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  • 851. Weber, Michael A.
    et al.
    Schiffrin, Ernesto L.
    White, William B.
    Mann, Samuel
    Lindholm, Lars H.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Kenerson, John G.
    Flack, John M.
    Carter, Barry L.
    Materson, Barry J.
    Ram, C. Venkata S.
    Cohen, Debbie L.
    Cadet, Jean-Claude
    Jean-Charles, Roger R.
    Taler, Sandra
    Kountz, David
    Townsend, Raymond
    Chalmers, John
    Ramirez, Agustin J.
    Bakris, George L.
    Wang, Jiguang
    Schutte, Aletta E.
    Bisognano, John D.
    Touyz, Rhian M.
    Sica, Dominic
    Harrap, Stephen B.
    Clinical Practice Guidelines for the Management of Hypertension in the Community A Statement by the American Society of Hypertension and the International Society of Hypertension2014In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 32, no 1, p. 3-15Article in journal (Refereed)
  • 852. Weber, Michael A
    et al.
    Schiffrin, Ernesto L
    White, William B
    Mann, Samuel
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Kenerson, John G
    Flack, John M
    Carter, Barry L
    Materson, Barry J
    Ram, C Venkata S
    Cohen, Debbie L
    Cadet, Jean-Claude
    Jean-Charles, Roger R
    Taler, Sandra
    Kountz, David
    Townsend, Raymond R
    Chalmers, John
    Ramirez, Agustin J
    Bakris, George L
    Wang, Jiguang
    Schutte, Aletta E
    Bisognano, John D
    Touyz, Rhian M
    Sica, Dominic
    Harrap, Stephen B
    Clinical practice guidelines for the management of hypertension in the community a statement by the American society of hypertension and the International society of hypertension2014In: The Journal of Clinical Hypertension, ISSN 1524-6175, E-ISSN 1751-7176, Vol. 16, no 1, p. 14-26Article in journal (Refereed)
  • 853.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Partnership for health: on the role of primary health care in a community intervention programme1997Doctoral thesis, comprehensive summary (Other academic)
  • 854.
    Weinehall, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Öhgren, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Persson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Stegmayr, Birgitta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    High remaining risk in poorly treated hypertension: the "rule of halves" still exists2002In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 20, no 10, p. 2081-2088Article in journal (Refereed)
    Abstract [en]

    To estimate risk factors for stroke, to examine how different categories of patients with increased blood pressure are associated with risk for first-ever stroke event, and to estimate the proportions of these categories in a geographically defined population in northern Sweden. Setting : The study was nested within the Vasterbotten Intervention Program and the Northern Sweden MONICA cohorts. Design and participants : A population-based cross-sectional study and an incident case-control study were carried out. The incident case-control study comprised 129 cases of first-ever stroke diagnosed during 1985-96, with two randomly selected controls per case, chosen from the same geographically defined population. The cross-sectional study was based on 59 735 participants. Blood pressure status was categorized as: normotensive [systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg]; treated and adequately controlled hypertension (SBP <140 mmHg and DBP <90 mmHg); treated but poorly controlled hypertension (SBP >=140 mmHg or DBP >=90 mmHg, or both); untreated hypertension (SBP >=140 mmHg or DBP >=90 mmHg, or both); newly detected increased blood pressure (SBP >=140 mmHg or DBP >=90 mmHg, or both). Main outcome measure: Risk for first-ever stroke. Results: In the cross-sectional study, 68% of individuals were normotensive, 3% had treated and adequately controlled hypertension, 6% had treated but poorly controlled hypertension, 7% had untreated hypertension, and 16% had newly detected increased blood pressure. In univariate analysis of the case-control study, history of diabetes, daily smoking, obesity, increased blood pressure and the hypertension categories 'treated but poorly controlled' and 'untreated' were associated with an increased stroke risk. In multivariate logistic regression analysis, only diabetes and the hypertension categories treated but poorly controlled and untreated remained significant, with odds ratios 6.1 (95% confidence interval 2.4 to 15.3) and 4.3 (95% confidence interval 1.7 to 10.5), respectively. Only one of the 129 individuals who suffered stroke had treated and adequately controlled hypertension. Conclusions : The study illustrates the importance of adequate blood pressure control and, at the same time, that the vast majority in the population with increased blood pressure did not receive optimal care. Thus the 'rule of halves' still exists, and the high remaining risk in poorly treated hypertensive individuals in Sweden is remarkable and requires attention from the medical profession.

  • 855.
    Wennberg, Anna Lena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Medicine, Department of Nursing.
    Pregnant women and midwives are not in tune with each other about dietary counseling: studies in Swedish antenatal care2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background During pregnancy, a healthy diet is beneficial for the expecting mother and her fetus. Midwives in antenatal care have an ideal position for promoting a healthy diet and thereby help women to not only lower the risks of pregnancy complications and adverse birth outcomes, but improve maternal health. The overall aim of this thesis was to describe diet and dietary changes during pregnancy from the women’s and the midwives’ perspectives with a focus on dietary counseling. The thesis comprises four studies. The specific aims in the respective studies were to: I) Describe pregnant women’s attitudes to and experiences of dietary information and advice, as well as dietary management during pregnancy. II) Explore midwives’ strategies in challenging dietary counseling situations. III) Describe how midwives’ perceive their role and their significance in dietary counseling of pregnant women.  IV) Describe women’s food habits during pregnancy and up to six months postpartum.

    Methods Studies I-III were qualitative. Study I included focus group interviews with 23 pregnant women. Study II included telephone interviews with 17 experienced midwives working in Swedish antenatal health care. Study III included the same 17 interviews from study II and supplemented them with four face-to-face-interviews. Qualitative content analysis was performed in all three studies. Study IV was a longitudinal study including a quantitative analysis of a questionnaire, which was given to women at five occasions during and after pregnancy. It concerned their food habits and it was answered by 163 women. The quantitative data was analyzed using comparative and descriptive statistics.

    Results The overall findings of the thesis were summarized as the main theme “Pregnant women and midwives are not in tune with each other about dietary counseling”. The main theme included the two themes ‘Pregnant women are concerned about risks for their child but fail to change to healthier dietary habits over time’, and ‘Midwives view themselves as authorities, though questioned ones’. In subthemes it was highlighted that pregnant women are well informed and interested in risk reduction for their child’s best and that they try to do their best to improve their diet during pregnancy. However, their diet did not reach levels of healthy eating recommendations and became even unhealthier after pregnancy. It was also highlighted that midwives experienced insufficient knowledge in dietary issues and related risks and that they had difficulties to give dietary support to pregnant women. Midwives were found to mainly focus on giving information and they lacked sufficient competence for challenging counseling.

    Conclusion Pregnant women, on the one hand, experience a lack of support from the midwives when dealing with dietary changes. The midwives, on the other hand, feel exposed and express a need for both further education in dietary issues and training in counseling. Women’s food habits during, but in particular after pregnancy need improvement, and dietary counseling could be more focused on healthy eating in a long-term perspective.

  • 856.
    Wennberg, Anna-Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Social Sciences, Department of Food and Nutrition. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lundqvist, Anette
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hörnell, Agneta
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Swedish women’s food habits during pregnancy up to six months post-partum:: A longitudinal study2016In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 8, p. 31-36Article in journal (Refereed)
    Abstract [en]

    Objectives: Diet influences the health of the foetus and the woman during pregnancy and later in life. Itis therefore important to investigate pregnant women’s food habits. The aim of this study was to describewomen’s food habits during pregnancy and up to six months post-partum.Study design: A Food Frequency Questionnaire (VIP-FFQ) was distributed to 163 pregnant women on fiveoccasions during and after pregnancy. Data were analysed using Friedman’s ANOVA and a Bonferronipost-hoc test.Main outcome measures: Food habits in relation to the National Food Agency’s (NFA) food index.Results: The pregnant women’s diets were inadequate according to the NFA food index. A tendency towardsan even poorer diet after delivery was identified, something which was related to an increased intakeof discretionary food, e.g. sweets, cakes, cookies, crisps, ice cream, and decreased intake of fruit and vegetable.The alcohol consumption was low throughout.Conclusions: The food habits during pregnancy were inadequate compared to recommendations and thesehabits became unhealthier after delivery. These suggest that dietary counselling needs to be more effectiveand continued into the lactating period. An increased focus should be given to healthy eating fromthe life course perspective, not just focus on effects on the foetus and pregnancy outcomes.

  • 857.
    Wennberg, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gustafsson, Per E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Poor breakfast habits in adolescence predict the metabolic syndrome in adulthood2015In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 18, no 1, p. 122-129Article in journal (Refereed)
    Abstract [en]

    Objective: To analyse whether poor breakfast habits in adolescence predict the metabolic syndrome and its components in adulthood. Previous studies suggest that regular breakfast consumption improves metabolic parameters. Design: Prospective. Breakfast habits and other lifestyle variables at age 16 years were assessed from questionnaires. Poor breakfast habits were defined as skipping breakfast or only drinking or eating something sweet. At age 43 years, the effective sample consisted of 889 participants defined as having the metabolic syndrome or not, using the International Diabetes Federation criteria. Logistic regression was used to calculate odds ratios and confidence intervals. Setting: The Northern Swedish Cohort, a longitudinal population-based cohort with 27-year follow-up. Subjects: Adolescents (age 16 years). Results: Prevalence of the metabolic syndrome at age 43 years was 27.0%. Of the participants, 9.9% were classified with poor breakfast habits at age 16 years. Adjusted odds for the metabolic syndrome at age 43 years was OR = 1.68 (95% CI 1.01, 2.78) for those with poor breakfast habits at age 16 years compared with breakfast eaters. Looking at the metabolic syndrome components, poor breakfast habits at age 16 years were associated with central obesity (OR = 1.71; 95% CI 1.00, 2.92) and high fasting glucose (OR = 1.75; 95% CI 1.01, 3.02) at age 43 years, even after multivariate adjustments. Conclusions: Poor breakfast habits in adolescence predicted the metabolic syndrome in adulthood. Of the metabolic syndrome components, poor breakfast habits in adolescence predicted central obesity and high fasting glucose in adulthood. Further research is needed to fully understand the relationship between early breakfast habits and adult metabolic syndrome.

  • 858.
    Wennberg, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Gustafsson, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Irregular eating of meals in adolescence and the metabolic syndrome in adulthood: results from a 27-year prospective cohort2016In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 19, no 3, p. 667-673Article in journal (Refereed)
    Abstract [en]

    Objective: The objective was to investigate whether irregular eating of meals in adolescence predicts the metabolic syndrome and its components in adulthood, and if any specific meal is of particular importance. Design: Prospective cohort study with 27 years of follow-up. Information on meals (breakfast, school lunch and dinner with family), lifestyle (alcohol consumption, smoking habits, physical activity, consumption of sweets and pastries) at age 16 years was assessed from questionnaires, and presence or not of the metabolic syndrome and its components were defined at age 43 years in 889 participants (82.1 % of total cohort). Logistic regression was used to calculate odds ratios and confidence intervals. Setting: The Northern Swedish Cohort; all school-leavers of the 9th grade in the town Lulea in 1981. Subjects: Adolescents (age 16 years). Results: Irregular eating of meals at age 16 years was associated with higher prevalence of the metabolic syndrome at age 43 years (OR=1.74; 95 % CI 1.12, 2.71), but this was explained by concurrent unhealthy lifestyle at age 16 years. Poor breakfast at age 16 years was the only meal associated with the metabolic syndrome at age 43 years, independent of other meals, BMI (kg/m2) and lifestyle at age 16 years (OR = 1.67; 95 % CI 1.00, 2.80). Conclusions: Irregular eating of meals in adolescence predicted the metabolic syndrome in adulthood, but not independently of BMI and lifestyle in adolescence. Poor breakfast in adolescence was the only specific meal associated with future metabolic syndrome, even after adjustments. Breakfast eating should be encouraged in adolescence.

  • 859.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Beyond the established risk factors of myocardial infarction: lifestyle factors and novel biomarkers2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Age, male sex, hypertension, smoking, diabetes, dyslipidaemia, and obesity are considered as established risk factors for cardiovascular diseases. Several of these established cardiovascular risk factors are strongly influenced by lifestyle. Novel biomarkers from different mechanistic pathways have been associated with cardiovascular risk, but their clinical utility is still uncertain.

    The overall objective of the thesis was to evaluate the associations between certain lifestyle factors (physical activity and snuff use), biomarkers reflecting the haemostatic and the inflammatory systems and risk of a future first-ever myocardial infarction.

     A prospective incident nested case-control study design was used with a total of 651 cases of myocardial infarction and 2238 matched controls from the population-based Northern Sweden Health and Disease Study.

     The effects of commuting activity, occupational and leisure time physical activity on risk of myocardial infarction were studied. A clearly increased risk of myocardial infarction was found for car commuting compared to active commuting (walking, cycling or going by bus). High versus low leisure time physical activity was associated with decreased risk of myocardial infarction. Low occupational physical activity was associated with risk of myocardial infarction in men.

     The risk of myocardial infarction or sudden cardiac death was studied in male snuff users compared to non-tobacco users. No increased risk was found for myocardial infarction or sudden cardiac death among snuff users without a previous history of smoking. However, for sudden cardiac death the study did not have statistical power to detect small differences in risk.

     Plasma levels of haemostatic markers have previously shown to be associated with risk of myocardial infarction, but as haemostatic markers are also acute-phase reactants, it is not clear if their association with myocardial infarction is independent of inflammatory markers. In the present study, the haemostatic markers D-dimer, von Willebrand factor (VWF), tissue plasminogen activator (t-PA), and tissue plasminogen activator/plasminogen activator inhibitor-1 complex (t-PA/PAI-1 complex) were associated with risk of myocardial infarction after adjustment for established risk factors and the inflammatory markers C-reactive protein (CRP) and interleukin 6 (IL-6). Furthermore, the addition of eight haemostatic and inflammatory markers could improve the predictive ability for future myocardial infarction beyond that of a model utilizing only established risk factors.

     Established risk factors and novel biomarkers were explored as potential mediators of the reduced risk of myocardial infarction related to active commuting. A combination of established risk factors, haemostatic and inflammatory markers appeared to explain a substantial proportion (40%) of the difference in risk for myocardial infarction between active commuters and car commuters. IL-6, t-PA, t-PA/PAI-1 complex, apo B/apo A-1 ratio, and BMI seemed to be the largest potential mediators when tested individually.

    In conclusion, regular physical activity such as active commuting is associated with reduced risk of a first-ever myocardial infarction. This effect could in part be mediated through a beneficial influence on haemostasis and inflammation, as well as a positive impact on established risk factors. Several haemostatic markers are associated with risk of myocardial infarction independent of established risk factors and inflammatory markers. The combination of haemostatic and inflammatory markers may enhance predictive ability beyond established risk factors. Our findings do not support the hypothesis that snuff use increases the risk of myocardial infarction.

  • 860.
    Wennberg, Patrik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Wheeler, Michael
    Howard, Bethany
    Dempsey, Paddy C.
    Lambert, Gavin
    Eikelis, Nina
    Larsen, Robyn
    Sethi, Parneet
    Occleston, Jessica
    Hernestål-Boman, Jenny
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ellis, Kathryn A.
    Owen, Neville
    Dunstan, David W.
    Acute effects of breaking up prolonged sitting on fatigue and cognition: a pilot study2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 2, article id e009630Article in journal (Refereed)
    Abstract [en]

    Objectives: To compare the acute effects of uninterrupted sitting with sitting interrupted by brief bouts of light-intensity walking on self-reported fatigue, cognition, neuroendocrine biomarkers and cardiometabolic risk markers in overweight/obese adults.

    Design: Randomised two-condition crossover trial.

    Setting: Laboratory study conducted in Melbourne, Australia.

    Participants: 19 overweight/obese adults (45–75 years).

    Interventions: After an initial 2 h period seated, participants consumed a meal-replacement beverage and completed (on 2 days separated by a 6-day washout period) each condition over the next 5 h: uninterrupted sitting (sedentary condition) or sitting with 3 min bouts of light-intensity walking every 30 min (active condition).

    Primary outcome measures: Self-reported fatigue, executive function and episodic memory at 0 h, 4 h and 7 h.

    Secondary outcome measures: Neuroendocrine biomarkers and cardiometabolic risk markers (blood collections at 0 h, 4 h and 7 h, blood pressure and heart rate measured hourly and interstitial glucose measured using a continuous glucose monitoring system).

    Results: During the active condition, fatigue levels were lower at 4 h (−13.32 (95% CI −23.48 to −3.16)) and at 7 h (−10.73 (95% CI −20.89 to −0.58)) compared to the sedentary condition. Heart rate was higher at 4 h (4.47 (95% CI 8.37 to 0.58)) and at 7 h (4.32 (95% CI 8.21 to 0.42)) during the active condition compared to the sedentary condition. There were no significant differences between conditions by time for other variables. In the sedentary condition, changes in fatigue scores over time correlated with a decrease in heart rate and plasma dihydroxyphenylalanine (DOPA) and an increase in plasma dihydroxyphenylglycol (DHPG).

    Conclusions: Interrupting prolonged sitting with light-intensity walking breaks may be an effective fatigue countermeasure acutely. Fatigue levels corresponded with the heart rate and neuroendocrine biomarker changes in uninterrupted sitting in this pilot study. Further research is needed to identify potential implications, particularly for the occupational health context.

  • 861.
    Wennberg, Patrik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Johansson, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Medicin.
    The risk of myocardial infarction and sudden cardiac death amongst snuff users with or without a previous history of smoking.2007In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 262, no 3, p. 360-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the risk of a first myocardial infarction (MI) and sudden cardiac death (SCD) amongst male snuff users. DESIGN: We used a prospective incident case-referent study design nested in the population-based Västerbotten Intervention Program and the Northern Sweden MONICA study. SUBJECTS: Tobacco habits and cardiovascular risk factors were assessed at baseline screening and compared in 525 male MI cases (including 93 SCD cases) and 1798 matched referents. RESULTS: Myocardial infarction occurred on average 4 years and 2 months after the baseline screening. No increased risk for MI was found amongst snuff users without a previous history of smoking compared with nontobacco users after adjustments for body mass index, leisure time physical activity, educational level and cholesterol level (OR 0.82; 95% CI, 0.46-1.43). For snuff users with a previous history of smoking, the adjusted OR was 1.25 (95% CI, 0.80-1.96). Significantly increased risk for MI was found in current smokers with or without current snuff use. For SCD cases with survival time<24 h, the adjusted OR for snuff users without previous history of smoking was 1.18 (95% CI, 0.38-3.70) and for cases with survival time<1 h the OR was 0.38 (95% CI, 0.08-1.89). CONCLUSIONS: We found no increased risk for MI amongst snuff users without a previous history of smoking. Amongst snuff users with a previous history of smoking, the tendency towards an increased risk for MI may reflect the residual risk from former smoking. This study does not support the hypothesis that the risk for SCD is increased amongst snuff users.

  • 862.
    Wennberg, Patrik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gustafsson, Per E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Dunstan, David W
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Television viewing and low leisure-time physical activity in adolescence independently predict the metabolic syndrome in mid-adulthood2013In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 36, no 7, p. 2090-2097Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE We investigated whether television (TV) viewing and low leisure-time physical activity in adolescence predict the metabolic syndrome in mid-adulthood.

    RESEARCH DESIGN AND METHODS TV viewing habits and participation in leisure-time physical activity at age 16 years were assessed by self-administered questionnaires in a population-based cohort in Northern Sweden. The presence of the metabolic syndrome at age 43 years was ascertained in 888 participants (82% of the baseline sample) using the International Diabetes Federation criteria. Odds ratios (ORs) and CIs were calculated using logistic regression.

    RESULTS The overall prevalence of the metabolic syndrome at age 43 years was 26.9%. Adjusted OR for the metabolic syndrome at age 43 years was 2.14 (95% CI 1.24-3.71) for those who reported "watching several shows a day" versus "one show/week" or less and 2.31 (1.13-4.69) for leisure-time physical activity "several times/month" or less compared with "daily" leisure-time physical activity at age 16 years. TV viewing at age 16 years was associated with central obesity, low HDL cholesterol, and hypertension at age 43 years, whereas low leisure-time physical activity at age 16 years was associated with central obesity and triglycerides at age 43 years.

    CONCLUSIONS Both TV viewing and low leisure-time physical activity in adolescence independently predicted the metabolic syndrome and several of the metabolic syndrome components in mid-adulthood. These findings suggest that reduced TV viewing in adolescence, in addition to regular physical activity, may contribute to cardiometabolic health later in life.

  • 863.
    Wennberg, Patrik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gustafsson, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Howard, Bethany
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Television viewing over the life course and the metabolic syndrome in mid-adulthood: a longitudinal population-based study2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 10, p. 928-933Article in journal (Refereed)
  • 864.
    Wennberg, Patrik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Messner, Torbjörn
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Johansson, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    The effects of commuting activity and occupational and leisure time physical activity on risk of myocardial infarction2006In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 13, no 6, p. 924-930Article in journal (Refereed)
    Abstract [en]

    AB Background: Risk reduction of myocardial infarction has been shown for leisure time physical activity. The results of studies on occupational physical activity and risk of myocardial infarction are incongruous and studies on commuting activity are scarce. The aim of this study was to investigate how commuting activity, occupational physical activity and leisure time physical activity were associated with risk of future first myocardial infarction.

    Design: We used a prospective incident case-referent study design nested in Vasterbotten Intervention Program and the Northern Sweden MONICA study.

    Methods: Commuting habits, occupational physical activity, leisure time physical activity and cardiovascular risk factors were assessed at baseline screening and compared in 583 cases (20% women) with a first myocardial infarction and 2098 matched referents.

    Results: Regular car commuting was associated with increased risk of myocardial infarction versus commuting by bus, cycling or walking [odds ratio (OR) 1.74; 95% confidence interval (CI), 1.20-2.52] after multivariate adjustment. High versus low leisure time physical activity was associated with reduced risk of myocardial infarction (OR 0.69; 95% CI, 0.50-0.95) after adjustment for occupational physical activity and commuting activity, but the association was not statistically significant after further multivariate adjustment. After multivariate adjustment we observed a reduced risk for myocardial infarction in men with moderate (OR 0.70; 95% CI, 0.50-0.98) or high (OR 0.67; 95% CI, 0.42-1.08) versus low occupational physical activity.

    Conclusions: We found a clear association between car commuting and a first myocardial infarction and a corresponding inverse association with leisure time physical activity, while the impact of occupational physical activity on the risk of myocardial infarction was weaker. (C) 2006 European Society of Cardiology

  • 865.
    Wennberg, Patrik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    van der A, Daphne L.
    Spijkerman, Annemieke M. W.
    Kaaks, Rudolf
    Boeing, Heiner
    Feller, Silke
    Bergmann, Manuela M.
    Langenberg, Claudia
    Sharp, Stephen J.
    Forouhi, Nita
    Riboli, Elio
    Wareham, Nicholas
    Self-rated health and type 2 diabetes risk in the European Prospective Investigation into Cancer and Nutrition-InterAct study: a case-cohort study2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 3, p. e002436-Article in journal (Refereed)
    Abstract [en]

    Objectives:

    To investigate the association between self-rated health and risk of type 2 diabetes and whether the strength of this association is consistent across five European centres.

    Design: Population-based prospective case-cohort study.

    Setting: Enrolment took place between 1992 and 2000 in five European centres (Bilthoven, Cambridge, Heidelberg, Potsdam and Umea).

    Participants: Self-rated health was assessed by a baseline questionnaire in 3399 incident type 2 diabetic case participants and a centre-stratified subcohort of 4619 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct study which was drawn from a total cohort of 340 234 participants in the EPIC.

    Primary outcome measure: Prentice-weighted Cox regression was used to estimate centre-specific HRs and 95% CIs for incident type 2 diabetes controlling for age, sex, centre, education, body mass index (BMI), smoking, alcohol consumption, energy intake, physical activity and hypertension. The centre-specific HRs were pooled across centres by random effects meta-analysis.

    Results: Low self-rated health was associated with a higher hazard of type 2 diabetes after adjusting for age and sex (pooled HR 1.67, 95% CI 1.48 to 1.88). After additional adjustment for health-related variables including BMI, the association was attenuated but remained statistically significant (pooled HR 1.29, 95% CI 1.09 to 1.53). I-2 index for heterogeneity across centres was 13.3% (p=0.33).

    Conclusions: Low self-rated health was associated with a higher risk of type 2 diabetes. The association could be only partly explained by other health-related variables, of which obesity was the strongest. We found no indication of heterogeneity in the association between self-rated health and type 2 diabetes mellitus across the European centres.

  • 866.
    Wennberg, Patrik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wensley, Frances
    Di Angelantonio, Emanuele
    Johansson, Lars A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Rumley, Ann
    Lowe, Gordon
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Danesh, John
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Haemostatic and inflammatory markers are independently associated with myocardial infarction in men and women2012In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 129, no 1, p. 68-73Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Previous studies have shown that plasma levels of haemostatic and inflammatory markers are associated with risk of coronary heart disease (CHD). As haemostatic markers are also acute-phase reactants, it is not clear if their association with CHD is independent of inflammatory markers and established cardiovascular risk factors.

    MATERIALS AND METHODS: We used a prospective incident case-control study design nested in two cohorts from Sweden. Baseline measurements of a panel of cardiovascular risk factors and eight established markers of haemostasis or inflammation were assessed in 469 first-ever myocardial infarction (MI) cases and 895 matched controls.

    RESULTS: After adjustment for baseline values of established risk factors, von Willebrand factor appeared to have the strongest association with MI among the haemostatic markers assayed, with an odds ratio of 2.52 (95% CI, 1.72-3.67) for a comparison of individuals in extreme thirds of baseline levels. For a similar comparison, after adjustment for established risk factors and haemostatic markers, odds ratios for IL-6 and CRP were 1.67 (95% CI, 1.08-2.60) and 1.58 (95% CI, 1.03-2.41), respectively. The relative predictive ability of the individual markers over and above established risk factors was modest according to comparisons of Area under the Receiver Operating Characteristic (AUROC) curves. However, when all eight markers were combined in a single model, the AUROC curve was significantly increased to 0.820 (95% CI, 0.795-0.846) compared to 0.762 (95% CI, 0.732-0.791) for established risk factors only.

    CONCLUSIONS: These findings suggest that haemostasis and inflammation have at least partially separate roles in risk of myocardial infarction.

  • 867.
    Wennberg, Patrik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wensley, Frances
    Di Angeloantonio, Emanuele
    Johansson, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Rumley, Ann
    Lowe, Gordon
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Danesh, John
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Haemostatic and inflammatory markers are independently associated with a first-ever myocardial infarction in men and women2012In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 129, no 1, p. 68-73Article in journal (Refereed)
    Abstract [en]

    Introduction: Previous studies have shown that plasma levels of haemostatic and inflammatory markers are associated with risk of coronary heart disease (CHD). As haemostatic markers are also acute-phase reactants, it is not clear if their association with CHD is independent of inflammatory markers and established cardiovascular risk factors.

    Materials and Methods: We used a prospective incident case-control study design nested in two cohorts from Sweden. Baseline measurements of a panel of cardiovascular risk factors and eight established markers of haemostasis or inflammation were assessed in 469 first-ever myocardial infarction (MI) cases and 895 matched controls.

    Results: After adjustment for baseline values of established risk factors, von Willebrand factor appeared to have the strongest association with MI among the haemostatic markers assayed, with an odds ratio of 2.52 (95% CI, 1.72-3.67) for a comparison of individuals in extreme thirds of baseline levels. For a similar comparison, after adjustment for established risk factors and haemostatic markers, odds ratios for IL-6 and CRP were 1.67 (95% CI, 1.08-2.60) and 1.58 (95% CI, 1.03-2.41), respectively. The relative predictive ability of the individual markers over and above established risk factors was modest according to comparisons of Area under the Receiver Operating Characteristic (AUROC) curves. However, when all eight markers were combined in a single model, the AUROC curve was significantly increased to 0.820 (95% CI, 0.795-0.846) compared to 0.762 (95% CI, 0.732-0.791) for established risk factors only.

    Conclusions: These findings suggest that haemostasis and inflammation have at least partially separate roles in risk of myocardial infarction.

  • 868.
    Wennberg, Patrik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wensley, Frances
    Johansson, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Di Angeloantonio, Emanuele
    Rumley, Ann
    Lowe, Gordon
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Reduced risk of myocardial infarction related to active commuting: inflammatory and haemostatic effects are potential major mediating mechanisms2010In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 17, no 1, p. 56-62Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Regular physical activity is inversely associated with risk of coronary heart disease, but the precise mechanisms remain unclear. Active commuting is an environmental friendly way to achieve the recommended 30 min of daily physical activity. The aim of this study was to explore the relative contribution of markers from different potential mediating pathways on the association between active commuting and risk of myocardial infarction (MI) in a general population. DESIGN: Prospective incident nested case-control study. METHODS: Commuting habits, traditional risk factors and biomarkers were assessed at baseline and compared in 204 MI cases and 327 matched controls. RESULTS: Car commuting was significantly associated with MI risk, even after adjusting for potential confounders (odds ratio: 1.77, 95% confidence interval: 1.05-2.99). When potential mediators were included in the model, the risk was substantially attenuated. Among the traditional risk factors, apolipoprotein B/apolipoprotein A-1 ratio seemed to be the largest mediator (26.0%), followed by body mass index (18.7%). The inflammatory and haemostatic markers similarly dampened the effect, with tissue plasminogen activator/plasminogen activator inhibitor-1 complex and IL-6 explaining 33.6 and 27.6% of MI risk, respectively. Combined, the potential mediators investigated seemed to explain 40.1% of MI risk related to car commuting. CONCLUSION: Overall, the traditional, inflammatory and haemostatic markers seemed to explain a substantial proportion of the reduction in MI risk related to active commuting in this study population. The predominant effect of the inflammatory and haemostatic markers supports the hypothesis that regular physical activity may work through additional biological mechanisms to reduce coronary risk beyond traditional risk factors. However, these findings need to be confirmed in larger studies.

  • 869.
    Wentzel, Yvonne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Self-rated health and Existential meaning making2016Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 870. Westerlund, Hugo
    et al.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Theorell, Tores
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Social Adversity in Adolescence Increases the Physiological Vulnerability to Job Strain in Adulthood: A Prospective Population-Based Study2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 4, p. e35967-Article in journal (Refereed)
    Abstract [en]

    Background: It has been argued that the association between job strain and health could be confounded by early life exposures, and studies have shown early adversity to increase individual vulnerability to later stress. We therefore investigated if early life exposure to adversity increases the individual's physiological vulnerability job strain in adulthood. Methodology/Principal Findings: In a population-based cohort (343 women and 330 men, 83% of the eligible participants), we examined the association between on the one hand exposure to adversity in adolescence, measured at age 16, and job strain measured at age 43, and on the other hand allostatic load at age 43. Adversity was operationalised as an index comprising residential mobility and crowding, parental loss, parental unemployment, and parental physical and mental illness (including substance abuse). Allostatic load summarised body fat, blood pressure, inflammatory markers, glucose, blood lipids, and cortisol regulation. There was an interaction between adversity in adolescence and job strain (B = 0.09, 95% CI 0.02 to 0.16 after adjustment for socioeconomic status), particularly psychological demands, indicating that job strain was associated with increased allostatic load only among participants with adversity in adolescence. Job strain was associated with lower allostatic load in men (beta = -0.20, 95% CI -0.35 to -0.06). Conclusions/Significance: Exposure to adversity in adolescence was associated with increased levels of biological stress among those reporting job strain in mid-life, indicating increased vulnerability to environmental stressors.

  • 871. Westerlund, Hugo
    et al.
    Gustafsson, Per E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Theorell, Töres
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Parental academic involvement in adolescence, academic achievement over the life course and allostatic load in middle age: a prospective population-based cohort study2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 6, p. 508-513Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Parental involvement in their children's studies, particularly in terms of academic socialisation, has been shown to predict academic achievement, and is thus a candidate modifiable factor influencing life course socioeconomic circumstances. Socioeconomic disadvantage is thought to impact on health over the life course partly by allostatic load, that is, cumulative biological risk. We sought to elucidate the role of parental involvement at age 16 on the life course development of allostatic load.

    METHODS: In a population-based cohort (365 women and 352 men, 67% of the eligible participants), we examined the association between parental involvement in their offspring's studies, measured by teacher and pupil ratings at age 16 and an allostatic load index summarising 12 physiological risk markers at age 43. Mediation through life course academic and occupational achievement was assessed by entering school grades, adult educational achievement and socioeconomic position at age 43 in a linear regression analysis in a stepwise manner and testing for mediation.

    RESULTS: Parental interest in their offspring's studies during the last year of compulsory school-rather than the parent's social class or availability of practical academic support-was found to predict adult allostatic load (β=-0.12, 95% CI -0.20 to -0.05). Further adjustments indicated that academic achievement over the life course mediated a large part of the effect of parental interest on allostatic load.

    CONCLUSIONS: Parental interest in their offspring's studies may have protective effects by decreasing the likelihood of a chain of risk involving low academic achievement, low socioeconomic position and high accumulated physiological stress.

  • 872.
    Westman, Göran
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Att disputera: ofta början på något nytt2008In: Forskarhandledares robusta råd., Lund: Studentlitteratur , 2008, p. 69-82Chapter in book (Other (popular science, discussion, etc.))
  • 873. Wickramasinghe, S N
    et al.
    Hasan, R
    Menike, D
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wahlin, A
    Serum thymidine kinase in congenital dyserythropoietic anaemia type I and homozygous beta-thalassaemia.1997In: European Journal of Haematology, ISSN 0902-4441, E-ISSN 1600-0609, Vol. 59, no 5, p. 333-4Article in journal (Refereed)
  • 874.
    Widerström, Micael
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. Jämtland Cty Council, Östersund, Sweden.
    Schönning, Caroline
    Lilja, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lebbad, Marianne
    Ljung, Thomas
    Allestam, Görel
    Ferm, Martin
    Björkholm, Britta
    Hansen, Anette
    Hiltula, Jan I.
    Långmark, Jonas
    Löfdahl, Margareta
    Omberg, Maria
    Reuterwall, Christina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Samuelsson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Widgren, Katarina
    Wallensten, Anders
    Lindh, Johan
    Large outbreak of cryptosporidium hominis infection transmitted through the public water supply, Sweden2014In: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 20, no 4, p. 581-589Article in journal (Refereed)
    Abstract [en]

    In November 2010, approximate to 27,000 (approximate to 45%) inhabitants of Östersund, Sweden, were affected by a waterborne outbreak of cryptosporidiosis. The outbreak was characterized by a rapid onset and high attack rate, especially among young and middle-aged persons. Young age, number of infected family members, amount of water consumed daily, and gluten intolerance were identified as risk factors for acquiring cryptosporidiosis. Also, chronic intestinal disease and young age were significantly associated with prolonged diarrhea. Identification of Ctyptosporidium hominis subtype lbA10G2 in human and environmental samples and consistently low numbers of oocysts in drinking water confirmed insufficient reduction of parasites by the municipal water treatment plant. The current outbreak shows that use of inadequate microbial barriers at water treatment plants can have serious consequences for public health. This risk can be minimized by optimizing control of raw water quality and employing multiple barriers that remove or inactivate all groups of pathogens.

  • 875.
    Wiik, Benedicte P.
    et al.
    Department of Cardiology and Department of Nephrology, Oslo University Hospital, Norway.
    Larstorp, Anne C.K.
    Department of Cardiology and Department of Nephrology, Oslo University Hospital, Norway.
    Höieggen, Aud
    Department of Cardiology and Department of Nephrology, Oslo University Hospital, Norway.
    Kjeldsen, Sverre E.
    Department of Cardiology and Department of Nephrology, Oslo University Hospital, Norway.
    Hecht Olsen, Michael
    The Cardiovascular Research Unit, Cardiology Section, Department of Internal Medicine, Glostrup University Hospital, Glostrup, Denmark.
    Ibsen, Hans
    Division of Cardiology, Holbaek Hospital, Holbaek, Denmark.
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Dahlöf, Björn
    Department of Medicine, Sahlgrenska University Hospital/östra, Göteborg, Sweden.
    Devereux, Richard B.
    Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York, USA.
    Okin, Peter M.
    Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York, USA.
    Wachtell, Kristian
    The Heart Center, Rigshospitalet, Copenhagen, Denmark.
    Serum uric acid is associated with new-onset diabetes in hypertensive patients with left ventricular hypertrophy: The LIFE study2010In: American Journal of Hypertension, ISSN 0895-7061, Vol. 23, no 8, p. 845-851Article in journal (Refereed)
    Abstract [en]

    Background

    It is unclear whether serum uric acid (SUA) is associated with development of new-onset diabetes (NOD) in patients with hypertension and left ventricular hypertrophy (LVH). The aim of the present investigation was to test the hypothesis that SUA predicts development of NOD in these patients.

    Methods

    In the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, a double-masked, parallel-group design, 9,193 patients with hypertension and electrocardiographic LVH were randomized to losartan- or atenolol-based antihypertensive treatment and followed for a mean of 4.9 years. At baseline, 7,489 patients with available SUA measurements did not have diabetes mellitus and were thus at risk of its development during the study. We used Cox regression analyses to investigate whether SUA predicted development of NOD.

    Results

    NOD developed in 522 of 7,489 patients. The association between baseline SUA and development of NOD was significant (hazard ratio (HR) 1.29 per s.d. (1.3 mg/dl), 95% confidence interval (CI) 1.18–1.42, P < 0.001) after adjustment for treatment with losartan vs. atenolol, baseline serum glucose, urinary albumin/creatinine ratio, estimated glomerular filtration rate and Framingham risk score, time-varying systolic and diastolic blood pressure, and time-varying LVH by Cornell voltage-duration product and Sokolow–Lyon voltage. In parallel analyses, baseline quartiles of SUA were significantly associated with increasing NOD (HR 1.28, 95% CI 1.18–1.40, P < 0.001). Time-varying SUA was also associated with NOD (HR 1.10 per s.d. [1.3 mg/dl], 95% CI 1.02–1.19, P = 0.015).

    Conclusion

    Our analysis suggests that SUA is an independent risk marker for NOD in hypertensive patients with LVH.

  • 876.
    Wiklund, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Danielsson, Ulla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Strömbäck, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Bengs, Carita
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Dissonanser och möjligheter: i ljuset av genus, normativitet och samhällets individualisering2015In: När livet känns fel: ungas upplevelser kring psykisk ohälsa / [ed] Myndigheten för ungdoms- och civilsamhällsfrågor, Stockholm: mucf.se , 2015, p. 153-173Chapter in book (Other academic)
    Abstract [sv]

    I denna fördjupande artikel riktar vi blickarna mot ungas psykiska ohälsa – dissonanser och möjligheter – i förhållande till genuskonstruktioner, normativitet och inflytelserika samhällstrender som individualisering.

  • 877. Willers, Carl
    et al.
    Iderberg, Hanna
    Axelsen, Mette
    Dahlström, Tobias
    Julin, Bettina
    Leksell, Janeth
    Lindberg, Agneta
    Lindgren, Peter
    Muth, Karin Loostrom
    Svensson, Ann-Marie
    Lilja, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Sociodemographic determinants and health outcome variation in individuals with type 1 diabetes mellitus: A register-based study2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 6, article id e0199170Article in journal (Refereed)
    Abstract [en]

    Background: Socioeconomic status, origin or demographic attributes shall not determine the quality of healthcare delivery, according to e.g. United Nations and European Union rules. Health equity has been defined as the absence of systematic disparities and unwarranted differences between groups defined by differences in social advantages. A study was performed to investigate whether this was applicable to type 1 diabetes mellitus (T1D) care in a setting with universal, tax-funded healthcare. Methods: This retrospective registry-study was based on patient-level data from individuals diagnosed with T1D during 2010-2011 (n = 16,367) in any of seven Swedish county councils (covering -65% of the Swedish population). Health equity in T1D care was analysed through multivariate regression analyses on absolute HbA1c level at one-year follow-up, one-year change in estimated glomerular filtration rate (eGFR) and one-year change in cardiovascular risk score, using selected sociodemographic dimensions as case-mix factors. Results: Higher educational level was consistently associated with lower levels of HbA1c, and so was being married. Never married was associated with worse eGFR development, and lower educational level was associated with higher cardiovascular risk. Women had higher HbA1c levels than men, and glucose control was significantly worse in patients below the age of 25. Conclusion: Patients' sociodemographic profile was strongly associated with absolute levels of risk factor control in T1 D, but also with an increased annual deterioration in eGFR. Whether these systematic differences stem from patient-related problems or healthcare organisational shortcomings is a matter for further research. The results, though, highlight the need for intensified diabetes management education and secondary prevention directed towards T1D patients, taking sociodemographic characteristics into account.

  • 878. Willers, Carl
    et al.
    Lekander, Ingrid
    Ekstrand, Elisabeth
    Lilja, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Pessah-Rasmussen, Hélène
    Sunnerhagen, Katharina S.
    von Euler, Mia
    Sex as predictor for achieved health outcomes and received care in ischemic stroke and intracerebral hemorrhage: a register-based study2018In: Biology of Sex Differences, ISSN 2042-6410, Vol. 9, article id 11Article in journal (Refereed)
    Abstract [en]

    Background: Differences in stroke care and health outcomes between men and women are debated. The objective of this study was to explore the relationship between patients' sex and post-stroke health outcomes and received care in a Swedish setting.

    Methods: Patients with a registered diagnosis of acute intracerebral hemorrhage (ICH) or ischemic stroke (IS) within regional administrative systems (ICD-10 codes I61* or I63*) and the Swedish Stroke Register during 2010-2011 were included and followed for 1 year. Data linkage to multiple other data sources on individual level was performed. Adjustments were performed for age, socioeconomic factors, living arrangements, ADL dependency, and stroke severity in multivariate regression analyses of health outcomes and received care. Health outcomes (e.g., survival, functioning, satisfaction) and received care measures (regional and municipal resources and processes) were studied.

    Results: Study population: 13,775 women and 13,916 men. After case-mix adjustments for the above factors, we found women to have higher 1-year survival rates after both IS (ORfemale = 1.17, p < 0.001) and ICH (ORfemale = 1.65, p < 0.001). Initial inpatient stay at hospital was, however, shorter for women βfemale, IS = -0.05, p < 0.001; βfemale, ICH = -0.08, p < 0.005). For IS, good function (mRS <= 2) was more common in men (ORfemale = 0.86, p < 0.001) who also received more inpatient care during the first year βfemale = -0.05, p < 0.001).

    Conclusions: A lower proportion of women had good functioning, a difference that remained in IS after adjustments for age, socioeconomic factors, living arrangements, ADL dependency, and stroke severity. The amount of received hospital care was lower for women after adjustments. Whether shorter hospital stay results in lower function or is a consequence of lower function cannot be elucidated. One-year survival was higher in men when no adjustments were made but lower after adjustments. This likely reflects that women were older at time of stroke, had more severe strokes, and more disability pre-stroke-factors that make a direct comparison between the sexes intricate.

  • 879. Winefield, AH
    et al.
    Saebel, J
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Predictors of future employment status among Australian and Swedish school-leavers: longitudial data2005In: International Journal of Psychology, ISSN 0020-7594, E-ISSN 1464-066X, Vol. 40, no 5, p. 349-356Article in journal (Refereed)
  • 880.
    Winefield, Helen
    et al.
    School of Psychology, University of Adelaide, Adelaide, Australia.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Nygren, Karina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Internalized symptoms in adolescence as predictors of mental health in adulthood in the Northern Swedish cohort2013In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 5, no 7, p. 1164-1171Article in journal (Refereed)
    Abstract [en]

    Although mental health symptoms in children and adolescents are shown to predict young adult mental health outcomes, long-term prospective studies of childhood cohorts are few. The aim of the present study was to analyze the prospective importance of internalized mental health symptoms in adolescence for internalized symptoms in adulthood. Methods: A communitybased prospective longitudinal cohort provided information by questionnaire about psychological status at age 16 and 43 (n = 1010, representing 94.3% of those still alive). Socio-demographic variables which were indicative of possible childhood adversity (parental class, absence, illness, unemployment, relationship, crowding, number of moves) were treated as confounders and controlled for in ordinal regression. Results: For both women and men, internalizing mental health symptoms reported at 16 significantly predicted the same outcome at 43 years, after controlling for previous adverse environmental conditions (OR = 1.2 for women, 1.3 for men). Conclusion: In this representative cohort studied over 27 years with excellent retention rates, the occurrence of self-reported worry, panic and sadness in mid-adolescence significantly increased the likelihood of similar states in middle adulthood.

  • 881. Wood, Angela M.
    et al.
    Kaptoge, Stephen
    Butterworth, Adam S.
    Willeit, Peter
    Warnakula, Samantha
    Bolton, Thomas
    Paige, Ellie
    Paul, Dirk S.
    Sweeting, Michael
    Burgess, Stephen
    Bell, Steven
    Astle, William
    Stevens, David
    Koulman, Albert
    Selmer, Randi M.
    Verschuren, W. M. Monique
    Sato, Shinichi
    Njolstad, Inger
    Woodward, Mark
    Salomaa, Veikko
    Nordestgaard, Borge G.
    Yeap, Bu B.
    Fletcher, Astrid
    Melander, Olle
    Kuller, Lewis H.
    Balkau, Beverley
    Marmot, Michael
    Koenig, Wolfgang
    Casiglia, Edoardo
    Cooper, Cyrus
    Arndt, Volker
    Franco, Oscar H.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gallacher, John
    de la Camara, Agustin Gomez
    Volzke, Henry
    Dahm, Christina C.
    Dale, Caroline E.
    Bergmann, Manuela M.
    Crespo, Carlos J.
    van der Schouw, Yvonne T.
    Kaaks, Rudolf
    Simons, Leon A.
    Lagiou, Pagona
    Schoufour, Josje D.
    Boer, Jolanda M. A.
    Key, Timothy J.
    Rodriguez, Beatriz
    Moreno-Iribas, Conchi
    Davidson, Karina W.
    Taylor, James O.
    Sacerdote, Carlotta
    Wallace, Robert B.
    Quiros, J. Ramon
    Tumino, Rosario
    Blazer, Dan G., II
    Linneberg, Allan
    Daimon, Makoto
    Panico, Salvatore
    Howard, Barbara
    Skeie, Guri
    Strandberg, Timo
    Weiderpass, Elisabete
    Nietert, Paul J.
    Psaty, Bruce M.
    Kromhout, Daan
    Salamanca-Fernandez, Elena
    Kiechl, Stefan
    Krumholz, Harlan M.
    Grioni, Sara
    Palli, Domenico
    Huerta, Jose M.
    Price, Jackie
    Sundstrom, Johan
    Arriola, Larraitz
    Arima, Hisatomi
    Travis, Ruth C.
    Panagiotakos, Demosthenes B.
    Karakatsani, Anna
    Trichopoulou, Antonia
    Kuhn, Tilman
    Grobbee, Diederick E.
    Barrett-Connor, Elizabeth
    van Schoor, Natasja
    Boeing, Heiner
    Overvad, Kim
    Kauhanen, Jussi
    Wareham, Nick
    Langenberg, Claudia
    Forouhi, Nita
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Despres, Jean-Pierre
    Cushman, Mary
    Cooper, Jackie A.
    Rodriguez, Carlos J.
    Sakurai, Masaru
    Shaw, Jonathan E.
    Knuiman, Matthew
    Voortman, Trudy
    Meisinger, Christa
    Tjonneland, Anne
    Brenner, Hermann
    Palmieri, Luigi
    Dallongeville, Jean
    Brunner, Eric J.
    Assmann, Gerd
    Trevisan, Maurizio
    Gillum, Richard F.
    Ford, Ian
    Sattar, Naveed
    Lazo, Mariana
    Thompson, Simon G.
    Ferrari, Pietro
    Leon, David A.
    Smith, George Davey
    Peto, Richard
    Jackson, Rod
    Banks, Emily
    Di Angelantonio, Emanuele
    Danesh, John
    Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies2018In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 391, no 10129, p. 1513-1523Article in journal (Refereed)
    Abstract [en]

    Background: Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease.

    Methods: We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose-response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12.5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5.6 years [5th-95th percentile 1.04-13.5]) from 71 011 participants from 37 studies.

    Findings: In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5.4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1.14, 95% CI, 1.10-1.17), coronary disease excluding myocardial infarction (1.06, 1.00-1.11), heart failure (1.09, 1.03-1.15), fatal hypertensive disease (1.24, 1.15-1.33); and fatal aortic aneurysm (1.15, 1.03-1.28). By contrast, increased alcohol consumption was loglinearly associated with a lower risk of myocardial infarction (HR 0.94, 0.91-0.97). In comparison to those who reported drinking >0-<= 100 g per week, those who reported drinking >100-<= 200 g per week, >200-<= 350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1-2 years, or 4-5 years, respectively.

    Interpretation: In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines.

  • 882. Wormser, David
    et al.
    Di Angelantonio, Emanuele
    Kaptoge, Stephen
    Wood, Angela M.
    Gao, Pei
    Sun, Qi
    Walldius, Goeran
    Selmer, Randi
    Verschuren, W. M. Monique
    Bueno-de-Mesquita, H. Bas
    Engstrom, Gunnar
    Ridker, Paul M.
    Njolstad, Inger
    Iso, Hiroyasu
    Holme, Ingar
    Giampaoli, Simona
    Tunstall-Pedoe, Hugh
    Gaziano, J. Michael
    Brunner, Eric
    Kee, Frank
    Tosetto, Alberto
    Meisinger, Christa
    Brenner, Hermann
    Ducimetiere, Pierre
    Whincup, Peter H.
    Tipping, Robert W.
    Ford, Ian
    Cremer, Peter
    Hofman, Albert
    Wilhelmsen, Lars
    Clarke, Robert
    de Boer, Ian H.
    Jukema, J. Wouter
    Ibanez, Alejandro Marin
    Lawlor, Debbie A.
    D'Agostino, Ralph B., Sr.
    Rodriguez, Beatriz
    Casiglia, Edoardo
    Stehouwer, Coen D. A.
    Simons, Leon A.
    Nietert, Paul J.
    Barrett-Connor, Elizabeth
    Panagiotakos, Demosthenes B.
    Bjorkelund, Cecilia
    Strandberg, Timo E.
    Wassertheil-Smoller, Sylvia
    Blazer, Dan G.
    Meade, Tom W.
    Welin, Lennart
    Svardsudd, Kurt
    Woodward, Mark
    Nissinen, Aulikki
    Kromhout, Daan
    Jorgensen, Torben
    Tilvis, Reijo S.
    Guralnik, Jack M.
    Rosengren, Annika
    Taylor, James O.
    Kiechl, Stefan
    Dagenais, Gilles R.
    Fowkes, F. Gerry R.
    Wallace, Robert B.
    Khaw, Kay-Tee
    Shaffer, Jonathan A.
    Visser, Marjolein
    Kauhanen, Jussi
    Salonen, Jukka T.
    Gallacher, John
    Ben-Shlomo, Yoav
    Kitamura, Akihiko
    Sundstrom, Johan
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Kiyohara, Yutaka
    Daimon, Makoto
    Gomez de la Camara, Agustin
    Cooper, Jackie A.
    Onat, Altan
    Devereux, Richard
    Mukamal, Kenneth J.
    Dankner, Rachel
    Knuiman, Matthew W.
    Crespo, Carlos J.
    Gansevoort, Ron T.
    Goldbourt, Uri
    Nordestgaard, Borge G.
    Shaw, Jonathan E.
    Mussolino, Michael
    Nakagawa, Hidaeki
    Fletcher, Astrid
    Kuller, Lewis H.
    Gillum, Richard F.
    Gudnason, Vilmundur
    Assmann, Gerd
    Wald, Nicholas
    Jousilahti, Pekka R.
    Greenland, Philip
    Trevisan, Maurizio
    Ulmer, Hanno
    Butterworth, Adam S.
    Folsom, Aaron R.
    Davey-Smith, George
    Hu, Frank B.
    Danesh, John
    Adult height and the risk of cause-specific death and vascular morbidity in 1 million people: individual participant meta-analysis2012In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 41, no 5, p. 1419-1433Article in journal (Refereed)
    Abstract [en]

    Background The extent to which adult height, a biomarker of the interplay of genetic endowment and early-life experiences, is related to risk of chronic diseases in adulthood is uncertain. Methods We calculated hazard ratios (HRs) for height, assessed in increments of 6.5 cm, using individual-participant data on 174 374 deaths or major non-fatal vascular outcomes recorded among 1 085 949 people in 121 prospective studies. Results For people born between 1900 and 1960, mean adult height increased 0.5-1 cm with each successive decade of birth. After adjustment for age, sex, smoking and year of birth, HRs per 6.5 cm greater height were 0.97 (95% confidence interval: 0.96-0.99) for death from any cause, 0.94 (0.93-0.96) for death from vascular causes, 1.04 (1.03-1.06) for death from cancer and 0.92 (0.90-0.94) for death from other causes. Height was negatively associated with death from coronary disease, stroke subtypes, heart failure, stomach and oral cancers, chronic obstructive pulmonary disease, mental disorders, liver disease and external causes. In contrast, height was positively associated with death from ruptured aortic aneurysm, pulmonary embolism, melanoma and cancers of the pancreas, endocrine and nervous systems, ovary, breast, prostate, colorectum, blood and lung. HRs per 6.5 cm greater height ranged from 1.26 (1.12-1.42) for risk of melanoma death to 0.84 (0.80-0.89) for risk of death from chronic obstructive pulmonary disease. HRs were not appreciably altered after further adjustment for adiposity, blood pressure, lipids, inflammation biomarkers, diabetes mellitus, alcohol consumption or socio-economic indicators. Conclusion Adult height has directionally opposing relationships with risk of death from several different major causes of chronic diseases.

  • 883. Yang, Fei
    et al.
    Pedersen, Nancy L
    Ye, Weimin
    Liu, Zhiwei
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Forsgren, Lars
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Trolle Lagerros, Ylva
    Bellocco, Rino
    Alfredsson, Lars
    Knutsson, Anders
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Galanti, Maria Rosaria
    Lager, Anton C J
    Araghi, Marzieh
    Lundberg, Michael
    Magnusson, Cecilia
    Wirdefeldt, Karin
    Moist smokeless tobacco (Snus) use and risk of Parkinson's disease2017In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 46, no 3, p. 872-880Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cigarette smoking is associated with a lower risk of Parkinson's disease. It is unclear what constituent of tobacco smoke may lower the risk. Use of Swedish moist smokeless tobacco (snus) can serve as a model to disentangle what constituent of tobacco smoke may lower the risk. The aim of this study was to determine whether snus use was associated with a lower risk of Parkinson's disease.

    METHODS: Individual participant data were collected from seven prospective cohort studies, including 348 601 men. We used survival analysis with multivariable Cox regression to estimate study-specific relative risk of Parkinson's disease due to snus use, and random-effects models to pool estimates in a meta-analysis. The primary analyses were restricted to never-smokers to eliminate the potential confounding effect of tobacco smoking.

    RESULTS: During a mean follow-up time of 16.1 years, 1199 incident Parkinson's disease cases were identified. Among men who never smoked, ever-snus users had about 60% lower Parkinson's disease risk compared with never-snus users [pooled hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.28-0.61]. The inverse association between snus use and Parkinson's disease risk was more pronounced in current (pooled HR 0.38, 95% CI 0.23-0.63), moderate-heavy amount (pooled HR 0.41, 95% CI 0.19-0.90) and long-term snus users (pooled HR 0.44, 95% CI 0.24-0.83).

    CONCLUSIONS: Non-smoking men who used snus had a substantially lower risk of Parkinson's disease. Results also indicated an inverse dose-response relationship between snus use and Parkinson's disease risk. Our findings suggest that nicotine or other components of tobacco leaves may influence the development of Parkinson's disease.

  • 884. Zamora-Ros, Raul
    et al.
    Forouhi, Nita G.
    Sharp, Stephen J.
    Gonzalez, Carlos A.
    Buijsse, Brian
    Guevara, Marcela
    van der Schouw, Yvonne T.
    Amiano, Pilar
    Boeing, Heiner
    Bredsdorff, Lea
    Fagherazzi, Guy
    Feskens, Edith J.
    Franks, Paul W.
    Grioni, Sara
    Katzke, Verena
    Key, Timothy J.
    Khaw, Kay-Tee
    Kuehn, Tilman
    Masala, Giovanna
    Mattiello, Amalia
    Molina-Montes, Esther
    Nilsson, Peter M.
    Overvad, Kim
    Perquier, Florence
    Luisa Redondo, M.
    Ricceri, Fulvio
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Romieu, Isabelle
    Roswall, Nina
    Scalbert, Augustin
    Schulze, Matthias
    Slimani, Nadia
    Spijkerman, Annemieke M. W.
    Tjonneland, Anne
    Jose Tormo, Maria
    Touillaud, Marina
    Tumino, Rosario
    van der A, Daphne L.
    van Woudenbergh, Geertruida J.
    Langenberg, Claudia
    Riboli, Elio
    Wareham, Nicholas J.
    Dietary intakes of individual flavanols and flavonols are inversely associated with incident type 2 diabetes in european populations2014In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 144, no 3, p. 335-343Article in journal (Refereed)
    Abstract [en]

    Dietary flavanols and flavonols, flavonoid subclasses, have been recently associated with a lower risk of type 2 diabetes (T2D) in Europe. Even within the same subclass, flavonoids may differ considerably in bioavailability and bioactivity. We aimed to examine the association between individual flavanol and flavonol intakes and risk of developing T2D across European countries. The European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study was conducted in 8 European countries across 26 study centers with 340,234 participants contributing 3.99 million person-years of follow-up, among whom 12,403 incident T2D cases were ascertained and a center-stratified subcohort of 16,154 individuals was defined. We estimated flavonoid intake at baseline from validated dietary questionnaires using a database developed from Phenol-Explorer and USDA databases. We used country-specific Prentice-weighted Cox regression models and random-effects meta-analysis methods to estimate HRs. Among the flavanol subclass, we observed significant inverse trends between intakes of all individual flavan-3-ol monomers and risk of T2D in multivariable models (all P-trend < 0.05). We also observed significant trends for the intakes of proanthocyanidin dimers (HR for the highest vs. the lowest quintile. 0.81; 95% Cl: 0.71, 0.92; P-trend = 0.003) and trimers (HR: 0.91; 95% Cl: 0.80, 1.04; P-trend = 0.07) but not for proanthocyanidins with a greater polymerization degree. Among the flavonol subclass, myricetin (HR: 0.77; 95% Cl: 0.64, 0.93; P-trend = 0.001) was associated with a lower incidence of T2D. This large and heterogeneous European study showed inverse associations between all individual flavan-3-ol monomers, proanthocyanidins with a low polymerization degree, and the flavonol myricetin and incident T2D. These results suggest that individual flavonoids have different roles in the etiology of T2D.

  • 885. Zdebska, E
    et al.
    Gołaszewska, E
    Fabijańska-Mitek, J
    Schachter, H
    Shalev, H
    Tamary, H
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wahlin, A
    Kościelak, J
    Glycoconjugate abnormalities in patients with congenital dyserythropoietic anaemia type I, II and III.2001In: British Journal of Haematology, ISSN 0007-1048, E-ISSN 1365-2141, Vol. 114, no 4, p. 907-13Article in journal (Refereed)
    Abstract [en]

    Congenital dyserythropoietic anaemia type II (CDA II) is well known for glycosylation abnormalities affecting erythrocyte membrane glycoconjugates that encompass hypoglycosylation of band 3 glycoprotein and accumulation of glycosphingolipids: lactotriaosylceramides, neolactotriaosylceramide and polyglycosylceramides. These abnormalities were not observed in erythrocytes from patients with CDA of either type I or III. Recently, however, we have described a CDA type I patient in Poland with identical, though less pronounced, glycoconjugate abnormalities to those observed in patients with CDA type II. The abnormalities included partial unglycosylation of O-linked glycosylation sites in glycophorin A. These abnormalities are now reported in three Bedouin patients from Israel with CDA type I. In addition, the erythrocyte membranes of these patients exhibited highly increased globotetraosylceramide content. Glycoconjugate abnormalities were also present in erythrocyte membranes from three patients from Northern Sweden with CDA type III but they almost exclusively affected glycosphingolipids. In erythrocytes of all patients examined including one with CDA type II, polyglycosylceramides were significantly hypoglycosylated although, on a molar basis, their contents in erythrocyte membranes were increased. Thus, glycoconjugate abnormalities of varying intensity occur in erythrocyte membranes from all patients with CDA that were investigated.

  • 886. Zheng, Ju-Sheng
    et al.
    Imamura, Fumiaki
    Sharp, Stephen J.
    van der Schouw, Yvonne T.
    Sluijs, Ivonne
    Gundersen, Thomas E.
    Ardanaz, Eva
    Boeing, Heiner
    Bonet, Catalina
    Humberto Gomez, Jesus
    Dow, Courtney
    Fagherazzi, Guy
    Franks, Paul W.
    Jenab, Mazda
    Kuehn, Tilman
    Kaaks, Rudolf
    Key, Timothy J.
    Khaw, Kay-Tee
    Lasheras, Cristina
    Mokoroa, Olatz
    Mancini, Francesca Romana
    Nilsson, Peter M.
    Overvad, Kim
    Panico, Salvatore
    Palli, Domenico
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Sieri, Sabina
    Salamanca-Fernandez, Elena
    Sacerdote, Carlotta
    Spijkerman, Annemieke M. W.
    Stepien, Magdalena
    Tjonneland, Anne
    Tumino, Rosario
    Butterworth, Adam S.
    Riboli, Elio
    Danesh, John
    Langenberg, Claudia
    Forouhi, Nita G.
    Wareham, Nicholas J.
    Association of Plasma Vitamin D Metabolites With Incident Type 2 Diabetes: EPIC-InterAct Case-Cohort Study2019In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 104, no 4, p. 1293-1303Article in journal (Refereed)
    Abstract [en]

    Background: Existing evidence for the prospective association of vitamin D status with type 2 diabetes (T2D) is focused almost exclusively on circulating total 25-hydroxyvitamin D [25(OH)D] without distinction between its subtypes: nonepimeric and epimeric 25(OH)D3 stereoisomers, and 25(OH)D2, the minor component of 25(OH)D. We aimed to investigate the prospective associations of circulating levels of the sum and each of these three metabolites with incident T2D.

    Methods: This analysis in the European Prospective Investigation into Cancer and Nutrition (EPIC)–InterAct case-cohort study for T2D included 9671 incident T2D cases and 13,562 subcohort members. Plasma vitamin D metabolites were quantified by liquid chromatography–mass spectrometry. We used a multivariable Prentice-weighted Cox regression to estimate hazard ratios (HRs) of T2D for each metabolite. Analyses were performed separately within country, and estimates were combined across countries using random-effects meta-analysis.

    Results: The mean concentrations (SD) of total 25(OH)D, nonepimeric 25(OH)D3, epimeric 25(OH)D3, and 25(OH)D2 were 41.1 (17.2), 40.7 (17.3), 2.13 (1.31), and 8.16 (6.52) nmol/L, respectively. Plasma total 25(OH)D and nonepimeric 25(OH)D3 were inversely associated with incident T2D [multivariable-adjusted HR per 1 SD = 0.81 (95% CI, 0.77, 0.86) for both variables], whereas epimeric 25(OH)D3 was positively associated [per 1 SD HR = 1.16 (1.09, 1.25)]. There was no statistically significant association with T2D for 25(OH)D2 [per 1 SD HR = 0.94 (0.76, 1.18)].

    Conclusions: Plasma nonepimeric 25(OH)D3 was inversely associated with incident T2D, consistent with it being the major metabolite contributing to total 25(OH)D. The positive association of the epimeric form of 25(OH)D3 with incident T2D provides novel information to assess the biological relevance of vitamin D epimerization and vitamin D subtypes in diabetes etiology.

  • 887. Zimmerman, Malin
    et al.
    Enes, Sara Rolandsson
    Skarstrand, Hanna
    Pourhamidi, Kaveh
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gottsater, Anders
    Wollmer, Per
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Westergren-Thorsson, Gunilla
    Dahlin, Lars B.
    Temporal trend of autonomic nerve function and HSP27, MIF and PAI-1 in type 1 diabetes2017In: Journal of clinical and translational endocrinology, ISSN 2214-6237, Vol. 8, p. 15-21Article in journal (Refereed)
    Abstract [en]

    Aim: Diabetes mellitus type 1 (T1D) has numerous complications including autonomic neuropathy, i.e. dysfunction of the autonomous nervous system. This study focuses on Heat Shock Protein 27 (HSP27), Macrophage Migration Inhibitory Factor (MIF), Plasminogen Activator Inhibitor-1 (PAI-1) and HbA1c and their possible roles in effects of diabetes on the autonomic nervous system.

    Methods: Patients with T1D (n = 32, 41% women) were recruited in 1985 and followed up on four occasions (1989, 1993, 1998, and 2005). Autonomic function was tested using expiration/inspiration (E/I-ratio). Blood samples, i.e. HSP27 (last three occasions), MIF, PAI-1 (last two occasions) and HbA1c (five occasions), were analyzed.

    Results: Autonomic nerve function deteriorated over time during the 20-year-period, but levels of HSP27, MIF, and PAI-1 were not associated with cardiovascular autonomic neuropathy. MIF and PAI-1 were lower in T1D than in healthy controls in 2005. Increased HbA1c correlated with a decrease in E/I-ratio.

    Conclusions: Neither the neuroprotective substance HSP27 nor the inflammatory substances, MIF and PAI-1 were associated with measures of cardiovascular autonomic nerve function, but a deterioration of such function was observed in relation to increasing HbA1c in T1D during a 20-year follow-up period. Improved glucose control might be associated with protection against autonomic neuropathy in T1D.

  • 888. Zimmerman, Malin
    et al.
    Pourhamidi, Kaveh
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Dahlin, Lars B.
    Autonomic Neuropathy: a Prospective Cohort Study of Symptoms and E/I Ratio in Normal Glucose Tolerance, Impaired Glucose Tolerance, and Type 2 Diabetes2018In: Frontiers in Neurology, ISSN 1664-2295, E-ISSN 1664-2295, Vol. 9, article id 154Article in journal (Refereed)
    Abstract [en]

    Background: Autonomic neuropathy in diabetes, in addition to causing a range of symptoms originating from the autonomic nervous system, may increase cardiovascular morbidity. Our aim was to study the progression of autonomic neuropathy, based on symptom score and evaluation of an autonomic test, in persons with normal and impaired glucose tolerance and in patients with type 2 diabetes (T2D).

    Methods: Participants were recruited in 2003/2004 with a follow-up in 2014. The participants' glucose tolerance was categorized using oral glucose tolerance tests. Symptoms were evaluated using an autonomic symptom score (ASS), ECG was used to test cardiac autonomic function based on the expiration/inspiration ratio (E/I ratio), and blood samples were taken on both occasions.

    Results: ASSs were higher at follow-up in the T2D patients than in the normal glucose tolerance group (mean 1.21 +/- 1.30 vs. 0.79 +/- 0.7; p < 0.05). E/I ratio did not deteriorate more than could be expected as an aging effect in well-controlled T2D. No relationship was found between E/I ratio and HbA1c or ASS.

    Conclusion: The presence of autonomic symptoms increased over time in T2D patients, but the symptoms did not correlate with the Ell ratio in this metabolically well-controlled cohort. ASSs can be a useful clinical tool when assessing the progression of autonomic dysfunction in patients with abnormal glucose metabolism.

  • 889.
    Zusmanis, Erik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Inifrån Sjukstugan: En kvalitativ studie av Storumans sjukstuga från ett medarbetarperspektiv2015Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 890.
    Ådén, Emma
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Carlsson, Maine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Poortvliet, Eric
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Linder, Jan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Neurology.
    Edström, Mona
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Neurology.
    Forsgren, Lars
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Neurology.
    Håglin, Lena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Dietary intake and olfactory function in patients with newly diagnosed Parkinson's disease: a case-control study.2011In: Nutritional neuroscience, ISSN 1476-8305, Vol. 14, no 1, p. 25-31Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate energy and nutrient intake in newly diagnosed Parkinson's disease (PD) patients and association between olfaction and nutrient density of the diet.

    DESIGN: Baseline data from a prospective cohort study.

    SUBJECTS: Eighty-seven patients and 28 age- and sex-matched controls participated in the study.

    METHODS: Dietary intake was assessed by using 3-day dietary records and 24-hour dietary recalls. The Brief Smell Identification Test (B-SIT) was used to test olfaction.

    RESULTS: Patients, compared with controls, had lower intake of polyunsaturated fatty acids (P = 0.024) and a higher intake of carbohydrates (P = 0.027) in energy percent (E%). Lower intake of protein (E%) (P = 0.045), and a low nutrient density of folate (P = 0.022), magnesium (P = 0.012), and phosphorus (P = 0.029) were associated with lower B-SIT score in both patients and controls. PD patients had a lower B-SIT score than controls (P < 0.001).

    CONCLUSION: The results indicate a higher relative contribution of energy from carbohydrates in PD patients. An association between low protein, folate, magnesium, and phosphorus density of the diet and olfaction was seen in the whole population.

  • 891.
    Ådén, Emma
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Johansson, I
    Håglin, Lena
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Diet before and during pregnancy.2007In: Scandinavian Journal of Food and Nutrition, Vol. 51, p. 67-73Article in journal (Other academic)
  • 892.
    Öhman, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Sörlin, Anette
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Tano, Krister
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Patients' experiences of living with superior canal dehiscence syndrome2018In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 57, no 11, p. 825-830Article in journal (Refereed)
    Abstract [en]

    Objective: The study investigated how the symptoms of superior canal dehiscence syndrome (SCDS) affected patients in their daily life, and how patients coped with the disease.

    Design: This was a qualitative study; semi-structured interviews were performed and analysed according to the systematic text condensation method.

    Study sample: Twelve of 13 identified patients with SCDS in the county of Norrbotten, Sweden, were included in the study.

    Results: Five main categories were created based on the patients' experiences of living with SCDS: (1) Experiencing strange symptoms: One "new" symptom was identified - mental fatigue. (2) A restricted life socially, physically and at work: All patients experienced some extent of limitation in their daily life. (3) To accept and to protect oneself: All patients had developed strategies to protect their ears from noise. (4) Misunderstood in health care: The diagnosis was sometimes delayed several years due to lack of knowledge among healthcare workers. (5) Carefully considering treatment (surgery): Symptoms were weighed against the risk of side effects.

    Conclusions: SCDS was rendered an invisible disability. In the present study, we identified mental fatigue as a symptom not previously considered in the literature.

  • 893. Österlund, Anders
    et al.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Utvärdering av projektet "Sex med spex" vid Strömbackaskolan i Piteå. Rapport till Socialstyrelsen.2011Report (Other academic)
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