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  • 301.
    Jacobsson, Brittmarie
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Oral health.
    On Oral Health in Young Individuals with a Focus on Sweden and Vietnam: A Cultural Perspective2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    AIM: The overall aim of this thesis was to study culture as an oral health determinant for dental caries and gingivitis in children living in Jönköping, Sweden, in relation to children living in Da Nang, Vietnam.

    MATERIALS AND METHODS: In 1993 and 2003, cross-sectional studies with clinical examinations and questionnaires were performed in Jönköping, Sweden, with a random sample of 130 children from each of four age groups; 3, 5, 10 and 15 years. The final study sample comprised 739 children, 154 (21%) with two foreign-born parents and 585 (79%) with two Swedish-born parents (Paper I). In 2000, all 15-year-olds (n=143) at one school in Jönköping, Sweden, were asked to participate in a questionnaire study connected to clinical data. The final sample comprised 117 individuals, 51 (44%) with foreign-born parents and 66 (56%) with Swedish-born parents (Paper II). In 2008, a cross-sectional study with clinical examinations and questionnaires was performed in Da Nang, Vietnam with 840 randomly selected children, 210 in each of four age groups; 3, 5, 10 and 15 years. The final sample comprised 745 individuals (Papers III and IV).

    RESULTS: In 2003, the mean number of decayed (initial and manifest) and filled tooth surfaces was significantly higher in all age groups in children with foreign-born parents compared with children with Swedish-born parents. The gap between children with foreign-born parents and Swedish-born parents increased over the ten-year period from 1993 to 2003. The odds ratio of dental caries development among 10- and 15-year-old children with foreign-born-parents was more than six times higher than for their counterparts with Swedish-born parents (Paper I). Fifteen-year-olds born in Sweden of foreignborn parents and those who had immigrated before one year of age had a caries prevalence similar to 15-year-olds with Swedish-born parents, whereas the caries prevalence in children who had immigrated to Sweden after 7 years of age was 2-3 times higher (Paper II). Among the 3- and 5-year-olds in Vietnam, 98% suffered from dental caries, compared with 91% of 10- and 15-year-olds (Paper IV). The distribution of the most frequent values of decayed and filled primary tooth surfaces (dfs) in 5-year-olds was 16–20, and of decayed and filled permanent tooth surfaces (DFS) in 15-year-olds was 1–5. The maximum dfs was 76–80, and significant numbers of children had dfs between 20 and 50. The percentage of tooth sites with plaque and gingivitis was higher for children in all age groups with foreign-born parents compared with children with Swedish-born parents, except among the 15-year-olds in 2003. In Vietnam, the prevalence of plaque and gingivitis was high in all age groups, especially in 10- and 15-year-olds. Fifteen-yearolds in Sweden with foreign-born parents had a higher intake of snack products between principal meals compared with 15-year-olds with Swedish-born parents (Paper II). In Sweden, most children in all age groups brushed their teeth themselves or with help from their parents twice or more than twice a day (Paper I). Among 3- and 5-year-olds in Vietnam, about half of the parents reported that their children brushed their teeth themselves or with help from parents twice or more than twice a day (Paper III). All 3-year-olds and 99% of 5-year-olds in Sweden brushed their teeth with fluoride toothpaste (Paper I). Among 15-year-olds in Sweden with foreign-born parents, 88% reported that they brushed their teeth with fluoride toothpaste at least twice a day compared with 98% of 15-year-olds with Swedish-born parents (Paper II). In Vietnam, 44–78% of the children used fluoride toothpaste for toothbrushing and 51% consumed sweets between principal meals at least once a day (Paper III). Sweetened milk was the most common source of this sugar intake for the 3- and 5-year-olds (Paper III).

    CONCLUSIONS: Culture is an important oral health determinant for dental caries and gingivitis in children. There is an urgent need to improve oral health care promotion and preventive programmes for children with foreign-born parents in Sweden, but also a great need for such programmes for children in Vietnam.

  • 302.
    Jacobsson, Brittmarie
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Oral health.
    On oral health in young individuals with foreign and Swedish backgrounds2011Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    In Sweden, children and adolescents with two foreign-born parents constitute 17% of all children in the Swedish population.

    AIMS: The aims of this thesiswere to collect knowledge of the prevalence of gingivitis, caries and caries associated variables, in the 3-, 5-, 10- and 15-year age groups with two foreign born parents compared with their counterparts with Swedish-born parents in a ten-year perspective (Study I). To investigate the prevalence of caries and caries-associated variables in 15-year-olds in relation to foreign backgrounds and to examine differences in the prevalence of caries in adolescents with foreign backgrounds according to their length of residence in Sweden (StudyII).

    MATERIAL AND METHODS: In 1993 and 2003, cross-sectional studies with random samples of individuals in the age groups of 3, 5, 10 and 15 years were performed in Jönköping, Sweden. The oral health status of all individuals was examined clinically and radiographically. The children or their parents also answered a questionnaire about their attitudes to, and knowledge of, teeth and oral health care habits. The final study sample comprised 739 children and adolescents, 154 with two foreign-born parents (F cohort) and 585 with two Swedish-born parents (S cohort) (Study I). In Study II, all 15-year-olds(n=143) at one school in the city of Jönköping were asked to participate in the study. The final sample comprised 117 individuals, 51 with foreign-born parents and 66 with Swedish-born parents. All the individuals were interviewed using a structured questionnaire with visualisation e.g. food packages, sweets and snacks. Information about DFS was collected from case records at the Public Dental Service.

    RESULTS: In both 1993 and 2003, more 3- and 5-yearolds in the S cohort were caries free compared with the F cohort. In 1993, dfs was higher among 3- and 5-year-olds in the F cohort (p<0.01) compared with the S cohort. In 2003, dfs/DFS was statistically significantly higher in all age groups among children and adolescents in the F cohort compared with the S cohort. In 2003, the odds ratio of being exposed to dental caries among 10- and 15-year-olds in the F cohort, adjusted for gender and age, was more than six times higher (OR=6.3, 95% CI:2.51-15.61; p<0.001) compared with the S cohort (Study I). Fifteen-year-olds born in Sweden with foreign-born parents, or who had arrived before one year of age, had a caries prevalence similar to that of adolescents with Swedish-born parents, whereas children who had immigrated to Sweden after seven years of age had a caries prevalence that was two to three times higher (p <0.06) (Study II). Both in 1993 and 2003, the mean of the percentage of tooth sites with plaque and gingivitis was numerically higher in all age groups in individuals with foreign backgrounds compared with Swedish background, except between the 15-year-olds (Study I).

    CONCLUSIONS: The decrease in caries prevalence, in a ten-year perspective, was less among children and adolescents with foreign-born parents compared with children and adolescents with Swedish-born parents. In 2003, there was statistically significantly more caries in all age groups among children and adolescents with foreign-born parents compared with children and adolescents with Swedish-born parents. Children who immigrated to Sweden at age seven or later had a two to three times higher caries prevalence compared with their Swedish counterparts. The odds ratio for being exposed to dental caries was almost six times higher for 10- and 15-year olds with foreign-born parents compared with their Swedish counterparts. The intake of carbohydrate-rich food was higher among 15-year olds with foreign backgrounds compared to those with Swedish background. There is an obvious need to improve the promotion of oral health care programmes among children and adolescents with foreign-born parents.

  • 303.
    Jacobsson, Brittmarie
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine.
    Research to develop system for oral health among children in Vietnam: a cross sectional study between Sweden and Vietnam (Da Nang)2008In: Making Health care Sustainable and Affordable, 2008Conference paper (Other academic)
  • 304.
    Jacobsson, Brittmarie
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Ho, Thanh Thi
    Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam.
    Chuong, Hoang Ngoc
    Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam.
    Hugoson, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Sociodemographic conditions, knowledge of dental diseases, dental care, and dietary habits2015In: Journal of Public Health Dentistry, ISSN 0022-4006, E-ISSN 1752-7325, Vol. 75, no 4, p. 308-316Article in journal (Refereed)
    Abstract [en]

    Objectives

    This study's aim was to present data on the sociodemographic conditions, knowledge of dental diseases, dental care, and dietary habits among children aged 3, 5, 10, and 15 years in Da Nang, Vietnam.

    Methods

    A cross-sectional epidemiological questionnaire study was conducted in a population of 840 children randomly selected by their year and month of birth (January to July), including 210 individuals in each age group. A self-reported questionnaire was completed by the parents of 3- and 5-year-olds, and a modified questionnaire was given to 10- and 15-year-olds to complete by themselves.

    Results

    Mass media constituted the main source of oral healthcare information. Parents assisted with tooth brushing in 86 percent of 3-year-olds and 71 percent of 5-year-olds. Fluoride toothpaste was used by 44-78 percent of children, with no clear age-related trend. Within the past year, 60 percent of 3- and 5-year-olds, 20 percent of 10-year-olds, and 49 percent of 15-year-olds reported they had not visited a dental professional. Sweets were consumed between principal meals by 70-80 percent of children. Milk with sugar was regularly consumed by 71 percent of 3-year-olds and 91 percent of 5-year-olds.

    Conclusions

    Children showed frequent sugar consumption and insufficient frequency of brushing their teeth with fluoride toothpaste. Food-based dietary guidelines should play a significant role in nutrition and oral health. It is especially important that oral health prevention programs reach preschool children before they establish unhealthy dietary habits. Parental education about oral health and access to oral healthcare services are also needed to improve children's oral health.

  • 305.
    Jacobsson, Brittmarie
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Oral health.
    Ho Thi, T
    Hoang Ngoc, C
    Hugoson, Anders
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Oral health.
    Oral Health of Children in Da Nang, Vietnam: Dental caries, caries associated factors and gingivitisManuscript (preprint) (Other academic)
  • 306.
    Jacobsson, Brittmarie
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Oral health.
    Ho Thi, T
    Hoang Ngoc, C
    Hugoson, Anders
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Oral health.
    Oral Health of Children in Da Nang, Vietnam: Sociodemographic conditions, knowledge of dental diseases, dental care and dietary habitsManuscript (preprint) (Other academic)
  • 307.
    Jacobsson, Brittmarie
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine.
    Hugoson, Anders
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine.
    Ho Thi, Thanh
    National Technical College of Medicine No II.
    Knowledge, attitudes and behaviour about dental diseases and dental care habits in adolescents in Jönköping, Sweden and in Da Nang, Vietnam2008In: Knowledge, attitude and behaviour in oral health care among 10-15 year olds in Jönköping, Sweden and DaNang, Vietnam, 2008Conference paper (Refereed)
    Abstract [en]

    The aim of this article was to present data about oral hygiene and knowledge about dental diseases and dental care habits in 10-15 year olds in Jönköping, Sweden and 10-11 year-olds in Da Nang, Vietnam in 2003. Methods A random sample of 206 individuals 10 and 15 year olds, from the City of Jönköping and 369 individuals from the City of Da Nang, were asked about their attitudes towards and knowledge of teeth and dental care habits. Results In Jönköping 9% answered that gingivitis is the same as inflammation of the gum. In Da Nang study 40% knew about early sign of gingivitis (easily gum bleeding).  67% in Jönköping answered that bacteria and sugar cause the acid that gives caries. In Da Nang 47% could answer correctly the cause of dental caries. The percentage of children who brush their teeth twice a day was the same, around 80 %, in both studies. In Jönköping 100% of the children used fluoride toothpaste. In Da Nang 73 % always used Fluoride toothpaste and 14 % did not know if the toothpaste they used contained Fluoride or not.

  • 308.
    Jacobsson, Brittmarie
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Koch, Göran
    The Institute for Postgraduate Dental Education.
    Magnusson, Tomas
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Hugoson, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Oral Health in young individuals with foreign and Swedish backgrounds - a ten-year perspective2011In: European Archives of Paediatric Dentistry, ISSN 1818-6300, E-ISSN 1996-9805, Vol. 12, no 3, p. 151-158Article in journal (Refereed)
    Abstract [en]

    AIM:

    To investigate oral health status and coherent determinants in children with foreign backgrounds compared with children with a Swedish background, during a ten year period.

    DESIGN AND METHODS:

    In 1993 and 2003, cross-sectional studies with random samples of individuals in the age groups 3, 5, 10 and 15 years were performed in Jönköping, Sweden. All the individuals were personally invited to a clinical and radiographic examination of their oral health status. They were also asked about their attitudes to and knowledge of teeth and oral health care habits. The final study sample comprised 739 children and adolescents, 154 with a foreign background (F cohort) and 585 with a Swedish background (S cohort).

    RESULTS:

    In both 1993 and 2003, more 3- and 5 year olds in the S cohort were caries-free compared with the F cohort. In 1993, dfs was higher among 3- and 5 year olds in the F cohort (p<0.01) compared with the S cohort. In 2003, dfs/DFS was statistically significantly higher in all age groups among children and adolescents in the F cohort compared with the S cohort. When it came to proximal tooth surfaces, the percentages of individuals who were caries-free, with initial carious lesions, with manifest carious lesions and with restorations among 10-year-olds in the F cohort were 55%, 23%, 4% and 18% in 1993. The corresponding figures for the S cohort were 69%, 20%, 6% and 5% respectively. In 2003, the values for the F cohort were 54%, 29%, 4% and 13% compared with 82%, 12%, 1% and 5% in the S cohort. In 2003, the odds of being exposed to dental caries among 10- and 15-yearolds in the F cohort, adjusted for gender and age, were more than six times higher (OR=6.3, 95% CI:2.51-15.61; p<0.001) compared with the S cohort.

    CONCLUSIONS:

    There has been a decline in caries prevalence between 1993 and 2003 in all age groups apart from 3-year-olds. However, the improvement in dfs/DFS was greater in the S cohort compared with the F cohort in all age groups. The difference between the F and S cohorts in terms of dfs/ DFS was larger in 2003 compared with 10 years earlier. In 2003, the odds ratio for being exposed to dental caries was almost six times higher for 10- and 15-year-olds with two foreign-born parents compared with their Swedish counterparts.

  • 309.
    Jacobsson, Brittmarie
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Oral health.
    Thanh, Ho Thi
    Dental Department, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam.
    Chuong, Hoang Ngoc
    Dental Department, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam.
    Hugoson, Anders
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Oral health.
    Oral health of children and adolescents in Da Nang2014In: Oral Hygiene & Health, ISSN 2332-0672, Vol. 2, no 4, p. 1-6Article in journal (Refereed)
    Abstract [en]

    This is a cross-sectional epidemiological study comprising 840 randomly selected children in the age groups of 3, 5, 10 and 15 year-olds. All children were clinically examined for number of teeth, dental caries, dental fillings, plaque, gingivitis and probing pocket depth. Dental care and dietary habits were collected using a self-reported questionnaire. Among 3 and 5 year olds, 98% suffered from dental caries, compared to 91% of 10 and 15 year olds. The mean (SD) of decayed (initial and manifest) and filled tooth surfaces (dfs/DFS) in the different age groups was: 18.2 (14.1), 23.0 (15.4), 5.1 (4.2) and 6.9 (6.0), respectively. There was an average of ~ 30% in all age groups with plaque and gingivitis. Consuming milk with sugar more than 2–3 times a week (3 and 5 year olds) and eating sweets between principal meals twice a day (in 10 and 15 year olds) were statistically significant with caries prevalence. It is concluded that dental caries and gingivitis are significant public health problems among children in Da Nang, Vietnam.

  • 310.
    Jacobsson, Brittmarie
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine.
    Viczko, Lynne
    Camosun College, Victoria B.C. Canada.
    Gilliland, Margo
    Camosun College, Victoria B.C. Canada.
    Schaefer, Melissa
    Camosun College, Victoria B.C. Canada.
    The Swedish-Canadian Connection1998In: The Dental Hygienist: A Needed Reality, 1998Conference paper (Other academic)
    Abstract [en]

    Styudents and faculty from two dental hygiene schools know that international dental hygiene is high-tech, education-and fun. In the fall of 1996, at the invitation of the Hälsohögskolan-Jönköping University, College of Health Sciences in Sweden, their dental hygiene department and that of Camosun College in Victoria, British Columbia, Canada, jointly organized an ongoing e-mail exchange program between second year students. Students are assigned topics to research and then, with their international partner, are asked to share and discuss information on their findings. A six weekfaculty exchange took place in the fall of 1997 with each sharing their dental hygiene expertise. Both joint ventures have been very successful in promoting the use of high technology in education and fostering international dental hygiene learning and goodwill.

  • 311.
    Jacobsson, Brittmarie
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Oral health.
    Wendt, Lill-Kari
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Oral health.
    Johansson, Ingegerd
    Dental caries and caries associated factors in Swedish 15-year-olds in relation to immigrant background.2005In: Swedish Dental Journal, ISSN 0347-9994, Vol. 29, no 2, p. 71-79Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to evaluate the prevalence of caries and caries associated variables in 15-year-olds in relation to foreign background and to examine differences in the prevalence of caries in immigrant adolescents according to their length of residence in Sweden. All 15-year-old adolescents (n=143) at one public school in the city of Jönköping, Sweden were asked to participate in the study. The adolescents were divided into two groups according to their background: immigrants and non-immigrants. Data on caries prevalence were extracted from the dental records of the examination made when the participants were 15 years old. The proportions of immigrants and non-immigrants free from carious lesions were equal. Immigrant adolescents, however, had on average more enamel carious lesions. Adolescents born in Sweden of immigrant parents or who had arrived before 1 year of age had a caries prevalence similar to those of non-immigrant adolescents, whereas children who had immigrated to Sweden after 7 years of age had a caries prevalence that was 2-3 times higher. As the caries carious lesions in immigrant adolescents is mainly restricted to the enamel, and possibly reversible, early introduction of preventive programmes seems essential.

  • 312.
    Jansson, Hanna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Jawad, Fereshteh
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Det kromogena odlingsmediet UriSelectTM4 kan inkuberas i 5 % koldioxid2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Urinary tract infection is one of the most common infections among humans. For diagnostics, the chromogenic media UriSelectTM4 can be used to visualize the urinary tract pathogens. The primary purpose of the study was to evaluate if the chromogenic media UriSelectTM4 could be incubated in 5% carbon dioxide instead of aerobic environment without impacting total growth and morphology. Furthermore, total growth and number of free colonies was evaluated when cultivating on a half UriSelectTM4 agar media with two streak patterns to examine if further diagnostics is possible. Urine samples were incubated in aerobic environment and in 5% carbon dioxide and visually compared for total growth, number of free colonies, morphology and color change of bacterial colonies and the agar media. The results showed that total growth and free colonies only had slight differences between the incubation environments. On the other hand, morphology and color of the colonies may vary. Further a half agar media could be used for cultivation and further diagnostics. Consequently, the study shows that UriSelectTM4 can be incubated in 5% carbon dioxide without any impact on total growth, free colonies or of the chromogenic media.

  • 313.
    Jansson, Therése
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Källmyr, Nicole
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Jämförelse mellan total lungkapacitetberäknat utifrån single-breath metangasspädningrespektive kroppspletysmografi2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Total lung capacity (TLC) is the gas volume in the lungs after maximal inspiration. It can be calculated using whole-body plethysmography, pressure changes and Boyle’s law, or using gas dilution with methane or helium as inert gas. Agreement between the methods is of interest to make substitution of the more commonly used whole-body plethysmography with methane dilution possible.

    This retrospective cross-sectional study aimed to compare TLC from single-breath methane dilution with TLC from whole-body plethysmography. Data concerning patients who underwent these two standard procedure examinations in one visit was collected. The population of 48 had an even gender distribution, included ages 10 to 87 and patients with or without known respiratory diseases.

    TLC from whole-body plethysmography ranged between 2,6 and 8,4 liters. TLC from methane dilution ranged between 2,5 and 7,7 liters. TLC from gas dilution averaged 0,59 liters less than TLC from whole-body plethysmography and underestimated TLC by 11,3%. Paired samples t-test determined the difference between methods to be significant.

    Due to the nature of this population, further studies of larger populations are needed. Methane dilution TLC amounted to 88,7% of TLC from whole-body plethysmography which therefore cannot be substituted with methane dilution without increased risk of underestimating TLC.

  • 314.
    Jiang, Nan
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. School of Nursing, Tianjin Medical University, Tianjin, China.
    Zhao, Yue
    School of Nursing, Tianjin Medical University, Tianjin, China.
    Jansson, Henrik
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Periodontology, Centre for Oral Health, Malmö University, Malmö, Sweden.
    Chen, Xiaocen
    Departments of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Experiences of xerostomia after radiotherapy in patients with head and neck cancer: A qualitative study2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 1-2, p. e100-e108Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe the experiences of radiation-induced xerostomia in patients with head and neck cancer.

    BACKGROUND: Xerostomia is the most commonly occurring complication during and following radiotherapy. It can persist for several months or years and can have a significant impact on patients' quality of life.

    DESIGN: This was a qualitative descriptive study.

    METHODS: Semi-structured interviews were conducted with a sample of 20 participants. Inductive content analysis was used to analyse the qualitative data.

    RESULTS: Analysis of the manifest content identified five categories: communication problems, physical problems, psychosocial problems, treatment problems and relief strategies. The latent content was formulated into a theme: due to lack of information from professionals, the patients had to find their own solutions for their problems.

    CONCLUSIONS: Xerostomia is not only a biophysical symptom but also has a profound effect on the emotional, intellectual and sociocultural dimensions of life. The majority of patients continued to suffer from xerostomia and its associated symptoms after radiotherapy, in part, because of a lack of professional support, including the inability of nurses to provide oral health care.

    RELEVANCE TO CLINICAL PRACTICE: Nurses need to be knowledgeable about the effects of radiotherapy on oral mucosa and about appropriate interventions. The healthcare system requires a symptom management platform for radiation-induced complications, to help patients, their families and healthcare professionals obtain information about self-care, treatments and relief strategies.

  • 315.
    Johansson, Carina S
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine.
    Hildebrand, C
    Povlsen, B
    Anatomy and developmental chronology of the rat inferior alveolar nerve1992In: Anatomical Record, ISSN 0003-276X, E-ISSN 1097-0185, Vol. 234, no 1, p. 144-152Article in journal (Refereed)
  • 316.
    Johansson, Carina S
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine.
    Stenström, M
    Hildebrand, C
    Target influence on aging of myelinated sensory nerve fibres1996In: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 17, no 1, p. 61-66Article in journal (Refereed)
  • 317.
    Johansson, Emelie
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Lindgren, Anna
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Intima-media tjocklek och lumendiameter i arteria carotis communis: en jämförelse av höger och vänster sida2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: A common cause to cardiovascular disease is atherosclerosis. An increased IMT and LD reflects early stages of atherosclerosis. Ultrasound is used to investigate IMT and LD. There are several risk factors for an increased IMT and LD. Possibly there is a side difference of IMT and LD, but the cause is not clear. Aim: The aim was to compare intima-media thickness (IMT) and lumen diameter (LD) between right- and left common carotid artery (CCA). The aim was also to compare if there was any side difference based on risk groups related to each corresponding reference group. Method: This thesis was a retrospective study including 41 randomly selected participants. Results: No significant side difference of IMT and LD was seen in the entire group. When comparing side difference of IMT and LD between the risk groups and reference groups, no significant side difference could be seen. Discussion: The aim was achieved, but limitations that could affect the result occurred. Compared with previous studies, this work has both similar results as well as divergent results. Conclusion: Future studies are recommended to improve more knowledge. Thus, measurement of IMT and LD can be developed and used to prevent cardiovascular diseases. 

  • 318.
    Johansson, Isabelle
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Jansson, Henrik
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Oral health status of older adults in Sweden receiving elder care: Findings from nursing assessments2016In: Nursing Research, ISSN 0029-6562, E-ISSN 1538-9847, Vol. 65, no 3, p. 215-223Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Frail elderly people often have poor oral hygiene, contributing to oral health problems that can detract significantly from quality of life.

    OBJECTIVE: The aim of this study was to describe oral health status of frail elderly individuals using the Revised Oral Assessment Guide-Jönköping (ROAG-J), a mouth assessment instrument that can be used in daily nursing care.

    METHODS: Data were obtained from the Swedish Senior Alert quality registry in one Swedish municipality. ROAG-J assessments on admission to elder care and one subsequent occasion were used. ROAG-J measurements documented oral health in nine areas: voice, lips, oral mucosa, tongue, gums, teeth, saliva, swallowing, and presence of any prostheses or implants. Assessments were made by nursing staff during the course of daily nursing care.

    RESULTS: Individuals 65 years of age or older and receiving elder care services (N = 667) were involved; 1,904 assessments made between November 2011 and March 2014 were used for the analysis. On the basis of both assessments, less than one third of participants had oral health problems. No significant difference in any of the oral health variables was found between first and subsequent assessments. At first assessment, men and women differed in tongue health (p < .01); at the subsequent assessment, gender differences in voice (p < .05), mucous membranes (p < .003), tongue (p < .01), and saliva (p < .006) were observed.

    DISCUSSION: Most participants had good oral health. Assessments made by nursing staff using the ROAG-J demonstrate that this tool can be used in daily nursing care, where different, important oral conditions may be encountered. However, knowledge about oral health conditions and the ROAG-J instrument is important to ensure high validity. The ROAG-J enables nursing staff to detect problems in the mouth and to guide decisions related to oral health interventions.

  • 319.
    Johansson, Isabelle
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Torgé, Cristina Joy
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Jansson, Henrik
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Effekt på munhälsa av samarbete mellan tandhygienist och personal i äldreomsorg2017Conference paper (Other academic)
  • 320.
    Johansson, Isabelle
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Torgé, Cristina Joy
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Is an oral health coaching programme a way to sustain oral health for elderly people in nursing homes: A feasibility studyManuscript (preprint) (Other academic)
  • 321.
    Johansson, Linnéa
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Isaksson, Malin
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Prevalens av Trichomonas vaginalis i STI-prover från Västra Götalands län med Aptima™ TV Assay på Panther™ System: Samt utvärdering av Aptima™ TV Assay på Panther™ System med jämförelse mot Xpert® TV Kit på GeneXpert®2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Prevalence of Trichomonas vaginalis in STI-samples from Västra Götaland county with Aptima™ TV Assay on Panther™ System

    Also, evaluation of Aptima™ TV Assay on Panther™ System with comparison with Xpert® TV Kit on GeneXpert®

    Trichomonas vaginalis is a parasite that is spread by sexual contact, it is also the biggest sexually transmitted infection in both the United States and Europe. The prevalence in Sweden today is unknown as no national basic data exist. The routine procedure of identification is Wet-Smear although nucleic acid amplification enable a higher level of specificity and sensitivity. Panther™ System and GeneXpert® are two systems using RNA respectively DNA for analysis. The objective of the study was primarily to investigate the prevalence of Trichomonas vaginalis in STI-samples from Västra Götaland county with Aptima™ TV Assay on Panther™ System and secondarily to evaluate Aptima™ TV Assay with comparison to Xpert® TV Kit on GeneXpert®. The evaluation and prevalence study took place at Clinical Microbiology, Unilabs AB, Skaraborgs Hospital Skövde during the period of April-May 2017. The results of the evaluation indicate that Aptima™ TV Assay is specific for Trichomonas vaginalis and that the sensitivity falls within the detection limits for the kit. Therefore, the kit is suitable for use in the prevalence study. The prevalence study displayed a positive outcome on two out of 606 analyzed patient samples, corresponding to 0.3%. The conclusion is that the prevalence is enough for further studies.

  • 322.
    Johansson, Lisbeth
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Unit for Research and Development in Primary Health Care, Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden.
    Lingfors, Hans
    Linköping University, Linköping, Sweden.
    Golsäter, Marie
    Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Linköping University, Linköping, Sweden.
    Kristenson, Margareta
    Unit for Community Medicine, Department of Medicine and Health, Linköping University, Linköping, Sweden.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Linköping University, Linköping, Sweden.
    Can physical activity compensate for low socioeconomic status with regard to poor self-rated health and low quality-of-life?2019In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 17, no 1, p. 1-10, article id 33Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Both high socioeconomic status (SES) and high physical activity (PA) are associated with better self-rated health (SRH) and higher quality-of-life (QoL).

    AIM: To investigate whether high levels of PA may compensate for the association between low SES and subjective health outcomes in terms of poorer SRH and lower QoL.

    METHOD: Data from a cross-sectional, population-based study (n = 5326) was utilized. Multiple logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between indicators of SES (economic situation and educational level), SRH and QoL, as well as between the combination of SES and PA in relation to SRH and QoL.

    RESULT: Participants with high PA and economic problems had approximately the same OR for good SRH as those with low PA and without economic problems (OR 1.75 [95% CI 1.20-2.54] and 1.81 [1.25-2.63] respectively). Participants with high PA and low education had higher odds for good SRH (OR 3.34 [2.96-5.34] compared to those with low PA and high education (OR 1.46 [0.89-2.39]).Those with high PA and economic problems had an OR of 2.09 [1.42-3.08], for high QoL, while the corresponding OR for those with low PA and without economic problems was 4.38 [2.89-6.63].

    CONCLUSION: Physically active people with low SES, had the same or even better odds to report good SRH compared to those with low PA and high SES. For QoL the result was not as consistent. The findings highlight the potential for promotion of PA to reduce SES-based inequalities in SRH.

  • 323.
    Johansson, Mona
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Biomedical Platform.
    Whiss, Per
    Weak relationship between ionized and total magnesium in serum of patients requiring magnesium status2007In: Biological Trace Element Research, ISSN 0163-4984, E-ISSN 1559-0720, Vol. 115, no 1, p. 13-21Article in journal (Refereed)
    Abstract [en]

    Measurement and monitoring of magnesium (Mg) are important to prevent the development of serious and potentially fatal complications in critically ill patients. Although ion-selective electrodes are available and earlier reports suggest that free ionized magnesium (iMg2+) is the most useful test to estimate Mg status, most clinical laboratories still only measure total Mg. To compare the relationship among iMg2+, total Mg, and albumin in serum, samples were collected from 48 consecutive patients admitted to an intensive care unit or a primary health center. The mean serum level of iMg2+ in 44 patients was 0.53 mmol/L, the total Mg was 0.96 mmol/L, and the albumin was 34.93 g/L. The correlation between iMg2+ and total Mg in serum was r=0.585; the correlation between iMg2+ and albumin in serum was r=378; and the correlation between total Mg and albumin in serum was r=0.340. The mean percent iMg2+ in relation to total Mg in serum was calculated to be 55% in the patient samples. The important level of biologically active iMg2+ was not reflected upon analysis of total Mg in 25% of consecutive patients. This report shows that the correlation of iMg2+ and total Mg is weak, not only in critically ill patients but also in patients in whom Mg status is inquired as a whole.

  • 324. Johansson, P
    et al.
    Berggren, U
    Hakeberg, Magnus
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Oral health.
    Hirsch, J M
    Measures of dental beliefs and attitudes: their relationships with measures of fear.1993In: Community Dental Health, ISSN 0265-539X, Vol. 10, no 1, p. 31-39Article in journal (Refereed)
  • 325.
    Johansson, Simone
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Kvist, Elin
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Utvärdering av Xpert® GBS med GeneXpert® för diagnostisering av GBS hos kvinnor i förlossningsskedet2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 326.
    Johnsen, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Alfredsson, Lars
    Karolinska Institutet and Center for Occupational and Environmental Medicine, Stockholm County Council.
    Knutsson, Anders
    Mid Sweden University.
    Westerholm, Peter JM
    Uppsala University.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Weak associations between occupational physical activity and myocardial infarction2016In: Occupational and Environmental Medicine, BMJ Publishing Group Ltd, 2016, Vol. 73, p. A198-Conference paper (Refereed)
    Abstract [en]

    IntroductionRecommendations regarding physical activity typically include both leisure time and occupational physical activity. However, the results of research on occupational physical activity and the association to myocardial infarction are inconsistent. The aim of this study was to investigate if occupational physical activity affects the risk of myocardial infarction.

    Method In this prospective cohort study, data from the WOLF study are analysed. In total, 9,961 employees having no history of myocardial infarction were followed from inclusion to their first incidence of myocardial infarction. Hazard ratios (HR) were estimated using Cox proportional hazard regression, for different levels of occupational physical activity in relation to the risk of myocardial infarction.

    Results A follow-up with a mean of 13.1 years found 249 cases of myocardial infarction. In analyses adjusted for age, sex and socio-economic status, participants standing and walking more than 50% of their working day had HR of 1.13 (95% CI: 0.83– 1.54), compared to participants seated more than 50% of their working day. The corresponding HR for participants whose work included lifting or carrying was 0.86 (95% CI: 0.59–1.24). Stratified analyses resulted in a significantly decreased risk for young people whose work included lifting or carrying, HR 0.37 (95% CI: 0.17–0.84), compared with younger persons who sat most of their working day.

    ConclusionOnly weak associations between occupational physical activity and the risk of myocardial infarction were observed in this study. A significant reduced risk were seen for young participants with work including lifting and carrying, but this result must be interpreted with caution due to few participants in the stratified analyses. Based on the results from this study, occupational physical activity does not seem to be enough for reducing the risk of myocardial infarction, which is an important message to people with high levels of occupational physical activity.

  • 327.
    Johnsen, Anna M.
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Westerholm, Peter J. M.
    Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Association between occupational physical activity and myocardial infarction: a prospective cohort study2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 10, article id e012692Article in journal (Refereed)
    Abstract [en]

    Objective Recommendations regarding physical activity typically include both leisure time and occupational physical activity. However, the results from previous studies on occupational physical activity and the association with myocardial infarction have been inconsistent. The aim of this study was to investigate if occupational physical activity is associated with the risk of myocardial infarction.

    Design Prospective cohort study.

    Participants Data from the Swedish Work, Lipids and Fibrinogen (WOLF) study was used, comprising 9961 employees (6849 men, 3112 women, mean age 42.7 years) having no history of myocardial infarction. The participants were categorised into 3 groups according to their level of occupational physical activity.

    Outcome Data regarding incident myocardial infarction were obtained from the Swedish National Patient Register and the Cause of Death Register. Cox proportional hazard regression was used for estimation of HRs for different levels of occupational physical activity in relation to the risk of myocardial infarction.

    Results During a mean follow-up of 13.1 years, 249 cases of incident myocardial infarction were identified. In analyses adjusted for age, sex and socioeconomic status, participants standing and walking more than 50% of their working day had an HR of 1.13 (95% CI 0.83 to 1.54), compared with participants seated more than 50% of their working day. The corresponding HR for participants whose work included lifting or carrying was 0.86 (95% CI 0.59 to 1.24). Further adjustment did not alter the results. Stratified analyses resulted in a significantly decreased risk for young people whose work included lifting or carrying, HR 0.37 (95% CI 0.17 to 0.84), compared with younger persons who sat most of their working day.

    Conclusions No significant association between occupational physical activity and the risk of myocardial infarction was observed in the total group of employees in this study. Based on the results from this study, occupational physical activity in general does not seem to be enough for reducing the risk of myocardial infarction.

  • 328. Jonasson, L
    et al.
    Tompa, Andrea
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ. Biomedical Platform.
    Wikby, Anders
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Expansion of peripheral CD8+ T cells in patients with coronary artery disease: relation to cytomegalovirus infection.2003In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 254, no 5, p. 472-478Article in journal (Refereed)
  • 329. Jonasson, L
    et al.
    Wikby, Anders
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Olsson, A G
    Low serum beta-carotene reflects immune activation in patients with coronary artery disease2003In: NMCD. Nutrition Metabolism and Cardiovascular Diseases, ISSN 0939-4753, E-ISSN 1590-3729, Vol. 13, no 3, p. 120-125Article in journal (Refereed)
  • 330. Jonasson, Lena
    et al.
    Linderfalk, Carina
    Olsson, Jadwiga
    Wikby, Anders
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Olsson, Anders G
    Systemic T-cell activation in stable angina pectoris.2002In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 89, no 6, p. 754-756Article in journal (Refereed)
  • 331.
    Jonsson, Alexander
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Said, Mena
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Metodutveckling av en vätskebaserad cytologisk metod vid preparering av exsudat: En jämförelse med konventionell cytologi2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Two main principles is used within cytology in order to diagnose cytological abnormalities; conventional and liquid-based cytology. Both methods can be applied on both gynaecological and non-gynaecological samples of which the later includes samples categorized as exudate. The aim of this study was to develop the method for liquid-based cytology so that exudate fixated with ethanol could be prepared and also achieve better results compared to conventional method. In order to do so, 61 unique samples were prepared of which 61 with conventional method, 54 with liquid-based method and 22 with liquid-based method with added acetic acid. The slides was then examined in microscope and was given score values within four parameters: amount of cells; cell morphology; amount of inflammatory component and amount of background. The results indicated no difference between the slides prepared with conventional or liquid-based method. However, the slides prepared with addition of acetic acid indicated more opportunistic score values when compared.

    The conclusion was that liquid-based method with the addition of acetic acid did satisfy the aim of this study as it reduces the amount of background, reduces “ring formation” on the slides and preserve the cells morphology well, which makes the samples easier to diagnose.

  • 332.
    Jonsson, Mats
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Holmberg, Johanna
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Patienters upplevelser utav den skriftliga informationen inför en CT-colonundersökning: En kvantitativ enkätstudie2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Computer tomography (CT) - colonography is an examination which is on the rise since coloncancer is more common and acknowledged in todays’ community. In conjunction with a CT-colonography the preparations are demanding and requires the patients' full compliance to get a successful examination. This means that the patient needs a comprehensive information leaflet to understand the extent of the preparations. This study's purpose was to examine if the patient information was sufficient enough in conjunction with the CT-colonography and determine if the experience of the patient information differ between the two hospitals. Also examine if there were and differences genders between each other as well as age. The study will also overhaul if there were any improvement proposals. This study's design followed a quantitative survey with own constructed questions. The number of participants were 51 which filled the survey anonymously during the period March to April 2018. The majority of the participants had a good impression of the information. Between the men and the women there were no differences of the information, the survey answers also showed that the ages was no differnce based on age of the subjects. Few participants had any opinions about improvements but the ones who had wanted to evolve the information in a way that decreased the amount of information. The participants were pleased with the information and there was no significant difference between the two hospitals, gender or age.

  • 333.
    Josefsson, Eva
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Oral health.
    Immigrant background and orthodontic treatment need: Quantitative and qualitative studies in Swedish adolescents2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    During the last three decades there has been an increased influx of refugees and immigrants into Scandinavia. The overall aim of this thesis was primarily to improve our knowledge of malocclusion and orthodontic treatment need, both normative and self-perceived, in adolescents of varying geographic origin. A further aim was to determine whether any differences with respect to perception of general appearance and psychosocial well-being were related to geographic origin.

    Papers I and II concerned self perceived and normative orthodontic treatment need. About 500 12-13 year-old subjects, stratified into different groups: A-Sweden, B-Eastern/Southeastern Europe, C-Asia and D-other countries, answered a questionnaire and underwent clinical examination by the author. In paper III the association between the two variables in papers I and II was investigated. Paper IV was a follow up study, at 18-19 years of age, of the relationship between geographic origin and prevalence of malocclusion, self-perceived treatment need, temporomandibular symptoms and psychosocial wellbeing. In Paper V a qualitative study of 19-20 year old subjects was conducted, to identify the strategies they had adopted to handle the issue of persisting poor dental aesthetics.

    The main findings were that at 12-13 years of age, immigrant subjects had a lower perceived orthodontic treatment need than subjects of Swedish background. Girls of Swedish background had the highest self perceived treatment need, whilst girls of non-Swedish background were most concerned that fixed appliance therapy would be painful. In a few of the clinical variables measured at 12-13 years of age, the Swedish group exhibited the greatest space deficiency and irregularity in both the maxillary and mandibular anterior segments and greater overjet, compared to the Eastern/Southeastern European and Asian groups. The clinical implications were negligible. The orthodontic treatment need according to “Index of Orthodontic Treatment Need - Dental HealthComponent” (IOTN-DHC) grades 4 and 5, ranged from 30 to 40 percent, without any inter-group differences. There were strong associations between subjects perceiving a need for orthodontic treatment and 6IOTN-DHC grades 4 and 5, anterior crossbite and avoiding smiling because they were self-conscious about their teeth. At the age of 18-19 years, the frequency of malocclusion was similar in all groups. Subjects of Asian origin had a higher self-perceived orthodontic treatment need than their Swedish counterparts and a higher frequency of headache than those of Eastern/Southeastern European origin. Psychological wellbeing was reduced in nearly one quarter of the sample, more frequently in girls than boys. No association was found between self-perceived orthodontic treatment need and psychological wellbeing.

    The theory “Being under the pressure of social norms” was generated in Paper V, and it can be applied to improve our understanding of young adults who have adjusted to living with poor dental aesthetics and also aid to identify those who are not as well-adjusted and would probably benefit from treatment. Undisclosed dental fear is an important barrier to acceptance of orthodontic treatment in early adolescence. Despite demographic changes due to immigration, no major change in the prevalence of malocclusion and normative orthodontic treatment need has been disclosed. This does not apply to adolescents and adults who immigrated at an older age.

  • 334.
    Kammerlind, Ann-Sofi
    et al.
    Futurum – the Academy for Healthcare, County Council, Jönköping, Sweden.
    Ernsth Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Fransson, Eleonor
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Prevalence of and factors related to mild and substantial dizziness in community-dwelling older adults: A cross-sectional study2016In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, no 1, article id 159Article in journal (Refereed)
    Abstract [en]

    Background

    Dizziness is highly prevalent among older people and associated with many health factors. The aim of the study was to determine the prevalence of and factors related to dizziness among community-dwelling older adults in Sweden. In contrast to previous studies, the subjects with dizziness were divided into two groups, mild and substantial dizziness, according to the frequency and intensity of dizziness.

    Methods

    A sample of 305 older persons between 75 and 90 years of age (mean age 81 years) were interviewed and examined. Subjects with dizziness answered the University of California Los Angeles Dizziness Questionnaire and questions about provoking movements. The groups with substantial, mild, or no dizziness were compared with regard to age, sex, diseases, drugs, blood pressure, physical activity, exercises, falls, fear of falling, quality of life, general health, mobility aids, and physical performance.

    Results

    In this sample, 79 subjects experienced substantial and 46 mild dizziness. Subjects with substantial dizziness were less physically active, reported more fear of falling, falls, depression/anxiety, diabetes, stroke/TIA, heart disease, a higher total number of drugs and antihypertensive drugs, lower quality of life and general health, and performed worse physically.

    Conclusions

    There are many and complex associations between dizziness and factors like falls, diseases, drugs, physical performance, and activity. For most of these factors, the associations are stronger in subjects with substantial dizziness compared with subjects with mild or no dizziness; therefore, it is relevant to differ between mild and substantial dizziness symptoms in research and clinical practice in the future.

  • 335.
    Kammerlind, Ann-Sofi
    et al.
    Futurum – the Academy for Healthcare, County Council, Jönköping, Sweden.
    Fristedt, Sofi
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Ernsth Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Fransson, Eleonor
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Test–retest reliability of the Swedish version of the life-space assessment questionnaire among community-dwelling older adults2014In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 28, no 8, p. 817-823Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the test–retest reliability of the Swedish version of the Life-Space Assessment Questionnaire.

    Design: Test–retest reliability study.

    Subjects: A total of 298 community-dwelling subjects between 75 and 90 years of age.

    Methods: The Life-Space Assessment Questionnaire was translated into Swedish. By personal interviews during home visits and two weeks later by telephone interviews the subjects were asked about their life-space mobility during the past four weeks, and how often and whether they were independent or needed assistance from another person or equipment to reach different life-space levels.

    Results: None of the four scoring methods showed significant difference between test sessions. The mean (SD) total scores were 65 (22) and 65 (23) out of the maximum possible score of 120 at the two sessions. High levels were found for independent, assisted, and maximal life-space at both sessions. Intraclass correlation coefficients and weighted Kappa-values between 0.84–0.94 were found for the total score, the independent, and the assisted life-space levels, indicating good to excellent reliability. A lower Kappa-value was observed for the maximal life-space level, mainly owing to skewed distributions. The method error values showed that a change of 10 in the total score and a change of one level in any of the three life-space levels can be considered to indicate a real change in clinical practice.

    Conclusion: The Swedish version of the Life-Space Assessment Questionnaire can be reliably used among community-dwelling older adults.

  • 336.
    Kammerlind, A-S
    et al.
    Linköpings universitet.
    Fristedt, Sofi
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    Ernsth Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Fransson, Eleonor
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Test-retest reliability of the Swedish version of the Life-Space Assessment Questionnaire among community-dwelling older adults2014In: Age well: Challenges for individual and society, 2014Conference paper (Refereed)
    Abstract [en]

    Background: Mobility is a vitally important activity throughout life. Advanced age carries increased risk of experiencing decreased mobility, with associated activity limitations and participation restrictions in social events. The Life-Space Assessment (LSA), originally developed by Sawyer Baker and colleagues in the U.S.A., has been used to measure mobility in community dwelling older adults. The LSA includes six levels of life-space, ranging from the person's bedroom to places beyond the person's hometown. A total LSA score is obtained by multiplying the life-space level reached by a value for independence and a value for the frequency of transportations. Three additional measures of life-space levels can be calculated: the independent life-space level; the assistive life-space level; and the maximal life-space level. Objective: To examine the test-retest reliability of the Swedish version of the Life-Space Assessment Questionnaire. Methods: At two test sessions, two weeks apart, 298 community-dwelling subjects between 75 and 90 years of age were asked about their life-space mobility during the past four weeks, and how often and whether they were independent from another person or equipment to reach different life-space levels. Results: None of the four scoring methods showed significant differences between test sessions. The mean total scores were 65 out of the maximum possible score of 120 at both test sessions. High levels were also found for independent, assisted, and maximal life-space at both sessions. ICC coefficients and weighted Kappa values between 0.84-0.94 were found for the total score, the independent and the assisted life-space levels indicating good to excellent reliability. The method error values showed that a change of 10 in the total score and a change of one level in any of the three life-space levels can be considered to indicate a real change in clinical practice. Conclusion: The Swedish version of the Life-Space Assessment Questionnaire can be reliably used among community-dwelling older adults.

  • 337.
    Kangas, Elina
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Ucar, Berfin
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Stråldos till personal vid hantering av diagnostiska radiofarmaka vid förberedelse och undersökning av patient2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 338.
    Karlsson, Charlott
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Association between Oral mucositis, oral symtoms and problems in patients undergoing radiotherapy and chemoradiotherapy for head- and neckcancer2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 339.
    Karlsson, Christina
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Fredriksson, Liza
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Prevalensen av HPA1a-negativa blodgivare i Jönköpings- och Östergötlands län med flödescytometrisk fenotypning2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Humana trombocytantigen (Human Platelet Antigens, HPA) är genetiska polymorfismer som uttrycks på trombocyters membranglykoproteiner. Om icke-kompatibla trombocytantigen införs i blodcirkulationen kan alloimmunisering uppstå där antikroppar produceras mot främmande antigen, det kan därför vara av betydelse att registrera blodgivares antigen. Studiens syfte var att utvärdera prevalensen av HPA1a-negativa blodgivare i Jönköpings- och Östergötlands län med hjälp av flödescytometrisk fenotypning. Studien inkluderade totalt 300 blodgivare, varav 150 från Jönköpings län och 150 från Östergötlands län. Fluorokrommärkta antikroppar riktade mot CD42a och CD61 användes för att detektera HPA1a-negativitet med flödescytometrisk metod. I Jönköpings län detekterades fyra (2,7 %) HPA1a-negativa blodgivare och i Östergötlands län detekterades sex (4,0 %) HPA1a-negativa blodgivare. Statistisk analys visade ingen signifikant skillnad mellan antal HPA1a-negativa blodgivare i de undersökta länen. Länens prevalens av HPA1a-negativitet motsvarade den genomsnittliga prevalensen i Sverige och nya HPA1a-negativa blodgivare har registrerats vilket är en viktig tillgång då patienter är i behov av trombocytkoncentrat. Då studien begränsades av dess ringa storlek samt att kvinnor exkluderats bör vidare studier med större populationer och fler län i Sverige utföras.

  • 340. Karlsson, Ewelina
    et al.
    Lymer, Ulla-Britt
    Hakeberg, Magnus
    Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Periodontitis from the patient's perspective, a qualitative study2009In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 7, no 1, p. 23-30Article in journal (Refereed)
  • 341.
    Karlsson, Frida
    et al.
    Public Dental Service, Region Kronoberg, Lammhult, Sweden..
    Stensson, Malin
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health.
    Jansson, Henrik
    Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden..
    Caries incidence and risk assessment during a five-year period in adolescents living in southeastern Sweden2019In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim was to examine the caries incidence in adolescents using the Public Dental Service (PDS) during a 5-year period in relation to their caries experience at baseline and risk classification.

    METHODS: A five-year retrospective cohort study based of the dental records from 17 PDS clinics in southeastern Sweden was conducted; 159 individuals born in 1997 were included, and their caries risk was classified at 12 and 17 years of age. Caries prevalence and documented risk groups were assessed at baseline and after five years.

    RESULTS: The increment of caries (both initial and manifest caries) was higher, to a statistically significant degree, after five years in adolescents who were recorded as caries-free at baseline compared to individuals with caries at baseline (p<0.001). In individuals with caries at baseline, the greatest increment of caries was found at approximal sites (p<0.001). At baseline, individuals were classified as low (94%), medium (6%) and high risk (0%). After five years, the figures were 74%, 20% and 6%, respectively. Although classified in a low-caries-risk group, 9% had ≥ 6 decayed or filled surfaces at baseline, and 23% did after five years. Approximately 62% of individuals were registered as caries-free at baseline, and 45% were after five years.

    CONCLUSIONS: There was an increase in caries over five years, especially among adolescents without caries experience at baseline. The majority of adolescents had the same risk classification after five years. Further research with a larger sample size is needed to evaluate risk assessment for caries.

  • 342.
    Karlsson, Magnus
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine.
    Zackrisson, Magdalena
    Relation between putative afferent axons and the glia limitans in rat motor roots1998In: Journal of the peripheral nervous system, ISSN 1085-9489, E-ISSN 1529-8027, Vol. 3, no 1, p. 47-53Article in journal (Refereed)
  • 343.
    Karlsson, Samuel
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Palma Jansson, Nelly
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Jämförelse av kommersiella och InHouse kontroller för realtids-PCR vid diagnostik av Herpes simplexvirus 1 och 22018Independent thesis Basic level (degree of Bachelor), 180 HE creditsStudent thesis
    Abstract [en]

    Herpes simplex viruses 1 and 2 which usually cause benign diseases but can even cause mortality. The diagnostics of herpes simplex virus 1 and 2 are performed with real-time Polymerase chain reaction (PCR). In the real-time PCR method, specific deoxyribonucleic acid (DNA) sequences are amplified into millions of copies which are then detected with fluorescein. Positive and negative controls are used in real-time PCR. The positive controls can be InHouse or commercial. The interpretation of the results includes inspection of the controls. DNA is subject to degradation processes of different kinds and can be stored in different ways to maintain stability. The purpose of the study was to compare the laboratory's InHouse controls with two commercial controls, to evaluate which of these were more stable over time. The evaluation was performed by analyzing the three controls with real-time PCR after they were stored in temperatures at -20° C, at 5° C and at 20° C, and were diluted in TE-buffer or in water. The commercial and InHouse controls proved to be equitable. Further studies carried out for a longer period of time, to a greater extent and where concentrations are the same for each control are suggested.  

  • 344.
    Keinan, Sara
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Zaklan, Elma
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Kartläggning av hjärnundersökningar med PET/CT på svenska universitetssjukhus: Redovisning av modalitetsuppbyggnad, undersökningsmetod och rekonstruktionsmetod samt stråldosjämförelse mellan PET och SPECT2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Positron emission tomography/computed tomography (PET/CT) is a method that quantitatively visualizes physiological processes. The most common indications for PET brain are early diagnosis of various dementia types with 18F-Fludeoxyglucose (18F-FDG). The hospital in Jonkoping installed a new PET/CT and brain examinations have not yet been performed. The aim of the study was to map how hospitals in Sweden performed seven selected brain examinations with PET/CT focusing on modality structure, examination method and reconstruction method, with a comparison of radiation dose between PET/CT and single photon emission computed tomography/CT (SPECT)/CT. Out of the nine university hospitals selected, two were excluded. The method was prospective with quantitative approach and data was collected through a protocol. Compilation was made on Excel and the statistics were processed using the Wilcoxon Signed Ranks Test. The result showed similarities, for example reconstruction method and differences, for example fasting time. Effective dose was higher on SPECT than PET in examination of Parkinson's disease, however no significant difference (p = 0,059) was detected. Higher effective doses on SPECT was due to longer half-lives and greater dosages of Ioflupane (123I-Datscan) than 18F-FDG. For further studies, more hospitals and parameters in the protocol can be included. 

  • 345.
    Khanbhai, Rashida
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Hanna, Nareeman
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Sambandet mellan övervikt/fetma och orala sjukdomar hos barn och ungdomar: En litteraturöversikt2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The link between overweight/obesity and oral diseases in children and adolescents

     

    Background: Overweight/obesity is a health problem that is increasing rapidly in Sweden and around the world. Overweight/obesity, dental caries and periodontitis are all chronic and multifactorial diseases. These diseases are common in both children and adolescents. The oral diseases are linked to unhealthy dietary habits that affect both oral- and general health, which in turn may affect the weight of children and adolescents. Aim: To study whether there is a possible link between overweight/obesity and oral diseases in children and adolescents. Me-thod: This work was a literature review. DOSS and PubMed were used for search of scientific articles. Total generated hits were 393 of which 50 articles were selected for fulltext review. Using a modified review the articles were then examined for probative value and analyzed to determine if the the articles are weak, moderate or strong. Finally, 19 articles were included in the study. Results: Socioeconomi, BMI in children and parents, level of education, ethnicity, hygiene, nutrition and health status was of great importance in the development of overweight/obesity and dental caries. Overweight/obesity had a direct impact on periodontal disease but because of the studies in this area being few the authors of this study believe that further research in this area is required. Conclusion: The majority of these 19 studies have shown a statistically significant association between overweight/obesity and oral diseases and the relationship was shown to be dependent on several factors.

  • 346.
    Kivimäki, Mika
    et al.
    Department of Epidemiology and Public Health, University College London, London, UK; Faculty of Medicine, University of Helsinki, Helsinki, Finland .
    Jokela, Markus
    Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
    Nyberg, Solja T
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, London, UK; Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
    Fransson, Eleonor I
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Bjorner, Jakob B.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Borritz, Marianne
    Department of Occupational Medicine, Koege Hospital, Copenhagen, Denmark.
    Burr, Hermann
    Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany.
    Casini, Annalisa
    School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium.
    Clays, Els
    Department of Public Health, Ghent University, Ghent, Belgium.
    De Bacquer, Dirk
    Department of Public Health, Ghent University, Ghent, Belgium.
    Dragano, Nico
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
    Erbel, Raimund
    Department of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany.
    Geuskens, Goedele A.
    TNO, Hoofddorp, Netherlands.
    Hamer, Mark
    Department of Epidemiology and Public Health, University College London, London, UK.
    Hooftman, Wendela E.
    TNO, Hoofddorp, Netherlands.
    Houtman, Irene L.
    TNO, Hoofddorp, Netherlands.
    Jöckel, Karl-Heinz
    Institute for Medical Informatics, Biometry, and Epidemiology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.
    Kittel, France
    School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Koskenvuo, Markku
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Lunau, Thorsten
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
    Madsen, Ida E. H.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Nielsen, Martin L.
    Unit of Social Medicine, Frederiksberg University Hospital, Copenhagen, Denmark.
    Nordin, Maria
    Stress Research Institute, Stockholm University, Stockholm, Sweden; Department of Psychology, Umeå University, Umeå, Sweden.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Pejtersen, Jan H.
    The Danish National Centre for Social Research, Copenhagen, Denmark.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Rugulies, Reiner
    National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
    Salo, Paula
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland; Department of Psychology, University of Turku, Turku, Finland.
    Shipley, Martin J.
    Department of Epidemiology and Public Health, University College London, London, UK.
    Siegrist, Johannes
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
    Steptoe, Andrew
    Department of Epidemiology and Public Health, University College London, London, UK.
    Suominen, Sakari B.
    Department of Public Health, University of Turku, Turku, Finland; Folkhälsan Research Center, Helsinki, Finland; University of Skövde, Skövde, Sweden.
    Theorell, Töres
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Vahtera, Jussi
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland; Department of Public Health, University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland.
    Westerholm, Peter J. M.
    Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    O'Reilly, Dermot
    Centre for Public Health, Queen's University Belfast, Belfast, UK.
    Kumari, Meena
    Department of Epidemiology and Public Health, University College London, London, UK; Institute for Social and Economic Research, University of Essex, Colchester, UK.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, London, UK; Centre for Cognitive Ageing and Cognitive Epidemiology and Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
    Ferrie, Jane E.
    Department of Epidemiology and Public Health, University College London, London, UK; School of Community and Social Medicine, University of Bristol, Bristol, UK.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 10005, p. 1739-1746Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke.

    METHODS: We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data.

    FINDINGS: We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603 838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528 908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02-1·26; p=0·02) and incident stroke (1·33, 1·11-1·61; p=0·002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1·30-1·42). We recorded a dose-response association for stroke, with RR estimates of 1·10 (95% CI 0·94-1·28; p=0·24) for 41-48 working hours, 1·27 (1·03-1·56; p=0·03) for 49-54 working hours, and 1·33 (1·11-1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (ptrend<0·0001).

    INTERPRETATION: Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours.

    FUNDING: Medical Research Council, Economic and Social Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working Environment, Academy of Finland, Ministry of Social Affairs and Employment (Netherlands), US National Institutes of Health, British Heart Foundation.

  • 347.
    Kivimäki, Mika
    et al.
    University College London, London, UK, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland, Finnish Institute of Occupational Health, Helsinki, Finland.
    Kuosma, Eeva
    Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Ferrie, Jane E.
    Department of Epidemiology and Public Health, University College London, London, UK, School of Social and Community Medicine, University of Bristol, Bristol, UK.
    Luukkonen, Ritva
    Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Nyberg, Solja T.
    Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Alfredsson, Lars
    Centre for Occupational and Environmental Medicine, Stockholm County Council, Sweden, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, London, UK.
    Brunner, Eric J.
    Department of Epidemiology and Public Health, University College London, London, UK.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Institute of Environmental Medicine, Karolinska Institutet, Sweden, Stress Research Institute, Stockholm University, Sweden.
    Goldberg, Marcel
    Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France.
    Knutsson, Anders
    Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France.
    Koskenvuo, Markku
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Nordin, Maria
    Stress Research Institute, Stockholm University, Stockholm, Sweden, Department of Psychology, Umeå University, Umeå, Sweden.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Rugulies, Reiner
    Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark, National Research Centre for the Working Environment, Copenhagen, Denmark.
    Shipley, Martin J
    Department of Epidemiology and Public Health, University College London, London, UK.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, London, UK, Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
    Steptoe, Andrew
    Department of Epidemiology and Public Health, University College London, London, UK.
    Suominen, Sakari B.
    Department of Public Health, University of Turku, Turku, Finland, Folkhälsan Research Center, Helsinki, Finland, University of Skövde, Skövde, Sweden.
    Theorell, Töres
    Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Turku, Finland, Turku University Hospital, Turku, Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Westerholm, Peter
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Zins, Marie
    Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France.
    Hamer, Mark
    Department of Epidemiology and Public Health, University College London, London, UK, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK.
    Bell, Joshua A.
    Department of Epidemiology and Public Health, University College London, London, UK, MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.
    Tabak, Adam G.
    Department of Epidemiology and Public Health, University College London, London, UK, 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary.
    Jokela, Markus
    Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
    Overweight, obesity, and risk of cardiometabolic multimorbidity: Pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe2017In: The Lancet. Public health, Vol. 2, no 6, p. e277-e285Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although overweight and obesity have been studied in relation to individual cardiometabolic diseases, their association with risk of cardiometabolic multimorbidity is poorly understood. Here we aimed to establish the risk of incident cardiometabolic multimorbidity (ie, at least two from: type 2 diabetes, coronary heart disease, and stroke) in adults who are overweight and obese compared with those who are a healthy weight.

    METHODS: We pooled individual-participant data for BMI and incident cardiometabolic multimorbidity from 16 prospective cohort studies from the USA and Europe. Participants included in the analyses were 35 years or older and had data available for BMI at baseline and for type 2 diabetes, coronary heart disease, and stroke at baseline and follow-up. We excluded participants with a diagnosis of diabetes, coronary heart disease, or stroke at or before study baseline. According to WHO recommendations, we classified BMI into categories of healthy (20·0-24·9 kg/m(2)), overweight (25·0-29·9 kg/m(2)), class I (mild) obesity (30·0-34·9 kg/m(2)), and class II and III (severe) obesity (≥35·0 kg/m(2)). We used an inclusive definition of underweight (<20 kg/m(2)) to achieve sufficient case numbers for analysis. The main outcome was cardiometabolic multimorbidity (ie, developing at least two from: type 2 diabetes, coronary heart disease, and stroke). Incident cardiometabolic multimorbidity was ascertained via resurvey or linkage to electronic medical records (including hospital admissions and death). We analysed data from each cohort separately using logistic regression and then pooled cohort-specific estimates using random-effects meta-analysis.

    FINDINGS: Participants were 120  813 adults (mean age 51·4 years, range 35-103; 71 445 women) who did not have diabetes, coronary heart disease, or stroke at study baseline (1973-2012). During a mean follow-up of 10·7 years (1995-2014), we identified 1627 cases of multimorbidity. After adjustment for sociodemographic and lifestyle factors, compared with individuals with a healthy weight, the risk of developing cardiometabolic multimorbidity in overweight individuals was twice as high (odds ratio [OR] 2·0, 95% CI 1·7-2·4; p<0·0001), almost five times higher for individuals with class I obesity (4·5, 3·5-5·8; p<0·0001), and almost 15 times higher for individuals with classes II and III obesity combined (14·5, 10·1-21·0; p<0·0001). This association was noted in men and women, young and old, and white and non-white participants, and was not dependent on the method of exposure assessment or outcome ascertainment. In analyses of different combinations of cardiometabolic conditions, odds ratios associated with classes II and III obesity were 2·2 (95% CI 1·9-2·6) for vascular disease only (coronary heart disease or stroke), 12·0 (8·1-17·9) for vascular disease followed by diabetes, 18·6 (16·6-20·9) for diabetes only, and 29·8 (21·7-40·8) for diabetes followed by vascular disease.

    INTERPRETATION: The risk of cardiometabolic multimorbidity increases as BMI increases; from double in overweight people to more than ten times in severely obese people compared with individuals with a healthy BMI. Our findings highlight the need for clinicians to actively screen for diabetes in overweight and obese patients with vascular disease, and pay increased attention to prevention of vascular disease in obese individuals with diabetes.

    FUNDING: NordForsk, Medical Research Council, Cancer Research UK, Finnish Work Environment Fund, and Academy of Finland.

  • 348. Kivimäki, Mika
    et al.
    Luukkonen, Ritva
    Batty, G David
    Ferrie, Jane E
    Pentti, Jaana
    Nyberg, Solja T
    Shipley, Martin J
    Alfredsson, Lars
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Goldberg, Marcel
    Knutsson, Anders
    Koskenvuo, Markku
    Kuosma, Eeva
    Nordin, Maria
    Suominen, Sakari B
    Theorell, Töres
    Vuoksimaa, Eero
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Maria
    Kivipelto, Miia
    Vahtera, Jussi
    Kaprio, Jaakko
    Singh-Manoux, Archana
    Jokela, Markus
    Body mass index and risk of dementia: Analysis of individual-level data from 1.3 million individuals2018In: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 14, no 5, p. 601-609Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects.

    METHODS: We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis.

    RESULTS: Hazard ratios per 5-kg/m(2) increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis.

    CONCLUSIONS: The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short.

  • 349. Kivimäki, Mika
    et al.
    Nyberg, Solja
    Batty, David
    Fransson, Eleonor
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Heikkilä, Katriina
    Alfredsson, Lars
    Bjorner, Jakob
    Borritz, Marianne
    Burr, Hermann
    Casini, Annalisa
    Clays, Els
    DeBacquer, Dirk
    Dragano, Nico
    Ferrie, Jane
    Gueskens, Goedele
    Goldberg, Marcel
    Hamer, Mark
    Hooftman, Wendela
    Houtman, Irene
    Joensuu, Matti
    Jokela, Markus
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Kumari, Meena
    Madsen, Ida
    Marmot, Michael
    Nielsen, Martin
    Nordin, Maria
    Oksanen, Tuula
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Siegrist, Johannes
    Singh-Manoux, Archana
    Suominen, Sakari
    Väänänen, Ari
    Vahtera, Jussi
    Virtanen, Marianna
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Steptoe, Andrew
    Theorell, Töres
    Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data2012In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 380, no 9852, p. 1491-1497Article in journal (Refereed)
    Abstract [en]

    Background Published work assessing psychosocial stress (job strain) as a risk factor for coronary heart disease is inconsistent and subject to publication bias and reverse causation bias. We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished studies.

    Methods We used individual records from 13 European cohort studies (1985—2006) of men and women without coronary heart disease who were employed at time of baseline assessment. We measured job strain with questions from validated job-content and demand-control questionnaires. We extracted data in two stages such that acquisition and harmonisation of job strain measure and covariables occurred before linkage to records for coronary heart disease. We defined incident coronary heart disease as the first non-fatal myocardial infarction or coronary death.

    Findings 30 214 (15%) of 197 473 participants reported job strain. In 1·49 million person-years at risk (mean follow-up 7·5 years [SD 1·7]), we recorded 2358 events of incident coronary heart disease. After adjustment for sex and age, the hazard ratio for job strain versus no job strain was 1·23 (95% CI 1·10—1·37). This effect estimate was higher in published (1·43, 1·15—1·77) than unpublished (1·16, 1·02—1·32) studies. Hazard ratios were likewise raised in analyses addressing reverse causality by exclusion of events of coronary heart disease that occurred in the first 3 years (1·31, 1·15—1·48) and 5 years (1·30, 1·13—1·50) of follow-up. We noted an association between job strain and coronary heart disease for sex, age groups, socioeconomic strata, and region, and after adjustments for socioeconomic status, and lifestyle and conventional risk factors. The population attributable risk for job strain was 3·4%.

    Interpretation Our findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking.

  • 350. Kivimäki, Mika
    et al.
    Nyberg, Solja
    Fransson, Eleonor
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Heikkilä, Katriina
    Alfredsson, Lars
    Casini, Annalisa
    Clays, Els
    DeBacquer, Dirk
    Dragano, Nico
    Ferrie, Jane
    Goldberg, Marcel
    Hamer, Mark
    Jokela, Markus
    Karasek, Robert
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Nordin, Maria
    Oksanen, Tuula
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Siegrist, Johannes
    Suominen, Sakari
    Theorell, Töres
    Vahtera, Jussi
    Virtanen, Marianna
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Steptoe, Andrew
    Singh-Manoux, Archana
    Batty, David
    Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data2013In: CMJA. Canadian Medical Association Journal. Onlineutg. Med tittel: ECMAJ. ISSN 1488-2329, ISSN 0820-3946, E-ISSN 1488-2329, Vol. 185, no 9, p. 763-769Article in journal (Refereed)
    Abstract [en]

    Background: It is unclear whether a healthy lifestyle mitigates the adverse effects of job strain on coronary artery disease. We examined the associations of job strain and lifestyle risk factors with the risk of coronary artery disease.

    Methods: We pooled individual-level data from 7 cohort studies comprising 102 128 men and women who were free of existing coronary artery disease at baseline (1985–2000). Questionnaires were used to measure job strain (yes v. no) and 4 lifestyle risk factors: current smoking, physical inactivity, heavy drinking and obesity. We grouped participants into 3 lifestyle categories: healthy (no lifestyle risk factors), moderately unhealthy (1 risk factor) and unhealthy (2–4 risk factors). The primary outcome was incident coronary artery disease (defined as first nonfatal myocardial infarction or cardiac-related death).

    Results: There were 1086 incident events in 743 948 person-years at risk during a mean follow-up of 7.3 years. The risk of coronary artery disease among people who had an unhealthy lifestyle compared with those who had a healthy lifestyle (hazard ratio [HR] 2.55, 95% confidence interval [CI] 2.18–2.98; population attributable risk 26.4%) was higher than the risk among participants who had job strain compared with those who had no job strain (HR 1.25, 95% CI 1.06–1.47; population attributable risk 3.8%). The 10-year incidence of coronary artery disease among participants with job strain and a healthy lifestyle (14.7 per 1000) was 53% lower than the incidence among those with job strain and an unhealthy lifestyle (31.2 per 1000).

    Interpretation: The risk of coronary artery disease was highest among participants who reported job strain and an unhealthy lifestyle; those with job strain and a healthy lifestyle had half the rate of disease. A healthy lifestyle may substantially reduce disease risk among people with job strain.

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