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  • 401.
    Lindberg, Per
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Karlsson, Thomas
    Strömberg, Annika
    Gustafsson, Susanne
    Anderzen, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Can a systematic participative method for processing workplace survey data enhance organizational communication skills?: Experience from the GodA-project for healthy workplaces2015Inngår i: Proceedings 19thTriennial Congress of the IEA, 2015Konferansepaper (Fagfellevurdert)
  • 402. Lindbäck, Camilla
    et al.
    Nordgren, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Mälardalens högskola.
    To be on sick-leave due to heart failure: a qualitative perspective2015Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, nr 18-19, s. 1732-1738Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: The aim of the present study was to explore and describe meanings of being on sick leave due to heart failure.

    Methods: The study was conducted in Sweden during 2011-2012. Five men and one woman, aged 46 to 62, were interviewed. A reflective life-world research approach based on phenomenological philosophy was used. The result of the analysis is presented in three themes.

    Results: To be on sick leave due to heart failure implies a life situation characterized by anxiety, insecurity and uncertainty. When rehabilitation professionals do not take on their professional responsibility, sick listed people with heart failure perceive they are dismissed and abandoned. If rehabilitation professionals take on their professional responsibility it can be experienced as supportive.

    Conclusions: People who are on sick leave due to heart failure are abandoned by rehabilitation professionals and they lack opportunities to participate in their own sick leave/rehabilitation processes. Rehabilitation professionals need to take more responsibility and allow the patients to participate by connecting and recognizing patients as equal human beings. The present results can be used by rehabilitation professionals to reflect on and discuss the needs of people on sick leave due to heart failure. Implications for Rehabilitation Heart failure is a chronic condition implying a complicated life-situation. People with heart failure experience abandonment by rehabilitation professionals and lack participation in their own rehabilitation process. In order to support people on sick leave due to heart failure collaboration and coordination between rehabilitation professionals are needed.

  • 403.
    Lindgren, Anne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. anne.lindgren@pubcare.uu.se.
    Pregnancy-related low back and pelvic girdle pain: with reference to joint hypermobility and treatment2020Licentiatavhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Objectives: To explore if joint mobility, as a measure of connective tissue quality, could be a predictor for pregnancy-related low back pain after pregnancy and to evaluate local corticosteroid injection treatment in women with persistent pelvic girdle pain long after childbirth.

    Material and methods: To investigate joint mobility in relation to pain, 200 women were examined repeatedly from early pregnancy until three months after delivery. Their mobility in left fourth finger abduction in early pregnancy was compared with clinically assessed low back and pelvic pain 3 months after delivery. To evaluate local corticosteroid injection treatment, 36 women with persistent PGP were included in a randomised controlled trial (RCT) and randomised to either corticosteroid injection or saline injection on one occasion at the ischial spine bilaterally, with a follow-up after four weeks. In both studies, the women were asked about obstetric history, to complete a pain drawing, estimate their level of pain on a visual analogue scale (0-100) and estimate how they manage their everyday activities on a questionnaire, Disability Rating Index (DRI). In the RCT, the 36 women also completed Short Form 36 (SF-36), a quality of life questionnaire, six-minute walk test (6MWT), and isometric trunk flexion and extension were examined.

    Results: Women with low back and pelvic pain three months after pregnancy had increased finger laxity in early pregnancy. The larger the finger angle and the more pregnancies, the greater the risk of low back and pelvic pain after pregnancy. In the RCT, at follow-up, the women who received corticosteroid injection treatment improved in walking ability, estimated physical ability and isometric trunk extension more than those who received saline injections.

    Conclusions: Increased joint mobility, as measured by finger joint mobility, together with the number of previous pregnancies, may be an indicator of low back and pelvic pain postpartum. One single corticosteroid injection treatment to intra-pelvic structures improved function in women with persistent PGP which may indicate a source of pain.

    Delarbeid
    1. Finger joint laxity, number of previous pregnancies and pregnancy induced back pain in a cohort study.
    Åpne denne publikasjonen i ny fane eller vindu >>Finger joint laxity, number of previous pregnancies and pregnancy induced back pain in a cohort study.
    2014 (engelsk)Inngår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, s. 61-Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    BACKGROUND: General joint hypermobility is estimated to affect about 10% of the population and is a prerequisite of heritable connective tissue disorders where fragile connective tissue is a prominent feature. Pregnancy induced back pain is common whereas about 10% of women still have disabling pain several years after childbirth. The pathogenesis of the pain condition is uncertain, although several risk factors are suggested including general joint hypermobility. In the present study, the possible association of peripheral joint mobility in early pregnancy on the incidence of back pain with onset during pregnancy and persisting after childbirth was explored.

    METHODS: A cohort of 200 pregnant women recruited from antenatal health care clinics was assessed by questionnaire and clinical examination, including measurement of passive abduction of the left fourth finger, throughout pregnancy and at 13 weeks postpartum. Comparisons were made between women with and without back pain. Statistical tests used were χ2-test, t-test, Spearman correlation and multiple logistic regression.

    RESULTS: In the cohort, the mean passive abduction angle of the left fourth finger increased from 40.1° in early pregnancy to 41.8° at the postpartum appointment. At the postpartum appointment, women in the back pain group had a significantly larger mean passive abduction angle of the left fourth finger of 4.4°, twice as many previous pregnancies and deliveries, and more than twice as frequent back pain in previous pregnancy, as compared with women with no persistent back pain. A similar pattern was displayed in late pregnancy. In a multiple regression analysis, the passive abduction angle of the left fourth finger in early pregnancy and the number of previous pregnancies were positively, significantly and independently associated to the incidence of back pain in late pregnancy and postpartum.

    CONCLUSIONS: Finger joint laxity as a reflection of constitutional weakness of connective tissue and number of previous pregnancies were associated with the development of back pain induced in pregnancy and persisting after childbirth. These factors may provide a foundation for development of targeted prevention strategies, but this have to be confirmed in future research including measurement of general joint laxity.

    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-220444 (URN)10.1186/1471-2393-14-61 (DOI)000331221200002 ()24507564 (PubMedID)
    Tilgjengelig fra: 2014-03-14 Laget: 2014-03-14 Sist oppdatert: 2019-12-06bibliografisk kontrollert
    2. Improved function in women with persistent pregnancy-related pelvic pain after a single corticosteroid injection to the ischiadic spine: a randomized double blind controlled trial
    Åpne denne publikasjonen i ny fane eller vindu >>Improved function in women with persistent pregnancy-related pelvic pain after a single corticosteroid injection to the ischiadic spine: a randomized double blind controlled trial
    2013 (engelsk)Inngår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 29, nr 5, s. 371-378Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Background: Pregnancy-related low back and pelvic pain is a worldwide problem. A large proportion of women still experience disabling daily back pain 2 years after childbirth, resulting in major changes in activities and general well-being. In spite of this, the source of pain and effective treatment are uncertain. Objective: To evaluate the short-term effects on function of a single corticosteroid injection treatment to the ischiadic spine in women with persistent pregnancy-related pelvic pain (PPPP). Methods: Thirty-six women were allocated to injection treatment with slow-release triamcinolone and lidocain or saline and lidocain, given once at the sacrospinous ligament insertion on the ischiadic spine bilaterally with follow-up at 4 weeks. Outcome measures were Disability Rating Index (DRI), self-rated functional health (SF-36), gait speed and endurance (6MWT), and strength and endurance of trunk muscles (isometric trunk extensor and flexor tests). Results: Women in the triamcinolone group showed significantly improved DRI (p  =  0.046), 6MWT (p  =  0.016), and isometric trunk extensor tests (p  =  0.004), as compared with the saline group. Close co-variation was shown between improved function and reduced pain intensity. Conclusions: Improved function was achieved among women with PPPP after a single injection treatment with slow-release corticosteroid. The effect was positively correlated to the reduced pain intensity.

    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-191351 (URN)10.3109/09593985.2012.734009 (DOI)000319577000003 ()23713407 (PubMedID)
    Tilgjengelig fra: 2013-01-10 Laget: 2013-01-10 Sist oppdatert: 2019-12-06bibliografisk kontrollert
  • 404.
    Lindgren, Anne
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Kristiansson, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Finger joint laxity, number of previous pregnancies and pregnancy induced back pain in a cohort study.2014Inngår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, s. 61-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: General joint hypermobility is estimated to affect about 10% of the population and is a prerequisite of heritable connective tissue disorders where fragile connective tissue is a prominent feature. Pregnancy induced back pain is common whereas about 10% of women still have disabling pain several years after childbirth. The pathogenesis of the pain condition is uncertain, although several risk factors are suggested including general joint hypermobility. In the present study, the possible association of peripheral joint mobility in early pregnancy on the incidence of back pain with onset during pregnancy and persisting after childbirth was explored.

    METHODS: A cohort of 200 pregnant women recruited from antenatal health care clinics was assessed by questionnaire and clinical examination, including measurement of passive abduction of the left fourth finger, throughout pregnancy and at 13 weeks postpartum. Comparisons were made between women with and without back pain. Statistical tests used were χ2-test, t-test, Spearman correlation and multiple logistic regression.

    RESULTS: In the cohort, the mean passive abduction angle of the left fourth finger increased from 40.1° in early pregnancy to 41.8° at the postpartum appointment. At the postpartum appointment, women in the back pain group had a significantly larger mean passive abduction angle of the left fourth finger of 4.4°, twice as many previous pregnancies and deliveries, and more than twice as frequent back pain in previous pregnancy, as compared with women with no persistent back pain. A similar pattern was displayed in late pregnancy. In a multiple regression analysis, the passive abduction angle of the left fourth finger in early pregnancy and the number of previous pregnancies were positively, significantly and independently associated to the incidence of back pain in late pregnancy and postpartum.

    CONCLUSIONS: Finger joint laxity as a reflection of constitutional weakness of connective tissue and number of previous pregnancies were associated with the development of back pain induced in pregnancy and persisting after childbirth. These factors may provide a foundation for development of targeted prevention strategies, but this have to be confirmed in future research including measurement of general joint laxity.

  • 405.
    Lindgren, Anne
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Torstensson, Thomas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Kristiansson, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Kan laserbehandling hjälpa vid kvarstående foglossning/bäckensmärta?: En randomiserad kontrollerad trippelblind studie2015Annet (Annet (populærvitenskap, debatt, mm))
  • 406.
    Lindh, Annika
    et al.
    Örebro Univ, Fac Med & Hlth, Sch Hlth Sci, Örebro, Sweden; Cty Council Värmland, Clin Res Ctr, Karlstad, Sweden.
    Theander, Kersti
    Cty Council Värmland, Clin Res Ctr, Karlstad, Sweden.
    Arne, Mats
    Cty Council Värmland, Clin Res Ctr, Karlstad, Sweden.
    Lisspers, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Lundh, Lena
    Acad Primary Hlth Care Ctr, Stockholm, Sweden; Karolinska Inst, Div Family Med & Primary Care, NVS, Stockholm, Sweden.
    Sandelowsky, Hanna
    Acad Primary Hlth Care Ctr, Stockholm, Sweden; Karolinska Inst, Div Family Med & Primary Care, NVS, Stockholm, Sweden.
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Adolfsson, Eva Thors
    Reg Västmanland, Primary Hlth Care, Västerås, Sweden.
    Westerdahl, Elisabeth
    Örebro Univ, Fac Med & Hlth, Sch Hlth Sci, Örebro, Sweden.
    Zakrisson, Ann-Britt
    Örebro Univ, Fac Med & Hlth, Univ Healthcare Res Ctr, Örebro, Sweden.
    Description of inhalation technique in patients with COPD in primary care2018Inngår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Artikkel i tidsskrift (Annet vitenskapelig)
  • 407. Lindh, Annika
    et al.
    Theander, Kersti
    Arne, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Lisspers, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Lundh, Lena
    Sandelowsky, Hanna
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna.
    Westerdahl, Elisabeth
    Zakrisson, Ann-Britt
    Errors in inhaler use related to devices and to inhalation technique among patients with chronic obstructive pulmonary disease in primary health care.2019Inngår i: Nursing open, ISSN 2054-1058, Vol. 6, nr 4, s. 1519-1527Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: The aim of this study was to describe inhaler use in primary health care patients with chronic obstructive pulmonary disease (COPD) and to categorize these patients into those making errors related to devices, those making errors related to inhalation technique and those making errors related to both.

    Design: Observational study.

    Methods: COPD nurses used a checklist to assess the use of inhalers by patients with spirometry-verified COPD (N = 183) from primary healthcare centres. The STROBE checklist has been used.

    Results: The mean age of the patients was 71 (SD 9) years. Almost half of them (45%) made at least one error; of these, 50% made errors related to devices, 31% made errors related to inhalation technique and 19% made errors related both to devices and to inhalation technique.

  • 408.
    Lindmark, K.
    et al.
    Umea Univ Hosp, Dept Publ Hlth & Clin Med, Umea, Sweden;Umea Univ Hosp, Ctr Heart, Umea, Sweden.
    Boman, K.
    Skelleftea Cty Hosp, Dept Publ Hlth & Clin Med, Res Unit, Med Geriatr, Umea, Sweden.
    Olofsson, M.
    Skelleftea Cty Hosp, Dept Publ Hlth & Clin Med, Res Unit, Med Geriatr, Umea, Sweden.
    Wirta, S. Bruce
    Novartis Sweden AB, Stockholm, Sweden.
    Proenca, C. C.
    Wellmera AG, Basel, Switzerland.
    Levine, A.
    IQVIA, Solna, Sweden.
    Castelo-Branco, A.
    IQVIA, Solna, Sweden.
    Stålhammar, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Wikström, Gerhard
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Increased all-cause mortality in newly diagnosed patients with heart failure between 2006 and 2012: a retrospective, population-based study in Sweden2018Inngår i: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 20, nr S1, s. 6-6Artikkel i tidsskrift (Annet vitenskapelig)
  • 409.
    Lindmark, Krister
    et al.
    Umea Univ Hosp, Dept Publ Hlth & Clin Med, S-90187 Umea, Sweden;Umea Univ Hosp, Heart Ctr, S-90187 Umea, Sweden.
    Boman, Kurt
    Umea Univ, Res Unit, Med Geriatr, Skelleftea Cty Hosp,Dept Publ Hlth & Clin Med, Umea, Sweden.
    Olofsson, Mona
    Umea Univ, Res Unit, Med Geriatr, Skelleftea Cty Hosp,Dept Publ Hlth & Clin Med, Umea, Sweden.
    Tornblom, Michael
    IQVIA, Real World & Analyt Solut, Solna, Sweden.
    Levine, Aaron
    IQVIA, Real World & Analyt Solut, Solna, Sweden.
    Castelo-Branco, Anna
    IQVIA, Real World & Analyt Solut, Solna, Sweden.
    Schlienger, Raymond
    Novartis Pharma AG, Quantitat Safety & Epidemiol, Basel, Switzerland.
    Wirta, Sara Bruce
    Novartis Sweden AB, Global RWE Cardiometabol, Stockholm, Sweden.
    Stålhammar, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Wikström, Gerhard
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Epidemiology of heart failure and trends in diagnostic work-up: a retrospective, population-based cohort study in Sweden2019Inngår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 11, s. 231-244Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: The purpose of this study was to examine the trends in heart failure (HF) epidemiology and diagnostic work-up in Sweden.

    Methods: Adults with incident HF (>= 2 ICD-10 diagnostic codes) were identified from linked national health registers (cohort 1, 2005-2013) and electronic medical records (cohort 2, 2010-2015; primary/secondary care patients from Uppsala and Vasterbotten). Trends in annual HF incidence rate and prevalence, risk of all-cause and cardiovascular disease (CVD)-related 1-year mortality and use of diagnostic tests 6 months before and after first HF diagnosis (cohort 2) were assessed.

    Results: Baseline demographic and clinical characteristics were similar for cohort 1 (N=174,537) and 2 (N=8,702), with mean ages of 77.4 and 76.6 years, respectively; almost 30% of patients were aged >= 85 years. From 2010 to 2014, age-adjusted annual incidence rate of HF/1,000 inhabitants decreased (from 3.20 to 2.91, cohort 1; from 4.34 to 3.33, cohort 2), while age-adjusted prevalence increased (from 1.61% to 1.72% and from 2.15% to 2.18%, respectively). Age-adjusted 1-year all-cause and CVD-related mortality was higher in men than in women among patients in cohort 1 (all-cause mortality hazard ratio [HR] men vs women 1.07 [95% CI 1.06-1.09] and CVD-related mortality subdistribution HR for men vs women 1.04 [95% CI 1.02-1.07], respectively). While 83.5% of patients underwent N-terminal pro-B-type natriuretic peptide testing, only 36.4% of patients had an echocardiogram at the time of diagnosis, although this increased overtime. In the national prevalent HF population (patients with a diagnosis in 1997-2004 who survived into the analysis period; N=273,999), death from ischemic heart disease and myocardial infarction declined between 2005 and 2013, while death from HF and atrial fibrillation/flutter increased (P<0.0001 for trends over time).

    Conclusion: The annual incidence rate of HF declined over time, while prevalence of HF has increased, suggesting that patients with HF were surviving longer over time. Our study confirms that previously reported epidemiological trends persist and remain to ensure proper diagnostic evaluation and management of patients with HF.

  • 410.
    Linnman, Clas
    et al.
    Harvard Med Sch, Boston Childrens Hosp, Dept Anesthesiol Perioperat & Pain Med, Ctr Pain & Brain, Boston, MA USA..
    Catana, Ciprian
    Harvard Med Sch, Massachusetts Gen Hosp, Martinos Ctr Biomed Imaging, Boston, MA USA..
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Appel, Lieuwe
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Engler, Henry
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi. Univ Republica, Uruguayan Ctr Mol Imaging CUDIM, Fac Med, Montevideo, Uruguay.;Univ Republica, Fac Sci, Montevideo, Uruguay..
    Långström, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi. Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Kemiska sektionen, Institutionen för kemi - BMC, Organisk kemi. Imperial Coll, Fac Med, Neuropsychopharmacol Sect, London, England..
    Sörensen, Jens
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Furmark, Tomas
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Fredrikson, Mats
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Borsook, David
    Harvard Med Sch, Boston Childrens Hosp, Dept Anesthesiol Perioperat & Pain Med, Ctr Pain & Brain, Boston, MA USA..
    Peterson, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Decreased Brain Neurokinin-1 Receptor Availability in Chronic Tennis Elbow2016Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 9, artikkel-id e0161563Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Substance P is released in painful and inflammatory conditions, affecting both peripheral processes and the central nervous system neurokinin 1 (NK1) receptor. There is a paucity of data on human brain alterations in NK1 expression, how this system may be affected by treatment, and interactions between central and peripheral tissue alterations. Ten subjects with chronic tennis elbow (lateral epicondylosis) were selected out of a larger (n = 120) randomized controlled trial evaluating graded exercise as a treatment for chronic tennis elbow (lateral epicondylosis). These ten subjects were examined by positron emission tomography (PET) with the NK1-specific radioligand 11C-GR205171 before, and eight patients were followed up after treatment with graded exercise. Brain binding in the ten patients before treatment, reflecting NK1-receptor availability (NK1-RA), was compared to that of 18 healthy subjects and, longitudinally, to the eight of the original ten patients that agreed to a second PET examination after treatment. Before treatment, patients had significantly lower NK1-RA in the insula, vmPFC, postcentral gyrus, anterior cingulate, caudate, putamen, amygdala and the midbrain but not the thalamus and cerebellum, with the largest difference in the insula contralateral to the injured elbow. No significant correlations between brain NK1-RA and pain, functional severity, or peripheral NK1-RA in the affected limb were observed. In the eight patients examined after treatment, pain ratings decreased in everyone, but there were no significant changes in NK1-RA. These findings indicate a role for the substance P (SP) / NK1 receptor system in musculoskeletal pain and tissue healing. As neither clinical parameters nor successful treatment response was reflected in brain NK1-RA after treatment, this may reflect the diverse function of the SP/NK1 system in CNS and peripheral tissue, or a change too small or slow to capture over the three-month treatment.

  • 411.
    Lisspers, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Larsson, Kjell
    Karolinska Inst, Dept Environm Med, Stockholm, Sweden..
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Telg, Gunilla
    AstraZeneca Nord Balt, Sodertalje, Sweden..
    Thuresson, Marcus
    Statisticon AB, Uppsala, Sweden..
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Comorbidity, disease burden and mortality across age groups in a Swedish primary care asthma population: An epidemiological register study (PACEHR)2018Inngår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 136, s. 15-20Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:

    Asthma is often associated with other diseases. To identify and manage comorbidities is important, as these conditions may increase the disease burden.

    Objective:

    To describe the prevalence of comorbidities, disease burden and mortality across age groups in a large Swedish primary care real-life asthma population.

    Methods:

    Observational cohort study of asthma patients, all ages, identified from electronic medical records by ICD-10-CM code, data from 36 primary care centers. Data were linked to national mandatory Swedish health registers. Comorbidities were identified by ICD-10-CM codes and collected from electronic medical records and the National Patient Registers, mortality data from the Cause of Death Register. Exacerbations were defined as hospitalizations due to asthma, and/or emergency visits at hospital and/or prescription claims of oral steroids.

    Results:

    In total 33,468 patients ( 58% women) were included. The most prevalent comorbidities were acute upper respiratory tract infection ( 53%), rhinitis ( 25%), acute lower respiratory tract infection ( 25%), hypertension ( 21%), anxiety and depression ( 20%). The comorbidities associated with highest risk for an exacerbation were COPD OR 1.98 ( 95% CI: 1.80-2.19), nasal polyps OR 1.75 ( 95% CI: 1.49-2.05) and rhinitis OR 1.52 ( 95% CI: 1.41-1.63). All-cause mortality was similar to the Swedish population, 1011 deaths per 100,000 person/year compared with 1058 deaths ( standardized risk=0.99 [ 95% CI: 0.95-1.04]). The pulmonary related death rate was greater in the study population versus the Swedish population ( 122 versus 72 per 100,000person/year).

    Conclusion:

    Comorbid disease was frequent in this large real-life asthma population with an impact on exacerbations. To identify and treat comorbidities with impact on asthma outcomes are essential to improve

  • 412.
    Lisspers, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Jansson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Larsson, Kjell
    Stratelis, Georgios
    Hedegaard, Morten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Improvement in COPD management by access to asthma/COPD clinics in primary care: Data from the observational PATHOS study2014Inngår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 108, nr 9, s. 1345-1354Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Chronic obstructive pulmonary disease (COPD) guidelines emphasize the importance of patient education to improve quality of life and avoid exacerbations. Longitudinal evaluations of structured management of COPD in primary care are lacking. Aim: To evaluate the impact of primary care asthma/COPD clinics on exacerbations, hospitalizations, and associated costs in COPD. Methods: This population-based, retrospective, observational study, linking primary care medical records data to mandatory Swedish national registries, included patients with COPD from 76 primary healthcare centers (1999-2009). A questionnaire on access to an asthma/COPD clinic was retrospectively answered. Propensity score matching was performed at index (COPD diagnosis) by center type (with and without an asthma/COPD clinic). Poisson regression was used to compare the yearly rate of exacerbations (hospitalization, emergency visits, or prescription for oral steroids or antibiotics) and COPD-related prescriptions at the centers. An economic analysis was performed from the Swedish healthcare perspective using 2011 unit costs and the incremental cost-effectiveness ratio was calculated. Results: The study included 21,361 patients (mean age, 68.0 years; 53% female). Access to asthma/COPD clinics increased from 34% to 85% during the study period. Patients at primary healthcare centers with asthma/COPD clinics had 27% fewer exacerbations (0.71 vs. 0.98) and 37% fewer hospitalizations annually (0.36 vs. 0.58) (p < 0.0001). Asthma/COPD clinics reduced the annual cost of medication and healthcare contacts by 37% (SEK 52,892 [(sic)5858] to SEK 33,410 [(sic)3700] per patient). Conclusions: Patients at primary healthcare centers with asthma/COPD clinics experienced fewer COPD exacerbations and hospitalizations, and overall treatment costs were substantially reduced. ClinicalTrials.gov identifier: NCT01146392. (C) 2014 The Authors. Published by Elsevier Ltd.

  • 413.
    Lisspers, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Larsson, K.
    Karolinska Inst, Solna, Sweden..
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Gutzwiller, F. S.
    Novartis Pharma AG, Basel, Switzerland..
    Mezzi, K.
    Novartis Pharma AG, Basel, Switzerland..
    Uhde, M.
    QuintilesIMS, Stockholm, Sweden..
    Jorgensen, L.
    QuintilesIMS, Copenhagen, Denmark..
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Extent And Impact Of Late Versus Early COPD Diagnosis In Women In The Swedish Arctic Study2017Inngår i: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 195, artikkel-id A4705Artikkel i tidsskrift (Annet vitenskapelig)
  • 414.
    Lisspers, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Larsson, Kjell
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna.
    Tsiligianni, Ioanna
    Gutzwiller, Florian S
    Mezzi, Karen
    Bjerregaard, Bine Kjoeller
    Jorgensen, Leif
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Gender differences among Swedish COPD patients: results from the ARCTIC, a real-world retrospective cohort study.2019Inngår i: NPD Bulletin, ISSN 1892-8110, E-ISSN 2055-1010, Vol. 29, nr 1, artikkel-id 45Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The present study aimed to generate real-world evidence regarding gender differences among chronic obstructive pulmonary disease (COPD) patients, especially as regards the diagnosis and outcomes in order to identify areas for improvement and management and optimize the associated healthcare resource allocation. ARCTIC is a large, real-world, retrospective cohort study conducted in Swedish COPD patients and a matched reference population from 52 primary care centers in 2000-2014. The incidence of COPD, prevalence of asthma and other comorbidities, risk of exacerbations, mortality rate, COPD drug prescriptions, and healthcare resource utilization were analyzed. In total, 17,479 patients with COPD were included in the study. During the study period, COPD was more frequent among women (53.8%) and women with COPD experienced more exacerbations vs. men (6.66 vs. 4.66). However, the overall mortality rate was higher in men compared with women (45% vs. 38%), but no difference for mortality due to COPD was seen between genders over the study period. Women seemed to have a greater susceptibility to asthma, fractures, osteoporosis, rheumatoid arthritis, rhinitis, depression, and anxiety, but appeared less likely to have diabetes, kidney diseases, and cardiovascular diseases. Furthermore, women had a greater risk of COPD-related hospitalization and were likely to receive a significantly higher number of COPD drug prescriptions compared with men. These results support the need to reduce disease burden among women with COPD and highlight the role of healthcare professionals in primary care who should consider all these parameters in order to properly diagnose and treat women with COPD.

  • 415.
    Lisspers, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Larsson, Kjell
    Karolinska Inst, Natl Inst Environm Med, Dept Work Environm Toxicol, Solna, Sweden..
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Costa-Scharplatz, Madlaina
    Novartis AB, Taby, Sweden..
    Gruenberger, Jean-Bernard
    Novartis, Basel, Switzerland..
    Uhde, Milica
    IQVIA, Solna, Sweden..
    Jorgensen, Leif
    IQVIA, Copenhagen, Denmark..
    Gutzwiller, Florian S.
    Novartis, Basel, Switzerland..
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Economic burden of COPD in a Swedish cohort: the ARCTIC study2018Inngår i: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 13, s. 275-285Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: We assessed direct and indirect costs associated with COPD in Sweden and examined how these costs vary across time, age, and disease stage in a cohort of patients with COPD and matched controls in a real-world, primary care (PC) setting.

    Patients and methods: Data from electronic medical records linked to the mandatory national health registers were collected for COPD patients and a matched reference population in 52 PC centers from 2000 to 2014. Direct health care costs (drug, outpatient or inpatient, PC, both COPD related and not COPD related) and indirect health care costs (loss of income, absenteeism, loss of productivity) were assessed.

    Results: A total of 17,479 patients with COPD and 84,514 reference controls were analyzed. During 2013, direct costs were considerably higher among the COPD patient population ((sic)13,179) versus the reference population ((sic)2,716), largely due to hospital nights unrelated to COPD. Direct costs increased with increasing disease severity and increasing age and were driven by higher respiratory drug costs and non-COPD-related hospital nights. Indirect costs (similar to(sic)28,000 per patient) were the largest economic burden in COPD patients of working age during 2013.

    Conclusion: As non-COPD-related hospital nights represent the largest direct cost, management of comorbidities in COPD would offer clinical benefits and relieve the financial burden of disease.

  • 416.
    Lisspers, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Sex-differences in quality of life and asthma control in Swedish asthma patients2013Inngår i: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 50, nr 10, s. 1090-1095Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: To study sex-related differences in quality of life, asthma control and asthma management in different age groups. Methods: A cross-sectional survey and patient record study in primary and secondary care. A total of 1226 patients in primary and 499 in secondary care, ages 18-75 and randomly selected, with a response rate of 71%. Patients were classified into four groups, 18-34, 35-49, 50-64 and 65-75 years. Results: Younger women (18-49 years) had a lower total MiniAQLQ score than men in the same age group (5.41 vs. 5.80, p<0.001), while no significant difference was found between older women and men (50-75 years) (5.08 vs. 5.16, p = 0.42). The sex differences in the younger group remained significant after adjusting for medication, educational level, smoking, body mass index, allergy and depression (p = 0.008). The odds ratios for younger women to have night-awakenings was 1.7 (95% CI 1.07-2.57), for asthma exacerbations 1.9 (95% CI 1.21-2.98) and for not achieving asthma control 1.5 (95% CI 1.00-2.13) when adjusting for smoking, educational level and body mass index. No differences in asthma control were found when comparing older women with men of similar ages. Conclusions: Younger women had lower quality of life and less often asthma control than men in the same age range, while no corresponding sex differences were found between older women and men of similar ages. Female sex hormones could be an important factor affecting these outcomes.

  • 417.
    Lisspers, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Teixeira, Pedro
    Univ Minho, Sch Hlth Sci, Life & Hlth Sci Res Inst ICVS, ICVS PT Govt Associate Lab 3Bs, Braga, Portugal..
    Blom, Coert
    Radboud Univ Nijmegen, Dept Primary & Community Care, NL-6525 ED Nijmegen, Netherlands..
    Kocks, Janwillem
    Univ Groningen, Univ Med Ctr Groningen, Dept Gen Practice, Groningen, Netherlands.;Univ Groningen, Univ Med Ctr Groningen, GRIAC Res Inst Groningen, Groningen, Netherlands..
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Price, David
    Univ Aberdeen, Div Appl Hlth Sci, Acad Primary Care, Aberdeen, Scotland..
    Chavannes, Niels
    Leiden Univ, Med Ctr, Publ Hlth & Primary Care, Leiden, Netherlands..
    Are pharmacological randomised controlled clinical trials relevant to real-life asthma populations?: A protocol for an UNLOCK study from the IPCRG2016Inngår i: NPD Bulletin, ISSN 1892-8110, E-ISSN 2055-1010, Vol. 26, artikkel-id 16016Artikkel i tidsskrift (Fagfellevurdert)
  • 418. Lofvenborg, J. E.
    et al.
    Andersson, T.
    Carlsson, Per-Ola
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Transplantation och regenerativ medicin.
    Dorkhan, M.
    Groop, L.
    Martinell, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Rasouli, B.
    Storm, P.
    Tuomi, T.
    Carlsson, S.
    Coffee consumption and the risk of latent autoimmune diabetes in adults-results from a Swedish case-control study2014Inngår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 31, nr 7, s. 799-805Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims Coffee consumption is associated with a reduced risk of Type2 diabetes. Our aim was to investigate if coffee intake may also reduce the risk of latent autoimmune diabetes in adults, an autoimmune form of diabetes with features of Type2 diabetes. Methods We used data from a population-based case-control study with incident cases of adult onset (35years) diabetes, including 245 cases of latent autoimmune diabetes in adults (glutamic acid decarboxylase antibody positive), 759 cases of Type2 diabetes (glutamic acid decarboxylase antibody negative), together with 990 control subjects without diabetes, randomly selected from the population. Using questionnaire information on coffee consumption, we estimated the odds ratio of latent autoimmune diabetes in adults and Type2 diabetes adjusted for age, sex, BMI, smoking, physical activity, alcohol, education and family history of diabetes. Results Coffee intake was inversely associated with Type2 diabetes (odds ratio0.92, 95%CI 0.87-0.98 per cup/day). With regard to latent autoimmune diabetes in adults, the general trend was weak (odds ratio1.04, 95%CI 0.96-1.13), but stratification by degree of autoimmunity (median glutamic acid decarboxylase antibody levels) suggested that coffee intake may be associated with an increased risk of high glutamic acid decarboxylase antibody latent autoimmune diabetes in adults (odds ratio1.11, 95%CI 1.00-1.23 per cup/day). Furthermore, for every additional cup of coffee consumed per day, there was a 15.2% (P=0.0268) increase in glutamic acid decarboxylase antibody levels. Conclusions Our findings confirm that coffee consumption is associated with a reduced risk of Type2 diabetes. Interestingly, the findings suggest that coffee may be associated with development of autoimmunity and possibly an increased risk of more Type1-like latent autoimmune diabetes in adults.

  • 419. Lumley, Mark A.
    et al.
    Shi, Weisong
    Wiholm, Clairy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Slatcher, Richard B.
    Sandmark, Helene
    Wang, Shinan
    Hytter, Anders
    Arnetz, Bengt B.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    The Relationship of Chronic and Momentary Work Stress to Cardiac Reactivity in Female Managers: Feasibility of a Smart Phone-Assisted Assessment System2014Inngår i: Psychosomatic Medicine, ISSN 0033-3174, E-ISSN 1534-7796, Vol. 76, nr 7, s. 512-518Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To evaluate a wireless smart phone-assisted (SPA) system that assesses ongoing heart rate (HR) and HR-triggered participant reports of momentary stress when HR is elevated during daily life. This SPA system was used to determine the independent and interactive roles of chronic and momentary work stress on HR reactivity among female managers. Methods: A sample of 40 female managers reported their chronic work stress and wore the SPA system during a regular workday. They provided multiple reports of their momentary stress, both when triggered by increased HR and at random times. Relationships among chronic stress, momentary stress, and HR were analyzed with hierarchical linear modeling. Results: Both chronic work stress (b = 0.08, standard error [SE] = 0.03, p = .003) and momentary work stress (b = 1.25, SE = 0.62, p = .052) independently predicted greater HR reactivity, adjusting for baseline HR, age, smoking, caffeine, alcohol use, and momentary physical activity levels. More importantly, chronic and momentary stress significantly interacted (b = 1.00, SE = 0.04, p = .036); high momentary stress predicted elevated HR only in the context of high chronic stress. Conclusions: Female managers who experience chronic work stress displayed elevated cardiac reactivity during momentary stress at work. The joint assessment of chronic stress and momentary stress and their relationship to physiological functioning during work clarifies the potential health risks associated with work stress. Moreover, this wireless SPA system captures the immediate subjective context of individuals when physiological arousal occurs, which may lead to tailored stress management programs in the workplace.

  • 420.
    Lytsy, Per
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Andersen, Åsa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Liljestam Hurtigh, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Kams, Piret
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Anderzén, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Vitalis: A randomized intervention and coordination program aimed at Return to Work for women with long term sick leave2014Rapport (Annet vitenskapelig)
  • 421.
    Lytsy, Per
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Burell, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Westerling, Ragnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    How do prescribing doctors anticipate the effect of statins?2011Inngår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 17, nr 3, s. 420-428Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives:

    Statins are a lipid-lowering treatment, prescribed frequently to prevent cardiovascular events. The objective of this study was to explore how doctors anticipate the effect of statins and what factors are associated with their willingness to initiate treatment.

    Methods:

    A total of 330 Swedish cardiologists, internists and general practitioners were asked to consider two hypothetical patient cases, one with and one without previous coronary heart disease. Based on these cases, the respondents answered questions about their willingness to initiate treatment and what effects they might expect. The expectation of effect was assessed in two ways: (1) the absolute risk reduction of myocardial infarction in 1000 patients treated with statins for 5 years; and (2) statins' average effect on increased life expectancy. The doctors' beliefs about absolute risk reduction were compared with results from clinical trials.

    Results:

    Most doctors had a suboptimal expectation about absolute risk reduction; only about one-third had expectations in the range supported by evidence-based data. There were different views about statins' ability to prolong life: that is, average gain in life expectancy due to treatment was believed to be 2 years in the primary patient case, and 3 years in the second patient case. The doctors' beliefs about statins' ability to prolong life were associated significantly with their willingness to initiate treatment.

    Conclusion:

    The overall results imply that doctors have varying and suboptimal understanding of the effect of statins. This may inhibit the goal of integrating clinical research into clinical practice.

  • 422.
    Lytsy, Per
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin. Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Carlsson, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Anderzén, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Effectiveness of two vocational rehabilitation programmes in women with long-term sick leave due to pain syndrome or mental illness: 1-year follow-up of a randomized controlled trial2017Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, nr 2, s. 170-177Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Mental illness and chronic pain are common reasons for long-term sick leave, typically more so for women. This study investigated the effects on return to work of 2 vocational rehabilitation programmes. Methods: In this randomized controlled study, 308 women were allocated to treatment with acceptance and commitment therapy, to multidisciplinary assessment and individualized rehabilitation interventions, or to a control group. Return-to-work at 12 months was assessed as: (i) returning to health insurance; (ii) number of reimbursed health insurance days during follow-up; (iii) self-reported change in working hours; (iv) a composite measure of self-reported change in work-related engagement. Results: The mean age of the Swedish study population was 48.5 years (standard deviation (SD) 6.3 years) and the mean time on sick leave 7.5 years (SD 3.2 years). There were no significant differences in reimbursed days or returning to the health insurance at 12 months. The multidisciplinary assessment and individualized rehabilitation interventions group, compared with control, reported a significant increase in working hours per week, as well as a significant increase in work-related engagement. Conclusion: Multidisciplinary assessments and individual rehabilitation interventions may improve the chance of return-to-work in women with long-term sick leave due to pain condition or mental illness.

  • 423.
    Lytsy, Per
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicinsk epidemiologi. Karolinska Inst, Div Insurance Med, Dept Clin Neurosci, SE-17177 Stockholm, Sweden.
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Alexanderson, Kristina
    Karolinska Inst, Div Insurance Med, Dept Clin Neurosci, SE-17177 Stockholm, Sweden.
    Åhs, Annika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicinsk epidemiologi.
    Gender differences in healthcare management of depression: aspects of sick leave and treatment with psychoactive drugs in a Swedish setting2019Inngår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 73, nr 7, s. 441-450Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To investigate whether women and men diagnosed with depressive disorder were managed equally in terms of being sick-leave certified and being prescribed psychoactive drugs.

    Materials and methods: Data from all patients diagnosed with depression during 2010-2015 in Uppsala county, Sweden (n = 19 448) were used to investigate associations between gender and issued sick-leave certificate, prescriptions of anti-depressants, anxiolytics, hypnotics and sedatives, and cognitive behavioral psychotherapy referrals, at different time points up till 180 days after diagnosis.

    Results: At diagnosis date, 50.1% were prescribed antidepressants; 14.2% anxiolytics; 13.3% hypnotics or sedatives. Corresponding proportion regarding issue of sick-leave certificate among working aged (18-64 years) was 16.6%. Men had higher odds than women of being prescribed antidepressants (OR 1.16; 95% CI 1.09-1.24); anxiolytics (1.10; 95% CI 1.02-1.21), hypnotics and sedatives (OR 1.09; 95% CI 1.00-1.19) and lower odds (among those aged 18-64 years) of being sick-leave certified (OR 0.90; 95% CI 0.82-0.98) in adjusted regression models. There were subtle changes in ORs for outcomes at 3- and 6-month follow-up periods.

    Conclusions: Men had somewhat higher odds of being prescribed psychoactive drugs and slightly lower odds of being sick-leave certified as compared to women at date when diagnosed with depression. The absolute differences were, however, small and the overall conclusion is that women and men with current diagnosed depressive episode/recurrent depressive disorder are generally managed likewise regarding sick leave and psychoactive treatment.

  • 424.
    Lytsy, Per
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Larsson, Kjerstin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Forskning om funktionshinder och habilitering.
    Anderzén, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Health in women on long-term sick leave because of pain or mental illness2015Inngår i: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 38, nr 1, s. 27-33Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Mental illness and pain are common causes of long-term sick absence and major difficulties in vocational rehabilitation. The aim of this study was to investigate health in a group of women with pain or mental illness who had exhausted their days of sickness benefit. This cross-sectional study uses baseline data from 355 women on long-term sick leave participating in controlled intervention studies aiming at returning to work. The study population filled in a written questionnaire with questions of self-rated health and sleep quality and validated indexes of mental health, satisfaction with life and general self-efficacy. Clinical psychiatric screening was performed on 230 individuals. The study population had a mean age of 48.8 years (SD 8.4), with an average time on sick leave of 7.8 years (SD 3.2). Self-rated health and sleep quality was poor compared with other populations. In all, 80.1% had at least one psychiatric diagnosis according to the psychiatric screening, and the average numbers of psychiatric diagnoses were 2.2 (SD 1.9). Foreign-born women showed significantly higher levels of mental illness, poorer self-rated health and sleep quality and lower self-efficacy and life satisfaction than native Swedish women. Women with long sick leave because of mental illness and/or pain have poor self-rated health and sleep quality, high prevalence of mental illness and low self-efficacy and life satisfaction. Psychiatric screening suggests more extensive mental illness than what was stated on the sick leave certificates. The health of foreign-born women seems to be worse than that of native Swedish women.

  • 425. László, K D
    et al.
    Ahnve, S
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Ahlbom, A
    Janszky, I
    Job strain predicts recurrent events after a first acute myocardial infarction: the Stockholm Heart Epidemiology Program2010Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 267, nr 6, s. 599-611Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives

    Studies investigating the prognostic role of job stress in coronary heart disease are sparse and have inconclusive findings. We aimed (i) to investigate whether job strain predicts recurrent events after acute myocardial infarction (AMI) and if so (ii) to determine behavioural and biological factors that contribute to the explanation of this association.

     

    Design

    Prospective study.

     

    Setting

    Ten emergency hospitals in the larger Stockholm area, Sweden.

    Subjects

    Non-fatal AMI cases from the Stockholm Heart Epidemiology Program case-control study who were employed and younger than 65 years at the time of their hospitalization (n = 676).

     

    Results

    During the 8.5 year follow-up, 155 patients experienced cardiac death or non-fatal AMI; totally 96 patients died, 52 of cardiac causes. After adjustment for potential confounders, patients with high job strain had an increased risk for the combination of cardiac death and non-fatal AMI relative to those with low job strain, the hazard ratio (HR) and the 95% confidence interval (CI) being 1.73 (1.06-2.83). Results were similar for cardiac [HR (95% CI): 2.81 (1.16-6.82)] and total mortality [HR (95% CI): 1.65 (0.91-2.98)]. We found no evidence for mediation from lifestyle, sleep, lipids, glucose, inflammatory and coagulation markers on the association between job strain and the combination of cardiac death and non-fatal AMI.

    Conclusions

    Job strain was associated with poor long-term prognosis after a first myocardial infarction. Interventions focusing on reducing stressors at the workplace or on improving coping with work stress in cardiac patients might improve their survival post-AMI.

  • 426. László, Krisztina D
    et al.
    Engström, Karin
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Ahlbom, Anders
    Janszky, Imre
    Job insecurity and prognosis after myocardial infarction: The SHEEP Study2013Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 167, nr 6, s. 2824-2830Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    The prognostic role of job insecurity in coronary heart disease is unknown. We aimed to analyze whether job insecurity predicts mortality and recurrent events after a first acute myocardial infarction (AMI).

    METHODS:

    We studied non-fatal AMI cases involved in the Stockholm Heart Epidemiology Program who were in paid employment and younger than 65years (n=676). Shortly after their AMI, patients completed a questionnaire about job insecurity, demographic, work-related, clinical and lifestyle factors and participated in a clinical examination three months after discharge from the hospital. They were followed for 8.5years for mortality and cardiovascular events.

    RESULTS:

    After adjusting for previous morbidity, demographic and work-related factors, job insecurity was associated with an increased risk of the combined endpoint of cardiac death and non-fatal AMI, of total mortality and of heart failure; the hazard ratios (HR) and the 95% confidence intervals (CI) were 1.50 (1.02-2.22), 1.69 (1.04-2.75) and 1.62 (1.07-2.44), respectively. Similar associations, but with less statistical power were observed between job insecurity and cardiac death (HR (95% CI): 1.57 (0.80-3.09)) and stroke (HR (95% CI): 1.46 (0.71-3.02)), respectively. Adjustment for potential mediators, i.e. sleep problems, health behaviour, hypertension, blood lipids, glucose, inflammatory and coagulation factors did not alter considerably the relationship between job insecurity and the combination of cardiac mortality and non-fatal AMI.

    CONCLUSIONS:

    Our results suggest that job insecurity is an adverse prognostic factor in patients with a first AMI. Future studies are needed to confirm this finding and to determine the mechanisms underlying the observed relationship.

  • 427.
    Lännerström, Linda
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Sick Leave Questions in Telephone Nursing: Perspectives of Persons on Sick Leave and Registered Nurses in Primary Health Care2018Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Aim and methods: To explore experiences of being on sick leave by interviewing 16 persons on sick leave and using a phenomenological approach. To explore registered nurses’ work in the care of persons on sick leave by performing three focus group discussions with registered nurses. To explore the effect and experiences of an educational intervention in social insurance medicine with registered nurses by studying the effect of a randomized controlled study with 100 registered nurses and by interviewing 12 registered nurses who participated in the intervention.

    Findings: The essential meaning of being on long-term sick leave was losing one’s independence. This loss was connected to mostly negative experiences of being absent from work, the social insurance rules, and experiences in encounters with many professionals.

    The registered nurses’ work in handling sick leave questions included assessing, dispositioning, supporting, and collaborating actions. They expressed lacking competence, had different understandings of their role, and experienced stress connected to contradictory demands in their roles as carers, co-workers, and distributors of organizational resources.

    The short educational intervention in social insurance medicine seemed to have had an effect, but due to the small study population, the effect was inconclusive. The process evaluation showed that the educational intervention was perceived to have contributed to registered nurses gaining role clarity in their work with sick leave questions. The registered nurses described increasing their knowledge and skills as well as taking on more of the traditional actions related to telephone nursing, for example giving more information and being more attentive, coaching, and encouraging towards patients.

    Conclusions: Being on long-term sick leave can be experienced negatively, and can be connected to several dimensions of life. Registered nurses at the studied primary health care centres had a role in the care of patients on sick leave, but had different understandings of their role that affected how they handled telephone calls with them. The educational intervention failed to show a conclusive effect due to the rather small study population. However, the registered nurses experienced that participating had enhanced their competence.

    Delarbeid
    1. Losing independence: the lived experience of being long-term sick-listed
    Åpne denne publikasjonen i ny fane eller vindu >>Losing independence: the lived experience of being long-term sick-listed
    2013 (engelsk)Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, s. 745-Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    BACKGROUND: Sickness absence is a multifaceted problem. Much is known about risk factors for being long-term sick-listed, but there is still little known about the various aftermaths and experiences of it. The aim of this qualitative study was to describe, analyze and understand long-term sickness-absent people's experiences of being sick-listed.

    METHODS: The design was descriptive and had a phenomenological approach. Sixteen long-term sickness-absent individuals were purposively sampled from three municipalities in Sweden in 2011, and data were collected through semi-structured, individual interviews. The interview questions addressed how the participants experienced being sick-listed and how the sick-listing affected their lives. Transcribed interviews were analysed using Giorgi's phenomenological method.

    RESULTS: The interviews revealed that the participants' experiences of being sick-listed was that they lost their independence in the process of stepping out of working society, attending the mandatory steps in the rehabilitation chain and having numerous encounters with professionals. The participants described that their life-worlds were radically changed when they became sick-listed. Their experiences of their changing life-worlds were mostly highly negative, but there were also a few positive experiences. The most conspicuous findings were the fact that stopping working brought with it so many changes, the participants' feelings of powerlessness in the process, and their experiences of offensive treatment by and/or encounters with professionals.

    CONCLUSIONS: Sick-listed persons experienced the process of being on long-term sickness absent as very negative. The negative experiences are linked to consequences of stopping to work, consequences of social insurance rules and to negative encounters with professionals handling the sickness absence. The positive experiences of being sick-listed were few in the present study. There is a need to further examine the extent of these negative experiences are and how they affect sick-listed people's recovery and return to work. Long-term sickness absence; sick leave; experiences; interviews; phenomenology; Sweden.

    Emneord
    long-term sickness absence, sick leave, experiences, interviews, phenomenology, Sweden
    HSV kategori
    Forskningsprogram
    Allmänmedicin
    Identifikatorer
    urn:nbn:se:uu:diva-205547 (URN)10.1186/1471-2458-13-745 (DOI)000323311900001 ()23938128 (PubMedID)
    Tilgjengelig fra: 2013-08-19 Laget: 2013-08-19 Sist oppdatert: 2018-10-04bibliografisk kontrollert
    2. Nurses' experiences of managing sick-listing issues in telephone advisory services at primary health care centres
    Åpne denne publikasjonen i ny fane eller vindu >>Nurses' experiences of managing sick-listing issues in telephone advisory services at primary health care centres
    2013 (engelsk)Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, nr 4, s. 857-863Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Introduction:

    Over the last decade Swedish health care has focused on improving the management of sick-listing issues. At primary health care centres sick-listing is mainly dealt with by the patient’s physician but when patients have requests related to sick-listing and contact the telephone advisory service nurses will be involved. The aim of this study was to describe nurses’ experiences of managing sick-listing issues in telephone advisory services in a primary health care setting.

    Methods:

    The study was a qualitative focus group study. Data collection was conducted in three focus group conversations in a county in central Sweden in 2009. The conversations were recorded, transcribed and analyzed using qualitative content analysis. The study included fourteen nurses, purposively sampled as having current experience of telephone advisory services at primary health care centres.

    Findings:

    The management of sick-listing issues was described by the nurses as Nurses Actions which were affected by Enabling conditions and Obstructing conditions. The Nurses’ Actions included making an assessment for appropriate action, making an appointment and/or giving information and guidance to the patient and/or monitoring patient’s rights. Enabling conditions included documentation, routines, supportive co-operation and training in insurance medicine. The obstructing conditions were related to patients’ expectations, co-operation with other professionals, lack of training and the nurses’ professional role.

    Conclusion:

    The nurses experienced stress and difficulties related to being gatekeepers and related to the act of balancing different demands from patients, co-workers and the organisation. This in combination with the lack of training caused the nurses to state that they did not want responsibility for managing sick-listing issues. Sufficient documentation, education, routines, support of and discussions with other professionals at the primary health care centre could be ways of improving nurses’ and other professionals’ management of sick-listing issues.

    Emneord
    sick listing, telephone advisory services, primary health care, nursing, focus group, qualitative content analysis
    HSV kategori
    Forskningsprogram
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-185457 (URN)10.1111/j.1471-6712.2012.01093.x (DOI)000328140200010 ()
    Tilgjengelig fra: 2012-11-25 Laget: 2012-11-25 Sist oppdatert: 2018-10-04bibliografisk kontrollert
    3. The effect of a short educational intervention in social insurance medicine: A randomised controlled trial.
    Åpne denne publikasjonen i ny fane eller vindu >>The effect of a short educational intervention in social insurance medicine: A randomised controlled trial.
    (engelsk)Manuskript (preprint) (Annet vitenskapelig)
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-362239 (URN)
    Tilgjengelig fra: 2018-10-02 Laget: 2018-10-02 Sist oppdatert: 2018-10-04
    4. Gaining role clarity in working with sick leave questions - Registered Nurses' experiences of an educational intervention
    Åpne denne publikasjonen i ny fane eller vindu >>Gaining role clarity in working with sick leave questions - Registered Nurses' experiences of an educational intervention
    2019 (engelsk)Inngår i: Nursing Open, E-ISSN 2054-1058, Vol. 6, nr 2, s. 236-244Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Aim

    To describe how a short educational intervention in social insurance medicine was experienced by Registered Nurses and what changes it brought to their work with sick leave questions in telephone nursing.

    Design

    Qualitative explorative interview study.

    Methods

    Interviews with 12 purposively sampled Registered Nurses were conducted and analysed using manifest content analysis.

    Results

    The intervention increased Registered Nurses’ knowledge of the sick leave process and changed their work habits as they now have more of the skills needed to handle sick leave questions. In this way, they gained role clarity in their work with sick leave questions. The new knowledge included rules and regulations, actors’ roles and patients’ experiences. Learning from peers, reflecting and having the opportunity to ask questions were also described as increasing their knowledge. The skills following the participation were described as knowing what to say and do and knowing where to turn for support.

    Emneord
    cluster randomized controlled study, educational intervention, interviews, sick leave, social insurance medicine, telephone nursing
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-361653 (URN)10.1002/nop2.201 (DOI)000461835600004 ()30918675 (PubMedID)
    Tilgjengelig fra: 2018-09-26 Laget: 2018-09-26 Sist oppdatert: 2019-05-07bibliografisk kontrollert
  • 428.
    Lännerström, Linda
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Holmström, Inger K.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning. Malardalen Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Wallman, Thorne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Possible causes of experiencing problems with sick leave questions in telephone nursing2017Inngår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, nr 4, s. 249-253Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Registered nurses at primary health care centres in Sweden receive about 20 million telephone calls annually. Questions related to sick leave occur regularly. Previous studies conclude that those calls often are perceived as problematic. The aim of this study was to explore factors associated with problems regarding sick leave questions in telephone nursing.

    METHODS: A questionnaire was distributed to all registered nurses (n = 185) working with telephone nursing in 26 Swedish primary health care centres, of whom 114 (61.6%) responded. Based on the results of a Spearman correlation analysis a logistic regression analysis was performed of significant exposure variables on outcome (perceived problems).

    RESULTS: Significant exposure variables were: experience of telephone nursing, age, being educated in social insurance medicine, and frequency of telephone calls with sick leave questions. Young age was associated with more problems than old age. Those having education in social insurance medicine reported fewer problems than those who had not, and so did those having few telephone calls with sick leave questions as compared with those who had many.

    CONCLUSIONS: Young age, lack of education in insurance medicine, and high frequency of sick leave questions increased the perceived problem level in telephone nursing.

  • 429.
    Lännerström, Linda
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    Holmström, Inger K
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning. School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Wallman, Thorne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    The effect of a short educational intervention in social insurance medicine: A randomized controlled trial2019Inngår i: Nursing Open, E-ISSN 2054-1058, Vol. 00, s. 1-7Artikkel i tidsskrift (Fagfellevurdert)
  • 430.
    Lännerström, Linda
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Holmström, Inger
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning. Mälardalens Högskola, Akademien för hälsa, vård och välfärd Mälardalen University School of health, care and social welfare.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Wallman, Thorne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    The effect of a short educational intervention in social insurance medicine: A randomised controlled trial.Manuskript (preprint) (Annet vitenskapelig)
  • 431.
    Lännerström, Linda
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    von Celsing, Anna-Sophia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Holmström, Inger
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Wallman, Thorne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Registered nurses' work with sick leave questions by telephone in primary health care2017Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, nr 5/6, s. 641-647Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS AND OBJECTIVES:

    To describe registered nurses' work with sick leave questions by telephone.

    BACKGROUND:

    In Sweden, when a sick person needs to request a sickness certification, it is common to contact the primary healthcare centre. The main access to primary health care is by telephone, with a registered nurse answering the care seeker's questions, triaging and helping care seekers to the right level of care. Registered nurses' work with sick leave questions has not been studied, except for two qualitative interview studies.

    DESIGN:

    A descriptive cross-sectional study.

    METHODS:

    A questionnaire with 120 questions was distributed to 185 registered nurses in one county in central Sweden. Descriptive statistics were used for analysis.

    RESULTS:

    Response rate was 62% (n = 114). Registered nurses (n = 105) in this study talked weekly to persons on, or at risk, for sick leave. A large part (n = 78) felt they had a role in the care of persons on sick leave, consisting of booking appointments as well as acting as a pilot, advisor, caretaker and coordinator. For 74 of 114 registered nurses, it was problematic to handle the phone calls weekly. Measures were 'often' booking appointments with physicians (n = 67) and 'seldom' providing information on social insurance rules ('never' n = 51). The registered nurses expressed a great need for more education.

    CONCLUSION:

    Registered nurses in this study reported having a role in the care of persons on sick leave when handling sick leave questions by telephone. The telephone calls were problematic to handle, and the registered nurses expressed a great need for education and training in social insurance medicine.

    RELEVANCE TO CLINICAL PRACTICE:

    There is a need to educate and train registered nurses in social insurance medicine to provide high-quality nursing for patients on or at risk for sick leave.

  • 432.
    Lännerström, Linda
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Wallman, Thorne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Holmström, Inger K
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Losing independence: the lived experience of being long-term sick-listed2013Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, s. 745-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Sickness absence is a multifaceted problem. Much is known about risk factors for being long-term sick-listed, but there is still little known about the various aftermaths and experiences of it. The aim of this qualitative study was to describe, analyze and understand long-term sickness-absent people's experiences of being sick-listed.

    METHODS: The design was descriptive and had a phenomenological approach. Sixteen long-term sickness-absent individuals were purposively sampled from three municipalities in Sweden in 2011, and data were collected through semi-structured, individual interviews. The interview questions addressed how the participants experienced being sick-listed and how the sick-listing affected their lives. Transcribed interviews were analysed using Giorgi's phenomenological method.

    RESULTS: The interviews revealed that the participants' experiences of being sick-listed was that they lost their independence in the process of stepping out of working society, attending the mandatory steps in the rehabilitation chain and having numerous encounters with professionals. The participants described that their life-worlds were radically changed when they became sick-listed. Their experiences of their changing life-worlds were mostly highly negative, but there were also a few positive experiences. The most conspicuous findings were the fact that stopping working brought with it so many changes, the participants' feelings of powerlessness in the process, and their experiences of offensive treatment by and/or encounters with professionals.

    CONCLUSIONS: Sick-listed persons experienced the process of being on long-term sickness absent as very negative. The negative experiences are linked to consequences of stopping to work, consequences of social insurance rules and to negative encounters with professionals handling the sickness absence. The positive experiences of being sick-listed were few in the present study. There is a need to further examine the extent of these negative experiences are and how they affect sick-listed people's recovery and return to work. Long-term sickness absence; sick leave; experiences; interviews; phenomenology; Sweden.

  • 433.
    Lännerström, Linda
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Wallman, Thorne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Kaminsky, Elenor
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning. Mälardalens högskola, Västerås, Sweden.
    Holmström, Inger K
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning. Mälardalens högskola, Västerås, Sweden.
    Gaining role clarity in working with sick leave questions - Registered Nurses' experiences of an educational intervention2019Inngår i: Nursing Open, E-ISSN 2054-1058, Vol. 6, nr 2, s. 236-244Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim

    To describe how a short educational intervention in social insurance medicine was experienced by Registered Nurses and what changes it brought to their work with sick leave questions in telephone nursing.

    Design

    Qualitative explorative interview study.

    Methods

    Interviews with 12 purposively sampled Registered Nurses were conducted and analysed using manifest content analysis.

    Results

    The intervention increased Registered Nurses’ knowledge of the sick leave process and changed their work habits as they now have more of the skills needed to handle sick leave questions. In this way, they gained role clarity in their work with sick leave questions. The new knowledge included rules and regulations, actors’ roles and patients’ experiences. Learning from peers, reflecting and having the opportunity to ask questions were also described as increasing their knowledge. The skills following the participation were described as knowing what to say and do and knowing where to turn for support.

  • 434.
    Lännerström, Linda
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Wallman, Thorne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Söderbäck, Maja
    Akademin för hälsa, vård och välfärd, Mälardalens Högskola.
    Nurses' experiences of managing sick-listing issues in telephone advisory services at primary health care centres2013Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, nr 4, s. 857-863Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction:

    Over the last decade Swedish health care has focused on improving the management of sick-listing issues. At primary health care centres sick-listing is mainly dealt with by the patient’s physician but when patients have requests related to sick-listing and contact the telephone advisory service nurses will be involved. The aim of this study was to describe nurses’ experiences of managing sick-listing issues in telephone advisory services in a primary health care setting.

    Methods:

    The study was a qualitative focus group study. Data collection was conducted in three focus group conversations in a county in central Sweden in 2009. The conversations were recorded, transcribed and analyzed using qualitative content analysis. The study included fourteen nurses, purposively sampled as having current experience of telephone advisory services at primary health care centres.

    Findings:

    The management of sick-listing issues was described by the nurses as Nurses Actions which were affected by Enabling conditions and Obstructing conditions. The Nurses’ Actions included making an assessment for appropriate action, making an appointment and/or giving information and guidance to the patient and/or monitoring patient’s rights. Enabling conditions included documentation, routines, supportive co-operation and training in insurance medicine. The obstructing conditions were related to patients’ expectations, co-operation with other professionals, lack of training and the nurses’ professional role.

    Conclusion:

    The nurses experienced stress and difficulties related to being gatekeepers and related to the act of balancing different demands from patients, co-workers and the organisation. This in combination with the lack of training caused the nurses to state that they did not want responsibility for managing sick-listing issues. Sufficient documentation, education, routines, support of and discussions with other professionals at the primary health care centre could be ways of improving nurses’ and other professionals’ management of sick-listing issues.

  • 435.
    Löfvander, Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Karolinska Inst, Ctr Family Med, Dept Neurobiol Caring Sci & Soc, Huddinge, Sweden.
    Pain drawings, interpreter support and clinical findings among immigrant patients on sick leave in Swedish primary health care2019Inngår i: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 20, artikkel-id e137Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To evaluate the spread of pain and its correlates among immigrant patients on sick leave.

    Background: Backache, outspread pain and sick-leave questions are problematic to handle primary health care, especially in multicultural settings.

    Methods: Two hundred and thirty-five patients 20-45 years on paid sick leave (59% women, 93% foreign-born, mostly non-Europeans). Many had little formal education. One-third had professional interpreter support. The patients pointed out on their bodies where they felt pain. This information was transferred on a pain drawing [pain drawing fields (PDFs) 0-18] by a doctor. Major depression and psychosocial stressors were assessed using Diagnostic and Statistical Manual of Mental Disorders. Nociceptive locations for pain were established (pain-sites 0-18). Dependent variable was the number of PDFs. Independent variables were social data, sick leave, interpreter, depression, stress levels and number of pain sites. Calculations were done using descriptive methods and multi-variable linear regression in full models, by gender.

    Findings: Many patients had depression (51% women versus 32% men). A majority were exposed to psychosocial stressors. Women had more PDFs, in median 5 [inter-quartile ranges (IQR) 4-8] versus men 3 (IQR 2-5), and also more pain sites, in median 3 (IQR 2-5) versus men in median 2 (IQR 1-3). For men, the regression calculations revealed that numbers of PDFs associated only with increasing numbers of pain sites (B 0.871 P < 0.001). For women, this association was weaker (B 0.364, P < 0.001), with significant values also for age (B 0.103) and sick leave > one year (B 0.767, P = 0.010), and a negative predicting value for interpreter support (B -1.198, P < 0.043). To conclude, PDFs associated often with somatic findings but varied much among the women. This implies potential problems regarding cause, function and sick leave questions. However, support by professional interpreters may facilitate a shared understanding with immigrant women having long-standing pain.

  • 436.
    Löfvander, Monica
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Rosenblad, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Mortality among immigrant patients 20-45 years of age with chronic back pain in primary care in Sweden: A 15-year follow-up cohort study.2019Inngår i: Journal of Back and Musculoskeletal Rehabilitation, ISSN 1053-8127, E-ISSN 1878-6324Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Mortality rates among immigrant patients undergoing rehabilitation for musculoskeletal backache are unknown.

    OBJECTIVE: To study the association between marital status, severe psychosocial strain, receiving long-term time-limited sickness allowance (TLSA) and all-cause mortality (ACM) in a cohort of immigrants aged 20-45 years with long-standing backache in Sweden.

    METHODS: We studied 318 patients (92% foreign-born, 76% non-European) of known marital status on sick-leave for musculoskeletal backache. They were followed up for ACM until 2015. Socio-demographic data, TLSA and psychosocial strain, including major depression, severe psychosocial stressors and pessimistic thoughts, were analysed using multiple-imputation Cox regression.

    RESULTS: Over a mean (standard deviation) follow-up time of 15 (5.0) years, 11 (3.5%) participants died. At baseline, 34% were unmarried, 19% were receiving TLSA, and 71% had ⩾ 1 psychosocial strain component (38% depression; 47% severe stressors; 35% pessimistic thoughts). After concomitant risk factors were adjusted for, being unmarried and receiving TLSA were associated with higher mortality by factors of 6.2 (p= 0.005) and 5.8 (p= 0.006), respectively. Psychosocial strain was only significantly associated with higher mortality in the unadjusted analyses.

    CONCLUSIONS: Being unmarried and receiving TLSA were associated with significantly higher ACM in this highly marginalized group of immigrant patients.

  • 437.
    Löfvander, Monica
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Rosenblad, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Wiklund, Tony
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Bennström, Halina
    Leppert, Jerzy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    A case-control study of self-reported health, quality-of-life and general functioning among recent immigrants and age- and sex-matched Swedish-born controls2014Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, nr 8, s. 734-742Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To examine whether new immigrants had inferior quality-of-life, well-being and general functioning compared with Swedish age- and sex-matched controls.

    Methods: A prospective case-control study was designed including immigrants from non-European countries, 18-65 years of age, with recent Permanent Permits to Stay (PPS) in Sweden, and age- and sex-matched Swedish-born (SB) persons from the general population in Västmanland County, Sweden. The General Health Questionnaire (GHQ-12), the brief version of the World Health Organization Quality-of-Life (WHOQOL-BREF) Scale and the General Activity Functioning Assessment Scale (GAF) from DSM-IV were posted (SB), or applied in personal interviews (PPS) with interpreters. Differences between the PPS and SB groups were measured using McNemar's test and Wilcoxon signed-rank test conducted separately for observations at baseline, 6- and 12-month follow-up.

    Results: There were 93 pairs (mean age 36 years). Persons from Somalia (67%) and Iraq (27%) dominated the PPS group. The differences between the groups were statistically significant for all time points for the Psychological health and Social relationship domains of WHOQOL-BREF, and for the baseline and 6-month follow-up time points of GHQ-12 where the PPS-group had a higher degree of well-being, health and quality-of-life than the SB. This tendency applied for both sexes in the immigrant group.

    Conclusions: These new immigrants did not have inferior physical or psychological health, quality-of-life, well-being or social functioning compared with their age- and sex-matched Swedish born pairs during a 1-year follow-up. Thus, there is reason to advocate immigrants' fast integration into society.

  • 438. Löfvenborg, J E
    et al.
    Andersson, T
    Carlsson, Per-Ola
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Transplantation och regenerativ medicin.
    Dorkhan, M
    Groop, L
    Martinell, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Tuomi, T
    Wolk, A
    Carlsson, S
    Fatty fish consumption and risk of latent autoimmune diabetes in adults2014Inngår i: Nutrition & Diabetes, ISSN 2044-4052, E-ISSN 2044-4052, Vol. 4, s. e139-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: It has been suggested that intake of fatty fish may protect against both type 1 and type 2 diabetes. Hypotheses rest on the high marine omega-3 fatty acid eicosapentaenoic acid+docosahexaenoic acid (EPA+DHA) and vitamin D contents, with possible beneficial effects on immune function and glucose metabolism. Our aim was to investigate, for the first time, fatty fish consumption in relation to the risk of latent autoimmune diabetes in adults (LADA).

    METHODS: Analyses were based on data from a Swedish case-control study with incident cases of LADA (n=89) and type 2 diabetes (n=462) and randomly selected diabetes-free controls (n=1007). Diabetes classification was based on the onset of age (⩾35), glutamic acid decarboxylase autoantibodies, and C-peptide. A validated food frequency questionnaire was used to derive information on previous intake of fish, polyunsaturated long-chain omega-3 fatty acids (n-3 PUFA) and supplementation of fish oil and vitamin D. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using logistic regression, adjusted for age, gender, body mass index (BMI), family history of diabetes, physical activity, smoking, education, and consumption of alcohol, fruit, vegetables and red meat.

    RESULTS: Weekly fatty fish consumption (⩾1 vs <1 serving per week), was associated with a reduced risk of LADA but not type 2 diabetes (OR 0.51, 95% CI 0.30-0.87, and 1.01, 95% CI 0.74-1.39, respectively). Similar associations were seen for estimated intake of n-3 PUFA (⩾0.3 g per day; LADA: OR 0.60, 95% CI 0.35-1.03, type 2 diabetes: OR 1.14, 95% CI 0.79-1.58) and fish oil supplementation (LADA: OR 0.47, 95% CI 0.19-1.12, type 2 diabetes: OR 1.58, 95% CI 1.08-2.31).

    CONCLUSIONS: Our findings suggest that fatty fish consumption may reduce the risk of LADA, possibly through effects of marine-originated omega-3 fatty acids.

  • 439.
    Löfvenborg, Josefin E.
    et al.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Andersson, Tomas
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Carlsson, Per-Ola
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Transplantation och regenerativ medicin.
    Dorkhan, Mozhgan
    Lund Univ, Dept Clin Sci, Malmo, Sweden..
    Groop, Leif
    Lund Univ, Dept Clin Sci, Malmo, Sweden..
    Martinell, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Tuomi, Tiinamaija
    Univ Helsinki, Res Program Diabet & Obes, Helsinki Univ Hosp, Abdominal Ctr,Endocrinol, Helsinki, Finland.;Univ Helsinki, Finnish Inst Mol Med, Helsinki, Finland..
    Wolk, Alicja
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Carlsson, Sofia
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Sweetened beverage intake and risk of latent autoimmune diabetes in adults (LADA) and type 2 diabetes2016Inngår i: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 175, nr 6, s. 605-614Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Sweetened beverage intake is associated with increased risk of type 2 diabetes, but its association with autoimmune diabetes is unclear. We aimed to investigate sweetened beverage intake and risk of latent autoimmune diabetes in adults (LADA); autoimmune diabetes with features of type 2 diabetes. Design/methods: Data from a Swedish population-based study was used, including incident cases of LADA (n = 357) and type 2 diabetes (n = 1136) and randomly selected controls (n = 1371). Diabetes classification was based on onset age (= 35), glutamic acid decarboxylase autoantibodies (GADA) and C-peptide. Sweetened beverage intake information was derived from a validated food frequency questionnaire. ORs adjusted for age, sex, family history of diabetes, education, lifestyle, diet, energy intake and BMI were estimated using logistic regression. Results: Daily intake of >2 servings of sweetened beverages (consumed by 6% of participants) was associated with increased risk of LADA (OR: 1.99, 95% CI: 1.11-3.56), and for each 200 mL daily serving, OR was 1.15 (95% CI: 1.02-1.29). Findings were similar for sugar-sweetened (OR: 1.18, 95% CI: 1.00-1.39) and artificially sweetened beverages (OR: 1.12, 95% CI: 0.95-1.32). Similarly, each daily serving increment in total sweetened beverage conferred 20% higher type 2 diabetes risk (95% CI: 1.07-1.34). In type 2 diabetes patients, high consumers displayed higher HOMA-IR levels (4.5 vs 3.5, P = 0.0002), but lower HOMA-B levels (55 vs 70, P = 0.0378) than non-consumers. Similar tendencies were seen in LADA. Conclusions: High intake of sweetened beverages was associated with increased risk of LADA. The observed relationship resembled that with type 2 diabetes, suggesting common pathways possibly involving insulin resistance.

  • 440.
    Malinovschi, Andrei
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Bröms, Kristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Lisspers, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Högman, Marieann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Clinical clustering of COPD patients is useful to predict future COPD exacerbations2018Inngår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Artikkel i tidsskrift (Annet vitenskapelig)
  • 441. Mandalenakis, Zacharias
    et al.
    Eriksson, Henry
    Welin, Lennart
    Caidahl, Kenneth
    Dellborg, Mikael
    Rosengren, Annika
    Lappas, Georgios
    Hedner, Jan
    Johansson, Saga
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Hansson, Per-Olof
    Atrial natriuretic peptide as a predictor of atrial fibrillation in a male population study. The Study of Men Born in 1913 and 19232014Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 171, nr 1, s. 44-48Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Atrial fibrillation is one of the most common arrhythmias in clinical practice and it is often diagnosed after a complication occurs. The study aimed to evaluate the predictive value of atrial natriuretic peptide (ANP) for atrial fibrillation in a male population-based study. Methods and results: This study is a part of the "Study of Men Born in 1913 and 1923", a longitudinal prospective cohort study of men, living in the city of Gothenburg in Sweden. A population-based sample of 528 men was investigated in 1988 when they were aged 65 years (n = 134) and 75 years (n = 394), and they were followed up for 16 years. Blood samples were collected from all 528 men at baseline and plasma ANP levels were analyzed by radioimmunoassay. Hazard ratios were estimated by competing-risk regression analysis. One hundred five participants were excluded because of a prior diagnosis of atrial fibrillation, congestive heart failure, severe hypertension, or severe chronic renal insufficiency. Of the remaining 423 participants, 90 men were diagnosed with atrial fibrillation over the 16-year follow-up. In multivariable analysis, men in the two highest quartiles of ANP levels had a significantly higher risk for atrial fibrillation compared with men in the lowest ANP quartile. The adjusted ratio was 3.14 (95% CI 1.59-6.20) for the third ANP quartile and 3.36 (95% CI 1.72-6.54) for the highest quartile of ANP level. Conclusions: In this population-based longitudinal study, we found that elevated ANP levels at baseline predicted atrial fibrillation during a follow-up time of 16 years. 

  • 442. Manithip, Chanthanom
    et al.
    Edin, Kerstin
    Sihavong, Amphoy
    Wahlström, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Wessel, Hans
    Poor quality of antenatal care services-Is lack of competence and support the reason?: An observational and interview study in rural areas of Lao PDR2013Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, nr 3, s. 195-202Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: to explore the health-care providers' performance and their own perceptions of the ANC services they provide. Design, setting and participants: this cross-sectional exploratory survey was carried out in 2009 at four district hospitals and 18 health centres in Khammouane and Champasack provinces in rural areas of Laos. Measurements and findings: combinations of quantitative and qualitative methods were used: (i) 59 observations of ANC sessions (components performed and equipment used); (ii) 26 semi-structured interviews with health-care providers engaged in ANC services, interpreted through content analysis. The findings indicated an overall poor quality and performance of ANC services in rural health facilities with lack of routines, scarce or insufficient equipment and limited skills among providers. The health-care providers gave an often pessimistic picture of their competence and motivation to work with ANC. Some articulated a resignation due to lack of feedback from the patients and they expressed a need for support from health-care superiors. Compared to the district hospitals, the health centres were less well-equipped and supplied, and the providers had a heavier workload, because all activities including ANC were carried out by the same provider. The average consultation time for each woman was 5 mins. Conclusions: the quality of ANC services in rural health facilities in Laos was poor due to lack of resources, the providers' limited skills concurrent with inadequate routines and insufficient backup from superiors. Implications for practice: to comply with national and international recommendations for ANC services, our suggestion is to improve the quality of the rural health facilities in Laos by providing basic equipment, support from experienced superiors and in-service training.

  • 443. Manrique-Garcia, Edison
    et al.
    Sidorchuk, Anna
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Moradi, Tahereh
    Socioeconomic position and incidence of acute myocardial infarction: a meta-analysis2011Inngår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 65, nr 4, s. 301-309Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    A negative socioeconomic gradient is established for coronary heart disease (CHD) mortality and survival, while socioeconomic patterning of disease incidence is less well investigated. To study socioeconomic inequalities in the incidence of acute myocardial infarction (AMI), the major component of CHD, a meta-analysis was undertaken to summarise existing evidence on the issue.

    Methods

    A systematic search was performed in PubMed and EMBASE databases for observational studies on AMI incidence and socioeconomic position (SEP), published in English to April 2009. A random-effects model was used to pool the risks estimates from the individual studies.

    Results

    Among 1181 references, 70 studies fulfilled the inclusion criteria. An overall increased risk of AMI among the lowest SEP was found for all three indicators: income (pooled RR 1.71, 95% CI 1.43 to 2.05), occupation (pooled RR 1.35, 95% CI 1.19 to 1.53) and education (pooled RR 1.34, 95% CI 1.22 to 1.47). The strongest associations were seen in high-income countries such as USA/Canada and Europe, while the results were inconsistent for middle and low-income regions.

    Conclusion

    AMI incidence is associated with low SEP. The nature of social stratification at the level of economic development of a country could be involved in the differences of risk of AMI between social groups.

  • 444.
    Martinell, Mats
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Dorkhan, Mozhgan
    Lund Univ, Dept Clin Sci Malmo, Uppsala, Sweden..
    Stålhammar, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Storm, Petter
    Lund Univ, Dept Clin Sci Malmo, Uppsala, Sweden..
    Groop, Leif
    Lund Univ, Dept Clin Sci Malmo, Uppsala, Sweden..
    Gustavsson, Carin
    Lund Univ, Dept Clin Sci Malmo, Uppsala, Sweden..
    Prevalence and risk factors for diabetic retinopathy at diagnosis (DRAD) in patients recently diagnosed with type 2 diabetes (T2D) or latent autoimmune diabetes in the adult (LADA)2016Inngår i: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 30, nr 8, s. 1456-1461Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: 

    To study prevalence of diabetic retinopathy (DR) at diagnosis (DRAD) and to estimate contributing risk by sociodemographic, cardiovascular and metabolic characteristics present in patients recently diagnosed with type 2 diabetes (T2D) or latent autoimmune diabetes in the adult (LADA).

    METHODS: 

    Patients (n=2174) recently diagnosed T2D (93%) or LADA (7%) were included upon arrival for their baseline DR screening. Fundus photographs of 4902 eyes were graded by a senior ophthalmologist according to the International Diabetic Retinopathy Disease Severity Scale. Official registers held by Statistics Sweden provided sociodemographic variables. The National Patient Register and Swedish Prescribed Drug Register were used to assess cardiovascular risk. Beta cell function (HOMA2%b) and insulin sensitivity (HOMA2%s) were estimated from fasting (f) C-Peptide using the homeostasis model assessment (HOMA) 2 calculator. Odds ratios (OR) for DRAD were estimated using generalized estimating equation models.

    RESULTS: 

    The prevalence of DRAD was 12% (7% mild and 5% moderate) and of diabetic macular edema it was 11% (all within vascular arch). The prevalence did not significantly differ between T2D and LADA. Due to sample size, the regression analysis of LADA patients did not yield any significant estimates. In T2D low educational level (≤9years) increased risk for DRAD by 44% (OR 1.44; 95% CI 1.07-1.93) and <50% beta-cell function adjusted for HbA1c and insulin sensitivity at diagnosis increased the risk by 77% (OR 1.77; 95% CI 1.28-2.44). For every unit increase in BMI, risk for DRAD decreased by 3% (OR 0.97; 95% CI 0.95-0.99).

    CONCLUSIONS: 

    DRAD prevalence in patients recently diagnosed with T2D or is 12%. Low educational level and low beta cell function at diagnosis are risk factors for DRAD. Estimation of beta cell function from (f)C-Peptide and (f)P-Glucose may be a valuable tool in identifying patients at risk for DRAD.

  • 445.
    Martinell, Mats
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Espes, Daniel
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Carlsson, Per-Ola
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Increased Circulating Betatrophin Concentrations in Patients with Type 2 Diabetes2014Inngår i: Typ1 ?Typ x Språk: - Engelska Svenska Norska Arabiska Bokmål Bulgariska Danska Engelska Esperanto Estniska Finska Franska Färöiska Grönländska (Kalaallit oqaasi) Hebreiska Hindi Indonesiska Iriska Isländska Italienska Japanska Katalanska Kinesiska Koreanska Kroatiska Kurdiska Latin Lettiska Litauiska Madurese Makedonska Mongoliskt språk Nederländska Norska Nygrekiska (1453-) Nynorsk Odefinierat språk Persiska Polska Portugisiska Rumänska Ryska Samiskt språk Sanskrit Serbiska Slovakiska Slovenska Spanska Svenska Tjeckiska Turkiska Tyska Ukrainska Ungerska Urdu Vietnamesiska / [ed] Prof Ulf Eriksson, 2014Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Aim

    To test the hypothesis of a Betatrophin deficiency in patients with diabetes by measuring circulating Betatrophin in patients with type 2 diabetes (T2D) and non-diabetic, insulin resistant controls.

     

    Material and methods

    ELISA measured Betatrophin concentration in plasma of 27 patients with T2D and 18 matched controls. The participants were characterized by weight, height, waist-and hip (circumference and ratio), blood pressure, blood lipids, P-creatinine, fP-glucose, HbA1c, fC-peptide and family history of diabetes. Inputting fP-glucose and fC-peptide into the HOMA2 model assessed the beta-cell function, insulin sensitivity and insulin resistance.

     

    Results

    Betatrophin concentrations were approximately 40% higher in the patients with T2D and also correlated positively to HbA1c. In the control group, Betatrophin concentration increased with age. All T2D patients and controls were insulin resistant with mean insulin resistance in both groups well exceeding 2 and the insulin sensitivity being less than 50%.

     

    Conclusion

    In this first study to report on betatrophin concentrations in type 2 diabetes and insulin resistant patients, elevated betatrophin levels were measured in the diabetic individuals. There is no obvious betatrophin deficiency to substitute in these patients.

     

  • 446.
    Martinell, Mats
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Singh, Kailash
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Zhengkang, Luo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Espes, Daniel
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Stålhammar, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Sandler, Stellan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Carlsson, Per-Ola
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Characterization of Cellular Immunology in LADA PatientsManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Objective: Patients with latent autoimmune diabetes mellitus in adults (LADA) have antibodies against the insulin-producing b-cells but at disease onset they are not insulin-dependent. This study presents cellular immunological differences between LADA, type 1, type 2 diabetes and healthy controls.

    Research Design and Methods: All patients and matched (by age, gender and body mass index) healthy controls were recruited from the County of Uppsala, Sweden. Peripheral blood mononuclear cells were isolated from freshly collected blood to determine proportions of innate, adaptive and regulatory immune cells by using flow cytometry.

    Results: Included were 14 patients with LADA, 16 with type 1 diabetes, 16 with type 2 diabetes and 13 healthy controls. The proportion of CD11c+CD123- antigen presenting cells (APCs) was lower, whilst proportions of CD11c+CD123+ APCs and Interleukin (IL)-35+ tolerogenic APCs were higher in LADA patients compared to patients with type 1 diabetes. The proportion of CD3-CD56highCD16+ Natural Killer (NK) cells was higher in LADA patients than in both healthy controls and type 2 diabetes patients. IL-35+ Treg cell numbers were similar to those observed in both type 1 diabetes and type 2 diabetes patients, but a lower frequency of IL-35+ regulatory T (Treg) cells was observed in LADA patients than in healthy controls. The proportion of regulatory B (Breg) cells in LADA patients was higher than in healthy controls, type 1 and type 2 diabetes patients and IL-35+ Breg cell numbers were higher than in type 1 diabetes patients.

    Conclusions: LADA patients present a mixed cellular immunological pattern compared to type 1 and type 2 diabetes patients. Numbers of APCs, IL-35+ tolerogenic APCs and IL-35+ Breg cells in LADA patients are similar to those observed in type 2 diabetes patients, whereas the changes in NK cells are similar to those observed in type 1 diabetes patients. 

  • 447.
    Martinell, Mats
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Stålhammar, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Automated data extraction: A feasible way to construct patient registers of primary care utilization2012Inngår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 117, nr 1, s. 52-56Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction. Electronic medical records (EMRs) enable analysis of health care data by using data mining techniques to build research databases. Though the reliability of the data extraction process is crucial for the credibility of the final analysis, there are few published validations of this process. In this paper we validate the performance of an automated data mining tool on EMR in a primary care setting.

    Methods. The Pygargus Customized eXtraction Program (CXP) was programmed to find and then extract data from patients meeting criteria for type 2 diabetes mellitus (T2DM) at one primary health care clinic (PHC). The ability of CXP to extract relevant cases was assessed by comparing cases extracted by an EMR integrated search engine. The concordance of extracted data with the original EMR source was manually controlled.

    Results. Prevalence of T2DM was 4.0%, which correspond well to previous estimations. By searching for drug prescriptions, diagnosis codes, and laboratory values, 38%, 53%, and 91% of relevant cases were found, respectively. The sensitivity of CXP regarding extraction of relevant cases was 100%. The specificity was 99.9% due to 12 non-T2DM cases extracted. The congruity at single-item level was 99.6%. The 13 incorrect data items were all located in the same structural module.

    Conclusion. The CXP is a reliable and accurate data mining tool to extract selective data from EMR.

  • 448.
    Martin-Merino, Elisa
    et al.
    Spanish Ctr Pharmacoepidemiol Res CEIFE, Madrid, Spain..
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Andersson, Susan
    Bayer Pharma AG, Global Epidemiol, Berlin, Germany..
    Soriano-Gabarro, Montse
    Bayer Pharma AG, Global Epidemiol, Berlin, Germany..
    Garcia Rodriguez, Luis Alberto
    Spanish Ctr Pharmacoepidemiol Res CEIFE, Madrid, Spain..
    The reporting and diagnosis of uterine fibroids in the UK: an observational study2016Inngår i: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 16, artikkel-id 45Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Uterine fibroids (UFs) are the most common benign tumour in women, and many undergo hysterectomy or uterus-preserving procedures (UPPs) to manage their symptoms. We aimed to validate the recording of UFs in a primary care database, The Health Improvement Network (THIN), and to determine the incidence of UFs in the UK. Methods: In this observational study, women in THIN aged 15-54 years between January 2000 and December 2009 with no previous record of UFs, hysterectomy or UPPs were identified. Individuals were followed up until there was a Read code indicating UFs, they reached 55 years of age or died, or the study ended. Among those without a UF code, women were identified with a code for hysterectomy, UPPs or heavy menstrual bleeding (HMB). Anonymized patient profiles from each category were randomly selected and reviewed. Subsequently, primary care physicians were asked to complete questionnaires to verify the diagnosis for a randomly selected subgroup. Results: In total, 737,638 women were identified who met the initial inclusion criteria. The numbers of women with a code for UFs, hysterectomy, UPPs and HMB were 9380, 11,002, 3220 and 60,915, respectively; the proportions of confirmed cases of UFs were 88.8, 29.7, 57.7 and 15.9 %. The estimated number of women with UFs was 23,140 (64. 0 % without a recorded UF diagnosis). The overall incidence of UFs was 5.8 per 1000 woman-years. Conclusions: UFs were confirmed in a high proportion of women with UF Read codes. However, almost two-thirds of cases were identified among women with a code for hysterectomy, UPPs or HMB. These results show that UFs are under-recorded in UK primary care, and suggest that primary care physicians tend to code the symptoms of UFs more often than the diagnosis.

  • 449. Martín-Merino, Elisa
    et al.
    García Rodríguez, Luis Alberto
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Andersson, Susan
    Soriano-Gabarró, Monste
    The incidence of hysterectomy, uterus-preserving procedures and recurrent treatment in the management of uterine fibroids2015Inngår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 194, s. 147-152Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To determine the incidence of hysterectomy and uterus-preserving procedures (UPPs) among women with uterine fibroids (UFs) and the incidence of further procedures after a UPP.

    STUDY DESIGN: This was an observational study using a primary care database, The Health Improvement Network (THIN). Women in THIN with UFs aged 15-54 years between January 2000 and December 2009 were eligible for study. The UPPs examined were myomectomy, endometrial ablation (EA) and uterine artery embolization (UAE). Using Read codes, women were followed up until one of the following was met: there was a record of hysterectomy or UPPs, they died or the study ended (end of 2010).

    RESULTS: The cumulative incidence of hysterectomy or UPPs was 23.6% at 1 year, and 40.9% after the follow-up period (median 3.6 years). At the end of the follow-up period, the cumulative incidences of hysterectomy, myomectomy, EA and UAE were 33.0%, 3.9%, 6.4% and 1.9%, respectively. For women initially treated with a UPP, the cumulative incidence of second procedures was 11.5% at 1 year. At the end of the follow-up period (median 2.7 years), the cumulative incidence of further procedures was 26.1%, and the cumulative incidences of women undergoing hysterectomy, myomectomy, EA and UAE were 19.0%, 4.3%, 3.4% and 1.4%, respectively.

    CONCLUSIONS: Women considering UPPs for the management of UFs should be made aware that the incidence of further treatments is high, with hysterectomy being the most frequent procedure undergone.

  • 450.
    Masefield, Sarah
    et al.
    European Lung Fdn, 442 Glossop Rd, Sheffield S10 2PX, S Yorkshire, England..
    Edwards, Jessica
    Asthma UK, London, England..
    Hansen, Kjeld
    Uppsala Univ, European Lung Fdn, Uppsala, Sweden..
    Hamerlijnck, Dominique
    Uppsala Univ, European Lung Fdn, Uppsala, Sweden..
    Lisspers, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    van der Schee, Marc
    Univ Amsterdam, Paediat Resp Med, Acad Med Ctr, Amsterdam, Netherlands..
    Silva, Liliana
    Matosinhos Local Hlth Unit, Commun Care Unit, Matosinhos, Portugal..
    Matthews, John
    Genentech Inc, 460 Point San Bruno Blvd, San Francisco, CA 94080 USA..
    Gaga, Mina
    Athens Chest Hosp, Dept Resp Med 7, Athens, Greece..
    Adcock, Ian
    Imperial Coll London, Thorac Med, London, England..
    Holgate, Stephen
    Southampton Gen Hosp, Fac Med, Southampton, Hants, England..
    Walker, Samantha
    Asthma UK, London, England..
    Powell, Pippa
    European Lung Fdn, 442 Glossop Rd, Sheffield S10 2PX, S Yorkshire, England..
    The future of asthma research and development: a roadmap from the European Asthma Research and Innovation Partnership (EARIP)2017Inngår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 49, nr 5, artikkel-id 1602295Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A coordinated European multi-stakeholder approach to asthma research Asthma is highly prevalent and associated with high morbidity and mortality. It affects 30-50 million people in Europe, often starting in infancy and persisting throughout life. Asthma is a major global health challenge, affecting more than 300 million people worldwide and at least 10% of all Europeans [1]. People with asthma live at risk of life-threatening asthma attacks, leading to over 500 000 hospitalisations each year. Approximately 5-10% of asthma cases are so severe that current treatments do not work. The Framework Programme 7-funded European Asthma Research and Innovation Partnership (EARIP; www.EARIP.eu) was established in 2013 to harmonise efforts to reduce mortality and morbidity from asthma by agreeing the most important research priorities across relevant stakeholders in Europe. This is essential to address the significant impact of asthma on the individual, healthcare systems and national and European economies, outlined in the accompanying editorial in this issue of the European Respiratory Journal [2]. EARIP produced an evidence- and consensus-based list of the research priorities (a "roadmap") and investment needed to reduce asthma deaths and hospitalisations. By identifying the priorities, a coordinated effort can be made to fast-track change to better manage, prevent and cure asthma [3]. The roadmap will be the foundation on which future EU, national and international research funding programmes can transform asthma outcomes throughout Europe. The roadmap is the product of a comprehensive multi-stage process, led by the European Lung Foundation and Asthma UK (figure 1) [4]. Multiple stakeholder groups informed the roadmap process to ensure scientific accuracy, clinical relevance and outcomes that reflect the priorities of patients and caregivers, with an overarching steering board. A final consensus workshop brought together 28 experts from 15 European countries comprising: patients, patient organisations, primary healthcare professionals (HCPs), secondary HCPs, researchers, industry representatives and policy influencers. A full list of the roadmap contributors is available at www.EARIP.eu/roadmap. The rest of this article describes its development and outcomes.

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