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  • 651.
    Levi, Richard
    et al.
    Solberga Spinal Cord Injury Research Project, Karolinska Institute Huddinge University Hospital, Stockholm, Sweden.
    Hultling, C
    Solberga Spinal Cord Injury Research Project, Karolinska Institute Huddinge University Hospital, Stockholm, Sweden.
    Nash, M S
    Solberga Spinal Cord Injury Research Project, Karolinska Institute Huddinge University Hospital, Stockholm, Sweden.
    Seiger, A
    Solberga Spinal Cord Injury Research Project, Karolinska Institute Huddinge University Hospital, Stockholm, Sweden.
    The Stockholm spinal cord injury study: 1. Medical problems in a regional SCI population.1995Inngår i: Paraplegia, ISSN 0031-1758, Vol. 33, nr 6, s. 308-315Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Out of a regional traumatic spinal cord injury population consisting of 379 individuals, 353 (93.1%) participated in the present study. Subjects were individually interviewed using semi-structured protocols. In addition, previous medical records were available for over 96% of subjects, and were used in all these cases to minimise recall bias. Cause of injury, prevalence of present medical symptoms and occurrence of medical complications in the post-acute, post-discharge phase were recorded. Neurological classification was verified by physical examination according to ASIA/IMSOP standards. Many subjects had experienced complications since discharge from initial hospitalisation, especially urinary tract infections, decubitus ulcers, urolithiasis, and neurological deterioration. Prevalence of medical symptoms was also high. More than 41% of subjects with spastic paralysis reported excessive spasticity to be associated with additional functional impairment and/or pain. Almost two-thirds of subjects reported significant pain, with a predominance of neurogenic-type pain. Bladder and bowel dysfunction were each rated by nearly 41% of subjects as a moderate to severe life problem. As expected, sexual dysfunction was also commonly reported. Prevalence of reported symptoms by general systems review was high, particularly fatigue, constipation, ankle oedema, joint and muscle problems, and disturbed sleep. However, lack of adequate normative data precludes comparison with the general population. The frequent occurrence of reported medical problems and complications support advocacy of comprehensive, life-long care for SCI patients. The commonly reported problems of neurogenic pain and neurological deterioration, in particular, require more attention, as these symptoms are not seldom ominous, either by virtue of their impact on quality of life, or because of underlying pathology.

  • 652.
    Levi, Richard
    et al.
    Solberga Project/Karolinska Institute and Centre for Neurotraumatology, Karolinska Hospital, Stockholm, Sweden.
    Hultling, C
    Solberga Project/Karolinska Institute and Centre for Neurotraumatology, Karolinska Hospital, Stockholm, Sweden.
    Westgren, N
    Solberga Project/Karolinska Institute and Centre for Neurotraumatology, Karolinska Hospital, Stockholm, Sweden.
    A computer assisted follow up system for spinal cord injury patients.1994Inngår i: Paraplegia, ISSN 0031-1758, Vol. 32, nr 11, s. 736-742Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The comprehensive care of patients with traumatic spinal cord injuries (SCI) necessitates, among other things, a structured, life-long follow up. The high consumption of medical care in chronic SCI patients, often a result of diseases affecting many different organ systems, soon causes the cumulated medical documentation to be extensive and therefore hard to survey. The possibilities for rational patient management, adequate quality assurance, and clinical research may improve considerably by computerisation of medical records. A computerised medical records system for SCI has recently been developed, using a semistructured medical record format for data input and a medical entity dictionary for facilitated data storage and retrieval. The principles for developing this computer-assisted follow up system are described.

  • 653.
    Li, Lin
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Somatic and occupational outcomes in adult ADHD: epidemiology studies based on real-world data2022Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders, characterized by inattention or hyperactivity–impulsivity, or both. ADHD is a multifactorial disorder influenced by the complex interplay between genetic and environmental risk factors, but a detailed understanding of the causal status of these factors is lacking. ADHD is associated with many psychiatric disorders, but somatic comorbidity in ADHD has received less attention in the research literature. Pharmacological treatment is effective in reducing the core symptoms of ADHD, but the effects on occupational outcomes remain unclear. The overarching aim of this thesis is to extend previous knowledge on the early risk factors of ADHD, and to increase the awareness and the understanding on somatic and occupational outcomes of ADHD in adults.

    In Study I, we combined a systematic review and mate-analysis with a population based cohort of 971,501 individuals born between 1992 and 2004 in Sweden. The meta-analysis revealed a positive association between maternal pre-pregnancy overweight/obesity and risk of ADHD in offspring. However, these associations gradually attenuated toward the null when adjusted for measured confounders,unmeasured factors shared by cousins and unmeasured factors shared by siblings. In Study II, by using a Swedish population-based twin study with 17,999 individuals aged 20–47 years, we found both inattention and hyperactivity/impulsivity was associated with higher consumption of high-sugar food and unhealthy dietary habits, although these associations were generally weak. Further, the observed associations was explained by both genetic and non-shared environmental factors.In Study III, we explored the prospective associations between ADHD and a broad range of cardiovascular diseases in 5,389,519 adults from Sweden, and found that ADHD may be a novel and independent risk factor for cardiovascular diseases. In Study IV, based on the longitudinal cohort of 12,875 middle-aged adults with ADHD, we found the use of ADHD medications during the previous two years was associated with a 10% reduction in the risk of long-term unemployment in the following year.

    Taken together, findings from the thesis highlight the need of future studies with various study designs, to fully understand the aetiology and long-term health outcomes of ADHD across the lifespan.

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  • 654.
    Li, Lin
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Chang, Zheng
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Sun, Jiangwei
    The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Garcia-Argibay, Miguel
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Du Rietz, Ebba
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dobrosavljevic, Maja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Brikell, Isabell
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Jernberg, Tomas
    Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden.
    Solmi, Marco
    Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ontario, Canada; Centre for Innovation in Mental Health-Developmental Lab, School of Psychology, University of Southampton, and NHS Trust, Southampton, United Kingdom.
    Cortese, Samuel
    Centre for Innovation in Mental Health-Developmental Lab, School of Psychology, University of Southampton, and NHS Trust, Southampton, United Kingdom; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
    Larsson, Henrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Attention-deficit/hyperactivity disorder as a novel risk factor for cardiovascular diseases: a nationwide population-based cohort studyManuskript (preprint) (Annet (populærvitenskap, debatt, mm))
  • 655.
    Li, Lin
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Chang, Zheng
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Sun, Jiangwei
    The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Jangmo, Andreas
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Zhang, Le
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Andersson, Lars Magnus
    Medical Affairs, Shire Sweden AB, a Takeda Company, Stockholm, Sweden.
    Werner-Kiechle, Tamara
    Global Medical Affairs, Shire International GmbH, a Takeda Company, Zug, Switzerland.
    Ahnemark, Ewa
    Medical Affairs, Shire Sweden AB, a Takeda Company, Stockholm, Sweden.
    D’Onofrio, Brian M.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychological and Brain Sciences, Indiana University, 1101 E. 10th St., Bloomington, IN 47405, USA.
    Larsson, Henrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Association between Pharmacological Treatment and Long-term Unemployment Among Workingaged Individuals with Attention-Deficit/Hyperactivity Disorder in SwedenManuskript (preprint) (Annet vitenskapelig)
  • 656.
    Lichtenstein, Paul
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Halldner, Linda
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Zetterqvist, Johan
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Sjölander, Arvid
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Serlachius, Eva
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Fazel, Seena
    Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
    Långström, Niklas
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Medication for attention deficit-hyperactivity disorder and criminality2012Inngår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 367, nr 21, s. 2006-2014Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Attention deficit-hyperactivity disorder (ADHD) is a common disorder that has been associated with criminal behavior in some studies. Pharmacologic treatment is available for ADHD and may reduce the risk of criminality.

    Methods: Using Swedish national registers, we gathered information on 25,656 patients with a diagnosis of ADHD, their pharmacologic treatment, and subsequent criminal convictions in Sweden from 2006 through 2009. We used stratified Cox regression analyses to compare the rate of criminality while the patients were receiving ADHD medication, as compared with the rate for the same patients while not receiving medication.

    Results: As compared with nonmedication periods, among patients receiving ADHD medication, there was a significant reduction of 32% in the criminality rate for men (adjusted hazard ratio, 0.68; 95% confidence interval [CI], 0.63 to 0.73) and 41% for women (hazard ratio, 0.59; 95% CI, 0.50 to 0.70). The rate reduction remained between 17% and 46% in sensitivity analyses among men, with factors that included different types of drugs (e.g., stimulant vs. nonstimulant) and outcomes (e.g., type of crime).

    Conclusions: Among patients with ADHD, rates of criminality were lower during periods when they were receiving ADHD medication. These findings raise the possibility that the use of medication reduces the risk of criminality among patients with ADHD. (Funded by the Swedish Research Council and others.).

  • 657.
    Lichtenstein, Paul
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Medication for attention deficit-hyperactivity disorder and criminality2013Inngår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 368, nr 8, s. 775-776Artikkel i tidsskrift (Fagfellevurdert)
  • 658.
    Lilja, Aina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    DeMarinis, Valerie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Department of Theology, Psychology of Religion and Cultural Psychology, Uppsala University, Uppsala, Sweden; Mental Health Division, Innlandet Hospital Trust, Hamar, Norway.
    Lehti, Arja
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Forssén, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Experiences and explanations of mental ill health in a group of devout Christians from the ethnic majority population in secular Sweden: a qualitative study2016Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 6, nr 10, artikkel-id e011647Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To explore existential meaning-making in an ethnic-majority subgroup with mental ill health and to increase knowledge about the importance of gaining access to such information in mental healthcare.

    DESIGN: Qualitative study using in-depth interviews and systematic text condensation analysis.

    PARTICIPANTS: 17 devote Christians with an ethnic-Swedish background, 12 women and 5 men, 30-73 years old, from different congregations across Sweden, having sought medical care for mental ill health of any kind.

    SETTING: The secular Swedish society.

    RESULTS: A living, although asymmetric, relationship with God often was seen as the most important relationship, giving hope and support when ill, but creating feelings of abandonment and fear if perceived as threatened. Symptoms were interpreted through an existential framework influenced by their view of God. A perceived judging God increased feelings of guilt, sinfulness and shame. A perceived merciful God soothed symptoms and promoted recovery. Existential consequences, such as being unable to pray or participate in congregational rituals, caused feelings of 'spiritual homelessness'. Participants gave biopsychosocial explanations of their mental ill health, consonant with and sometimes painfully conflicting with existential explanations, such as being attacked by demons. Three different patterns of interaction among biopsychosocial and existential dimensions in their explanatory systems of illness causation were identified: (a) comprehensive thinking and consensus; (b) division and parallel functions and (c) division and competitive functions.

    CONCLUSIONS: Prevailing medical models for understanding mental ill health do not include the individual's existential experiences, which are important for identifying risk and protective factors as well as possible resources for recovery. The various expressions of existential meaning-making identified in this devout religious subgroup illustrate that existential information cannot be generalised, even within a small, seemingly homogenous group. The three identified patterns of interactions formed a typology that may be of use in clinical settings.

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  • 659.
    Liljeroos, Maria
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Caring needs in patient-partner dyads affected by heart failure: An evaluation of the long-term effects of a dyadic psycho-educational intervention2017Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Introduction: As medical treatment has improved, patients with heart failure (HF) now live longer and care mostly takes place at home with partners providing the main assistance. Taking care of an ill or disabled individual imposes a well-documented burden on the partner’s healthrelated quality of life. The awareness of partners’ burdensome situation is increasing, but few interventions have targeted the needs of patientpartner dyads with HF. The results have been inconclusive and give no clear guidance on how interventional programmes should be designed to improve both patient and partner outcomes.

    Aim: The overall aim of this thesis was to evaluate the effects of a psychoeducational intervention delivered to patient-partner dyads with HF during long-term follow-up, and to explore the dyads’ perceived caring needs.

    Methods: The thesis is based on four papers that used both quantitative and qualitative data. Study I and II used a randomized controlled design with a follow-up assessment after 24 months including 155 patientpartner dyads. The control group received care as usual. The intervention group received care as usual, and in addition they participated in the nurse-led psycho-educational intervention. Data was collected using questionnaires before and 24 months after the intervention, in order to determine the long-term effects on patients and partners regarding health related quality of life, perceived control, symptoms of depression and partners’ caregiver burden (I, II). A conceptual health promotion model inspired the intervention. To describe how the model was applied, a qualitative approach analysing nurses’ documentation of the sessions with 71 dyads in the intervention group (III) was used. Study IV has an explorative design. To further explore the dyads’ perceived caring needs, focus groups interviews with 19 patient-partner dyads with heart failure (IV) were performed.

    Results: The intervention did not have any significant effect on physical or mental health- related quality of life, depressive symptoms, or perceived control over the heart failure among the dyads (I) or caregiver burden in the partners (II) after 24 months. Furthermore, time to first event did not differ significantly between the dyads in the intervention group and the control group (I, II). As for the partners, both the intervention and control group reported decreased physical health between the baseline assessment and the 24-month follow-up (I). The intervention was composed of three components; 1) cognitive 2) supportive, and 3) behavioural component. The analysis of the nurses’ documentation confirmed the coverage of all the components and the analysis revealed a vide range of caring needs among the dyads (III). The dyads described a need to learn about HF to be able to manage everyday life. Regular outpatient clinic visits and access to telephone support were vital and both the patient and the partner need to be present at the clinic visits. Meeting others who are in the same situation and sharing the burden in nurse-led group sessions was proposed as an opportunity to support each other and others (IV).

    Conclusions: Over the 24-month follow-up period, the intervention had a neutral effect on health- related quality of life, depressive symptoms and perceived control over the HF among the dyads, and on partners’ caregiver burden. Considering the fact that partners serve as a critical extension of the formal healthcare system, and that both patients and partners ask for more support, it will become crucial to find new ways to support dyads affected by heart failure. This thesis may be viewed as a first step in trying to understand dyads’ perceived caring needs, and it can serve as a guide in clinical work and when designing new dyadic interventions.

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  • 660.
    Liljeroos, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linköping University, Department of Medicine and Health Sciences, Linköping.
    Ågren, Susanna
    Linköping University, Department of Medicine and Health Sciences, Linköping.; Linköping University, Department of Cardiothoracic Surgery, Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Linköping.
    Stromberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Linköping.; Linköping University, Department of Cardiology, Linköping.; University of California Irvine, Sue and Bill Gross School of Nursing, Irvine.
    Dialogues between nurses, patients with heart failure and their partners during a dyadic psychoeducational intervention: a qualitative study2017Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 7, nr 12, artikkel-id e018236Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To describe nurses’ documentation of the content in a psychoeducational intervention inspired by Stuifbergen’s model addressing cognitive, supportive and behavioural needs of patient–partner dyads affected by heart failure.

    Design: A descriptive qualitative design was used analysing nurses’ documentation in a dialogue guide based on a health promotion model.

    Settings: The dialogue guide was used during three nurse-led sessions at two heart failure clinics in Sweden with patients affected with heart failure and their partners during the years 2005–2008.

    Participants: The dialogue guides from 71 patient–partner dyads were analysed using direct deductive content analyses. Patients’ mean age was 69 years and 31% were female, partners’ mean age was 67 years and 69% were female.

    Results: The findings supported the conceptual health promotion model and identified barriers, recourses and self-efficacy described by the dyads within each category.

    Conclusion: The dyads described that during the sessions, they had gained enhanced knowledge and greater confidence to handle their life situation and expressed that they needed psychoeducational support during the whole illness trajectory. The results may guide and help to improve content and quality when caring for patients affected with heart failure and their partners and also when designing new interventions.

    Trial registration number: NCT02398799; Post-results.

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  • 661.
    Liljeroos, Maria
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Department of Medicine, Mälarsjukhuset, Eskilstuna, Sweden.
    Ågren, Susanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. School of Health and Caring Sciences, Faculty of Health, Social Work and Behavioral Sciences, Linnaeus University, Kalmar, Sweden.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Long-term effects of a dyadic psycho-educational intervention on caregiver burden and morbidity in partners of patients with heart failure: a randomized controlled trial2017Inngår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 26, nr 2, s. 367-379Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Partners of patients with heart failure provide both practical and emotional support. Many partners assume caregiving responsibilities without being aware of the burden related with this role.

    Objective

    Our work has established that a psycho-educational intervention has benefits at 3, but not at 12 months for patients with heart failure. Further we had not described the long-term effects in caregivers. This study aimed to determine the 24-months effects of a dyadic psycho-educational intervention on caregiver burden and morbidity in partners of patients with heart failure and study factors associated with a change in caregiver burden.

    Design

    A randomized controlled study design, with a follow-up assessment after 24 months.

    Setting and participants

    Partners to patients with heart failure were recruited from two hospitals in the southeast of Sweden.

    Intervention

    A three session nurse-led psycho-educational program was tested and included psychosocial support to maintain the partners’ physical and mental functions, and perceived control. Several instrument were used to measure caregiver burden, perceived control, physical and mental health, depression and morbidity.

    Results

    One hundred fifty-five partners were included. There were no significant differences in any index of caregiver burden or morbidity among the partners in the intervention and control groups after 24 months. Overall, the mean total caregiver burden was found to be significantly increased compared to baseline (36 ± 12 vs 38 ± 14, p < 0.05). A younger partner, less comorbidity, higher levels of perceived control, better physical health and less symptoms of depression in patients, and better mental health in the partners were factors associated with absence of increased caregiver burden over time.

    Discussion and conclusion

    Our intervention did not significantly decrease caregiver burden or morbidity. Over time, several aspects of burden increased in both groups. To improve outcomes, individualized and targeted interventions might be beneficial.

  • 662.
    Linander, Ida
    et al.
    Umeå universitet, Umeå centrum för genusstudier (UCGS).
    Hammarström, Anne
    Umeå universitet, Allmänmedicin.
    Johansson, Klara
    Umeå universitet, Allmänmedicin.
    Which socio-economic measures are associated with psychological distress for men and women?: A cohort analysis2015Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, nr 2, s. 231-236Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: There are contradictory results regarding whether there is a social gradient in common mental disorders or not, or if this relation differs for different indicators or by gender. We analysed the relation between various measures of socio-economic position and later psychological distress among men and women in a Swedish context. Methods: The study is based on data from the Northern Swedish Cohort (N= 1001, 93.5% response rate), a 27-year prospective study. Logistic regression was used to explore the relation between various indicators of socio-economic position at age 30 (occupation, education, financial strain, cash margin, unemployment and living primarily on social welfare or unemployment insurance) and psychological distress (age 42), controlling for earlier psychological distress (age 21) and parental occupational class. Register data were used to measure unemployment. All other variables were self-reported, and measured by a questionnaire. Results: Financial strain and living on social welfare or unemployment insurance at age 30 were associated with psychological distress at age 42 for men and women. Poor cash margin and unemployment were only associated with psychological distress in women, after controlling for potential confounders. Low occupational class and low education were not significantly related to later psychological distress. Conclusion: The two most commonly used measures of socio-economic position, occupation and education, were not significantly associated with psychological distress while other, less studied measures were. This study highlights the importance of measuring socio-economic position in several ways when studying common mental disorders, as well as to take gender into account.

  • 663.
    Linander, Ida
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS). Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, Klara
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Which socio-economic measures are associated with psychological distress for men and women?: A cohort analysis2015Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, nr 2, s. 231-236Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: There are contradictory results regarding whether there is a social gradient in common mental disorders or not, or if this relation differs for different indicators or by gender. We analysed the relation between various measures of socio-economic position and later psychological distress among men and women in a Swedish context. Methods: The study is based on data from the Northern Swedish Cohort (N= 1001, 93.5% response rate), a 27-year prospective study. Logistic regression was used to explore the relation between various indicators of socio-economic position at age 30 (occupation, education, financial strain, cash margin, unemployment and living primarily on social welfare or unemployment insurance) and psychological distress (age 42), controlling for earlier psychological distress (age 21) and parental occupational class. Register data were used to measure unemployment. All other variables were self-reported, and measured by a questionnaire. Results: Financial strain and living on social welfare or unemployment insurance at age 30 were associated with psychological distress at age 42 for men and women. Poor cash margin and unemployment were only associated with psychological distress in women, after controlling for potential confounders. Low occupational class and low education were not significantly related to later psychological distress. Conclusion: The two most commonly used measures of socio-economic position, occupation and education, were not significantly associated with psychological distress while other, less studied measures were. This study highlights the importance of measuring socio-economic position in several ways when studying common mental disorders, as well as to take gender into account.

  • 664.
    Lind, P. Monica
    et al.
    Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Salihovic, Samira
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Stubleski, Jordan
    Man-Technology-Environment (MTM) Research Center, School of Science and Technology, Örebro University, Örebro, Sweden.
    Kärrman, Anna
    Örebro universitet, Institutionen för naturvetenskap och teknik.
    Lind, Lars
    Cardiovascular Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Association of Exposure to Persistent Organic Pollutants With Mortality Risk: An Analysis of Data From the Prospective Investigation of Vasculature in Uppsala Seniors (PIVUS) Study2019Inngår i: JAMA Network Open, E-ISSN 2574-3805, Vol. 2, nr 4, artikkel-id e193070Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Importance: It has been suggested that persistent organic pollutants (POPs) are harmful to human health.

    Objective: To investigate if POP levels in plasma are associated with future mortality.

    Design, Setting, and Participants: Cohort study using data from the population-based Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, collected between May 2001 and June 2004 when participants reached age 70 years. Participants were followed up for 5 years after the first examination. Mortality was tracked from age 70 to 80 years. Data analysis was conducted in January and February 2018.

    Exposures: Eighteen POPs identified by the Stockholm Convention, including polychlorinated biphenyls (PCBs), organochlorine pesticides, and a brominated flame retardant, were measured in plasma levels by gas chromatography-mass spectrometry.

    Main Outcomes and Measures: All-cause mortality.

    Results: The study sample initially included 992 individuals (497 [50.1%] men) aged 70 years, who were examined between 2001 and 2004. At the second examination 5 years later, 814 individuals (82.1%; 412 [50.7%] women) completed follow-up. During a follow-up period of 10.0 years, 158 deaths occurred. When updated information on POP levels at ages 70 and 75 years was associated with all-cause mortality using Cox proportional hazard analyses, a significant association was found between hexa-chloro- through octa-chloro-substituted (highly chlorinated) PCBs and all-cause mortality (except PCB 194). The most significant association was observed for PCB 206 (hazard ratio [HR] for 1-SD higher natural log-transformed circulating PCB 206 levels, 1.55; 95% CI, 1.26-1.91; P < .001). Following adjustment for hypertension, diabetes, smoking, body mass index, and cardiovascular disease at baseline, most associations were no longer statistically significant, but PCBs 206, 189, 170, and 209 were still significantly associated with all-cause mortality (PCB 206: adjusted HR, 1.47; 95% CI, 1.19-1.81; PCB 189: adjusted HR, 1.29; 95% CI, 1.08-1.55; PCB 170: adjusted HR, 1.24; 95% CI, 1.02-1.52; PCB 209: adjusted HR, 1.29; 95% CI, 1.04-1.60). In a secondary analysis, these associations were mainly because of death from cardiovascular diseases rather than noncardiovascular diseases. Three organochlorine pesticides, including dichlorodiphenyldichloroethylene, and the brominated flame retardant diphenyl ether 47 were also evaluated but did not show any significant associations with all-cause mortality.

    Conclusions and Relevance: Higher levels of highly chlorinated PCBs were associated with an increased mortality risk, especially from cardiovascular diseases. These results suggest that public health actions should be undertaken to minimize exposure to highly chlorinated PCBs.

  • 665.
    Lind, Thomas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos.
    Lind, P. Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Hu, Lijuan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos.
    Melhus, Håkan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos.
    Studies of indirect and direct effects of hypervitaminosis A on rat bone by comparing free access to food and pair-feeding.2018Inngår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, nr 2, s. 82-85Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The most prominent features of hypervitaminosis A in rats are spontaneous fractures and anorexia. Since caloric restriction induces alterations in bone, some effects could be secondary to loss of appetite. To clarify the mechanisms behind vitamin A-induced bone fragility it is necessary to distinguish between direct and indirect effects.

    MATERIALS AND METHODS: In this study we compared rats fed high doses of vitamin A both with pair-fed controls, which were fed the same amount of chow as that consumed by the vitamin A group to keep food intake the same, and to controls with free access to food.

    RESULTS: In contrast to the pair-fed animals, rats in the free access group fed high doses of vitamin A for 7 days had 13% lower food intake, 15% lower body weight, and 2.7% shorter femurs compared with controls. In addition, serum biomarkers of bone turnover were reduced. Peripheral quantitative computed tomography of the femurs showed that the bone mineral content, cross sectional area, and periosteal circumference were similarly reduced in the pair-fed and free access groups. However, bone mineral density (BMD) and cortical parameters were only significantly decreased in the free access group.

    CONCLUSIONS: Our data indicate that the major direct short-term effect of high doses of vitamin A on rat bone is a reduced bone diameter, whereas the effects on bone length, serum biomarkers of bone turnover, BMD, and bone cortex appear to be mainly indirect, caused by a systemic toxicity with loss of appetite, reduced food intake, and general effects on growth.

    Fulltekst (pdf)
    fulltext
  • 666.
    Lindberg, Bo S.
    Uppsala universitet.
    Physiology of the senses-a prominent area of science in Uppsala at the end of the nineteenth century2015Inngår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 120, nr 2, s. 78-89Artikkel i tidsskrift (Annet vitenskapelig)
  • 667. Lindberg, Eva
    et al.
    Benediktsdottir, Bryndis
    Franklin, Karl A.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Holm, Mathias
    Johannessen, Ane
    Jögi, Rain
    Gislason, Thorarinn
    Real, Francisco Gomez
    Schlunssen, Vivi
    Janson, Christer
    Women with symptoms of sleep-disordered breathing are less likely to be diagnosed and treated for sleep apnea than men2017Inngår i: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 35, s. 17-22Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Women are often underrepresented at sleep clinics evaluating sleep-disordered breathing (SDB). The aim of the present study was to analyze gender differences in sleep apnea diagnosis and treatment in men and women with similar symptoms of SDB. Methods: Respiratory Health in Northern Europe (RHINE) provided information about snoring, excessive daytime sleepiness (EDS), BMI and somatic diseases at baseline (1999-2001) and follow-up (2010-2012) from 4962 men and 5892 women. At follow-up participants were asked whether they had a diagnosis of and/or treatment for sleep apnea. Results: Among those with symptoms of SDB (snoring and EDS), more men than women had been given the diagnosis of sleep apnea (25% vs. 14%, p < 0.001), any treatment (17% vs. 11%, p = 0.05) and CPAP (6% vs. 3%, p = 0.04) at follow-up. Predictors of receiving treatment were age, BMI, SDB symptoms at baseline and weight gain, while female gender was related to a lower probability of receiving treatment (adj OR 0.3, 95% CI 0.3-0.5). In both genders, the symptoms of SDB increased the risk of developing hypertension (adj OR, 95% CI: 1.5, 1.2-1.8); and diabetes (1.5, 1.05-2.3), independent of age, BMI, smoking and weight gain. Conclusions: Snoring females with daytime sleepiness may be under-diagnosed and under-treated for sleep apnea compared with males, despite running a similar risk of developing hypertension and diabetes. 

  • 668.
    Lindberg, Eva
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Bonsignore, Maria R.
    Univ Palermo, PROMISE Dept, Palermo, Italy;IBIM CNR, Palermo, Italy.
    Polo-Kantola, Paivi
    Turku Univ Hosp, Dept Obstet & Gynaecol, Turku, Finland;Turku Univ Hosp, Sleep Res Unit, Turku, Finland;Univ Turku, Turku, Finland.
    Role of menopause and hormone replacement therapy in sleep-disordered breathing2020Inngår i: Sleep Medicine Reviews, ISSN 1087-0792, E-ISSN 1532-2955, Vol. 49, artikkel-id 101225Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    There are suggestions that the loss of female sex hormones following menopause is critical for the development or progression of sleep-disordered breathing (SDB). We conducted a review of the literature on the role of menopause and hormone replacement therapy (HRT) in SDB risk. There is an increase in SDB during the menopausal transition period, but data on an effect beyond that of increasing age and changes in body habitus are weak or absent. Early community-based, observational studies reported a protective effect by HRT on SDB prevalence, but this could possibly be explained as a healthy user effect. Interventional studies of the effect of HRT on SDB are sparse, with only a few randomized placebo-controlled studies, often performed on small samples of women without clinically significant SDB. HRT regimens have varied and all the studies are fairly old. They do not definitely assure the alleviation of SDB and HRT cannot thus be recommended as treatment for SDB. It is concluded that there is no evidence that female sex hormone changes during menopause per se are able to explain the increase in SDB in midlife women and conclusions on the effect of HRT on SDB cannot be drawn from the current literature.

  • 669.
    Lindberg, Felix
    et al.
    Karolinska Univ Hosp, Sweden.
    Lund, Lars H.
    Karolinska Univ Hosp, Sweden; Karolinska Univ Hosp, Sweden.
    Benson, Lina
    Karolinska Univ Hosp, Sweden.
    Schrage, Benedikt
    Karolinska Univ Hosp, Sweden; Univ Heart & Vasc Ctr Hamburg, Germany; German Ctr Cardiovasc Res DZHK, Germany.
    Edner, Magnus
    Karolinska Inst, Sweden.
    Dahlström, Ulf
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Linde, Cecilia
    Karolinska Univ Hosp, Sweden; Karolinska Univ Hosp, Sweden.
    Rosano, Giuseppe
    IRCCS San Raffaele Roma, Italy.
    Savarese, Gianluigi
    Karolinska Univ Hosp, Sweden; Karolinska Univ Hosp, Sweden.
    Patient profile and outcomes associated with follow-up in specialty vs. primary care in heart failure2022Inngår i: ESC Heart Failure, E-ISSN 2055-5822, Vol. 9, nr 2, s. 822-833Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims Factors influencing follow-up referral decisions and their prognostic implications are poorly investigated in patients with heart failure (HF) with reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) ejection fraction (EF). We assessed (i) the proportion of, (ii) independent predictors of, and (iii) outcomes associated with follow-up in specialty vs. primary care across the EF spectrum. Methods and results We analysed 75 518 patients from the large and nationwide Swedish HF registry between 2000-2018. Multivariable logistic regression models were fitted to identify the independent predictors of planned follow-up in specialty vs. primary care, and multivariable Cox models to assess the association between follow-up type and outcomes. In this nationwide registry, 48 115 (64%) patients were planned for follow-up in specialty and 27 403 (36%) in primary care. The median age was 76 [interquartile range (IQR) 67-83] years and 27 546 (36.5%) patients were female. Key independent predictors of planned follow-up in specialty care included optimized HF care, that is follow-up in a nurse-led HF clinic [odds ratio (OR) 4.60, 95% confidence interval (95% CI) 4.41-4.79], use of HF devices (OR 3.99, 95% CI 3.62-4.40), beta-blockers (OR 1.39, 95% CI 1.32-1.47), renin-angiotensin system/angiotensin-receptor-neprilysin inhibitors (OR 1.21, 95% CI 1.15-1.27), and mineralocorticoid receptor antagonists (OR 1.31, 95% CI 1.26-1.37); and more severe HF, that is higher NT-proBNP (OR 1.13, 95% CI 1.06-1.20) and NYHA class (OR 1.13, 95% CI 1.08-1.19). Factors associated with lower likelihood of follow-up in specialty care included older age (OR 0.29, 95% CI 0.28-0.30), female sex (OR 0.89, 95% CI 0.86-0.93), lower income (OR 0.79, 95% CI 0.76-0.82) and educational level (OR 0.77, 95% CI 0.73-0.81), higher EF [HFmrEF (OR 0.65, 95% CI 0.62-0.68) and HFpEF (OR 0.56, 95% CI 0.53-0.58) vs. HFrEF], and higher comorbidity burden, such as presence of kidney disease (OR 0.91, 95% CI 0.87-0.95), atrial fibrillation (OR 0.85, 95% CI 0.81-0.89), and diabetes mellitus (OR 0.92, 95% CI 0.88-0.96). A planned follow-up in specialty care was independently associated with lower risk of all-cause [hazard ratio (HR) 0.78, 95% CI 0.76-0.80] and cardiovascular death (HR 0.76, 95% CI 0.73-0.78) across the EF spectrum, but not of HF hospitalization (HR 1.06, 95% CI 1.03-1.10). Conclusions In a large nationwide HF population, referral to specialty care was linked with male sex, younger age, lower EF, lower comorbidity burden, better socioeconomic environment and optimized HF care, and associated with better survival across the EF spectrum. Our findings highlight the need for greater and more equal access to HF specialty care and improved quality of primary care.

    Fulltekst (pdf)
    fulltext
  • 670.
    Lindell Pettersson, Malin
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Nedstrand, Elisabeth
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Bladh, Marie
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Svanberg, Agneta Skoog
    Uppsala Univ, Sweden.
    Lampic, Claudia
    Karolinska Inst, Sweden; Uppsala Univ, Sweden.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Mothers who have given birth at an advanced age - health status before and after childbirth2020Inngår i: Scientific Reports, E-ISSN 2045-2322, Vol. 10, nr 1, artikkel-id 9739Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Women postpone childbirth to an age when morbidity is higher and fertility has decreased and yet the knowledge of mothers morbidity related to age remains scarce. Swedish national register data from the Medical Birth Register and National Patient Register was used to investigate the incidence of diseases listed in the International Classification of Diseases, version 10 (ICD-10) in women who gave birth 2007-8. The index group consisted of women 40 years of age or older (n=8 203) were compared to a control group of women, younger than 40 years (n=15 569) at childbirth. The period studied was five years before childbirth to five years after. The main outcome measures were incidence of disease diagnosed in specialized hospital care. Demographical data and use of assisted reproduction (ART) were adjusted for. The results showed that older women were more likely to be single; less frequently used tobacco; were educated on a higher level; had a higher BMI and more often had used ART to become pregnant. The older women showed a higher morbidity rate. In the diagnostic groups: Neoplasms, Blood and immune system, Eye and adnexa, Ear and mastoid, Circulatory, Digestive, Skin and subcutaneous tissue, Musculoskeletal and connective tissue, and Genitourinary. The results add to the body of knowledge of a number of specific risks faced by older mothers and may be used to identify preventive actions concerning fertility and morbidity both before and after childbirth.

    Fulltekst (pdf)
    fulltext
  • 671.
    Lindgren, Anne
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Torstensson, Thomas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Kristiansson, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Kan laserbehandling hjälpa vid kvarstående foglossning/bäckensmärta?: En randomiserad kontrollerad trippelblind studie2015Annet (Annet (populærvitenskap, debatt, mm))
  • 672.
    Lindholm, Elisabeth S
    et al.
    Division of Obstetrics and Gynecology, Department of Clinical Science, Karolinska Institutet.
    Altman, Daniel
    Division of Obstetrics and Gynecology, Department of Clinical Science, Karolinska Institutet.
    Norman, Margareta
    Division of Obstetrics and Gynecology, Department of Clinical Science, Karolinska Institutet.
    Blomberg, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Health Care Consumption during Pregnancy in relation to Maternal Body Mass Index: A Swedish Population Based Observational Study2015Inngår i: Journal of Obesity, ISSN 2090-0708, E-ISSN 2090-0716, Vol. 2015, s. 7-, artikkel-id 215683Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To assess whether antenatal health care consumption is associated with maternal body mass index (BMI). Design. A register based observational study. Methods. The Swedish Medical Birth Register, the Maternal Health Care Register, and the Inpatient Register were used to determine antenatal health care consumption according to BMI categories for primiparous women with singleton pregnancies, from 2006 to 2008, . Pairwise comparisons among BMI groups are obtained post hoc by Tukey HSD test. Result. Obese women were more often admitted for in-patient care (), had longer antenatal hospital stays (), and were more often sick-listed by an obstetrician () during their pregnancy, compared to women with normal weight women. Preeclampsia was more than four times as common, hypertension five times as common, and gestational diabetes 11 times as common when comparing in-patient care, obese to normal weight women ( for all comparisons). Underweight mothers had longer stay in hospitals () and hydronephrosis and hyperemesis gravidarum were more than twice as common (both ). Conclusion. Obese and underweight mothers consumed significantly more health care resources and obese women were significantly more often sick-listed during their pregnancy when compared to pregnant women of normal weight.

    Fulltekst (pdf)
    fulltext
  • 673. Lindholm, Torun
    et al.
    Sjöberg, Rickard
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Memon, Amina
    Misreporting signs of child abuse: The role of decision-making and outcome information2014Inngår i: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 55, nr 1, s. 1-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Two studies provided evidence that a decision to report an ambiguous case of child abuse affected subsequent memory of the case information, such that participants falsely recognized details that were not presented in the original information, but that are schematically associated with child abuse. Moreover, post-decision information that the child had later died from abuse influenced the memory reports of participants who had chosen not to report the case, increasing their reports of false schema-consistent details. This suggests that false decision-consistent memories are primarily due to sense-making, schematic processing rather than the motivation to justify the decision. The present findings points to an important mechanism by which decision information can become distorted in retrospect, and emphasize the difficulties of improving future decision-making by contemplating past decisions. The results also indicate that decisions may generate false memories in the apparent absence of external suggestion or misleading information. Implications for decision-making theory, and applied practices are discussed.

  • 674.
    Lindh-Åstrand, Lotta
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Spetz, Anna-Clara
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institute, Sweden.
    Carlbring, Per
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Psychology, Stockholm University, Sweden..
    Nedstrand, Elisabeth
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Internet-delivered applied relaxation for vasomotor symptoms in postmenopausal women: Lessons from a failed trial.2015Inngår i: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 80, nr 4, s. 432-434Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Internet-delivered therapies have a short history and promising results have been shown for several health problems, particularly for psychiatric conditions. This study was a first attempt to evaluate whether Internet-delivered applied relaxation for hot flushes in postmenopausal women may be useful. Due to a high drop-out rate the study was prematurely terminated after inclusion of approximately two thirds of calculated women. The Internet-delivered applied relaxation must probably be modified for such populations and settings before it can be used further. This article will discuss the benefits and pitfalls to learn in order to meet the challenges of future studies.

  • 675.
    Lindqvist, Sanna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hälsoeffekter av deltagande i livsstilsprogram i primärvård - en pilotstudie2015Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 676.
    Lindstedt, Katarina
    Örebro universitet, Institutionen för medicinska vetenskaper.
    A life put on hold: inside and outside perspectives on illness, treatment, and recovery in adolescents with restrictive eating disorders2019Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The overall aim of this thesis was to study adolescents with restrictive eating disorders in relation to illness, treatment, and recovery from an inside and outside perspective. Studies I and II are based on data from a national quality register for eating-disorder treatment. Studies III and IV are based on interviews with adolescents previously treated in outpatient care for a restrictive eating disorder. The results showed that 55% of the adolescents were in remission at the end of treatment, and 85% were within a healthy weight range. The average treatment duration was 15 months. Over the years 1999–2014, remission rates and weight recovery increased, whereas treatment duration decreased. Young patients who received mainly family-based treatment had the highest probability of achieving remission at one-year followup, but the patients themselves were most satisfied with individual therapy. The interviews with the adolescents revealed that they often felt a strong ambivalence during the first treatment sessions, both regarding being defined as sick and the involvement of their parents. In retrospect they believed that family involvement was important, but that individual treatment sessions were crucial. The informants highlighted that trust in the therapist was the key to successful treatment. The adolescents’ narratives drew a picture of a life that was “put on hold” during the time of illness, as their involvement in social contexts outside the family was strongly influenced. It was in these contexts that their problems first became visible, and the quality of their interpersonal relationships played a great role in the recovery process. The results suggest that treatment for adolescents with restrictive eating disorders should be better adapted to changed social structures and patients’ individual contexts – a relevant area for future research.

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    A life put on hold - inside and outside perspectives on illness, treatment and recovery in adolescents with restrictive eating disorders
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  • 677.
    Lindström, Caisa
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Burnout in parents of chronically ill children2016Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Parents of children with a chronic disease are usually highly involved in their child’s treatment and may be affected by the heavy demands and constant stress. This can increase the risk of developing burnout, which is an individual reaction to long-term stress consisting of symptoms associated with emotional exhaustion, as well as physical and cognitive fatigue. The overall aim was to estimate the prevalence of burnout in parents of children with Type 1 Diabetes Mellitus (T1DM) and inflammatory bowel disease (IBD) (paper I), identify the risk factors associated with parenting a child with T1DM (paper II), explore how mothers suffering from burnout describe their mothering of a child with diabetes, with special focus on their need for control and Performance-based self-esteem (PBSE) (paper IV), and to evaluate the effect of a group intervention aimed at reducing stress-related symptoms (paper III). A total of 251 parents of children with T1DM, 38 parents of children with IBD and 124 parents of healthy children participated in a population-based study (I, II). The validated Shirom-Melamed Burnout Questionnaire (SMBQ) was used to assess burnout. 16 parents (SMBQ ≥3.75) participated in a group intervention and were evaluated for changes in SMBQ and PBSE (III). A total of 21 mothers of children with T1DM who scored for clinical burnout (SMBQ) participated in a qualitative study. Semi-structured interviews were conducted and Inductive content analysis was used (IV). In the study group 36.0% parents of children with a chronic disease scored for clinical burnout (SMBQ ≥3.75) compared to 20.2% of the reference parents (p=0.001) with a preponderance of mothers compared to fathers, 42% vs. 20.5% (p=0.001), respectively (I). Less support from the social network, sleep disturbances and lack of personal leisure time and recovery seem to be important risk factors for clinical burnout in parents of children with T1DM, especially mothers (II). Mothers’ experiences of mothering a child with T1DM were interpreted as one theme; Mission impossible, illustrating the extremely difficult circumstances under which they bring up the child with diabetes to adulthood (IV). Parents’ subjective evaluation of the intervention group was mainly positive and SMBQ (p=0.01) and PBSE scale (p= 0.04) measurements were significantly reduced 6 months after completion of the intervention (III). It is important to pay attention to how parents and especially mothers experience their daily life in order to support those who are at risk of developing burnout.

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  • 678.
    Lindström, Caisa
    et al.
    Örebro universitet, Hälsoakademin. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Åman, Jan
    Örebro universitet, Hälsoakademin. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Lindahl Norberg, Annika
    Karolinska Institute, Stockholm, Sweden.
    Increased prevalence of burnout symptoms in parents of chronically ill children2010Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, nr 3, s. 427-432Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To examine the prevalence of burnout symptoms in the context of parenting a chronically ill child. Methods: A total of 252 parents of children with Type 1 Diabetes Mellitus and 38 parents of children with Inflammatory Bowel Diseases participated in a population-based study. A control group consisted of 124 randomly selected parents of healthy children. We used self-report questionnaires to assess symptoms of burnout. Results: The main finding was that significantly more parents of children with chronic diseases (36%) scored for clinical burnout, compared with parents of healthy children (20%). Burnout symptoms were most prominent among mothers of children with diabetes, although fathers of children with diabetes and mothers and fathers of children with inflammatory bowel diseases also reported higher levels of various burnout symptoms. Conclusion: Burnout may be a useful model for understanding long-term parental responses and should be acknowledged among the different types of psychological consequences of the multi-faceted experience of parenting a child with chronic illness. Gender seems to influence the risk of burnout symptoms. Continued research about other background factors, and how the parents' situation changes over time are warranted. In the clinic, we need to draw attention to the group of parents who may suffer from burnout.

  • 679.
    Lindström, Caisa
    et al.
    Örebro universitet, Hälsoakademin.
    Åman, Jan
    Örebro universitet, Hälsoakademin.
    Lindahl Norberg, Annika
    Parental burnout in relation to sociodemographic, psychosocial and personality factors as well as disease duration and glycaemic control in children with Type 1 diabetes mellitus2011Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, nr 7, s. 1011-1017Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To examine associations between burnout and sociodemographic, psychosocial, personality and medical factors in parents of children with Type 1 Diabetes Mellitus (T1DM). Methods: A total of 252 parents of children with T1DM participated in a population-based study. We used self-report questionnaires to assess symptoms of burnout and background factors. Results: Psychosocial background factors were significantly associated with burnout in parents, whereas there were no associations between sociodemographic or medical factors and burnout. For both genders, parental burnout was associated with low social support, lack of leisure time, financial concerns and a perception that the child's disease affects everyday life. Low self-esteem and high need for control were risk factors for maternal burnout. Conclusion: In the screening of risk factors for long-term stress in parents of children with T1DM, we should recognize parents' attitudes as well as situational psychosocial issues. In clinics, we need to pay attention to the day-to-day life circumstances in the support of these parents. Certain factors were associated with the risk for burnout only for mothers, which warrant further investigation of gender aspects. Continued research about the causal relationship between the parental responsibility, psychosocial factors and burnout is warranted.

  • 680.
    Lindström, Caisa
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Pediatrics.
    Åman, Jan
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Pediatrics.
    Lindahl Norberg, Annika
    Centre for occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden; Karolinska Institute, Stockholm, Sweden.
    Forssberg, M.
    Department of Pediatrics, Central hospital, Karlstad.
    Anderzén - Carlsson, Agneta
    Örebro universitet, Institutionen för hälsovetenskap och medicin. University Health Care Research Center, Region Örebro County, Örebro Sweden.
    “Mission impossible”: The mothering of a child with diabetes type 1 - from the perspective of mothers suffering from burnoutManuskript (preprint) (Annet vitenskapelig)
  • 681.
    Lindström, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Bodlund, Owe
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Hamberg, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Professionell utveckling: Så förs ämnet stegvis in i läkarutbildningen i Umeå2008Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, nr 12-13, s. 909-913Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Since the early 90's a course called Professional Development (PD) runs through all terms of Medical School in Umeå. The course has continuously been reformed on the basis of course evaluations. Today there is a well-reasoned progression in the curricula to synthesize students' actual knowledge level, skills, and attitudes into professionalism. The teaching items and the pedagogical methods in PU all aim to develop the students' reflective stance, gender awareness, empathy, ethical reasoning and consultations skills. Taking communication as an example: During the first terms, theories and small-group training sessions are introduced. By clinical courses, students video-tape their own consultations and get structured feedback in tutor-guided groups. The last terms, role plays on difficult clinical situations are staged for training, but also to challenge attitudes on for instance ethnicity and sexuality. Finally, insights in communication theories and their applicability are examined in a written video case exam.

  • 682. Linton, Steven J
    et al.
    Kecklund, Göran
    Franklin, Karl A
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Leissner, Lena C
    Sivertsen, Børge
    Lindberg, Eva
    Svensson, Anna C
    Hansson, Sven O
    Sundin, Örjan
    Hetta, Jerker
    Björkelund, Cecilia
    Hall, Charlotte
    The effect of the work environment on future sleep disturbances: a systematic review2015Inngår i: Sleep Medicine Reviews, ISSN 1087-0792, E-ISSN 1532-2955, Vol. 23, s. 10-19Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Workers often attribute poor sleep to factors at work. Despite the large number of workers with sleep disturbances, there is a lack of consensus on the relationship between the work environment and sleep. The purpose of this systematic review therefore was to conduct a comprehensive evaluation. To this end, we employed standardized methods to systematically locate, review, and tabulate the results of prospective or randomized studies of the impact of work factors on sleep disturbances. From the 7981 articles located in five databases, 24 fulfilled our inclusion criteria and formed the base of the review including meta-analyses of the effect sizes. Results showed that the psychosocial work variables of social support at work, control, and organizational justice were related to fewer sleep disturbances, while high work demands, job strain, bullying, and effort-reward imbalance were related to more future sleep disturbances. Moreover, working a steady shift was associated with disturbances while exiting shift work was associated with less disturbed sleep. We conclude that psychosocial work factors and the scheduling of work have an impact on sleep disturbances and this might be utilized in the clinic as well as for planning work environments. Future research needs to employ better methodology and focus on underlying mechanisms.

  • 683.
    Linton, Steven J.
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Kienbacher, Thomas
    Karl Landsteiner Institute for Outpatient Rehabilitation Research, Vienna, Austria.
    Psychological Subgrouping to Assess the Risk for the Development or Maintenance of Chronic Musculoskeletal Pain: Is This the Way Forward?2020Inngår i: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 36, nr 3, s. 172-177Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Because musculoskeletal pain problems are so prevalent, new methods of evaluating and treating patients are needed to increase effectiveness. Subgrouping is a method wherein patients are classified into defined groups on the basis of psychosocial factors with the expectation of more specific and tailored treatments can be prescribed for them. For those seeking care for a new episode, the risk of developing chronic pain-related disability is assessed, whereas, for those with existing pain, the risk for the maintenance of the chronic pain problem is evaluated.

    AIM: The purpose of this narrative review is to examine how patients are classified into subgroups with regard to methods of evaluation and to ascertain whether subgrouping actually facilitates treatment.

    RESULTS: For the development of disability, screening tools, for example, the Örebro Musculoskeletal Pain Screening Questionnaire, accurately stratify patients into groups (eg, high, medium, low risk) that predict future pain-related work disability. In addition, several studies show that treatments that directly key in on risk groups enjoy enhanced outcomes compared with treatment as usual. For the maintenance of chronic musculoskeletal pain problems, there are several instruments that classify patients into specific groups or profiles, for example, on the basis of the avoidance and endurance model or the International Classification of Functioning, Disability and Health (ICF) assessment. Although some evidence shows that these classifications are related to treatment outcome, we found no study that directly tested a system for providing treatment matched to the subgrouping for maintenance.

    CONCLUSIONS: We conclude that it is possible to reliably subgroup patients with musculoskeletal problems. Likewise, treatments that address the risk factors in the screening procedure may enhance outcomes compared with treatment as usual. More work is needed, however, to better understand the mechanism, so that assessment methods can be improved, and treatment specific to subgroups can be developed and evaluated.

  • 684.
    Lisspers, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Organisation of Asthma in Primary Care, Quality of Life and Sex-related Aspects in Asthma Outcomes2008Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Objectives: To investigate the organisation of asthma care in primary care and evaluate outcomes for patients attending primary care centres with and without asthma clinics.

    Other objectives were to study the association between quality of life and asthma control in patients in primary care and to analyse sex differences regarding asthma outcomes related to menopausal status.

    Material and methods: Cross-sectional surveys and a patient record study.

    Results: Of all the primary health care centres, 77% had a spirometer and 53% an asthma clinic. At centres with asthma clinics 77% of the patients reported sufficient knowledge of asthma as compared with 65% at centres without asthma clinics (p<0.001). With more time allocated for the nurse, 44% of patients achieved asthma control as compared with 27% at asthma clinics with less time (p<0.003). Patients using short-acting beta-2 agonists more than twice in the last week had clinically significant lower MiniAQLQ scores (5.17 versus 5.91). This finding also held for night awakenings during the previous week (4.42 versus 5.86), courses of oral corticosteroids (5.26 versus 5.64) and reported emergency consultations during the last six months (4.85 versus 5.71). Premenopausal women had significantly lower total MiniAQLQ scores than men in the same age group (5.44 versus 5.89, p<0.001), while no difference was found between postmenopausal women and men of similar ages. The adjusted odds for premenopausal women for asthma exacerbations was 2.0 (95%CI 1.22-3.43) as compared with men in the same age group. No differences were found when comparing postmenopausal women with men of similar ages.

    Conclusions: Half the primary health care centres had an asthma clinic and the majority had access to a spirometer. Patients at primary health care centres with asthma clinics reported better knowledge of their disease, and asthma control is more often achieved if the nurse is allocated more time. Achieving asthma control is associated with better quality of life in patients in primary care. Premenopausal women had lower quality of life and less often asthma control then men of the same ages, while no corresponding difference was found between postmenopausal women and men of similar ages.

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  • 685.
    Lisspers, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Teixeira, Pedro
    Univ Minho, Sch Hlth Sci, Life & Hlth Sci Res Inst ICVS, ICVS PT Govt Associate Lab 3Bs, Braga, Portugal..
    Blom, Coert
    Radboud Univ Nijmegen, Dept Primary & Community Care, NL-6525 ED Nijmegen, Netherlands..
    Kocks, Janwillem
    Univ Groningen, Univ Med Ctr Groningen, Dept Gen Practice, Groningen, Netherlands.;Univ Groningen, Univ Med Ctr Groningen, GRIAC Res Inst Groningen, Groningen, Netherlands..
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Price, David
    Univ Aberdeen, Div Appl Hlth Sci, Acad Primary Care, Aberdeen, Scotland..
    Chavannes, Niels
    Leiden Univ, Med Ctr, Publ Hlth & Primary Care, Leiden, Netherlands..
    Are pharmacological randomised controlled clinical trials relevant to real-life asthma populations?: A protocol for an UNLOCK study from the IPCRG2016Inngår i: npj Primary Care Respiratory Medicine, E-ISSN 2055-1010, Vol. 26, artikkel-id 16016Artikkel i tidsskrift (Fagfellevurdert)
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  • 686.
    Ljungvall, Hanna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Lind, Anne-Li
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Zetterberg, Hedvig
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Wagner, Sofia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Ekselius, Lisa
    Uppsala universitet, WoMHeR (Centre for Women’s Mental Health during the Reproductive Lifespan).
    Karlsten, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Klinisk smärtforskning.
    Heilig, Markus
    Linköpings Univ, Dept Biomed & Clin Sci, Linköping, Sweden.
    Åsenlöf, Pernilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    U-PAIN cohort study among patients with chronic pain in specialised pain care: a feasibility study2022Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 12, artikkel-id e062265Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To examine acceptability of study participation and feasibility of (1) recruitment, (2) data collection and (3) outcome measures for the prospective U-PAIN cohort.

    Design: Internal feasibility study of a prospective cohort.

    Participants and setting: 64 patients, >18 years, with chronic pain at a multidisciplinary pain centre at a university hospital in Sweden.

    Outcome measures: Acceptability of study participation was measured with a study-specific 10-item Likert scale. A score <3 was considered feasible, for the two items that assessed respondent burden a higher score indicated lesser participant burden and a score >3 was feasible. Recruitment was assessed by participation rates at baseline and retention at the 1-year follow-up, with threshold values for feasibility at 75% and 80%, respectively. Data collection and outcome measures were examined by completions rates of study procedures (90% was considered feasible), sample scores, internal consistency (alpha>0.70 was considered feasible), and agreement between self-reported data and data retrieved from medical records on opioid use (ICC or kappa>0.60 was considered feasible).

    Results: Acceptability for study procedures was feasible, but participation rates were low: 25%. The retention rate at 1-year follow-up was 81% for those included in the feasibility study, that is, filling out computerised patient-reported outcome measures, and 65% for those using paper and pencil format. The completion rates for the different data collection methods ranged from 83% to 95%. Agreement between self-reported opioid use and prescribed dose and between opioid use disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and clinical International Classification of Diseases-10 (ICD-10) diagnoses for opioid dependence were almost perfect (kappa=0.91and kappa=0.90, respectively).

    Conclusions: This feasibility study has helped to explore and improve methods for recruitment, data collection and use of outcome measures for the U-PAIN cohort. Low participation rate and high refusal rate at baseline is a challenge that needs to be further addressed.

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  • 687.
    Lodin, Karin
    et al.
    Karolinska Institute, Care Sciences and Society, Department of Neurobiology; Karolinska Institute, Department of Clinical Neuroscience.
    Lekander, Mats
    Karolinska Institute, Department of Clinical Neuroscience; Stockholm University, Stress Research Institute.
    Syk, Jörgen
    Karolinska Institute, Care Sciences and Society, Department of Neurobiology; Karolinska Institute, Centre for Allergy Research; Academic Primary Health Care Centre, Stockholm.
    Alving, Kjell
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnors och barns hälsa), Pediatrisk inflammationsforskning.
    Andreasson, Anna
    Karolinska Institute, Care Sciences and Society, Department of Neurobiology; Stockholm University, Stress Research Institute; Macquarie University, Department of Psychology.
    Associations between self-rated health, sickness behaviour and inflammatory markers in primary care patients with allergic asthma: a longitudinal study2017Inngår i: npj Primary Care Respiratory Medicine, E-ISSN 2055-1010, Vol. 27, artikkel-id 67Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Allergic asthma is a chronic inflammatory disorder associated with elevated levels of immunoglobulin E (IgE), serum eosinophilic cationic protein (S-ECP), plasma eosinophil-derived neurotoxin (P-EDN) and fraction of exhaled nitric oxide (FENO). Poor self-rated health and sickness behaviour has repeatedly been associated with inflammatory markers, but the nature of this relationship in chronic inflammatory disease is not known. Likewise, such findings largely rely on cross-sectional investigations. Self-rated health (How would you rate your general state of health?), sickness behaviour (mean rating of satisfaction with energy, sleep, fitness, appetite and memory), IgE, S-ECP, P-EDN, and FENO were assessed in 181 non-smoking primary care patients with asthma in a 1-year longitudinal study. Associations between repeated measurements were calculated using mixed regression models and Spearman’s correlations for change scores. Poor self-rated health was associated with high levels of seasonal IgE (p = 0.05) and food IgE (p = 0.04), but not total IgE or inflammatory markers. An increase over 1 year in perennial IgE was associated with a worsening of self-rated health (ρ = 0.16, p = 0.04). Poor self-rated health was associated with more pronounced sickness behaviour (p < 0.001), and a worsening in sickness behaviour was associated with a worsening of self-rated health over time (ρ = 0.21, p = 0.007). The study corroborates the importance of sickness behaviour as a determinant of self-rated health by showing that these factors co-vary over a 1-year period in a group of patients with allergic asthma. The importance of specific IgE for perceived health in primary care patients with mild to moderate asthma needs further investigation.

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  • 688.
    Loikas, Desirée
    et al.
    Department of Medicine, Centre for Pharmacoepidemiology (CPE), Solna Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Healthcare Development, Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden.
    Wettermark, Björn
    Department of Medicine, Centre for Pharmacoepidemiology (CPE), Solna Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Healthcare Development, Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden; Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    von Euler, Mia
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Bergman, Ulf
    Department of Medicine, Centre for Pharmacoepidemiology (CPE), Solna Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Schenck-Gustafsson, Karin
    Department of Medicine, Cardiac Unit and Centre for Gender Medicine, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden.
    Differences in drug utilisation between men and women: a cross-sectional analysis of all dispensed drugs in Sweden2013Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 3, nr 5, artikkel-id e002378Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: Ascertain the extent of differences between men and women in dispensed drugs since there is a lack of comprehensive overviews on sex differences in the use of prescription drugs.

    DESIGN: Cross-sectional population database analysis.

    METHODS: Data on all dispensed drugs in 2010 to the entire Swedish population (9.3 million inhabitants) were obtained from the Swedish Prescribed Drug Register. All pharmacological groups with ambulatory care prescribing accounting for >75% of the total volume in Defined Daily Doses and a prevalence of >1% were included in the analysis. Crude and age-adjusted differences in prevalence and incidence were calculated as risk ratios (RRs) of women/men.

    RESULTS: In all, 2.8 million men (59%) and 3.6 million women (76%) were dispensed at least one prescribed drug during 2010. Women were dispensed more drugs in all age groups except among children under the age of 10. The largest sex difference in prevalence in absolute numbers was found for antibiotics that were more common in women, 265.5 patients (PAT)/1000 women and 191.3 PAT/1000 men, respectively. This was followed by thyroid therapy (65.7 PAT/1000 women and 13.1 PAT/1000 men) and antidepressants (106.6 PAT/1000 women and 55.4 PAT/1000 men). Age-adjusted relative sex differences in prevalence were found in 48 of the 50 identified pharmacological groups. The pharmacological groups with the largest relative differences of dispensed drugs were systemic antimycotics (RR 6.6 CI 6.4 to 6.7), drugs for osteoporosis (RR 4.9 CI 4.9 to 5.0) and thyroid therapy (RR 4.5 CI 4.4 to 4.5), which were dispensed to women to a higher degree. Antigout agents (RR 0.4 CI 0.4 to 0.4), psychostimulants (RR 0.6 CI 0.6 to 0.6) and ACE inhibitors (RR 0.7 CI 0.7 to 0.7) were dispensed to men to a larger proportion.

    CONCLUSIONS: Substantial differences in the prevalence and incidence of dispensed drugs were found between men and women. Some differences may be rational and desirable and related to differences between the sexes in the incidence or prevalence of disease or by biological differences. Other differences are more difficult to explain on medical grounds and may indicate unequal treatment.

  • 689. Long, G H
    et al.
    Johansson, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Rolandsson, Olov
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Fhärm, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Griffin, S J
    Simmons, R K
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Healthy behaviours and 10-year incidence of diabetes: a population cohort study2015Inngår i: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 71, s. 121-127Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To examine the association between meeting behavioural goals and diabetes incidence over 10years in a large, representative Swedish population.

    METHODS: Population-based prospective cohort study of 32,120 individuals aged 35 to 55years participating in a health promotion intervention in Västerbotten County, Sweden (1990 to 2013). Participants underwent an oral glucose tolerance test, clinical measures, and completed diet and activity questionnaires. Poisson regression quantified the association between achieving six behavioural goals at baseline - body mass index (BMI) <25kg/m(2), moderate physical activity, non-smoker, fat intake <30% of energy, fibre intake ≥15g/4184kJ and alcohol intake ≤20g/day - and diabetes incidence over 10years.

    RESULTS: Median interquartile range (IQR) follow-up time was 9.9 (0.3) years; 2211 individuals (7%) developed diabetes. Only 4.4% of participants met all 6 goals (n=1245) and compared to these individuals, participants meeting 0/1 goals had a 3.74 times higher diabetes incidence (95% confidence interval (CI)=2.50 to 5.59), adjusting for sex, age, calendar period, education, family history of diabetes, history of myocardial infarction and long-term illness. If everyone achieved at least four behavioural goals, 14.1% (95% CI: 11.7 to 16.5%) of incident diabetes cases might be avoided.

    CONCLUSION: Interventions promoting the achievement of behavioural goals in the general population could significantly reduce diabetes incidence.

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  • 690.
    Lopez-Fauqued, Marta
    et al.
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium.
    Campora, Laura
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium.
    Delannois, Frederique
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium.
    El Idrissi, Mohamed
    GSK, Rixensart, Belgium.
    Oostvogels, Lidia
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium;CureVac AG, Tubingen, Germany.
    De Looze, Ferdinandus J.
    AusTrials Pty Ltd, Sherwood, Qld, Australia;Univ Queensland, Sch Med, Brisbane, Qld, Australia.
    Diez-Domingo, Javier
    Fdn Fomento Invest Sanitaria & Biomed, Vaccine Res Unit, Valencia, Spain.
    Heineman, Thomas C.
    GSK, King Of Prussia, PA USA;Halozyme Therapeut, San Diego, CA USA.
    Lal, Himal
    GSK, King Of Prussia, PA USA;Pfizer Vaccine Inc, Collegeville, PA USA.
    McElhaney, Janet E.
    Hlth Sci North Res Inst, Sudbury, ON, Canada.
    McNeil, Shelly A.
    Dalhousie Univ, Canadian Ctr Vaccinol, Halifax, NS, Canada;Dalhousie Univ, IWK Hlth Ctr, Halifax, NS, Canada;Dalhousie Univ, Nova Scotia Hlth Author, Halifax, NS, Canada.
    Yeo, Wilfred
    Univ Wollongong, Sch Med, Wollongong, NSW, Australia.
    Tavares-Da-Silva, Fernanda
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium.
    Ahonen, Anitta
    Univ Tampere, Jarvenpaa Vaccine Clin, Tampere, Finland.
    Avelino-Silva, Thiago Junquera
    Univ Sao Paulo, Sch Med, Sao Paulo, Brazil.
    Fernando Barba-Gomez, Jose
    Inst Dermatol Jalisco, Guadalajara, Jalisco, Mexico.
    Berglund, Johan
    Blekinge Inst Technol, Karlskrona, Sweden.
    Brotons Cuixart, Carlos
    EAP Sardenya, Barcelona, Spain.
    Caso, Covadonga
    Hosp Clin San Carlos, Madrid, Spain.
    Chlibek, Roman
    Univ Def, Fac Mil Hlth Sci, Brno, Czech Republic.
    Choi, Won Suk
    Korea Univ, Coll Med, Seoul, South Korea.
    Cunningham, Anthony L.
    Univ Sydney, Westmead Inst Med Res, Sydney, NSW, Australia.
    Desole, Maria Guiseppina
    Serv Igiene Pubbl, Sassari, Italy.
    Eizenberg, Peter
    Doctors Ivanhoe, Ivanhoe, Australia.
    Esen, Meral
    Univ Clin Tubingen, Inst Tropenmed, Tubingen, Germany.
    Espie, Emmanuelle
    GSK, Brussels, Belgium.
    Gervais, Pierre
    Q&T Res Sherbrooke, Sherbrooke, PQ, Canada.
    Ghesquiere, Wayne
    Univ British Columbia, Vancouver, BC, Canada.
    Godeaux, Olivier
    GSK, Brussels, Belgium.
    Gorfinkel, Iris
    York Univ, N York, ON, Canada.
    Hui, David Shu Cheong
    Prince Wales Hosp, Hong Kong, Peoples R China.
    Hwang, Shinn-Jang
    Taipei Vet Gen Hosp, Taipei, Taiwan;Natl Yang Ming Univ, Sch Med, Taipei, Taiwan.
    Korhonen, Tiina
    Univ Tampere, Sch Med, Vaccine Res Ctr, Tampere, Finland.
    Kovac, Martina
    GSK, New York, NY USA.
    Ledent, Edouard
    GSK, Rixensart, Belgium.
    Leung, Edward
    Hong Kong Assoc Gerontol, Hong Kong, Peoples R China.
    Levin, Myron J.
    Univ Colorado, Anschutz Med Campus, Aurora, CO USA.
    Narejos Perez, Silvia
    CAP Centelles, Centelles, Spain.
    Neto, Jose Luiz
    Inst AZ Pesquisa & Ensino, Curitiba, Parana, Brazil.
    Pauksen, Karlis
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Infektionssjukdomar.
    Poder, Airi
    Kliiniliste Uuringute Keskus, Tartu, Estonia.
    Rodriguez de la Pinta, Maria Luisa
    Hosp Puerta de Hierro, Madrid, Spain.
    Rombo, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Schwarz, Tino F.
    Standort Juliusspital, Wurzburg, Germany.
    Smetana, Jan
    Univ Def, Fac Mil Hlth Sci, Brno, Czech Republic.
    Staniscia, Tommaso
    Univ G dAnnunzio, Chieti, Italy.
    Tinoco, Juan Carlos
    Hosp Gen Durango, Durango, Mexico.
    Toma, Azhar
    Manna Res, Toronto, ON, Canada.
    Vastiau, Ilse
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium.
    Vesikari, Timo
    Univ Tampere, Tampere, Finland.
    Volpi, Antonio
    AO Univ Policlin Tor Vergata, Rome, Italy.
    Watanabe, Daisuke
    Kobe Univ, Grad Sch Med, Kobe, Hyogo, Japan.
    Weckx, Lily Yin
    Univ Fed Sao Paulo, Sao Paulo, Brazil.
    Zahaf, Toufik
    GSK, Brussels, Belgium.
    Safety profile of the adjuvanted recombinant zoster vaccine: Pooled analysis of two large randomised phase 3 trials2019Inngår i: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 37, nr 18, s. 2482-2493Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The ZOE-50 (NCT01165177) and ZOE-70 (NCT01165229) phase 3 clinical trials showed that the adjuvanted recombinant zoster vaccine (RZV) was >= 90% efficacious in preventing herpes zoster in adults. Here we present a comprehensive overview of the safety data from these studies.

    Methods: Adults aged >= 50 (ZOE-50) and >= 70 (ZOE-70) years were randomly vaccinated with RZV or placebo. Safety analyses were performed on the pooled total vaccinated cohort, consisting of participants receiving at least one dose of RZV or placebo. Solicited and unsolicited adverse events (AEs) were collected for 7 and 30 days after each vaccination, respectively. Serious AEs (SAEs) were collected from the first vaccination until 12 months post-last dose. Fatal AEs, vaccination-related SAEs, and potential immune-mediated diseases (pIMDs) were collected during the entire study period.

    Results: Safety was evaluated in 14,645 RZV and 14,660 placebo recipients. More RZV than placebo recipients reported unsolicited AEs (50.5% versus 32.0%); the difference was driven by transient injection site and solicited systemic reactions that were generally seen in the first week post-vaccination. The occurrence of overall SAEs (RZV: 10.1%; Placebo: 10.4%), fatal AEs (RZV: 4.3%; Placebo: 4.6%), and pIMDs (RZV: 1.2%; Placebo: 1.4%) was balanced between groups. The occurrence of possible exacerbations of pIMDs was rare and similar between groups. Overall, except for the expected local and systemic symptoms, the safety results were comparable between the RZV and Placebo groups irrespective of participant age, gender, or race.

    Conclusions: No safety concerns arose, supporting the favorable benefit-risk profile of RZV. 

    Fulltekst (pdf)
    FULLTEXT01
  • 691.
    Low, Nicola
    et al.
    Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
    Unemo, Magnus
    Region Örebro län. World Health Org Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Örebro University Hospital, Örebro, Sweden.
    Jensen, Jorgen Skov
    Dept Microbiol & Infect Control, Statens Serum Inst, Copenhagen, Denmark.
    Breuer, Judith
    Div Infect & Immun, Medical Research Council (MRC) UCL Ctr Med Mol Virol, University College London, London, England.
    Stephenson, Judith M.
    Inst Womens Hlth, University College London, London, England.
    Molecular Diagnostics for Gonorrhoea: Implications for Antimicrobial Resistance and the Threat of Untreatable Gonorrhoea2014Inngår i: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 11, nr 2, artikkel-id e1001598Artikkel i tidsskrift (Fagfellevurdert)
  • 692.
    Lowden, Arne
    et al.
    Stress Research Institute, University of Stockholm.
    Moreno, Claudia
    School of Public Health, University of Sao Paulo, Brazil.
    Holmbäck, Ulf
    Department of Public Health and Caring Sciences, Faculty of Medicine, Uppsala University.
    Lennernäs, Maria
    Högskolan Kristianstad, Sektionen för Hälsa och Samhälle.
    Tucker, Philip
    Department of Psychology, Swansea University, Wales, United Kingdom.
    Eating and shift work: effects on habits, metabolism and performance2010Inngår i: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 36, nr 2, s. 150-162Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Compared to individuals who work during the day, shift workers are at higher risk of a range of metabolic disorders and diseases (eg, obesity, cardiovascular disease, peptic ulcers, gastrointestinal problems, failure to control blood sugar levels, and metabolic syndrome). At least some of these complaints may be linked to the quality of the diet and irregular timing of eating, however other factors that affect metabolism are likely to play a part, including psychosocial stress, disrupted circadian rhythms, sleep debt, physical inactivity, and insufficient time for rest and revitalization. In this overview, we examine studies on food and nutrition among shift workers [ie, dietary assessment (designs, methods, variables) and the factors that might influence eating habits and metabolic parameters]. The discussion focuses on the quality of existing dietary assessment data, nutritional status parameters (particularly in obesity), the effect of circadian disruptions, and the possible implications for performance at work. We conclude with some dietary guidelines as a basis for managing the nutrition of shift workers.

  • 693.
    Ludvigsson, Jonas F.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Adami, H. O.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.
    The urgency to embrace Big Data opportunities in medicine2018Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 283, nr 5, s. 479-480Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    .

  • 694.
    Ludvigsson, Jonas F.
    et al.
    Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Green, Peter H. R.
    Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surge., New York, United States.
    The missing environmental factor in celiac disease2014Inngår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 371, nr 14, s. 1341-1343Artikkel i tidsskrift (Annet vitenskapelig)
  • 695.
    Ludvigsson, Jonas F.
    et al.
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Inghammar, M.
    Section for Respiratory Medicine AND Allergology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
    Ekberg, M.
    Section for Respiratory Medicine AND Allergology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
    Egesten, A.
    Section for Respiratory Medicine AND Allergology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
    A nationwide cohort study of the risk of chronic obstructive pulmonary disease in coeliac disease2012Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 271, nr 5, s. 481-489Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Chronic obstructive pulmonary disease (COPD) continues to be an important cause of morbidity, mortality and healthcare costs in the western world. Although smoking is an important trigger of COPD, other factors such as chronic inflammation and malnutrition are known to influence its development. Because coeliac disease (CD) is characterized both by dysregulated inflammation and malnutrition, the possibility of an association between CD and COPD was investigated.

    Methods: Through biopsy data from all Swedish pathology departments, we identified 10990 individuals with CD who were biopsied between 1987 and 2008 (Marsh 3: villous atrophy). As controls, 54129 reference individuals matched for age, sex, county and calendar year of first biopsy were selected. Cox regression analysis was then performed to estimate hazard ratios (HRs) for having a diagnosis of COPD according to the Swedish Patient Register.

    Results: During follow-up, 380 individuals with CD (3.5%) and 1391 (2.6%) controls had an incident diagnosis of COPD, which corresponds to an HR of 1.24 (95% CI: 1.10-1.38) and an excess risk of COPD of 79/100000 person-years in CD. The risk increase remained 5years after biopsy (HR=1.17; 95% CI: 1.00-1.37). Risk estimates did not change with adjustment for type 1 diabetes, thyroid disease, rheumatoid arthritis, country of birth or level of education. Men with CD were at a higher risk of COPD (HR=1.39; 95% CI: 1.18-1.62) than women with CD (HR=1.11; 95% CI: 0.94-1.30). Of note, CD was also associated with COPD before CD diagnosis (odds ratio=1.22; 95% CI: 1.02-1.46).

    Conclusion: Patients with CD seem to be at a moderately increased risk of COPD both before and after CD diagnosis.

  • 696.
    Ludvigsson, Jonas F.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, United Kingdom; Department of Medicine, Columbia University, College of Physicians and Surgeons, New York NY, United States.
    Neovius, Martin
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Sweden.
    Söderling, Jonas
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Sweden.
    Gudbjörnsdottir, Soffia
    National Diabetes Register, Centre of Registers Västra Götaland, Sweden; Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Svensson, Ann-Marie
    National Diabetes Register, Centre of Registers Västra Götaland, Sweden.
    Franzén, Stefan
    National Diabetes Register, Centre of Registers Västra Götaland, Sweden.
    Stephansson, Olof
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Pasternak, Björn
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Sweden; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
    Periconception glycaemic control in women with type 1 diabetes and risk of major birth defects: population based cohort study in Sweden2018Inngår i: The BMJ, E-ISSN 1756-1833, Vol. 362, artikkel-id k2638Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To examine the association between maternal type 1 diabetes and the risk of major birth defects according to levels of glycated haemoglobin (HbA1C) within three months before or after estimated conception.

    DESIGN: Population based historical cohort study using nationwide health registers. SETTING Sweden, 2003-15.

    PARTICIPANTS: 2458 singleton liveborn infants of mothers with type 1 diabetes and a glycated haemoglobin measurement within three months before or after estimated conception and 1 159 865 infants of mothers without diabetes.

    MAIN OUTCOME MEASURES: Major cardiac and non-cardiac birth defects according to glycated haemoglobin levels.

    RESULTS: 122 cases of major cardiac defects were observed among 2458 infants of mothers with type 1 diabetes. Compared with 15 cases of major cardiac defects per 1000 infants of mothers without diabetes, the rates among infants of mothers with type 1 diabetes were 33 per 1000 for a glycated haemoglobin level of <6.5% (adjusted risk ratio 2.17, 95% confidence interval 1.37 to 3.42), 49 per 1000 for 6.5% to <7.8% (3.17, 2.45 to 4.11), 44 per 1000 for 7.8% to <9.1% (2.79, 1.90 to 4.12), and 101 per 1000 for >= 9.1% (6.23, 4.32 to 9.00). The corresponding adjusted risk differences were 17 (5 to 36), 32 (21 to 46), 26 (13 to 46), and 77 (49 to 118) cases of major cardiac defects per 1000 infants, respectively. 50 cases of major non-cardiac defects were observed among infants of mothers with type 1 diabetes. Compared with 18 cases of major non-cardiac defects per 1000 infants of mothers without diabetes, the rates among infants of mothers with type 1 diabetes were 22 per 1000 for a glycated haemoglobin level of <6.5% (adjusted risk ratio 1.18, 0.68 to 2.07), 19 per 1000 for 6.5% to <7.8% (1.01, 0.66 to 1.54), 17 per 1000 for 7.8% to <9.1% (0.89, 0.46 to 1.69), and 32 per 1000 for >= 9.1%(1.68, 0.85 to 3.33).

    CONCLUSIONS: Among liveborn infants of mothers with type 1 diabetes, increasingly worse glycaemic control in the three months before or after estimated conception was associated with a progressively increased risk of major cardiac defects. Even with glycated haemoglobin within target levels recommended by guidelines (<6.5%), the risk of major cardiac defects was increased more than twofold. The risk of major non-cardiac defects was not statistically significantly increased at any of the four glycated haemoglobin levels examined; the study had limited statistical power for this outcome and was based on live births only.

  • 697.
    Ludvigsson, Jonas F.
    et al.
    Region Örebro län. Dept Pediat, Örebro University Hospital, Örebro, Sweden; Dept Med, Clin Epidemiol Unit, Karolinska Instute, Stockholm, Sweden; Dept Med, Div Gastroenterol & Hepatol, Coll Med, Rochester MN, USA; Dept Immunol, Div Gastroenterol & Hepatol, Coll Med, Mayo Clin, Rochester MN, USA.
    Pathak, Jyotishman
    Coll Med, Dept Hlth Sci, Mayo Clin, Rochester MN, USA.
    Murphy, Sean
    Coll Med, Dept Hlth Sci, Mayo Clin, Rochester MN, USA.
    Durski, Matthew
    Coll Med, Dept Hlth Sci, Mayo Clin, Rochester MN, USA.
    Kirsch, Phillip S.
    Coll Med, Dept Hlth Sci, Mayo Clin, Rochester MN, USA.
    Chute, Christophe G.
    Coll Med, Dept Hlth Sci, Mayo Clin, Rochester MN, USA.
    Ryu, Euijung
    Coll Med, Dept Hlth Sci, Mayo Clin, Rochester MN, USA.
    Murray, Joseph A.
    Dept Med, Div Gastroenterol & Hepatol, Coll Med, Mayo Clin, Rochester MN, USA; Coll Med, Dept Hlth Sci, Mayo Clin, Rochester MN, USA.
    Use of computerized algorithm to identify individuals in need of testing for celiac disease2013Inngår i: JAMIA Journal of the American Medical Informatics Association, ISSN 1067-5027, E-ISSN 1527-974X, Vol. 20, nr E2, s. E306-E310Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and aim Celiac disease (CD) is a lifelong immune-mediated disease with excess mortality. Early diagnosis is important to minimize disease symptoms, complications, and consumption of healthcare resources. Most patients remain undiagnosed. We developed two electronic medical record (EMR)-based algorithms to identify patients at high risk of CD and in need of CD screening. Methods (I) Using natural language processing (NLP), we searched EMRs for 16 free text (and related) terms in 216 CD patients and 280 controls. (II) EMRs were also searched for ICD9 (International Classification of Disease) codes suggesting an increased risk of CD in 202 patients with CD and 524 controls. For each approach, we determined the optimal number of hits to be assigned as CD cases. To assess performance of these algorithms, sensitivity and specificity were calculated. Results Using two hits as the cut-off, the NLP algorithm identified 72.9% of all celiac patients (sensitivity), and ruled out CD in 89.9% of the controls (specificity). In a representative US population of individuals without a prior celiac diagnosis (assuming that 0.6% had undiagnosed CD), this NLP algorithm could identify a group of individuals where 4.2% would have CD (positive predictive value). ICD9 code search using three hits as the cut-off had a sensitivity of 17.1% and a specificity of 88.5% (positive predictive value was 0.9%). Discussion and conclusions This study shows that computerized EMR-based algorithms can help identify patients at high risk of CD. NLP-based techniques demonstrate higher sensitivity and positive predictive values than algorithms based on ICD9 code searches.

  • 698.
    Ludvigsson, Jonas F.
    et al.
    Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden .
    Ström, Peter
    Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden .
    Lundholm, Cecilia
    Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden .
    Cnattingius, Sven
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Ekbom, Anders
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Örtqvist, Åke
    Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden.
    Feltelius, Nils
    Medical Products Agency, Uppsala, Sweden.
    Granath, Fredrik
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Stephansson, Olof
    Department of Women's and Children's Health, Karolinska Institutet and Hospital, Stockholm, Sweden .
    Risk for Congenital Malformation With H1N1 Influenza Vaccine: A Cohort Study With Sibling Analysis2016Inngår i: Annals of Internal Medicine, ISSN 0003-4819, E-ISSN 1539-3704, Vol. 165, nr 12, s. 848-855Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Earlier studies reporting varying risk estimates for congenital malformation in offspring of mothers undergoing vaccination against H1N1 influenza during pregnancy did not consider the potential role of confounding by familial (genetic and shared environmental) factors.

    Objective: To evaluate an association between maternal H1N1 vaccination during pregnancy and offspring malformation, with familial factors taken into account.

    Design: Population-based prospective study.

    Setting: Sweden.

    Participants: Liveborn offspring born between 1 October 2009 and 1 October 2011 to mothers receiving monovalent AS03-adjuvanted H1N1 influenza vaccine (Pandemrix [GlaxoSmithKline]) during pregnancy. A total of 40 983 offspring were prenatally exposed to the vaccine, 14 385 were exposed within the first trimester (14 weeks), and 7502 were exposed during the first 8 weeks of pregnancy. Exposed offspring were compared with 197 588 unexposed offspring. Corresponding risks in exposed versus unexposed siblings were also estimated.

    Measurements: Congenital malformation, with subanalyses for congenital heart disease, oral cleft, and limb deficiency.

    Results: Congenital malformation was observed in 2037 (4.97%) exposed offspring and 9443 (4.78%) unexposed offspring. Adjusted risk for congenital malformation was 4.98% in exposed offspring versus 4.96% in unexposed offspring (risk difference, 0.02% [95% CI, -0.26% to 0.30%]). The corresponding risk differences were 0.16% (CI, -0.23% to 0.56%) for vaccination during the first trimester and 0.10% (CI, -0.41% to 0.62%) for vaccination in the first 8 weeks. Using siblings as comparators yielded no statistically significant risk differences.

    Limitations: The study was based on live births, and the possibility that data on miscarriage or induced abortion could have influenced the findings cannot be ruled out. Study power was limited in analyses of specific malformations.

    Conclusion: When intrafamilial factors were taken into consideration, H1N1 vaccination during pregnancy did not seem to be linked to overall congenital malformation in offspring, although risk increases for specific malformations could not be ruled out completely.

  • 699.
    Luhr, Robert
    et al.
    School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Söderquist, Bo
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
    Cajander, Sara
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
    Trends in sepsis mortality over time in randomised sepsis trials: a systematic literature review and meta-analysis of mortality in the control arm, 2002-20162019Inngår i: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 23, artikkel-id 241Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Background: Epidemiologic data have shown an increasing incidence and declining mortality rate in sepsis. However, confounding effects due to differences in disease classification might have contributed to these trends.To assess if a declining mortality over time could be supported by data derived from high-quality prospective studies, we performed a meta-analysis using data from randomised controlled trials (RCTs) on sepsis. The primary aim was to assess whether the mortality in sepsis trials has changed over time. The secondary aim was to investigate how many of the included trials could show efficacy of the studied intervention regarding 28-day mortality.

    Methods: We searched PubMed for RCTs enrolling patients with severe sepsis and septic shock, published between 2002 and 2016. The included trials were assessed for quality and sorted by date of first inclusion. A meta-analysis was performed to synthesise data from the individual sepsis trials.

    Results: Of 418 eligible articles, 44 RCTs on sepsis were included in the analysis, enrolling 13,315 patients in the usual care arm between 1991 and 2013. In this time period, mortality decreased by 0.42% annually (p=0.04) to give a total decline of 9.24%. In subgroup analyses with adjustments for APACHE II, SAPS II and SOFA scores, the observed time trend was not significant (p=0.45, 0.23 and 0.98 respectively). Only four of the included trials showed any efficacy with regard to mortality.

    Conclusions: Data from RCTs show a declining trend in 28-day mortality in severe sepsis and septic shock patients during the years from 1991 to 2013. However, when controlling for severity at study inclusion, there was no significant change in mortality over time. The number of trials presenting new treatment options was low.

    Trial registration: PROSPERO CRD42018091100. Registered 27 August 2018.

  • 700.
    Lundberg, Erik
    et al.
    Umeå Univ, Sweden.
    Hagberg, Oskar
    Lund Univ Hosp, Sweden.
    Jahnson, Staffan
    Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Urologiska kliniken i Östergötland. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi.
    Ljungberg, Börje
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Urologiska kliniken i Östergötland.
    Association between occurrence of urinary bladder cancer and treatment with statin medication2019Inngår i: TURKISH JOURNAL OF UROLOGY, ISSN 2149-3235, Vol. 45, nr 2, s. 97-102Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The incidence of urinary bladder cancer (UBC) has increased in Sweden despite decreased smoking, indicating that other factors might be associated. The increased use of statin medication for elevated blood lipids might be one such influencing factor. The aim of the present study was to assess whether statins are afflicted with an increased incidence of UBC. Material and methods: Data from the Swedish National Register of Urinary Bladder Cancer, National Population Register, and Swedish Prescribed Drug Register were extracted. There were 22,936 patients with new diagnosed UBC between 2005 and 2014. Statin prescription was defined as any medication prescribed with the Anatomical Therapeutic Classification code C10A. For each patient, 10 control individuals were matched by age, gender, and living area, comprising 229,326 individuals. The Cochran-Mantel-Haenszel test was used to evaluate the hazards ratios. Results: Statins were more frequently used in patients with UBC (33.8%) than in controls (29.8%, pamp;lt;0.0001). The use of statins was afflicted with a 23% increased odds ratio (OR) for UBC (OR 1.23 (1.19-1.27), pamp;lt;0.001). Subgroup analyses showed that an increased OR was found in non-muscle invasive UBC only. There was a tendency that OR was stronger for men and for younger patients. Limitations include its retrospective register-based design and potential risk of bias of confounding factors, such as smoking and body mass index. Conclusion: This nationwide register study suggests an association between the occurrence of UBC and patients using statins. The association was found in patients with non-muscle invasive disease only. Confounding factors, such as smoking, cannot be overruled.

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