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  • 301.
    Ställberg, Björn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Jansson, Christer
    Organisation of asthma and COPD care in secondary care in Mid-Sweden2006Conference paper (Other academic)
  • 302.
    Ställberg, Björn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Jansson, Christer
    Organisation of asthma and COPD care in secondary care in Mid-Sweden (ABS77)2006In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 15, no 3, p. 207-Article in journal (Other academic)
  • 303.
    Ställberg, Björn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Marklund, B
    SBU-rapporten om astma och KOL: Matnyttig och lättläst även för en jäktad allmänläkare2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, no 4, p. 285-286Article in journal (Refereed)
  • 304.
    Ställberg, Björn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Nokela, Mika
    Ehrs, Per-Olof
    Hjemdal, Paul
    Jonsson, Eva Wikström
    Validation of the clinical COPD Questionnaire (CCQ) in primary care2009In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 7, p. 26-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patient centred outcomes, such as health status, are important in Chronic Obstructive Pulmonary Disease (COPD). Extensive questionnaires on health status have good measurement properties, but are not suitable for use in primary care. The newly developed, short Clinical COPD Questionnaire, CCQ, was therefore validated against the St George's Respiratory Questionnaire (SGRQ). METHODS: 111 patients diagnosed by general practitioners as having COPD completed the questionnaires twice, 2-3 months apart, without systematic changes in treatment. Within this sample of patients with "clinical COPD" a subgroup of patients with spirometry verified COPD was identified. All analyses was performed on both groups. RESULTS: The mean FEV1 (% predicted) was 58.1% for all patients with clinical COPD and 52.4% in the group with verified COPD (n = 83). Overall correlations between SGRQ and CCQ were strong for all patients with clinical COPD (0.84) and the verified COPD subgroup (0.82). The concordance intra-class correlation between SGRQ and CCQ was 0.91 (p < 0.05). Correlations between CCQ and SGRQ were moderate to good, regardless of COPD severity. CONCLUSION: The CCQ is a valid and reliable instrument for assessments of health status on the group level in patients treated for COPD in primary care but its reliability may not be sufficient for the monitoring of individual patients.

  • 305.
    Ställberg, Björn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Nyström Kronander, U
    Olsson, P
    Gottberg, L
    Rönnbäck, E
    Lundbäck, B
    Living with asthma in Sweden: the ALMA Study2003In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 97, no 7, p. 835-843Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Recently performed studies have found a number of limitations in the daily lives of asthmatics, and a large disparity between the perception of the sufferers and what health care professionals believe matters to asthmatics.

    AIM:

    What matters to Swedish asthma patients, what medicines do they use, and are they compliant with given prescriptions? A further aim was to compare perceptions about asthma and asthma management in asthmatics and among Swedish general practitioners (GP).

    DESIGN:

    A structured telephone interview of a representative sample of Swedish asthmatics, and a mailed questionnaire survey among GPs from different parts of Sweden.

    METHODS:

    Screening by telephone of a random sample of 10,350 subjects aged 18-45. Of those, 240 were subsequently selected for a detailed structured telephone interview about their asthma. A mailed structured questionnaire containing similar questions to those asked of the asthmatics was sent to 600 GPs, and 139 returned completed answers.

    RESULTS:

    16% of the asthmatics reported (asthma) symptoms occurring every day during the previous month. Nocturnal symptoms at least twice per week were reported by 19%. Both these were reported by considerably higher proportions of the asthmatics than the GPs had expected. A large majority classified their disease as mild or very mild, although great majority reported frequent symptoms. Activities or situations which caused symptoms of asthma often or "now and then" were physical exertion, 67%; bad weather, 59%; contact with animals/pets, 58%; and visits to cafes or restaurants, 36%; and several asthmatics avoided these activities due to their asthma.

    CONCLUSION:

    A great majority of asthmatics report a large number of symptoms and limitations in their daily living in proportions which were roughly expected by the GPs.

  • 306.
    Ställberg, Björn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Olsson, P
    Jörgensen, LA
    Lindmarck, N
    Ekström, T
    Budesonide/formoterol adjustable maintenance dosing reduces asthma exacerbations versus fixed dosing2003In: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 57, no 8, p. 656-661Article in journal (Refereed)
    Abstract [en]

    A guided, adjustable-dosing regimen with budesonide/formoterol was investigated in asthma patients. In a randomised, open, multicentre study, 1034 patients received budesonide/ formoterol (Symbicort((R)), Turbuhalero((R)),) 80/4.5 mug or 160/4.5 mug (depending on pre-study inhaled corticosteroid dose) two inhalations twice daily for four weeks, followed by adjustable or fixed maintenance dosing for six months. Patients receiving adjustable dosing stepped down to one inhalation twice daily if symptoms were controlled and could, if symptoms worsened, step up to four inhalations twice daily for one or two weeks according to a self-guided management plan. The primary efficacy variable was occurrence of exacerbations. Compared with fixed dosing, adjustable dosing was associated with fewer patients experiencing exacerbations (6.2% vs 9.5%, NNT 30, p<0.05), fewer daily inhalations of budesonide/formoterol (2.35 vs 3.95, p<0.001), lower costs (six-month saving 98, p<0.001) and was similarly well tolerated. Adjustable maintenance dosing with budesonide/formoterol provides more effective asthma control than fixed dosing, and reduces costs.

  • 307.
    Ställberg, Björn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Pilman, Eva
    Skoogh, Bengt-Erik
    Hermansson, Bengt Arne
    Potency ratio fluticasone propionate (Flixotide Diskus)/budesonide (Pulmicort Turbuhaler)2007In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, no 3, p. 610-615Article in journal (Refereed)
    Abstract [en]

    Background

    The severity of asthma varies in patients in primary care. The aim of this study was to identify factors related to asthma severity in a primary care setting.

    Methods

    In this cross-sectional asthma study a random sample of 1477 patients, aged 15–45 years, from 42 primary health care centres received two questionnaires: one disease oriented and one quality of life oriented, MiniAQLQ. A classification of the asthma severity similar to the GINA guidelines was made with the information obtained from the questionnaire. The classification was based on current treatment, use of rescue medication, night symptoms, emergency consultations and use of oral steroids for treatment of exacerbations.

    Results

    Thirty-five per cent of the women and 24% of the men were classified as having severe asthma. Women used more inhaled corticosteroids, more often took long acting beta-2 agonists or a leukotrien antagonist in addition to corticosteroids, experienced more frequent night awakenings and were more often smokers than men. In a multivariable analysis, female sex increased the odds of having severe asthma by 60% as compared with male sex, age by 3% per year, not having the asthma prescription filled owing to cost by 59%, daily smoking by 66% and pollen allergy by 85%.

    Conclusions

    Female sex, age, pollen and pet allergy, not having the asthma prescription filled owing to cost, and daily smoking were all independently associated with asthma severity.

  • 308.
    Ställberg, Björn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Selroos, Olof
    Vogelmeier, Claus
    Andersson, Eva
    Ekström, Tommy
    Larsson, Kjell
    Budesonide/formoterol as effective as prednisolone plus formoterol in acute exacerbations of COPD: a double-blind, randomised, non-inferiority, parallel-group, multicentre study2009In: Respiratory research (Online), ISSN 1465-9921, E-ISSN 1465-993X, Vol. 10, p. 11-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Oral corticosteroids and inhaled bronchodilators with or without antibiotics represent standard treatment of COPD exacerbations of moderate severity. Frequent courses of oral steroids may be a safety issue. We wanted to evaluate in an out-patient setting whether a 2-week course of inhaled budesonide/formoterol would be equally effective for treatment of acute COPD exacerbations as standard therapy in patients judged by the investigator not to require hospitalisation. METHODS: This was a double-blind, randomised, non-inferiority, parallel-group, multicentre study comparing two treatment strategies; two weeks' treatment with inhaled budesonide/formoterol (320/9 microg, qid) was compared with prednisolone (30 mg once daily) plus inhaled formoterol (9 microg bid) in patients with acute exacerbations of COPD attending a primary health care centre. Inclusion criteria were progressive dyspnoea for less than one week, FEV1 30-60% of predicted normal after acute treatment with a single dose of oral corticosteroid plus nebulised salbutamol/ipratropium bromide and no requirement for subsequent immediate hospitalisation, i.e the clinical status after the acute treatment allowed for sending the patient home.A total of 109 patients (mean age 67 years, 33 pack-years, mean FEV1 45% of predicted) were randomized to two weeks' double-blind treatment with budesonide/formoterol or prednisolone plus formoterol and subsequent open-label budesonide/formoterol (320/9 microg bid) for another 12 weeks. Change in FEV1 was the primary efficacy variable. Non-inferiority was predefined. RESULTS: Non-inferiority of budesonide/formoterol was proven because the lower limit of FEV1-change (97.5% CI) was above 90% of the efficacy of the alternative treatment. Symptoms, quality of life, treatment failures, need for reliever medication (and exacerbations during follow-up) did not differ between the groups. No safety concerns were identified. CONCLUSION: High dose budesonide/formoterol was as effective as prednisolone plus formoterol for the ambulatory treatment of acute exacerbations in non-hospitalized COPD patients. An early increase in budesonide/formoterol dose may therefore be tried before oral corticosteroids are used. CLINICAL TRIAL REGISTRATION: NCT00259779.

  • 309.
    Ställberg, Björn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Skoogh, Bengt-Eric
    Tidig diagnos av KOL utmaning för primärvården: [Early diagnosis of COPD a challenge to primary health care]2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 13, p. 1036-1039Article in journal (Refereed)
    Abstract [sv]

    KOL är en sjukdom som kan både förebyggas och behandlas. Korrekt och tidig diagnos och rökstopp vid KOL är en förutsättning för att förhindra progress av sjukdomen.

    Viktiga mål för vårt omhändertagande är att minska patientens symtom samt minska antalet exacerbationer. Att identifiera och behandla dessa patienter är därför en utmaning för primärvården.

  • 310. Sundh, Josefin
    et al.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Montgomery, Scott
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Clinical COPD Questionnaire score (CCQ) and mortality2012In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 7, p. 833-842Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    The Clinical COPD Questionnaire (CCQ) measures health status and can be used to assess health-related quality of life (HRQL). We investigated whether CCQ is also associated with mortality.

    METHODS:

    Some 1111 Swedish primary and secondary care chronic obstructive pulmonary disease (COPD) patients were randomly selected. Information from questionnaires and medical record review were obtained in 970 patients. The Swedish Board of Health and Welfare provided mortality data. Cox regression estimated survival, with adjustment for age, sex, heart disease, and lung function (for a subset with spirometry data, n = 530). Age and sex-standardized mortality ratios were calculated.

    RESULTS:

    Over 5 years, 220 patients (22.7%) died. Mortality risk was higher for mean CCQ ≥ 3 (37.8% died) compared with mean CCQ < 1 (11.4%), producing an adjusted hazard ratio (HR) (and 95% confidence interval [CI]) of 3.13 (1.98 to 4.95). After further adjustment for 1 second forced expiratory volume (expressed as percent of the European Community for Steel and Coal reference values ), the association remained (HR 2.94 [1.42 to 6.10]). The mortality risk was higher than in the general population, with standardized mortality ratio (and 95% CI) of 1.87 (1.18 to 2.80) with CCQ < 1, increasing to 6.05 (4.94 to 7.44) with CCQ ≥ 3.

    CONCLUSION:

    CCQ is predictive of mortality in COPD patients. As HRQL and mortality are both important clinical endpoints, CCQ could be used to target interventions.

  • 311. Svedberg, P
    et al.
    Johansson, Saga
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Hamelin, B
    Pedersen, N L
    Extra-intestinal manifestations associated with irritable bowel syndrome: a twin study2002In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 16, no 5, p. 975-983Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Little is known about the role of genetic and environmental factors in irritable bowel syndrome. Various extra-intestinal manifestations are more prevalent in cases than in controls. Genetic effects may be important in the liability to develop functional bowel disorders.

    AIMS:

    To evaluate the associations of irritable bowel syndrome with several disorders co-morbid with the condition, using both a case-control design and a co-twin control design.

    METHODS:

    A sample of 850 Swedish twin pairs, aged 18-85 years, was contacted for a telephone interview. Through a diagnostic algorithm, 72 unrelated cases of irritable bowel syndrome and 216 age- and gender-matched controls were identified. Fifty-eight twin pairs discordant for irritable bowel syndrome were evaluated in co-twin analyses.

    RESULTS:

    Renal problems (odds ratio (OR)=3.3; confidence interval (CI), 1.3-8.2), obesity (OR=2.6; CI, 1.0-6.4), underweight in the past (OR=2.4; CI, 1.1-6.4), gluten intolerance (OR=9.0; CI, 1.4-60.1), rheumatoid arthritis (OR=3.2; CI, 1.1-9.4) and poor self-rated health (OR=1.8; CI, 1.0-3.2) were significantly associated with irritable bowel syndrome. In the co-twin analyses, the only factors maintaining significance were renal and recurrent urinary tract problems.

    CONCLUSIONS:

    The association between irritable bowel syndrome and renal and urinary tract problems does not reflect a genetic or familial mediation. Eating disorders in childhood represent a familial-environmental influence on irritable bowel syndrome, whereas the association with rheumatoid arthritis and perhaps gluten intolerance probably reflects genetic mediation.

  • 312. Svedberg, Pia
    et al.
    Johansson, Saga
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Pedersen, Nancy L.
    No evidence of sex differences in heritability of irritable bowel syndrome in Swedish twins.2008In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 11, no 2, p. 197-203Article in journal (Refereed)
    Abstract [en]

    Studies have shown that familial aggregation is of importance for abdominal symptoms including irritable bowel syndrome and there are a few reports of a moderate heritability for irritable bowel syndrome. Sex differences in prevalence and incidence of irritable bowel syndrome have been demonstrated however less is known about sex differences in heritability. The objective was to investigate whether there were sex differences in heritability of irritable bowel syndrome while accounting for different prevalences among women and men in different age groups. A sample of 45,750 Swedish twins, whereof 16,961 were complete twin pairs, participated in a telephone interview. The sample was divided into three age groups (40-54, 55-64 and 65 years and older) and the diagnosis of irritable bowel syndrome was operationally defined with a number of disorder specific symptoms. Standard biometrical model fitting analyses were conducted using raw ordinal data from same-sex and opposite-sex twins. The prevalence of irritable bowel syndrome was greater among women than men and more prevalent at younger ages (e.g., women 10.3%, men 6.3% at ages 40-54 years vs. women 6.1%, men 4% at ages over 65 years). The heritability of the disorder was approximately 25% in all age groups. We found no evidence for sex differences in heritability in any of the age groups, however, models allowing prevalences of irritable bowel syndrome to differ between sexes and age groups fitted best.

  • 313.
    Svärdsudd, Kurt
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Gulliksson, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    The Use of Cognitive Behavioral Therapy for Secondary Prevention in Patients With Coronary Heart Disease—Reply: Reply2011In: Archives of Internal Medicine, ISSN 0003-9926, E-ISSN 1538-3679, Vol. 171, no 16, p. 1506-1507Article in journal (Refereed)
  • 314.
    Swartling, Malin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Alexanderson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Barriers to good sickness certification: an interview study with Swedish general practitioners2008In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 36, no 4, p. 408-414Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To date, there is no gold standard for sick-listing practices, and physicians find sickness certification problematic. Measures have been taken to improve physician's sick-listing practices, but with ambiguous results. To be able to make such interventions effective, it is important to identify and target barriers to good practices. Our aim was to identify barriers preventing general practitioners (GPs) from sick-listing in the way they think is best. METHODS: Semi-structured individual interviews were carried out with 19 GPs in 17 primary healthcare centres in four central Swedish counties. Interview transcripts were analysed using qualitative content analysis to identify types of barriers to good sick-listing practices. RESULTS: Barriers within the healthcare system included: complexity of clinical judgements; the physician's competence - especially, poor skills in handling situations regarding conflicting perceptions of the need for sickness certification; the performance of other healthcare professionals; and deficiencies in the healthcare system itself. Barriers outside the healthcare system included: general attitudes to sick-listing and benefits; the labour-market situation; patients' social problems; and the performance of and collaboration with other stakeholders. CONCLUSIONS: GPs experienced a number of barriers to what they perceived to be good sick-listing practice. Such barriers need to be addressed in interventions for change. We propose communication skills training, with a special emphasis on difficult situations in sick-listing practice.

  • 315.
    Swartling, Malin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine.
    Hagberg, Jan
    Alexanderson, Kristina
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Sick-listing as a psychosocial work problem: a survey of 3997 Swedish physicians2007In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 17, no 3, p. 398-408Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To quantify the extent of emotionally straining sick-listing problems among three categories of physicians and find associations with workplace characteristics. METHODS: A questionnaire was answered by 3997 physicians (response rate: 71%). RESULTS: A larger proportion of physicians at orthopaedic clinics and, in particular, at Primary Health Care Centres (PHCCs), experienced sick-listing problems, compared to physicians at other clinics. Ten percent of PHCC physicians felt threatened by patients, at least once per month, in relation to sickness certification or worried about getting reported to the disciplinary board. PHCC physicians found sick-listing more problematic compared to others (OR 4.9; 95% CI 4.1-6.0). Having a workplace policy on sick-listing was associated with a reduced risk of experiencing several problems (OR 0.5-0.6, P < 0.05). CONCLUSION: The extent and nature of sick-listing problems warrant further concerns, especially in PHCCs. The nature of perceived threats should be elucidated. Developing workplace policies on sick-listing should be encouraged.

  • 316.
    Swartling, Malin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Peterson, Stefan
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Views on sick-listing practice among Swedish General Practitioners: A phenomenographic study2007In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 8, p. 44-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The number of people on sick-leave started to increase in Sweden and several other European countries towards the end of the 20th century. Physicians play an important role in the sickness insurance system by acting as gate-keepers. Our aim was to explore how General Practitioners (GPs) view their sick-listing commission and sick-listing practice. METHODS: Semi-structured interviews with 19 GPs in 17 Primary Health Care settings in four mid-Sweden counties. Interview transcripts were analysed with phenomenographic approach aiming to uncover the variation in existing views regarding the respondents' sick-listing commission and practice. RESULTS: We found large qualitative differences in the GPs' views on sick-listing. The sick-listing commission was experienced to come either from society or from patients, with no responsibility for societal interests, or as an integration of these two views. All the GPs were aware of a possible conflict between the interests of society and patients. While some expressed feelings of strong conflict, others seemed to have solved the conflict, at least partly, between these two loyalties. Some GPs experienced carrying the full responsibility to decide whether a patient would get monetary sick-leave benefits or not and they were not comfortable with this situation. Views on the physician's and the patient's responsibility in sick-listing and rehabilitation varied from a passive to an empowering role of the physician. GPs expressing a combination of less inclusive views of the different aspects of sick-listing experienced strong conflict and appeared to feel distressed in their sick-listing role. Some GPs described how they had changed from less to more inclusive views. CONCLUSION: The clearer understanding of the different views on sick-listing generated in this study can be used in educational efforts to improve physicians' sick-listing practices, benefiting GPs' work situation as well as their patients' well-being. The GP's role as a gatekeeper in the social security system needs further exploration. Our findings could be used to develop a questionnaire to measure the distribution of different views in a wider population of GPs.

  • 317.
    Swartling, Malin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Isolated specialist or system integrated physician - different views on sickness certification among orthopaedic surgeons: an interview study2008In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 8, p. 273-Article in journal (Refereed)
    Abstract [en]

    Background: Sickness certification is a frequent and sometimes problematic task for orthopaedic surgeons. Our aim was to explore how orthopaedic surgeons view their sick-listing commission and sick-listing practice. Methods: Semi-structured interviews with seventeen orthopaedic surgeons from five orthopaedic clinics in four Swedish counties. The focus was on the experiences of these physicians in relation to handling of sickness certification. Phenomenographic analysis was performed to reveal differences in existing views. Results: The orthopaedic surgeons' views on sick-listing seemed mainly to be a consequence of how they perceived their role in the healthcare system. Three categories were found: The "isolated specialists", whose work and responsibilities were confined to the orthopaedic clinic, and did not really include sickness certification; the "orthopaedic   advisers", who saw themselves mainly as advice-givers in the general health care system and perceived sickness certification as part of their job; the "system-integrated physicians", who perceived the orthopaedic clinic as one part of the healthcare system and whose   ultimate goal was to get the patient well functioning in her life again with regained work ability, seeing sick-listing as one of the instruments to achieve this. Some informants described difficulties in handling conflicting opinions with patients in relation to the need for   sick-leave. Conclusion: Orthopaedic surgeons certify a large proportion of total sickness benefits. Some orthopaedic surgeons may certify sickness benefits sub-optimally for patients and society due to a narrow view of their role in the health care system or due to poor skills in handling discordant opinions with the patient. This problem can be addressed at the level of the individual physician and at the system level.

  • 318.
    Thelin, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Holmberg, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Farmers and retirement: a longitudinal cohort study2010In: Journal of Agromedicine, ISSN 1059-924X, E-ISSN 1545-0813, Vol. 15, no 1, p. 38-46Article in journal (Refereed)
    Abstract [en]

    Background

    Studies report low prevalence of several health problems among farmers. Health status and psychosocial factors are generally assumed to impact on retirement age and the ability to stay in work.

    Objectives

    To study retirement in a male rural population and to test the hypothesis that farmers retire later than nonfarmers thanks to better health status and advantageous psychosocial factors.

    Method

    The study design was a longitudinal cohort study on farmers and rural nonfarmers with data assessment at two surveys 12 years apart. Analyses were performed with multiple logistic regression models.

    Results

    Among subjects 64 years or younger at survey 2, 93% of the farmers were still working (full or part time) as compared with 76% of the employed nonfarmers. Among those 65 years or older, 64% of the farmers, 33% of nonfarming entrepreneurs, and 6% of employed nonfarmers were still occupationally active. Significant differences in reported diseases and psychosocial factors were found between farmers and nonfarmers, but in the fully adjusted model these variables did not modify the low odds ratios of retirement found for farmers. The farmers adjusted risk (OR) for premature retirement (64 or younger) was 0.30 (95% CI 0.16–0.55) and for standard retirement (65 or older) 0.01 (95% CI 0.00–0.05).

    Conclusions

    Farmers continue to work full or part time around retirement age to a much larger extent than employees. The employment status of farmers may only partly explain this. Health status and psychosocial factors did not impact on the results.

  • 319.
    Thelin, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Holmberg, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Hip osteoarthritis in a rural male population: a prospective population-based register study2007In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 50, no 8, p. 604-607Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: A cohort of rural men with urban referents was followed over 13 years to study the risk of developing osteoarthritis of the hip joint. METHODS: A group of 1,220 farmers, 1,130 matched rural non-farming men, and 1,087 urban men were identified in 1989 and followed over time. Information on hospital care and surgery was obtained from the national Swedish register of hospital care and surgery. RESULTS: More farmers than referents had been hospitalized for osteoarthritis and had undergone surgery for osteoarthritis of the hip joint. Hazard ratio for osteoarthritis of the hip joint was 3.0 (95% CI: 1.7-5.3) for farmers versus urban controls. Non-farming rural men had no increased risk as compared with urban referents. CONCLUSION: Farmers but not non-farming rural men had a significantly increased risk of developing osteoarthritis of the hip joint as compared with urban referents.

  • 320. Thelin, Anders
    et al.
    Holmberg, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Thelin, Nils
    Functioning in neck and low back pain from a 12-year perspective: a prospective population-based study.2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 7, p. 555-561Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to evaluate the effects of unspecific neck pain and low back pain at a given time (1990-91) with respect to physical and social functioning and role limitations due to emotional problems 12 years later. METHODS: A rural male study population (2351 individuals) was established in 1989 and a first survey conducted in 1990-91. A follow-up survey was performed in 2002-03. A total of 1405 persons participated in both surveys. Functioning and role limitations in 2002-03 were evaluated using the SF-36 instrument. Several possible confounders were included in the analyses. RESULTS: Unspecific neck pain or low back pain in 1990-91 was shown in a multivariate longitudinal regression model to be significantly related to limited physical (odds ratio (OR)=2.08; 95% confidence interval (CI) 1.51-2.87) and social (OR=1.92; 95% CI 1.33-2.75) functioning 12 years later. The effects were only slightly modified by the confounders analysed. However, higher education independently and significantly predicted a low risk for functional limitations. CONCLUSION: Non-specific neck pain and low back pain at a given time impacted on the risk of limited physical and social functioning many years later. Current symptoms of depression and anxiety at the time for the second survey had a high impact on functional limitations.

  • 321. Thelin, N.
    et al.
    Holmberg, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Thelin, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Knee injuries account for the sports-related increased risk of knee osteoarthritis2006In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 16, no 5, p. 329-333Article in journal (Refereed)
    Abstract [en]

    Increased risk of osteoarthritis has been found among athletes active in different kinds of sports. Knee injury is an established risk factor for knee osteoarthritis. In this population-based case–control study we investigated the risk of knee osteoarthritis with respect to sports activity and previous knee injuries. A total of 825 cases with x-ray-verified femorotibial osteoarthritis were identified at six hospitals in southern Sweden. The cases were matched (age, sex and residential area) with 825 controls from the general population. Mailed questionnaire data on sports activity for more than 1 year after the age of 16, knee injuries and confounding variables (weight, height, heredity, smoking and occupation) were collected and analyzed using logistic regression models. The response frequency was 89%. Among men knee osteoarthritis was related to soccer (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.1–2.2), ice hockey (OR 1.9, 95% CI 1.2–3.0) and tennis (OR 2.0, 95% CI 1.1–3.8) but not to track and field sports, cross-country skiing, and orienteering. After adjustment for confounding variables soccer and ice hockey remained significantly related to knee osteoarthritis, but after adjustment for knee injuries no significant relation remained. The sports-related increased risk for knee osteoarthritis was explained by knee injuries.

  • 322. Thelin, Nils
    et al.
    Holmberg, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Nettelbladt, Per
    Thelin, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Mortality and morbidity among farmers, nonfarming rural men, and urban referents: a prospective population-based study2009In: International journal of occupational and environmental health, ISSN 1077-3525, E-ISSN 2049-3967, Vol. 15, no 1, p. 21-28Article in journal (Refereed)
    Abstract [en]

    A cohort of 1,220 farmers, 1,130 nonfarming rural men, and 1,087 urban referents from Sweden were monitored for 12 years. Farmers had lower mortality than urban referents for all causes of death (hazard ratio [HR] = 0.51; 95% confidence interval [CI], 0.37-0.71), cancer (HR = 0.44; 95% CI, 0.24-0.78) and cardiovascular diseases (HR = 0.60; 95% CI, 0.36-0.99). Nonfarming rural men had lower mortality than urban referents for all causes of deaths (HR = 0.81; 95% CI, 0.70-0.94). Farmers and nonfarming rural men had significantly lower morbidity risks of cancer and of psychiatric disorders than urban referents. Farmers had significantly lower risk of endocrine disorders, cardiovascular disorders, and respiratory disorders. In general, morbidity was lower among nonfarming rural men compared with urban referents and was even lower among farmers. Urban referents had, however, significantly less musculoskeletal disorder morbidity. An urban-rural factor and a farming occupational or lifestyle factor results in lower mortality and morbidity rates except concerning musculoskeletal disorders.

  • 323. Thorell, Eva
    et al.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Andersson, Kjell
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Moderate impact of full-term pregnancy on estimated peak oxygen uptake, physical activity and perceived health2010In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 9, p. 1140-1148Article in journal (Refereed)
    Abstract [en]

    Objective. To study the impact of pregnancy on estimated peak oxygen uptake ((V) over dotO(2) (peak, est.)), physical activity and perceived health. Design. Prospective cohort study. Setting. Maternal health centers. Population. A cohort of pregnant women. Methods. Cycle ergometer test and questionnaires in early pregnancy and 5 months postpartum. Main outcome measures. (V) over dotO(2) (peak, est.), physical activity and perceived health. Results. Regular physical activity was reported by a successively lower proportion of women as pregnancy advanced but the proportion was regained postpartum. Despite this the difference between average absolute (V) over dotO(2) (peak, est.) in early pregnancy and postpartum of 2.44 and 2.42 l/minute, respectively, was not significant. The adjusted absolute (V) over dotO(2) (peak, est.) in early pregnancy successively increased with age to a maximum at 35 years, after which it decreased and among women of the same age the time between 8 and 12 weeks lowered the (V) over dotO(2) (peak, est.) by 0.130 l/minute. With the Short Form 36 (SF-36) questionnaire in early pregnancy the women scored their mean mental health to 72.0 and mean physical health to 79.7. At the postpartum appointment these scores were higher (p < 0.0001). Absolute and relative (V) over dotO(2) (peak, est.) in early pregnancy were positively correlated to the variation of SF-36' s mean physical health in early pregnancy (p < 0.0001) and postpartum (p < 0.0001). Conclusions. Pregnancy had a moderate influence on physical fitness and perceived health half a year postpartum despite less regular physical activity during pregnancy. (V) over dotO(2) (peak, est.) in early pregnancy was positively correlated to perceived physical health.

  • 324. Thorn, Jörgen
    et al.
    Samuelsson, Eva
    Wändell, Per
    Häkansson, Anders
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Borgquist, Lars
    Björkelund, Cecilia
    Läget för svensk allmänmedicinsk forskning: inventering av större forskningsprojekt och deras finansiering.2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 40, p. 2778-2780Article in journal (Refereed)
  • 325.
    Tibblin, Gösta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    76 kommuner: en studie av samhällsprofil, sjukdomsprofil och vårdprofil i Uppsala-Örebro-regionens kommuner1989Report (Other academic)
  • 326.
    Tibblin, Gösta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Studier av sjukskrivningspraxis1993Report (Other academic)
  • 327.
    Tibblin, Gösta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Cnattingius, Sven
    Barnet är mannens far även hos 1913 års män: Nya rön om fetala faktorer och vuxnas sjukdom1994In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 91, no 24, p. 2427-2429Article in journal (Refereed)
  • 328.
    Tibblin, Gösta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Cnattingius, Sven
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Ekbom, Anders
    High birthweight as a predictor of prostate cancer risk1995In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 6, no 4, p. 423-424Article in journal (Refereed)
    Abstract [en]

    In a follow-up study of a cohort of 50-year-old men who were born in 1913 and were living in Gothenburg, Sweden, we found an association between birthweight and prostate cancer. Of 366 men with known birthweight, there were 21 patients with prostate cancer. The incidence is about five times higher in the highest quartile of birthweight than in other birthweight groups. The findings indicate that aspects of the pre- and perinatal period may affect the risk of subsequent prostate cancer.

  • 329. Tilling, Björn
    et al.
    Jagorstrand, Birgitta
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Kull, Inger
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Romberg, Kerstin
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Astma/KOL-mottagning i primärvård: Nya kriterier2008In: Allmänsmedicin, ISSN 0281-3513, Vol. 5, p. 9-13Article in journal (Refereed)
  • 330.
    Torstensson, Thomas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Butler, Stephen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Lindgren, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Nilsson-Wikmar, Lena
    Karolinska Institutet.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Provoked pain intensity on intra-pelvic structures in women with and without chronic pelvic painManuscript (preprint) (Other academic)
  • 331. van der Molen, Thys
    et al.
    Østrem, Anders
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Østergaard, Marianne Stubbe
    Singh, Raj B.
    International Primary Care Respiratory Group (IPCRG) Guidelines: management of asthma2006In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 15, no 1, p. 35-47Article in journal (Refereed)
    Abstract [en]

    Worldwide, most patients with asthma are treated in primary care. Optimal primary care management of asthma is therefore of considerable importance. This IPCRG Guideline paper on the management of asthma in primary care is fully consistent with GINA guidelines. It is split into two sections, the first on the management of adults and schoolchildren, and the second on the management of pre-school children. It highlights the treatment goals for asthma and gives an overview of optimal management including the topics which should be covered by the primary care health professional when educating a patient about asthma. It covers the classification of the disease, the stepwise approach to pharmacologic therapy, disease monitoring, the management of exacerbations, and the identification of patients at risk of asthma death.

  • 332. van Schayck, Onno C P
    et al.
    D´Urzo, Anthony
    Invernizzi, Giovanni
    Román, Miguel
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Urbina, Christopher
    Early detection of chronic obstructive pulmonary disease (COPD): the role of spirometry as a diagnostic tool in primary care2003In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 12, no 3, p. 90-93Article in journal (Refereed)
    Abstract [en]

    Chronic obstructive pulmonary disease (COPD) is common and often undiagnosed in its early stages, especially in smokers, who are also most at risk. Patients can develop severe or very severe disease before they consult a physician. It is therefore important to identify patients at-risk of COPD and check their lung function regularly since early stage disease is often asymptomatic or mistaken for asthma. Primary care physicians are often the first health care providers to encounter patients with COPD in the early stages, and their role in early detection and treatment process is pivotal.

    Spirometry is a cheap, simple and reliable method for the early detection and monitoring of COPD patients, and for establishing a differential diagnosis. Spirometry gives immediate results and communicating the results to smokers has been shown to motivate them to quit. Early diagnosis and appropriate therapy can positively influence disease course, slowing progression, relieving symptoms and reducing the incidence of acute 'flares', or exacerbations.

  • 333.
    Vægter, Keld
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Wedel, Hans
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Effect of mailed feedback on drug prescribing profiles in general practice: a seven-year longitudinal study in Storstrom County, Denmark2010In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 115, no 4, p. 238-244Article in journal (Refereed)
    Abstract [en]

    Background. Whether written feedback on drug prescribing in general practice affects prescribing habits is controversial. Most short-term studies showed no effect. However, the issue has not been tested in long-term studies involving the local general practitioner community. Aims of the study. To assess whether prescribing levels in general practice are affected by long-term, unsolicited, systematically repeated, mailed feedback. Methods. Each of the 94 general practices in Storstrom County, Denmark, received semi-annual, mailed feedback about their prescribing volumes and costs within 13 major drug groups, in relation to the levels for all the other 93 practices over a 7-year period in a project initiated by the local general practitioner association. Data on the number of defined daily doses (DDDs) prescribed per 1000 listed patients in each practice per 6-months, and practice characteristics, were obtained from the Pharmaceutical Database at the County Health Department. Results. There was a large variation in drug prescribing volume between practices, but little within-practice variation over time. After adjustments for the influence of practice size and other potential outcome-affecting variables, there was no evidence of a general change of prescribing volume over time, no change among practices with a high or a low prescribing level, and no significant change within the various drug groups. Conclusions. We found no significant effects on prescribing levels of mailed feedback, even when repeated semi-annually during 7 years and initiated by the local general practitioner community.

  • 334. Wahlqvist, P
    et al.
    Brook, RA
    Campbell, SM
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Alexander, AM
    Smeeding, JE
    Kleinman, NL
    Objective measurement of work absence and on-the-job productivity: a case-control study of US employees with and without gastroesophageal reflux disease2008In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 50, no 1, p. 25-31Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To establish an association between gastroesophageal reflux disease (GERD) and increased work absence, as well as reduced productivity while at work, by using objective productivity measurements. METHODS: Retrospective case-control analysis of a database containing US employees' administrative health care and payroll data for employees (N = 11,653 with GERD; N = 255,616 without GERD) who were enrolled for at least one year in an employer-sponsored health insurance plan. RESULTS: Employees with GERD had 41% more sick leave days (P < 0.0001), 59% more short-term disability days (P < 0.0001), 39% more long-term disability days (P = 0.1910), 48% more workers' compensation days (P < 0.0001), 4.4% lower objective productivity per hour worked (P = 0.0481), and 6.0% lower annual objective productivity (P = 0.0391) than the employees without GERD. CONCLUSIONS: GERD is associated with a significant impact on employees' work absence and productivity while at work as measured using objective data.

  • 335. Wahlqvist, P
    et al.
    Karlsson, M
    Johnson, D
    Carlsson, J
    Bolge, SC
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Relationship between symptom load of gastro-oesophageal reflux disease and health-related quality of life, work productivity, resource utilization and concomitant diseases: survey of a US cohort2008In: Alimentary pharmacology & therapeutics, ISSN 1365-2036, Vol. 27, no 10, p. 960-70Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Analysis of the burden of gastro-oesophageal reflux disease (GERD) in relation to the severity and frequency of symptoms is essential to identify individuals and groups in whom targeted management is justified. AIM: To describe the relationship between symptoms of GERD and self-reported health-related quality of life (HRQL), work productivity, healthcare utilization and concomitant diseases. METHODS: US respondents to the Internet-based 2004 National Health and Wellness Survey who had self-reported GERD (n = 10,028, mean age: 52 years, 58% female) were age- and gender-matched to a control group without GERD (n = 10,028). Respondents with GERD were classified according to symptom severity and frequency. HRQL and productivity were assessed using the Short-Form 8 survey (SF-8) and Work Productivity and Activity Impairment questionnaire, respectively. RESULTS: Symptom frequency increased with increasing symptom severity. Compared with controls, respondents with GERD had more concomitant diseases [mean difference (MD): 1.6], lower SF-8 physical and mental health scores (MD: 4.1 units and 3.1 units, respectively), increased absenteeism (MD: 0.9 h/week), reduced percent productivity at work (MD: 7.5%) and increased healthcare utilization. All tested variables deteriorated with increasing symptom severity and/or frequency. CONCLUSIONS: Increasing severity and frequency of GERD symptoms is associated with more concomitant diseases, lower HRQL, lower work productivity and increased healthcare utilization, suggesting that patients with moderate or severe GERD should receive targeted management with the most effective treatment strategies.

  • 336.
    Wallander, Mari-Ann
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Saga
    Ruigómez, A
    García Rodríguez, LA
    Unspecified abdominal pain in primary care: the role of gastrointestinal morbidity2007In: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 61, no 10, p. 1663-1670Article in journal (Refereed)
    Abstract [en]

    Background: Many patients with abdominal pain have no obvious cause for their symptoms and receive a diagnosis of unspecified abdominal pain. Aim: The objective of this study was to ascertain risk factors and consequences of a diagnosis of unspecified abdominal pain in primary care. Methods: A population-based, case-control study was conducted using the UK General Practice Research Database. We identified 29,299 patients with a new diagnosis of abdominal pain, and 30,000 age- and sex-matched controls. Only diagnostic codes that did not specify the type or location of abdominal pain were included. Results and discussion: The incidence of newly diagnosed unspecified abdominal pain was 22.3 per 1000 person-years. The incidence was higher in females than in males, and 29% of patients were below 20 years of age. Prior gastrointestinal morbidity was associated with abdominal pain, but high body mass index, smoking and alcohol intake were not. Patients newly diagnosed with abdominal pain were 16 to 27 times more likely than controls to receive a subsequent new diagnosis of gallbladder disease, diverticular disease, pancreatitis or appendicitis in the year after the diagnosis of abdominal pain. The likelihood of receiving other gastrointestinal diagnoses such as peptic ulcer disease, hiatus hernia, gastro-oesophageal reflux disease (GERD), irritable bowel syndrome (IBS) or dyspepsia was increased three- to 14-fold among patients consulting for abdominal pain. Conclusion: When managing abdominal pain in primary care, morbidities such as GERD and IBS should be considered as diagnoses once potentially life-threatening problems have been excluded.

  • 337.
    Wallander, Mari-Ann
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Saga
    Ruigómez, A
    García Rodríguez, LA
    Jones, R
    Dyspepsia in general practice: incidence, risk factors, comorbidity and mortality2007In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 24, no 5, p. 403-411Article in journal (Refereed)
    Abstract [en]

    Background. Many individuals consulting their GP with upper abdominal symptoms are initially classified as having dyspepsia. Few studies have described the incidence of dyspepsia or the comorbidities, risk factors or prognosis associated with this diagnosis. Methods. We used the UK General Practice Research Database to find patients with a new diagnosis of dyspepsia in 1996 (n = 6913) and a control cohort (n = 11 036). We determined the incidence of dyspepsia, potential risk factors and comorbidity, and the risk of new onset morbidity in the year following the index date. Results. The incidence of dyspepsia was 15.3 per 1000 person-years. An increased probability of a dyspepsia diagnosis was associated with chest pain [odds ratio (OR): 2.4], general pain (OR: 1.8), sleep disorders (OR: 1.5), angina (OR: 1.5), osteoarthritis/rheumatoid arthritis (OR: 1.4) and smoking (OR: 1.2). There was only a borderline association with obesity (OR: 1.1). Patients with dyspepsia had an increased likelihood of a diagnosis of irritable bowel syndrome (IBS) (OR: 264), gastroesophageal reflux disease (GERD) (OR: 62.8) or peptic ulcer disease (PUD) (OR: 27.2) during the following year. Conclusions. The commonest diagnosis to emerge after an initial consultation for dyspepsia was IBS, followed by GERD and PUD.

  • 338.
    Wallander, Mari-Ann
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Saga
    Ruigómez, Ana
    García Rodríguez, Luis A
    Jones, Roger
    Morbidity Associated With Sleep Disorders in Primary Care: A Longitudinal Cohort Study.2007In: PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY, ISSN 1523-5998, Vol. 9, no 5, p. 338-345Article in journal (Refereed)
    Abstract [en]

    Objective

    Few epidemiologic studies evaluate the relative contribution of different risk factors on sleep problems. The aim of the present study was to assess demographics, comorbid characteristics, and health outcomes in patients with sleep disorders.

    Method

    A population-based cohort study with nested case-control analysis was conducted in adults using the U.K. General Practice Research Database. Information was collected for 12,437 patients with a new sleep disorder diagnosis during the year 1996 and 18,350 age- and sex-matched controls. Logistic regression analysis was used to compute odds ratios (OR) and 95% confidence intervals (CI).

    Results

    The incidence of a new sleep disorder diagnosis was 12.5 per 1000 person-years. There was a clear association of sleep disorders with smoking and excessive alcohol consumption; prior psychiatric disorders, including stress (OR = 3.6, 95% CI = 2.9 to 4.4) and depression (OR = 3.1, 95% CI = 2.8 to 3.3); prior circulatory diseases, including heart failure (OR = 1.8, 95% CI = 1.4 to 2.2) and coronary heart disease (OR = 1.4, 95% CI = 1.2 to 1.6); and prior gastrointestinal diseases, including gastroesopha-geal reflux disease (OR = 1.4, 95% CI = 1.2 to 1.7) and irritable bowel syndrome (OR = 1.5, 95% CI = 1.2 to 1.9). Use of hypnotics and anti-depressants was increased in the year after diagnosis. Relative 1-year mortality risk was 3-fold higher in the sleep disorder group than in controls, with a noticeably higher proportion of deaths due to suicide.

    Conclusion

    The fact that sleep disorders were associated with several morbidities, most strongly with psychiatric disorders as well as with increased mortality, underscores the importance of sleep problems as indicators of health status.

  • 339.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Disability Pension with Special Reference to Sick Leave Track Record, Health Effects, Health Care Utilisation and Survival: A Population-based Study2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background. In Sweden 10 percent (550,000) of the labour force, aged 18 to 65 years are disability pensioners and about four percent are on sick leave. The knowledge of the course from healthy individual to disability pensioner is not well known and was the theme of this thesis.

    Objectives, Material and Methods. The aims of the thesis were to follow the study population regarding sickness absence, health care utilisation, quality of life, and survival. Population based data including 14,538 women and men from three cities in Sweden were used, of whom 1,952 were granted a disability pension at baseline or received one during follow up. Register data, including sickness spells, health care utilisation, and mortality data during 30 years of follow up, and questionnaire data including socio-economic and quality of life data were used.

    Results. The most powerful determinant for being granted a disability pension was cumulative annual sick leave days, more powerful than all other tested determinants together. The degree of explanation for all determinants combined was 96%. Health care utilisation among disability pensioners continued to be high also after disability pension, 2.3 times higher for hospital admissions and 8 times higher for primary health case appointments than among referents. Disability pensioners had lower quality of life than non-pensioners and old age pensioners. For those who became disability pensioners after the baseline measurements quality of life measures decreased progressively until disability pension was granted and were then stabilised on a low level. During follow up 525 (7.6%) subjects died. Compared with subjects who did not become disability pensioners the hazards ratio was 2.78 among women and 3.43 among men, even when the effect of a number of other outcome affecting variables were taken into account. The mortality differences were not explained by underlying disease.

    Conclusions. The risk of disability pension may be predicted but only late in the course of events. Disability pensioners continue to have a high level of health care utilisation, and have a worse quality of life development and a higher mortality rate than non-pensioners. Given the unfavourable outcome of disability pension, other means of managing the reduced work capacity might be considered.

    List of papers
    1. Sick leave track record and other potential determinants of a disability pension: A population based study of 8,218 men and women followed for 16 years
    Open this publication in new window or tab >>Sick leave track record and other potential determinants of a disability pension: A population based study of 8,218 men and women followed for 16 years
    Show others...
    2009 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, p. 104-Article in journal (Refereed) Published
    Abstract [en]

    Background: A number of previous studies have investigated various  predictors for being granted a disability pension. The aim of this  study was to test the efficacy of sick-leave track record as a   predictor of being granted a disability pension in a large dataset   based on subjects sampled from the general population and followed for  a long time.  Methods: Data from five ongoing population-based Swedish studies was  used, supplemented with data on all compensated sick leave periods,  disability pensions granted, and vital status, obtained from official   registers. The data set included 8,218 men and women followed for 16   years, generated 109,369 person years of observation and 97,160  sickness spells. Various measures of days of sick leave during follow up were used as independent variables and disability pension grant was  used as outcome. Results: There was a strong relationship between individual sickness  spell duration and annual cumulative days of sick leave on the one hand  and being granted a disability pension on the other, among both men and   women, after adjustment for the effects of marital status, education,  household size, smoking habits, geographical area and calendar time   period, a proxy for position in the business cycle. The interval   between sickness spells showed a corresponding inverse relationship. Of   all the variables studied, the number of days of sick leave per year   was the most powerful predictor of a disability pension. For both men  and women 245 annual sick leave days were needed to reach a 50%  probability of transition to disability. The independent variables,  taken together, explained 96% of the variation in disability pension   grantings. Conclusion: The sick-leave track record was the most important  predictor of the probability of being granted a disability pension in  this study, even when the influences of other variables affecting the  outcome were taken into account.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-97611 (URN)10.1186/1471-2458-9-104 (DOI)000265928400002 ()19368715 (PubMedID)
    Available from: 2008-10-16 Created: 2008-10-16 Last updated: 2017-12-14Bibliographically approved
    2. Health care utilisation before and after retirement due to illness - A 13-year population-based follow-up study of prematurely retired men and referents from the general population
    Open this publication in new window or tab >>Health care utilisation before and after retirement due to illness - A 13-year population-based follow-up study of prematurely retired men and referents from the general population
    2004 (English)In: Scand J Prim Health Care, ISSN 0281-3432, Vol. 22, no 2, p. 95-100Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-97612 (URN)10.1080/02813430410005126 (DOI)
    Available from: 2008-10-16 Created: 2008-10-16 Last updated: 2011-01-17Bibliographically approved
    3. Quality of life measures among disability pensioners and referents in a longitudinal population-based study
    Open this publication in new window or tab >>Quality of life measures among disability pensioners and referents in a longitudinal population-based study
    Show others...
    (English)Article in journal (Refereed) Submitted
    Identifiers
    urn:nbn:se:uu:diva-97613 (URN)
    Available from: 2008-10-16 Created: 2008-10-16 Last updated: 2011-01-17Bibliographically approved
    4. The prognosis for individuals on disability retirement: an 18-year mortality follow-up study of 6887 men and women sampled from the general population
    Open this publication in new window or tab >>The prognosis for individuals on disability retirement: an 18-year mortality follow-up study of 6887 men and women sampled from the general population
    Show others...
    2006 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 6, no 103Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Several studies have shown a markedly higher mortality rate among disability pensioners than among non-retired. Since most disability pensions are granted because of non-fatal diseases the reason for the increased mortality therefore remains largely unknown. The aim of this study was to evaluate potential explanatory factors. METHODS: Data from five longitudinal cohort studies in Sweden, including 6,887 men and women less than 65 years old at baseline were linked to disability pension data, hospital admission data, and mortality data from 1971 until 2001. Mortality odds ratios were analyzed with Poisson regression and Cox's proportional hazards regression models. RESULTS: 1,683 (24.4%) subjects had a disability pension at baseline or received one during follow up. 525 (7.6%) subjects died during follow up. The subjects on disability pension had a higher mortality rate than the non-retired, the hazards ratio (HR) being 2.78 (95%CI 2.08-3.71) among women and 3.43 (95%CI 2.61-4.51) among men. HR was highest among individuals granted a disability pension at young ages (HR >7), and declined parallel to age at which the disability pension was granted. The higher mortality rate among the retired subjects was not explained by disability pension cause or underlying disease or differences in age, marital status, educational level, smoking habits or drug abuse. There was no significant association between reason for disability pension and cause of death. CONCLUSION: Subjects with a disability pension had increased mortality rates as compared with non-retired subjects, only modestly affected by adjustments for psycho-socio-economic factors, underlying disease, etcetera. It is unlikely that these factors were the causes of the unfavorable outcome. Other factors must be at work.

    Keywords
    Adult, Age Distribution, Disabled Persons/*statistics & numerical data, Female, Follow-Up Studies, Hospitalization/statistics & numerical data, Humans, Insurance; Disability/*utilization, Longitudinal Studies, Male, Middle Aged, Mortality, Odds Ratio, Pensions/classification/*statistics & numerical data, Poisson Distribution, Prognosis, Proportional Hazards Models, Research Support; Non-U.S. Gov't, Retirement/*statistics & numerical data, Survival Analysis, Sweden/epidemiology
    National Category
    General Practice
    Identifiers
    urn:nbn:se:uu:diva-83616 (URN)10.1186/1471-2458-6-103 (DOI)16630360 (PubMedID)
    Available from: 2007-03-21 Created: 2007-03-21 Last updated: 2018-01-13Bibliographically approved
  • 340.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Effekter och biverkningar av sjukskrivning: Vad åstadkommer vi med långtidssjukskrivning?2009In: Sjukskrivning på gott och ont:: Läkardagarna i Örebro 31 mars - 1 april 2009, Universitetssjukhuset Örebro, Wilandersalen / arrangeras av Örebro läkaresällskap i samarbete med Svenska läkaresällskapet, 2009, p. 39-45Conference paper (Other (popular science, discussion, etc.))
  • 341.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Leder förtidspension till för tidig död?: 18 års uppföljning av 6887 män och kvinnor från Eskilstuna, Göteborg och Uppsala2006In: Föredrag 8 i Allmänmedicin, 2006Conference paper (Other academic)
  • 342.
    Wallman, Thorne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Burell, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Kullman, Sven
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Health care utilisation before and after retirement due to illness - A 13-year population-based follow-up study of prematurely retired men and referents from the general population2004In: Scand J Prim Health Care, ISSN 0281-3432, Vol. 22, no 2, p. 95-100Article in journal (Refereed)
  • 343.
    Wallman, Thorne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Do disability pensioners have a higher mortality rate than non-pensioners? Adjusting for potential confounding: A commentary on Hult, Stattin, Janlert and Jarvholm2010In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, no 10, p. 1487-1488Article in journal (Other academic)
  • 344.
    Wallman, Thorne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Wedel, Hans
    Johansson, Saga
    Rosengren, Annika
    Eriksson, Henry
    Welin, Lennart
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    The prognosis for individuals on disability retirement: an 18-year mortality follow-up study of 6887 men and women sampled from the general population2006In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 6, no 103Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several studies have shown a markedly higher mortality rate among disability pensioners than among non-retired. Since most disability pensions are granted because of non-fatal diseases the reason for the increased mortality therefore remains largely unknown. The aim of this study was to evaluate potential explanatory factors. METHODS: Data from five longitudinal cohort studies in Sweden, including 6,887 men and women less than 65 years old at baseline were linked to disability pension data, hospital admission data, and mortality data from 1971 until 2001. Mortality odds ratios were analyzed with Poisson regression and Cox's proportional hazards regression models. RESULTS: 1,683 (24.4%) subjects had a disability pension at baseline or received one during follow up. 525 (7.6%) subjects died during follow up. The subjects on disability pension had a higher mortality rate than the non-retired, the hazards ratio (HR) being 2.78 (95%CI 2.08-3.71) among women and 3.43 (95%CI 2.61-4.51) among men. HR was highest among individuals granted a disability pension at young ages (HR >7), and declined parallel to age at which the disability pension was granted. The higher mortality rate among the retired subjects was not explained by disability pension cause or underlying disease or differences in age, marital status, educational level, smoking habits or drug abuse. There was no significant association between reason for disability pension and cause of death. CONCLUSION: Subjects with a disability pension had increased mortality rates as compared with non-retired subjects, only modestly affected by adjustments for psycho-socio-economic factors, underlying disease, etcetera. It is unlikely that these factors were the causes of the unfavorable outcome. Other factors must be at work.

  • 345.
    Wallman, Thorne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Wedel, Hans
    Palmer, Edward
    Johansson, Saga
    Rosengren, Annika
    Eriksson, Henry
    Welin, Lennart
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Quality of life measures among disability pensioners and referents in a longitudinal population-based studyArticle in journal (Refereed)
  • 346.
    Wallman, Thorne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Wedel, Hans
    Palmer, Edward
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Economics.
    Rosengren, Annika
    Johansson, Saga
    Eriksson, Henry
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Sick leave track record and other potential determinants of a disability pension: A population based study of 8,218 men and women followed for 16 years2009In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, p. 104-Article in journal (Refereed)
    Abstract [en]

    Background: A number of previous studies have investigated various  predictors for being granted a disability pension. The aim of this  study was to test the efficacy of sick-leave track record as a   predictor of being granted a disability pension in a large dataset   based on subjects sampled from the general population and followed for  a long time.  Methods: Data from five ongoing population-based Swedish studies was  used, supplemented with data on all compensated sick leave periods,  disability pensions granted, and vital status, obtained from official   registers. The data set included 8,218 men and women followed for 16   years, generated 109,369 person years of observation and 97,160  sickness spells. Various measures of days of sick leave during follow up were used as independent variables and disability pension grant was  used as outcome. Results: There was a strong relationship between individual sickness  spell duration and annual cumulative days of sick leave on the one hand  and being granted a disability pension on the other, among both men and   women, after adjustment for the effects of marital status, education,  household size, smoking habits, geographical area and calendar time   period, a proxy for position in the business cycle. The interval   between sickness spells showed a corresponding inverse relationship. Of   all the variables studied, the number of days of sick leave per year   was the most powerful predictor of a disability pension. For both men  and women 245 annual sick leave days were needed to reach a 50%  probability of transition to disability. The independent variables,  taken together, explained 96% of the variation in disability pension   grantings. Conclusion: The sick-leave track record was the most important  predictor of the probability of being granted a disability pension in  this study, even when the influences of other variables affecting the  outcome were taken into account.

  • 347. Wang, J X
    et al.
    Norman, R J
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    The effect of various infertility treatments on the risk of preterm birth2002In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 17, no 4, p. 945-949Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The high incidence of preterm birth (<37 weeks gestation) is a major concern in assisted reproductive technology. The objective of this study was to compare the risk of preterm birth from singleton pregnancies following either low technology treatment (intrauterine insemination and donor insemination) or high technology treatment (IVF, ICSI and gamete intra-Fallopian transfer) with that of naturally conceived pregnancies.

    METHODS:

    Three cohorts of pregnancies resulting from either low or high technology treatment or from natural conception were included in the study. A number of potential risk factors were adjusted for.

    RESULTS:

    The incidence of very preterm birth (<32 weeks of gestation) was not significantly increased in the low technology treatment group (1.0 versus 1.3% in controls) but was significantly higher in the high technology treatment group (5.2%, P < 0.001). In spontaneous, elective Caesarean section (CS) and induced delivery onset, the risk of preterm birth increased gradually from the controls to the low technology treatment group to the high technology treatment group, while for an emergency CS the risk of preterm birth was very high in both treatment groups.

    CONCLUSIONS:

    The overall incidence of preterm birth increased significantly from the controls to the low technology treatment group and to the high technology treatment group. Logistic regression analysis showed that younger and older age, previous perinatal death and emergency CS were associated with an increased risk, while a previous live birth reduced the risk. The length of the infertile period did not seem to affect the risk in any of the treatment groups.

  • 348. Wang, R
    et al.
    Yan, X
    Ma, X-Q
    Cao, Y
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Saga
    He, J
    Burden of gastroesophageal reflux disease in Shanghai, China2009In: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, ISSN 1878-3562, Vol. 41, no 2, p. 110-115Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Data on the impact of gastroesophageal reflux disease (GERD) on health-related quality of life (HRQL) in Asian countries are scarce.

    AIM

    This study evaluated the impact of GERD on HRQL in Shanghai, China.

    SUBJECTS

    One thousand two hundred adult inhabitants of Shanghai, selected using randomized cluster sampling.

    METHODS

    Participants completed Mandarin versions of the Reflux Disease Questionnaire (RDQ), GERD impact scale, quality of life in reflux and dyspepsia (QOLRAD) questionnaire and short-form-36 (SF-36). GERD was defined as heartburn and/or regurgitation of any frequency during the 1-week recall period of the RDQ. A clinically meaningful impairment of HRQL was defined as a statistically significant decrease of >or=0.5 points in a QOLRAD dimension or >or=5 points in an SF-36 dimension.

    RESULTS

    Overall, 1034 subjects completed the survey (86.2% response rate); 919 responses were suitable for analysis. The prevalence of GERD was 6.2%. GERD was associated with meaningfully impaired HRQL in the QOLRAD dimensions of vitality, eating/drinking and emotional well-being, but not sleep or physical/social functioning, and in all SF-36 dimensions except social functioning. Respondents with GERD experienced eating and drinking problems (47%), sleep impairment (32%) and reduced work productivity (32%).

    CONCLUSION

    GERD has a clinically meaningful impact on HRQL in Shanghai, China.

  • 349. Welin, Lennart
    et al.
    Adlerberth, Annika
    Caidahl, Kenneth
    Eriksson, Henry
    Hansson, Per-Olof
    Johansson, Saga
    Rosengren, Annika
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Welin, Catharina
    Wilhelmsen, Lars
    Prevalence of cardiovascular risk factors and the metabolic syndrome in middle-aged men and women in Gothenburg, Sweden2008In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 8, p. 403-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Random samples of 50-year-old men living in Gothenburg have been examined every 10th year since 1963 with a focus on cardiovascular risk factors. The aims of the study were to acquire up-to-date information about risk factors in the fifth cohort of 50-year-old men and women, to re-examine those who were 50 years of age in 1993, and to analyse the prevalence of the metabolic syndrome (MetSyn) using different definitions.

    METHODS

    A random sample of men and women born in 1953 were examined in 2003-2004 for cardiovascular risk factors. Men born in 1943 and that participated in the examination in 1993 were also invited. Descriptive statistics were calculated.

    RESULTS

    The participation rate among men and women born in 1953 was 60 and 67% respectively. Among men born in 1943, the participation rate was 87%. The prevalence of obesity was from 15 to 17% (body mass index, BMI >or= 30) in the three samples. The prevalence of known diabetes was 4% among the 50-year-old men and 6% among the 60-year-old men, and 2% among the women. Increased fasting plasma glucose varied substantially from 4 to 33% depending on cut-off level and gender. Mean cholesterol was 5.4 to 5.5 mmol/l. Smoking was more common among women aged 50 (26%) than among men aged 50 (22%) and 60 years (15%). The prevalence of the MetSyn varied with the definition used: from 10 to 15.8% among the women, from 16.1 to 26% among 50-year-old men, and from 19.9 to 35% among the 60-year-old men. Only 5% of the men and women had no risk factors.

    CONCLUSION

    This study provides up-to-date information about the prevalence of cardiovascular risk factors and the MetSyn in middle-aged Swedish men and women. Different definitions of the MetSyn create confusion regarding which definition to use.

  • 350. Welin, Lennart
    et al.
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Elmfeldt, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Säkerhetsutvärdering av Plendil i kliniska hypertoniprövningar: bakgrund, säkerhetsmetodologi och resultat1997In: Hässle Information, ISSN 0346-9751, Vol. 6, p. 11-17Article in journal (Other academic)
45678 301 - 350 of 356
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