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Kristenson, Margareta
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Publications (10 of 71) Show all publications
Lundgren, O., Garvin, P., Andersson, G., Jonasson, L. & Kristenson, M. (2018). Inverted items and validity: A psychobiological evaluation of two measures of psychological resources and one depression scale. Health psychology open, 5(1), Article ID 2055102918755045.
Open this publication in new window or tab >>Inverted items and validity: A psychobiological evaluation of two measures of psychological resources and one depression scale
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2018 (English)In: Health psychology open, ISSN 2055-1029, Vol. 5, no 1, article id 2055102918755045Article in journal (Refereed) Published
Abstract [en]

Psychological resources and risk factors influence risk of coronary heart disease. We evaluated whether inverted items in the Self-esteem, Mastery, and Center for Epidemiological Studies Depression scales compromise validity in the context of coronary heart disease. In a population-based sample, validity was investigated by calculating correlations with other scales (n = 1004) and interleukin-6 (n = 374), and by analyzing the relationship with 8-year coronary heart disease risk (n = 1000). Negative items did not affect the validity of the resource scales. In contrast, positive items from Center for Epidemiological Studies Depression showed no significant relationships with biological variables. However, they had no major impact on the validity of the original scale.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
coronary heart disease, depressiveness, interleukin-6, mastery, self-esteem, wording effect
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-146087 (URN)10.1177/2055102918755045 (DOI)29479456 (PubMedID)
Available from: 2018-03-27 Created: 2018-03-27 Last updated: 2018-06-08Bibliographically approved
Nilsson, E., Orwelius, L. & Kristenson, M. (2016). Patient-reported outcomes in the Swedish National Quality Registers. Journal of Internal Medicine, 279(2), 141-153
Open this publication in new window or tab >>Patient-reported outcomes in the Swedish National Quality Registers
2016 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 279, no 2, p. 141-153Article, review/survey (Refereed) Published
Abstract [en]

Patient-reported outcomes (PROs) are important in the healthcare system to gain understanding of patients views on the effects of a treatment. There is an abundance of available patient-reported outcome measures (PROMs), both disease specific and generic. In the Swedish healthcare system, the national quality registers are obliged to incorporate PROs for certification at a high level. A review of the latest annual applications for funding (n = 108) shows that at present, 93 national quality registers include some form of PROM or patient-reported experience measure (PREM). Half of the registers include some type of generic measure, more than half include disease/symptom-specific measures, and around 40% include PREMs. Several different measures and combinations of measures are used, the most common of which are the EQ-5D, followed by the SF-36/RAND-36. About one-fifth of the registers report examples of how patient-reported data are used for local quality improvement. These examples include enhancing shared decision-making in clinical encounters (most common), as a basis for care plans, clinical decision aids and treatment guidelines, to improve the precision of indications for surgery (patient and healthcare professional assessments may differ), to monitor complications after the patient has left hospital and to improve patient information. In addition, funding applications reveal that most registers plan to extend their array of PROMs and PREMs in future, and to increase their use of patient-reported data as a basis for quality improvement.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2016
Keywords
health-related quality of life; PREM; PROM; quality improvement; quality register
National Category
Clinical Medicine Basic Medicine
Identifiers
urn:nbn:se:liu:diva-126847 (URN)10.1111/joim.12409 (DOI)000371617500003 ()26306802 (PubMedID)
Note

Funding Agencies|Quality Register Center Stockholm; PROMcenter; Swedish Intensive Care Register; Executive Committee for the National Quality Registers

Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2018-03-23
Garvin, P., Nilsson, E., Ernerudh, J. & Kristenson, M. (2016). The joint subclinical elevation of CRP and IL-6 is associated with lower health-related quality of life in comparison with no elevation or elevation of only one of the biomarkers. Quality of Life Research, 25(1), 213-221
Open this publication in new window or tab >>The joint subclinical elevation of CRP and IL-6 is associated with lower health-related quality of life in comparison with no elevation or elevation of only one of the biomarkers
2016 (English)In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 25, no 1, p. 213-221Article in journal (Refereed) Published
Abstract [en]

Measures of health-related quality of life (HRQoL), like the Short Form (SF)-36, have been suggested to correlate with inflammatory biomarkers. It is, however, unclear whether a joint measure of two inflammatory biomarkers would bring additional information in comparison with evaluation of one inflammatory biomarker. To evaluate associations between SF-36 and low-grade inflammation in a Swedish population, with emphasis on a combined measure of C-reactive protein (CRP) and interleukin-6 (IL-6) as a proxy for low-grade inflammation. In a randomly selected sample of a middle-aged Swedish general population (n = 905; aged 45-69 years, 50 % women), relations between SF-36 parameters and the biomarkers were tested. Regression and correlation analyses were adjusted for sex, age, presence of disease, lifestyle, and psychological factors. After adjustment for sex and age, HRQoL was significantly lower in the group with a joint elevation of CRP and IL-6 in comparison with either the group with no elevation or the groups showing elevation of one of the two biomarkers. Also after full adjustments, the combined measure of elevated CRP and IL-6, with few exceptions, was associated with significantly lower HRQoL in comparison with elevations in one of them, difference ranging from 4 (Mental Health scale) to 18 scale steps (Role-Physical scale). This study confirms that there is a relationship between HRQoL and low-grade inflammation. In particular, SF-36 scores are significantly lower in a group with joint elevation of IL-6 and CRP, in comparison with elevation of either one of them.

Place, publisher, year, edition, pages
SPRINGER, 2016
Keywords
Biomarkers; CRP; Health-related quality of life; Inflammation; Interleukin; Population; SF-36
National Category
Sociology Basic Medicine
Identifiers
urn:nbn:se:liu:diva-124641 (URN)10.1007/s11136-015-1068-6 (DOI)000367896300023 ()26195318 (PubMedID)
Note

Funding Agencies|Swedish Research Council [2004-1881]; Swedish Heart and Lung Foundation [2004053]

Available from: 2016-02-08 Created: 2016-02-08 Last updated: 2018-01-10
Pössel, P., Mitchell, A. M., Sjögren, E. & Kristenson, M. (2015). Do Depressive Symptoms Mediate the Relationship Between Hopelessness and Diurnal Cortisol Rhythm?. International Journal of Behavioral Medicine, 22(2), 251-257
Open this publication in new window or tab >>Do Depressive Symptoms Mediate the Relationship Between Hopelessness and Diurnal Cortisol Rhythm?
2015 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 22, no 2, p. 251-257Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Research has revealed a well-established relationship of depressive symptoms and hopelessness with a variety of physical illnesses that are associated with a dysfunction of the hypothalamic-pituitary-adrenal-axis.

PURPOSE: The purpose of this study was to test if depressive symptoms mediate the relationship between hopelessness and cortisol, a measure of the hypothalamic-pituitary-adrenal-axis.

METHODS: Hopelessness, depressive symptoms, and diurnal cortisol rhythm were measured in 257 adults (128 women and 129 men; age range, 20-74 years) in this cross-sectional study. To test the hypothesis, two linear regression analyses and asymmetrical confidence intervals around the regression weights were conducted. A second set of analyses was calculated to be able to exclude the possibility of hopelessness as a mediator between depressive symptoms and cortisol.

RESULTS: As predicted, after adjusting for age, gender, awakening time, and medication use, more hopelessness predicted more depressive symptoms and more depressive symptoms predicted a flatter diurnal cortisol rhythm. The 95 % confidence intervals revealed that the indirect relationship between hopelessness and diurnal cortisol rhythm was significant. The analyses with hopelessness as a potential mediator revealed that hopelessness does not mediate the association between depressive symptoms and cortisol.

CONCLUSIONS: While the relationship between hopelessness and cortisol was mediated by depressive symptoms in this cross-sectional study, many other risk factors of depression have not been examined. Thus, future longitudinal studies should examine the relationships between those risk factors of depression and the hypothalamic-pituitary-adrenal-axis.

Keywords
Population-based Cross-sectional study Mediation model Hopelessness Depressive symptoms Diurnal cortisol rhythm
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-115573 (URN)10.1007/s12529-014-9422-6 (DOI)000351523600011 ()25475609 (PubMedID)
Available from: 2015-03-18 Created: 2015-03-17 Last updated: 2017-12-04
Granström, F., Molarius, A., Garvin, P., Elo, S., Feldman, I. & Kristenson, M. (2015). Exploring trends in and determinants of educational inequalities in self-rated health. Scandinavian Journal of Public Health, 43(7), 677-686
Open this publication in new window or tab >>Exploring trends in and determinants of educational inequalities in self-rated health
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2015 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 7, p. 677-686Article in journal (Refereed) Published
Abstract [en]

Aims: Educational inequalities in self-rated health (SRH) in European welfare countries are documented, but recent trends in these inequalities are less well understood. We examined educational inequalities in SRH in different age groups, and the contribution of selected material, behavioural and psychosocial determinants from 2000 to 2008. Methods: Data were derived from cross-sectional surveys conducted in 2000, 2004 and 2008 including 37,478, 34,876 and 32,982 respondents, respectively, aged 25-75 in mid-Sweden. Inequalities were analysed by age-standardized and age-stratified rate ratios of poor SRH and age-standardized prevalence of determinants, and contribution of determinants by age-adjusted logistic regression. Results: Relative educational inequalities in SRH increased among women from 2000 (rate ratio (RR) 1.70, 95% CI 1.55-1.85) to 2008 (RR 2.07, 95% CI 1.90-2.26), but were unchanged among men (RR 1.91-2.01). The increase among women was mainly due to growing inequalities in the age group 25-34 years. In 2008, significant age differences emerged with larger inequalities in the youngest compared with the oldest age group in both genders. All determinants were more prevalent in low educational groups; the most prominent were lack of a financial buffer, smoking and low optimism. Educational differences were unchanged over the years for most determinants. In all three surveys, examined determinants together explained a substantial part of the educational inequalities in SRH. Conclusions: Increased relative educational health inequalities among women, and persisting inequalities among men, were paralleled by unchanged, large differences in material/structural, behavioural and psychosocial factors. Interventions to reduce these inequalities need to focus on early mid-life.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2015
Keywords
Health status disparities; social medicine; socioeconomic factors; educational status
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-122099 (URN)10.1177/1403494815592271 (DOI)000361768900002 ()26138729 (PubMedID)
Note

Funding Agencies|Centre for Clinical Research Sormland, Uppsala University; Sormland County Council, Sweden; County Council of Vastmanland; County Council of Uppsala; County Council of Sormland; County Council of Orebro; County Council of Varmland

Available from: 2015-10-19 Created: 2015-10-19 Last updated: 2017-12-01
Garvin, P., Jonasson, L., Nilsson, L., Falk, M. & Kristenson, M. (2015). Plasma Matrix Metalloproteinase-9 Levels Predict First-Time Coronary Heart Disease: An 8-Year Follow-Up of a Community-Based Middle Aged Population. PLoS ONE, 10(9), e0138290
Open this publication in new window or tab >>Plasma Matrix Metalloproteinase-9 Levels Predict First-Time Coronary Heart Disease: An 8-Year Follow-Up of a Community-Based Middle Aged Population
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2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 9, p. e0138290-Article in journal (Refereed) Published
Abstract [en]

Background The enzyme in matrix metalloproteinase (MMP)-9 has been suggested to be an important determinant of plaque degradation. While several studies have shown elevated levels in patients with coronary heart disease, results in prospective population based studies evaluating MMP-9 in relation to first time coronary events have been inconclusive. As of today, there are four published studies which have measured MMP-9 in serum and none using plasma. Measures of MMP-9 in serum have been suggested to have more flaws than measures in plasma. Aim To investigate the independent association between plasma levels of MMP-9 and first-time incidence of coronary events in an 8-year follow-up. Material and Methods 428 men and 438 women, aged 45-69 years, free of previous coronary events and stroke at baseline, were followed-up. Adjustments were made for sex, age, socioeconomic position, behavioral and cardiovascular risk factors, chronic disease at baseline, depressive symptoms, interleukin-6 and C-reactive protein. Results 53 events were identified during a risk-time of 6 607 person years. Hazard ratio (HR) for MMP-9 after adjustment for all covariates were HR = 1.44 (1.03 to 2.02, p = 0.033). Overall, the effect of adjustments for other cardiovascular risk factors was low. Conclusion Levels of plasma MMP-9 are independently associated with risk of first-time CHD events, regardless of adjustments. These results are in contrast to previous prospective population-based studies based on MMP-9 in serum. It is essential that more studies look at MMP-9 levels in plasma to further evaluate the association with first coronary events.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2015
National Category
Clinical Medicine Basic Medicine
Identifiers
urn:nbn:se:liu:diva-122112 (URN)10.1371/journal.pone.0138290 (DOI)000361791000022 ()26389803 (PubMedID)
Note

Funding Agencies|Swedish Research Council [2004-1881]; Swedish Heart and Lung Foundation [2004053]

Available from: 2015-10-19 Created: 2015-10-19 Last updated: 2018-01-11
Lundgren, O., Garvin, P., Jonasson, L., Andersson, G. & Kristenson, M. (2014). Psychological Resources are Associated with Reduced Incidence of Coronary Heart Disease: An 8-Year Follow-up of a Community-Based Swedish Sample. International Journal of Behavioral Medicine, 22(1), 77-84
Open this publication in new window or tab >>Psychological Resources are Associated with Reduced Incidence of Coronary Heart Disease: An 8-Year Follow-up of a Community-Based Swedish Sample
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2014 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 22, no 1, p. 77-84Article in journal (Refereed) Published
Abstract [en]

Background

A large number of studies have provided clear evidence for a link between the risk of coronary heart disease and psychological risk factors. Much less attention has been given to the potential protective effect of psychological resources.

Purpose

The major aim of this study was to investigate the independent association between psychological resources and incidence of coronary heart disease (CHD) in an 8-year follow-up study of a Swedish community-based cohort.

Methods

The cohort consisted of 484 men and 497 women, aged 45–69 years at baseline. The incidence of first-time major event of CHD was analysed in relation to baseline levels of psychological resources, including mastery, self-esteem, and sense of coherence as well as psychological risk factors including cynicism and hostile affect, vital exhaustion, hopelessness, and depressive symptoms. In Cox proportional hazard models, adjustments were made for age, sex, eight traditional cardiovascular risk factors, and depressive symptoms.

Results

A total of 56 CHD events had occurred after the 8-year follow-up. After adjustment for age, sex, and eight traditional risk factors, a significantly decreased risk of CHD was found for mastery (HR 0.62 per SD, p = 0.003), self-esteem (HR 0.64, p = 0.004), and sense of coherence (HR 0.70, p = 0.031). An increased risk of CHD was found for vital exhaustion (HR 1.46, p = 0.014), hopelessness (HR 1.59, p = 0.003), and depressive symptoms (HR 1.45, p = 0.009). After further adjustment for depressive symptoms, significant associations remained for mastery (HR 0.67, p = 0.034), self-esteem (HR 0.69, p = 0.048), and hopelessness (HR 1.48, p = 0.023).

Conclusions

The psychological resources, mastery and self-esteem, showed robust protective effects on CHD, also after adjustment for established risk factors as well as depressive symptoms. In parallel, hopelessness was an independent risk factor for CHD. The results may have implications for novel approaches in preventive efforts

Place, publisher, year, edition, pages
Springer, 2014
Keywords
Mastery, Self-esteem, Sense of coherence, Hopelessness, Psychosocial, Coronary heart disease, Myocardial infarction
National Category
Clinical Medicine Health Sciences
Identifiers
urn:nbn:se:liu:diva-108566 (URN)10.1007/s12529-014-9387-5 (DOI)000349011500009 ()24430130 (PubMedID)
Available from: 2014-06-30 Created: 2014-06-30 Last updated: 2018-06-08Bibliographically approved
Orwelius, L., Fredrikson, M., Kristenson, M., Walther, S. & Sjöberg, F. (2013). Health-related quality of life scores after intensive care are almost equal to those of the normal population: a multicenter observational study. Critical Care, 17(5), R236
Open this publication in new window or tab >>Health-related quality of life scores after intensive care are almost equal to those of the normal population: a multicenter observational study
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2013 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 17, no 5, p. R236-Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION:

Health-related quality of life (HRQoL) in patients treated in intensive care has been reported to be lower compared with age- and sex-adjusted control groups. Our aim was to test whether stratifying for coexisting conditions would reduce observed differences in HRQoL between patients treated in the ICU and a control group from the normal population. We also wanted to characterize the ICU patients with the lowest HRQoL within these strata.

METHODS:

We did a cross-sectional comparison of scores of the short-form health survey (SF-36) questionnaire in a multicenter study of patients treated in the ICU (n = 780) and those from a local public health survey (n = 6,093). Analyses were in both groups adjusted for age and sex, and data stratified for coexisting conditions. Within each stratum, patients with low scores (below -2 SD of the control group) were identified and characterized.

RESULTS:

After adjustment, there were minor and insignificant differences in mean SF-36 scores between patients and controls. Eight (n = 18) and 22% (n = 51) of the patients had low scores (-2 SD of the control group) in the physical and mental dimensions of SF-36, respectively. Patients with low scores were usually male, single, on sick leave before admission to critical care, and survived a shorter time after being in ICU.

CONCLUSIONS:

After adjusting for age, sex, and coexisting conditions, mean HRQoL scores were almost equal in patients and controls. Up to 22% (n = 51) of the patients had, however, a poor quality of life as compared with the controls (-2 SD). This group, which more often consisted of single men, individuals who were on sick leave before admission to the ICU, had an increased mortality after ICU. This group should be a target for future support.

Place, publisher, year, edition, pages
BioMed Central, 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-102566 (URN)10.1186/cc13059 (DOI)000331540900052 ()24119915 (PubMedID)
Available from: 2013-12-13 Created: 2013-12-13 Last updated: 2017-12-06Bibliographically approved
Mitchell, A. M., Poessel, P., Sjögren, E. & Kristenson, M. (2013). HOPELESSNESS THE "ACTIVE INGREDIENT"? ASSOCIATIONS OF HOPELESSNESS AND DEPRESSIVE SYMPTOMS WITH INTERLEUKIN-6. International Journal of Psychiatry in Medicine, 46(1), 109-117
Open this publication in new window or tab >>HOPELESSNESS THE "ACTIVE INGREDIENT"? ASSOCIATIONS OF HOPELESSNESS AND DEPRESSIVE SYMPTOMS WITH INTERLEUKIN-6
2013 (English)In: International Journal of Psychiatry in Medicine, ISSN 0091-2174, E-ISSN 1541-3527, Vol. 46, no 1, p. 109-117Article in journal (Refereed) Published
Abstract [en]

Objective: Previous research has revealed a relationship of depressive symptoms and hopelessness with cardiovascular diseases (CVDs) which are associated with elevated levels of interleukin-6 (IL-6). The objective of this study was to explore whether depressive symptoms and hopelessness are independent predictors of IL-6 levels. Method: Hopelessness, depressive symptoms, and IL-6 were measured in 45 Swedish adults (26 women and 19 men; age range: 31-65 years). Two separated linear regressions were conducted with hopelessness and depressive symptoms serving as individual predictors of IL-6. Another regression analysis examined whether the two predictors predict IL-6 when controlling for each other. The regression coefficients of the models with one predictor and with both predictors were compared. Results: As predicted, after adjusting for age, BMI, illness, smoking, and gender, more depressive symptoms and more hopelessness predicted higher IL-6 levels in independent regressions. When controlling for each other, hopelessness, but not depressive symptoms, predicted IL-6 levels. Finally, when controlling for hopelessness, the regression between depressive symptoms and IL-6 level was significantly reduced; however, there was no significant change in the regression between hopelessness and IL-6 level when controlling for depressive symptoms. Conclusions: Thus, these results suggest that depressive symptoms and hopelessness are not independent predictors of IL-6 levels. Future research should explore the interplay of hopelessness and depressive symptoms on other risk factors of CVDs.

Place, publisher, year, edition, pages
Baywood Publishing, 2013
Keywords
cross-sectional study, hopelessness, depressive symptoms, interleukin-6
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-102794 (URN)10.2190/PM.46.1.g (DOI)000327728000007 ()
Available from: 2014-01-07 Created: 2013-12-26 Last updated: 2017-12-06
Kristenson, M. (2012). Impact of socioeconomic determinants on psychosocial factors and lifestyle - implications for health service: The Swedish experience. Social Science and Medicine, 74(5), 661-664
Open this publication in new window or tab >>Impact of socioeconomic determinants on psychosocial factors and lifestyle - implications for health service: The Swedish experience
2012 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 74, no 5, p. 661-664Article in journal (Refereed) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
Elsevier, 2012
Keywords
Health determinants, Health services, Sweden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-76621 (URN)10.1016/j.socscimed.2011.12.014 (DOI)000301626000008 ()
Available from: 2012-04-13 Created: 2012-04-13 Last updated: 2017-12-07
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