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  • 651.
    Wright, A. Michelle
    et al.
    Wayne State Univ, Dept Psychol, 71 W Warren Ave, Detroit, MI 48202 USA.;Wayne State Univ, Dept Family Med & Publ Hlth Sci, Detroit, MI USA..
    Aldhalimi, Abir
    Wayne State Univ, Dept Family Med & Publ Hlth Sci, Detroit, MI USA.;Univ Detroit Mercy, Dept Psychol, Detroit, MI 48221 USA..
    Lumley, Mark A.
    Wayne State Univ, Dept Psychol, 71 W Warren Ave, Detroit, MI 48202 USA..
    Jamil, Hikmet
    Wayne State Univ, Dept Family Med & Publ Hlth Sci, Detroit, MI USA.;Wayne State Univ, Inst Environm Hlth Sci, Detroit, MI USA..
    Pole, Nnamdi
    Smith Coll, Dept Psychol, Northampton, MA 01063 USA..
    Arnetz, Judith E.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Wayne State Univ, Dept Family Med & Publ Hlth Sci, Detroit, MI USA.;Wayne State Univ, Inst Environm Hlth Sci, Detroit, MI USA..
    Arnetz, Bengt B.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Wayne State Univ, Dept Family Med & Publ Hlth Sci, Detroit, MI USA.;Wayne State Univ, Cardiovasc Res Inst, Detroit, MI USA.;Michigan State Univ, Coll Human Med, E Lansing, MI 48824 USA..
    Determinants of resource needs and utilization among refugees over time2016Ingår i: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 51, nr 4, s. 539-549Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study examined refugees' resource needs and utilization over time, investigated the relationships between pre-displacement/socio-demographic variables and resource needs and utilization, and explored the role of resource needs and utilization on psychiatric symptom trajectories. Iraqi refugees to the United States (N = 298) were assessed upon arrival and at 1-year intervals for 2 years for socio-demographic variables and pre-displacement trauma experiences, their need for and utilization of 14 different resources, and PTSD and depressive symptoms. Although refugees reported reduction of some needs over time (e.g., need for cash assistance declined from 99 to 71 %), other needs remained high (e.g., 99 % of refugees reported a need for health care at the 2-year interview). Generally, the lowest needs were reported after 2 years, and the highest utilization occurred during the first year post-arrival. Pre-displacement trauma exposure predicted high health care needs but not high health care utilization. Both high need for and use of health care predicted increasing PTSD and depressive symptoms. Specifically, increased use of psychological care across the three measurement waves predicted more PTSD and depression symptoms at the 2-year interview. Differences emerged between need for and actual use of resources, especially for highly trauma-exposed refugees. Resettlement agencies and assistance programs should consider the complex relationships between resource needs, resource utilization, and mental health during the early resettlement period.

  • 652.
    Wright, A. Michelle
    et al.
    Wayne State Univ, Dept Psychol, Detroit, MI USA.;Wayne State Univ, Dept Family Med & Publ Hlth Sci, Detroit, MI USA.;Western Michigan Univ, Office Vice President Res, Kalamazoo, MI USA..
    Dhalimi, Abir
    Wayne State Univ, Dept Family Med & Publ Hlth Sci, Detroit, MI USA.;Univ Detroit Mercy, Dept Psychiat, Detroit, MI 48221 USA.;Yale Univ, Sch Med, Dept Psychiat, New Haven, CT USA..
    Lumley, Mark A.
    Wayne State Univ, Dept Psychol, Detroit, MI USA..
    Jamil, Hikmet
    Wayne State Univ, Dept Family Med & Publ Hlth Sci, Detroit, MI USA.;Michigan State Univ, Coll Human Med, Dept Family Med, E Lansing, MI 48824 USA..
    Pole, Nnamdi
    Smith Coll, Dept Psychol, Northampton, MT, England..
    Arnetz, Judith E.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Michigan State Univ, Coll Human Med, Dept Family Med, E Lansing, MI 48824 USA.
    Arnetz, Bengt B.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Michigan State Univ, Coll Human Med, Dept Family Med, E Lansing, MI 48824 USA.
    Unemployment in Iraqi refugees: The interaction of pre and post-displacement trauma2016Ingår i: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 57, nr 6, s. 564-570Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Previous refugee research has been unable to link pre-displacement trauma with unemployment in the host country. The current study assessed the role of pre-displacement trauma, post-displacement trauma, and the interaction of both trauma types to prospectively examine unemployment in a random sample of newly-arrived Iraqi refugees. Participants (N=286) were interviewed three times over the first two years post-arrival. Refugees were assessed for pre-displacement trauma exposure, post-displacement trauma exposure, a history of unemployment in the country of origin and host country, and symptoms of posttraumatic stress disorder (PTSD) and depression. Analyses found that neither pre-displacement nor post-displacement trauma independently predicted unemployment 2years post-arrival; however, the interaction of pre and post-displacement trauma predicted 2-year unemployment. Refugees with high levels of both pre and post-displacement trauma had a 91% predicted probability of unemployment, whereas those with low levels of both traumas had a 20% predicted probability. This interaction remained significant after controlling for sociodemographic variables and mental health upon arrival to the US. Resettlement agencies and community organizations should consider the interactive effect of encountering additional trauma after escaping the hardships of the refugee's country of origin.

  • 653.
    Wright, A. Michelle
    et al.
    Wayne State Univ, Sch Med, Dept Family Med & Publ Hlth Sci, Detroit, MI 48202 USA.;Wayne State Univ, Dept Psychol, 71 W Warren Ave, Detroit, MI 48202 USA.;Western Michigan Univ, Off Vice President Res, Kalamazoo, MI 49008 USA..
    Talia, Yousif R.
    Wayne State Univ, Sch Med, Dept Family Med & Publ Hlth Sci, Detroit, MI 48202 USA..
    Aldhalimi, Abir
    Wayne State Univ, Sch Med, Dept Family Med & Publ Hlth Sci, Detroit, MI 48202 USA.;Univ Detroit Mercy, Dept Psychol, Detroit, MI 48221 USA..
    Broadbridge, Carissa L.
    Wayne State Univ, Sch Med, Dept Family Med & Publ Hlth Sci, Detroit, MI 48202 USA.;St Xavier Univ, Dept Psychol, Chicago, IL USA..
    Jamil, Hikmet
    Wayne State Univ, Sch Med, Dept Family Med & Publ Hlth Sci, Detroit, MI 48202 USA.;Michigan State Univ, Dept Family Med, Coll Human Med, 788 Serv Rd,Room B106D Clin Ctr, E Lansing, MI 48824 USA..
    Lumley, Mark A.
    Wayne State Univ, Dept Psychol, 71 W Warren Ave, Detroit, MI 48202 USA..
    Pole, Nnamdi
    Smith Coll, Dept Psychol, Northampton, MA 01063 USA..
    Arnetz, Bengt B.
    Wayne State Univ, Sch Med, Dept Family Med & Publ Hlth Sci, Detroit, MI 48202 USA.;Michigan State Univ, Dept Family Med, Coll Human Med, 788 Serv Rd,Room B106D Clin Ctr, E Lansing, MI 48824 USA.;Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden..
    Arnetz, Judith E.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Wayne State Univ, Sch Med, Dept Family Med & Publ Hlth Sci, Detroit, MI 48202 USA.;Michigan State Univ, Dept Family Med, Coll Human Med, 788 Serv Rd,Room B106D Clin Ctr, E Lansing, MI 48824 USA..
    Kidnapping and Mental Health in Iraqi Refugees: The Role of Resilience2017Ingår i: Journal of Immigrant and Minority Health, ISSN 1557-1912, E-ISSN 1557-1920, Vol. 19, nr 1, s. 98-107Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Although kidnapping is common in war-torn countries, there is little research examining its psychological effects. Iraqi refugees (N = 298) were assessed upon arrival to the U.S. and 1 year later. At arrival, refugees were asked about prior trauma exposure, including kidnapping. One year later refugees were assessed for posttraumatic stress disorder (PTSD) and major depression disorder (MDD) using the SCID-I. Individual resilience and narratives of the kidnapping were also assessed. Twenty-six refugees (9 %) reported being kidnapped. Compared to those not kidnapped, those who were had a higher prevalence of PTSD, but not MDD, diagnoses. Analyses examining kidnapping victims revealed that higher resilience was associated with lower rates of PTSD. Narratives of the kidnapping were also discussed. This study suggests kidnapping is associated with PTSD, but not MDD. Additionally, kidnapping victims without PTSD reported higher individual resilience. Future studies should further elucidate risk and resilience mechanisms.

  • 654.
    Zakrisson, Ann-Britt
    et al.
    Orebro Univ, Fac Med & Hlth, Dept Univ Healthcare Res Ctr, Orebro, Sweden.
    Arne, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning. Cty Council Varmland, Ctr Clin Res, Karlstad, Sweden.
    Hasselgren, Mikael
    Orebro Univ, Sch Med Sci, Orebro, Sweden.
    Lisspers, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Theander, Kersti
    Cty Council Varmland, Ctr Clin Res, Karlstad, Sweden.
    A complex intervention of self-management for patients with COPD or CHF in primary care improved performance and satisfaction with regard to own selected activities; A longitudinal follow-up2019Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, nr 1, s. 175-186Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To test a self-management intervention in primary health care (PHC) for patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) on self-efficacy, symptoms, functioning, and health.

    Background: Patients with COPD or CHF experience often the same symptoms such as shortness of breath, cough, lack of energy, dry mouth, numbness or tingling in hands and feet, pain and sleeping problems.

    Design: A multicentre randomized control trial.

    Method: The trial was conducted with one intervention group (N = 73) and one control group (N = 77). The trial was performed from September 2013-September 2015 at nine PHC centres in three county councils in Sweden. At baseline patients with COPD and CHF experienced any symptom. Follow-ups were performed after 3 months and 1 year. The intervention was structured on Bandura's theory of self-efficacy in six meetings and individual action plans based on personal problems were performed and discussed.

    Results: At baseline, there were no differences between the groups except for SF-36 social function. After 3 months, the intervention group improved performance and satisfaction with regard to own selected activities, otherwise no differences were found. Conclusion When designing a program, the patient's own difficulties must be taken into consideration if person-centred care is to be established. It is feasible to include both patients with COPD and CHF in the same group in PHC. Healthcare professionals need supervision in pedagogics during intervention in self-management.

  • 655. Zakrisson, Ann-Britt
    et al.
    Engfeldt, Peter
    Hagglund, Doris
    Odencrants, Sigrid
    Hasselgren, Mikael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Arne, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Theander, Kersti
    Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial2011Ingår i: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 20, nr 4, s. 427-433Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To investigate the effects of a nurse-led multidisciplinary programme (NMP) of pulmonary rehabilitation in primary health care with regard to functional capacity, quality of life (QoL), and exacerbations among patients with chronic obstructive pulmonary disease (COPD).

    Method: A 1-year longitudinal study with a quasi-experimental design was undertaken in patients with COPD, 49 in the intervention group and 54 in the control group. Functional capacity was assessed using the 6-minute walking test, and quality of life (QoL) was assessed using the Clinical COPD Questionnaire. Exacerbations were calculated by examination of patient records.

    Results: No significant differences were found between the groups in functional capacity and QoL after 1 year. The exacerbations decreased in the intervention group (n = -0.2) and increased in the control group (n = 0.3) during the year after NMP. The mean difference of change in exacerbation frequency between the groups was statistically significant after one year (p=0.009).

    Conclusions: The NMP in primary care produced a significant reduction in exacerbation frequency, but functional capacity and QoL were unchanged. More and larger studies are needed to evaluate potential benefits in functional capacity and QoL.

  • 656.
    Zethelius, Björn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik. Med Prod Agcy, Uppsala, Sweden..
    Cederholm, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Comparison between indexes of insulin resistance for risk prediction of cardiovascular diseases or development of diabetes2015Ingår i: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 110, nr 2, s. 183-192Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The predictive effect of various insulin resistance indexes for risk of cardiovascular diseases (CVD) or type 2 diabetes (T2DM) is still unclear. Methods: One thousand and forty-nine 71-years-old male subjects from the Swedish ULSAM study, mean follow-up 9 years. All subjects performed the euglycemic insulin clamp for M/I [glucose disposal/mean insulin], and 75-g oral glucose tolerance test for Ceder-IR: 1/glucose uptake rate/[mean glucose x log mean insulin]; Matsuda-IR: 1/10,000/square root [glucose0 x insulin0 x glucose120 x insulin120]; Belfiore-IR: 1/([glucose0 + glucose120]/normal mean glucose x [insulin0 + insulin120]/normal mean insulin)+1); and HOMA-IR: [glucose0 x insulin0]/22.5. Results: Bland-Altman plots showed best agreement between M/I versus Belfiore-IR and Ceder-IR with mean difference near zero, -0.21 to -0.46, while -0.68 to -0.77 for the other indexes. ISI-Ceder was the strongest predictor for incident nonfatal/fatal ischemic heart disease (CHD) or CVD at Cox regression in all subjects, and for incident T2DM at logistic regression in 1024 subjects with no baseline T2DM, with significantly higher hazard ratios or odds ratios than with all other indexes, also with best model fit, after adjusting for clinical characteristics and the traditional cardiovascular risk factors, including metabolic syndrome for CVD risk. Conclusion: Ceder-IR performed strongest as independent predictor for incidences of CHD/CVD and T2DM.

  • 657.
    Zethelius, Björn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Eliasson, Björn
    Eeg-Olofsson, Katarina
    Svensson, Ann-Marie
    Gudbjörnsdottir, Soffia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Cederholm, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    A new model for 5-year risk of cardiovascular disease in type 2 diabetes, from the Swedish National Diabetes Register (NDR)2011Ingår i: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 93, nr 2, s. 276-284Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM:

    We assessed the association between risk factors and cardiovascular disease (CVD) in an observational study of type 2 diabetes patients from the Swedish National Diabetes Register.

    METHODS:

    A derivation sample of 24,288 patients, aged 30-74 years, 15.3% with previous CVD, baseline 2002, 2488 CVD events when followed for 5 years until 2007. A separate validation data set of 4906 patients, baseline 2003, 522 CVD events when followed for 4 years.

    RESULTS:

    Adjusted hazard ratios at Cox regression for fatal/nonfatal CVD were: onset-age 1.59, diabetes duration 1.55, total-cholesterol-to-HDL-cholesterol ratio 1.20, HbA1c 1.12, systolic BP 1.09, BMI 1.07 (1 SD increase in natural log continuous variables); males 1.41, smoker 1.35, microalbuminuria 1.27, macroalbuminuria 1.53, atrial fibrillation 1.50, previous CVD 1.98 (all p<0.001 except BMI p=0.0018). All 12 variables were used to elaborate an equation for 5-year CVD risk in the derivation dataset: mean 5-year risk 11.9±8.4%. Calibration in the validation dataset was adequate: ratio predicted 4-year risk/observed rate 0.97. Discrimination was sufficient: C statistic 0.72, sensitivity 51% and specificity 78% for top quartile.

    CONCLUSION:

    This CVD risk model from a large observational study of patients in routine care showed adequate calibration and discrimination, and can be useful for clinical practice.

  • 658.
    Zethelius, Björn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Gudbjornsdottir, S.
    Eliasson, B.
    Eeg-Olofsson, K.
    Svensson, A. -M
    Cederholm, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Risk factors for atrial fibrillation in type 2 diabetes: Report from the Swedish National Diabetes Register: NDR2014Ingår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 57, nr S1, s. S137-S138Artikel i tidskrift (Övrigt vetenskapligt)
  • 659.
    Zethelius, Björn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Gudbjornsdottir, S
    Eliasson, B
    Eeg-Olofsson, K
    Svensson, AM
    Cederholm, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Risk prediction of cardiovascular disease in type 2 diabetes: a new risk equation from the Swedish NDR2010Ingår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 53, nr Suppl 1, s. S68-Artikel i tidskrift (Refereegranskat)
  • 660.
    Zethelius, Björn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Gudbjornsdottir, Soffia
    Univ Gothenburg, Sahlgrenska Univ Hosp, Dept Med, Gothenburg, Sweden..
    Eliasson, Bjorn
    Univ Gothenburg, Sahlgrenska Univ Hosp, Dept Med, Gothenburg, Sweden..
    Eeg-Olofsson, Katarina
    Univ Gothenburg, Sahlgrenska Univ Hosp, Dept Med, Gothenburg, Sweden..
    Svensson, Ann-Marie
    Univ Gothenburg, Sahlgrenska Univ Hosp, Dept Med, Gothenburg, Sweden..
    Cederholm, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Electrical atrial vulnerability and renal complications in type 2 diabetes. Reply to Montaigne D, Coisne A, Sosner P et al [letter]2016Ingår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 59, nr 4, s. 863-864Artikel i tidskrift (Övrigt vetenskapligt)
  • 661.
    Zethelius, Björn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Gudbjornsdottir, Soffia
    Univ Gothenburg, Dept Med, Sahlgrenska Univ Hosp, Gothenburg, Sweden..
    Eliasson, Bjorn
    Univ Gothenburg, Dept Med, Sahlgrenska Univ Hosp, Gothenburg, Sweden..
    Eeg-Olofsson, Katarina
    Univ Gothenburg, Dept Med, Sahlgrenska Univ Hosp, Gothenburg, Sweden..
    Svensson, Ann-Marie
    Univ Gothenburg, Dept Med, Sahlgrenska Univ Hosp, Gothenburg, Sweden..
    Cederholm, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Risk factors for atrial fibrillation in type 2 diabetes: report from the Swedish National Diabetes Register (NDR)2015Ingår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 58, nr 10, s. 2259-2268Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims/hypothesis Atrial fibrillation (AF) is more frequent in patients with diabetes than in the general population. However, characteristics contributing to AF risk in diabetes remain speculative. Methods Observational study of 83,162 patients with type 2 diabetes, aged 30-79 years, with no baseline AF, 17% had history of cardiovascular disease (CVD) and 3.3% history of congestive heart failure (CHF), followed up for development of AF during mean 6.8 years from 2005-2007 to 2012. A subgroup of 67,780 patients without history of CVD or CHF was also analysed. Results Using Cox regression, cardiovascular risk factors associated with risk for AF were updated mean BMI (HR 1.31 per 5 kg/m(2)) or obesity (HR 1.51), updated mean systolic BP (SBP; HR 1.13 per 10 mmHg) or hypertension (HR 1.71), and cumulative microalbuminuria (HR 1.21), p < 0.001 for all analyses. Male sex, increasing age and height were also significant predictors. HRs were 1.76 for a history of CHF and 2.56 for in-study CHF, while 1.32 for history of CVD and 1.38 for in-study CHD (p < 0.001). Among patients without history of CVD or CHF, significant predictors were similarly BMI, SBP, and cumulative microalbuminuria and CHF. The risk of AF differed in the subgroups achieving or not achieving a target BP < 140/85 mmHg. The HRs for AF were (per 10 mmHg increase) 0.88 and 1.24, respectively. Conclusions/interpretation The modifiable risk factors high BP, high BMI and albuminuria were strongly associated with AF in type 2 diabetes. CVD, advancing age and height were also associated with AF in type 2 diabetes.

  • 662.
    Zethelius, Björn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Gudbjörnsdottir, S.
    Göteborgs universitet.
    Eliasson, B.
    Göteborgs universitet.
    Eeg-Olofsson, K.
    Göteborgs universitet.
    Cederholm, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Level of physical activity associated with risk of cardiovascular diseases and mortality in patients with type-2 diabetes: report from the Swedish National Diabetes Register.2014Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 21, nr 2, s. 244-251Artikel i tidskrift (Refereegranskat)
  • 663.
    Zhong, You
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.;Beijing Hosp, Dept Cardiol, Beijing, Peoples R China..
    Rosengren, Annika
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden..
    Fu, Michael
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden..
    Welin, Lennart
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.;Lidkoping Hosp, Dept Med, Lidkoping, Sweden..
    Welin, Catharina
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden..
    Caidahl, Kenneth
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Mandalenakis, Zacharias
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden..
    Dellborg, Mikael
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden..
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala Univ, Dept Publ Hlth & Caring Sci, Family Med & Prevent Med Sect, Uppsala, Sweden..
    Hansson, Per-Olof
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden..
    Secular changes in cardiovascular risk factors in Swedish 50-year-old men over a 50-year period: The study of men born in 1913, 1923, 1933, 1943, 1953 and 19632017Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, nr 6, s. 612-620Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: During the past decades, declining trends in mean cholesterol levels and smoking have been observed in Western Europe, whereas obesity and a sedentary lifestyle have increased. Simultaneously, there has been a marked decrease in mortality from cardiovascular (CV) diseases. Methods: The aim of the study was to determine whether these trends in CV risk factors continued over a period of 50 years. Six systematic or random population samples of 50-year-old men (n = 3563) living in Gothenburg, Sweden, were investigated between 1963 and 2013. Results: During the 50 years, mean body mass index (BMI) at 50 years of age increased by 2 kg/m(2), from 24.8 kg/m(2) in 1963 to 26.8 kg/m(2) in 2013 (p< 0.001). A decrease in systolic blood pressure of nearly 10mmHg was observed from 1963 to 1993, but was not sustained through the past two decades. Mean serum cholesterol fell from 6.42 (SD 1.12) mmol/L to 5.34 (SD 0.97) mmol/L. The prevalence of smoking at 50 years of age decreased markedly from 56.1% in 1963 to 11.9% in 2013. The number of participants with a sedentary lifestyle during leisure time decreased until 1993, but has remained unchanged since. In 2013, 50-year-old men had a 6.9-times higher likelihood of lacking CV risk factors than 50-year-old men in 1963 (95% confidence interval (CI): 3.5-13.3, p< 0.001). The odds ratio for having four or more risk factors was only 0.13 (95% CI: 0.062-0.29, p< 0.001). Conclusion: Despite increasing body weight, the total CV risk factor burden has decreased in 50-year-old men over the past 50 years.

  • 664.
    Åberg, Joakim
    et al.
    Orebro Univ, Sch Med Sci, S-70185 Orebro, Sweden.
    Hasselgren, Mikael
    Orebro Univ, Sch Med Sci, S-70185 Orebro, Sweden.
    Montgomery, Scott
    Orebro Univ, Clin Epidemiol & Biostat, S-70182 Orebro, Sweden;Karolinska Inst, Dept Med, Clin Epidemiol Unit, Stockholm, Sweden;UCL, Dept Epidemiol & Publ Hlth, London, England.
    Lisspers, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Sundh, Josefin
    Orebro Univ, Sch Med Sci, Dept Resp Med, S-70185 Orebro, Sweden.
    Sex-related differences in management of Swedish patients with a clinical diagnosis of chronic obstructive pulmonary disease2019Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 14, s. 961-969Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Women with chronic obstructive pulmonary disease (COPD) have more symptoms, more exacerbations, lower health status scores, and more comorbidity. However, it is unclear whether management of COPD differs by sex. The aim of the study was to investigate differences by sex in the care of patients with COPD. Patients and methods: The population included 1329 primary and secondary care patients with a doctor ' s diagnosis of COPD in central Sweden. Data were obtained from patient questionnaires and included patient characteristics and data on achieved COPD care. Analyses included cross-tabulations, chi-squared test and multiple logistic regression using several measures in COPD management as dependent variables, female sex as independent variable, and with adjustment for age groups, previous exacerbations, COPD Assessment Test, level of dyspnea assessed by the modified Medical Research Council scale, comorbid conditions, self-rated moderate/severe disease, level of education and body mass index. Results: Women were more likely to receive triple therapy (OR 1.86 (95% CI 1.38-2.51)), to have any maintenance treatment (OR 1.82 (95% CI 1.31-2.55)), to be on sick leave (OR 2.16 (95% CI 1.19-3.93)), to have received smoking cessation support (OR 1.80 (95% CI 1.18-2.75)) and to have had pneumococcal vaccination (OR 1.82 (95% CI 1.37-2.43)), all independently of age, severity of disease or other potential confounders. Conclusion: Management of COPD differs by sex, with women being more actively managed than men. It is unclear whether this is due to patient-or care-related factors.

  • 665.
    Ångerud, Katja
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Annerbäck, Eva-Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Tydén, Tanja
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Boddeti, Santosh
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Kristiansson, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Adverse childhood experiences and depressive symptomatology among pregnant women2018Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, nr 6, s. 701-708Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Adverse childhood experiences (ACE) result in somatic and mental health disturbances. Its influence on antenatal depression is scarcely studied. This study examined the association between experience of ACE and antenatal depressive symptomatology.

    MATERIAL AND METHODS: 1257 women from 172 antenatal clinics in Sweden were surveyed during pregnancy and one year after delivery. Demographics, previous medical history and Edinburgh Postpartum Depression Scale (EPDS) were collected in pregnancy and postpartum and ACE one year postpartum. ACEs were partitioned into 10 categories. Statistical analyses used linear and logistic regression with EPDS score as main outcome measure.

    RESULTS: 736 (58.6%) women reported at least one ACE category and 88 women (7%) reported five or more ACE categories. An EPDS score of ≥13, which qualifies for a probable depression diagnosis, was reported by 277 (23%) women. In simple regression analyses the EPDS score was positively associated with the number of ACEs, cigarette smoking before pregnancy, body mass index and psychiatric disorders while education level was inversely associated. In a multiple regression analysis ACEs, education level and psychiatric disorder remained associated to the EPDS score. Among women with an ACE score ≥5 the odds ratio of having an EPDS score indicating probable depression was 4.2 (CI; 2.5-7.0).

    CONCLUSIONS: ACE was commonly reported. ACE and depressive symptomatology in late pregnancy were strongly associated in a dose-response manner. Women with several ACEs had high odds of depressive symptomatology in late pregnancy and were more likely to report depressive symptoms both in late pregnancy and postpartum.

  • 666. Österlund Efraimsson, Eva
    et al.
    Klang, Birgitta
    Ehrenberg, Anna
    Larsson, Kjell
    Fossum, Björn
    Olai, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care2015Ingår i: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 2, artikel-id 27915Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Smokers with chronic obstructive pulmonary disease (COPD) have high nicotine dependence making it difficult to quit smoking. Motivational interviewing (MI) is a method that is used in stimulating motivation and behavioral changes.

    Objective: To describe smoking cessation communication between patients and registered nurses trained in MI in COPD nurse-led clinics in Swedish primary health care.

    Methods: A prospective observational study with structured quantitative content analyses of the communication between six nurses with basic education in MI and 13 patients in non-smoking consultations.

    Results: Only to a small extent did nurses’ evoke patients’ reasons for change, stimulate collaboration, and support patients’ autonomy. Nurses provided information, asked closed questions, and made simple reflections. Patients’ communication was mainly neutral and focusing on reasons for and against smoking. It was uncommon for patients to be committed and take steps toward smoking cessation.

    Conclusion: The nurses did not adhere to the principles of MI in smoking cessation, and the patients focused to a limited extent on how to quit smoking.

    Practice implications: To make patients more active, the nurses need more education and continuous training in motivational communication.

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