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Löfman, Owe
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Publications (10 of 23) Show all publications
Holmqvist, B.-M., Löfman, O. & Samuelsson, U. (2008). A low incidence of Type 1 diabetes between 1977 and 2001 in south-eastern Sweden in areas with high population density and which are more deprived. Diabetic Medicine, 25(3), 255-260
Open this publication in new window or tab >>A low incidence of Type 1 diabetes between 1977 and 2001 in south-eastern Sweden in areas with high population density and which are more deprived
2008 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 25, no 3, p. 255-260Article in journal (Refereed) Published
Abstract [en]

Aims  To explore how socioeconomic factors and population density may contribute to the geographical variation of incidence of Type 1 diabetes in children in south-eastern Sweden.

Method  All children diagnosed with Type 1 diabetes in south-eastern Sweden during 1977–2001 were defined geographically to their place of residence and were allocated x and y coordinates in the national grid. The population at risk and socioeconomic data were aggregated in 82 000 200-m squares and geocoded likewise. A socioeconomic index was calculated using a signed χ2 method. Rural–urban gradients were defined by overlay analysis in a geographic information system.

Results  The incidence during the past 25 years has been rising steadily, particularly in the last 6 years. The incidence was highest in areas with a high proportion of small families, of families with a high family income and better education, and this was found both at the time of diagnosis and at the time of birth. In the rural–urban analysis, the lowest incidence was found in the urban area with > 20 000 inhabitants, where there was also a higher frequency of deprivation.

Conclusions  Our findings indicate that geographical variations in incidence rates of Type 1 diabetes in children are associated with socioeconomic factors and population density, although other contributing factors remain to be explained.

Keywords
socioeconomic factors, Type 1 diabetes, urban-rural areas
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-42210 (URN)10.1111/j.1464-5491.2007.02342.x (DOI)61597 (Local ID)61597 (Archive number)61597 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
Samuelsson, U., Carstensen, J., Löfman, O. & Nordfeldt, S. (2007). Seasonal variation in the diagnosis of type 1 diabetes in south-east Sweden. Diabetes Research and Clinical Practice, 76(1), 75-81
Open this publication in new window or tab >>Seasonal variation in the diagnosis of type 1 diabetes in south-east Sweden
2007 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 76, no 1, p. 75-81Article in journal (Refereed) Published
Abstract [en]

With the aim to survey the seasonal pattern of diagnosis of type 1 diabetes we included all 1903 children <16 years of age and who had been diagnosed with type 1 diabetes between 1977 and 2001 in the south-east of Sweden. To investigate the seasonal pattern a mixture of two cosine functions was included in a logistic regression model.

There was a clear seasonal variation over the years (p < 0.001). Children in the oldest age group (11–15 years) showed the most obvious seasonal variation (p < 0.001). Children with a short duration of symptoms had about the same seasonal variation as children with a long duration. Both children with and without an infection 3 months prior to diagnosis showed significant seasonal variation (p < 0.001) although the seasonal pattern differed between the two groups (p < 0.001). As the incidence of diabetes increased during the 25 years the study period was divided into periods of 5 years and it was only during the two last periods that significant seasonal variation occurred.

There is a clear seasonal variation in diagnosis of type 1 diagnosis in children and the results suggest that children with a less aggressive disease process at diagnosis were most responsible for this variation. Children with and without prior infection showed a different seasonal pattern.

Keywords
Type 1 diabetes, seasonality, pH-value, infection, duration of symptoms
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-39415 (URN)10.1016/j.diabres.2006.07.023 (DOI)48271 (Local ID)48271 (Archive number)48271 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
Löfman, O., Hallberg, I., Berglund, K., Wahlström, O., Kartous, L., Rosenqvist, A.-M., . . . Toss, G. (2007). Women with low-energy fracture should be investigated for osteoporosis. Acta Orthopaedica, 78(6), 813-821
Open this publication in new window or tab >>Women with low-energy fracture should be investigated for osteoporosis
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2007 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 78, no 6, p. 813-821Article in journal (Refereed) Published
Abstract [en]

Introduction: Treatment of osteoporosis is becoming more effective, but methods to identify patients who are most suitable for investigation and treatment are still being debated. Should any type of fracture have higher priority for investigation of osteoporosis than any other? Is the number of previous fractures useful information? Material and methods: We investigated 303 consecutive women patients between 55 and 75 years of age who had a newly diagnosed low-energy fracture. They answered a questionnaire on previous fractures which also dealt with risk factors. Bone mineral density (BMD) was measured at the hip, lumbar spine, and forearm. Results: The distribution of fracture location was: distal forearm 56%, proximal humerus 12%, vertebra 18%, and hip 13%, all with similar age. Half of the subjects had had at least one previous fracture before the index fracture, 19% had had two previous fractures, and 6% had had three or more previous fractures. Patients with vertebral or hip fracture had lower BMD and had had more previous fractures than patients with forearm or humerus fractures. There was an inverse correlation between number of fractures and BMD. Osteoporosis was present in one-third of patients with forearm fracture, in one-half of those with hip or humerus fracture, and in two-thirds of those with vertebral fracture. Interpretation: Vertebral fractures were the strongest marker of low BMD and forearm fractures the weakest. The number of previous fractures is helpful information for finding the most osteoporotic patient in terms of severity. Investigation of osteoporosis therefore seems warranted in every woman between the ages of 55 and 75 with a recent low-energy fracture, with highest priority being given to those with vertebral, hip, or multiple fractures. Copyright© Taylor & Francis 2007. all rights reserved.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-41402 (URN)10.1080/17453670710014608 (DOI)56296 (Local ID)56296 (Archive number)56296 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
Grahn Kronhed, A.-C., Blomberg, C., Löfman, O., Timpka, T. & Möller, M. (2006). Evaluation of an osteoporosis and fall risk intervention program for community-dwelling elderly.: a quasi-experimental study of behavioural modifications. Aging Clinical and Experimental Research, 18(3), 235-241
Open this publication in new window or tab >>Evaluation of an osteoporosis and fall risk intervention program for community-dwelling elderly.: a quasi-experimental study of behavioural modifications
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2006 (English)In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 18, no 3, p. 235-241Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: Osteoporosis and fall fractures are increasing problems amongst the elderly. The aim of this study was to explore whether combined population-based and individual interventions directed at risk factors for osteoporosis and falls result in behavioral changes in an elderly population.

METHODS: A quasi-experimental design was used for the study. Persons aged >or=65 years were randomly selected in the intervention and control community. An intervention program was managed from the primary health care center and delivered to the community. Health education was designed to increase awareness of risk factors for the development of osteoporosis and falling. Questionnaires about lifestyle, health, previous fractures, safety behavior and physical activity level were distributed at baseline in 1989 and at the follow-ups in 1992 and 1994 in both communities.

RESULTS: There was a difference of 17.7% between the dual intervention (receiving both population-based and individual interventions) and the control samples regarding the self-reported use of shoe/cane spikes, and a difference of 20.5% regarding the reported "moderate level" of physical activity in 1994. There was an increase in the number of participants in the dual intervention sample who, at baseline, had not reported equipping their homes with non-slip mats and removing loose rugs but who did report these changes in 1994. The increase in the reported use of shoe/cane spikes in the dual intervention sample was observed mainly for the period 1992-1994.

CONCLUSIONS: A public health intervention model, including both population-based and individual interventions, can contribute to behavioral changes in the prevention of falls and changed physical activity patterns amongst elderly people.

Keywords
Environmental hazard, fall prevention, population-based
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13681 (URN)
Available from: 2003-05-19 Created: 2003-05-19 Last updated: 2017-12-13
Löfman, O., Magnusson, P., Toss, G. & Larsson, L. (2005). Common biochemical markers of bone turnover predict future bone loss: A 5-year follow-up study. Clinica Chimica Acta, 356(1-2), 67-75
Open this publication in new window or tab >>Common biochemical markers of bone turnover predict future bone loss: A 5-year follow-up study
2005 (English)In: Clinica Chimica Acta, ISSN 0009-8981, E-ISSN 1873-3492, Vol. 356, no 1-2, p. 67-75Article in journal (Refereed) Published
Abstract [en]

Background

Bone mineral density (BMD) is used to follow gain or loss of bone mass but cannot detect changes within a short period of time. Biochemical markers of bone turnover may be of value for prediction of individual bone loss.

Methods

We studied the relation between common inexpensive markers of bone turnover (serum alkaline phosphatase (ALP), osteocalcin (OC), urinary hydroxyproline (OHPr), and calcium (Ca)), BMD, age, and menopause in a combined cross-sectional and longitudinal design comprising 429 pre- and postmenopausal randomly selected women aged 21–79 years (mean 50 years). A follow-up was initiated after 5 years (including 192 of these women), which focused on changes in bone mass and the ability of these four common markers of bone turnover (sampled at baseline) to predict future bone loss.

Results

A marked increase was observed for all markers at the beginning of menopause. During the postmenopausal period ALP and Ca decreased to near premenopausal levels, while OC and OHPr remained high even 15 years after menopause. We also found inverse correlations at baseline between the bone markers and BMD, independent of the selected marker or skeletal site, r=−0.14 to −0.46, P<0.05. The correlations between ALP, OC, OHPr, and subsequent bone loss over 5 years, was significant for arm, r=−0.23 to −0.36, P<0.01. Baseline levels of all bone markers correlated significantly at group level with the 5-year follow-up of BMD for all sites. The ability of markers to predict individual bone loss was estimated by a multivariate regression model, which included baseline BMD, age, and body mass index as independent variables. ROC analysis showed a validity of approximately 76% for the forearm model, but was lower for the hip (55%) and lumbar spine (65%).

Conclusions

These data show that the common inexpensive biochemical markers of bone turnover ALP, OC, OHPr, and Ca were related to the current bone mass and, moreover, provides information about future bone loss at the individual level. Future investigations should include an evaluation of the clinical relevance of markers of bone turnover in relation to fracture risk.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-29375 (URN)10.1016/j.cccn.2004.12.014 (DOI)14707 (Local ID)14707 (Archive number)14707 (OAI)
Note

On the day of the defence day the status of this article was a manuscript.

Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
Grahn Kronhed, A.-C., Blomberg, C., Karlsson, N., Löfman, O., Timpka, T. & Möller, M. (2005). Impact of a community-based osteoporosis and fall prevention program on fracture incidence. Osteoporosis international, 16(6), 700-706
Open this publication in new window or tab >>Impact of a community-based osteoporosis and fall prevention program on fracture incidence
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2005 (English)In: Osteoporosis international, ISSN 0937-941X, Vol. 16, no 6, p. 700-706Article in journal (Refereed) Published
Abstract [en]

Associations between a 10-year community-based osteoporosis and fall prevention program and fracture incidence amongst middle-aged and elderly residents in an intervention community are studied, and comparisons are made with a control community. A health-education program was provided to all residents in the intervention community, which addressed dietary intake, physical activity, smoking habits and environmental risk factors for osteoporosis and falls. Both communities are small, semi-rural and situated in Östergötland County in southern Sweden. The analysis is based on incidences of forearm fractures in the population 40 years of age or older, and hip fractures in the population 50 years of age or older. Data for three 5-year periods (pre-, early and late intervention) are accumulated and compared. In the intervention community, forearm fracture incidence decreased in women. There are also tendencies towards decreasing forearm fracture incidence in men, and towards decreasing trochanteric hip fracture incidences in women and in men in the late intervention period. No such changes in fracture incidences are found in the control community. Cervical hip fracture incidence did not change in the intervention and the control communities. Although the reported numbers of fractures are small (a total of 451 forearm and 357 hip fractures), the numbers are based on total community populations and thus represent a true difference. The decrease in forearm fracture incidence among women, and the tendency towards decreasing trochanteric hip fractures, in contrast to the absence of change in cervical hip fractures, might be mainly due to a more rapid effect of fall preventive measures than an increase in bone strength in the population. For the younger age groups an expected time lag between intervention and effect might invalidate the short follow-up period for outcome measurements. Thus, the effect of the 10-year intervention program on fracture incidence should be followed during an extended post-intervention period.

Keywords
Fracture outcome, Fragility fractures, Prevention, Quasi-experimental
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13683 (URN)10.1007/s00198-004-1732-0 (DOI)
Available from: 2003-05-19 Created: 2003-05-19 Last updated: 2013-09-05
Sandblom, G., Varenhorst, E., Löfman, O., Rosell, J. & Carlsson, P. (2004). Clinical consequences of screening for prostate cancer: 15 Years follow-up of a randomised controlled trial in Sweden. European Urology, 46(6), 717-723
Open this publication in new window or tab >>Clinical consequences of screening for prostate cancer: 15 Years follow-up of a randomised controlled trial in Sweden
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2004 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 46, no 6, p. 717-723Article in journal (Refereed) Published
Abstract [en]

Objective:

To test the feasibility of a population-based prostate cancer screening programme in general practice and explore the outcome after a 15-year follow-up period.

Methods:

From the total population of men aged 50–69 years in Norrköping (n = 9026) every sixth man (n = 1494) was randomly selected to be screened for prostate cancer every third year over a 12-year period. The remaining 7532 men were treated as controls. In 1987 and 1990 only digital rectal examination (DRE) was performed, in1993 and 1996 DRE was combined with a test for Prostate-Specific Antigen (PSA). TNM categories, grade of malignancy, management and cause of death were recorded in the South-East Region Prostate Cancer Register.

Results:

There were 85 (5.7%) cancers detected in the screened group (SG), 42 of these in the interval between screenings, and 292 (3.8%) in the unscreened group (UG). In the SG 48 (56.5%) of the tumours and in the UG 78 (26.7%) were localised at diagnosis (p < 0.001). In the SG 21 (25%) and in the UG 41 (14%) received curative treatment. There was no significant difference in total or prostate cancer-specific survival between the groups.

Conclusions:

Although PSA had not been introduced in the clinical practice at the start of the study, we were still able to show that it is possible to perform a long-term population-based randomised controlled study with standardised management and that screening in general practice is an efficient way of detecting prostate cancer whilst it is localised. Complete data on stage, treatment and mortality for both groups was obtained from a validated cancer register, which is a fundamental prerequisite when assessing screening programmes.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24279 (URN)10.1016/j.eururo.2004.08.011 (DOI)3889 (Local ID)3889 (Archive number)3889 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
Samuelsson, U. & Löfman, O. (2004). Geographical mapping of type 1 diabetes in children and adolescents in south east Sweden. Journal of Epidemiology and Community Health, 58(5), 388-392
Open this publication in new window or tab >>Geographical mapping of type 1 diabetes in children and adolescents in south east Sweden
2004 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 58, no 5, p. 388-392Article in journal (Refereed) Published
Abstract [en]

Study objective: As earlier studies have shown space-time clusters at onset of type 1 diabetes in the south east region of Sweden we investigated if there also has been any geographical clusters of diabetes in this region.

Design: The place of residence (coordinates) at the time of diagnosis were geocoded in a geographical information system (GIS). All children diagnosed with type 1 diabetes up to 16 years of age at diagnosis between 1977–1995 were included. The population at risk was obtained directly from the population registry for the respective years and geographical area levels.

Setting: South east region of Sweden containing 5 counties, 49 municipalities, and 525 parishes.

Main results: A significant geographical variation in incidence rate were found between the municipalities (p<0.001) but not between the counties. The variation became somewhat weaker when excluding the six largest municipalities (p<0.02). In municipalities with increased risk (>35.1/100 000) the major contribution comes from children in age group 6–10 years of age at diagnosis. There were no obvious differences between the age groups in municipalities with decreased risk (<20.1/100 000). Boys and girls had about the same degree of geographical variation.

Conclusions: Apart from chance, the most probable explanation for the geographical variation in the risk for children and adolescents to develop type 1 diabetes between the municipalities in the region is that local environmental factors play a part in the process leading to the disease.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-22023 (URN)10.1136/jech.2002.004135 (DOI)1056 (Local ID)1056 (Archive number)1056 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
Hallberg, I., Rosenqvist, A. M., Kartous, L., Löfman, O., Wahlström, O. & Toss, G. (2004). Health-related quality of life after osteoporotic fractures. Osteoporosis International, 15(10), 834-841
Open this publication in new window or tab >>Health-related quality of life after osteoporotic fractures
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2004 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 15, no 10, p. 834-841Article in journal (Refereed) Published
Abstract [en]

Objective: To estimate the impact of osteoporosis fractures on health-related quality of life (HRQOL) in postmenopausal women. Methods: To compare the impact on HRQOL of different osteoporotic fractures, 600 consecutive women 55-75 years old with a new fracture (inclusion fracture) were invited by mail. After exclusions by preset criteria (high-energy fractures, ongoing osteoporosis treatment, or unwillingness to participate), 303 women were included, 171 (56%) of whom had a forearm, 37 (12%) proximal humerus, 40 (13%) hip, and 55 (18%) vertebral fracture, respectively, and all were investigated and treated according to the current local consensus program for osteoporosis. In addition, HRQOL was evaluated by the SF-36 questionnaire and compared with local, age-matched reference material. Examinations were performed 82 days (median) after the fracture and 2 years later. Results: HRQOL was significantly reduced at baseline regarding all SF-36 domains after vertebral fractures and most after hip fractures, but only regarding some domains after forearm and humerus fracture. After 2 years, improvements had occurred after all types of fractures, and after forearm or humerus fracture, HRQOL was completely normalized in all domains. However, 2 years after hip fracture, HRQOL was still below normal regarding physical function, role-physical and social function, while after vertebral fracture, scores were still significantly lower for all domains, physical as well as mental. Patients with one or more previous fractures before the inclusion fracture had lower HRQOL at baseline and after 2 years, compared with those with no previous fracture. Patients with osteoporosis (T-score < - 2.5 in hip or spine) had lower HRQOL than those with normal BMD. Conclusion: Vertebral and hip fractures have a considerably greater and more prolonged impact on HRQOL than forearm and humerus fractures. The number of fractures was inversely correlated to HRQOL. These differences should be taken into account when making priorities in health care programs.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24150 (URN)10.1007/s00198-004-1622-5 (DOI)3733 (Local ID)3733 (Archive number)3733 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
Grahn Kronhed, A.-C., Knutsson, I., Löfman, O., Timpka, T., Toss, G. & Möller, M. (2004). Is calcaneal stiffness more sensitive to physical activity than forearm bone mineral density?: A population-based study of persons aged 20-79 years. Scandinavian Journal of Public Health, 32(5), 333-339
Open this publication in new window or tab >>Is calcaneal stiffness more sensitive to physical activity than forearm bone mineral density?: A population-based study of persons aged 20-79 years
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2004 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, Vol. 32, no 5, p. 333-339Article in journal (Refereed) Published
Abstract [en]

Aims: The aim of this study was to investigate the associations between forearm bone mineral density (BMD), calcaneal stiffness, and physical activity levels in a normal population using different non-invasive methods.

Methods: The participants were invited to undergo bone measurements using single photon absorptiometry of the forearm and quantitative ultrasound (QUS) of the calcaneal bone, and also to complete a questionnaire. Physical activity levels were designated low, moderate, and high in the question on leisure-time activity.

Results: There were 956 participants included in the present study. Forearm BMD in the eighth age decade was 0.40 g/cm2 (95% CI 0.33 - 0.46 g/cm2) lower than in the third decade among women and 0.28 g/cm2 (95% CI 0.18 - 0.37 g/cm2) lower among men. The differences in calcaneal stiffness between the same age decades were 22.4 (95% CI 17.5 - 27.4) among women and 15.8 (95% CI 8.0 - 23.5) among men. The correlation between forearm BMD and calcaneal stiffness was 0.58 (95% CI 0.52 - 0.64) in women and 0.34 (95% CI 0.25 - 0.42) in men. Reported moderate and high leisure-time activity levels in both genders were associated with higher calcaneal stiffness but not with forearm BMD.

Conclusions: The QUS may be used to measure the effect of present physical activity levels on calcaneal bone at the population level. Further longitudinal studies are warranted in order to determine the most appropriate non-invasive method in population-based studies.

Keywords
community-based interventions, osteoporosis, prevention, quantitative ultrasound, questionnaire, reference values, single photon absorptiometry
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13682 (URN)10.1080/14034940410026273 (DOI)
Available from: 2003-05-19 Created: 2003-05-19 Last updated: 2013-09-05
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