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  • 1.
    Dahlén, Elsa M
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Bjarnegård, Niklas
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Länne, Toste
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Department of Medical and Health Sciences, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL. Linköping University, Faculty of Health Sciences.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, West County Primary Health Care.
    Sagittal Abdominal Diameter is a more Independent Measure compared with Waist Circumference to predict Arterial Stiffness in subjects with Type 2 DiabetesManuscript (preprint) (Other academic)
    Abstract [en]

    Aim: The aim of this study was to prospectively explore how laboratory and anthropometric risk factors predicted subclinical organ damage in 255 patients, with type 2 diabetes, after four years.

    Methods: Baseline investigations were performed in 2006 and were repeated at follow-up in 2010. Carotid intima-media thickness (IMT) was evaluated by ultrasonography and aortic pulse wave velocity (PWV) was measured with applanation tonometry over the carotid and femoral arteries at baseline and at follow-up in a cohort of subjects with type 2 diabetes aged 55-65 years old.

    Results: There were significant correlations between apolipoprotein B (apoB) (r= 0.144, p=0.03), C - reactive protein (CRP) (r=0.172, p=0.009) at baseline and IMT measured at follow-up. After adjustment for sex, age, treatment with statins and Hba1c, the associations remained statistically significant. HbA1c, total cholesterol or LDL-cholesterol did not correlate to IMT at follow-up. Baseline body mass index (BMI) (r=0.130, p=0.049), waist circumference (WC) (r=0.147, p=0.027) and sagittal Abdominal Diameter (SAD) (r=0.184, p=0.007) correlated to PWV at follow-up. Challenged with sex, SBP and HbA1c, the association between SAD, not WC nor BMI, and PWV remained statistically significant (p=0.036). In a stepwise linear regression, entering both SAD and WC, the association between SAD and PWV was stronger than the association between WC and PWV.

    Conclusion: We conclude that apoB and CRP, but not LDL-cholesterol predicted subclinical atherosclerosis. Furthermore, SAD was more independent in predicting arterial stiffness over time, compared with WC, in middle-aged men and women with type 2 diabetes.

  • 2.
    Dahlén, Elsa M
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland.
    Länne, Toste
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Clinchy, Birgitta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Nyström, Fredrik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, West County Primary Health Care.
    Abdominal Obesity and low grade Systemic Inflammation as Markers for Subclinical Organ Damage in type 2 diabetes2014In: Diabetes & Metabolism, ISSN 1262-3636, E-ISSN 1878-1780, Vol. 40, no 1, p. 76-81Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore associations between abdominal obesity, inflammatory markers, and subclinical organ damage in 740 patients with type 2 diabetes. Waist circumference (WC) and sagittal abdominal diameter (SAD) was measured. Blood samples were analyzed for; C-reactive protein (CRP), interleukin (IL) -1β and IL-6. Carotid intimamedia thickness (IMT) was evaluated by ultrasonography. Aortic pulse wave velocity (PWV) was measured with applanation tonometry.

    Abdominal obesity were significantly correlated with; IL-6, CRP (both p= <0.001, WC and SAD, respectively), IMT (WC p=0.012, SAD p=0.003) and PWV (p<0.001, for WC and SAD, respectively). In multiple linear regressions with IMT as dependent variable and age, sex, statins, systolic blood pressure (SBP), Body Mass Index (BMI), CRP and HbA1c, as independent variables, SAD (p=0.047) but not WC, remained associated with IMT. In stepwise linear regression, entering both SAD and WC, the association between SAD and PWV was stronger than the association between WC and PWV.

    We conclude that SAD and WC are feasible measures of obesity that provides information on inflammation, atherosclerosis and arterial stiffness in type 2 diabetes. However, SAD was slightly more robustly associated to subclinical organ damage, compared with WC.

  • 3.
    Dahlén, Elsa M
    et al.
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Länne, Toste
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Department of Medicine and Health Sciences, Vascular surgery . Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Health Sciences.
    Engvall, Jan
    Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology. Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Lindström, T
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL. Linköping University, Faculty of Health Sciences.
    Grodzinsky, Ewa
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland. Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL. Linköping University, Faculty of Health Sciences.
    Östgren, Carl Johan
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, West County Primary Health Care.
    Complications Carotid intima-media thickness and apolipoprotein B/apolipoprotein A-I ratio in middle-aged patients with Type 2 diabetes2009In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 26, no 4, p. 384-390Article in journal (Refereed)
    Abstract [en]

    AIMS: To explore the association between carotid intima-media thickness (IMT) and the apolipoprotein B (apoB)/apolipoprotein A-I (apoA-I) ratio compared with conventional lipids in middle-aged patients with Type 2 diabetes. METHODS: We analysed data from 247 patients with Type 2 diabetes, aged 55-66 years, in the Cardiovascular Risk factors in Patients with Diabetes-a Prospective study in Primary care (CARDIPP-1) study. Primary care nurses measured blood pressure and anthropometric characteristics. Blood samples were taken for laboratory analyses. The carotid IMT was determined by ultrasonography at the University Hospital in Linköping and at the County Hospital Ryhov, Jönköping, Sweden. RESULTS: The ApoB/apoA-I ratio (r = 0.207, P = 0.001), apoB (r = 0.166, P = 0.009) and non-high-density lipoprotein cholesterol (non-HDL-c) (r = 0.129, P = 0.046) correlated with IMT. Conventional lipids, high-sensitivity C-reactive protein (hsCRP), glycated haemoglobin (HbA(1c)) and systolic blood pressure were not significantly correlated to IMT. A stepwise logistic regression analysis was conducted with IMT as the dependent variable and the apoB/apoA-I ratio, HbA(1c), hsCRP, low-density lipoprotein cholesterol (LDL-c), total cholesterol, non-HDL-c and treatment with statins as independent variables. Following adjustment for age and gender, only the apoB/apoA-I ratio remained significantly associated with IMT (odds ratio 4.3, 95% confidence intervals 1.7-10.8, P = 0.002). CONCLUSIONS: We conclude that there was a significant association between the apoB/apoA-I ratio and IMT in middle-aged patients with Type 2 diabetes. The association was independent of conventional lipids, hsCRP, glycaemic control and use of statins.

  • 4.
    Fredriksson, Ingemar
    et al.
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
    Larsson, Marcus
    Linköping University, Department of Biomedical Engineering. Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation.
    Nyström, Fredrik
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology .
    Länne, Toste
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology .
    Östgren, Carl Johan
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, West County Primary Health Care.
    Strömberg, Tomas
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
    Microcirculatory changes in type 2 diabetes assessed with velocity resolved quantitative laser Doppler flowmetryManuscript (preprint) (Other academic)
    Abstract [en]

    The response to local heating (44oC for 20 min) was evaluated in 28 type 2 diabetes patients (DM) and 29 non-diabetes controls (ND). Microcirculatory perfusion was assessed using conventional and quantitative Laser Doppler flowmetry (cLDF and qLDF), respectively. The qLDF estimates perfusion in a physiological relevant unit (g RBC / 100 g tissue × mm/s) in a fixed output volume, separated into three velocity regions, v < 1 mm/s, 1 - 10 mm/s, and v > 10 mm/s. Perfusion in cLDF is given in arbitrary units with unknown velocity distribution and measurement volume.

    A significantly lower response in DM than in ND was found after heat provocation both for the initial peak and the plateau response, while no significant differences were found at baseline. The qLDF showed increased perfusion for the velocity regions 1-10 mm/s and above 10 mm/s, while no significant increase was found for v < 1 mm/s. In conclusion, we found a lowered LDF response to local heating in DM. The new qLDF method showed that the increased blood flow occurs in vessels with a velocity above 1 mm/s. Baseline qLDF-data indicated that a redistribution of flow to higher velocity regions was associated with longer DM duration and for DM a negative correlation between perfusion and BMI.

  • 5.
    Guldbrand, Hans
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.
    Lindström, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.
    Dizdar, B.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Bunjaku, B.
    Östergötlands Läns Landsting. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, West County Primary Health Care.
    Nyström, Fredrik H.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.
    Bachrach-Lindström, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Randomization to a low-carbohydrate diet advice improves health related quality of life compared with a low-fat diet at similar weight-loss in Type 2 diabetes mellitus2014In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 106, no 2, p. 221-227Article in journal (Refereed)
    Abstract [en]

    Aims

    To compare the effects on health-related quality of life (HRQoL) of a 2-year intervention with a low-fat diet (LFD) or a low-carbohydrate diet (LCD) based on four group-meetings to achieve compliance. To describe different aspects of taking part in the intervention following the LFD or LCD.

    Methods

    Prospective, randomized trial of 61 adults with Type 2 diabetes mellitus. The SF-36 questionnaire was used at baseline, 6, 12 and 24 months. Patients on LFD aimed for 55–60 energy percent (E%) and those on LCD for 20 E% from carbohydrates. The patients were interviewed about their experiences of the intervention.

    Results

    Mean body-mass-index was 32.7 ± 5.4 kg/m2 at baseline. Weight-loss did not differ between groups and was maximal at 6 months, LFD: −3.99 ± 4.1 kg, LCD: −4.31 ± 3.6 kg (p < 0.001 within groups). There was an increase in the physical component score of SF-36 from 44.1 (10.0) to 46.7 (10.5) at 12 months in the LCD group (p < 0.009) while no change occurred in the LFD group (p < 0.03 between groups). At 12 months the physical function, bodily pain and general health scores improved within the LCD group (p values 0.042–0.009) while there was no change within the LFD group.

    Conclusions

    Weight-changes did not differ between the diet groups while improvements in HRQoL only occurred after one year during treatment with LCD. No changes of HRQoL occurred in the LFD group in spite of a similar reduction in body weight.

     

  • 6.
    Jennersjo, P E
    et al.
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Länne, Toste
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Engvall, Jan
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Nyström, Fredrik
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Östgren, Carl Johan
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, West County Primary Health Care.
    Circadian blood pressure variation in patients with type 2 diabetes - relationship between dipper status and early cardiovascular organ damage2009In: in DIABETOLOGIA, vol 52, 2009, Vol. 52, p. S430-S430Conference paper (Refereed)
    Abstract [en]

    n/a

  • 7.
    Jennersjö, Pär
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Guldbrand, Hans
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, West County Primary Health Care.
    Björne, Stefan
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Länne, Toste
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Lindström, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology.
    Wijkman, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, "Primary Health Care in Motala".
    Nyström, Fredrik H
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology.
    A prospective observational study of all-cause mortality in relation to serum 25-OH vitamin D-3 and parathyroid hormone levels in patients with type 2 diabetes2015In: Diabetology and Metabolic Syndrome, ISSN 1758-5996, E-ISSN 1758-5996, Vol. 7, no 53Article in journal (Refereed)
    Abstract [en]

    Background: Low levels of vitamin D have been related to increased mortality and morbidity in several non-diabetic studies. We aimed to prospectively study relationships between serum 25-OH vitamin D-3 (vitamin D) and of serum parathyroid hormone (PTH) to total mortality in type 2 diabetes. We also aimed to compare the levels of these potential risk-factors in patients with and without diabetes. Methods: The main study design was prospective and observational. We used baseline data from 472 men and 245 women who participated in the "Cardiovascular Risk factors in Patients with Diabetes-a Prospective study in Primary care" study. Patients were 55-66 years old at recruitment, and an age-matched non-diabetic sample of 129 individuals constituted controls for the baseline data. Carotid-femoral pulse-wave velocity (PWV) was measured with applanation-tonometry and carotid intima-media thickness (IMT) with ultrasound. Patients with diabetes were followed for all-cause mortality using the national Swedish Cause of Death Registry. Results: Levels of vitamin D were lower in patients with diabetes than in controls, also after correction for age and obesity, while PTH levels did not differ. Nine women and 24 men died during 6 years of median follow up of the final cohort (n = 698). Vitamin D levels were negatively related to all-cause mortality in men independently of age, PTH, HbA1c, waist circumference, 24-h systolic ambulatory-blood pressure (ABP) and serum-apoB (p = 0.049). This finding was also statistically significant when PWV and IMT were added to the analyses (p = 0.028) and was not affected statistically when medications were also included in the regression-analysis (p = 0.01). In the women with type 2 diabetes, levels of PTH were positively related with all-cause mortality in the corresponding calculations (p = 0.016 without PWV and IMT, p = 0.006 with PWV and IMT, p = 0.045 when also adding medications to the analysis), while levels of vitamin D was without statistical significance (p greater than 0.9). Conclusions: Serum vitamin D in men and serum PTH in women give prognostic information in terms of total-mortality that are independent of regular risk factors in addition to levels of ABP, IMT and PWV.

  • 8. Order onlineBuy this publication >>
    Stratelis, Georgios
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, West County Primary Health Care.
    Chronic Obstructive PulmonaryDisease: Early detection and prevention in primary care2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and aims. Early detection of Chronic Obstructive Pulmonary Disease (COPD) and secondary prevention by means of smoking cessation are the only available methods of stopping the progression of the disease. The overall aim was to examine the possibilities of early detection and prevention of COPD in General Practice. The specific aims were to evaluate a method of detecting COPD at its early stages, to investigate the rate of emphysema in smokers with normal lung function and smokers defined as preclinical COPD, to investigate the effects of performed spirometries and brief smoking cessation advice on smoking habits and to test if concentrations of certain biomarkers in blood, saliva and exhaled breath condensate (EBC) could identify subjects with COPD or non-COPD subjects supposed to be at risk of developing COPD.

    Methods. The first study evaluated an invitational method, which offered voluntary screening spirometry to a targeted population of smokers 40-55 years old. In the second follow-up study, all smokers with COPD and half of the smokers with normal lung function (NLF) were annually invited for spirometry and brief smoking cessation advice for a duration of 3 years, with half of the smokers with NLF being tested only last year. In the third study, 54 smokers with NLF were examined with High Resolution Computed Tomography (HRCT), with blood samples also being collected from each subject. In study four, 19 subjects categorised as having COPD, 30 non-COPD subjects and 15 healthy non-smoking volunteers were studied by means of spirometry, DLCO, and analysis of biomarkers in EBC, saliva and serum.

    Results. A total of 512 smokers responded. The prevalence of COPD was 27.5% and was classified as mild in 85% of the sufferers, moderate in 13% and severe in 2%. At year 1, 10% of the smokers with COPD had been continuously abstinent from smoking, compared to 2% of smokers with NLF. The prolonged abstinence rate increased yearly, and at year 3 the smoking cessation rates in smokers with COPD was 25% compared to 7% in smokers with NLF. By visual analysis, HRCT showed signs of emphysema in 43% of the subjects. Emphysema was also associated with low BMI. Higher serum concentrations of lysozyme and lower DLCO were recorded in those with COPD compared to non-COPD subjects. With the exception of chlorine, none of the remaining biomarkers were detected in EBC.

    Conclusions. By invitational targeted screening, COPD can be easily detected in its mild stages by using spirometry. By becoming diagnosed with COPD, smokers seem to be more motivated to stop smoking, and COPD patients should repeatedly be offered spirometry and smoking cessation advice which may prevent the progression of the disease to a severe disabling form. HRCT may detect smoke related parenchymal lung damage (i.e. emphysema) in symptom-free smokers with normal spirometry. Serum lysozyme and DLCO appeared to be the strongest discriminator between COPD and non-COPD subjects. The use of EBC as a tool to measure exhaled inflammatory biomarkers involved in COPD is as yet uncertain.

    List of papers
    1. Early detection of COPD in primary care: screening by invitation of smokers aged 40 to 55 years
    Open this publication in new window or tab >>Early detection of COPD in primary care: screening by invitation of smokers aged 40 to 55 years
    2004 (English)In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 54, no 500, p. 201-206Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: The incidence of chronic obstructive pulmonary disease (COPD) is increasing in developed countries, as is the mortality rate. The main cause of COPD is smoking, and COPD is usually diagnosed at a late stage. AIM: To evaluate a method to detect COPD at an early stage in smokers in a young age group (40-55 years).

    DESIGN OF STUDY: Prospective descriptive study.

    SETTING: The city of Motala (45,000 inhabitants) and its surrounding rural areas (43,000 inhabitants) in south-east Sweden. Nineteen thousand, seven hundred and fifty subjects were between 40 and 55 years of age. According to Swedish statistics, approximately 27% of this population are smokers.

    METHOD: Smokers aged between 40 and 55 years were invited to have free spirometry testing in primary healthcare centres. Placards were placed in pharmacies and health centres and advertising was carried out locally twice a year.

    RESULTS: A total of 512 smokers responded. The prevalence of COPD was 27% (n = 141). The COPD was classified as mild obstruction in 85% (n = 120), moderate in 13% (n = 18) and severe in 2% (n = 3) according to the European Respiratory Society classification. Knowledge of the disease COPD was acknowledged by 39% of the responders to the questionnaire. Logistic regression analysis showed that age, male sex, number of pack years, dyspnoea and symptoms of chronic bronchitis significantly increased the odds of having COPD. The adjusted odds ratio was significant for having > 30 pack years.

    CONCLUSIONS: This method of inviting relatively young smokers selected a population of smokers with a high incidence of COPD, and may be one way of identifying smokers with COPD in the early stages.

    Keywords
    Body mass index, computed tomography, family practice, pulmonary emphysema, smoking, spirometry
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-20729 (URN)15006126 (PubMedID)
    Available from: 2009-09-18 Created: 2009-09-18 Last updated: 2017-12-13
    2. The impact of repeated spirometry and smoking cessation advice on smokers with mild COPD
    Open this publication in new window or tab >>The impact of repeated spirometry and smoking cessation advice on smokers with mild COPD
    2006 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 24, no 3, p. 133-139Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Smoking cessation is the most important therapeutic intervention in patients with chronic obstructive pulmonary diseases (COPD) and the health benefits are immediate and substantial. Major efforts have been made to develop methods with high smoking cessation rates.

    OBJECTIVES: To study whether a combination of spirometry and brief smoking cessation advice to smokers with COPD, annually for three years, increased their smoking cessation rate in comparison with groups of smokers with normal lung function.

    METHOD: Prospective, randomized study in primary care. Smoking cessation rates were compared between smokers with COPD followed-up yearly over a period of three years and smokers with normal lung function followed-up yearly for three years or followed-up only once after three years.

    RESULTS: The point-prevalence abstinence rate and prolonged abstinence rate at 6 and 12 months increased yearly and in smokers with COPD at year 3 was 29%, 28%, and 25%, respectively. The abstinence rates were significantly higher in smokers with COPD than in smokers with normal lung function. Smoking cessation rates among smokers with normal lung function did not increase with increasing number of follow-ups.

    CONCLUSION: Smokers diagnosed with COPD stopped smoking significantly more often than those with normal lung function.

    Keywords
    COPD, family practice, general practice, primary health care, smoking cessation, spirometry
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-20733 (URN)10.1080/02813430600819751 (DOI)16923621 (PubMedID)
    Available from: 2009-09-18 Created: 2009-09-18 Last updated: 2017-12-13
    3. High prevalence of emphysema and its association with BMI: A study of smokers with normal spirometry
    Open this publication in new window or tab >>High prevalence of emphysema and its association with BMI: A study of smokers with normal spirometry
    Show others...
    2008 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 26, no 4, p. 241-247Article in journal (Refereed) Published
    Abstract [en]

    Objectives: To evaluate to what extent emphysema was evident, as identified by High Resolution Computed Tomography (HRCT), in smokers with normal lung function and to relate age, gender, smoking history, and body mass index (BMI) to the HRCT results. A secondary aim was to study to what extent emphysema was present in smokers with lower normal values of lung function defined as FEV1/FVC ratio percentage of predicted value (89-93% of predicted value for males and 90-93% for females) or FEF50 60% of predicted compared with smokers without this definition.

    Methods: Fifty-nine smokers, with a mean age of 53 years and with normal lung function, were examined with HRCT.

    Results: Emphysema evidenced visually by HRCT was present in 43% of the subjects. Using a 0-5 grade scale (0=normal finding; 5=emphysema in most slices), the degree of emphysema was almost exclusively 3-4. The type of emphysema was distributed as centrilobular emphysema predominant in 43.5%, paraseptal emphysema predominant in 43.5%, and as an equal mixture of these types in 13%. The presence of emphysema did not differ between the group of smokers with lower normal values of lung function and the rest of the smokers. Smokers with emphysema had significantly lower BMI than those devoid of emphysema, 24 and 27 respectively (p0.0011).

    Conclusion: There was a high occurrence of visual emphysema in middle-aged smokers with normal lung function. The densitometric quantitative analysis method is inadequate for detecting mild emphysema. High prevalence of emphysema was associated with low BMI.

    Keywords
    Body mass index, computed tomography, family practice, pulmonary emphysema, smoking, spirometry
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16159 (URN)10.1080/02813430802452732 (DOI)
    Available from: 2009-01-08 Created: 2009-01-07 Last updated: 2017-12-14
    4. Can we predict development of COPD?
    Open this publication in new window or tab >>Can we predict development of COPD?
    2008 (English)Article in journal (Refereed) Submitted
    Abstract [en]

    Background: Cigarette smoking is one of the main causes of chronic obstructive pulmonarydisease (COPD). Chronic inflammation of airways may start years before manifestation ofclinical symptoms, thus early identification of smokers at risk to develop COPD is crucial.Objectives: To evaluate if a single breath test for diffusion capacity (DLCO) or concentrationsof certain biomarkers in exhaled breath condensate (EBC), saliva or serum could identifysubjects with COPD or non-COPD smokers and ex-smokers supposed to be at risk to developCOPD, as suggested by rapid decline of forced expiratory volume in one second (FEV1) during afive year period.

    Methods: Twenty-nine symptom free smokers/ex-smokers, 16 smokers/ex-smokers with COPDand 19 matched healthy non-smoking volunteers were studied by means of spirometry, DLCO,and analyses of EBC, saliva and serum [chlorine, lysozyme, eosinophil cationic protein (ECP)and myeloperoxidase (MPO)]. Area under a receiver operated curve (AUCROC) was used toassess sensitivity and specificity of measurements to identify manifest or risk to get COPD.

    Results: Only DLCO could identify subjects with COPD or risk to develop COPD, as judged byAUCROC (0.85 or 0.75, respectively). Lower DLCO (p=0.003) and higher serum concentrationsof lysozyme (p=0.011) were recorded in those with COPD than non-COPD subjects.Furthermore, concentration of chlorine was higher in EBC from COPD subjects than fromhealthy volunteers (p<0.05). Except for chlorine, none of the remaining biomarkers weredetected in EBC and there was a vast variability of concentrations of biomarkers in saliva.

    Conclusion: DLCO was the most effective discriminator of COPD and rapid decline of lungfunction. Serum concentration of lysozyme was the second strongest discriminator, confirmingprevious findings on involvement of neutrophils in the disease process. The use of EBC as a toolto measure exhaled biomarkers involved in COPD is dubious due to large variability and lowconcentrations of markers in EBC.

    Keywords
    Exhaled Breath Condensate, serum, DLCO, COPD, lysozyme and chlorine
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16293 (URN)
    Available from: 2009-01-13 Created: 2009-01-13 Last updated: 2009-09-18Bibliographically approved
  • 9.
    Stratelis, Georgios
    et al.
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, West County Primary Health Care.
    Jakobsson, Per
    Linköping University, Department of Medicine and Health Sciences, Pulmonary Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Respiratory Medicine UHL.
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Zetterström, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Allergy Centre . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Allergy Centre.
    Early detection of COPD in primary care: screening by invitation of smokers aged 40 to 55 years2004In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 54, no 500, p. 201-206Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The incidence of chronic obstructive pulmonary disease (COPD) is increasing in developed countries, as is the mortality rate. The main cause of COPD is smoking, and COPD is usually diagnosed at a late stage. AIM: To evaluate a method to detect COPD at an early stage in smokers in a young age group (40-55 years).

    DESIGN OF STUDY: Prospective descriptive study.

    SETTING: The city of Motala (45,000 inhabitants) and its surrounding rural areas (43,000 inhabitants) in south-east Sweden. Nineteen thousand, seven hundred and fifty subjects were between 40 and 55 years of age. According to Swedish statistics, approximately 27% of this population are smokers.

    METHOD: Smokers aged between 40 and 55 years were invited to have free spirometry testing in primary healthcare centres. Placards were placed in pharmacies and health centres and advertising was carried out locally twice a year.

    RESULTS: A total of 512 smokers responded. The prevalence of COPD was 27% (n = 141). The COPD was classified as mild obstruction in 85% (n = 120), moderate in 13% (n = 18) and severe in 2% (n = 3) according to the European Respiratory Society classification. Knowledge of the disease COPD was acknowledged by 39% of the responders to the questionnaire. Logistic regression analysis showed that age, male sex, number of pack years, dyspnoea and symptoms of chronic bronchitis significantly increased the odds of having COPD. The adjusted odds ratio was significant for having > 30 pack years.

    CONCLUSIONS: This method of inviting relatively young smokers selected a population of smokers with a high incidence of COPD, and may be one way of identifying smokers with COPD in the early stages.

  • 10.
    Stratelis, Georgios
    et al.
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, West County Primary Health Care.
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Jakobsson, Per
    Linköping University, Department of Medicine and Health Sciences, Pulmonary Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Respiratory Medicine UHL.
    Zetterström, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Allergy Centre . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Allergy Centre.
    The impact of repeated spirometry and smoking cessation advice on smokers with mild COPD2006In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 24, no 3, p. 133-139Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Smoking cessation is the most important therapeutic intervention in patients with chronic obstructive pulmonary diseases (COPD) and the health benefits are immediate and substantial. Major efforts have been made to develop methods with high smoking cessation rates.

    OBJECTIVES: To study whether a combination of spirometry and brief smoking cessation advice to smokers with COPD, annually for three years, increased their smoking cessation rate in comparison with groups of smokers with normal lung function.

    METHOD: Prospective, randomized study in primary care. Smoking cessation rates were compared between smokers with COPD followed-up yearly over a period of three years and smokers with normal lung function followed-up yearly for three years or followed-up only once after three years.

    RESULTS: The point-prevalence abstinence rate and prolonged abstinence rate at 6 and 12 months increased yearly and in smokers with COPD at year 3 was 29%, 28%, and 25%, respectively. The abstinence rates were significantly higher in smokers with COPD than in smokers with normal lung function. Smoking cessation rates among smokers with normal lung function did not increase with increasing number of follow-ups.

    CONCLUSION: Smokers diagnosed with COPD stopped smoking significantly more often than those with normal lung function.

  • 11.
    Tengblad, Anders
    et al.
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Borgquist, Lars
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Östgren, Carl Johan
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, West County Primary Health Care.
    Health care costs and glycaemic control in type 2 diabetesin Swedish primary careManuscript (preprint) (Other academic)
    Abstract [en]

    Aims: The aim of this study was to explore the annual health care cost for patients with type 2diabetes and its association with glycaemic control in primary care.

    Methods: All patients with diabetes at 18 primary health care centres (PHCC) in Swedenwere surveyed in this cross sectional observational study. From a total population of 208 490,we identified 6495 patients with type 2 diabetes and information were retrieved from medicalrecords on resource utilisation, clinical data, treatment category and use of self monitoring ofblood glucose (SMBG). Data on costs for pharmaceuticals and test strips for SMBG wereimported from the general ledger.

    Results: The mean annual health care cost per patient with type 2 diabetes, was 586 Euro (SD435). Factors associated with high costs at individual level were; type of treatment (r=0.67),number of GP visits (r=0.61), use of SMBG (r=0.46), number of visits to nurse (r=0.34), andlevel of HbA1c (r=0.33). No association was found between costs per health care centre andmean HbA1c per PHCC (r=0.17). Use of SMBG was associated with high total cost evenwhen adjusted for duration of diabetes and treatment type (p<0.01).

    Conclusions: Health care costs for type 2 diabetes varied substantially in primary care,primarily explained by differences in costs for SMBG and insulin.

  • 12.
    Tengblad, Anders
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Lindström, Kjell
    Unit of Research and Development in Primary Care, County of Jönköping, Sweden.
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Borgquist, Lars
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Östgren, Carl Johan
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, West County Primary Health Care.
    Self-monitoring of blood glucose and glycaemic control in type 2 diabetes2007In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 25, no 3, p. 140-146Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Previous studies have shown inconsistent results with regard to whether or not self-monitoring of blood glucose (SMBG) is related to better glycaemic control in type 2 diabetes. The aim of this study was to explore the use of SMBG and its association with glycaemic control in patients with type 2 diabetes in primary care.

    DESIGN: A cross-sectional observational study was conducted in 2003 at 18 primary health care centres in Sweden, in which all known patients with diabetes were surveyed. The study included 6495 patients with type 2 diabetes. A sample of 896 patients was selected for further exploration of data from medical records. A telephone interview was performed with all patients in this group using SMBG (533 patients).

    RESULTS: There were no differences in HbA1c levels between users (6.9%) and non-users (6.8%) of SMBG in patients treated with insulin or in patients treated with oral agents (6.3% in both groups). In patients treated with diet only, users of SMBG had higher levels of HbA1c compared with non-users (5.5% vs. 5.4%, p =0.002). Comparing medical records between users and non-users of SMBG showed no differences in diabetes-related complications in any treatment category group.

    CONCLUSION: The use of SMBG was not associated with improved glycaemic control in any therapy category of patients with type 2 diabetes in primary care. The absence of difference in glycaemic control between users and non-users of SMBG could not be explained by differences in comorbidity between users and non-users of SMBG.

  • 13.
    Tengblad, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Länne, Toste
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Nyström, Fredrik
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Endocrinology and Gastroenterology.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, West County Primary Health Care.
    Sagittal abdominal diameter and waist circumference as markers of early organ damage in patients with Type 2 diabetes2011In: Journal of Clinical Metabolism & Diabetes, Vol. 2, no 1Article in journal (Refereed)
    Abstract [en]

    Aims: In a cohort of 465 patients with Type 2 diabetes aged 55-66 years the associationbetween the anthropometric measures: Waist circumference (WC) and Sagittal abdominaldiameter (SAD) versus subclinical cardiovascular organ damage by measuring Pulse wavevelocity (PWV) and Left ventricular mass index (LVMI) was studied.

    Methods: Blood pressure, weight, height and WC were measured within primary care. SADwas measured by using standardized calliper equipment. Blood samples were taken foranalysis of HbA1c and serum lipids. LVMI was measured by M-mode echocardiography.Aortic PWV was measured by applanation tonometry (Sphygmocor®) over the carotid andfemoral arteries.

    Results: There were significant correlations between aortic PWV and WC (r=0.23; p<0.01)and SAD (r=0.25; p<0.01). LVMI was also correlated to WC (r=0.26; p<0.01) and SAD(r=0.25; p<0.01). When analysed in a multiple regression model, SAD and WC were bothassociated with PWV and LVMI, independently of age, sex, systolic blood pressure, serumlipids and HbA1c.

    Conclusion: This study shows that abdominal obesity, measured either with WC or SAD, is afeasible risk assessment tool for early subclinical organ damage in patients who have alreadydeveloped Type 2 diabetes.

  • 14.
    Wijkman, Magnus
    et al.
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences.
    Länne, Toste
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Engvall, Jan
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Lindström, Torbjörn
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Östgren, Carl Johan
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, West County Primary Health Care.
    Nyström, Fredrik
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    MASKED NOCTURNAL HYPERTENSION IN TYPE 2 DIABETES - A NEW MARKER OF RISK2009In: in JOURNAL OF HYPERTENSION, vol 27, 2009, Vol. 27, p. S169-S169Conference paper (Refereed)
    Abstract [en]

    n/a

  • 15.
    Wijkman, Magnus
    et al.
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, Department of Internal Medicine VHN.
    Länne, Toste
    Linköping University, Department of Medicine and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Lindström, Torbjörn
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Östgren, Carl Johan
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, West County Primary Health Care.
    Nystrom, Fredrik
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Treatment with beta-blockers is associated with high aortic but not brachial blood pressure and with cardiac hypertrophy in men with type 2 diabetes2008In: Journal of Hypertension, 2008, p. S29-S29Conference paper (Refereed)
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