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Wiréhn, Ann-Britt
Alternative names
Publications (10 of 32) Show all publications
Rådholm, K., Wiréhn, A.-B., Chalmers, J. & Östgren, C. J. (2016). Use of antidiabetic and antidepressant drugs is associated with increased risk of myocardial infarction: a nationwide register study. Diabetic Medicine, 33(2), 218-223.
Open this publication in new window or tab >>Use of antidiabetic and antidepressant drugs is associated with increased risk of myocardial infarction: a nationwide register study
2016 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, no 2, 218-223 p.Article in journal (Refereed) Published
Abstract [en]

Aims

To explore the gender- and age-specific risk of developing a first myocardial infarction in people treated with antidiabetic and/or antidepressant drugs compared with people with no pharmaceutical treatment for diabetes or depression.

Methods

A cohort of all Swedish residents aged 45–84 years (n = 4 083 719) was followed for a period of 3 years. Data were derived from three nationwide registers. The prescription and dispensing of antidiabetic and antidepressant drugs were used as markers of disease. All study subjects were reallocated according to treatment and the treatment categories were updated every year. Data were analysed using a Cox regression model with a time-dependent variable. The outcome of interest was first fatal or non-fatal myocardial infarction.

Results

During follow-up, 42 840 people had a first myocardial infarction, 3511 of which were fatal. Women aged 45–64 years, receiving both antidiabetic and antidepressant drugs had a hazard ratio for myocardial infarction of 7.4 (95% CI 6.3–8.6) compared with women receiving neither. The corresponding hazard ratio for men was 3.1 (95% CI 2.8–3.6).

Conclusions

The combined use of antidiabetic and antidepressant drugs was associated with a higher risk of myocardial infarction compared with use of either group of drugs alone. The increase in relative risk was greater in middle-aged women than in middle-aged men.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
National Category
Public Health, Global Health, Social Medicine and Epidemiology Other Health Sciences General Practice
Identifiers
urn:nbn:se:liu:diva-121285 (URN)10.1111/dme.12822 (DOI)000370161800011 ()26036276 (PubMedID)
Note

Funding agencies: King Gustaf V and Queen Victoria Freemason Foundation

Available from: 2015-09-11 Created: 2015-09-11 Last updated: 2018-01-11Bibliographically approved
Ekdahl, A. W., Wirehn, A.-B., Alwin, J., Jaarsma, T., Unosson, M., Husberg, M., . . . Carlsson, P. (2015). Costs and Effects of an Ambulatory Geriatric Unit (the AGe-FIT Study): A Randomized Controlled Trial. Journal of the American Medical Directors Association, 16(6), 497-503.
Open this publication in new window or tab >>Costs and Effects of an Ambulatory Geriatric Unit (the AGe-FIT Study): A Randomized Controlled Trial
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2015 (English)In: Journal of the American Medical Directors Association, ISSN 1538-9375, Vol. 16, no 6, 497-503 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To examine costs and effects of care based on comprehensive geriatric assessment (CGA) provided by an ambulatory geriatric care unit (AGU) in addition to usual care.

DESIGN: Assessor-blinded, single-center randomized controlled trial.

SETTING: AGU in an acute hospital in southeastern Sweden.

PARTICIPANTS: Community-dwelling individuals aged 75 years or older who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion and randomized to the intervention group (IG; n = 208) or control group (CG; n = 174). Mean age (SD) was 82.5 (4.9) years.

INTERVENTION: Participants in the IG received CGA-based care at the AGU in addition to usual care.

OUTCOME MEASURES: The primary outcome was number of hospitalizations. Secondary outcomes were days in hospital and nursing home, mortality, cost of public health and social care, participant' sense of security in care, and health-related quality of life (HRQoL).

RESULTS: Baseline characteristics did not differ between groups. The number of hospitalizations did not differ between the IG (2.1) and CG (2.4), but the number of inpatient days was lower in the IG (11.1 vs 15.2; P = .035). The IG showed trends of reduced mortality (hazard ratio 1.51; 95% confidence interval [CI] 0.988-2.310; P = .057) and an increased sense of security in care interaction. No difference in HRQoL was observed. Costs for the IG and CG were 33,371£ (39,947£) and 30,490£ (31,568£; P = .432).

CONCLUSIONS AND RELEVANCE: This study of CGA-based care was performed in an ambulatory care setting, in contrast to the greater part of studies of the effects of CGA, which have been conducted in hospital settings. This study confirms the superiority of this type of care to elderly people in terms of days in hospital and sense of security in care interaction and that a shift to more accessible care for older people with multimorbidity is possible without increasing costs. This study can aid the planning of future interventions for older people.

TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01446757.

Place, publisher, year, edition, pages
Elsevier, 2015
Keyword
Comprehensive geriatric assessment; ambulatory geriatric care; costs; hospitalization; multimorbidity; randomized controlled trial; security
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-118967 (URN)10.1016/j.jamda.2015.01.074 (DOI)000355134100009 ()25703450 (PubMedID)
Available from: 2015-06-05 Created: 2015-06-05 Last updated: 2016-04-24
Falk, M., Sjödahl, R., Wiréhn, A.-B., Lagerfelt, M., Woisetschläger, M., Ahlström, U. & Myrelid, P. (2015). Modifierad brittisk modell kortade ledtid till datortomografi av kolon. Läkartidningen, 112.
Open this publication in new window or tab >>Modifierad brittisk modell kortade ledtid till datortomografi av kolon
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2015 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Article in journal (Refereed) Published
Abstract [en]

The British national Institute for Health and Care Excellence (NICE) has presented guidelines based on signs and symptoms which should raise a suspicion of colorectal cancer. A slightly modified version of these guidelines, adapted to Swedish conditions, named Swedish NICE (sNICE) criteria, was implemented at eight primary care centres. By following the sNICE criteria, cases with higher degree of suspicion of colorectal cancer were advised for computer tomography (CT) of the colon, whereas cases of low degree of suspicion were advised for the considerably less time and patient demanding CT of the abdomen. For patients with isolated anal symptoms without presence of sNICE criteria, active expectancy for six weeks was recommended, followed by renewed consideration. Results showed that the ratio between CT colon and CT abdomen was reduced from 2.2 to 1.1 after introduction of the sNICE criteria. Also, the proportion of patients undergoing CT colon within two weeks from admittance was increased from 3 to 25 %. We conclude that the sNICE criteria may be a useful supportive tool for the primary care physician.

Abstract [sv]

Vid misstanke om kolorektal cancer är det angeläget att patienter där misstankegraden är hög får genomgå snar utredning och diagnostik. På många håll i landet föreligger oönskat långa väntetider för sådan utredning.

Användningen av ett evidensbaserat beslutsstöd för kolonutredning, baserat på riktlinjer från brittiska NICE (National Institute for Health and Care Excellence), implementerades på 8 vårdcentraler i Östergötland.

Efter implementeringen förkortades ledtider till datortomografi av kolon, diagnos och behandling.

Beslutsstödet bidrog till att patienter där graden av misstanke om kolorektal cancer var låg kunde styras om till att genomgå datortomografi av buken i stället för av kolon.

Place, publisher, year, edition, pages
Stockholm, Sweden: Läkartidningen Förlag AB, 2015
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-126059 (URN)26485132 (PubMedID)
Available from: 2016-03-14 Created: 2016-03-14 Last updated: 2017-11-30Bibliographically approved
Lind, L., Carlgren, G., Mudra, J., Synnergren, H., Hilding, N., Karlsson, d., . . . Persson, H. L. (2015). Preliminary results of a telemonitoring study: COPD and heart failure patients exhibit great difference in their need of health care. In: Marc Humbert (Ed.), European Respiratory Journal: Official Scientific Journal of ERS. Paper presented at ERS International Congress, ERS2015, Amsterdam, Netherlands, 26-30 September 2015 (pp. PA2790-PA2790). European Respiratory Society, 46/suppl 59.
Open this publication in new window or tab >>Preliminary results of a telemonitoring study: COPD and heart failure patients exhibit great difference in their need of health care
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2015 (English)In: European Respiratory Journal: Official Scientific Journal of ERS / [ed] Marc Humbert, European Respiratory Society , 2015, Vol. 46/suppl 59, PA2790-PA2790 p.Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Background: Growing populations of elderly patients with advanced stages of COPD or heart failure (HF) urge the need for specialized health care in the patients' home. A telemonitoring study has been initiated including patients using digital pens. Health care was provided by the specialized home care unit at a university hospital. Through an IT system the staff checked all daily patient reports. We hypothesized that the two groups of patients, advanced COPD or HF, would exhibit differences regarding exacerbations and the need of health care.

Objective: To study exacerbations of COPD or HF, and patient health care consumption.

Methods: A tele-monitoring system, the Health diary, which is based on digital pen technology, was employed. Exacerbations were identified using information provided through the telemonitoring system. Consumed health care was assessed as the number of patient contacts (home visits or telephone consultations).

Results: Presently, 33 patients with advanced disease are enrolled (13 COPD and 20 HF patients) of which 11 patients (6 COPD and 5 HF patients) have completed the 1-yr study period or have died during the study period (2 COPD and 4 HF patients). Exacerbations were 2.8 and 0.8 and patient contacts were 96 and 42 per COPD and HF patient, respectively. While HF patients were significantly older than COPD patients, the two groups demonstrated no difference regarding gender distribution and comorbidity.

Conclusions: COPD patients exhibit exacerbations more frequently and demand much more home health care than patients with HF do. It seems that this difference of health care consumption is mainly due to disease characteristics.

Place, publisher, year, edition, pages
European Respiratory Society, 2015
Series
The European Respiratory Journal, ISSN 0903-1936
National Category
Other Medical Engineering
Identifiers
urn:nbn:se:liu:diva-128905 (URN)10.1183/13993003.congress-2015.PA2790 (DOI)
Conference
ERS International Congress, ERS2015, Amsterdam, Netherlands, 26-30 September 2015
Projects
eHälsodagboken
Available from: 2016-06-07 Created: 2016-06-07 Last updated: 2016-06-21Bibliographically approved
Eckerblad, J., Theander, K., Ekdahl, A., Unosson, M., Wiréhn, A.-B., Milberg, A., . . . Jaarsma, T. (2015). Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study. BMC Geriatrics, 15(1).
Open this publication in new window or tab >>Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study
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2015 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, no 1Article in journal (Refereed) Published
Abstract [en]

Background: Globally, the population is ageing and lives with several chronic diseases for decades. A high symptom burden is associated with a high use of healthcare, admissions to nursing homes, and reduced quality of life. The aims of this study were to describe the multidimensional symptom profile and symptom burden in community-dwelling older people with multimorbidity, and to describe factors related to symptom burden. Methods: A cross-sectional study including 378 community-dwelling people greater than= 75 years, who had been hospitalized greater than= 3 times during the previous year, had greater than= 3 diagnoses in their medical records. The Memorial Symptom Assessment Scale was used to assess the prevalence, frequency, severity, distress and symptom burden of 31 symptoms. A multiple linear regression was performed to identify factors related to total symptom burden. Results: The mean number of symptoms per participant was 8.5 (4.6), and the mean total symptom burden score was 0.62 (0.41). Pain was the symptom with the highest prevalence, frequency, severity and distress. Half of the study group reported the prevalence of lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score. Conclusion: The older community-dwelling people with multimorbidity in this study suffered from a high symptom burden with a high prevalence of pain. Persons with poor vision, likelihood of depression, and diseases of the digestive system are at risk of a higher total symptom burden and might need age-specific standardized guidelines for appropriate management.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keyword
Chronic disease; Older people; Symptom assessment
National Category
Sociology Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114010 (URN)10.1186/1471-2318-15-1 (DOI)000347569800001 ()25559550 (PubMedID)
Note

Funding Agencies|Faculty of Health sciences, Linkoping University; county council of Ostergotland; Signe and Olof Wallenius trust fund; Solstickan; Swedish Association of Geriatric Medicine; Mundipharma

Available from: 2015-02-06 Created: 2015-02-05 Last updated: 2017-12-04
Falk, L., Hegic, S., Wilson, D. & Wiréhn, A.-B. (2014). Home-sampling as a Tool in the Context of Chlamydia trachomatis Partner Notification: A Randomized Controlled Trial [Letter to the editor]. Acta Dermato-Venereologica, 94(1), 72-74.
Open this publication in new window or tab >>Home-sampling as a Tool in the Context of Chlamydia trachomatis Partner Notification: A Randomized Controlled Trial
2014 (English)In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 94, no 1, 72-74 p.Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Society for the Publication of Acta Dermato - Venereologica, 2014
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:liu:diva-95424 (URN)10.2340/00015555-1624 (DOI)000329482200015 ()
Available from: 2013-07-03 Created: 2013-07-03 Last updated: 2017-12-06
Sarberg, M., Svanborg, E., Wiréhn, A.-B. & Josefsson, A. (2014). Snoring during pregnancy and its relation to sleepiness and pregnancy outcome - a prospective study. BMC Pregnancy and Childbirth, 14(15).
Open this publication in new window or tab >>Snoring during pregnancy and its relation to sleepiness and pregnancy outcome - a prospective study
2014 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, no 15Article in journal (Refereed) Published
Abstract [en]

Background: The incidence of snoring and sleepiness is known to increase during pregnancy, and this might impact maternal health and obstetric outcome. However, the association between snoring and sleepiness during pregnancy is not fully understood. This study was aimed at investigating the development of snoring during pregnancy and prospectively assessing if there is an association between snoring and sleepiness or adverse pregnancy outcomes, such as preeclampsia, mode of delivery, and fetal complications. Methods: Consecutively recruited pregnant women (n = 500) received a questionnaire concerning snoring and sleep at the 1st and 3rd trimester of pregnancy. The women who had rated their frequency of snoring at both occasions (n = 340) were divided into subgroups according to the development of snoring they reported and included in the subsequent analyses. Additional medical data were collected from the medical records. Results: The frequency of snoring was 7.9% in the 1st trimester and increased to 21.2% in the 3rd trimester of pregnancy. The women who snored already in early pregnancy had significantly higher baseline BMI (p = 0.001) than the women who never snored, but snoring was not associated with the magnitude of weight gain during pregnancy. Snoring women were more likely to experience edema in late pregnancy than the non-snorers. Women who started to snore during pregnancy had higher Epworth Sleepiness Scores than the non snorers in both early and late pregnancy. No significant association between obstetric outcome and snoring was found. Conclusion: Snoring does increase during pregnancy, and this increase is associated with sleepiness, higher BMI at the start of pregnancy and higher prevalence of edema, but not with weight gain.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keyword
Pregnancy; Snoring; Sleepiness; Epworth sleepiness score; Body mass index; Edema; Pregnancy outcome
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-105253 (URN)10.1186/1471-2393-14-15 (DOI)000331215600004 ()
Available from: 2014-03-14 Created: 2014-03-14 Last updated: 2017-12-05
Josefsson, A., Wiréhn, A.-B., Lindberg, M., Foldemo, A. & Brynhildsen, J. (2013). Continuation rates of oral hormonal contraceptives in a cohort of first-time users: a population-based registry study, Sweden 2005-2010. BMJ Open, 3(10).
Open this publication in new window or tab >>Continuation rates of oral hormonal contraceptives in a cohort of first-time users: a population-based registry study, Sweden 2005-2010
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2013 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 10Article in journal (Refereed) Published
Abstract [en]

Objective To investigate if continuation rates in first-time users of oral hormonal contraceptives differed between different formulations and to measure if the rates were related to the prescribing categories, that is, physicians and midwives.                                

Design A longitudinal national population-based registry study.                                

Setting The Swedish prescribed drug register.                                

Participants All women born between 1977 and 1994 defined as first-time users of hormonal contraceptives from 2007 to 2009 (n=226 211).                                

Main outcome measures A tendency to switch the type of hormonal contraceptive within 6 months use and repeated dispensation identical to the first were estimated as percentages and relative risks (RRs). Physicians’ and midwives’ prescription patterns concerning the women's                                    continuation rates of oral hormonal contraceptive type.                                

Results In Sweden, there were 782 375 women born between 1977 and 1994 at the time of the study. Of these, 226 211 women were identified as first-time users of hormonal contraceptives. Ethinylestradiol+levonorgestrel, desogestrel-only and ethinylestradiol+drospirenone were the hormonal contraceptives most commonly dispensed to first-time users at rates of 43.3%, 24.4% and 11.1%, respectively. The overall rate of switching contraceptive types in the first 6 months was 11.3%, which was highest for desogestrel-only (14.3%) and lowest for ethinylestradiol+drospirenone (6.6%). The switching rate for all three products was highest in the 16-year to 19-year age group. Having a repeated dispensation identical to the initial dispensation was highest for users of ethinylestradiol either combined with levonorgestrel or drospirenone, 81.4% and 81.2%, respectively, whereas this rate for the initial desogestrel-only users was 71.5%. The RR of switching of contraceptive type within the first 6 months was 1.35 (95% CI 1.32 to 1.39) for desogestrel-only and 0.63 (0.59 to 0.66) for ethinylestradiol+drospirenone compared with ethinylestradiol+levonorgestrel as the reference category. There were no differences in the women's continuation rates depending on the prescriber categories.                                

Conclusions Desogestrel-only users conferred the highest switcher rate to another hormonal contraceptive within a 6-month period. Users of ethinylestradiol+levonorgestrel were more prone to switch to another product within 6 months than women using ethinylestradiol+drospirenone. These findings may be of clinical importance when tailoring hormonal contraceptives on an individual basis.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-100021 (URN)10.1136/bmjopen-2013-003401 (DOI)000326882800028 ()
Available from: 2013-10-25 Created: 2013-10-25 Last updated: 2017-12-06Bibliographically approved
Rådholm, K., Wiréhn, A.-B., Falk, M., Marcusson, J. & Östgren, C. J. (2013). Myocardial infarction in subjects using anti-diabetic and/or anti-depressant agents compared tonon-users: a nationwide register study in Sweden. In: : . Paper presented at EASD Barcelona 2013. .
Open this publication in new window or tab >>Myocardial infarction in subjects using anti-diabetic and/or anti-depressant agents compared tonon-users: a nationwide register study in Sweden
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2013 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-115912 (URN)
Conference
EASD Barcelona 2013
Available from: 2015-03-23 Created: 2015-03-23 Last updated: 2018-01-11
Lindberg, M., Foldemo, A., Josefsson, A. & Wiréhn, A.-B. (2012). Differences in prescription rates and odds ratios of antidepressant drugs in relation to individual hormonal contraceptives: A nationwide population-based study with age-specific analyses. European journal of contraception & reproductive health care, 17(2), 106-118.
Open this publication in new window or tab >>Differences in prescription rates and odds ratios of antidepressant drugs in relation to individual hormonal contraceptives: A nationwide population-based study with age-specific analyses
2012 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 17, no 2, 106-118 p.Article in journal (Refereed) Published
Abstract [en]

Objectives To examine, among young women, the association of individual hormonal contraceptives, within two broad groupings, with antidepressant therapy. less thanbrgreater than less thanbrgreater thanMethods In a nationwide register-based study, we examined the prescription rates of antidepressant drugs in relation to individual combined hormonal and progestin-only contraceptives among Swedish women aged 16-31 years (N = 917,993). Drug data were obtained from the Swedish Prescribed Drug Register for the period 1 July 2005-30 June 2008. Data on the total population of women aged 16-31 in 2008 were obtained from the Total Population Register of Statistics Sweden. The proportion of women using both hormonal contraception and antidepressants, and odds ratios (ORs) for antidepressant use for hormonal contraceptive users versus non-users, were calculated, the latter by logistic regression, for each formulation. less thanbrgreater than less thanbrgreater thanResults The highest antidepressant OR in all age groups, particularly in the 16-19 years age group, related to medroxyprogesterone-only, followed by etonogestrel-only, levonorgestrel-only and ethinylestradiol/norelgestromin formulations. Oral contraceptives containing ethinylestradiol combined with lynestrenol or drospirenone had considerably higher ORs than other pills. ORs significantly lower than 1 were observed when ethinylestradiol was combined with norethisterone, levonorgestrel or desogestrel. less thanbrgreater than less thanbrgreater thanConclusion The association between use of hormonal contraceptives and antidepressant drugs varies considerably within both the combined hormonal contraceptive and the progestin-only groups.

Place, publisher, year, edition, pages
Informa Healthcare, 2012
Keyword
Antidepressants, Combined hormonal contraceptives, Depression, Hormonal contraceptives, Progestin-only contraceptives, Mood, Registries
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-76525 (URN)10.3109/13625187.2012.658925 (DOI)000301493800003 ()
Note
Funding Agencies|Swedish Society of Medicine Soderstrom-Konigska Foundation||Available from: 2012-04-12 Created: 2012-04-11 Last updated: 2017-12-07
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