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  • 201. Cea Soriano, Lucía
    et al.
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Andersson, Susan
    Filonenko, Anna
    García Rodríguez, Luis Alberto
    Use of long-acting reversible contraceptives in the UK from 2004 to 2010: Analysis using The Health Improvement Network Database2014Inngår i: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 19, nr 6, s. 439-447Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives To determine the use of long-acting reversible contraceptives (LARCs) in the UK over the period 2004 to 2010, using the general practice database The Health Improvement Network (THIN).

    Methods Women in THIN, aged 18 to 44 years during 2004 to 2010, who had been registered with their general practitioner for at least five years, with a prescription history of at least one year were included. THIN was searched using the Read and MULTILEX codes for: copper intrauterine devices (Cu-IUDs), the levonorgestrel releasing-intrauterine system (LNG-IUS), progestogen-only implants, and progestogen-only injections.

    Results The prevalence of progestogen-only implant use rose from 0.5 to 3.4%, and that of the LNG-IUS from 3.1 to 5.2%. The annual incidence and prevalence of progestogen-only implant use increased for all age groups but was most marked in younger women, whereas the use of the LNG-IUS augmented with increasing age. For all women, there was a small decrease in the prevalence of use of Cu-IUDs (from 5.4 to 4.8%) and progestogen-only injections (from 3.6 to 3.2%).

    Conclusions Uptake of progestogen-only implants and the LNG-IUS increased over the period 2004 to 2010 in the UK, but LARC use in young women remains low.

  • 202.
    Chang, Zheng
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Långström, Niklas
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Larsson, Henrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Fazel, Seena
    Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England.
    Association Between Prescription of Major Psychotropic Medications and Violent Reoffending After Prison Release2016Inngår i: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 316, nr 17, s. 1798-1807Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Importance: Individuals released from prison have high rates of violent reoffending, and there is uncertainty about whether pharmacological treatments reduce reoffending risk.

    Objective: To investigate the associations between major classes of psychotropic medications and violent reoffending.

    Design, Setting, and Participants: This cohort study included all released prisoners in Sweden from July 1, 2005, to December 31, 2010, through linkage of population-based registers. Rates of violent reoffending during medicated periods were compared with rates during nonmedicated periods using within-individual analyses. Follow-up ended December 31, 2013.

    Exposures: Periods with or without dispensed prescription of psychotropic medications (antipsychotics, antidepressants, psychostimulants, drugs used in addictive disorders, and antiepileptic drugs) after prison release. Prison-based psychological treatments were investigated as a secondary exposure.

    Main Outcomes and Measures: Violent crime after release from prison.

    Results: The cohort included 22 275 released prisoners (mean [SD] age, 38 [13] years; 91.9% male). During follow-up (median, 4.6 years; interquartile range, 3.0-6.4 years), 4031 individuals (18.1%) had 5653 violent reoffenses. The within-individual hazard ratio (HR) associated with dispensed antipsychotics was 0.58 (95% CI, 0.39-0.88), based on 100 events in 1596 person-years during medicated periods and 1044 events in 11 026 person-years during nonmedicated periods, equating to a risk difference of 39.7 (95% CI, 11.3-57.7) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed psychostimulants was 0.62 (95% CI, 0.40-0.98), based on 94 events in 1648 person-years during medicated periods and 513 events in 4553 person-years during nonmedicated periods, equating to a risk difference of 42.8 (95% CI, 2.2-67.6) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed drugs for addictive disorders was 0.48 (95% CI, 0.23-0.97), based on 46 events in 1168 person-years during medicated periods and 1103 events in 15 725 person-years during nonmedicated periods, equating to a risk difference of 36.4 (95% CI, 2.1-54.0) fewer violent reoffenses per 1000 person-years. In contrast, antidepressants and antiepileptics were not significantly associated with violent reoffending rates (HR = 1.09 [95% CI, 0.83-1.43] and 1.14 [95% CI, 0.79-1.65], respectively). The most common prison-based program was psychological treatments for substance abuse, associated with an HR of 0.75 (95% CI, 0.63-0.89), which equated to a risk difference of 23.2 (95% CI, 10.3-34.1) fewer violent reoffenses per 1000 person-years.

    Conclusions and Relevance: Among released prisoners in Sweden, rates of violent reoffending were lower during periods when individiduals were dispensed antipsychotics, psychostimulants, and drugs for addictive disorders, compared with periods in which they were not dispensed these medications. Further research is needed to understand the causal nature of this association.

  • 203.
    Chau, Pui Hing
    et al.
    School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
    Lau, Kevin Ka-Lun
    Luleå tekniska universitet, Institutionen för samhällsbyggnad och naturresurser, Arkitektur och vatten.
    Qian, Xing Xing
    School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
    Luo, Hao
    Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China.
    Woo, Jean
    Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
    Visits to the accident and emergency department in hot season of a city with subtropical climate: association with heat stress and related meteorological variables2022Inngår i: International journal of biometeorology, ISSN 0020-7128, E-ISSN 1432-1254, Vol. 66, nr 10, s. 1955-1971Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Literature reporting the association between heat stress defined by universal thermal climate index (UTCI) and emergency department visits is mainly conducted in Europe. This study aimed to investigate the association between heat stress, as defined by the UTCI, and visits to the accident and emergency department (AED) in Hong Kong, which represents a subtropical climate region.

    Methods A retrospective study involving 13,438,846 AED visits in the public sector from May 2000 to September 2016, excluding 2003 and 2009, was conducted in Hong Kong. Age-sex-specific ANCOVA models of daily AED rates on heat stress and prolonged heat stress, adjusting for air quality, prolonged poor air quality, typhoon, rainstorm, year, day of the week, public holiday, summer vacation, and fee charging, were used.

    Results On a day with strong heat stress (32.1 °C ≤ UTCI ≤ 38.0 °C), the AED visit rate (per 100,000) increased by 0.9 (95% CI: 0.5, 1.3) and 1.7 (95% CI: 1.3, 2.1) for females and males aged 19–64 and 4.1 (95% CI: 2.7, 5.4) and 4.1 (95% CI: 2.6, 5.6) for females and males aged ≥ 65, while keeping other variables constant. On a day with very strong heat stress (38.1 °C ≤ UTCI ≤ 46.0 °C), the corresponding rates increased by 0.6 (95% CI: 0.1, 1.2), 2.2 (95% CI: 1.7, 2.7), 4.9 (95% CI: 3.1, 6.7), and 4.7 (95% CI: 2.7, 6.6), respectively. The effect size of heat stress associated with AED visit rates was negligible among those aged ≤ 18. Heat stress showed the greatest effect size for males aged 19–64 among all subgroups.

    Conclusion Biothermal condition from heat stress was associated with the health of the citizens in a city with a subtropical climate and reflected in the increase of daily AED visit. Public health recommendations have been made accordingly for the prevention of heat-related AED visits.

  • 204.
    Chen, Qi
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Sjölander, Arvid
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Runeson, Bo
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    D'Onofrio, Brian M.
    Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Drug treatment for attention-deficit/hyperactivity disorder and suicidal behaviour: register based study2014Inngår i: BMJ-BRITISH MEDICAL JOURNAL, E-ISSN 1756-1833, Vol. 348, artikkel-id g3769Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To investigate the association between drug treatment for attention-deficit/hyperactivity disorder (ADHD) and risk of concomitant suicidal behaviour among patients with ADHD.

    Design: Register based longitudinal study using within patient design.

    Setting: Linkage of multiple national registers in Sweden.

    Participants: 37,936 patients with ADHD born between 1960 and 1996 and followed from 2006 to 2009 for treatment status by ADHD drug treatment and suicide related events (suicide attempt and completed suicide).

    Main outcome measure: Incidence rate of suicide related events during ADHD drug treatment periods compared with that during non-treatment periods.

    Results: Among 37,936 patients with ADHD, 7019 suicide related events occurred during 150,721 person years of follow-up. At the population level, drug treatment of ADHD was associated with an increased rate of suicide related events (hazard ratio 1.31, 95% confidence interval 1.19 to 1.44). However, the within patient comparison showed a reverse association between ADHD drug treatment and rate of suicide related events (0.89, 0.79 to 1.00). Among stimulant users, a reduced within patient rate of suicide related events was seen during treatment periods (0.81, 0.70 to 0.94). Among non-stimulant/mixed users, no significantly increased within patient rate of suicide related events during non-stimulant treatment periods was seen (0.96, 0.72 to 1.30).

    Conclusions: This study found no evidence for a positive association between the use of drug treatments for ADHD and the risk of concomitant suicidal behaviour among patients with ADHD. If anything, the results pointed to a potential protective effect of drugs for ADHD on suicidal behaviour, particularly for stimulant drugs. The study highlights the importance of using within patient designs to control for confounding in future pharmacoepidemiological studies.

  • 205.
    Chew, Michelle
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US.
    Puelacher, Christian
    Univ Basel, Switzerland.
    Myocardial injury after noncardiac surgery: facts, fallacies and how to approach clinically2021Inngår i: Current Opinion in Critical Care, ISSN 1070-5295, E-ISSN 1531-7072, Vol. 27, nr 6, s. 670-675Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Purpose of review Acute myocardial injury occurs commonly during perioperative care. There is still considerable confusion regarding its diagnosis and definition, and a lack of consensus on who and how to screen, exacerbated by a lack of studies addressing how to manage patients with detected myocardial injury. Recent findings Far from a benign biochemical anomaly, myocardial injury occurring perioperatively is largely a silent disease and is not necessarily because of ischaemia. Preoperative, postoperative, and perioperative changes in cardiac troponins (cTns) are independently associated with increased mortality and adverse cardiovascular outcomes. Routine screening with cTns is required for reliable detection of myocardial injury. Measurement of changes (from preoperative to postoperative) will detect acute events as well as identify patients with chronic troponin increases. This review aims to bring together current literature regarding myocardial injury that is detected perioperatively, identifies knowledge gaps for future research and provides suggestions for management.

    Fulltekst (pdf)
    fulltext
  • 206.
    Chiavaroli, Valentina
    et al.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.
    Hopkins, Sarah A.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.
    Derraik, Jose G. B.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa. Univ Auckland, Liggins Inst, Auckland, New Zealand;Univ Auckland, A Better Start Natl Sci Challenge, Auckland, New Zealand.
    Biggs, Janene B.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.
    Rodrigues, Raquel O.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.
    Brennan, Christine H.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.
    Seneviratne, Sumudu N.
    Univ Auckland, Liggins Inst, Auckland, New Zealand;Univ Colombo, Dept Paediat, Fac Med, Colombo, Sri Lanka.
    Higgins, Chelsea
    Univ Auckland, Liggins Inst, Auckland, New Zealand.
    Baldi, James C.
    Univ Otago, Dunedin Sch Med, Dept Med, Dunedin, New Zealand.
    McCowan, Lesley M. E.
    Univ Auckland, Dept Obstet & Gynaecol, Fac Med & Hlth Sci, Auckland, New Zealand.
    Cutfield, Wayne S.
    Univ Auckland, Liggins Inst, Auckland, New Zealand;Univ Auckland, A Better Start Natl Sci Challenge, Auckland, New Zealand.
    Hofman, Paul L.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.
    Exercise in pregnancy: 1-year and 7-year follow-ups of mothers and offspring after a randomized controlled trial2018Inngår i: Scientific Reports, E-ISSN 2045-2322, Vol. 8, artikkel-id 12915Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    There are limited data on long-term outcomes of mothers or their offspring following exercise interventions during pregnancy. We assessed long-term effects of an exercise intervention (home-based stationary cycling) between 20-36 weeks of gestation on anthropometry and body composition in mothers and offspring after 1 and 7 years. 84 women were randomised to intervention or usual activity, with follow-up data available for 61 mother-child pairs (38 exercisers) at 1 year and 57 (33 exercisers) at 7 years. At 1 year, there were no observed differences in measured outcomes between mothers and offspring in the two groups. At the 7-year follow-up, mothers were mostly similar, except that exercisers had lower systolic blood pressure (-6.2 mmHg; p = 0.049). However, offspring of mothers who exercised during pregnancy had increased total body fat (+3.2%; p = 0.034) and greater abdominal (+4.1% android fat; p = 0.040) and gynoid (+3.5% gynoid fat; p = 0.042) adiposity compared with controls. Exercise interventions beginning during pregnancy may be beneficial to long-term maternal health. However, the initiation of exercise during pregnancy amongst sedentary mothers may be associated with adverse effects in the offspring during childhood. Larger follow-up studies are required to investigate long-term effects of exercise in pregnancy.

    Fulltekst (pdf)
    fulltext
  • 207.
    Chillón, Palma
    et al.
    Department of Physical Education and Sport, School of Sport Sciences, University of Granada, Granada, Spain.
    Ortega, Francisco B
    Department of Physical Education and Sport, School of Sport Sciences, University of Granada, Granada, Spain; Department of Biosciences and Nutrition, Unit for Preventive Nutrition, Karolinska Institutet, Stockholm, Sweden; Department of Physiology, School of Medicine, University of Granada, Granada, Spain.
    Ruiz, Jonatan R
    Department of Physical Education and Sport, School of Sport Sciences, University of Granada, Granada, Spain; Department of Biosciences and Nutrition, Unit for Preventive Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Evenson, Kelly R
    Department of Epidemiology, Gillings School of Global Public Health, University of North Carolinat, Chapel Hill NC, United States; Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill NC, United States.
    Labayen, Idoia
    Department of Biosciences and Nutrition, Unit for Preventive Nutrition, Karolinska Institutet, Stockholm, Sweden; Department of Nutrition and Food Sciences, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain.
    Martínez-Vizcaino, Vicente
    Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain.
    Hurtig-Wennlöf, Anita
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Veidebaum, Toomas
    National Institute for Heath Development, Centre of Behavioral and Health Sciences, Tallinn, Estonia.
    Sjöström, Michael
    Department of Biosciences and Nutrition, Unit for Preventive Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Bicycling to school is associated with improvements in physical fitness over a 6-year follow-up period in Swedish children2012Inngår i: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 55, nr 2, s. 108-112Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To examine whether modes of commuting to school at baseline and changes in commuting were related to 6-year changes in cardiorespiratory fitness in youth.

    METHODS: A total of 262 (142 girls) Swedish children (9 years at entry) were measured at baseline (1998/9) and follow-up (2004/5). Mode of commuting to school was assessed by questionnaire and fitness by a maximal bicycle test.

    RESULTS: At baseline, 34% of children used passive modes of commuting (e.g., car, motorcycle, bus, train), 54% walked, and 12% bicycled to school. Six years later the percentage of bicyclists increased 19% and the percentage of walkers decreased 19%. On average, children who bicycled to school increased their fitness 13% (p=0.03) more than those who used passive modes and 20% (p=0.002) more than those who walked. Children who used passive modes or walked at baseline and bicycled to school at 6 years later increased their fitness 14% (p=0.001) more than those who remained using passive modes or walking at follow-up.

    CONCLUSIONS: Implementing initiatives that encourage bicycling to school may be a useful strategy to increase cardiorespiratory fitness of children.

  • 208.
    Chorell, Elin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Norrlands University Hospital, Umeå University, Umeå, Sweden .
    Ryberg, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Larsson, Christel
    Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Sandberg, Susanne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Mellberg, Caroline
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Lindahl, Bernt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Antti, Henrik
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Plasma metabolomic response to postmenopausal weight loss induced by different diets2016Inngår i: Metabolomics, ISSN 1573-3882, E-ISSN 1573-3890, Vol. 12, nr 5, artikkel-id 85Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Menopause is associated with increased abdominal fat and increased risk of developing diabetes and cardiovascular disease. Objectives The present study evaluated the plasma metabolic response in relation to insulin sensitivity after weight loss via diet intervention. Methods This work includes two studies; i) Ten women on a 5 weeks Paleolithic-type diet (PD, 30 energy percent (E%) protein, 40 E% fat, 30 E% carbohydrates), ii) 55 women on 6 months of either PD or Nordic Nutrition Recommendations diet (NNR, 15 E% protein, 30 E% fat, and 55 E% carbohydrates). Plasma metabolic profiles were acquired at baseline and post diet using gas chromatography time-of-flight/mass spectrometry and investigated in relation to insulin sensitivity using multivariate bioinformatics. Results Both the PD and NNR diet resulted in significant weight loss, reduced waist circumference, improved serum lipid profiles, and improved insulin sensitivity. We detected a baseline metabolic profile that correlated significantly with insulin sensitivity, and of which components increased significantly in the PD group compared to NNR. Specifically, a significant increase in myo-inositol (MI), a second messenger of insulin action, and beta-hydroxybutyric acid (beta-HB)increased while dihomogamma-linoleic acid (DGLA) decreased in PD compared to NNR, which correlated with improved insulin sensitivity. We also detected a significant decrease in tyrosine and tryptophan, potential markers of insulin resistance when elevated in the circulation, with the PD but not the NNR. Conclusions Using metabolomics, we detected changes in the plasma metabolite profiles associated with weight loss in postmenopausal women by different diets. The metabolic profiles following 6 months of PD were linked to beneficial effects on insulin sensitivity compared to NNR.

  • 209.
    Chow, Clara K.
    et al.
    Univ Sydney, Australia; Westmead Hosp, Australia; Univ New South Wales, Australia.
    Thiagalingam, Aravinda
    Univ Sydney, Australia; Westmead Hosp, Australia; Univ New South Wales, Australia.
    Santo, Karla
    Univ Sydney, Australia.
    Kok, Cindy
    Univ Sydney, Australia; Univ New South Wales, Australia.
    Thakkar, Jay
    Univ Sydney, Australia; Westmead Hosp, Australia; Univ New South Wales, Australia.
    Stepien, Sandrine
    Univ Sydney, Australia; Univ New South Wales, Australia.
    Billot, Laurent
    Univ Sydney, Australia; Univ New South Wales, Australia.
    Jan, Stephen
    Univ Sydney, Australia; Univ New South Wales, Australia.
    Joshi, Rohina
    Univ Sydney, Australia; Univ New South Wales, Australia.
    Hillis, Graham S.
    Univ Western Australia, Australia.
    Brieger, David
    Univ Sydney, Australia; Concord Repatriat Gen Hosp, Australia.
    Chew, Derek P.
    Flinders Univ S Australia, Australia.
    Rådholm, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Ödeshög.
    Atherton, John J.
    Royal Brisbane and Womens Hosp, Australia; Univ Queensland, Australia.
    Bhindi, Ravinay
    Royal North Shore Hosp, Australia.
    Collins, Nicholas
    John Hunter Hosp, Australia.
    Coverdale, Steven
    Sunshine Coast Univ Hosp, Australia.
    Hamilton-Craig, Christian
    Prince Charles Hosp, Australia; Univ Queensland, Australia.
    Kangaharan, Nadarajah
    Royal Darwin Hosp, Australia; Alice Springs Hosp, Australia.
    Maiorana, Andrew
    Curtin Univ, Australia; Fiona Stanley Hosp, Australia.
    McGrady, Michelle
    Royal Prince Alfred Hosp, Australia.
    Shetty, Pratap
    Wollongong Hosp, Australia.
    Thompson, Peter
    Sir Charles Gairdner Hosp, Australia.
    Rogers, Anthony
    Univ Sydney, Australia; Univ New South Wales, Australia.
    Redfern, Julie
    Univ Sydney, Australia; Westmead Hosp, Australia; Univ New South Wales, Australia.
    TEXT messages to improve MEDication adherence and Secondary prevention (TEXTMEDS) after acute coronary syndrome: a randomised clinical trial protocol2018Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 8, nr 1, artikkel-id e019463Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Identifying simple, low-cost and scalable means of supporting lifestyle change and medication adherence for patients following a cardiovascular (CV) event is important. Objective The TEXTMEDS (TEXT messages to improve MEDiGation adherence and Secondary prevention) study aims to investigate whether a cardiac education and support programme sent via mobile phone text message improves medication adherence and risk factor levels in patients following an acute coronary syndrome (ACS). Study design A single-blind, multicentre, randomised clinical trial of 1400 patients after an ACS with 12 months follow-up. The intervention group will receive multiple weekly text messages that provide information, motivation, support to adhere to medications, quit smoking (if relevant) and recommendations for healthy diet and exercise. The primary endpoint is the percentage of patients who are adherent to cardioprotective medications and the key secondary outcomes are mean systolic blood pressure (BP) and low density lipoprotein cholesterol. Secondary outcomes will also include total cholesterol, mean diastolic BP, the percentage of participants who are adherent to each cardioprotective medication class, the percentage of participants who achieve target levels of CV risk factors, major vascular events, hospital readmissions and all-cause mortality. The study will be augmented by formal economic and proGess evaluations to assess acceptability, utility and Gost-effectiveness. Summary The study will provide multicentre randomised trial evidence of the effects of a text message-based programme on cardioprotective medication adherence and levels of CV risk factors. Ethics and dissemination Primary ethics approval was received from Western Sydney Local Health District Human Research EthiGs Committee (HREC2012/12/4.1 (3648) AU RED HREC/13ANMEAD/15). Results will be disseminated via peer-reviewed publications and presentations at international conferences.

    Fulltekst (pdf)
    fulltext
  • 210.
    Christianson, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    What's behind sexual risk taking?: exploring the experiences of chlamydia-positive, HIV-positive, and HIV-tested young women and men in Sweden2006Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The overall aim was to explore the experiences of sexual risk taking among Chlamydia Trachomatis positive (CT+), HIV positive (HIV+), and HIV tested young women and men. The specific aims were to explore, from a gender perspective, the course of events, the norms, considerations and emotions involved in sexual risk taking in CT+, explore the perception of sexual risk taking in HIV+ youth, and their understanding of why they caught HIV and look at how the Law of Communicable Diseases Act impacts their sexuality. Moreover, to investigate why young adults test for HIV, how they construct the HIV risk, and what implications testing has for them.

    42 informants between 17-24 years of age were recruited from a youth clinic in Umeå and from three infection clinics for HIV patients in Sweden.

    In depth interviews and focus group interviews were tape-recorded, transcribed verbatim and analyzed according to a Grounded Theory approach.

    The finding revealed that behind sexual risk taking, there was a drive to go steady, where lust and trust guided if sex would take place. In one-night stands women were expected to be less forward compared with men. We found an uneven responsibility concerning condom use where men expected women to be "condom promoters". By catching CT, women experienced guilt, while men felt content through knowing "the source of contamination".

    Among the HIV+ youth, socio-cultural factors such as; lack of adult supervision, naivité, love, alcohol, drugs, the macho ideal and cultures of silence blinded the informants to the risks and made them vulnerable. By grouping narratives according to degree of consensus in sexual encounters, this demonstrated that sexual risks happened in a context of gendered power relations where the informants had varied agency. The Law of Communicable Diseases Act implied both support and burden for these HIV+ youth. A lot of responsibility was put on them and to be able to handle the infromation duty they tried to switch off lust, switch off the disease, or balance lust and obedience.

    Among the HIV tested youth, HIV was seen a distant threat. Many had event-driven reasons for testing for HIV; multiple partners being one. Risk zones, like bars were perceived to be a milieu that often was expected to include one-night stands. Responsibility for testing was a gendered issue; "natural" for women, while men rather escaped from responsibility and had a testing resistance. Receiving a "green card" confirmed healthiness and provided relief, and made the informants felt "clean". They could restart with new ambitious, including reconsidering risk.

    The findings can be used in public health and in health care sectors that work with young people. We present suggestions on how to decrease the spread of STIs:

    To implement how men could play an equal part in sexual and reproductive health.

    Promote general CT screening for men.

    Liberal HIV testing among both young women and men.

    Promote safer sex behaviour from the uninfected youth, especially focusing on men??.

    Consider the role of gender and social background in the context of risky behaviours.

    Give lots of positive rewards concerning HIV disclosure to diminish the risk for HIV transmission.

    Fulltekst (pdf)
    fulltext
  • 211.
    Christianson, Monica
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Berglin, Björn
    Johansson, Eva E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    "It should be an ordinary thing": a qualitative study about young people´s experiences of taking the HIV-test and getting the test result2010Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, nr 4, s. 678-683Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim:  Increased HIV-testing has public health benefits, but for youth there is a multitude of barriers against the test. The aim of this study is to explore how young women and men in Sweden experience HIV-testing within primary healthcare.

    Method:  Six focus-group interviews were tape recorded, transcribed verbatim and analysed according to qualitative content analysis.

    Results:  Three themes emerged, describing how the informants were met before, during and after testing; ‘Obstacles accessing the clinic’– describes their perceptions on how to overcome different barriers and enter into primary health care. ‘Quick and easy testing’– describes perceptions of the testing procedure and ‘Conflicting and unclear information about test results’– describes inconsistencies concerning communication of the test result and a concern about ‘what would happen’ in the event of an HIV-positive finding. Most of these youth preferred the HIV-test ‘quick and easy’ and preferred a telephone referral of the test result. A minority of them worried about HIV, and they thought that the staff seemed to be unprepared for an HIV-positive test result.

    Conclusion:  According to these youth, a quick and easy testing procedure together with a short pretest discussion may be sufficient and may also help normalising the testing practice. In a Swedish context, it may be common to see heterosexual youth as a risk-free population, and this perception may act as a barrier for HIV-testing and increase missed opportunities for early diagnose of HIV within primary care.

  • 212. Cohen, Cheryl
    et al.
    Moyes, Jocelyn
    Tempia, Stefano
    Groom, Michelle
    Walaza, Sibongile
    Pretorius, Marthi
    Dawood, Halima
    Chhagan, Meera
    Haffejee, Summaya
    Variava, Ebrahim
    Kahn, Kathleen
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Tshangela, Akhona
    von Gottberg, Anne
    Wolter, Nicole
    Cohen, Adam L.
    Kgokong, Babatyi
    Venter, Marietjie
    Madhi, Shabir A.
    Severe Influenza-associated Respiratory Infection in High HIV Prevalence Setting, South Africa, 2009-20112013Inngår i: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 19, nr 11, s. 1766-1774Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Data on influenza epidemiology in HIV-infected persons are limited, particularly for sub-Saharan Africa, where HIV infection is widespread. We tested respiratory and blood samples from patients with acute lower respiratory tract infections hospitalized in South Africa during 2009-2011 for viral and pneumococcal infections. Influenza was identified in 9% (1,056/11,925) of patients enrolled; among influenza case-patients, 358 (44%) of the 819 who were tested were infected with HIV. Influenza-associated acute lower respiratory tract infection incidence was 4-8 times greater for HIV-infected (186-228/100,000) than for HIV-uninfected persons (26-54/100,000). Furthermore, multivariable analysis showed HIV-infected patients were more likely to have pneumococcal co-infection; to be infected with influenza type B compared with type A; to be hospitalized for 2-7 days or >7 days; and to die from their illness. These findings indicate that HIV-infected persons are at greater risk for severe illnesses related to influenza and thus should be prioritized for influenza vaccination.

    Fulltekst (pdf)
    Severe Influenza-associated Respiratory Infection in High HIV Prevalence Setting, South Africa, 2009–2011
  • 213.
    Cosmo, Emelie
    et al.
    Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    Enquist, Mari
    Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    Trycksår: Sjuksköterskans kunskap, attityd och det praktiska utförandet2012Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [en]

    Background: A health damage that has been specifically related to nursing is pressure ulcers. Pressure ulcers are a complication caused by disease, care and treatment and can result in great suffering for the patient. Pressure ulcers can affect people both physically and psychosocially and is experienced, by most patients, as a serious and unnecessary complication of care. Today there are hundreds of identified risk factors for pressure ulcers described that can be divided into patient and care-related risk factors. A successful pressure ulcer prevention and treatment is to reduce or eliminate the underlying causes for the development of pressure ulcers, prevent deterioration and to treat existing ulcers. To prevent the occurrence of pressure ulcers and heal them, nurses’ knowledge and skills become important.

     

    Aim: The aim was to describe the nurses´ knowledge and attitude towards pressure ulcer prevention and treatment and how it affects the practice.

     

    Methods: The study was conducted as a literature study and was based on Willman, Stoltz och Bahtsevani (2011) methodology for reviewing scientific articles. 12 articles were chosen, three of which were qualitative, eight quantitative and one quantitative and qualitative. The analyze was conducted by Fribergs (2012) analysis regarding qualitative and quantitative research.

     

    Results: The result are presented under the four headings: Differences in nurses’ knowledge, Either you love pressure ulcers or you hate them, Lack of access to training, despite its positive impact, The attitude has a greater impact on the practice than knowledge.

     

    Discussions: The results were discussed based on the concept of health care environment, where the focus was directed towards a psychosocial component. Areas addressed include lack of access to education on pressure ulcers and what it can lead to, how the nurses’ negative attitude affect the practice and finally discussed the need to further examine of how nurses' attitudes can be improved and how they can be inspired to a greater interest in their work with pressure ulcers.

     

    Keywords: Pressure ulcer, Nurse, Prevention, Treatment, Knowledge, Attitude, Practice, Patient safety, Health care environment

    Fulltekst (pdf)
    Trycksår: Sjuksköterskans kunskap, attityd och det praktiska utförandet
  • 214.
    Cunningham, A. L.
    et al.
    Westmead Inst Med Res, Westmead, NSW, Australia.;Univ Sydney, Sydney, NSW, Australia..
    Lal, H.
    GSK Vaccines, King Of Prussia, PA USA..
    Kovac, M.
    GSK Vaccines, Wavre, Belgium..
    Chlibek, R.
    Univ Def, Fac Mil Hlth Sci, Hradec Kralove, Czech Republic..
    Hwang, S. -J
    Diez-Domingo, J.
    Fdn Fomento Invest Sanitaria & Biomed, Vaccine Res Unit, Valencia, Spain..
    Godeaux, O.
    GSK Vaccines, Wavre, Belgium..
    Levin, M. J.
    Univ Colorado, Dept Pediat, Anschutz Med Campus, Aurora, CO USA.;Univ Colorado, Dept Med, Anschutz Med Campus, Aurora, CO USA..
    McElhaney, J. E.
    Hlth Sci North Res Inst, Sudbury, ON, Canada..
    Puig-Barbera, J.
    Fdn Fomento Invest Sanitaria & Biomed, Vaccine Res Unit, Valencia, Spain..
    Abeele, C. Vanden
    GSK Vaccines, Wavre, Belgium..
    Vesikari, T.
    Univ Tampere, Vaccine Res Ctr, Tampere, Finland..
    Watanabe, D.
    Aichi Med Univ, Dept Dermatol, Nagakute, Aichi, Japan..
    Zahaf, T.
    GSK Vaccines, Wavre, Belgium..
    Ahonen, A.
    Univ Tampere, Vaccine Res Ctr, Tampere, Finland..
    Athan, E.
    Deakin Univ, Barwon Hlth, Dept Infect Dis, Geelong, Vic, Australia..
    Barba-Gomez, J. F.
    Inst Dermatol Jalisco Dr Jose Barba Rubio, Zapopan, Mexico..
    Campora, L.
    GSK Vaccines, Wavre, Belgium..
    de Looze, F.
    Univ Queensland, Sch Med, AusTrials, Brisbane, Qld, Australia.;Univ Queensland, Sch Med, Discipline Gen Practice, Brisbane, Qld, Australia..
    Downey, H. J.
    Jacksonville Ctr Clin Res, Jacksonville, FL USA..
    Ghesquiere, W.
    Univ British Columbia, Infect Dis Sect, Victoria, BC, Canada..
    Gorfinkel, I.
    PrimeHlth Clin Res, Toronto, ON, Canada..
    Korhonen, T.
    Univ Tampere, Vaccine Res Ctr, Tampere, Finland..
    Leung, E.
    United Christian Hosp, Dept Med & Geriatr, Div Geriatr Med, Hong Kong, Hong Kong, Peoples R China..
    McNeil, S. A.
    Dalhousie Univ, IWK Hlth Ctr, Canadian Ctr Vaccinol, Halifax, NS, Canada.;Dalhousie Univ, Nova Scotia Hlth Author, Halifax, NS, Canada..
    Oostvogels, L.
    GSK Vaccines, Wavre, Belgium..
    Rombo, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Sormland Cty Council, Clin Res Ctr, Eskilstuna, Sweden..
    Smetana, J.
    Univ Def, Fac Mil Hlth Sci, Hradec Kralove, Czech Republic..
    Weckx, L.
    Univ Fed Sao Paulo, Ctr Referencia Imunobiol Especiais, Sao Paulo, Brazil..
    Yeo, W.
    Univ Wollongong, Grad Sch Med, Illawarra Hlth & Med Res Inst, Wollongong, NSW, Australia..
    Heineman, T. C.
    GSK Vaccines, King Of Prussia, PA USA..
    Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older2016Inngår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 375, nr 11, s. 1019-1032Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND A trial involving adults 50 years of age or older (ZOE-50) showed that the herpes zoster subunit vaccine (HZ/su) containing recombinant varicella-zoster virus glycoprotein E and the AS01(B) adjuvant system was associated with a risk of herpes zoster that was 97.2% lower than that associated with placebo. A second trial was performed concurrently at the same sites and examined the safety and efficacy of HZ/su in adults 70 years of age or older (ZOE-70). METHODS This randomized, placebo-controlled, phase 3 trial was conducted in 18 countries and involved adults 70 years of age or older. Participants received two doses of HZ/su or placebo (assigned in a 1: 1 ratio) administered intramuscularly 2 months apart. Vaccine efficacy against herpes zoster and postherpetic neuralgia was assessed in participants from ZOE-70 and in participants pooled from ZOE-70 and ZOE-50. RESULTS In ZOE-70, 13,900 participants who could be evaluated (mean age, 75.6 years) received either HZ/su (6950 participants) or placebo (6950 participants). During a mean follow-up period of 3.7 years, herpes zoster occurred in 23 HZ/su recipients and in 223 placebo recipients (0.9 vs. 9.2 per 1000 person-years). Vaccine efficacy against herpes zoster was 89.8% (95% confidence interval [CI], 84.2 to 93.7; P<0.001) and was similar in participants 70 to 79 years of age (90.0%) and participants 80 years of age or older (89.1%). In pooled analyses of data from participants 70 years of age or older in ZOE-50 and ZOE-70 (16,596 participants), vaccine efficacy against herpes zoster was 91.3% (95% CI, 86.8 to 94.5; P<0.001), and vaccine efficacy against postherpetic neuralgia was 88.8% (95% CI, 68.7 to 97.1; P<0.001). Solicited reports of injection-site and systemic reactions within 7 days after injection were more frequent among HZ/su recipients than among placebo recipients (79.0% vs. 29.5%). Serious adverse events, potential immune-mediated diseases, and deaths occurred with similar frequencies in the two study groups. CONCLUSIONS In our trial, HZ/su was found to reduce the risks of herpes zoster and postherpetic neuralgia among adults 70 years of age or older. (Funded by GlaxoSmithKline Biologicals; ZOE-50 and ZOE-70 ClinicalTrials.govnumbers, NCT01165177 and NCT01165229.)

  • 215.
    Cuomo, Belinda M.
    et al.
    Curtin University, Australia.
    Vaz, Sharmila
    Curtin University, Australia.
    Ai Lim Lee, Elinda
    Curtin University, Australia; Cooperat Research Centre Living Autism Spectrum Disorders, Australia.
    Thompson, Craig
    Curtin University, Australia; Cooperat Research Centre Living Autism Spectrum Disorders, Australia.
    Rogerson, Jessica M.
    Curtin University, Australia.
    Falkmer, Torbjörn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum. Curtin University, Australia; Cooperat Research Centre Living Autism Spectrum Disorders, Australia; Jonköping University, Sweden.
    Effectiveness of Sleep-Based Interventions for Children with Autism Spectrum Disorder: A Meta-Synthesis2017Inngår i: Pharmacotherapy, ISSN 0277-0008, E-ISSN 1875-9114, Vol. 37, nr 5, s. 555-578Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Sleep problems are common in children with autism spectrum disorder (ASD). This meta-synthesis collated eight previously published systematic reviews examining the efficacy of sleep interventions in children with ASD in an attempt to present a clear analysis of trialed interventions. The collated reviews consider five major groups of sleep interventions for children with ASD: melatonin therapy, pharmacologic treatments other than melatonin, behavioral interventions, parent education/education programs, and alternative therapies (massage therapy, aromatherapy, and multivitamin and iron supplementation). These eight reviews were based on 38 original studies and address the efficacy of interventions across 17 sleep problem domains. The results of this meta-synthesis suggest that no single intervention is effective across all sleep problems in children with ASD. However, melatonin, behavioral interventions, and parent education/education program interventions appear the most effective at ameliorating multiple domains of sleep problems compared with other interventions. Due to the heterogeneous causative factors and presentations of disordered sleep, further research into the effectiveness of sleep interventions may target specific phenotypic subgroups rather than a broad analysis across the general ASD population. Similarly, future research needs to consider the efficacy of different polytherapeutic approaches in order to provide clinicians with evidence to inform best practice. In the meantime, this review supports clinicians decision making for a majority of the identified sleep problems in the ASD population.

  • 216.
    Dahlgren, Cecilia
    et al.
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden; Stockholms Läns Landsting, Center for Health Economics, Informatics and Healthcare Research, Stockholm, Sweden.
    Geary, Lukas
    Unit of Medicine, Capio S:t Görans Sjukhus, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Solna, Sweden.
    Hasselström, Jan
    Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Solna, Sweden; Stockholms Läns Landsting, Academic Primary Care Center, Stockholm, Sweden.
    Rehnberg, Clas
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden.
    Schenck-Gustafsson, Karin
    Department of Medicine, Cardiac Unit, Center for Gender Medicine, Karolinska Institutet, Solna, Sweden.
    Wändell, Per
    Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Solna, Sweden.
    von Euler, Mia
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Clinical Pharmacology Unit Solna, Karolinska Institutet, Solna, Sweden .
    Recording a diagnosis of stroke, transient ischaemic attack or myocardial infarction in primary healthcare and the association with dispensation of secondary preventive medication: a registry-based prospective cohort study2017Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 7, nr 9, artikkel-id e015723Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: The aim of this study was to explore whether recording in primary care of a previously recorded hospital diagnosis was associated with increased patient utilisation of recommended medications.

    DESIGN: Registry-based prospective cohort study.

    SETTING AND PARTICIPANTS: 19 072 patients with a hospital discharge diagnosis of transient ischaemic attack (TIA), stroke or acute coronary syndrome from hospitals in Stockholm County 2010-2013 were included in the study.

    MAIN OUTCOME MEASURE: The outcome of the study was medication dispensation as a marker of adherence to recommended medications. Adherence was defined as having had at least two filled prescriptions in the third year following hospital discharge.

    RESULTS: Recording a diagnosis was associated with higher utilisation of all recommended medications with the exception of antihypertensives in patients with TIA. The differences between the groups with and without a recorded diagnosis remained after adjusting for age, sex, index year and visits to private practitioners. Dispensation of antithrombotics was high overall, 80%-90% in patients without a recorded diagnosis and 90%-94% for those with a diagnosis. Women with recorded ischaemic stroke/TIA/acute coronary syndrome were dispensed more statins (56%-71%) than those with no recorded diagnosis (46%-59%). Similarly, 68%-83% of men with a recorded diagnosis were dispensed statins (57%-77% in men with no recorded diagnosis). The rate of diagnosis recording spanned from 15% to 47% and was especially low in TIA (men 15%, women 16%).

    CONCLUSION: Recording a diagnosis of TIA/stroke or acute coronary syndrome in primary care was found to be associated with higher dispensation of recommended secondary preventive medications. Further study is necessary in order to determine the mechanisms underlying our results and to establish the utility of our findings.

  • 217.
    Danielsson, Ulla E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Träffad av blixten eller långsam kvävning: genuskodade uttryck för depression2010Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, nr 23, s. 1537-Artikkel i tidsskrift (Annet vitenskapelig)
  • 218.
    Danielsson, Ulla EB
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Träffad av blixten eller långsam kvävning: genuskodade uttryck för depression i en primärvårdskontext2010Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Depression is a common mental health problem in primary health care. One third of the Swedish population is expected to experience depression at some point in their lives. The understanding of depression has expanded, both from a lay and primary health care perspective. The number of persons considering themselves as depressed, receiving the diagnosis, and getting treatment for it has increased steadily over the last decades.

    Unchanged, however, is that depression is diagnosed twice as often in women as in men, while twice as many men as women commit suicide. These gender differences appear in adolescence. In earlier research biomedical, psychological, and social-cultural explanations of gender differences have been discussed. Patient’s own perspectives have more seldom stood in focus, and men’s narratives in particular are still scarce. In this thesis, gender, i.e. how to be a woman or a man, is considered as a construct, formed and negotiated in social interaction.

    The aim of the study is to explore the gendered face of depression from a patient perspective: How is depression expressed and explained by patients in primary health care, by women and men, adults and adolescents? How are depressed women and men portrayed in the media? How do patient and media accounts of depression compare with the perspective offered in medical research articles?

    Method and material The analyses are based on data from three different sources: patient narratives, newspaper portrayals and scientific medical articles.

    – 37 in-depth interviews were undertaken with primary health care patients diagnosed with depression. Informants were chosen to include both men and women, grown-ups (Studies I + II) and young adults (Study V) of varying occupational and social class backgrounds. Data were analyzed according to grounded theory.

    – 26 articles portraying lay informants with depression (Study III) were drawn from three major Swedish daily newspapers by a search of database Mediearkivet 2002. The articles were analyzed by qualitative content analysis.

    –82 scientific articles concerning depression in relation to gender were identified in a PubMed search 2002. The understanding of depression in these articles was explored and compared with findings in the grown-up patient narratives and in the media portrayals by means of discourse analysis (Study IV).

    Findings Study I captured women’s and men’s formulations of their experiences of depression. To be marked with demands constituted a central experience for both women and men, but the outward manifestations differed in relation to gender as well as to class. Home and work had different priority. Men talked more about physical distress (often chest pain) than about emotions. Women readily verbalized emotional distress – shame and guilt – while physical symptoms were vague and secondary (often about the stomach). Men dealt with insecurity by aggrandizing their previous competence, women by self-effacement.

    Study II disclosed gendered trajectories into depression. Four symbolic illness narratives were identified: struck by lightning, nagging darkness, blackout and slowly suffocating. Most of the men considered their bodies suddenly “struck” by external circumstances beyond their control. The stories of women in the study were more diverse, reflecting all four illness narratives. However, the women had a tendency to blame their own personality and to describe depression as insidious and originating from the inside. The women expressed feelings of guilt and shame but also conveyed a personal responsibility and concern with relationships.

    Study III identified four themes in media portrayals of depression: displaying a successful facade, experiencing a cracking facade, losing and regaining control and explaining the illness. The mediated image of depression both upheld and challenged traditional gender stereotypes. The women’s stories were more detailed, relational, emotionally oriented and embodied. The portrayal of men was less emotional and expressive, and described a more dramatic onset of depression.

    Study IV revealed gaps in how depression in relation to gender is understood by the patients, the media, and the medical research establishment. There were differences in recognition, in understanding of the reasons, and in contextualization of depression. Although women and men described different symptoms and reasons for falling ill, in scientific articles these gendered differences were conceptualized mainly in terms of hormones and other biological markers.

    Study V elucidated the impact of gender on adolescent depression. The young women and men were all striving to be normal, influenced by demanding media images, confronted by identity trouble, and overwhelmed by feelings. They had dreams of an ordinary family and described normative expectations. Getting a safety net of friends and other adults was a way out. Both the young women and men were eager to communicate their distress when given the opportunity. This seemed especially important to some of the young men, who in talking about their emotional problems transgressed gender norms.

    Conclusions Patient perspectives enrich the understanding of gendered expressions of depression by making visible transgressions of and breaks with stereotype gender norms. Gender awareness is an important key in clinical consultation. To recognize gendered narratives of illness might have a salutary potential, making depression more visible among men, and relieving self-blame among women. By re-evaluating restrictive gender patterns, the clinician might encourage development of healthier practices of how to be a man or a woman, a development especially important for adolescents.

    An integrated model for understanding biological, gender and cultural aspects of depression has yet to be developed. As general practitioners we have a unique possibility to see and to study the whole individual in her social and cultural context.

    Fulltekst (pdf)
    FULLTEXT02
  • 219.
    Danielsson, Ulla EB
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Bengs, Carita
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Samuelsson, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, Eva E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    "My greatest dream is to be normal": the impact of gender on depression narratives of young Swedish women and men2011Inngår i: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 21, nr 5, s. 612-624Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Depression is common among young people. Gender differences in diagnosing depression appear during adolescence. The study aim was to explore the impact of gender on depression in young Swedish men and women. Grounded theory was used to analyze interviews with 23 young people aged 17 to 25 years who had been diagnosed with depression. Their narratives were marked by a striving to be normal and disclosed strong gender stereotypes, constructed in interaction with parents, friends, and the media. Gender norms were upheld by feelings of shame, and restricted the acting space of our informants. However, we also found transgressions of these gender norms. Primary health care workers could encourage young men to open up emotionally and communicate their personal distress, and young women to be daring and assertive of their own strengths, so that both genders might gain access to the positive coping strategies practiced respectively by each.

  • 220.
    Danielsson-Tham, Marie-Louise
    Department of Food Hygiene, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala, Sweden.
    Lura rötmånaden!1995Inngår i: SLU just nu! – Personaltidning för Sveriges lantbruksuniversitet, ISSN 1102-0954, nr 5, s. 20-20Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
    Abstract [sv]

    Tiden mellan den 22 juli och 23 augusti benämns i folkmun rötmånaden. Denna månad är känd för allehanda ruskigheter. Då föds kalvar med två huvuden, såren vill inte läka och mjölken surnar.

  • 221.
    Danielsson-Tham, Marie-Louise
    et al.
    Department of Food Hygiene, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala, Sweden.
    Bannerman, Elisabeth
    Institut Pasteur, Paris, France.
    Bille, Jacques
    Lausanne, Switzerland.
    Ericsson, Henrik
    Department of Food Hygiene, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala.
    Jacquet, Christine
    Institut Pasteur, Paris, France.
    Loncarevic, Semir
    Department of Food Hygiene, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala.
    Rocourt, Jocelyne
    Institut Pasteur, Paris, France.
    Tham, Wilhelm
    Department of Food Hygiene, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala, Sweden.
    Ursing, Jan
    Malmö Allmänna Sjukhus, Malmö, Sweden.
    The characterization of Swedish human Listeria monocygtogenes strains isolated 1958–19941995Inngår i: Proceedings of the XII International Symposium on Problems of Listeriosis, Canning Bridge: Promaco Conventions , 1995, s. 469-469Konferansepaper (Fagfellevurdert)
  • 222.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Lindelof, Ann
    Region Östergötland, Närsjukvården i östra Östergötland.
    Wallen, Torbjorn
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN. Vastervik Hospital, Sweden.
    Lindahl, Tomas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk kemi.
    Hallert, Claes
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland.
    Point-of-care monitoring of warfarin treatment in community dwelling elderly - A randomised controlled study2015Inngår i: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 21, nr 5, s. 298-301Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The objective of this study was to assess clinical effectiveness and costs of launching point-of-care monitoring of warfarin treatment in community dwelling frail elderly patients. A prospective multicentre controlled randomised study over 12 months comparing a point-of-care strategy with usual monitoring routines was carried out in primary healthcare centres and anticoagulation clinics in southeast Sweden. The subjects were community dwelling elderly across rural southeast Sweden on chronic warfarin treatment. Main outcome measures were time in therapeutic range (TTR), rate of treatment-related adverse events and costs. The study comprised 103 elderly people (61% women) mean age 86 yrs (range 75-98) treated with warfarin for median 9 yrs (range 1-18). Patients randomised to start point-of-care monitoring (n = 55) showed 75.9% in TTR before trial vs. 72.6% during trial (ns). The patients randomised to continue on usual monitoring routines (n = 48) showed 75.2% in TTR prior to trial vs. 72.9% during trial (ns). The point-of-care monitoring showed potential savings of SEK 624 per patient annually (based partly on effects that were not statistically significant). The study shows that point-of-care monitoring of warfarin treatment in community dwelling elderly in rural areas is as effective as usual monitoring routines and that it may offer savings to society.

  • 223. Dawed, A. Y.
    et al.
    Franks, Paul
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Lund Univ, Dept Clin Sci, Skane Univ Hosp, Genet & Mol Epidemiol Unit,Diabet Ctr, Malmö, Sweden; Harvard Univ, Sch Publ Hlth, Dept Nutr, Boston, MA 02115 USA.
    Walker, M.
    Mari, A.
    Pearson, E. R.
    Determinants of glucagon-like peptide-1 (GLP-1) response in prediabetes and diabetes: an IMI-DIRECT study2016Inngår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, nr Special Issue, Meeting Abstract: A15, s. 10-10Artikkel i tidsskrift (Annet vitenskapelig)
  • 224.
    de Barès, David
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Artificiell intelligens och smartphone-baserad diagnostik av otitis media – en diagnostisk träffsäkerhetsstudie.2022Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 225.
    de Brun, Maryam
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hyperglycaemia during pregnancy: The challenge of screening and deciding diagnostic criteria for gestational diabetes in Sweden2023Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Hyperglycaemia during pregnancy is one of the most common complicationsof pregnancy. In 2013, the World Health Organisation recommended diagnostic criteria (WHO-2013) for gestational diabetes mellitus (GDM), whichremains controversial due to an expected increase in prevalence, and the uncertainty as to the clinical relevance of treating these additional women or its cost-effectiveness.

    Paper I involves a cross-sectional study of 4 918 pregnant women using riskfactor screening, which was poorly predictive of the WHO-2013 criteria, with an area under the curve of 40% (95% CI 24–32). In Paper II, a systematic review and meta-analysis of the prevalence of GDM according to the WHO2013 criteria in 136 705 women showed a 75% (RR 1.75, 95% CI 1.53-2.01) increased prevalence compared to the other GDM criteria. In Papers III-IV, a national stepped wedge cluster randomised controlled trial of 26 160 pregnancies before and 28 509 after the implementation of the WHO-2013 criteria across eight clusters during 2018 led to a 2.90 fold increase in GDM prevalence. No significant decrease was seen in the primary outcome, large for gestational age (LGA). There were, however, health benefits in secondary outcomes for the mother and neonate. There was a significant decrease in LGA dependent on the definition used, including the clinically used in Sweden (>2SD) with adjusted OR of 0.89 (95% CI 0.82-0.97). In Paper IV, the WHO2013 criteria led to increased resource use and incremental costs (€341.1 (195.9)) per pregnancy. The cost-effectiveness needs to be related to health benefits for the mother and/or neonate.

    In conclusion, the current screening methods for GDM are in need of revision considering their poor predictive characteristics in finding GDM according to the WHO-2013 criteria. Implementing the WHO-2013 criteria in Sweden resulted in higher GDM prevalence with short-term increased resource use with uncertainty in costs savings and considerable healthcare benefits for the mother and neonate. This thesis provides evidence regarding the consequences of implementing the WHO-2013 criteria compared to former Swedish GDM criteria and may assist future decision-making.

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  • 226.
    de Brun, Maryam
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Region Västmanland-Uppsala University, Centre for Clinical Research, Västmanland Hospital Västerås, Sweden.
    Johansson, Naimi
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center.
    Simmons, David
    Örebro universitet, Institutionen för medicinska vetenskaper. Macarthur Clinical School, Western Sydney University, Campbelltown, Australia.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden. Department of Epidemiology and Public Health, University College London, UK .
    Berntorp, Kerstin
    Genomics, Diabetes and Endocrinology Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Jansson, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. University Health Care Research Center.
    Wennerholm, Ulla-Britt
    Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden.
    Wikström, Anna-Karin
    Department of Women’s and Children’s Health, Uppsala University. Akademiska sjukhuset, Uppsala.
    Strevens, Helena
    Department of Obstetrics and Gynecology, Skåne University Hospital, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
    Ahlsson, Fredrik
    Department of Women’s and Children’s Health, Uppsala University. Akademiska sjukhuset, Uppsala.
    Sengpiel, Verena
    Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden.
    Storck-Lindholm, Elisabeth
    Department of Obstetrics and Gynecology Södersjukhuset, Karolinska Institute, Sweden.
    Persson, Martina
    Department of Clinical Science and Education Karolinska Institute, Department of Medicine, Clinical Epidemiology Karolinska Institutet and Sachsska Childrens´ and Youth Hospital Stockholm, Sweden.
    Petersson, Kerstin
    Department of Obstetrics and Gynecology Södersjukhuset, Umeå University, Sweden.
    Ursing, Carina
    Södersjukhuset, Stockholm.
    Ryen, Linda
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center.
    Backman, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Obstetrics and Gynecology.
    Healthcare cost consequences of changing diagnostic criteria for gestational diabetes mellitus (CDC4G) in Sweden: Alongside a stepped wedge cluster randomised trialManuskript (preprint) (Annet vitenskapelig)
  • 227.
    de Brun, Maryam
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Magnusson, Anders
    Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden. Department of Epidemiology and Public Health, University College London, UK .
    Patil, Snehal
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Simmons, David
    Örebro universitet, Institutionen för medicinska vetenskaper. Macarthur Clinical School, Western Sydney University, Campbelltown, Australia.
    Berntorp, Kerstin
    Genomics, Diabetes and Endocrinology Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Wennerholm, Ulla-Britt
    Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden.
    Jansson, Stefan P. O.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. University Health Care Research Center.
    Wikström, Anna-Karin
    Department of Women’s and Children’s Health, Uppsala University. Akademiska sjukhuset, Uppsala.
    Strevens, Helena
    Department of Obstetrics and Gynecology, Skåne University Hospital, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
    Ahlsson, Fredrik
    Department of Women’s and Children’s Health, Uppsala University. Akademiska sjukhuset, Uppsala.
    Sengpiel, Verena
    Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden.
    Schwarcz, Erik
    Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Storck-Lindholm, Elisabeth
    Department of Obstetrics and Gynecology Södersjukhuset, Karolinska Institute, Sweden.
    Persson, Martina
    Department of Clinical Science and Education Karolinska Institute, Department of Medicine, Clinical Epidemiology Karolinska Institutet and Sachsska Childrens´ and Youth Hospital Stockholm, Sweden.
    Petersson, Kerstin
    Department of Obstetrics and Gynecology Södersjukhuset, Umeå University, Sweden.
    Ryen, Linda
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center.
    Ursing, Carina
    Södersjukhuset, Stockholm.
    Hildén, Karin
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Backman, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Obstetrics and Gynecology.
    Changing diagnostic criteria for gestational diabetes (CDC4G) in Sweden: a stepped wedge cluster randomised trialManuskript (preprint) (Annet vitenskapelig)
  • 228.
    De Bruyne, Bernard
    et al.
    Cardiovasc Ctr Aalst, Onze Lieve Vrouw Hosp, Aalst, Belgium.
    Fearon, William F.
    Med Ctr, Stanford Univ, Stanford CA, USA.; Palo Alto Vet Affairs Hlth Care Syst, Stanford CA, USA.
    Pijls, Nico H. J.
    Dept Cardiol, Catharina Hosp, Eindhoven, Netherlands; Dept Biomed Engn, Eindhoven Univ Technol, Eindhoven, Netherlands.
    Barbato, Emanuele
    Cardiovasc Ctr Aalst, Onze Lieve Vrouw Hosp, Aalst, Belgium.
    Tonino, Pim
    Dept Cardiol, Catharina Hosp, Eindhoven, Netherlands; Dept Biomed Engn, Eindhoven Univ Technol, Eindhoven, Netherlands.
    Piroth, Zsolt
    Hungarian Inst Cardiol, Budapest, Hungary.
    Jagic, Nikola
    Clin Ctr Kragujevac, Kragujeva, Serbia.
    Mobius-Winckler, Sven
    Heart Ctr Leipzig, Leipzig, Germany.
    Rioufol, Gilles
    Cardiovasc Hosp, Lyon, France.
    Witt, Nils
    Södersjukhuset, Karolinska Inst, Stockholm, Sweden.
    Kala, Petr
    Univ Hosp, Brno, Czech Republic.
    MacCarthy, Philip
    Kings Coll Hosp, London, England.
    Engstroem, Thomas
    Rigshosp, Univ Copenhagen Hosp,Copenhagen, Denmark.
    Oldroyd, Keith
    Golden Jubilee Natl Hosp, Glasgow, UK.
    Mavromatis, Kreton
    Atlanta Vet Affairs Med Ctr, Decatur GA, USA.
    Manoharan, Ganesh
    Royal Victoria Hosp, Belfast, North Ireland.
    Verlee, Peter
    Eastern Maine Med Ctr, Bangor, UK.
    Fröbert, Ole
    Region Örebro län.
    Curzen, Nick
    Southampton Univ Hosp NHS Trust, Southampton, England.
    Johnson, Jane B.
    St Jude Med, St Paul MN, USA.
    Limacher, Andreas
    Inst Social & Prevent Med, Univ Bern, Bern, Switzerland; Dept Clin Res, Clin Trials Unit, Univ Bern, Bern, Switzerland.
    Nueesch, Eveline
    Inst Social & Prevent Med, Univ Bern, Bern, Switzerland; Dept Clin Res, Clin Trials Unit, Univ Bern, Bern, Switzerland.
    Jueni, Peter
    Inst Social & Prevent Med, Univ Bern, Bern, Switzerland; Dept Clin Res, Clin Trials Unit, Univ Bern, Bern, Switzerland.
    Fractional Flow Reserve-Guided PCI for Stable Coronary Artery Disease2014Inngår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 371, nr 13, s. 1208-1217Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: We hypothesized that in patients with stable coronary artery disease and stenosis, percutaneous coronary intervention (PCI) performed on the basis of the fractional flow reserve (FFR) would be superior to medical therapy.

    METHODS: In 1220 patients with stable coronary artery disease, we assessed the FFR in all stenoses that were visible on angiography. Patients who had at least one stenosis with an FFR of 0.80 or less were randomly assigned to undergo FFR-guided PCI plus medical therapy or to receive medical therapy alone. Patients in whom all stenoses had an FFR of more than 0.80 received medical therapy alone and were included in a registry. The primary end point was a composite of death from any cause, nonfatal myocardial infarction, or urgent revascularization within 2 years.

    RESULTS: The rate of the primary end point was significantly lower in the PCI group than in the medical-therapy group (8.1% vs. 19.5%; hazard ratio, 0.39; 95% confidence interval [CI], 0.26 to 0.57; P<0.001). This reduction was driven by a lower rate of urgent revascularization in the PCI group (4.0% vs. 16.3%; hazard ratio, 0.23; 95% CI, 0.14 to 0.38; P<0.001), with no significant between-group differences in the rates of death and myocardial infarction. Urgent revascularizations that were triggered by myocardial infarction or ischemic changes on electrocardiography were less frequent in the PCI group (3.4% vs. 7.0%, P = 0.01). In a landmark analysis, the rate of death or myocardial infarction from 8 days to 2 years was lower in the PCI group than in the medical-therapy group (4.6% vs. 8.0%, P = 0.04). Among registry patients, the rate of the primary end point was 9.0% at 2 years.

    CONCLUSIONS: In patients with stable coronary artery disease, FFR-guided PCI, as compared with medical therapy alone, improved the outcome. Patients without ischemia had a favorable outcome with medical therapy alone.

  • 229.
    De Bruyne, Bernard
    et al.
    Onze-Lieve-Vrouw Clinic, Cardiovascular Center Aalst, Aalst, Belgium .
    Fröbert, Ole
    Örebro University Hospital, Region Örebro län, Örebro, Sweden.
    Fearon, William F.
    Stanford University Medical Center, Stanford CA, USA.
    Fractional Flow Reserve-Guided PCI versus Medical Therapy in Stable Coronary Disease2012Inngår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 367, nr 11, s. 991-1001Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The preferred initial treatment for patients with stable coronary artery disease is the best available medical therapy. We hypothesized that in patients with functionally significant stenoses, as determined by measurement of fractional flow reserve (FFR), percutaneous coronary intervention (PCI) plus the best available medical therapy would be superior to the best available medical therapy alone.

    Methods: In patients with stable coronary artery disease for whom PCI was being considered, we assessed all stenoses by measuring FFR. Patients in whom at least one stenosis was functionally significant (FFR, ≤0.80) were randomly assigned to FFR-guided PCI plus the best available medical therapy (PCI group) or the best available medical therapy alone (medical-therapy group). Patients in whom all stenoses had an FFR of more than 0.80 were entered into a registry and received the best available medical therapy. The primary end point was a composite of death, myocardial infarction, or urgent revascularization.

    Results: Recruitment was halted prematurely after enrollment of 1220 patients (888 who underwent randomization and 332 enrolled in the registry) because of a significant between-group difference in the percentage of patients who had a primary endpoint event: 4.3% in the PCI group and 12.7% in the medical-therapy group (hazard ratio with PCI, 0.32; 95% confidence interval [CI], 0.19 to 0.53; P<0.001). The difference was driven by a lower rate of urgent revascularization in the PCI group than in the medical-therapy group (1.6% vs. 11.1%; hazard ratio, 0.13; 95% CI, 0.06 to 0.30; P<0.001); in particular, in the PCI group, fewer urgent revascularizations were triggered by a myocardial infarction or evidence of ischemia on electrocardiography (hazard ratio, 0.13; 95% CI, 0.04 to 0.43; P<0.001). Among patients in the registry, 3.0% had a primary end-point event.

    Conclusions: In patients with stable coronary artery disease and functionally significant stenoses, FFR-guided PCI plus the best available medical therapy, as compared with the best available medical therapy alone, decreased the need for urgent revascularization. In patients without ischemia, the outcome appeared to be favorable with the best available medical therapy alone. (Funded by St. Jude Medical; ClinicalTrials.gov number, NCT01132495.)

  • 230. Dehghan, Abbas
    et al.
    Bis, Joshua C.
    White, Charles C.
    Smith, Albert Vernon
    Morrison, Alanna C.
    Cupples, L. Adrienne
    Trompet, Stella
    Chasman, Daniel I.
    Lumley, Thomas
    Voelker, Uwe
    Buckley, Brendan M.
    Ding, Jingzhong
    Jensen, Majken K.
    Folsom, Aaron R.
    Kritchevsky, Stephen B.
    Girman, Cynthia J.
    Ford, Ian
    Doerr, Marcus
    Salomaa, Veikko
    Uitterlinden, Andre G.
    Eiriksdottir, Gudny
    Vasan, Ramachandran S.
    Franceschini, Nora
    Carty, Cara L.
    Virtamo, Jarmo
    Demissie, Serkalem
    Amouyel, Philippe
    Arveiler, Dominique
    Heckbert, Susan R.
    Ferrieres, Jean
    Ducimetiere, Pierre
    Smith, Nicholas L.
    Wang, Ying A.
    Siscovick, David S.
    Rice, Kenneth M.
    Wiklund, Per-Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Taylor, Kent D.
    Evans, Alun
    Kee, Frank
    Rotter, Jerome I.
    Karvanen, Juha
    Kuulasmaa, Kari
    Heiss, Gerardo
    Kraft, Peter
    Launer, Lenore J.
    Hofman, Albert
    Markus, Marcello R. P.
    Rose, Lynda M.
    Silander, Kaisa
    Wagner, Peter
    Benjamin, Emelia J.
    Lohman, Kurt
    Stott, David J.
    Rivadeneira, Fernando
    Harris, Tamara B.
    Levy, Daniel
    Liu, Yongmei
    Rimm, Eric B.
    Jukema, J. Wouter
    Voelzke, Henry
    Ridker, Paul M.
    Blankenberg, Stefan
    Franco, Oscar H.
    Gudnason, Vilmundur
    Psaty, Bruce M.
    Boerwinkle, Eric
    O'Donnell, Christopher J.
    Genome-Wide Association Study for Incident Myocardial Infarction and Coronary Heart Disease in Prospective Cohort Studies: The CHARGE Consortium2016Inngår i: PLOS ONE, E-ISSN 1932-6203, Vol. 11, nr 3, artikkel-id e0144997Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Data are limited on genome-wide association studies (GWAS) for incident coronary heart disease (CHD). Moreover, it is not known whether genetic variants identified to date also associate with risk of CHD in a prospective setting. Methods We performed a two-stage GWAS analysis of incident myocardial infarction (MI) and CHD in a total of 64,297 individuals (including 3898 MI cases, 5465 CHD cases). SNPs that passed an arbitrary threshold of 5x10(-6) in Stage I were taken to Stage II for further discovery. Furthermore, in an analysis of prognosis, we studied whether known SNPs from former GWAS were associated with total mortality in individuals who experienced MI during follow-up. Results In Stage I 15 loci passed the threshold of 5x10(-6); 8 loci for MI and 8 loci for CHD, for which one locus overlapped and none were reported in previous GWAS meta-analyses. We took 60 SNPs representing these 15 loci to Stage II of discovery. Four SNPs near QKI showed nominally significant association with MI (p-value<8.8x10(-3)) and three exceeded the genome-wide significance threshold when Stage I and Stage II results were combined (top SNP rs6941513: p = 6.2x10(-9)). Despite excellent power, the 9p21 locus SNP (rs1333049) was only modestly associated with MI (HR = 1.09, p-value = 0.02) and marginally with CHD (HR = 1.06, p-value = 0.08). Among an inception cohort of those who experienced MI during follow-up, the risk allele of rs1333049 was associated with a decreased risk of subsequent mortality (HR = 0.90, p-value = 3.2x10(-3)). Conclusions QKI represents a novel locus that may serve as a predictor of incident CHD in prospective studies. The association of the 9p21 locus both with increased risk of first myocardial infarction and longer survival after MI highlights the importance of study design in investigating genetic determinants of complex disorders.

  • 231.
    Dejin-Karlsson, Elisabeth
    et al.
    Malmö högskola, Fakulteten för hälsa och samhälle (HS).
    Östergren, Per-Olof
    Country of origin, social support and the risk of small-for-gestational age birth.2004Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 32, nr 6, s. 442-449Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: This study investigates the risk of small for gestational age (SGA) in relation to country of origin of the mother. The role of psychosocial resources, socioeconomic and lifestyle factors was examined in different causal models. Methods: Among all pregnant nulliparous women in the city of Malmö, Sweden, who gave birth in 1991 - 92, 872 (87.7%) women completed a questionnaire during their first antenatal visit. The study was carried out among women whose pregnancies resulted in a singleton live birth (n=826); 22% (n=182) of these women were foreign-born. Results: Fifty-five (6.7%) of the infants were classified as SGA, 37 (5.7%) of mothers of Swedish origin and 18 (9.7%) of foreign origin. SGA deliveries were much more prevalent among Middle East- and North Africa-born women (22%) and sub-Saharan-born women (15%). In all, women of foreign origin had increased odds for delivering SGA babies (OR=1.8, 95% CI=1.0,3.2). In a multivariate analysis psychosocial and socioeconomic factors explained 30% and 40%, respectively, of the increased SGA risk. Psychosocial factors seemed to be more prominent risk factors for SGA among mothers of foreign origin. A possible synergistic relation was demonstrated between foreign origin of the mother and low social anchorage. Conclusions: This study showed that psychosocial factors, most probably linked to a disadvantaged social situation, could be the theoretically most important focus for preventing SGA in immigrant women. This could also further support a hypothesis of a link between psychosocial stress and SGA in general. However, this should not exclude the need for intervention in the antenatal care system in terms of specially tailored support and education.

  • 232.
    Delcoigne, Bénédicte
    et al.
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Provan, Sella A.
    Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
    Kristianslund, Eirik K
    Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
    Askling, Johan
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Rheumatology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden.
    Ljung, Lotta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi. Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    How does current disease activity in rheumatoid arthritis affect the short-term risk of acute coronary syndrome?: A clinical register based study from Sweden and Norway2023Inngår i: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 115, s. 55-61Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To estimate short-term risks of acute coronary syndrome (ACS) in patients with rheumatoid arthritis (RA) as a function of current RA disease activity including remission.

    Methods: Data from clinical visits of RA patients in Sweden (SE) and Norway (NO) between January 1st 2012 until December 31st 2020 were used. At each visit, patient's disease activity was assessed including remission status (measured with several metrics). Through linkage to national health and death registers, patients were followed up for incident ACS up to six months from each visit. We compared the short-term risk of ACS in patients not in remission vs. in remission using Cox regression analyses with robust standard errors, adjusted for country and covariates (e.g., age, sex, prednisolone use, comorbidities). We also explored disease activity categories as exposure.

    Results: We included 212,493 visits (10,444 from Norway and 202,049 from Sweden) among 41,250 patients (72% women, mean age at visit 62 years). During the 6-month follow-ups, we observed 524 incident ACS events. Compared to patients in remission, patients currently not in remission had an increased rate of ACS: adjusted hazard ratio (95% confidence interval) 1.52 (1.24–1.85) with DAS28 metric. The crude absolute six-month risks were 0.2% for patients in remission vs. 0.4% for patients with DAS28 high disease activity. The use of alternative RA disease activity and remission metrics provided similar results.

    Conclusion: Failure to reach remission is associated with elevated short-term risks of ACS, underscoring the need for CV risk factor optimization in these patients.

    Fulltekst (pdf)
    fulltext
  • 233.
    Delin, Malin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Berglund, Staffan K.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Umeå universitet, Medicinska fakulteten, Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM).
    Validation of red flags in the workup of children with long-term abdominal pain: a retrospective study2024Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To evaluate red flags as an instrument to distinguish other medical conditions from Functional Gastrointestinal Disorders (FGID) in children with long-term abdominal pain.

    Methods: In a retrospective follow-up, data were collected from 317 children who were referred for medical assessment due to long-term abdominal pain between the years 2011 and 2012 at three Swedish paediatric open clinic units in Sweden. Throughout the review of medical records, any documented red flags at the primary consultation and finally set diagnosis after 1 year were noted for all cases.

    Results: A non-FGID disease was diagnosed in 32 cases (10.1%). The sensitivity of red flags to predict inflammatory bowel disease (IBD) was 100% and the specificity 64.1%. The sensitivity of red flags to predict celiac disease was 45.5% and the specificity 63.7%. The sensitivity of red flags to predict any non-FGID disease was 59.4%, and the specificity was 65.6%.

    Conclusion: The use of red flags is a sensitive instrument to identify patients with IBD but less applicable when identifying celiac disease and other organic diseases. Specificity is generally low and future biomarkers for assessing children with long-term abdominal pain is needed.

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  • 234.
    Dell'Isola, Andrea
    et al.
    Lunds University, Lund, Sweden.
    Vinblad, Johanna
    Centre of Registers Västra Götaland, The Swedish Hip Arthroplasty Register, Goteborg, Sweden; University of Gothenburg, Gothenburg, Sweden.
    Lohmander, Stefan
    Lunds University, Lund, Sweden.
    Svensson, Ann-Marie
    National Diabetes Register, Centre of Registers in Region Västra Götaland, Goteborg, Sweden; University of Gothenburg, Goteborg, Sweden.
    Turkiewicz, Aleksandra
    Lunds University, Lund, Sweden.
    Franzén, Stefan
    National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden; University of Gothenburg, Goteborg, Sweden.
    Nauclér, Emma
    Centre of Registers Västra Götaland, The Swedish Hip Arthroplasty Register, Goteborg, Sweden.
    W-Dahl, A
    Lund University, Lund, Sverige, Sweden; The Swedish Knee Arthroplasty Register, Lund, Sweden.
    Abbott, Allan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Dahlberg, L
    Lunds University, Lund, Sweden.
    Rolfson, Ola
    Centre of Registers Västra Götaland, The Swedish Hip Arthroplasty Register, Goteborg, Sweden; University of Gothenburg, Gothenburg, Sweden.
    Englund, Martin
    Lunds University, Lund, Sweden.
    Understanding the role of diabetes in the osteoarthritis disease and treatment process: A study protocol for the Swedish osteoarthitis and disease (SOAD) cohort2019Inngår i: BMJ Open, E-ISSN 2044-6055, BMJ Open, Vol. 9, nr 12Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction Osteoarthritis (OA) is the most common form of arthritis and a leading cause of disability worldwide. Metabolic comorbidities such as type II diabetes occur with a higher rate in people with OA than in the general population. Several factors including obesity, hyperglycaemia toxicity and physical inactivity have been suggested as potential links between diabetes and OA, and have been shown to negatively impact patients’ health and quality of life. However, little is known on the role of diabetes in determining the outcome of non-surgical and surgical management of OA, and at the same time, how different OA interventions may affect diabetes control. Thus, the overall aim of this project is to explore (1) the impact of diabetes on the outcome of non-surgical and surgical OA treatments and (2) the impact of non-surgical and surgical OA treatments on diabetes control.

    Methods and analysis The study cohort is based on prospectively ascertained register data on a national level in Sweden. Data from OA patients who received a first-line non-surgical intervention and are registered in the National Quality Register for Better Management of Patients with Osteoarthritis will be merged with data from the Swedish Knee and Hip Arthroplasty Registers and the National Diabetes Register. Additional variables regarding patients’ use of prescribed drugs, comorbidities, socioeconomic status and cause of death will be obtained through other national health and population data registers. The linkage will be performed on an individual level using unique personal identity numbers.

    Ethics and dissemination This study received ethical approval (2019-02570) from the Swedish Ethical Review Authority. Results from this cohort will be submitted to peer-reviewed scientific journals and reported at the leading national and international meetings in the field.

  • 235.
    Derraik, Jose G. B.
    et al.
    Univ Auckland, Liggins Inst, Auckland 1, New Zealand..
    Ahlsson, Fredrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Diderholm, Barbro
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Lundgren, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Obesity rates in two generations of Swedish women entering pregnancy, and associated obesity risk among adult daughters2015Inngår i: Scientific Reports, E-ISSN 2045-2322, Vol. 5, artikkel-id 16692Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We examined changes in obesity rates in two generations of Swedish women entering pregnancy, and assessed the effects of maternal body mass index (BMI) on the risk of overweight or obesity among adult daughters. This study covered an intergenerational retrospective cohort of 26,561 Swedish mothers and their 26,561 first-born daughters. There was a 4-fold increase in obesity rates, which rose from 3.1% among women entering pregnancy in 1982-1988 to 12.3% among their daughters in 2000-2008 (p < 0.0001) when entering pregnancy. The greater the maternal BMI, the greater the odds of overweight and/or obesity among daughters. Underweight mothers had half the odds of having an overweight or obese daughter in comparison to mothers of normal BMI (p < 0.0001). In contrast, the odds ratio of obese mothers having obese daughters was 3.94 (p < 0.0001). This study showed a strong association between maternal obesity and the risk of obesity among their first-born daughters. In addition, we observed a considerable increase in obesity rates across generations in mother-daughter pairs of Swedish women entering pregnancy. Thus, it is important to have preventative strategies in place to halt the worsening intergenerational cycle of obesity.

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  • 236.
    Diderichsen, Saima
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    It's just a job: a new generation of physicians dealing with career and work ideals2017Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background: Today, women constitute about half of medical students. However, women are still underrepresented in prestigious specialties such as surgery. Some suggest that this could be explained by women being more oriented towards work-life balance.

    Aim: The overall aim of this dissertation was to explore aspects of gender in work-life priorities, career plans, clinical experiences and negotiations of professional ideals among medical students and newly graduated doctors, all in a Swedish setting.

    Method: We based the analysis on data from two different sources: an extensive questionnaire exploring gender and career plans among medical students (paper I-III) and interviews with newly graduated doctors (study IV).

    In paper I, four classes of first- and final-year medical (N=507, response rate 85%) answered an open-ended question about their future life, 60% were women. We conducted a mixed methods design where we analyzed the answers qualitatively to create categories that could be analyzed quantitatively in the second stage.

    In paper II, five classes of final-year medical students  were included (N = 372, response rate 89%), and 58% were women. We studied their specialty preference and how they rated the impact that the motivational factors had for their choice. In order to evaluate the independent impact of each motivational factor for specialty preference, we used logistic regression.

    In paper III, final-year medical students answered two open-ended questions: “Can you recall an event that made you interested of working with a certain specialty?” and “Can you recall an event that made you uninterested of working with a certain specialty?”. The response rate was 62% (N = 250),  and 58% were women. The analysis was similar to paper I, but here we focused on the qualitative results.

    In paper IV, thematic interviews were conducted in 2014 and 2015. We made a purposeful sampling of 15 junior doctors, including nine women and six men from eight different hospitals. Data collection and analysis was inspired by constructivist grounded theory methodology.

    Results: When looking at the work-life priorities of medical students and junior doctors it is clear that both men and women want more to life than work in their ideal future. The junior doctors renounced fully devoted and loyal ideal and presented a self-narrative where family and leisure was important to cope and stay empathic throughout their professional lives.

    The specialty preferences and the highly rated motives for choosing them were relatively gender neutral. However, the gender neutrality came to an end when the final-year medical students described clinical experiences that affected their specialty preference. Women were more often deterred by workplace cultures, whereas men were more often deterred by knowledge area, suggesting that it is a male privilege to choose a specialty according to interest.

    Among the newly graduated doctors, another male privilege seemed to be that men were able to pass more swiftly as real doctors, whereas the women experienced more dissonance between their self-understanding and being perceived as more junior and self-doubting.

    Conclusions: The career plans and work-life priorities of doctors-to-be were relatively gender neutral. Both female and male doctors, intended to balance work not only with a family but also with leisure. This challenges the health care system to establish more adaptive and flexible work conditions.

    Gender segregation in specialty choice is not the result of gender-dichotomized specialty preferences starting in medical school. This calls for a re-evaluation of the understanding where gender is seen as a mere background characteristic, priming women and men for different specialties. 

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  • 237.
    Diderichsen, Saima
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Andersson, Jenny
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, Eva E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Verdonk, Petra
    VU University Medical Center, Department of Medical Humanities, EMGO Institute for Health and Care Research, Amsterdam, the Netherlands.
    Lagro-Janssen, Toine
    Department of Primary and Community Care, Centre for Family Medicine, Geriatric and Public Helth, Unit Women's Studies, Radboud University Nijmegen Medical Health Centre, The Netherlands .
    Hamberg, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Swedish medical students' expectations of their future life2011Inngår i: International Journal of Medical Education, E-ISSN 2042-6372, Vol. 2, s. 140-146Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To investigate future life expectations among male and female medical students in their first and final year.

    Methods: The study was cross-sectional and conducted at a Swedish medical school. Out of 600 invited students, 507 (85%) answered an open-ended question about their future life, 298 (59%) first-year students and 209 (41%) last-year students. Women constituted 60% of the respondents. A mixed model design was applied; qualitative content analysis was utilized to create statistically comparable themes and categories.

    Results: Students' written answers were coded, categorized and clustered into four themes: "Work", "Family", "Leisure" and "Quality of personal life". Almost all students included aspects of work in their answers. Female students were more detailed than male ones in their family concerns. Almost a third of all students reflected on a future work-life balance, but considerations regarding quality of personal life and leisure were more common among last-year students.

    Conclusions: Today's medical students expect more of life than work, especially those standing on the doorstep of working life. They intend to balance work not only with a family but also with leisure activities. Our results reflect work attitudes that challenge the health care system for more adaptive working conditions. We suggest that discussions about work-life balance should be included in medical curricula.

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  • 238.
    Diderichsen, Saima
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, Eva E.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Verdonk, Petra
    Lagro-Janssen, Toine
    Hamberg, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Few gender differences in specialty preferences and motivational factors: a cross-sectional Swedish study on last-year medical students2013Inngår i: BMC Medical Education, E-ISSN 1472-6920, Vol. 13, artikkel-id 39Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Today, women constitute about half of medical students in several Western societies, yet women physicians are still underrepresented in surgical specialties and clustered in other branches of medicine. Gender segregation in specialty preference has been found already in medical school. It is important to study the career preferences of our future physicians, as they will influence the maintenance of an adequate supply of physicians in all specialties and the future provision of health care. American and British studies dominate the area of gender and medical careers whereas Swedish studies on medical students' reasons for specialty preference are scarce. The aim of this study is to investigate and compare Swedish male and female medical students' specialty preferences and the motives behind them. Methods: Between 2006 and 2009, all last-year medical students at Umea University, Sweden (N = 421), were invited to answer a questionnaire about their future career and family plans. They were asked about their specialty preference and how they rated the impact that the motivational factors had for their choice. The response rate was 89% (N = 372); 58% were women (N = 215) and 42% were men (N = 157). Logistic regression was used to evaluate the independent impact of each motivational factor for specialty preference. Results: On the whole, male and female last-year students opted for similar specialties. Men and women had an almost identical ranking order of the motivational factors. When analyzed separately, male and female students showed both similarities and differences in the motivational factors that were associated with their specialty preference. A majority of the women and a good third of the men intended to work part-time. The motivational factor combining work with family correlated with number of working hours for women, but not for men. Conclusions: The gender similarities in the medical students' specialty preferences are striking and contrast with research from other Western countries where male and female students show more differences in career aspirations. These similarities should be seized by the health care system in order to counteract the horizontal gender segregation in the physician workforce of today.

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  • 239.
    Diderichsen, Saima
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Kristoffersson, E.
    Verdonk, P.
    Hamberg, K.
    "You don’t want to disturb, you want to fix it yourself": negotiations of professional identity in newly graduated doctors' narrativesManuskript (preprint) (Annet vitenskapelig)
  • 240. Dimberg, Ivar
    et al.
    Grzymala-Lubanski, Bartosz
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Hägerfelth, Anette
    Rosenqvist, Mårten
    Svensson, Peter
    Själander, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Computerised assistance for warfarin dosage: effects on treatment quality2012Inngår i: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 23, nr 8, s. 742-744Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Well-managed warfarin treatment with a high time in therapeutic range (TTR) corresponds to fewer bleedings or thromboembolic complications. Many small centres manage their warfarin dosing manually, with little or no knowledge of their treatment quality as measured by TTR. AuriculA is a Swedish National web-based anticoagulation dosing system. Our hypothesis was that the web based dosing system, compared to manual dosing, would improve the TTR.

    Methods: Retrospective cohort study of medical records from patients with atrial fibrillation on warfarin treatment from two centres, with previously manual warfarin dosing regimens. Data for calculation of TTR was extracted manually from medical records from the time when using manual dosing and compared with the computerised regimen.

    Results: In centre 1, the mean TTR was significantly increased after the introduction of AuriculA, from 64.3% (95% CI 58.8-69.8) to 71.3% (95% CI 67.7-74.8), p=0.03. In centre 2, a high TTR of 73.6% (95% CI 71.3-75.9) was maintained after the implementation, 74.0% (95% CI 71.6-76.3). INR tests were prescribed significantly more frequent after the introduction of AuriculA in both centres; 20% more often at centre 1 and 21% at centre 2.

    Conclusion: Computerised dosing assistance within the Swedish national quality registry AuriculA improves or maintains a high treatment quality with warfarin as measured by TTR.

    (C) 2012 European Federation of Internal Medicine. Published by Elsevier B. V. All rights reserved.

  • 241.
    Ding, Wern Yew
    et al.
    Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England.;Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England..
    Kotalczyk, Agnieszka
    Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England.;Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England.;Med Univ Silesia, Silesian Ctr Heart Dis, Dept Cardiol Congenital Heart Dis & Electrotherap, Zabrze, Poland..
    Boriani, Giuseppe
    Univ Modena & Reggio Emilia, Policlin Modena, Dept Biomed Metab & Neural Sci, Cardiol Div, Modena, Italy..
    Marin, Francisco
    Univ Murcia, Hosp Univ Virgen de la Arrixaca, Dept Cardiol, CIBERCV, Murcia, Spain..
    Blomström-Lundqvist, Carina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi-arrytmi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala Univ, Dept Med Sci & Cardiol, Uppsala, Sweden..
    Potpara, Tatjana S.
    Univ Belgrade, Sch Med, Belgrade, Serbia.;Clin Ctr Serbia, Cardiol Clin, Intens Arrhythmia Care, Belgrade, Serbia..
    Fauchier, Laurent
    Ctr Hosp Univ Trousseau, Serv Cardiol, Tours, France..
    Lip, Gregory Y. H.
    Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England.;Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England.;Aalborg Univ, Dept Clin Med, Aalborg Thrombosis Res Unit, Aalborg, Denmark..
    Impact of diabetes on the management and outcomes in atrial fibrillation: an analysis from the ESC-EHRA EORP-AF Long-Term General Registry2022Inngår i: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 103, s. 41-49Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The prevalence of atrial fibrillation(AF) and diabetes mellitus is rising to epidemic proportions. We aimed to assess the impact of diabetes on the management and outcomes of patients with AF. Methods: The EORP-AF General Long-Term Registry is a prospective, observational registry from 250 centres across 27 European countries. Outcomes of interest were as follows: i)rhythm control interventions; ii)quality of life; iii)healthcare resource utilisation; and iv)major adverse events. Results: Of 11,028 patients with AF, the median age was 71 (63-77) years and 2537 (23.0%) had diabetes. Median follow-up was 24 months. Diabetes was related to increased use of anticoagulation but less rhythm control interventions. Using multivariable analysis, at 2-year follow-up, patients with diabetes were associated with greater levels of anxiety (p = 0.038) compared to those without diabetes. Overall, diabetes was associated with worse health during follow-up, as indicated by Health Utility Score and Visual Analogue Scale. Healthcare resource utilisation was greater with diabetes in terms of length of hospital stay (8.1 (+/- 8.2) vs. 6.1 (+/- 6.7) days); cardiology and internal medicine/general practitioner visits; and emergency room admissions. Diabetes was an independent risk factor of major adverse cardiovascular event (MACE; HR 1.26 [95% CI, 1.04-1.52]), all-cause mortality (HR 1.28 [95% CI, 1.08-1.52]), and cardiovascular mortality (HR 1.41 [95% CI, 1.09-1.83]). Conclusion: In this contemporary AF cohort, diabetes was present in 1 in 4 patients and it served as an independent risk factor for reduced quality of life, greater healthcare resource utilisation and excess MACE, all-cause mortality and cardiovascular mortality. There was increased use of anticoagulation therapy in diabetes but with less rhythm control interventions.

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  • 242.
    Ding, Wern Yew
    et al.
    Univ Liverpool, Liverpool John Moores Univ, Liverpool Ctr Cardiovasc Sci, Chest Hosp, Liverpool, Lancs, England.;Liverpool Heart & Chest Hosp, Liverpool, Lancs, England.
    Proietti, Marco
    Univ Liverpool, Liverpool John Moores Univ, Liverpool Ctr Cardiovasc Sci, Chest Hosp, Liverpool, Lancs, England.;Liverpool Heart & Chest Hosp, Liverpool, Lancs, England.;IRCCS Ist Clin Sci Maugeri, Div Subacute Care, Milan, Italy.;Univ Milan, Dept Clin Sci & Community Hlth, Milan, Italy.
    Romiti, Giulio Francesco
    Univ Liverpool, Liverpool John Moores Univ, Liverpool Ctr Cardiovasc Sci, Chest Hosp, Liverpool, Lancs, England.;Liverpool Heart & Chest Hosp, Liverpool, Lancs, England.;Sapienza Univ Rome, Dept Translat & Precis Med, Rome, Italy.
    Vitolo, Marco
    Univ Liverpool, Liverpool John Moores Univ, Liverpool Ctr Cardiovasc Sci, Chest Hosp, Liverpool, Lancs, England.;Liverpool Heart & Chest Hosp, Liverpool, Lancs, England.;Univ Modena & Reggio Emilia, Policlin Modena, Dept Biomed Metab & Neural Sci, Cardiol Div, Modena, Italy.;Univ Modena & Reggio Emilia, Clin & Expt Med PhD Program, Modena, Italy.
    Fawzy, Ameenathul Mazaya
    Univ Liverpool, Liverpool John Moores Univ, Liverpool Ctr Cardiovasc Sci, Chest Hosp, Liverpool, Lancs, England.;Liverpool Heart & Chest Hosp, Liverpool, Lancs, England.
    Boriani, Giuseppe
    Univ Modena & Reggio Emilia, Policlin Modena, Dept Biomed Metab & Neural Sci, Cardiol Div, Modena, Italy.
    Marin, Francisco
    Univ Murcia, Hosp Univ Virgen Arrixaca, IMIB Arrixaca, Dept Cardiol,CIBERCV, Murcia, Spain.
    Blomström-Lundqvist, Carina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper. Örebro Univ, Fac Med & Hlth, Sch Med Sci, Örebro, Sweden.
    Potpara, Tatjana S.
    Univ Belgrade, Sch Med, Belgrade, Serbia.;Clin Ctr Serbia, Cardiol Clin, Intens Arrhythmia Care, Belgrade, Serbia.
    Fauchier, Laurent
    Ctr Hosp Univ Trousseau, Serv Cardiol, Tours, France.
    Lip, Gregory Y. H.
    Univ Liverpool, Liverpool John Moores Univ, Liverpool Ctr Cardiovasc Sci, Chest Hosp, Liverpool, Lancs, England.;Liverpool Heart & Chest Hosp, Liverpool, Lancs, England.
    Impact of ABC (Atrial Fibrillation Better Care) pathway adherence in high-risk subgroups with atrial fibrillation: A report from the ESC-EHRA EORP-AF long-term general registry2023Inngår i: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 107, s. 60-65Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Effects of Atrial Fibrillation Better Care (ABC) adherence among high-risk atrial fibrillation (AF) subgroups remains unknown. We aimed to evaluate the impact of ABC adherence on clinical outcomes in these high-risk patients.

    Methods: EORP-AF General Long-Term Registry is a prospective, observational registry from 250 centres across 27 European countries. High-risk patients were defined as those with either CKD (eGFR <60 mL/min/1.73m2), elderly patients (>= 75 years) or prior thromboembolism. Primary outcome was a composite event of all-cause death, thromboembolism and acute coronary syndrome.

    Results: 6646 patients with AF were screened (median age was 70 [IQR 61 - 77] years; 40.2% females). There were 3304 (54.2%) patients with either CKD (n = 1750), older age (n = 2236) or prior thromboembolism (n = 728). Among these, 924 (28.0%) were managed as adherent to ABC. At 2-year follow-up, 966 (14.5%) patients reported the primary outcome. The incidence of the primary outcome was significantly lower in high-risk patients managed as adherent to ABC pathway (IRR 0.53 [95%CI, 0.43 - 0.64]). Consistent results were obtained in the individual subgroups. Using multivariable Cox proportional hazards analysis, ABC adherence in the high-risk cohort was independently associated with a lower risk of the primary outcome (aHR 0.64 [95%CI, 0.51 - 0.80]), as well as in the CKD (aHR 0.51 [95%CI, 0.37 - 0.70]) and elderly subgroups (aHR 0.69 [95%CI, 0.53 - 0.90]). Overall, there was greater reduction in the risk of primary outcome as more ABC criteria were fulfilled, both in the overall high-risk patients (aHR 0.39 [95%CI, 0.25 - 0.61]), as well as in the individual subgroups.

    Conclusion: In a large, contemporary cohort of patients with AF, we demonstrate that adherence to the ABC pathway was associated with a significant benefit among high-risk patients with either CKD, advanced age (>75 years old) or prior thromboembolism.

  • 243.
    Djekic, Demir
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Novel and Traditional Risk Factors for Coronary Artery Disease: Role of Coronary Artery Calcium, Lipidomics, Psychosocial Factors and Diet2020Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background: The aim of the research reported in this thesis was to determine the association of novel and traditional risk factors with coronary artery calcium (CAC), a marker of subclinical coronary artery disease (CAD) in healthy individuals. In addition, we investigated the effects of a vegetarian, compared to a meat diet, on novel and traditional risk factors in patients with diagnosed CAD.

    Methods: Studies I-II evaluated the inter-laboratory reproducibility of liquid chromatography-mass spectrometry (LC-MS) lipid analysis and the association of serum lipidome with CAC in a cohort of 70 patients. Studies III and IV analysed data of 1067 participants in the pilot study of the Swedish CArdioPulmonary bioImage Study to determine associations of psychosocial (residential area, education, housing, and social support) and traditional risk factors with CAC. Cardiac computed tomography was used to obtain a coronary artery calcium score (CACS) (Studies I–IV). Study V employed a crossover design in which 31 patients with CAD were randomly allocated to a four-week vegetarian diet alternating with four weeks of an isocaloric meat diet. Enzyme-linked immunosorbent assay was used to measure oxidised LDL-cholesterol. Plasma metabolome, including choline, trimethylamine N-oxide, L-carnitine, and acetyl-carnitine, as well as plasma lipidome were determined with LC-MS. Gut microbiota and faecal short- and branched-chain fatty acids were analysed with 16S rRNA gene sequencing and gas chromatography-MS, respectively.

    Results: In Study I, two laboratories independently identified six lipids in common that differentiated serum of patients with CACS >250 from that of those with CACS=0. Study II, revealed higher levels of phosphatidylcholine(PC)(16:0/20:4) and lower levels of PC(18:2/18:2), PC(36:3) and phosphatidylethanolamine (PE)(20:0/18:2) in patients with CACS >250 than found in those with CACS=0. Study III showed a CACS >0 prevalence of 46.3% and 36.6% in low and high socioeconomic residential areas, respectively, but the traditional risk factor–adjusted odds ratio for CACS >0 was not significantly higher in subjects living in low socioeconomic areas. In Study III, the traditional risk factor–adjusted odds ratio for CACS >100 relative to CACS=0 was significantly higher in women with low education level and living in a rented apartment. Studies III and IV showed traditional risk factor–adjusted odds ratios for CACS >0 to be significantly higher in women with a family history of premature cardiovascular disease and low social support. No relationship of psychosocial factors with CAC was observed in men. The vegetarian diet implemented in Study V significantly lowered mean oxidized LDL-cholesterol (-2.73 U/L), total cholesterol (-0.13 mmol/L), LDL-cholesterol (-0.10 mmol/L), and body mass index (-0.21 kg/m2), as well as the relative abundance of PCs, PEs, and several microbial genera compared with the meat diet. The effect of the vegetarian diet on oxidized LDL-C was associated with higher relative abundance of Ruminococcaceae genera and of Barnesiella and reduced abundance of Flavonifractor. The vegetarian diet lowered the relative abundance of ceramide(d18:1/16:0) and triacylglycerols with saturated fatty acyl chains and raised the relative abundance of triacylglycerols with high carbon and polyunsaturated fatty acyl chains compared with the meat diet.

    Conclusions: Novel and traditional cardiovascular risk factors are associated with subclinical CAD. Psychosocial factors are associated with subclinical CAD in women, but not in men. Short-term intervention with a vegetarian diet in individuals with CAD can positively impact novel and traditional factors that have been associated with risk of future cardiovascular events.

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  • 244.
    Dobrosavljevic, Maja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Attention-Deficit/Hyperactivity Disorder (ADHD) Beyond the Young Age: Investigation of the Prevalence of ADHD in Older Adults and the Risk of Age-related Disorders2023Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by impairing levels of inattention and/or hyperactivity-impulsivity. Symptoms of ADHD, which typically emerge in childhood, may persist until older age with a substantial adverse impact on health and functionality. Yet there is a notable knowledge gap in research on ADHD in older age and the potential associations of adult ADHD with disorders that are common in older age (i.e., age-related disorders). Thus, this thesis aimed to investigate the prevalence rates of ADHD in older age and whether ADHD in adulthood is associated with an increased risk of age-related disorders. 

    Study I, a systematic review and meta-analysis, suggests that a considerable number of older adults report elevated levels of ADHD symptoms, while the prevalence of treated ADHD is less than half of the prevalence of clinically diagnosed ADHD. In Studies II, III, and IV, we used data from Swedish population registers. We found that ADHD is associated with an increased risk of dementia and mild cognitive impairment (Study II), which substantially attenuates after controlling for psychiatric comorbidity. Further, ADHD symptoms in adulthood are associated with an increased risk of subsequent cardiometabolic disorders (Study III). The associations attenuate after controlling for educational attainment, psychiatric comorbidity, and lifestyle factors, and they are confounded by genetic factors. Finally, the prediction of cardiovascular risk in adults initiating pharmacological treatment for ADHD may improve by considering novel risk factors (i.e., psychiatric comorbidity and use of other psychotropic medications) in addition to traditional predictors (Study IV). 

    Overall, the findings indicate that a substantial number of older adults have increased levels of ADHD symptoms and that ADHD in adults is associated with an increased risk of age-related disorders. Further longitudinal studies, based on both community samples and epidemiological data, are needed to explore the risk of age-related disorders in ADHD, and the underlying mechanisms, until a more advanced older age. 

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  • 245.
    Dobrosavljevic, Maja
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Kuja-Halkola, Ralf
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Li, Lin
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Chang, Zheng
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    du Rietz, Ebba
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Attention-deficit/hyperactivity disorder symptoms and subsequent cardiometabolic disorders in adults: investigating underlying mechanisms using a longitudinal twin studyManuskript (preprint) (Annet vitenskapelig)
  • 246.
    Dong, Huan-Ji
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Larsson, Britt
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Fischer, Marcelo Rivano
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Gerdle, Björn
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Facing obesity in pain rehabilitation clinics: Profiles of physical activity in patients with chronic pain and obesity-A study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)2020Inngår i: PLOS ONE, E-ISSN 1932-6203, Vol. 15, nr 9, artikkel-id e0239818Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background The obesity epidemic has influenced pain rehabilitation clinics. To date, little is known about baseline level of physical activity (PA) in patients referred to pain rehabilitation clinics. We aimed to investigate the PA levels of patients referred to pain rehabilitation clinics and to evaluate the effect of excess weight on PA level. Methods and findings Data were obtained from the Swedish Quality Registry for Pain Rehabilitation between 2016 and 2017. These data included PA time (everyday PA and physical exercise per week), Body Mass Index (BMI), sociodemographic factors, chronic pain and psychological aspects (e.g., pain intensity, depressive and anxiety symptoms and insomnia problems). Insufficient PA was defined as less than 150 minutes per week. We performed logistic regressions as well as orthogonal partial least square regression to estimate the effects of excess weight on PA. Over one-fourth of the patients were classified as obese (BMI &gt;= 30 kg/m(2), 871/3110, 25.3%) and nearly one-third of these patients were classified as severely obese (BMI &gt;= 35 kg/m(2), 242/871, 27.8%). Time estimations for physical exercise varied among the BMI groups, but patients in the higher BMI category were more likely to spend less time on everyday PA. Compared to normal weight, mild obesity [odds ratio (OR) 0.65, 95% confidence interval (CI) 0.53-0.81] and severe obesity (OR 0.56, 95% CI 0.42-0.74) were associated with less PA. Mild obese patients had an elevated risk of 65% and severe obese patients had an elevated risk of 96% for insufficient PA. Increased pain intensity was positively related to insufficient PA (OR 1.17, 95% CI 1.06-1.29) among the obese patients. Conclusion Having low PA is very common for patients referred to pain rehabilitation clinics, especially for those with comorbid obesity. As a first step to increase PA, obese patients need to be encouraged to increase the intensity and amount of less painful daily PA.

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  • 247.
    Dong, Huan-Ji
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Larsson, Britt
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Bernfort, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Gerdle, Björn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Is excess weight a burden for older adults who suffer chronic pain?2018Inngår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, artikkel-id 270Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BackgroundObesity and chronic pain are common comorbidities and adversely influence each other. Advanced age is associated with more comorbidities and multi-morbidities. In this study, we investigated the burden of overweight/obesity and its comorbidities and their associations with chronic pain in a random population sample of Swedish older adults.MethodsThe cross-sectional analysis involved a random sample of a population65years in south-eastern Sweden (N=6243). Data were collected from a postal questionnaire that addressed pain aspects, body mass index (BMI), and health experiences. Chronic pain was defined as pain during the previous three months. According to the 0-10 Numeric Rating Scale, pain scored 7 corresponds to severe pain. Binary logistic regression was used to determine the variables associated to pain aspects.ResultsA total of 2633 (42%) reported chronic pain. More obese older adults (BMI 30kg/m(2)) experienced chronic pain (58%) than those who were low-normal weight (BMI amp;lt;25kg/m(2), 39%) or overweight (25BMI amp;lt;30kg/m(2), 41%). Obese elderly more frequently had pain in extremities and lower back than their peers. In the multivariate model, obesity (Odds Ratio (OR) 1.59, 95% Confidence Interval (CI) 1.33-1.91) but not overweight (OR 1.08, 95% CI 0.95-1.22) was associated with chronic pain. Obesity (OR 1.53, 95% CI 1.16-2.01) was also significantly related to severe pain. We also found other comorbidities - i.e., traumatic history (OR 2.52, 95% CI 1.99-3.19), rheumatic diseases (OR 5.21, 95% CI 4.54-5.97), age85years (OR 1.66, 95% CI 1.22-2.25), and depression or anxiety diagnosis (OR 1.83, 95% CI 1.32-2.53) - showed stronger associations with pain aspects than weight status. Conclusion: In older adults, excess weight (BMI 30 or above) is a potentially modifiable factor but not the only risk factor that is associated with chronic pain and severe pain. Future studies should investigate the effectiveness of interventions that treat comorbid pain and obesity in older adults.

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  • 248. Dragano, Nico
    et al.
    Siegrist, Johannes
    Nyberg, Solja T.
    Lunau, Thorsten
    Fransson, Eleonor I.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Karolinska Institutet, Sweden; Jönköping University, Sweden.
    Alfredsson, Lars
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Erbel, Raimund
    Fahlén, Göran
    Goldberg, Marcel
    Hamer, Mark
    Heikkilä, Katriina
    Jöckel, Karl-Heinz
    Knutsson, Anders
    Madsen, Ida E. H.
    Nielsen, Martin L.
    Nordin, Maria
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Umeå University, Sweden.
    Oksanen, Tuula
    Pejtersen, Jan H.
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Schupp, Jürgen
    Singh-Manoux, Archana
    Steptoe, Andrew
    Theorell, Töres
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Vahtera, Jussi
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Virtanen, Marianna
    Zins, Marie
    Batty, G. David
    Kivimäki, Mika
    Effort-Reward Imbalance at Work and Incident Coronary Heart Disease A Multicohort Study of 90,164 Individuals2017Inngår i: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 28, nr 4, s. 619-626Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Epidemiologic evidence for work stress as a risk factor for coronary heart disease is mostly based on a single measure of stressful work known as job strain, a combination of high demands and low job control. We examined whether a complementary stress measure that assesses an imbalance between efforts spent at work and rewards received predicted coronary heart disease.

    Methods: This multicohort study (the IPD-Work consortium) was based on harmonized individual-level data from 11 European prospective cohort studies. Stressful work in 90,164 men and women without coronary heart disease at baseline was assessed by validated effort-reward imbalance and job strain questionnaires. We defined incident coronary heart disease as the first nonfatal myocardial infarction or coronary death. Study-specific estimates were pooled by random effects meta-analysis.

    Results: At baseline, 31.7% of study members reported effort-reward imbalance at work and 15.9% reported job strain. During a mean follow-up of 9.8 years, 1,078 coronary events were recorded. After adjustment for potential confounders, a hazard ratio of 1.16 (95% confidence interval, 1.00-1.35) was observed for effort-reward imbalance compared with no imbalance. The hazard ratio was 1.16 (1.01-1.34) for having either effort-reward imbalance or job strain and 1.41 (1.12-1.76) for having both these stressors compared to having neither effort-reward imbalance nor job strain.

    Conclusions: Individuals with effort-reward imbalance at work have an increased risk of coronary heart disease, and this appears to be independent of job strain experienced. These findings support expanding focus beyond just job strain in future research on work stress.

  • 249.
    Dragioti, Elena
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Tsamakis, Konstantinos
    Kings Coll London, England.
    Larsson, Britt
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Gerdle, Björn
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Predictive association between immigration status and chronic pain in the general population: results from the SwePain cohort2020Inngår i: BMC Public Health, E-ISSN 1471-2458, Vol. 20, nr 1, artikkel-id 1462Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BackgroundPrevious studies suggest that immigration may influence the experience of pain.ObjectiveThis population-based study examines whether immigration status is associated with chronic pain (CP), chronic widespread pain (CWSP), and severe CP at a two-year follow-up. We also tested mediation by mood status (i.e., anxiety and depression).Methods15, 563 participants from a representative stratified random sample of 34,000 individuals living in south-eastern Sweden completed a postal survey, during 2013-2015, that included the following data: immigration status; presence of CP (pain lasting at least 3 months) and CWSP (a modified classification of widespread pain for use in epidemiological studies); severity of CP based on a numeric rating scale; and depression, anxiety, economic situation, and sociodemographic information. We applied logistic regressions using the generalized estimating equations (GEE), with Swedish-born as the reference group and path analyses models.ResultsCompared to the Swedish-born participants (n =14,093;90%), the immigrants (n =1470;10%) had an elevated risk of all pain outcomes (CP: odds ratio [OR]=1.18; 95% confidence interval [CI=1.04-1.33, CWSP: OR=1.39; 95% CI: 1.15-1.69 and severe CP: 1.51; 95% CI: 1.23-1.87) after adjustments. Path analyses showed that baseline age, immigrant status, and financial hardship had a significant influence on chronic pain outcomes at follow-up with baseline mood status as the mediator. Immigration status was also associated with age and financial hardship.ConclusionImmigrants may have increased risk of chronic pain, widespread pain, and severe pain and this risk is mediated by mood status. Targeted interventions better tailored to the socio-economic and psychological status of immigrants with chronic pain are warranted.

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  • 250. Dugas, Lara R.
    et al.
    Chorell, Elin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Plange-Rhule, Jacob
    Lambert, Estelle V.
    Cao, Guichan
    Cooper, Richard S.
    Layden, Brian T.
    Scholten, Denise
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Luke, Amy
    Goedecke, Julia H.
    Obesity-related metabolite profiles of black women spanning the epidemiologic transition2016Inngår i: Metabolomics, ISSN 1573-3882, E-ISSN 1573-3890, Vol. 12, nr 3, artikkel-id 45Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In developed countries, specific metabolites have been associated with obesity and metabolic diseases, e.g. type 2 diabetes. It is unknown whether a similar profile persists across populations of African-origin, at increased risk for obesity and related diseases. In a cross-sectional study of normal-weight and obese black women (33.3 +/- 6.3 years) from the US (N = 69, 65 % obese), South Africa (SA, N = 97, 49 % obese) and Ghana (N = 82, 33 % obese) serum metabolite profiles were characterized via gas chromatography-time of flight/mass spectrometry. In US and SA women, BMI correlated with branched-chain and aromatic amino acids, as well as dopamine and aminoadipic acid. The relationship between BMI and lipid metabolites differed by site; BMI correlated positively with palmitoleic acid (16: 1) in the US; negatively with stearic acid (18: 0) in SA, and positively with arachidonic acid (20: 4) in Ghana. BMI was also positively associated with sugar-related metabolites in the US; i.e. uric acid, and mannitol, and with glucosamine, glucoronic acid and mannitol in SA. While we identified a common amino acid metabolite profile associated with obesity in black women from the US and SA, we also found site-specific obesity-related metabolites suggesting that the local environment is a key moderator of obesity.

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