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  • 51.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Information Science.
    New Insights on Longitudinal Biostatistics Data from Using Quantile RegressionsManuscript (Other academic)
  • 52.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Nonlinear quantile regression estimation of longitudinal data2008In: Communications in statistics. Simulation and computation, ISSN 0361-0918, E-ISSN 1532-4141, Vol. 37, no 1, p. 114-131Article in journal (Refereed)
    Abstract [en]

    This article examines a weighted version of the quantile regression estimator as defined by Koenker and Bassett (1978), adjusted to the case of nonlinear longitudinal data. Using a four-parameter logistic growth function and error terms following an AR(1) model, different weights are used and compared in a simulation study. The findings indicate that the nonlinear quantile regression estimator is performing well, especially for the median regression case, that the differences between the weights are small, and that the estimator performs better when the correlation in the AR(1) model increases. A comparison is also made with the corresponding mean regression estimator, which is found to be less robust. Finally, the estimator is applied to a data set with growth patterns of two genotypes of soybean, which gives some insights into how the quantile regressions provide a more complete picture of the data than the mean regression.

  • 53.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Information Science. Avdelningen för statistik.
    Nonlinear Quantile Regression for Longitudinal Data2005Licentiate thesis, monograph (Other scientific)
    Abstract [en]

    The overall objective of the two papers in this thesis is to examine the properties of the weighted nonlinear quantile regression estimator for the analysis of longitudinal data. To this end, the question of which weights to be used, the bias of the estimator and the possibility to calculate confidence intervals has to be examined. The focus is on small samples, since this is the most common case for real world applications in biostatistics.

  • 54.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Information Science. Avdelningen för statistik.
    Review of Discrete distributions: applications in the health sciences2005In: Pharmaceutical Statistics, Vol. 4, no 3, p. 226-Article, book review (Other (popular science, discussion, etc.))
  • 55.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Information Science. Avdelningen för statistik.
    Review of Epidemiology: Study design and data analysis, 2nd ed.2006In: Statistical Methods in Medical Research, Vol. 15, no 4, p. 409-410Article, book review (Other (popular science, discussion, etc.))
  • 56.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Information Science. Avdelningen för statistik.
    Review of Microeconometrics: Methods and Applications2006In: Journal of Applied Statistics, Vol. 33, no 5, p. 571-572Article, book review (Other (popular science, discussion, etc.))
  • 57.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Information Science. Avdelningen för statistik.
    Review of Models for Discrete Longitudinal Data2006In: Biometrics, Vol. 62, no 2, p. 628-Article, book review (Other (popular science, discussion, etc.))
  • 58.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Information Science. Avdelningen för statistik.
    Review of Permutation, Parametric, and Bootstrap Tests of Hypotheses2006In: Journal of the Royal Statistical Society: Series A, Statistics in Society, Vol. 169, no 1, p. 171-Article, book review (Other (popular science, discussion, etc.))
  • 59.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Information Science. Avdelningen för statistik.
    Review of Scientific WorkPlace 5.5 and LyX 1.4.22006In: Journal of Statistical Software, E-ISSN 1548-7660, Vol. 17Article, book review (Other academic)
  • 60.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Information Science. Avdelningen för statistik.
    Review of Statistical analysis of epidemiological data2005In: Statistical Methods in Medical Research, Vol. 14, no 5, p. 531-532Article, book review (Other (popular science, discussion, etc.))
  • 61.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Information Science. Avdelningen för statistik.
    Review of Statistics in the Pharmaceutical Industry2006In: Pharmaceutical Statistics, Vol. 5, no 2, p. 150-151Article, book review (Other (popular science, discussion, etc.))
  • 62.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Information Science. Avdelningen för statistik.
    Review of Tutorials in Biostatistics, Volume 1, Statistical Methods in Clinical Studies2005In: Journal of the Royal Statistical Society: Series A, Statistics in Society, Vol. 168, no 3, p. 631-632Article, book review (Other (popular science, discussion, etc.))
  • 63.
    Karlsson Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Department of Statistics, Stockholm University, Stockholm, Sweden;Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Accuracy of automatic forecasting methods for univariate time series data: A case study predicting the results of the 2018 Swedish general election using decades-long data series2021In: Communications in Statistics: Case Studies, Data Analysis and Applications, E-ISSN 2373-7484, Vol. 7, no 3, p. 475-493Article in journal (Refereed)
    Abstract [en]

    This study compared the accuracy of automatic time series forecasting methods in predicting the results of the 2018 Swedish general election using data from the Party Preference Survey opinion poll collected during the years 1984–2018. The general exponential smoothing state space (ETS) model performed best, outperforming even the exit poll collected at the time of the election, while the complex seasonal autoregressive integrated moving average (ARIMA) model was beaten by the simple exponential smoothing method. Holt’s linear trend method performed worse than even the naïve method. The results of this study show the usefulness of easily applied automatic forecasting methods.

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  • 64.
    Karlsson Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Kompletteringar och rättelser rörande flera ätter i Elgenstiernas ättartavlor2021In: Släkt och Hävd, no 4, p. 248-253Article in journal (Other academic)
  • 65.
    Karlsson Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Department of Statistics, Stockholm University, Stockholm, Sweden..
    The mean, variance, and bias of the OLS based estimator of the extremum of a quadratic regression model for small samples2020In: Communications in Statistics - Theory and Methods, ISSN 0361-0926, E-ISSN 1532-415X, p. 1-17Article in journal (Refereed)
    Abstract [en]

    Many economic theories suggest that the relation between two variables y and x follow a function forming a convex or concave curve. In the classical linear model (CLM) framework, this function is usually modeled using a quadratic regression model, with the interest being to find the extremum value or turning point of this function. In the CLM framework, this point is estimated from the ratio of ordinary least squares (OLS) estimators of coefficients in the quadratic regression model. We derive an analytical formula for the expected value of this estimator, from which formulas for its variance and bias follow easily. It is shown that the estimator is biased without the assumption of normality of the error term, and if the normality assumption is strictly applied, the bias does not exist. A simulation study of the performance of this estimator for small samples show that the bias decreases as the sample size increases.

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  • 66.
    Karlsson Rosenblad, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Solna, Sweden.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Self-efficacy in breastfeeding predicts how mothers perceive their preterm infant's state-regulation2022In: International Breastfeeding Journal, ISSN 1746-4358, E-ISSN 1746-4358, Vol. 17, no 1, article id 44Article in journal (Refereed)
    Abstract [en]

    Background

    Mothers of preterm infants often perceive the infant as having problems with crying, sleeping and feeding, sometimes summarised as ‘state-regulation’. Breastfeeding rates are lower among preterm infants, and the mother’s self-efficacy in breastfeeding is central to understanding which mothers are going to breastfeed their infants. We have previously shown that mothers with higher self-efficacy have an easier time adapting to the infant and in this study we hypothesised that the degree of self-efficacy also is associated with how difficult the mother believes it is to take care of the infant. The aim of this study was to investigate whether the late preterm infant’s mother’s self-efficacy in breastfeeding was associated with how the mother experienced her infant’s state-regulation at three months of corrected age.

    Methods

    The study had a prospective and longitudinal design with a consecutive data collection through questionnaires. Inclusion criteria were mothers (n = 105) with a singleton infant born between 34 + 0 and 36 + 6 weeks of gestation. At term age, the mothers completed the Breastfeeding Self-efficacy Scale-Short Form and at the three months corrected age follow-up, mothers completed the Infant state-regulation index: questions related to whether the infant had difficulties with colic, persistent crying, comforting, falling asleep, sleep problems, breastfeeding, eating or poor weight gain.

    Results

    The analyses showed that being an older mother, perceiving breastfeeding support, and having a higher breastfeeding self-efficacy were all significantly associated with identifying the infant as having better state-regulation.

    Conclusions

    There was an association between mothers’ self-efficacy in breastfeeding and her perceptions of how good state-regulation the infant had. This is an important finding, as self-efficacy is a manageable factor that could positively affect how the mother perceives taking care of her infant. Clinical implication: Improved self-efficacy is known to be an important factor in increased breastfeeding prevalence and healthcare professionals should also target mother’s self-efficacy in breastfeeding to improve mother-infant relationship.

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  • 67.
    Karlsson Rosenblad, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Sundqvist, Pernilla
    Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Westman, Bodil
    Regional Cancer Centre Stockholm-Gotland, Region Stockholm, Box 6909, SE-102 39, Stockholm, Sweden. Department of Care Science, Sophiahemmet University, Stockholm, Sweden.
    Ljungberg, Börje
    Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
    A psychometric evaluation of the Functional assessment of cancer therapy—kidney symptom index (FKSI-19) among renal cell carcinoma patients suggesting an alternative two-factor structure2021In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 30, no 9, p. 2663-2670Article in journal (Refereed)
    Abstract [en]

    Purpose To psychometrically evaluate the hypothesized four-factor structure of the 19-item Functional Assessment of Cancer Therapy—Kidney Symptom Index (FKSI-19) health-related quality of life (HRQoL) instrument in a sample of surgically treated renal cell carcinoma (RCC) patients and examine if an alternative factor structure with good psychometric properties may be derived from the available items.

    Methods The model fit of the hypothesized four-factor structure was examined using confirmatory factor analysis on cohort data from 1731 individuals included in the National Swedish Kidney Cancer Register who had undergone surgery for RCC during the three years 2016–2018 and answered the FKSI-19 instrument within 6–12 months after surgery. Exploratory factor analysis was applied to the same dataset to derive a possible alternative factor solution.

    Results The four-factor structure did not reach the thresholds for good model fit using the normed χ2-value or the Comparative Fit Index, although the Standardized Root Mean Square Residual and Root Mean Square Error of Approximation measures indicated good and acceptable model fits, respectively. An alternative 14-item trimmed FKSI version (FKSI-14) with a two-factor structure derived from the available FKSI-19 items was found to measure the same aspects of HRQoL as the full FKSI-19 instrument.

    Conclusion The present study is the first to use psychometric methods for examining the factor structure of the FKSI-19 instrument. The hypothesized four-factor structure of FKSI-19 provided a barely acceptable model fit. The two-factor FKSI-14 structure may be used as an alternative or complement to the four-factor structure when interpreting the FKSI-19 instrument.

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  • 68.
    Katsogiannos, Petros
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Randell, Eva
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Eriksson, Jan W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Leksell, Janeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Quality of life after gastric bypass surgery in patients with type 2 diabetes: patients' experiences during 2 years of follow-up2020In: Diabetology & Metabolic Syndrome, E-ISSN 1758-5996, Vol. 12, no 1, article id 90Article in journal (Refereed)
    Abstract [en]

    Background

    To examine the effects of gastric bypass surgery on health-related quality of life (HRQoL) in obese patients with type 2 diabetes, and to investigate their experiences of life adjustments using quantitative and qualitative methods.

    Methods

    Thirteen patients with type 2 diabetes and obesity, (body mass index, BMI > 30 kg/m2), participating in a randomized clinical trial, completed this sub-study. HRQoL was evaluated before, and at 6 months and 2 years after gastric bypass surgery, using the RAND- 36-item health survey. At 2 years, interviews for in-depth analysis of HRQoL changes were performed.

    Results

    Significant improvement was observed from baseline to 6 months for 2 of the eight health concepts, general health, and emotional well-being. At 2 years, improvements were also seen in physical functioning, energy/fatigue, as well as sustained improvements in general health and emotional well-being. Multiple regression analyses showed mostly non-significant associations between the magnitude of decrease in weight, BMI, and HbA1c during follow-up and improvement in HRQoL. The analyses from qualitative interviews supported a common latent theme “Finding a balance between the experience of the new body weight and self-confidence”.

    Conclusions

    The improved HRQoL after gastric bypass surgery in obese patients with type 2 diabetes was not explained specifically by the magnitude of weight loss, but rather by the participants achieving a state of union between body and consciousness.

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  • 69.
    Kerstis, Birgitta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Engström, Gabriella
    Sundquist, Kristina
    Widarsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    The association between perceived relationship discord at childbirth and parental postpartum depressive symptoms: a comparison of mothers and fathers in Sweden2012In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 117, no 4, p. 430-438Article in journal (Refereed)
    Abstract [en]

    Aim

    To examine whether mothers' and fathers' levels of perceived relationship discord at childbirth were associated with postpartum depressive symptoms when the child was 3 months old. Another aim was to examine parents' levels of self-reported depressive symptoms. The hypothesis was that parents with high levels of perceived relationship discord have higher levels of postpartum depressive symptoms than parents with low levels of perceived relationship discord.

    Method

    One week after childbirth, 305 couples' perceived level of relationship discord was measured using the Dyadic Consensus Subscale (DCS) of the Dyadic Adjustment Scale (DAS). At 3 months postpartum, the same couples answered the Edinburgh Postnatal Depression Scale (EPDS) questionnaire. The relations between perceived level of relationship discord and postpartum depressive symptoms were analysed using standard non-parametric statistical methods.

    Results

    The mothers and fathers partly differed regarding which areas of their relationship they perceived that they disagreed with their partners about. Furthermore, 16.5% of the mothers and 8.7% of the fathers reported postpartum depressive symptoms, and there was a moderate level of correlation between the DCS and EPDS scores.

    Conclusion

    These results may be useful for professionals in antenatal care and child health centres as well as for family caregivers who need to be aware that mothers and fathers may have different views on relationship discord and of the high level of depressive symptoms in recent parents. Further research is needed to examine perceived relationship discord and the development of depressive symptoms postpartum over a longer term.

  • 70.
    Klarare, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women's and children's health), Clinical Psychology in Healthcare. Ersta Sköndal Bräcke Univ Coll, Dept Hlth Care Sci, Box 11189, S-10061 Stockholm, Sweden..
    Söderlund, Mona
    Ersta Sköndal Bräcke Univ Coll, Dept Hlth Care Sci, Box 11189, S-10061 Stockholm, Sweden..
    Wikman, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    McGreevy, Jenny
    Dept Dietet, Nyköping, Sweden.;Ctr Clin Res Sormland, Eskilstuna, Sweden..
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women's and children's health), Clinical Psychology in Healthcare. Ersta Sköndal Bräcke Univ Coll, Dept Hlth Care Sci, Box 11189, S-10061 Stockholm, Sweden..
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Caring Behaviors Inventory-24: translation, cross-cultural adaptation and psychometric testing for use in a Swedish context2021In: Human Resources for Health, E-ISSN 1478-4491, Vol. 19, article id 11Article in journal (Refereed)
    Abstract [en]

    Background: Patients' health and wellbeing are promoted when nurses successfully conceptualize caring in clinical practice. Measuring caring behaviors can advance knowledge about caring and has potential to improve caring practices and the outcomes of care. The Caring Behaviors Inventory-24 (CBI-24) is an empirical instrument for measuring caring, developed to determine perceptions of caring among patients and nurses. Since the instrument was not available in Swedish, the aim of this study was therefore to translate into Swedish and cross-culturally adapt CBI-24 for a Swedish healthcare context, and to psychometrically analyze the Swedish version of CBI-24.

    Methods: The study used a traditional forward and back translation process in six stages: (1) two simultaneous translations by bilingual experts; (2) expert review committee synthesis; (3) blind back translation; (4) expert review committee deliberations; (5) pre-testing with cognitive interviews, and (6) psychometric evaluations.

    Results: The translation process was systematically conducted and entailed discussions regarding semantic, idiomatic, experiential and conceptual equivalence. The cognitive interviews generated thoughts and reflections, which resulted in adjusting three items of the CBI-24 SWE. For psychometric analyses, 234 persons answered the questionnaire. Results indicated acceptable overall model fit in the chi(2)-value for the confirmatory factor analysis, while for the heuristic goodness-of-fit indices, the comparative fit index (CFI) and the standardized mean square residual (SMSR) indicated good model fits, and the root mean square error approximation (RMSEA) indicated an acceptable fit.

    Conclusions: CBI-24 SWE has been shown to be a psychometrically acceptable instrument for use in Swedish research contexts. Further studies regarding the clinical usefulness of the instrument may be in order. In particular, CBI-24 SWE should be evaluated among nurses in rural areas.

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  • 71.
    Klarare, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
    Wikman, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Söderlund, Mona
    McGreevy, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. Department of Dietetics, Region Sörmland, Nyköping, Sweden.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Translation, Cross-Cultural Adaptation, and Psychometric Analysis of the Attitudes Towards Homelessness Inventory for Use in Sweden2021In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 18, no 1, p. 42-49Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Homelessness is an increasing problem worldwide, and the origins of homelessness in high-income countries are multifaceted. Due to stigma and discrimination, persons in homelessness delay seeking health care, resulting in avoidable illness and death. The Attitudes Towards Homelessness Inventory (ATHI) was developed to cover multiple dimensions of attitudes toward persons in homelessness and to detect changes in multiple segments of populations. It has, however, not previously been translated to Swedish.

    AIMS: The aim of the present study was to translate, cross-culturally adapt, and psychometrically test the ATHI for use in a Swedish healthcare context.

    METHODS: The project used a traditional forward- and back-translation process in six stages: (1) two simultaneous translations by bilingual experts; (2) expert review committee synthesis; (3) blind back-translation; (4) expert review committee deliberations; (5) pre-testing with cognitive interviews including registered nurses (n = 5), nursing students (n = 5), and women in homelessness (n = 5); and (6) psychometric evaluations. The final ATHI questionnaire was answered by 228 registered nurses and nursing students in the year 2019.

    RESULTS: The translation process was systematically conducted and entailed discussions regarding semantic, idiomatic, experiential, and conceptual equivalence. Confirmatory factor analysis was used to examine if the collected data fitted the hypothesized four-factor structure of the ATHI. Overall, it was found that the model had an acceptable fit and that the Swedish version of ATHI may be used in a Swedish healthcare context.

    LINKING EVIDENCE TO ACTION: The ATHI has been shown to be a psychometrically acceptable research instrument for use in a Swedish healthcare context. The systematic and rigorous process applied in this study, including experts with diverse competencies in translation proceedings and testing, improved the reliability and validity of the final Swedish version of the ATHI. The instrument may be used to investigate attitudes toward women in homelessness among nursing students and RNs in Sweden.

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  • 72.
    Knutsson, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Vastmanland Cty Hosp, Dept Otorhinolaryngol, Vasteras, Sweden.;Orebro Univ Hosp, Dept Otolaryngol, Orebro, Sweden..
    Priwin, Claudia
    Sophiahemmet Univ, Dept Otorhinolaryngol, Stockholm, Sweden..
    Hessen-Soderman, Anne-Charlotte
    Cityakuten, Dept Otorhinolaryngol, Stockholm, Sweden.;Karolinska Inst, Div Clin Sci Intervent & Technol, Stockholm, Sweden..
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    von Unge, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Vastmanland Cty Hosp, Dept Otorhinolaryngol, Vasteras, Sweden.;Akershus Univ Hosp, Dept Otorhinolaryngol, Campus Ahus, Oslo, Norway.;Univ Oslo, Campus Ahus, Oslo, Norway..
    A randomized study of four different types of tympanostomy ventilation tubes: Full-term follow-up2018In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 107, p. 140-144Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the impact of tympanostomy ventilation tube material (silicone vs fluoroplastic) and shape (short vs long) regarding time to extrusion, occurrence of otorrhea, occlusion, tube removal and occurrence of persistent perforation.

    Methods and material: Four different types of ventilation tubes were used; Long Armstrong tubes, Donaldson tubes, Shepard tubes and straight tubes, representing four specific combinations of VT material (silicone or fluoroplastic) and shape (short, double flanged or long, single flanged). Four hundred children scheduled for bilateral tube insertion were included in a randomized trial. The patients received one type of tube in the right ear and another type in the left ear. The incidence of tube extrusion and complications were monitored post-operatively every third month by an otolaryngologist.

    Results: Twenty-two children were excluded during surgery. Out of the studied 378 children the mean age was 35.3 months. 63.8% were boys. Short tubes extruded earlier than long tubes; hazard ratio (HR) 4.84 (95% CI 3.50-6.69, p < 0.001). Long Armstrong tubes were least prone to extrude. Silicone tubes resulted in significantly longer time to first infection in a VT ear, HR 1.68 (95% CI 1.03-2.76, p = 0.039). Donaldson tubes rendered the longest mean time to first infection (p = 0.025). Infections did not affect tube extrusion rates significantly (p = 0.879). No significant differences were found regarding tube occlusion, tube extraction or persistent perforation.

    Conclusions: Long tubes are less prone to extrude early. Long Armstrong tubes have the least propensity to extrude early. Silicone tubes render significantly longer time to first infection. Donaldson tubes result in least infections. Infection does not affect extrusion rates significantly.

  • 73.
    Leksell, Janeth
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Toft, Eva
    Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden;Diabetes Unit, Ersta Hospital, Stockholm, Sweden.
    Rosman, Jessica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Eriksson, Jan W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Fischier, Johan
    Diabetes Unit, Karolinska University hospital, Stockholm, Sweden.
    Lindholm Olinder, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics. Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.
    Nerpin, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Virtual clinic for young people with type 1 diabetes: a randomised wait-list controlled study2023In: BMC Endocrine Disorders, E-ISSN 1472-6823, Vol. 23, no 1, article id 255Article in journal (Refereed)
    Abstract [en]

    Background

    The transition from paediatric to adult care for young adults with type 1 diabetes poses unique challenges. Virtual diabetes clinics using smartphone applications offer a promising approach to support self-management and enhance communication with healthcare providers. The primary objective of this study was to evaluate the effects of a virtual diabetes clinic on glycaemic control, treatment satisfaction, and quality of life among young adults diagnosed with type 1.

    Methods

    79 participants with type 1 diabetes aged 18–25 years were included in a prospective, single-centre, randomised, wait-list controlled trial. Participants were randomly assigned to either the intervention group or the wait-list control group. The intervention group received instant access to a virtual care platform called Vista Dialog, which facilitated real-time communication between patients and healthcare providers. Glycosylated haemoglobin (HbA1c) levels, time in range (TIR), time below range (TBR), diabetes treatment satisfaction, and quality of life were assessed at baseline and after 6 months.

    Results

    Baseline characteristics were similar between the intervention and control groups, except for education level, where there was a skewed distribution between the groups (the intervention group had a lower education level). At the 6-month follow-up, there were no significant differences in HbA1c levels, TIR, TBR, or diabetes treatment satisfaction between the two groups. However, the intervention group demonstrated a significant decrease in the burden on physical health compared with the control group, indicating an improved quality of life.

    Conclusions

    The implementation of a virtual diabetes clinic using the Vista Dialog platform did not result in significant improvements in glycaemic control or treatment satisfaction compared with usual care. However, it did show potential benefits in terms of reducing the burden on physical health and improving quality of life in young adults with type 1 diabetes. Further research is needed to explore the long-term effects and optimal use of virtual clinics in diabetes management.

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  • 74.
    Löfvander, Monica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Mortality among immigrant patients 20-45 years of age with chronic back pain in primary care in Sweden: A 15-year follow-up cohort study2020In: Journal of Back and Musculoskeletal Rehabilitation, ISSN 1053-8127, E-ISSN 1878-6324, Vol. 33, no 5, p. 801-809Article in journal (Refereed)
    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.

  • 75.
    Löfvander, Monica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Wiklund, Tony
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Bennström, Halina
    Leppert, Jerzy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    A case-control study of self-reported health, quality-of-life and general functioning among recent immigrants and age- and sex-matched Swedish-born controls2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 8, p. 734-742Article in journal (Refereed)
    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.

  • 76.
    Mattebo, Magdalena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Grün, Nathalie
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Centre of Clinical Research Västerås, Uppsala University, Central Hospital, Västerås.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Häggström-Nordin, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Dalianis, Tina
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Sexual experiences in relation to HPV vaccination status in female high school students in Sweden2014In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 19, no 2, p. 86-92Article in journal (Refereed)
    Abstract [en]

    Objectives

    To investigate sexual experiences, sexually transmitted infections (STIs) and use of condoms in relation to human papillomavirus (HPV)-vaccination status in female high school students.

    Methods

    In 2013, 355 female students with a median age of 18 years from randomly selected high schools in Sweden answered a classroom questionnaire on sexual experiences and HPV-vaccination status.

    Results

    In total 227/348 (65%) of the women reported having received at least one HPV vaccine dose. Median age at first intercourse was 15 and 16 years respectively, in the 141/227 (62%) vaccinated after, and the 86/227 (38%) vaccinated before their sexual debut. There were no differences between the HPV-vaccinated and non-vaccinated groups regarding condom use, STIs, and experiences of oral and anal sex, or friends- with-benefit relationships. However, having had sexual intercourse and 'one-night stands' were more common in the vaccinated group (both p < 0.05).

    Conclusion

    Many students (62%) were vaccinated against HPV, with two-thirds after their sexual debut. There were no differences in condom use and STIs, and only a few differences in sexual experiences between the HPV-vaccinated and non-vaccinated groups. Initiating HPV vaccination before sexual debut is important, as is information about the link between HPV, sexual behaviour and cancer.

  • 77. Nemlander, Elinor
    Maskininlärning användes för att förbättra upptäckt av tarmcancer2023In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 10-11Article in journal (Other (popular science, discussion, etc.))
  • 78.
    Nemlander, Elinor
    et al.
    Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Solna, Sweden.;Acad Primary Hlth Care Ctr, Reg Stockholm, Stockholm, Sweden..
    Ewing, Marcela
    Univ Gothenburg, Inst Med, Sahlgrenska Acad, Dept Community Med & Publ Hlth, Gothenburg, Sweden..
    Abedi, Eliya
    Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Solna, Sweden.;Acad Primary Hlth Care Ctr, Reg Stockholm, Stockholm, Sweden..
    Hasselstrom, Jan
    Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Solna, Sweden.;Acad Primary Hlth Care Ctr, Reg Stockholm, Stockholm, Sweden..
    Sjovall, Annika
    Karolinska Univ Hosp, Dept Pelv Canc, Div Coloproctol, Stockholm, Sweden.;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Carlsson, Axel C.
    Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Solna, Sweden.;Acad Primary Hlth Care Ctr, Reg Stockholm, Stockholm, Sweden..
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Solna, Sweden.;Reg Canc Ctr Stockholm Gotland, Reg Stockholm, Stockholm, Sweden..
    A machine learning tool for identifying non-metastatic colorectal cancer in primary care2023In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 182, p. 100-106Article in journal (Refereed)
    Abstract [en]

    Background: Primary health care (PHC) is often the first point of contact when diagnosing colorectal cancer (CRC). Human limitations in processing large amounts of information warrant the use of machine learning as a diagnostic prediction tool for CRC. Aim: To develop a predictive model for identifying non-metastatic CRC (NMCRC) among PHC patients using diagnostic data analysed with machine learning. Design and setting: A case-control study containing data on PHC visits for 542 patients >18 years old diagnosed with NMCRC in the Vastra Gotaland Region, Sweden, during 2011, and 2,139 matched controls. Method: Stochastic gradient boosting (SGB) was used to construct a model for predicting the presence of NMCRC based on diagnostic codes from PHC consultations during the year before the date of cancer diagnosis and the total number of consultations. Variables with a normalised relative influence (NRI) >1% were considered having an important contribution to the model. Risks of having NMCRC were calculated using odds ratios of marginal effects. Results: Of the 361 variables used as predictors in the stochastic gradient boosting model, 184 had non-zero influence, with 16 variables having NRI >1% and a combined NRI of 63.3%. Variables representing anaemia and bleeding had a combined NRI of 27.6%. The model had a sensitivity of 73.3% and a specificity of 83.5%. Change in bowel habit had the highest odds ratios of marginal effects at 28.8. Conclusion: Machine learning is useful for identifying variables of importance for predicting NMCRC in PHC. Malignant diagnoses may be hidden behind benign symptoms such as haemorrhoids.

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  • 79. Nemlander, Elinor
    et al.
    Ewing, Marcela
    Carlsson, Axel C.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics.
    Transforming early cancer detection in primary care: harnessing the power of machine learning2023In: Oncoscience, E-ISSN 2331-4737, Vol. 10, p. 20-21Article in journal (Other (popular science, discussion, etc.))
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    fulltext
  • 80.
    Nemlander, Elinor
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Solna, Sweden.;Reg Stockholm, Acad Primary Hlth Care Ctr, Stockholm, Sweden.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Solna, Sweden; Reg Stockholm, Reg Canc Ctr Stockholm Gotland, Stockholm, Sweden.
    Abedi, Eliya
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Solna, Sweden.;Reg Stockholm, Acad Primary Hlth Care Ctr, Stockholm, Sweden.
    Ekman, Simon
    Karolinska Univ Hosp, Thorac Oncol Ctr, Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden.
    Hasselström, Jan
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Solna, Sweden.;Reg Stockholm, Acad Primary Hlth Care Ctr, Stockholm, Sweden.
    Eriksson, Lars E.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Huddinge, Sweden.;City Univ London, Sch Hlth & Psychol Sci, London, England.;Karolinska Univ Hosp, Med Unit Infect Dis, Huddinge, Sweden.
    Carlsson, Axel C.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Solna, Sweden.;Reg Stockholm, Acad Primary Hlth Care Ctr, Stockholm, Sweden.
    Lung cancer prediction using machine learning on data from a symptom e-questionnaire for never smokers, formers smokers and current smokers2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 10, article id 0276703Article in journal (Refereed)
    Abstract [en]

    Purpose The aim of the present study was to investigate the predictive ability for lung cancer of symptoms reported in an adaptive e-questionnaire, separately for never smokers, former smokers, and current smokers.

    Patients and methods Consecutive patients referred for suspected lung cancer were recruited between September 2014 and November 2015 from the lung clinic at the Karolinska University Hospital, Stockholm, Sweden. A total of 504 patients were later diagnosed with lung cancer (n = 310) or no cancer (n = 194). All participants answered an adaptive e-questionnaire with a maximum of 342 items, covering background variables and symptoms/sensations suspected to be associated with lung cancer. Stochastic gradient boosting, stratified on smoking status, was used to train and test a model for predicting the presence of lung cancer.

    Results Among never smokers, 17 predictors contributed to predicting lung cancer with 82% of the patients being correctly classified, compared with 26 predictors with an accuracy of 77% among current smokers and 36 predictors with an accuracy of 63% among former smokers. Age, sex, and education level were the most important predictors in all models.

    Conclusion Methods or tools to assess the likelihood of lung cancer based on smoking status and to prioritize investigative and treatment measures among all patients seeking care with diffuse symptoms are much needed. Our study presents risk assessment models for patients with different smoking status that may be developed into clinical risk assessment tools that can help clinicians in assessing a patient's risk of having lung cancer.

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  • 81.
    Nemlander, Elinor
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet , Solna , Sweden;Academic Primary Health Care Centre , Region Stockholm, Stockholm , Sweden.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet , Solna , Sweden;Regional Cancer Centre Stockholm-Gotland , Region Stockholm, Stockholm , Sweden.
    Abedi, Eliya
    Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet , Solna , Sweden;Academic Primary Health Care Centre , Region Stockholm, Stockholm , Sweden.
    Hasselström, Jan
    Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet , Solna , Sweden;Academic Primary Health Care Centre , Region Stockholm, Stockholm , Sweden.
    Sjövall, Annika
    Division of Coloproctology, Department of Pelvic Cancer, Karolinska University Hospital, Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm , Sweden.
    Carlsson, Axel C
    Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet , Solna , Sweden;Academic Primary Health Care Centre , Region Stockholm, Stockholm , Sweden.
    Ewing, Marcela
    Institute of Medicine, Department of Community Medicine and Public Health, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.
    Validation of a diagnostic prediction tool for colorectal cancer: a case–control replication study2023In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229Article in journal (Refereed)
    Abstract [en]

    Background

    Early detection of colorectal cancer (CRC) is crucial for survival. Primary care, the first point of contact in most cases, needs supportive risk assessment tools. We aimed to replicate the Swedish Colorectal Cancer Risk Assessment Tool (SCCRAT) for non-metastatic CRC in primary care and examine if risk factor patterns depend on sex and age.

    Methods

    2,920 adults diagnosed with non-metastatic CRC during the years 2015–2019 after having visited a general practitioner the year before the diagnosis were selected from the Swedish Cancer Register and matched with 11,628 controls, using the same inclusion criteria except for the CRC diagnosis. Diagnostic codes from primary care consultations were collected from a regional health care database. Positive predictive values (PPVs) were estimated for the same 5 symptoms and combinations thereof as in the baseline study.

    Results

    The results for patients aged ≥50 years old in the present study were consistent with the results of the SCCRAT study. All symptoms and combinations thereof with a PPV >5% in the present study had a PPV >5% in the baseline study. The combination of bleeding with abdominal pain (PPV 9.9%) and bleeding with change in bowel habit (PPV 7.8%) were the highest observed PPVs in both studies. Similar risk patterns were seen for all ages and when men and women were studied separately.

    Conclusion

    This external validation of the SCCRAT for non-metastatic CRC in primary care replicated the baseline study successfully and identified patients at high risk for CRC.

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  • 82.
    Nilsson, Göran
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Leppert, Jerzy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Hedberg, P. O.
    Cent Hosp Vasteras, Dept Clin Physiol, Vasteras, Sweden..
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Ohrvik, C. J. O.
    Karolinska Inst, Stockholm, Sweden..
    Heavy torso and narrow hip means high risk of myocardial infarction in elderly men: findings from a population based case-control study on anthropometric measures2015In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no Suppl. 1, p. 119-120Article in journal (Other academic)
  • 83.
    Nilsson, Göran
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Hedberg, P. O.
    Leppert, Jerzy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Steeper increase of body weight and BMI in acute myocardial infarction patients than in control subjects from the general population: learning from a case control study2013In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no S1, p. 148-148Article in journal (Other academic)
  • 84.
    Nohlert, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Tegelberg, Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Tillgren, Per
    Johansson, Pia
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Helgason, Asgeir R.
    Comparison of a high and a low intensity smoking cessation intervention in a dentistry setting in Sweden: a randomized trial2009In: BMC Public Health, E-ISSN 1471-2458, Vol. 9, p. 121-Article in journal (Refereed)
    Abstract [en]

    Background

    Tobacco is still the number one life style risk factor for ill health and premature death and also one of the major contributors to oral problems and diseases. Dentistry may be a potential setting for several aspects of clinical public health interventions and there is a growing interest in several countries to develop tobacco cessation support in dentistry setting. The aim of the present study was to assess the relative effectiveness of a high intensity intervention compared with a low intensity intervention for smoking cessation support in a dental clinic setting.

    Methods

    300 smokers attending dental or general health care were randomly assigned to two arms and referred to the local dental clinic for smoking cessation support. One arm received support with low intensity treatment (LIT), whereas the other group was assigned to high intensity treatment (HIT) support. The main outcome measures included self-reported point prevalence and continuous abstinence (≥ 183 days) at the 12-month follow-up.

    Results

    Follow-up questionnaires were returned from 86% of the participants. People in the HIT-arm were twice as likely to report continuous abstinence compared with the LIT-arm (18% vs. 9%, p = 0.02). There was a difference (not significant) between the arms in point prevalence abstinence in favour of the HIT-protocol (23% vs. 16%). However, point prevalence cessation rates in the LIT-arm reporting additional support were relatively high (23%) compared with available data assessing abstinence in smokers trying to quit without professional support.

    Conclusion

    Screening for willingness to quit smoking within the health care system and offering smoking cessation support within dentistry may be an effective model for smoking cessation support in Sweden. The LIT approach is less expensive and time consuming and may be appropriate as a first treatment option, but should be integrated with other forms of available support in the community. The more extensive and expensive HIT-protocol should be offered to those who are unable to quit with the LIT approach in combination with other support.

  • 85.
    Nohlert, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Tegelberg, Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Tillgren, Per
    Johansson, Pia
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Helgason, Ásgeir R
    Comparison of a high and a low intensity smokingcessation intervention in a dentistry setting in Sweden: a randomized trial2009In: BMC Public Health, E-ISSN 1471-2458, Vol. 9, p. 121-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Tobacco is still the number one life style risk factor for ill health and premature death and also one of the major contributors to oral problems and diseases. Dentistry may be a potential setting for several aspects of clinical public health interventions and there is a growing interest in several countries to develop tobacco cessation support in dentistry setting. The aim of the present study was to assess the relative effectiveness of a high intensity intervention compared with a low intensity intervention for smoking cessation support in a dental clinic setting.

    METHODS:

    300 smokers attending dental or general health care were randomly assigned to two arms and referred to the local dental clinic for smoking cessation support. One arm received support with low intensity treatment (LIT), whereas the other group was assigned to high intensity treatment (HIT) support. The main outcome measures included self-reported point prevalence and continuous abstinence (> or = 183 days) at the 12-month follow-up.

    RESULTS:

    Follow-up questionnaires were returned from 86% of the participants. People in the HIT-arm were twice as likely to report continuous abstinence compared with the LIT-arm (18% vs. 9%, p = 0.02). There was a difference (not significant) between the arms in point prevalence abstinence in favour of the HIT-protocol (23% vs. 16%). However, point prevalence cessation rates in the LIT-arm reporting additional support were relatively high (23%) compared with available data assessing abstinence in smokers trying to quit without professional support.

    CONCLUSION:

    Screening for willingness to quit smoking within the health care system and offering smoking cessation support within dentistry may be an effective model for smoking cessation support in Sweden. The LIT approach is less expensive and time consuming and may be appropriate as a first treatment option, but should be integrated with other forms of available support in the community. The more extensive and expensive HIT-protocol should be offered to those who are unable to quit with the LIT approach in combination with other support.

    TRIAL REGISTRATION:

    Trial registration number: NCT00670514.

  • 86.
    Ostman, Maja Eriksson
    et al.
    Orebro Univ, Fac Hlth, Dept Cardiol, Orebro, Sweden.
    Calais, Fredrik
    Orebro Univ, Fac Hlth, Dept Cardiol, Orebro, Sweden.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Frobert, Ole
    Orebro Univ, Fac Hlth, Dept Cardiol, Orebro, Sweden.
    Leppert, Jerzy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Hedberg, Pär
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Vastmanland Cty Hosp, Dept Clin Physiol, Vasteras, Sweden.
    Prognostic impact of subclinical or manifest extracoronary artery diseases after acute myocardial infarction2017In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 263, p. 53-59Article in journal (Refereed)
    Abstract [en]

    Background and aims: In patients with coronary artery disease (CAD), clinically overt extracoronary artery diseases (ECADs), including claudication or previous strokes, are associated with poor outcomes. Subclinical ECADs detected by screening are common among such patients. We aimed to evaluate the prognostic impact of subclinical versus symptomatic ECADs in patients with acute myocardial infarction (AMI). Methods: In a prospective observational study, 654 consecutive patients diagnosed with AMI underwent ankle brachial index (ABI) measurements and ultrasonographic screening of the carotid arteries and abdominal aorta. Clinical ECADs were defined as prior strokes, claudication, or extracoronary artery intervention. Subclinical ECADs were defined as the absence of a clinical ECAD in combination with an ABI <= 0.9 or >1.4, carotid artery stenosis, or an abdominal aortic aneurysm. Results: At baseline, subclinical and clinical ECADs were prevalent in 21.6% and 14.4% of the patients, respectively. Patients with ECADs received evidence-based medication more often at admission but similar medications at discharge compared with patients without ECADs. During a median follow-up of 5.2 years, 166 patients experienced endpoints of hospitalization for AMI, heart failure, stroke, or cardiovascular death. With ECAD-free cases as reference and after adjustment for risk factors, a clinical ECAD (hazard ratio [HR] 2.10, 95% confidence interval [CI] 1.34-3.27, p = 0.001), but not a subclinical ECAD (HR 1.35, 95% CI 0.89-2.05, p = 0.164), was significantly associated with worse outcomes. Conclusions: Despite receiving similar evidence-based medication at discharge, patients with clinical ECAD, but not patients with a subclinical ECAD, had worse long-term prognosis than patients without an ECAD after AMI.

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  • 87.
    Rhodin, Annica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Gröndbladh, Alfhild
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Ginya, Harumi
    Precision System Science Japan.
    NIlsson, Kent W
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Zhou, Qin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Enlund, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Hallberg, Mathias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences. Division of Biological Research on Drug Dependence.
    Gordh, Torsten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Nyberg, Fred
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Combined analysis of circulating β-endorphin with gene polymorphisms in OPRM1, CACNAD2 and ABCB1 reveals correlation with pain, opioid sensitivity and opioid-related side effects2013In: Molecular Brain, ISSN 1756-6606, Vol. 6, p. 8-Article in journal (Refereed)
    Abstract [en]

    Background

    Opioids are associated with wide inter-individual variability in the analgesic response and a narrow therapeutic index. This may be partly explained by the presence of single nucleotide polymorphisms (SNPs) in genes encoding molecular entities involved in opioid metabolism and receptor activation. This paper describes the investigation of SNPs in three genes that have a functional impact on the opioid response: OPRM1, which codes for the μ-opioid receptor; ABCB1 for the ATP-binding cassette B1 transporter enzyme; and the calcium channel complex subunit CACNA2D2. The genotyping was combined with an analysis of plasma levels of the opioid peptide β-endorphin in 80 well-defined patients with chronic low back pain scheduled for spinal fusion surgery, and with differential sensitivity to the opioid analgesic remifentanil. This patient group was compared with 56 healthy controls.

    Results

    The plasma β-endorphin levels were significantly higher in controls than in pain patients.

    A higher incidence of opioid-related side effects and sex differences was found in patients with the minor allele of the ABCB1 gene. Further, a correlation between increased opioid sensitivity and the major CACNA2D2 allele was confirmed. A tendency of a relationship between opioid sensitivity and the minor allele of OPRM1 was also found.

    Conclusions

    Although the sample cohort in this study was limited to 80 patients it appears that it was possible to observe significant correlations between polymorphism in relevant genes and various items related to pain sensitivity and opioid response. Of particular interest is the new finding of a correlation between increased opioid sensitivity and the major CACNA2D2 allele. These observations may open for improved strategies in the clinical treatment of chronic pain with opioids.

  • 88.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Extending the Linear Model with R: Generalized Linear, Mixed Effects and Nonparametric Regression Models, 2nd edition2018In: Psychometrika, ISSN 0033-3123, E-ISSN 1860-0980, Vol. 83, no 4, p. 1011-1013Article, book review (Other academic)
  • 89.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Mer om soldat Björks 1:a hustru2021In: Habobygden: Tidskrift för släkt- och hembygdsforskare, no 1, p. 12-Article in journal (Other academic)
  • 90.
    Rosenblad, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Leppert, Jerzy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Nilsson, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Maternal age at childbirth is associated with changes in smoking status between late adolescence and early middle age: results from 22 years of follow-up2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, no Suppl 1, p. 615-615Article in journal (Other academic)
  • 91.
    Rosenblad, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Nilsson, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Leppert, Jerzy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Intelligence level in late adolescence is inversely associated with BMI change during 22 years of follow-up: results from the WICTORY study2012In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 27, no 8, p. 647-655Article in journal (Refereed)
    Abstract [en]

    The objective of this population-based retrospective cohort study was to examine the association between intelligence (IQ) at late adolescence and changes in body mass index (BMI) during 22 years of follow-up until 40 years of age, taking education level into account. Data from 5,286 males born 1950–1959 who had participated in the Westmannia Cardiovascular Risk Factors Study at 40 years of age and attended the Swedish military conscription examination between the ages of 17 and 22 were used. From a mean age of 18 years until follow-up at 40 years of age, BMI increased with a mean (95 % confidence interval (CI)) of 4.36 (4.28–4.43) kg/m2, equalling 0.20 kg/m2 per year. The difference in BMI change between IQ levels was strongly statistically significant (P < 0.001), with a strictly inverse relationship between IQ and BMI change. The lowest IQ level (<74) had a mean (95 % CI) BMI increase of 5.19 (4.63–5.74) kg/m2, equalling 0.24 kg/m2 per year, compared with 3.73 (3.40–4.07) kg/m2, equalling 0.17 kg/m2 per year, for the highest IQ level (>126). Education level also had a strictly inverse relationship with BMI change. After adjusting for confounding variables, including education level, IQ still had a strictly inverse relationship to BMI change, with all IQ levels < 111 having a significantly larger BMI change than IQ > 126 (P < 0.01 for all levels). Education level at 40 years of age but not at 18 years of age had a significant association with BMI change after adjusting for IQ.

  • 92.
    Rosenblad, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Reg Canc Ctr Stockholm Gotland, Stockholm, Sweden.;Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Sundqvist, Pernilla
    Örebro Univ, Fac Med & Hlth, Dept Urol, Örebro, Sweden..
    Harmenberg, Ulrika
    Karolinska Univ Hosp, Dept Oncol, Stockholm, Sweden.;Karolinska Inst, Stockholm, Sweden..
    Hellström, Mikael
    Gothenburg Univ, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Dept Radiol, Gothenburg, Sweden..
    Hofmann, Fabian
    Umeå Univ, Dept Urol, Luleå, Sweden..
    Kjellman, Anders
    Karolinska Inst, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Urol, Stockholm, Sweden..
    Dahlin, Britt-Inger Kröger
    Umeå Univ, Dept Surg & Perioperat Sci, Urol & Androl, S-90185 Umeå, Sweden..
    Lindblad, Per
    Örebro Univ, Fac Med & Hlth, Sch Med Sci, Örebro, Sweden..
    Lindskog, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cancer Pharmacology and Computational Medicine.
    Lundstam, Sven
    Univ Gothenburg, Sahlgrenska Acad, Dept Urol, Gothenburg, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Dept Oncol, Gothenburg, Sweden..
    Ljungberg, Börje
    Umeå Univ, Dept Surg & Perioperat Sci, Urol & Androl, S-90185 Umeå, Sweden..
    Surgical waiting times and all-cause mortality in patients with non-metastatic renal cell carcinoma2022In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 56, no 5-6, p. 383-390Article in journal (Refereed)
    Abstract [en]

    Objective To examine the association between surgical waiting times (SWTs) and all-cause mortality (ACM) in non-metastatic patients with RCC, in relation to tumour stage. Patients and methods This nation-wide population-based cohort study included 9,918 M0 RCC patients registered in the National Swedish Kidney Cancer Register, between 2009 and 2021, followed-up for ACM until 9 December 2021, and having measured SWTs. The associations between primarily SWTs from date of radiological diagnosis to date of surgery (WRS) and secondarily SWTs from date of radiological diagnosis to date of treatment decision (WRT) and date of treatment decision to date of surgery (WTS), in relation to ACM, were analysed using Cox regression analysis, adjusted for clinical and demographic characteristics, stratified and unstratified according to T-stage. Results During a mean follow-up time of 5 years (49,873 person-years), 23% (n = 2291) of the patients died. The adjusted hazard ratio (AHR) for WRS (months) for all patients was 1.03 (95% confidence interval [CI] = 1.02-1.04; p < 0.001). When subdividing WRS on T-stage, the AHRs were 1.03 (95% CI = 1.01-1.04; p < 0.001) and 1.05 (95% CI = 1.02-1.08; p = 0.003) for stages T1 and T3, respectively, while non-significant for T2 (p = 0.079) and T4 (p = 0.807). Similar results were obtained for WRT and WTS. Conclusions Prolonged SWTs significantly increased the risk of early overall death among patients with RCC. The increased risk of early death from any cause show the importance of shortening SWTs in clinical work of patients with this malignant disease.

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  • 93.
    Rosenblad, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics. Regional Cancer Centre Stockholm-Gotland, Box 6909, SE-102 39, Stockholm, Sweden;Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Westman, Bodil
    Bergkvist, Karin
    Segersvärd, Ralf
    Roos, Nathalie
    Bergenmar, Mia
    Sharp, Lena
    Differences in health-related quality of life between native and foreign-born gynaecological cancer patients in Sweden: a five-year cross-sectional study2023In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649Article in journal (Refereed)
    Abstract [en]

    Purpose

    To examine differences in health-related quality of life (HRQoL) between native and foreign-born gynaecological cancer patients in Sweden, taking into account clinical, demographic, and socioeconomic factors.

    Methods

    The 30-item European Organisation for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) and a study-specific questionnaire covering demographic and socioeconomic factors were answered by 684 women aged ≥ 18 years old, diagnosed in 2014, 2016, or 2018 with gynaecological cancer in the Stockholm-Gotland health care region, Sweden. Clinical data were obtained from the Swedish Cancer Register. Data were analysed using the Kruskal–Wallis test and linear regression.

    Results

    The women had a mean age of 65.4 years, with 555 (81.1%) born in Sweden, 54 (7.9%) in other Nordic countries (ONC), 43 (6.3%) in other European countries (OEC), and 32 (4.7%) in non-European countries (NEC). HRQoL differed significantly between the four groups for 14 of the 15 QLQ-C30 scales/items. On average, Swedish-born women scored 2.0, 15.2, and 16.7 points higher for QoL/functioning scales/items and 2.2, 14.1, and 18.7 points lower for symptom scales/items, compared with ONC-, OEC-, and NEC-born women, respectively. In adjusted analyses, none of the differences between Swedish-born and ONC-born women were significant, while for OEC- and NEC-born women the differences were significant for most QLQ-C30 scales/items.

    Conclusion

    HRQoL differs between native and foreign-born gynaecological cancer patients in Sweden, with lower HRQoL the further from Sweden the women are born. A more individualised cancer care, with tailored support to optimize HRQoL is needed for this vulnerable group of patients.

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  • 94.
    Rothman, M.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Johansson, A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Ortendahl, M.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Improved quality of life, working ability and patient satisfaction after a pre-treatment multimodal assessment method in patients with mixed chronic muscular pain: A randomized controlled study2012In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 72, no 6, p. 500-500Article in journal (Other academic)
  • 95.
    Rothman, Mats Georg
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Ortendahl, Monica
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Johansson, Ann-Christin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Improved Quality of Life, Working Ability, and Patient Satisfaction After a Pretreatment Multimodal Assessment Method in Patients With Mixed Chronic Muscular Pain: A Randomized-controlled Study2013In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 29, no 3, p. 195-204Article in journal (Refereed)
    Abstract [en]

    Objective:

    To investigate whether a pretreatment multimodal (MM) assessment of patients with chronic muscular pain has an impact on treatment outcome.

    Methods:

    The present randomized-controlled study evaluated an MM assessment compared with routine multidisciplinary assessment given to a control group. The study population consisted of primary care patients with mixed chronic muscular pain. Variables assessed were: pain intensity, depression, life stress, quality of life (QOL), disability, working ability, and treatment satisfaction. Follow-up was performed at 15 months and 182 patients of 220 (83%) completed the study.

    Results:

    Univariate and multivariate logistic regression showed from baseline to 15 months a significant improvement in QOL as measured by Short-Form 36 in the MM group compared with the control group on the domains of physical function (odds ratio 2.40; 95% confidence interval 1.32-4.37), role physical (2.37; 1.10-5.09), and role emotional (2.05; 1.05-3.96). Working ability improved more significantly in the MM group (46% vs. 35%) and impairment was less (1% vs. 15%) compared with the control group (P = 0.016). Satisfaction with the assessment was, on average, higher (P < 0.001) in the MM group than in the control group.

    Discussion:

    Patients who underwent an MM assessment before treatment in comparison with patients receiving routine multidisciplinary assessment improved QOL, working ability, and were also significantly more satisfied. This result indicates that MM pretreatment assessment could be advantageous in the selection of patients for suitable rehabilitation treatment in a primary care setting, and also be used to prepare patients for future rehabilitation.

  • 96.
    Salih Joelsson, Lana
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Berglund, Anna
    Uppsala University, National Centre for Knowledge on Men.
    Wånggren, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.
    Lood, Mikael
    Orebro Univ Hosp, Fertil Unit, Dept Womens Hlth, Orebro, Sweden.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Do subfertile women adjust their habits when trying to conceive?2016In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 121, no 3, p. 184-191Article in journal (Refereed)
    Abstract [en]

    AbstractAIM:

    The aim of this study was to investigate lifestyle habits and lifestyle adjustments among subfertile women trying to conceive.

    MATERIALS AND METHODS:

    Women (n = 747) were recruited consecutively at their first visit to fertility clinics in mid-Sweden. Participants completed a questionnaire. Data were analyzed using logistic regression, t tests, and chi-square tests.

    RESULTS:

    The response rate was 62% (n = 466). Mean duration of infertility was 1.9 years. During this time 13.2% used tobacco daily, 13.6% drank more than three cups of coffee per day, and 11.6% consumed more than two glasses of alcohol weekly. In this sample, 23.9% of the women were overweight (body mass index, BMI 25-29.9 kg/m(2)), and 12.5% were obese (BMI ≥30 kg/m(2)). Obese women exercised more and changed to healthy diets more frequently than normal-weight women (odds ratio 7.43; 95% confidence interval 3.7-14.9). Six out of ten women (n = 266) took folic acid when they started trying to conceive, but 11% stopped taking folic acid after some time. Taking folic acid was associated with a higher level of education (p < 0.001).

    CONCLUSIONS:

    Among subfertile women, one-third were overweight or obese, and some had other lifestyle factors with known adverse effects on fertility such as use of tobacco. Overweight and obese women adjusted their habits but did not reduce their body mass index. Women of fertile age would benefit from preconception counseling, and the treatment of infertility should routinely offer interventions for lifestyle changes.

    KEYWORDS:

    Alcohol consumption; assisted reproduction; diet; infertility; lifestyle; obesity; pregnancy; tobacco use

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  • 97.
    Stern, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Salih Joelsson, Lana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Berglund, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Ekstrand, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Hegaard, Hanne
    Aarts, Clara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Is pregnancy planning associated with background characteristics and pregnancy planning behavior?2016In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 2, p. 182-189Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Prevalence of planned pregnancies varies between countries but is often measured in a dichotomous manner. The aim of this study was to investigate to what level pregnant women had planned their pregnancies and whether pregnancy planning was associated with background characteristics and pregnancy planning behavior.

    MATERIAL AND METHODS: A cross-sectional study that utilized the baseline measurements from the Swedish Pregnancy Planning (SWEPP) study. Pregnant women (n= 3390) recruited at antenatal clinics answered a questionnaire. Data were analyzed with multinomial logistic regression, Kruskal-Wallis H and χ(2) tests.

    RESULTS: Three out of four pregnancies were very or fairly planned and 12 % fairly or very unplanned. Of women with very unplanned pregnancies, 32 % had considered an induced abortion. Women with planned pregnancies were more likely to have a higher level of education, higher household income, to be currently working ≥50 %, and to have longer relationships than women with unplanned pregnancies. The level of pregnancy planning was associated with planning behavior, such as information seeking and intake of folic acid, but without a reduction in alcohol consumption. One third of all women took folic acid one month prior to conception, 17 % used tobacco daily and 11 % used alcohol weekly three months before conception.

    CONCLUSIONS: A majority rated their pregnancy as very or fairly planned, with socio-economic factors as explanatory variables. The level of pregnancy planning should be queried routinely to enable individualized counselling, especially for women with unplanned pregnancies. Preconception recommendations need to be established and communicated to the public to increase health promoting planning behavior.

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  • 98.
    Sundström, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Björkelund, Cecilia
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med Primary Hlth Care, Gothenburg, Sweden.
    Giedraitis, Vilmantas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Hansson, Per-Olof
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Koupil, Ilona
    Stockholm Univ, Dept Publ Hlth Sci, Stockholm, Sweden;Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.
    Kristenson, Margareta
    Linkoping Univ, Dept Med & Hlth Sci, Div Community Med, Linkoping, Sweden.
    Lagerros, Ylva Trolle
    Karolinska Inst, Dept Med, Unit Clin Epidemiol, Stockholm, Sweden;Karolinska Univ Hosp Huddinge, Dept Endocrinol Metab & Diabet, Huddinge, Sweden.
    Leppert, Jerzy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Lissner, Lauren
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med Epidemiol & Social, Gothenburg, Sweden.
    Johansson, Ingegerd
    Umea Univ, Sch Dent, Dept Odontol, Umea, Sweden.
    Ludvigsson, Jonas F.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden;Orebro Univ, Orebro Univ Hosp, Dept Pediat, Orebro, Sweden.
    Nilsson, Peter M.
    Skane Univ Hosp, Dept Clin Sci, Malmo, Sweden;Lund Univ, Lund, Sweden.
    Olsson, Håkan
    Lund Univ, Dept Clin Sci Canc Epidemiol, Lund, Sweden.
    Pedersen, Nancy L.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Rosengren, Annika
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Sandin, Sven
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden;Icahn Sch Med Mt Sinai, Dept Psychiat, New York, NY 10029 USA;Seaver Autism Ctr Res & Treatment Mt Sinai, New York, NY USA.
    Snäckerström, Tomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Stenbeck, Magnus
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Söderberg, Stefan
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden;Umea Univ, Heart Ctr, Umea, Sweden.
    Weiderpass, Elisabete
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden;Inst Populat Based Canc Res, Dept Res, Canc Registry Norway, Oslo, Norway;Univ Helsinki, Fac Med, Folkhalsan Res Ctr, Genet Epidemiol Grp, Helsinki, Finland;Univ Tromso, Arctic Univ Norway, Dept Community Med, Tromso, Norway.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wennberg, Patrik
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Fortier, Isabel
    McGill Univ, Res Inst, Hlth Ctr, Montreal, PQ, Canada.
    Heller, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Storgärds, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Svennblad, Bodil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Rationale for a Swedish cohort consortium2019In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, no 1, p. 21-28Article in journal (Refereed)
    Abstract [en]

    We herein outline the rationale for a Swedish cohort consortium, aiming to facilitate greater use of Swedish cohorts for world-class research. Coordination of all Swedish prospective population-based cohorts in a common infrastructure would enable more precise research findings and facilitate research on rare exposures and outcomes, leading to better utilization of study participants' data, better return of funders' investments, and higher benefit to patients and populations. We motivate the proposed infrastructure partly by lessons learned from a pilot study encompassing data from 21 cohorts. We envisage a standing Swedish cohort consortium that would drive development of epidemiological research methods and strengthen the Swedish as well as international epidemiological competence, community, and competitiveness.

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  • 99.
    Sundström, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology. George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia..
    Söderholm, Martin
    Department of Clinical Sciences, Lund University , Lund, Sweden.
    Söderberg, Stefan
    Department of Public Health and Clinical Medicine, Umeå University , Umeå, Sweden.
    Alfredsson, Lars
    Institute of Environmental Medicine, Cardiovascular Epidemiology, Karolinska Institutet , Stockholm, Sweden.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Umeå University , Umeå, Sweden.
    Bellocco, Rino
    Department of Statistics and Quantitative Methods, University of Milano-Biocca , Milan, Italy; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm, Sweden.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Broberg, Per
    Department of Clinical Sciences, Cancer Epidemiology, Lund University , Lund, Sweden.
    Eriksson, Maria
    Department of Neurosurgery, Umeå University , Umeå, Sweden.
    Eriksson, Marie
    Department of Public Health and Clinical Medicine, Umeå University , Umeå, Sweden; Department of Statistics, Umeå University , Umeå, Sweden.
    Forsberg, Bertil
    Department of Public Health and Clinical Medicine, Umeå University , Umeå, Sweden.
    Fransson, Eleonor I
    Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University , Jönköping, Sweden.
    Giedraitis, Vilmantas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Hansson, Per-Olof
    Department of Molecular and Clinical Medicine, Sahlgrenska Academy/ Sahlgrenska University Hospital, University of Gothenburg , Gothenburg, Sweden.
    Heller, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR).
    Håkansson, Niclas
    Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet , Stockholm, Sweden.
    Ingelsson, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Järvholm, Bengt
    Department of Public Health and Clinical Medicine, Umeå University , Umeå, Sweden.
    Khalili, Payam
    Department of Cardiology and Acute Internal Medicine, Central Hospital , Karlstad, Sweden.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University , Östersund, Sweden.
    Lager, Anton
    Centre for Epidemiology and Community Medicine , Stockholm County Council, Stockholm, Sweden; Department of Public Health Sciences , Stockholm, Sweden.
    Lagerros, Ylva Trolle
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden; Department of Medicine, Karolinska University Hospital , Huddinge, Stockholm, Sweden.
    Larsson, Susanna C
    Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet , Stockholm, Sweden.
    Leander, Karin
    Institute of Environmental Medicine, Cardiovascular Epidemiology, Karolinska Institutet , Stockholm, Sweden.
    Leppert, Jerzy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Magnusson, Cecilia
    Centre for Epidemiology and Community Medicine , Stockholm County Council, Stockholm, Sweden; Department of Public Health Sciences , Stockholm, Sweden.
    Magnusson, Patrik K E
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm, Sweden.
    Malfert, Mauricio
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR).
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology.
    Nilsson, Peter
    Department of Clinical Sciences, Lund University , Lund, Sweden.
    Olsson, Håkan
    Department of Clinical Sciences, Cancer Epidemiology, Lund University , Lund, Sweden.
    Pedersen, Nancy L
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm, Sweden.
    Pennlert, Johanna
    Department of Public Health and Clinical Medicine, Umeå University , Umeå, Sweden.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland.
    Rosengren, Annika
    Department of Molecular and Clinical Medicine, Sahlgrenska Academy/ Sahlgrenska University Hospital, University of Gothenburg , Gothenburg, Sweden.
    Torén, Kjell
    Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wolk, Alicja
    Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet , Stockholm, Sweden.
    Engström, Gunnar
    Department of Clinical Sciences, Lund University , Lund, Sweden.
    Svennblad, Bodil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology.
    Wiberg, Bernice
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Risk factors for subarachnoid haemorrhage: a nationwide cohort of 950 000 adults2019In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 48, no 6, p. 2018-2025Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium.

    METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries.

    RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH.

    CONCLUSIONS: The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.

  • 100.
    Söderström, Lisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland.
    Bergkvist, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Oral nutritional supplement use is weakly associated with increased subjective health-related quality of life in malnourished older adults: a multicentre randomised controlled trial2022In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 127, no 1, p. 103-111Article in journal (Refereed)
    Abstract [en]

    Malnutrition is common among older adults in health-care settings and is associated with decreased quality of life (QoL). The present study aimed to investigate the effect on health-related QoL (HRQoL) among older adults after 6 months of treatment with individual dietary advice (DA) and/or oral nutritional supplements (ONS), utilising 409 patients included in a multicentre randomised controlled trial of patients >= 65 years old, stratified according to nutrition status (malnourished/at risk of malnutrition), admitted to hospital in Sweden 2010-2014. Patients were randomised into four arms: DA, ONS, DA + ONS or routine care (control). The intervention started at discharge from hospital, with HRQoL measured using European QoL five-dimension, three-level (EQ-5D-3L) and European QoL-visual analogue scale (EQ-VAS) at baseline and at 6-month, 1-year and 3-year follow-ups. Data were analysed using the Kruskal-Wallis test and multiple linear regression. Overall, HRQoL increased from baseline to follow-ups, although the magnitude of change in EQ-5D-3L did not differ significantly between the four arms in any of the nutrition groups. However, a significant difference was observed for change in EQ-VAS from baseline to 6-month follow-up in the malnourished group, with mean changes of 22 center dot 4 and -3 center dot 4 points for the ONS and control groups, respectively (P = 0 center dot 009). In the multiple linear regression analyses, participants in the ONS arm had 27 center dot 5, 34 center dot 4 and 38 center dot 8 points larger increases in EQ-VAS from baseline to the 6-month (P = 0 center dot 011), 1-year (P = 0 center dot 007) and 3-year (P = 0 center dot 032), respectively, follow-ups than the control group. The use of ONS improved subjectively assessed HRQoL in these malnourished older adults.

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