskrift (Annet vitenskapelig)
  • 274. Hedin, K
    et al.
    André, M
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Brorsson, A
    Gröndal, Hedvig
    Soares, J
    Strandberg, EL
    Mölstad, S
    Studie över faktorer som påverkar läkares beteende vid förskrivning av antibiotika2014Rapport (Annet vitenskapelig)
  • 275. Hedin, Katarina
    et al.
    Strandberg, Eva Lena
    Gröndal, Hedvig
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Brorsson, Annika
    Thulesius, Hans
    André, Malin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Management of patients with sore throats in relation to guidelines: An interview study in Sweden2014Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 32, nr 4, s. 193-199Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To explore how a group of Swedish general practitioners (GPs) manage patients with a sore throat in relation to current guidelines as expressed in interviews. Design. Qualitative content analysis was used to analyse semi-structured interviews. Setting. Swedish primary care. Subjects. A strategic sample of 25 GPs. Main outcome measures. Perceived management of sore throat patients. Results. It was found that nine of the interviewed GPs were adherent to current guidelines for sore throat and 16 were non-adherent. The two groups differed in terms of guideline knowledge, which was shared within the team for adherent GPs while idiosyncratic knowledge dominated for the non-adherent GPs. Adherent GPs had no or low concerns for bacterial infections and differential diagnosis whilst non-adherent GPs believed that in patients with a sore throat any bacterial infection should be identified and treated with antibiotics. Patient history and examination was mainly targeted by adherent GPs whilst for non-adherent GPs it was often redundant. Non-adherent GPs reported problems getting patients to abstain from antibiotics, whilst no such problems were reported in adherent GPs. Conclusion. This interview study of sore throat management in a strategically sampled group of Swedish GPs showed that while two-thirds were non-adherent and had a liberal attitude to antibiotics one-third were guideline adherent with a restricted view on antibiotics. Non-adherent GPs revealed significant knowledge gaps. Adherent GPs had discussed guidelines within the primary care team while non-adherent GPs had not. Guideline implementation thus seemed to be promoted by knowledge shared in team discussions.

  • 276.
    Hellstrand, Mats
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Competence Ctr Hlth, S-72189 Vasteras, Region Vastmanl, Sweden..
    Simonsson, Bo
    Competence Ctr Hlth, S-72189 Vasteras, Region Vastmanl, Sweden..
    Engström, Sevek
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Competence Ctr Hlth, S-72189 Vasteras, Region Vastmanl, Sweden..
    Nillson, Kent W.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Molarius, Anu
    Competence Ctr Hlth, S-72189 Vasteras, Region Vastmanl, Sweden.;Karlstad Univ, Dept Publ Hlth, Karlstad, Sweden..
    A health dialogue intervention reduces cardiovascular risk factor levels: a population based randomised controlled trial in Swedish primary care setting with 1-year follow-up2017Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, artikkel-id 669Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The total number of cardiovascular (CVD) deaths accounted for almost a third of all deaths globally in 2013. Population based randomised controlled trials, managed within primary care, on CVD risk factor interventions are scarce. The aim of the study was to evaluate the effects of a health dialogue intervention in a primary care setting offered to a population at the age of 55 years, focusing on CVD risk factors. Methods: The study was performed in five primary health care centres in the county of Vastmanland, Sweden between April 2011 and December 2012. Men and women were randomly assigned to intervention (n = 440) and control groups (n = 440). At baseline, both groups filled in a health questionnaire and serum cholesterol, fasting plasma glucose, glycated haemoglobin (HbA1c), weight, height, waist (WC) and hip circumference, waist hip ratio (WHR) and systolic/diastolic blood pressure were measured. Intervention group attended a health dialogue, supported by a visualised health profile, with a possibility for further activities. Participation rates at baseline were 53% and 52% respectively. A 1-year follow-up was carried out. Results: The intervention group (n = 165) showed reductions compared to the control group (n = 177) concerning body mass index (BMI) (0.3 kg/m(2), p = .031), WC (2.1 cm, p <= .001) and WHR (. 002, p <= .001) at the 1-year follow-up. No differences between the intervention and control groups were found in other variables. Intervention group, compared to baseline, had reduced weight, BMI, WC, WHR, HbA1c, and diet, while the men in the control group had reduced their alcohol consumption. Conclusions: A health dialogue intervention at the age of 55 years, conducted in ordinary primary care, showed a moderate effect on CVD risk factor levels, in terms of BMI, WC and WHR.

  • 277.
    Hellström, Per M.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Gastroenterologi/hepatologi.
    Stålhammar, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Beydogan, H.
    QuintilesIMS, Real World Evidence Solut & HEOR, Solna, Sweden..
    Huetson, P.
    QuintilesIMS, Real World Evidence Solut & HEOR, Solna, Sweden..
    Skup, M.
    AbbVie Inc, N Chicago, IL USA..
    Agreus, L.
    Karolinska Institute.
    Indirect burden of patients with moderate inflammatory bowel disease in Uppsala County Council, Sweden: a retrospective study using real-world data2017Inngår i: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 11, s. S457-S457Artikkel i tidsskrift (Annet vitenskapelig)
  • 278.
    Helmersson-Karlqvist, Johanna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion.
    Karlsson, Bo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Fredricsson, Annika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Gastroenterologi/hepatologi.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion.
    Evaluation of the Alere D-dimer test for point of care testing2014Inngår i: Journal of Thrombosis and Thrombolysis, ISSN 0929-5305, E-ISSN 1573-742X, Vol. 38, nr 2, s. 250-252Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The primary care regularly sees patients that have symptoms that could be due to thromboembolic diseases. It would be valuable to be able to rule out deep venous thrombosis or pulmonary embolism using Wells score and a negative D-dimer testing already at the primary care unit. This requires a validated D-dimer assay suitable for primary care use. We compared D-dimer results obtained with the new point of care analyzer Alere Triage(®) and the central hospital laboratory STA-R Evolution analyzer from the same patient samples (n = 102). We also calculated the total coefficient of variation (CV) for the Alere method. The two methods showed a good linear correlation (R(2) = 0.977) and a slope of 0.975. CV for the Alere D-dimer method was well below 10 %. The study shows that the Alere D-dimer assay and the central laboratory standard assay show similar results. We suggest that the Alere D-dimer assay could be used in primary care in combination with Wells score to reduce referrals to the emergency unit.

  • 279.
    Henriksson, Catrin
    et al.
    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 medicinska vetenskaper, Kardiologi.
    Larsson, Margareta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Judy, Arnetz
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Herlitz, Johan
    Karlsson, Jan-Erik
    Svensson, Leif
    Thuresson, Marie
    Zedig, Crister
    Wernroth, Lisa
    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 medicinska vetenskaper.
    Lindahl, Bertil
    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 medicinska vetenskaper, Kardiologi.
    Knowledge about Acute Myocardial Infarction (AMI) and attitudes to medical care seeking: a comparison between patients and the general public2012Inngår i: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 2, nr 4, s. 372-378Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:

    Patients with acute myocardial infarction often have long decision times before seeking medical care. The decision time is influenced by knowledge of AMI-symptoms, psychological factors and the response of people near the patient to the symptoms.

    Aim:

    To investigate and compare the knowledge of AMI, intended actions in response to AMI-symptoms and attitudes toward seeking medical care of patients and the general public.

    Method:

    This was a multicentre study with descriptive and comparative design, using questionnaires as an instrument. The population consisted of AMI-patients and representatives of the general public.

    Results:

    There was good knowledge about typical AMI-symptoms among the participants. The majority thought an AMI always starts suddenly. Patients did not know more about the time-dependency of treatment outcome than the general public. A greater proportion of the general public would contact an additional person before consulting medical professionals.

    Conclusions:

    Patients had no better knowledge about AMI than the general public, but would more commonly act appropriately in case of AMI-symptoms.

  • 280. Henriksson, M.
    et al.
    Russell, D.
    Bodegard, J.
    Kjeldsen, S.
    Hasvold, P.
    Stålhammar, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Levin, L-A
    Health-care costs of losartan and candesartan in the primary treatment of hypertension2011Inngår i: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 25, nr 2, s. 130-136Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A recent study of two widely used angiotensin receptor blockers reported a reduced risk of cardiovascular events (-14.4%) when using candesartan compared with losartan in the primary treatment of hypertension. In addition to clinical benefits, costs associated with treatment strategies must be considered when allocating scarce health-care resources. The aim of this study was to assess resource use and costs of losartan and candesartan in hypertensive patients. Resource use (drugs, outpatient contacts, hospitalizations and laboratory tests) associated with losartan and candesartan treatment was estimated in 14 100 patients in a real-life clinical setting. We electronically extracted patient data from primary care records and mandatory Swedish national registers for death and hospitalization. Patients treated with losartan had more outpatient contacts (+15.6%), laboratory tests (+13.8%) and hospitalizations (+13.8%) compared with the candesartan group. During a maximum observation time of 9 years, the mean total costs per patient were 10 369 Swedish kronor (95% confidence interval: 3109-17 629) higher in the losartan group. In conclusion, prescribing candesartan for the primary treatment of hypertension results in lower long-term health-care costs compared with losartan.

  • 281. Hergens, Maria-Pia
    et al.
    Galanti, Rosaria
    Hansson, Jenny
    Fredlund, Peeter
    Ahlbom, Anders
    Alfredsson, Lars
    Bellocco, Rino
    Eriksson, Marie
    Fransson, Eleonor I
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Jansson, Jan-Håkan
    Knutsson, Anders
    Pedersen, Nancy
    Lagerros, Ylva Trolle
    Östergren, Per-Olof
    Magnusson, Cecilia
    Use of Scandinavian moist smokeless tobacco (snus) and the risk of atrial fibrillation2014Inngår i: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 25, nr 6, s. 872-876Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Snus is a smokeless tobacco product, widely used among Swedish men and increasingly so elsewhere. There is debate as to whether snus is an acceptable "harm-reduction" tobacco product. Since snus use delivers a dose of nicotine equivalent to cigarettes, and has been implicated in cardiac arrhythmia because of associations with sudden cardiovascular death, a relation with atrial fibrillation is plausible and important to investigate.

    METHODS: To assess the relation between use of snus and risk of atrial fibrillation, we carried out a pooled analysis of 7 prospective Swedish cohort studies. In total, 274,882 men, recruited between 1978 and 2004, were followed via the National Patient Register for atrial fibrillation. Primary analyses were restricted to 127,907 never-smokers. Relative risks were estimated using Cox proportional hazard regression.

    RESULTS: The prevalence of snus use was 25% among never-smokers. During follow-up, 3,069 cases of atrial fibrillation were identified. The pooled relative risk of atrial fibrillation was 1.07 (95% confidence interval = 0.97-1.19) in current snus users, compared with nonusers.

    CONCLUSION: Findings from this large national pooling project indicate that snus use is unlikely to confer any important increase in risk of atrial fibrillation.

  • 282.
    Hermansson, J.
    et al.
    Angereds Narsjukhus, S-42422 Angered, Sweden;Karolinska Inst, Sodersjukhuset, Dept Clin Sci & Educ, S-11883 Stockholm, Sweden.
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Karlsson, B.
    Univ Umea, Dept Publ Hlth & Clin Med, Occupat Med, S-90185 Umea, Sweden.
    Knutsson, A.
    Mid Sweden Univ, Dept Hlth Sci, S-85170 Sundsvall, Sweden.
    Gadin, K. Gillander
    Mid Sweden Univ, Dept Hlth Sci, S-85170 Sundsvall, Sweden.
    Shift work, parental cardiovascular disease and myocardial infarction in males2018Inngår i: Occupational Medicine, ISSN 0962-7480, E-ISSN 1471-8405, Vol. 68, nr 2, s. 120-125Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Shift work has been associated with an increased risk of cardiovascular disease (CVD). However, there is a need for more studies to determine whether there is an interaction between shift work and other risk factors of CVD, thereby increasing the risk of CVD in shift workers. Aims To discern whether shift work and parental mortality from myocardial infarction (MI) or sudden cardiac death (SCD) interact to increase the risk of MI in men. Methods A case-control dataset was used to assess interaction between shift work and parental history of CVD, using death from MI or SCD, or death before age 65, on an additive scale. Results were reported as relative excess risk due to interaction, attributable proportion due to interaction (AP) and synergy index (SI). Results There was an interaction between shift work and paternal mortality from MI or SCD, when both factors were present [SI = 2.39; 95% confidence interval (CI) 1.02. 5.6 and AP = 0.4; 95% CI 0.08. 0.73]. Conclusions Paternal mortality from MI or SCD interacts with shift work to increase the risk of MI in men.

  • 283.
    Hermansson, Jonas
    et al.
    Angered Hosp, POB 63, S-42422 Angered, Sweden.
    Boggild, Henrik
    Aalborg Univ, Dept Hlth Sci & Technol, Publ Hlth & Epidemiol Grp, Aalborg, Denmark.
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Karlsson, Berndt
    Umea Univ, Dept Publ Hlth & Clin Med, Occupat Med, Umea, Sweden.
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
    Nilsson, Tohr
    Sundsvall Hosp, Dept Occupat & Environm Med, Sundsvall, Sweden.
    Reuterwall, Christina
    Umea Univ, Dept Publ Hlth & Clin Med, Occupat Med, Umea, Sweden.
    Gadin, Katja Gillander
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
    Interaction between Shift Work and Established Coronary Risk Factors2019Inngår i: International Journal of Occupational and Environmental Medicine, ISSN 2008-6520, E-ISSN 2008-6814, Vol. 10, nr 2, s. 57-65, artikkel-id PII 1466Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:

    Shift work is associated with increased risk of cardiovascular disease, but the causes have not yet been fully established. It has been proposed that the coronary risk factors are more hazardous for shift workers, resulting in a potential interaction effect with shift work.

    Objective:

    To analyse interaction effects of work schedule and established risk factors for coronary artery disease on the risk of myocardial infarction.

    Methods:

    This analysis was conducted in SHEEP/VHEEP, a case-control study conducted in two counties in Sweden, comprising all first-time cases of myocardial infarction among men and women 45-70 years of age with controls stratified by sex, age, and hospital catchment area, totalling to 4648 participants. Synergy index (SI) was used as the main outcome analysis method for interaction analysis.

    Results:

    There was an interaction effect between shift work and physical inactivity on the risk of myocardial infarction with SI of 2.05 (95% CI 1.07 to 3.92) for male shift workers. For female shift workers, interaction effects were found with high waist-hip ratio (SI 4.0, 95% CI 1.12 to 14.28) and elevated triglycerides (SI 5.69, 95% CI 1.67 to 19.38).

    Conclusion:

    Shift work and some established coronary risk factors have significant interactions.

  • 284. Hermansson, Jonas
    et al.
    Gillander Gådin, Katja
    Karlsson, Berndt
    Reuterwall, Christina
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Knutsson, Anders
    Case fatality of myocardial infarction among shift workers2015Inngår i: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 88, nr 5, s. 599-605Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: Shift work has been associated with an excess risk of cardiovascular disease (CVD) and more specifically myocardial infarction (MI). The majority of the studies that found a positive association between shift work and CVD have been based on incidence data. The results from studies on cardiovascular-related mortality among shift workers have shown little or no elevated mortality associated with shift work. None of the previous studies have analysed short-term mortality (case fatality) after MI. Therefore, we investigated whether shift work is associated with increased case fatality after MI compared with day workers.

    METHODS: Data on incident cases with first MI were obtained from case-control study conducted in two geographical sites in Sweden (Stockholm Heart Epidemiology Program and Västernorrland Heart Epidemiology Program), including 1,542 cases (1,147 men and 395 women) of MI with complete working time information and 65 years or younger. Case fatality was defined as death within 28 days of onset of MI. Risk estimates were calculated using logistic regression.

    RESULTS: The crude odds ratios for case fatality among male shift workers were 1.63 [95 % confidence interval (CI) 1.12, 2.38] and 0.56 (95 % CI 0.26, 1.18) for female shift workers compared with day workers. Adjustments for established cardiovascular risk factors such as diabetes type II and socio-economic status did not alter the results.

    CONCLUSION: Shift work was associated with increased risk of case fatality among male shift workers after the first MI.

  • 285. Hernandez, Rohini K.
    et al.
    Banefelt, Jonas
    Mesterton, Johan
    Stålhammar, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Persson, Bo-Eric
    Ke, Chunlei
    Sobocki, Patrik
    Liede, Alexander
    Impact of PSA Doubling Time (DT) Calculation Method on Estimate of Association With Bone Metastases in a Cohort of Prostate Cancer Patients Treated With Androgen Deprivation Therapy (ADT)2013Inngår i: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 22, nr S1, s. 220-220Artikkel i tidsskrift (Annet vitenskapelig)
  • 286. Hernandez, Rohini K.
    et al.
    Mesterton, Johan
    Banefelt, Jonas
    Stålhammar, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Sobocki, Patrik
    Persson, Bo-Eric
    Liede, Alexander
    Predictors of Clinical Metastases and Survival among Non-Metastatic Prostate Cancer (PC) Patients (pts) Treated with Androgen-Deprivation Therapy (ADT) in Sweden2013Inngår i: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 22, nr S1, s. 6-6Artikkel i tidsskrift (Annet vitenskapelig)
  • 287.
    Hjort, R.
    et al.
    Karolinska Inst, Inst Environm Med, Unit Epidemiol, S-17177 Stockholm, Sweden..
    Alfredsson, L.
    Karolinska Inst, Inst Environm Med, Unit Cardiovasc Epidemiol, Stockholm, Sweden..
    Andersson, T.
    Karolinska Inst, Inst Environm Med, Unit Epidemiol, S-17177 Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Carlsson, Per-Ola
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Grill, V.
    Norwegian Univ Sci & Technol, NTNU Inst Canc Res & Mol Med, Trondheim, Norway.;Trondheim Reg & Univ Hosp, Dept Endocrinol, Trondheim, Norway..
    Groop, L.
    Lund Univ, Clin Res Ctr, Dept Clin Sci Malmo, Malmo, Sweden..
    Martinell, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Rasouli, B.
    Karolinska Inst, Inst Environm Med, Unit Epidemiol, S-17177 Stockholm, Sweden..
    Storm, P.
    Lund Univ, Clin Res Ctr, Dept Clin Sci Malmo, Malmo, Sweden..
    Tuomi, T.
    Univ Helsinki, Div Endocrinol, Abdominal Ctr, Finnish Inst Mol Med, Helsinki, Finland.;Univ Helsinki, Res Program Diabet & Obes, Helsinki, Finland.;Helsinki Univ Hosp, Folkhalsan Res Ctr, Helsinki, Finland..
    Carlsson, S.
    Karolinska Inst, Inst Environm Med, Unit Epidemiol, S-17177 Stockholm, Sweden..
    Family history of type 1 and type 2 diabetes and risk of latent autoimmune diabetes in adults (LADA)2017Inngår i: Diabetes & Metabolism, ISSN 1262-3636, E-ISSN 1878-1780, Vol. 43, nr 6, s. 536-542Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. - A family history of diabetes (FHD) is a strong predictor of diabetes risk, yet has rarely been investigated in latent autoimmune diabetes in adults (LADA). This study therefore investigated the risk of LADA and type 2 diabetes (T2D) in relation to FHD, taking into account the type of diabetes in relatives. Methods. - Data from a population-based study were used, including incident cases of LADA [glutamic acid decarboxylase antibody (GADA)-positive, n = 378] and T2D (GADA-negative, n = 1199), and their matched controls (n = 1484). First-degree relatives with disease onset at age < 40 years and taking insulin treatment were classified as type 1 diabetes (T1D) or, if otherwise, as T2D. Odds ratios (ORs) were adjusted for age, gender, BMI, education and smoking. Cases were genotyped for high- and low-risk HLA genotypes. Results. - Both FHD-T1D (OR: 5.8; 95% CI: 3.2-10.3) and FHD-T2D (OR: 1.9; 95% CI: 1.5-2.5) were associated with an increased risk of LADA, whereas the risk of T2D was associated with FHD-T2D (OR: 2.7; 95% CI: 2.2-3.3), but not FHD-Tl D. In LADA patients, FHD-T1D vs FHD-T2D was associated with higher GADA but lower C-peptide levels, lower prevalence of low-risk HLA genotypes (5.0% vs 28.6%, respectively; P = 0.038) and a tendency for higher prevalence of high-risk genotypes (90.0% vs 69.1%, respectively; P = 0.0576). Conclusion. - The risk of LADA is substantially increased with FHD-Tl D but also, albeit significantly less so, with FHD-T2D. This supports the idea of LADA as a mix of both T1D and T2D, but suggests that the genes related to T1D have greater impact. LADA patients with FHD-Tl D had more T1D-like features, emphasizing the heterogeneity of LADA. (C) 2017 Elsevier Masson SAS. All rights reserved.

  • 288. Hjort, R.
    et al.
    Carlsson, Per-Ola
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Transplantation och regenerativ medicin.
    Dorkhan, M.
    Groop, L.
    Martinell, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Rasouli, B.
    Toumi, T.
    Carlsson, S.
    Low birth weight is associated with an increased risk of latent autoimmune diabetes in adults (LADA) and type 2 diabetes: results from ESTRID a Swedish case-control study2014Inngår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 57, nr S1, s. S80-S80Artikkel i tidsskrift (Annet vitenskapelig)
  • 289.
    Hjort, R.
    et al.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Lofvenborg, J. E.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Ahlqvist, E.
    Lund Univ, Dept Clin Sci Malmo, Malmo, Sweden..
    Alfredsson, L.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Andersson, T.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Carlsson, Per-Ola
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Transplantation och regenerativ medicin.
    Groop, L.
    Lund Univ, Dept Clin Sci Malmo, Malmo, Sweden.;Univ Helsinki, Finnish Inst Mol Med, Helsinki, Finland..
    Martinell, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Rasouli, B.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Rosengren, A.
    Lund Univ, Dept Clin Sci Malmo, Malmo, Sweden..
    Tuomi, T.
    Univ Helsinki, Finnish Inst Mol Med, Helsinki, Finland.;Univ Helsinki, Helsinki Univ Hosp, Res Program Diabet & Obes, Div Endocrinol,Abdominal Ctr, Helsinki, Finland.;Folkhalsan Res Ctr, Helsinki, Finland..
    Carlsson, S.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Overweight, obesity, genetic susceptibility and the risk of LADA: Latent Autoimmune Diabetes in Adults2017Inngår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 60, nr S1, s. S118-S118, artikkel-id 252Artikkel i tidsskrift (Annet vitenskapelig)
  • 290.
    Hjort, Rebecka
    et al.
    Karolinska Inst, Inst Environm Med, Unit Epidemiol, Box 210, S-17177 Stockholm, Sweden.
    Ahlqvist, Emma
    Lund Univ, Dept Clin Sci Malmo, Clin Res Ctr, Malmo, Sweden.
    Carlsson, Per-Ola
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Transplantation och regenerativ medicin.
    Grill, Valdemar
    Norwegian Univ Sci & Technol, Dept Clin & Mol Med, NTNU, Trondheim, Norway;Trondheim Reg & Univ Hosp, St Olavs Hosp, Dept Endocrinol, Trondheim, Norway.
    Groop, Leif
    Lund Univ, Dept Clin Sci Malmo, Clin Res Ctr, Malmo, Sweden;Univ Helsinki, Finnish Inst Mol Med, Helsinki, Finland.
    Martinell, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Rasouli, Bahareh
    Karolinska Inst, Inst Environm Med, Unit Epidemiol, Box 210, S-17177 Stockholm, Sweden.
    Rosengren, Anders
    Lund Univ, Dept Clin Sci Malmo, Clin Res Ctr, Malmo, Sweden.
    Tuomi, Tiinamaija
    Univ Helsinki, Helsinki Univ Hosp, Div Endocrinol, Abdominal Ctr,Res Program Diabet & Obes, Helsinki, Finland;Folkhalsan Res Ctr, Helsinki, Finland.
    Asvold, Bjorn Olav
    Trondheim Reg & Univ Hosp, St Olavs Hosp, Dept Endocrinol, Trondheim, Norway;Norwegian Univ Sci & Technol, Dept Publ Hlth & Nursing, KG Jebsen Ctr Genet Epidemiol, NTNU, Trondheim, Norway.
    Carlsson, Sofia
    Karolinska Inst, Inst Environm Med, Unit Epidemiol, Box 210, S-17177 Stockholm, Sweden.
    Overweight, obesity and the risk of LADA: results from a Swedish case-control study and the Norwegian HUNT Study2018Inngår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 61, nr 6, s. 1333-1343Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims/hypothesis Excessive weight is a risk factor for type 2 diabetes, but its role in the promotion of autoimmune diabetes is not clear. We investigated the risk of latent autoimmune diabetes in adults (LADA) in relation to overweight/obesity in two large population-based studies. Methods Analyses were based on incident cases of LADA (n = 425) and type 2 diabetes (n = 1420), and 1704 randomly selected control participants from a Swedish case-control study and prospective data from the Norwegian HUNT Study including 147 people with LADA and 1,012,957 person-years of follow-up (1984-2008). We present adjusted ORs and HRs with 95% CI. Results In the Swedish data, obesity was associated with an increased risk of LADA (OR 2.93, 95% CI 2.17, 3.97), which was even stronger for type 2 diabetes (OR 18.88, 95% CI 14.29, 24.94). The association was stronger in LADA with low GAD antibody (GADA; <median) (OR 4.25; 95% CI 2.76, 6.52) but present also in LADA with high GADA (OR 2.14; 95% CI 1.42, 3.24). In the Swedish data, obese vs normal weight LADA patients had lower GADA levels, better beta cell function, and were more likely to have low-risk HLA-genotypes. The combination of overweight and family history of diabetes (FHD) conferred an OR of 4.57 (95% CI 3.27, 6.39) for LADA and 24.51 (95% CI 17.82, 33.71) for type 2 diabetes. Prospective data from HUNT indicated even stronger associations; HR for LADA was 6.07 (95% CI 3.76, 9.78) for obesity and 7.45 (95% CI 4.02, 13.82) for overweight and FHD. Conclusions/interpretation Overweight/obesity is associated with increased risk of LADA, particularly when in combination with FHD. These findings support the hypothesis that, even in the presence of autoimmunity, factors linked to insulin resistance, such as excessive weight, could promote onset of diabetes.

  • 291.
    Hjort, Rebecka
    et al.
    Karolinska Inst, Inst Environm Med, Epidemiol Unit, S-17177 Stockholm, Sweden..
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, Unit Cardiovasc Epidemiol, S-17177 Stockholm, Sweden..
    Carlsson, Per-Ola
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Transplantation och regenerativ medicin.
    Groop, Leif
    Lund Univ, Clin Res Ctr, Dept Clin Sci Malmo, Malmo, Sweden..
    Martinell, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Storm, Petter
    Lund Univ, Clin Res Ctr, Dept Clin Sci Malmo, Malmo, Sweden..
    Tuomi, Tiinamaija
    Helsinki Univ Hosp, Div Endocrinol, Abdominal Ctr, Helsinki, Finland.;Univ Helsinki, Finnish Inst Mol Med, Helsinki, Finland.;Univ Helsinki, Res Program Diabet & Obes, Helsinki, Finland.;Folkhalsan Res Ctr, Helsinki, Finland..
    Carlsson, Sofia
    Karolinska Inst, Inst Environm Med, Epidemiol Unit, S-17177 Stockholm, Sweden..
    Low birthweight is associated with an increased risk of LADA and type 2 diabetes: results from a Swedish case-control study2015Inngår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 58, nr 11, s. 2525-2532Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims/hypothesis Our aim was to investigate the association between birthweight and latent autoimmune diabetes in adults (LADA), a common diabetes form with features of both type 1 and type 2 diabetes. Methods We used data from the Epidemiological Study of Risk Factors for LADA and Type 2 Diabetes (ESTRID), a Swedish population-based study. Eligible for the analysis were 134 incident LADA cases (glutamic acid decarboxylase antibody [GADA] positive), 350 incident type 2 diabetes cases (GADA negative) and 603 randomly selected controls. We present ORs and 95% CIs for LADA and type 2 diabetes in relation to birthweight, adjusted for sex, age, BMI and family history of diabetes. Results Low birthweight increased the risk of LADA as well as the risk of type 2 diabetes; OR per kg reduction was estimated as 1.52 (95% CI 1.12, 2.08) and 1.58 (1.23, 2.04), respectively. The OR for participants weighing < 3 kg compared with >= 4 kg at birth was estimated as 2.38 (1.23, 4.60) for LADA and 2.37 (1.37, 4.10) for type 2 diabetes. A combination of low birthweight (< 3 kg) and current overweight (BMI >= 25) further augmented the risk: LADA, OR 3.26 (1.69, 6.29); and type 2 diabetes, OR 39.93 (19.27, 82.71). Family history of diabetes had little impact on these estimates. Conclusions/interpretation Our results suggest that low birthweight may be a risk factor for LADA of the same strength as for type 2 diabetes. These findings support LADA, despite its autoimmune component, having an aetiology that includes factors related to type 2 diabetes.

  • 292.
    Holmberg, Sara
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Thelin, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    High dairy fat intake related to less central obesity: A male cohort study with 12 years' follow-up2013Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 31, nr 2, s. 89-94Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To study associations between dairy fat intake and development of central obesity. Design. A prospective population-based cohort study with two surveys 12 years apart. Setting. Nine municipalities selected from different parts of Sweden representing the rural areas in the country. Subjects. 1782 men (farmers and non-farmers) aged 40-60 years at baseline participated in a baseline survey (participation rate 76%) and 1589 men participated at the follow-up. 116 men with central obesity at baseline were excluded from the analyses. Main outcome measures. Central obesity at follow-up defined as waist hip ratio >= 1. Results. 197 men (15%) developed central obesity during follow-up. A low intake of dairy fat at baseline (no butter and low fat milk and seldom/never whipping cream) was associated with a higher risk of developing central obesity (OR 1.53, 95% CI 1.05-2.24) and a high intake of dairy fat (butter as spread and high fat milk and whipping cream) was associated with a lower risk of central obesity (OR 0.52, 95% CI 0.33-0.83) as compared with medium intake (all other combinations of spread, milk, and cream) after adjustment for intake of fruit and vegetables, smoking, alcohol consumption, physical activity, age, education, and profession. The associations between dairy fat intake and central obesity were consistent across body mass index categories at baseline. Conclusion. A high intake of dairy fat was associated with a lower risk of central obesity and a low dairy fat intake was associated with a higher risk of central obesity.

  • 293.
    Holst, Anna
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med Primary Hlth Care, Gothenburg, Sweden.
    Ginter, Annika
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med Hlth Metr, Gothenburg, Sweden.
    Bjorkelund, Cecilia
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med Primary Hlth Care, Gothenburg, Sweden.
    Hange, Dominique
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med Primary Hlth Care, Gothenburg, Sweden.
    Petersson, Eva-Lisa
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med Primary Hlth Care, Gothenburg, Sweden;Reg Vastra Gotaland, Narhalsan Res & Dev Primary Hlth Care, Gothenburg, Sweden.
    Svenningsson, Irene
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med Primary Hlth Care, Gothenburg, Sweden;Reg Vastra Gotaland, Narhalsan Res & Dev Primary Hlth Care, Gothenburg, Sweden.
    Westman, Jeanette
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med, Stockholm, Sweden.
    Andre, Malin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Wikberg, Carl
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med Primary Hlth Care, Gothenburg, Sweden.
    Wallin, Lars
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Stockholm, Sweden;Univ Gothenburg, Sahlgrenska Acad, Dept Hlth & Care Sci, Gothenburg, Sweden.
    Moller, Christina
    Reg Vastra Gotaland, Narhalsan, Primary Hlth Care Head Off, Hisings Backa, Sweden.
    Svensson, Mikael
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med Hlth Metr, Gothenburg, Sweden.
    Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: economic evaluation of a pragmatic randomised controlled study2018Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 11, artikkel-id e024741Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate the cost-effectiveness of a care manager (CM) programme compared with care as usual (CAU) for treatment of depression at primary care centres (PCCs) from a healthcare as well as societal perspective.

    Design: Cost-effectiveness analysis.

    Setting: 23 PCCs in two Swedish regions.

    Participants: Patients with depression (n=342).

    Main outcome measures: A cost-effectiveness analysis was applied on a cluster randomised trial at PCC level where patients with depression had 3 months of contact with a CM (11 intervention PCCs, n=163) or CAU (12 control PCCs, n=179), with follow-up 3 and 6 months. Effectiveness measures were based on the number of depression-free days (DFDs) calculated from the Montgomery-angstrom sberg Depression Rating Scale-Self and quality-adjusted life years (QALYs).

    Results were expressed as the incremental cost-effectiveness ratio: Cost/QALY and Cost/DFD. Sampling uncertainty was assessed based on non-parametric bootstrapping.

    Results: Health benefits were higher in intervention group compared with CAU group: QALYs (0.357 vs 0.333, p<0.001) and DFD reduction of depressive symptom score (79.43 vs 60.14, p<0.001). The mean costs per patient for the 6-month period were Euro368 (healthcare perspective) and Euro6217 (societal perspective) for the intervention patients and Euro246 (healthcare perspective) and Euro7371 (societal perspective) for the control patients (n.s.). The cost per QALY gained was Euro6773 (healthcare perspective) and from a societal perspective the CM programme was dominant.

    Discussion: The CM programme was associated with a gain in QALYs as well as in DFD, while also being cost saving compared with CAU from a societal perspective. This result is of high relevance for decision-makers on a national level, but it must be observed that a CM programme for depression implies increased costs at the primary care level.

  • 294.
    Hoti, Fabian
    et al.
    EPID Res, Espoo, Finland..
    Mushnikov, Vasili
    EPID Res, Espoo, Finland..
    Mehtala, Juha
    EPID Res, Espoo, Finland..
    Wentzell, Nadine
    Leibniz Inst Prevent Res & Epidemiol BIPS, Bremen, Germany..
    Kollhorst, Bianca
    Leibniz Inst Prevent Res & Epidemiol BIPS, Bremen, Germany..
    Schink, Tania
    Leibniz Inst Prevent Res & Epidemiol BIPS, Bremen, Germany..
    Garbe, Edeltraut
    Leibniz Inst Prevent Res & Epidemiol BIPS, Bremen, Germany..
    Mountford, William K.
    Quintiles, Cambridge, MA USA..
    Knox, Caitlin
    Quintiles, Cambridge, MA USA..
    Kaufman, Elise
    Quintiles, Cambridge, MA USA..
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Korhonen, Pasi
    EPID Res, Espoo, Finland..
    COPD Patients Initiating Roflumilast in Sweden, Germany and the United States: Findings from the Roflumilast PASS Study2016Inngår i: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 25, nr Suppl. 3, s. 679-679, artikkel-id Abstr. 1169Artikkel i tidsskrift (Fagfellevurdert)
  • 295. Hovelius, Birgitta (svensk redaktör)
    et al.
    Andersson, ChristerBardel, AnnikaUppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.Björkelund, CeciliaBorgquist, LarsEngfeldt, PeterMidlöv, PatrikNilsson, Gunnar
    Allmänmedicin: Huvudredaktör Steinar Hunskår2015Konferanseproceedings (Annet vitenskapelig)
  • 296. Hovelius, Birgitta (svensk redaktör)
    et al.
    Andersson, ChristerBardel, AnnikaUppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.Björkelund, CeciliaBorgquist, LarsFurhoff, Anna-Karin
    Allmänmedicin: Huvudredaktör Steinar Hunskår2007Konferanseproceedings (Annet vitenskapelig)
  • 297. Hultin, Hanna
    et al.
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Alexanderson, Kristina
    Johansson, Gun
    Lindholm, Christina
    Lundberg, Ingvar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Moller, Jette
    Lack of Adjustment Latitude at Work as a Trigger of Taking Sick Leave-A Swedish Case-Crossover Study2013Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, nr 4, s. e61830-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Research has shown that individuals reporting a low level of adjustment latitude, defined as having few possibilities to temporarily adjust work demands to illness, have a higher risk of sick leave. To what extent lack of adjustment latitude influences the individual when making the decision to take sick leave is unknown. We hypothesize that ill individuals are more likely to take sick leave on days when they experience a lack of adjustment latitude at work than on days with access to adjustment latitude. Methods: A case-crossover design was applied to 546 sick-leave spells, extracted from a cohort of 1 430 employees at six Swedish workplaces, with a 3-12 month follow-up of all new sick-leave spells. Exposure to lack of adjustment latitude on the first sick-leave day was compared with exposure during several types of control periods sampled from the previous two months for the same individual. Results: Only 35% of the respondents reported variations in access to adjustment latitude, and 19% reported a constant lack of adjustment latitude during the two weeks prior to the sick-leave spell. Among those that did report variation, the risk of sick leave was lower on days with lack of adjustment latitude, than on days with access (Odds Ratio 0.36, 95% Confidence Interval 0.25-0.52). Conclusions: This is the first study to show the influence of adjustment latitude on the decision to take sick leave. Among those with variations in exposure, lack of adjustment latitude was a deterrent of sick leave, which is contrary to the a priori hypothesis. These results indicate that adjustment latitude may not only capture long-lasting effects of a flexible working environment, but also temporary possibilities to adjust work to being absent. Further studies are needed to disentangle the causal mechanisms of adjustment latitude on sick-leave.

  • 298. Hultin, Hanna
    et al.
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Alexanderson, Kristina
    Johansson, Gun
    Lindholm, Christina
    Lundberg, Ingvar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Möller, Jette
    Low level of adjustment latitude: a risk factor for sickness absence2010Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 20, nr 6, s. 682-688Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:

    The prerequisite for obtaining sickness benefit is reduced work ability for medical reasons in combination with work demands which cannot be adjusted accordingly. The aim of this study was to investigate if low levels of adjustment latitude, defined as the possibility to temporarily adjust work demands in case of ill health, influence sickness absence.

    Methods:

    A prospective cohort study of 1420 employees (47% participation, aged 19-68; 56% women) was conducted at six Swedish workplaces. Exposure to two general and nine specific types of adjustment latitude was ascertained at baseline. Outcome was defined as the first new employer-reported sick-leave spell during a follow-up of 3-12 months. Hazard ratios (HR) of sick leave, with 95% confidence intervals (CI), were estimated by Cox proportional hazards regression.

    Results:

    The incidence of sickness absence was 2.85/1000 person-days. The self-reported reasons for sick leave were mainly minor complaints such as colds, influenzas and headaches. Employees lacking adjustment latitude had an adjusted HR of sickness absence of 1.51 (95% CI 1.08-2.11). Among specific adjustment latitude types, those not having the possibility to work from home generated an HR of 1.86 (95% CI 1.31-2.64). The effects of lack of adjustment latitude were similar for men and women but seemed to vary between different occupations.

    Conclusion:

    A low level of adjustment latitude at work is a risk factor for sickness absence.

  • 299. Hultin, Hanna
    et al.
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Alexanderson, Kristina
    Johansson, Gun
    Lindholm, Christina
    Lundberg, Ingvar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Möller, Jette
    Work-related psychosocial events as triggers of sick leave: results from a Swedish case-crossover study2011Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, s. 175-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:

    Although illness is an important cause of sick leave, it has also been suggested that non-medical risk factors may influence this association. If such factors impact on the period of decision making, they should be considered as triggers. Yet, there is no empirical support available.

    The aim was to investigate whether recent exposure to work-related psychosocial events can trigger the decision to report sick when ill.

    Methods:

    A case-crossover design was applied to 546 sick-leave spells, extracted from a Swedish cohort of 1 430 employees with a 3-12 month follow-up of new sick-leave spells. Exposure in a case period corresponding to an induction period of one or two days was compared with exposure during control periods sampled from workdays during a two-week period prior to sick leave for the same individual. This was done according to the matched-pair interval and the usual frequency approaches. Results are presented as odds ratios (OR) with 95% confidence intervals (CI).

    Results:

    Most sick-leave spells happened in relation to acute, minor illnesses that substantially reduced work ability. The risk of taking sick leave was increased when individuals had recently been exposed to problems in their relationship with a superior (OR 3.63; CI 1.44-9.14) or colleagues (OR 4.68; CI 1.43-15.29). Individuals were also more inclined to report sick on days when they expected a very stressful work situation than on a day when they were not under such stress (OR 2.27; CI 1.40-3.70).

    Conclusions:

    Exposure to problems in workplace relationships or a stressful work situation seems to be able to trigger reporting sick. Psychosocial work-environmental factors appear to have a short-term effect on individuals when deciding to report sick.

  • 300. Hultin, Hanna
    et al.
    Moller, Jette
    Alexanderson, Kristina
    Johansson, Gun
    Lindholm, Christina
    Lundberg, Ingvar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Low Workload as a Trigger of Sick Leave: Results From a Swedish Case-Crossover Study2012Inngår i: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 54, nr 2, s. 202-209Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives:

    To investigate if exposure to an unusually low workload when ill can trigger taking sick leave.

    Methods:

    A case-crossover design was applied to 546 sick-leave spells obtained from a cohort of 1430 employees within six Swedish workplaces. New sick-leave spells were reported from the workplaces during 3 to 12 months follow-up. Exposure was assessed in structured participant interviews at sick leave. Case and control periods from the same individual were sampled according to the matched-pair and usual-frequency approaches. Results are presented as odds ratios with surrounding 95% confidence intervals.

    Results:

    The odds ratio of sick leave on a day with an unusually low workload was 2.57 (confidence interval, 1.07-6.16).

    Conclusions:

    Becoming ill on a day with a lower workload than usual can trigger the decision to take sick leave.

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