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  • 1.
    af Geijerstam, Peder
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum.
    Engvall, Jan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Östgren, Carl Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Primary Care Center, Primary Health Care Center Ekholmen.
    Nyström, Fredrik
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum.
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna. The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Home Blood Pressure Compared With Office Blood Pressure in Relation to Dysglycemia2022In: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 35, no 9, p. 810-819Article in journal (Refereed)
    Abstract [en]

    Background: Masked hypertension is more common in individuals with type 2 diabetes than in individuals with normoglycemia. We aimed to explore if there is a discrepancy between office blood pressure (office BP) and home blood pressure monitoring (HBPM) in relation to HbA1c as well as glycemic status in 5,029 middle-aged individuals.

    Methods: HBPM was measured in a subsample of 5,029 participants in The Swedish CardioPulmonary BioImage Study (SCAPIS), a population-based cohort of 50–64 years old participants. Both office BP and HBPM were obtained after 5 minutes’ rest using the semiautomatic Omron M10-IT oscillometric device. White coat effect was calculated by subtracting systolic HBPM from systolic office BP. Participants were classified according to glycemic status: Normoglycemia, prediabetes, or diabetes based on fasting glucose, HbA1c value, and self-reported diabetes diagnosis.

    Results: Of the included 5,025 participants, 947 (18.8%) had sustained hypertension, 907 (18.0%) reported taking antihypertensive treatment, and 370 (7.4%) had diabetes mellitus. Both systolic office BP and HBPM increased according to worsened glycemic status (P for trend 0.002 and 0.002, respectively). Masked hypertension was more prevalent in participants with dysglycemia compared with normoglycemia (P = 0.036). The systolic white coat effect was reversely associated with HbA1c (P = 0.012).

    Conclusions: The systolic white coat effect was reversely associated with HbA1c, and the prevalence of masked hypertension increased with dysglycemia.

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  • 2.
    af Geijerstam, Peder
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum.
    Engvall, Jan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Östgren, Carl Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Primary Care Center, Primary Health Care Center Ekholmen.
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Nyström, Fredrik
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine.
    Masked hypertension in a middle-aged population and its relation to manifestations of vascular disease2023In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 41, no 7, p. 1084-1091Article in journal (Refereed)
    Abstract [en]

    Background: Masked hypertension is associated with cardiovascular disease (CVD). However, previous large studies have not used the same device to measure office and home blood pressure (BP) and adhered to current home BP measurement recommendations of the European Society of Hypertension. We aimed to characterize masked hypertension and explore its relation to manifestations of CVD.

    Methods: A randomly selected cohort of 5057 participants aged 50–64 years from the Swedish CardioPulmonary BioImage Study (SCAPIS) was evaluated with office and home BP using the semi-automatic Omron M10-IT oscillometric device. Additional analyses included pulse wave velocity (PWV) and coronary artery calcium score (CACS).

    Results: Of participants, 4122 did not have current antihypertensive treatment, and were thus included in our analyses. Of these, 2634 (63.9%) had sustained normotension, and 172 (4.2%) had masked hypertension. Participants with masked hypertension vs. sustained normotension were more often men (66.9 vs. 46.2%, P < 0.001). Those with masked hypertension had higher mean PWV [9.3 (95% confidence interval, 95% CI 9.1–9.5) vs. 8.3 (95% CI 8.2–8.4) m/s, P < 0.001] and odds ratio for CACS at least 100 [1.65 (95% CI 1.02–2.68), P = 0.040]. These associations were similar in a posthoc analysis of masked hypertension and sustained normotension, matched for age, sex and systolic office BP.

    Conclusion: Masked hypertension was associated with markers of CVD. This suggests that home BP is a better predictor of risk, even when the recordings are performed with the same measurement device, in a population-based setting with randomized recruitment.

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  • 3.
    af Geijerstam, Peder
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum.
    Harris, Katie
    The George Institute for Global Health, University of New South Wales.
    Johansson, Maria M.
    Linköping University, Faculty of Medicine and Health Sciences.
    Chalmers, John
    The George Institute for Global Health, University of New South Wales.
    Nägga, Katarina
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Orthostatic Hypotension and Cognitive Function in Individuals 85 Years of Age: A Longitudinal Cohort Study in Sweden2024In: Aging and Disease, ISSN 2152-5250, p. 0-0Article in journal (Refereed)
    Abstract [en]

    Background: Orthostatic hypotension (OH) is more common in the elderly, and associated with increased mortality. However, its implications in 85-year-olds are not known.

    Methods: In the prospective observational cohort study Elderly in Linköping Screening Assessment (ELSA 85), 496 individuals in Linköping, Sweden, were followed from age 85 years with cognitive assessments. Blood pressure (BP) was measured supine and after 1, 3, 5, and 10 minutes of standing. Participants with a BP fall of ≥20 mmHg systolic or ≥10 mmHg diastolic after 1 or 3 minutes were classified as classical continuous or classical transient OH depending on whether the BP fall was sustained or not, at subsequent measurements. Those with a BP fall of the same magnitude, but only after 5 or 10 minutes were classified as delayed OH.

    Results: Of participants, 329 took part in BP measurements and were included. Of these, 156 (47.4%) had classical OH (113 [34.3%] continuous classical, 38 [11.6%] transient classical), and 15 (4.6%) had delayed OH. Cognitive assessments were not markedly different between groups. After 8.6 years, 195 (59.3%) of the participants had died, and delayed vs no OH was associated with twice the risk of all-cause mortality, HR 2.15 (95% CI 1.12-4.12). Transient classical OH was associated with reduced mortality, HR 0.58 (95% CI 0.33-0.99), but not after multiple adjustments, and continuous classical OH was not associated with mortality.

    Conclusion: OH may have different implications for morbidity and mortality in 85-year-olds compared with younger populations.

  • 4.
    af Geijerstam, Peder
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum.
    Joelsson, Annelie
    Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum.
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Nyström, Fredrik H
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine.
    A low dose of daily licorice intake affects renin, aldosterone, and home blood pressure in a randomized crossover trial2024In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207Article in journal (Refereed)
    Abstract [en]

    BackgroundLicorice, through the effects of glycyrrhizic acid (GA), raises blood pressure (BP). The World Health Organization has suggested that 100 mg GA/d would be unlikely to cause adverse effects, but of 13 previously published studies none have been randomized and controlled and independently quantified the GA content.

    Objective

    Our aim was to analyze the effects on home BP of a daily licorice intake containing 100 mg GA.

    Methods

    Healthy volunteers were randomly assigned to start with either licorice or a control product in a nonblinded, 2 × 2 crossover study. Home BP was measured daily, and blood samples were collected at the end of each 2-wk period.

    Results

    There were 28 participants and no dropouts. The median age was 24.0 y (interquartile range 22.8–27.0 y). During the licorice compared with control intake period, the systolic home BP increased [mean difference: 3.1 mm Hg (95% confidence interval [CI]: 0.8, 5.4 mm Hg) compared with −0.3 mm Hg (95% CI: −1.8, 1.3 mm Hg); P = 0.018] and renin and aldosterone were suppressed [mean change: −30.0% (95% CI: −56.7%, −3.3%) compared with 15.8% (95% CI: −12.8%, 44.4%); P = 0.003; and −45.1% (95% CI: −61.5%, −28.7%) compared with 8.2% (95% CI: −14.7%, 31.1%); P <0.001, respectively]. In the quartile of participants with the most pronounced suppression of renin and aldosterone, N-terminal prohormone of brain natriuretic peptide concentration increased during the licorice compared with control period [mean change: 204.1% (95% CI: −11.6%, 419.7%) compared with 72.4% (95% CI: −52.2%, 197.1%); P = 0.016].

    Conclusions

    We found licorice to be more potent than previously known, with significant increases in BP, after a daily intake of only 100 mg GA. Thus, the safe limit of intake of this substance might need to be reconsidered.

  • 5.
    Anskär, Eva
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Sverker, Annette
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    ‘But there are so many referrals which are totally...only generating workand irritation’: a qualitative study of physicians’and nurses’experiences ofwork tasks in primary care in Sweden2022In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 40, no 3, p. 350-359Article in journal (Refereed)
    Abstract [en]

    Objective This study explored the perceptions of physicians and nurses in Swedish primary care regarding the legitimacy of their work tasks and the use of their professional competence. Design and setting This qualitative study was based on manifest content analysis. Data were collected with individual semi-structured interviews of physicians and nurses at publicly managed primary care centres in the Region ostergotland, Sweden. To include both large and small primary care centres, we applied strategic sampling. Among 15 primary care centres invited, nine agreed to participate, including four urban, two suburban, and three rural centres. Subjects The study included 11 physicians and 13 nurses from nine primary care centres. Main outcome measures and results The physicians and nurses perceived several of their work tasks as illegitimate. In addition, they experienced work-related difficulties, due to resource shortages, challenging electronic data systems, work inefficiencies, and that there were insufficient cooperation with, and problems drawing the line between, primary care and hospital care responsibilities. However, most found that their individual expertise was appropriately used, overall. Conclusions Strained work situations and illegitimate work tasks may inflate discontentment and lead to negative work stress. Nevertheless, the staff felt that competence was used appropriately in the tasks considered legitimate.

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  • 6.
    Anskär, Eva
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Mantorp.
    Lindberg, Malou
    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, 1177 Vårdguiden på telefon.
    Falk, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna, Linköping.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Operations management Region Östergötland, Research and Development Unit.
    Legitimacy of work tasks, psychosocial work environment, and time utilization among primary care staff in Sweden2019In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, no 4, p. 476-483Article in journal (Refereed)
    Abstract [en]

    Objective: Primary care staff faces a complex work environment including a heavy administrative work load and perceive some work tasks as illegitimate. This study aimed to elucidate associations between the perceived legitimacy of work tasks, the psychosocial work environment, and the utilization of work time among Swedish primary care staff.

    Design and setting: The study was designed as a multicenter study involving all staff categories, i.e. registered nurses, primary care physicians, care administrators, nurse assistants and allied professionals, at eleven primary care centers in Sweden.

    Subjects: Participants completed the Bern Illegitimate Tasks Scale and the Copenhagen Psychosocial Questionnaire. They also recorded time spent on all work tasks, day by day during two separate weeks.

    Main outcome measures and results: More than a quarter (27%) of primary care physicians perceived a high proportion of unnecessary work tasks. After adjusting for profession, age and gender, the perception of having to perform unreasonable work tasks was positively associated with experiencing role conflicts and with the proportion of organization-related administration and service work tasks.

    Conclusion: Across all staff groups, the perception of unreasonable work tasks was more pronounced among staff with a high proportion of non-patient related administration. Also, the perception of having to perform a large amount of illegitimate work tasks affected the psychosocial work environment negatively, which might influence staffs perception of their professional roles. These results illuminate the importance of decision makers to thoroughly consider the distribution and allocation of non-patient related work tasks among staff in primary care.Key pointsWe observed an interaction between perception of having a large proportion of illegitimate work tasks and impaired psychosocial work environment. • More than a quarter of the primary care physicians perceived a high proportion of unnecessary work tasks.• Across all staff groups, performing unreasonable work tasks was associated with an experience of having role conflicts.• Across all staff groups, a perception of performing unreasonable work tasks was associated with the proportion of non-patient related administrative work tasks.

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    Legitimacy of work tasks, psychosocial work environment, and time utilization among primary care staff in Sweden
  • 7.
    Anskär, Eva
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Mantorp. Region Östergötland, Regional Board, Research and Development Unit.
    Lindberg, Malou
    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.
    Falk, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna, Linköping.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regional Board, Research and Development Unit.
    Time utilization and perceived psychosocial work environment among staff in Swedish primary care settings2018In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 18, article id 166Article in journal (Refereed)
    Abstract [en]

    Background: Over the past decades, reorganizations and structural changes in Swedish primary care have affected time utilization among health care professionals. Consequently, increases in administrative tasks have substantially reduced the time available for face-to-face consultations. This study examined how work-time was utilized and the association between work time utilization and the perceived psychosocial work environment in Swedish primary care settings. Methods: This descriptive, multicentre, cross-sectional study was performed in 2014-2015. Data collection began with questionnaire. In the first section, respondents were asked to estimate how their workload was distributed between patients (direct and indirect patient work) and other work tasks. The questionnaire also comprised the Copenhagen Psychosocial Questionnaire, which assessed the psychosocial work environment. Next a time study was conducted where the participants reported their work-time based on three main categories: direct patient-related work, indirect patient-related work, and other work tasks. Each main category had a number of subcategories. The participants recorded the time spent (minutes) on each work task per hour, every day, for two separate weeks. Eleven primary care centres located in southeast Sweden participated. All professionals were asked to participate (n = 441), including registered nurses, primary care physicians, care administrators, nurse assistants, and allied professionals. Response rates were 75% and 79% for the questionnaires and the time study, respectively. Results: All health professionals allocated between 30.9% - 37.2% of their work-time to each main category: direct patient work, indirect patient work, and other work. All professionals estimated a higher proportion of time spent in direct patient work than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress, and role conflicts. Among allied professionals, the proportion of work-time spent on administrative tasks was associated with more role conflicts. Younger staff perceived more adverse working conditions than older staff. Conclusions: This study indicated that Swedish primary care staff spent a limited proportion of their work time directly with patients. PCPs seemed to perceive their work environment in negative terms to a greater extent than other staff members. This study showed that work task allocations influenced the perceived psychosocial work environment.

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  • 8.
    Bergram, Martin
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nasr, Patrik
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Mag- tarmmedicinska kliniken.
    Iredahl, Fredrik
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Åby.
    Kechagias, Stergios
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Mag- tarmmedicinska kliniken.
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Ekstedt, Mattias
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Mag- tarmmedicinska kliniken.
    Low awareness of non-alcoholic fatty liver disease in patients with type 2 diabetes in Swedish Primary Health Care2022In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 57, no 1, p. 60-69Article in journal (Refereed)
    Abstract [en]

    Objectives Non-alcoholic fatty liver disease (NAFLD) is more common in patients with type 2 diabetes mellitus (T2DM) compared to individuals without. Recent guidelines recommend screening for NAFLD in patients with T2DM. Our aim was to investigate the prevalence of NAFLD in patients with T2DM in a Swedish primary health care setting, how they are cared for and assess the risk of biochemical signs of advanced fibrosis. Material and methods In this cohort study, patients with T2DM from five primary health care centers were included. Medical records were retrospectively reviewed and living habits, medical history, results of diagnostic imaging and anthropometric and biochemical features were noted in a standardized form. The risk of steatosis and advanced fibrosis was assessed using commonly used algorithms (FLI, HSI, NAFLD-LFS, NAFLD ridge score, FIB-4 and NFS). Results In total 350 patients were included. Diagnostic imaging had been performed in 132 patients and of these, 34 (26%) had steatosis, which was not noted in the medical records in 16 (47%) patients. One patient with steatosis had been referred to a hepatologist. Of assessable patients, 71-97% had a high to intermediate risk of steatosis and 29-65% had an intermediate to high risk of advanced fibrosis according to the algorithms used. Conclusion This study indicates a high prevalence of NAFLD among T2DM patients in Swedish primary care. Patients with known NAFLD were followed up to a very low extent. Using fibrosis algorithms in primary health care would result in many patients needing further assessment in secondary care.

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  • 9.
    Carlsson, Adam
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna, Linköping.
    Melanoma Risk Estimation Based on Objective Measures as a Complement to Self-Assessment2020In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 40, no 6, p. 3325-3331Article in journal (Refereed)
    Abstract [en]

    Background/Aim: A variety of self-tests addressing individual skin cancer risk are available online. These are generally based on self-estimated measures, such as self-rated skin sensitivity to sun exposure, affecting its reliability. The aim of this study was to investigate whether the addition of objective variables, by means of ultraviolet (UV) sensitivity phototesting and nevi count, could be of contributory value for the composition of a comprehensive risk score for skin cancer, and whether the use of such a score could contribute to change of behavior in the sun after assessment of individual risk. Patients and Methods: A sample of 70 voluntary participants, all university students, were recruited for the study. The participants rated their sun exposure habits by filling out the Sun Exposure and Protection Index (SEPI) questionnaire, and their skin UV-sensitivity was decided both by self-estimation, using Fitzpatrickss skin type scale, and objectively, by the performance of a UV-sensitivity phototest. Finally, the number of pigmented nevi on the lower arm was counted both by the participants themselves and by a trained observer. A cumulated skin cancer risk score was calculated on the basis on these three variables (sun habits, UV-sensitivity and nevi count), and the outcome compared whether based on the participants self-assessments or on the objective assessment. The individual risk score, based on objective measures, along with a tailored sun protection advice, was communicated to the participants, and after three weeks they once again filled-out the SEPI part addressing propensity to increase sun protection. Results: The results showed good correlation between the self-assessed and trained observer performed nevi count, but poor agreement between self-estimated and objectively measured skin UV-sensitivity. For the cumulative risk score, the self-performed score was on average slightly lower than its reference, but no systematic difference could be observed. At follow-up, high-risk individuals showed a significant decrease in total SEPI score (p&lt;0.05). Conclusion: Objective assessment of nevi count and skin UV-sensitivity might be of significant value when estimating individual skin cancer risk, in order to communicate tailored sun protection advice.

  • 10.
    Carlsson, Sara
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Hedin, Katarina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Futurum The Acad Hlth & Care, Sweden; Lund Univ, Sweden.
    Cronberg, Olof
    Lund Univ, Sweden; Vaxjohalsan Primary Healthcare Ctr, Sweden; Reg Kronoberg, Sweden.
    Moberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Antibiotic Treatment for Lower Respiratory Tract Infections in Primary Care: A Register-Based Study Examining the Role of Radiographic Imaging2023In: Antibiotics, ISSN 0066-4774, E-ISSN 2079-6382, Vol. 12, no 7, article id 1165Article in journal (Refereed)
    Abstract [en]

    When imaging (i.e., chest-x-ray or computed tomography) is used to differentiate between acute bronchitis and pneumonia, many patients are being prescribed antibiotics despite the absence of radiographic pneumonia signs. This study of lower respiratory tract infections (LRTIs) with negative chest imaging compares cases where antibiotics were prescribed and not prescribed to find characteristics that could explain the prescription. Data were extracted from the regional electronic medical record system in Kronoberg County, Sweden, for patients aged 18-79 years diagnosed with acute bronchitis or pneumonia and who had any chest radiologic imaging between 2007-2014. Of 696 cases without evidence of pneumonia on imaging, 55% were prescribed antibiotics. Age, sex, and co-morbidity did not differ between those with or without antibiotics. The median level of C-reactive protein was low in both groups but differed significantly (21 vs. 10 mg/L; p &lt; 0.001). Resident physicians prescribed antibiotics more frequently than interns or specialists (p &lt; 0.001). It is unclear what features prompted the antibiotic prescribing in those with negative imaging indicating overuse of antibiotics for LRTIs.

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  • 11.
    Cederqvist, John
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Muhammad, Iram Faqir
    Lund Univ, Sweden.
    Engstrom, Gunnar
    Lund Univ, Sweden.
    Engvall, Jan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Östgren, Carl Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ekholmen. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Arterial stiffness and subclinical atherosclerosis in the coronary arteries at different stages of dysglycaemia2023In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 40, no 7, article id e15102Article in journal (Refereed)
    Abstract [en]

    Aim: Our aim was to investigate in a large population -based cohort study whether increased arterial stiffness and subclinical atherosclerosis in the coronary arteries differ at different stages of dysglycaemia.Methods: Data were obtained from SCAPIS, a population -based cohort of participants 50- 64 years. The study population of 9379 participants was categorised according to glycaemic status: normoglycaemic, pre-diabetes (fasting glucose: 6.1- 6.9 mmol/L and/or HbA1c 6%- 6.4%) and diabetes. Pulse wave velocity (PWV) was measured by the SphygmoCor XCEL system and arterial stiffness was defined by PWV =10 m/s. Coronary artery calcium score (CACS) was assessed by coronary computed tomography and coronary artery calcification was defined by CACS =100.Results: We identified 1964 (21%) participants with dysglycaemia, out of which 742 (7.9%) had diabetes mellitus. PWV =10 m/s was present in 808 (11%), 191 (16%), 200 (27%) and CACS =100 in 801 (11%), 190 (16%), 191 (28%) participants with normoglycaemia, pre-diabetes and diabetes, respectively, all, p &lt; 0.001. The overlap between PWV =10 m/s and CACS =100 within each glycaemic category was 188 (2.5%), 44 (3.6%) and 77 (10) respectively. There was an association between glycaemic status and increased PWV in the fully adjusted models, but not for glycaemic status and CACS =100, where there was no difference for pre-diabetes compared to normoglycaemia, OR 1.2 (95% CI 0.98- 1.4). In the total study population, there was an association between HbA1c and PWV after adjustment, p &lt;0.001.Conclusions: Our results show that increased arterial stiffness and subclinical coronary artery atherosclerosis are present in the early stages of dysglycaemia, but the overlap between markers of major subclinical vascular damage was small in all glycaemic categories. This could be explained by different pathways in the pathogenesis of arterial stiffness or atherosclerosis in the coronary arteries.

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  • 12.
    Eckhardt, Martin
    et al.
    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 Central Östergötland, Department of Emergency Medicine in Linköping.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Crespo-Burgos, Antonio
    Museo Nacl Med Eduardo Estrella, Ecuador.
    Forsberg, Birger C.
    Karolinska Inst, Sweden.
    Falk, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna, Linköping.
    Universal Health Coverage in Marginalized Populations: A Qualitative Evaluation of a Health Reform Implementation in Rural Ecuador2019In: Inquiry, ISSN 0046-9580, E-ISSN 1945-7243, Vol. 56, article id 0046958019880699Article in journal (Refereed)
    Abstract [en]

    In 2008, Ecuador underwent a major health reform with the aim of universal coverage. Little is known about the implementation of the reform and its perceived effects in rural parts of the country. The aim of this study was to explore the perceived effects of the 2008 health reform implementation, on rural primary health care services and financial access of the rural poor. A qualitative study using focus group discussions was conducted in a rural region in Ecuador, involving health staff, local health committee members, village leaders, and community health workers. Qualitative content analysis focusing on the manifest content was applied. Three categories emerged from the texts: (1) the prereform situation, which was described as difficult in terms of financial access and quality of care; (2) the reform process, which was perceived as top-down and lacking in communication by the involved actors; lack of interest among the population was reported; (3) the effects of the reform, which were mainly perceived as positive. However, testimonies about understaffing, drug shortages, and access problems for those living furthest away from the health units show that the reform has not fully achieved its intended effects. New problems are a challenging health information system and people without genuine care needs overusing the health services. The results indicate that the Ecuadorean reform has improved rural primary health care services. Still, the reform faces challenges that need continued attention to secure its current achievements and advance the health system further.

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  • 13.
    Eckhardt, Martin
    et al.
    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 Central Östergötland, Department of Emergency Medicine.
    Santillán, Dimitri
    Universidad Central del Ecuador, Facultad de Ciencias Médicas, Quito, Ecuador.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Forsberg, Birger C.
    Karolinska Institute, Department of Public Health Sciences, Stockholm, Sweden.
    Falk, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna, Linköping.
    Universal Health Coverage in Rural Ecuador: A Cross-sectional Study of Perceived Emergencies2018In: Western Journal of Emergency Medicine, ISSN 1936-900X, E-ISSN 1936-9018, Vol. 19, no 5, p. 889-900Article in journal (Refereed)
    Abstract [en]

    Introduction: In many low- and middle-income countries emergency care is provided anywhere in the health system; however, no studies to date have looked at which providers are chosen by patients with perceived emergencies. Ecuador has universal health coverage that includes emergency care. However, earlier research indicates that patients with emergencies tend to seek private care. Our primary research questions were these: What is the scope of perceived emergencies?; What is their nature?; and What is the related healthcare-seeking behavior? Secondary objectives were to study determinants of healthcare-seeking behavior, compare health expenditure with expenditure from the past ordinary illness, and measure the prevalence of catastrophic health expenditure related to perceived emergencies. 

    Methods: We conducted a cross-sectional survey of 210 households in a rural region of northwestern Ecuador. The households were sampled with two-stage cluster sampling and represent an estimated 20% of the households in the region. We used two structured, pretested questionnaires. The first questionnaire collected demographic and economic household data, expenditure data on the past ordinary illness, and presented our definition of perceived emergency. The second recorded the number of emergency events, symptoms, further case description, healthcare-seeking behavior, and health expenditure, which was defined as being catastrophic when it exceeded 40% of a household´s ability to pay.

    Results: The response rate was 85% with a total of 74 reported emergency events during the past year (90/1,000 inhabitants). We further analyzed the most recent event in each household (n=54). Private, for-profit providers, including traditional healers, were chosen by 57.4% (95% confidence interval [CI] [44-71%]). Public providers treated one third of the cases. The mean health expenditure per event was $305.30 United States dollars (USD), compared to $135.80 USD for the past ordinary illnesses. Catastrophic health expenditure was found in 24.4% of households. 

    Conclusion: Our findings suggest that the provision of free health services may not be sufficient to reach universal health coverage for patients with perceived emergencies. Changes in the organization of public emergency departments and improved financial protection for emergency patients may improve the situation.

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  • 14.
    Eek, Emma
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    van Driel, Mieke
    Univ Queensland, Australia.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Hollingworth, Samantha A.
    Univ Queensland, Australia.
    Merlo, Gregory
    Univ Queensland, Australia; Univ Queensland, Australia.
    Antidepressant use in Australia and Sweden-A cross-country comparison2021In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 30, no 4, p. 409-417Article in journal (Refereed)
    Abstract [en]

    Purpose To compare the dispensed use of antidepressants in Australia and Sweden. Methods We analysed publicly available data from Australia and Sweden on dispensed use of antidepressants from 2006 to 2018. Results The dispensed use of antidepressants has increased in both Australia and Sweden. Australia had a more rapid increase resulting in a higher total use. The utilisation profile was similar in both countries; SSRIs were the most commonly used group, "other antidepressants" were the group that increased the most, and seven of the eight most used substances were the same. There were differences in which antidepressants were most used, with the three most prescribed antidepressants being escitalopram, sertraline, and venlafaxine in Australia; and mirtazapine, sertraline, and citalopram in Sweden. Conclusion Dispensed use of antidepressants has increased remarkably in both Australia and Sweden between 2006 and 2018. Although similar with regard to economic status and health care system, use of antidepressants differs between both countries. This may be a result of a combination of factors related to medical, contextual and policy evidence. The differences displayed in this study may reflect varying accessibility of treatments, national programmes enhancing mental health literacy in the population, clinical prescribing guidelines and timing of approval of new antidepressants.

  • 15.
    Ekblom-Bak, Elin
    et al.
    Swedish Sch Sport & Hlth Sci, Sweden.
    Börjesson, Mats
    Gothenburg Univ, Sweden; Sahlgrens Univ Hosp, Sweden.
    Bergman, Frida
    Umea Univ, Sweden.
    Bergström, Göran
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Dahlin-Almevall, Albin
    Lulea Univ Technol, Sweden.
    Drake, Isabel
    Lund Univ, Sweden.
    Engström, Gunnar
    Lund Univ, Sweden.
    Engvall, Jan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Gummesson, Anders
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Hagström, Emil
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Hjelmgren, Ola
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Jernberg, Tomas
    Danderyd Hosp, Sweden.
    Johansson, Peter J.
    Uppsala Univ, Sweden.
    Lind, Lars
    Uppsala Univ, Sweden.
    Mannila, Maria
    Karolinska Univ Hosp, Sweden.
    Nyberg, Andre
    Umea Univ, Sweden.
    Persson, Margaretha
    Lund Univ, Sweden.
    Reitan, Christian
    Danderyd Hosp, Sweden.
    Rosengren, Annika
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Schmidt, Caroline
    Univ Gothenburg, Sweden.
    Sköld, Magnus C.
    Karolinska Univ Hosp Solna, Sweden; Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Sonestedt, Emily
    Lund Univ, Sweden.
    Sundström, Johan
    Uppsala Univ, Sweden; Univ New South Wales, Australia.
    Swahn, Eva
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Ohlin, Jerry
    Umea Univ, Sweden.
    Östgren, Carl Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ekholmen. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Ekblom, Örjan
    Swedish Sch Sport & Hlth Sci, Sweden.
    Accelerometer derived physical activity patterns in 27.890 middle-aged adults: The SCAPIS cohort study2022In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 32, no 5, p. 866-880Article in journal (Refereed)
    Abstract [en]

    The present study aims to describe accelerometer-assessed physical activity (PA) patterns and fulfillment of PA recommendations in a large sample of middle-aged men and women, and to study differences between subgroups of socio-demographic, socio-economic, and lifestyle-related variables. A total of 27 890 (92.5% of total participants, 52% women, aged 50-64 years) middle-aged men and women with at least four days of valid hip-worn accelerometer data (Actigraph GT3X+, wGT3X+ and wGT3X-BT) from the Swedish CArdioPulmonary bioImage Study, SCAPIS, were included. In total, 54.5% of daily wear time was spent sedentary, 39.1% in low, 5.4% in moderate, and only 0.1% in vigorous PA. Male sex, higher education, low financial strain, born in Sweden, and sedentary/light working situation were related to higher sedentary time, but also higher levels of vigorous PA. High BMI and having multiple chronic diseases associated strongly with higher sedentary time and less time in all three PA intensities. All-year physically active commuters had an overall more active PA pattern. The proportion fulfilling current PA recommendations varied substantially (1.4% to 92.2%) depending on data handling procedures and definition used. Twenty-eight percent was defined as having an "at-risk" behavior, which included both high sedentary time and low vigorous PA. In this large population-based sample, a majority of time was spent sedentary and only a fraction in vigorous PA, with clinically important variations between subgroups. This study provides important reference material and emphasizes the importance of a comprehensive assessment of all aspects of the individual PA pattern in future research and clinical practice.

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  • 16.
    Guorgis, Ghassan
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Anderson, Chris D.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Dermatology and Venerology.
    Lyth, Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Forskningsstrategiska enheten.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Actinic Keratosis Diagnosis and Increased Risk of Developing Skin Cancer: A 10-year Cohort Study of 17,651 Patients in Sweden2020In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 100, no 8, article id adv00128Article in journal (Refereed)
    Abstract [en]

    Actinic keratosis is the most common actinic lesion in fair-skinned populations. It is accepted as an indicator of actinic skin damage and as an occasional precursor of squamous cell carcinoma. The aim of this study was to investigate, in a cohort of patients with a diagnosis of actinic keratosis, the relative risk of developing skin cancer during a follow-up period of 10 years. This registry-based cohort study compared a cohort of 2,893 individuals in south-eastern Sweden, who were diagnosed with actinic keratosis during the period 2000 to 2004, with a matched-control cohort of 14,668 individuals without actinic keratosis during the same inclusion period. The subjects were followed for 10 years to identify skin cancer development in both cohorts. Hazard ratios with 95% confidence intervals (95% CI) were used as risk measures. Individuals in the actinic keratosis cohort had a markedly higher risk for all skin cancer forms compared with the control cohort (hazard ratio (HR) 5.1, 95% CI 4.7-5.6). The relative risk was highest for developing squamous cell carcinoma (SCC) (HR 7.7, 95% CI 6.7-8.8) and somewhat lower for basal cell carcinoma (BCC) (HR 4.4, 95% CI 4.1-5.0) and malignant melanoma (MM) (HR 2.7 (2.1-3.6). Patients with a diagnosis of actinic keratosis were found to be at increased risk of developing SCC, BCC and MM in the 10 years following diagnosis of actinic keratosis. In conclusion, a diagnosis of actinic keratosis, even in the absence of documentation of other features of chronic sun exposure, is a marker of increased risk of skin cancer, which should be addressed with individually directed preventive advice.

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  • 17.
    Hedin, Katarina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Lund Univ, Sweden; Futurum, Region Jönköping County, Sweden.
    van der Velden, Alike W.
    Univ Med Ctr Utrecht, Netherlands.
    Hansen, Malene Plejdrup
    Aalborg Univ, Denmark.
    Moberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Balan, Anca
    Balan Medfarm SRL, Romania.
    Bruno, Pascale
    Univ Cote Azur, France.
    Coenen, Samuel
    Univ Antwerp, Belgium.
    Johansen, Eskild
    Aalborg Univ, Denmark.
    Kowalczyk, Anna
    Med Univ Lodz, Poland.
    Kurotschka, Peter Konstantin
    Univ Hosp Wurzburg, Germany.
    van der Linde, Sanne R.
    Univ Med Ctr Utrecht, Netherlands.
    Malania, Lile
    Natl Ctr Dis Control & Publ Hlth, Georgia.
    Rohde, Jorn
    Univ Hosp Wurzburg, Germany.
    Verbakel, Jan
    Katholieke Univ Leuven, Belgium; Univ Oxford, England.
    Vornhagen, Heike
    Natl Univ Galway, Ireland.
    Vellinga, Akke
    Univ Coll Dublin, Ireland.
    Initial symptoms and three months follow-up after acute COVID-19 in outpatients: An international prospective cohort study2023In: European Journal of General Practice, ISSN 1381-4788, E-ISSN 1751-1402, Vol. 29, no 3, article id 2154074Article in journal (Refereed)
    Abstract [en]

    Background: Most studies on long-term follow-up of patients with COVID-19 focused on hospitalised patients. No prospective study with structured follow-up has been performed in non-hospitalised patients with COVID-19. Objectives: To assess long-COVID and post-COVID (WHO definition: symptomatic at least 12 weeks), describe lingering symptoms, their impact on daily activities, and general practice visits and explore risk factors for symptom duration in outpatients. Methods: A prospective study of adult outpatients with confirmed SARS-CoV-2 infection and symptoms consistent with COVID-19 in 11 European countries, recruited during 2020 and 2021 from primary care and the community. Structured follow-up by phone interviews (symptom rating, symptom impact on daily activities and general practice visits) was performed at weeks 2, 4, 8, and 12 by study personnel. Data was analysed descriptively by using correlation matrixes and Cox regression. Results: Of 270 enrolled patients, 52% developed long-COVID and 32% post-COVID-syndrome. When only considering the presence of moderate or (very) severe symptoms at weeks 8 and 12, these percentages were 28% and 18%, respectively. Fatigue was the most often reported symptom during follow-up. The impact of lingering symptoms was most evident in sports and household activities. About half (53%) had at least one general practice contact during follow-up. Obese patients took twice as long to return to usual health (HR: 0.5, 95%CI: 0.3-0.8); no other risk profile could predict lingering symptoms. Conclusion: Long-COVID and post-COVID are also common in outpatients. In 32%, it takes more than 12 weeks to return to usual health.

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  • 18.
    Helenason, Jonatan
    et al.
    AI Med Technol, Sweden.
    Ekstrom, Christoffer
    AI Med Technol, Sweden.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Papachristou, Panagiotis
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Exploring the feasibility of an artificial intelligence based clinical decision support system for cutaneous melanoma detection in primary care - a mixed method study2023In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724Article in journal (Refereed)
    Abstract [en]

    Objective: Skin examination to detect cutaneous melanomas is commonly performed in primary care. In recent years, clinical decision support systems (CDSS) based on artificial intelligence (AI) have been introduced within several diagnostic fields.Setting: This study employs a variety of qualitative and quantitative methodologies to investigate the feasibility of an AI-based CDSS to detect cutaneous melanoma in primary care.Subjects and Design: Fifteen primary care physicians (PCPs) underwent near-live simulations using the CDSS on a simulated patient, and subsequent individual semi-structured interviews were explored with a hybrid thematic analysis approach. Additionally, twenty-five PCPs performed a reader study (diagnostic assessment on the basis of image interpretation) of 18 dermoscopic images, both with and without help from AI, investigating the value of adding AI support to a PCPs decision. Perceived instrument usability was rated on the System Usability Scale (SUS).Results: From the interviews, the importance of trust in the CDSS emerged as a central concern. Scientific evidence supporting sufficient diagnostic accuracy of the CDSS was expressed as an important factor that could increase trust. Access to AI decision support when evaluating dermoscopic images proved valuable as it formally increased the physicians diagnostic accuracy. A mean SUS score of 84.8, corresponding to good usability, was measured.Conclusion: AI-based CDSS might play an important future role in cutaneous melanoma diagnostics, provided sufficient evidence of diagnostic accuracy and usability supporting its trustworthiness among the users. Effective primary care is important for discovering cutaneous melanoma, the deadliest and an increasingly prevalent form of skin cancer.Trust, usability and user experience, and the clinical context are the qualitative themes that emerged from the qualitative analysis. These areas need to be considered for the successful adoption of AI assisted decision support tools by PCPs.The AI CDSS tool was rated by the PCPs at grade B (average 84.8) on the System Usability Scale (SUS), which is equivalent to good usability.A reader study, (diagnostic assessment on the basis of image interpretation) with 25 PCPs rating dermoscopic images, showed increased value of adding an AI decision support to their clinical assessment.

  • 19.
    Herraiz Adillo, Ángel
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Ahlqvist, Viktor H.
    Karolinska Inst, Sweden.
    Higueras-Fresnillo, Sara
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Autonoma Madrid, Spain.
    Berglind, Daniel
    Karolinska Inst, Sweden; Ctr Epidemiol & Community Med, Sweden.
    Wennberg, Patrik
    Umea Univ, Sweden.
    Lenander, Cecilia
    Lund Univ, Sweden.
    Daka, Bledar
    Univ Gothenburg, Sweden.
    Ekstedt, Mattias
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Mag- tarmmedicinska kliniken. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Sundstrom, Johan
    Uppsala Univ, Sweden; Univ New South Wales, Australia.
    Ortega, Francisco B.
    CIBERobn Physiopathol Obes & Nutr, Spain; Univ Jyvaskyla, Finland.
    Östgren, Carl Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ekholmen. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna. Univ New South Wales, Australia; Univ Granada, Spain.
    Henriksson, Pontus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Lifes Essential 8 and carotid artery plaques: the Swedish cardiopulmonary bioimage study2023In: Frontiers in Cardiovascular Medicine, E-ISSN 2297-055X, Vol. 10, article id 1173550Article in journal (Refereed)
    Abstract [en]

    BackgroundTo quantify cardiovascular health (CVH), the American Heart Association (AHA) recently launched an updated construct of the "Lifes Simple 7" (LS7) score, the "Lifes Essential 8" (LE8) score. This study aims to analyse the association between both CVH scores and carotid artery plaques and to compare the predictive capacity of such scores for carotid plaques.MethodsRandomly recruited participants aged 50-64 years from the Swedish CArdioPulmonary bioImage Study (SCAPIS) were analysed. According to the AHA definitions, two CVH scores were calculated: i) the LE8 score (0, worst CVH; 100, best CVH) and two different versions of the LS7 score [(0-7) and (0-14), 0 indicating the worst CVH]. Ultrasound-diagnosed carotid plaques were classified as no plaque, unilateral, and bilateral plaques. Associations were studied by adjusted multinomial logistic regression models and adjusted (marginal) prevalences, while comparison between LE8 and LS7 scores was performed through receiver operating characteristic (ROC) curves.ResultsAfter exclusions, 28,870 participants remained for analysis (50.3% women). The odds for bilateral carotid plaques were almost five times higher in the lowest LE8 (&lt;50 points) group [OR: 4.93, (95% CI: 4.19-5.79); adjusted prevalence 40.5%, (95% CI: 37.9-43.2)] compared to the highest LE8 (& GE;80 points) group [adjusted prevalence 17.2%, (95% CI: 16.2-18.1)]. Also, the odds for unilateral carotid plaques were more than two times higher in the lowest LE8 group [OR: 2.14, (95% CI: 1.82-2.51); adjusted prevalence 31.5%, (95% CI: 28.9-34.2)] compared to the highest LE8 group [adjusted prevalence 29.4%, (95% CI: 28.3-30.5)]. The areas under ROC curves were similar between LE8 and LS7 (0-14) scores: for bilateral carotid plaques, 0.622 (95% CI: 0.614-0.630) vs. 0.621 (95% CI: 0.613-0.628), P = 0.578, respectively; and for any carotid plaque, 0.602 (95% CI: 0.596-0.609) vs. 0.600 (95% CI: 0.593-0.607), P = 0.194, respectively.ConclusionThe new LE8 score showed inverse and dose-response associations with carotid plaques, particularly bilateral plaques. The LE8 did not outperform the conventional LS7 score, which showed similar ability to predict carotid plaques, especially when scored as 0-14 points. We conclude that both the LE8 and LS7 may be useful in clinical practice for monitoring CVH status in the adult population.

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  • 20.
    Herraiz-Adillo, Ángel
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Ahlqvist, Viktor H.
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Daka, Bledar
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Wångdahl, Josefin
    Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden; Department of Public Health & Caring Sciences, Uppsala University, Uppsala, Sweden.
    Wennberg, Patrik
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
    Carlsson, Jakob
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Higueras-Fresnillo, Sara
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain.
    Lenander, Cecilia
    Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Lund, Sweden.
    Östgren, Carl Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Primary Care Center, Primary Health Care Center Ekholmen.
    Berglind, Daniel
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden.
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna. The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Henriksson, Pontus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Life’s Essential 8 in relation to self-rated health and health-related quality of life in a large population-based sample: the SCAPIS project2024In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649Article in journal (Refereed)
    Abstract [en]

    Purpose To monitor cardiovascular health, in 2022, the American Heart Association (AHA) updated the construct “Life’s Simple 7” (LS7) to “Life’s Essential 8” (LE8). This study aims to analyze the associations and capacity of discrimination of LE8 and LS7 in relation to self-rated health (SRH) and health-related quality of life (HRQoL). 

    Methods This study from the Swedish CArdioPulmonary bioImage Study (SCAPIS) included 28 731 Swedish participants, aged 50–64 years. Three diferent scores were derived from the SF-12 questionnaire: 1-item question SRH (“In general, would you say your health is …?”), mental-HRQoL and physical-HRQoL. Logistic regression, restricted cubic splines, and ROC analysis were used to study the associations between the AHA scores in relation to SRH and HRQoL. 

    Results Compared to those with a LE8 score of 80, participants with a LE8 score of 40 were 14.8 times more likely to report poor SRH (OR: 14.8, 95% CI: 13.0–17.0), after adjustments. Moreover, they were more likely to report a poor mental-HRQoL (OR: 4.9, 95% CI: 4.2–5.6) and a poor physical-HRQoL (OR: 8.0, 95% CI: 7.0–9.3). Area under curves for discriminating poor SRH were 0.696 (95% CI: 0.687–0.704), 0.666 (95% CI: 0.657–0.674), and 0.643 (95% CI: 0.634–0.651) for LE8, LS7 (0–14), and LS7 (0–7), respectively, all p values <0.001 in the DeLong’s tests.

    Conclusion LE8 and LS7 had strong and inverse associations with SRH, mental-HRQoL, and physical-HRQoL, though LE8 had a somewhat higher capacity of discrimination than LS7. The novel LE8, a construct initially conceived to monitor cardiovascular health, also conveys SRH and HRQoL.

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  • 21.
    Herraiz-Adillo, Ángel
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Higueras-Fresnillo, Sara
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain.
    Ahlqvist, Viktor H.
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Berglind, Daniel
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Region Stockholm, SE-10431, Stockholm, Sweden .
    Syrjälä, Maria B.
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
    Daka, Bledar
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lenander, Cecilia
    Department for Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Lund, Sweden.
    Sundström, Johan
    Clinical Epidemiology Unit, Department of Medical Sciences, Uppsala University, Sweden; The George Institute for Global Health, University of New South Wales, Sydney, Australia .
    Ortega, Francisco B.
    Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Granada, Spain.
    Östgren, Carl Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Primary Care Center, Primary Health Care Center Ekholmen.
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna. The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Henriksson, Pontus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Life’s Essential 8 and Life’s Simple 7 in Relation to Coronary Atherosclerosis: Results From the Population-Based SCAPIS Project2024In: Mayo Clinic proceedings, ISSN 0025-6196, E-ISSN 1942-5546, Vol. 99, no 1, p. 69-80Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the associations between the AmericanHeart Association scores (“Life’s Essential 8” [LE8] and “Life’s Simple 7” [LS7])and 2 subclinical coronary atherosclerosis indicators: coronary computed tomographic angiography (CCTA)-stenosis and coronary artery calcium (CAC).

    Patients and Methods:We includedapopulation-basedsample, aged 50 to 64 years, recruited between 2013 and 2018 from the Swedish Cardiopulmonary Bioimage Study (n¼24,819,50.3%women). CCTA-stenosis was graded as no stenosis, stenosis (1%-49%) or severe stenosis ( 50%), whereas CAC was graded as 0,1 to 99, 100 to 399, or 400 Agatston units. Multinomial logistic regression and receiver operating characteristic (ROC) curves were used to study the associations between cardiovascular health scores and subclinical coronary atherosclerosis.

    Results: Odds ratios (ORs) for CCTA-stenosis and severe CCTA-stenosis between the lowest (<50 points) vs the highest ( 80points) LE8 group were 4.18 (95% CI,3.56 to 4.91) and 11.17 (95% CI, 8.36 to 14.93), respectively. For corresponding CAC results, ORs were 3.36 (95% CI, 2.84 to 3.98), 7.72 (95% CI, 6.03 to 9.89), and 14.94 (95%CI, 10.47 to 21.31) for CAC scores of 1 to 99, 100 to 399, and 400, respectively. Area under ROC curves for predicting anystenosis were 0.642 (95% CI, 0.635 to 0.649) and 0.631 (95% CI, 0.624 to 0.638, P<.001) for LE8 and LS7, respectively.

    Conclusion: Our data indicate that LE8 showed a strong, graded, and inverse association with CCTA-stenosis and CAC score. The capacity to predict CCTA-stenosis was comparable between LE8 and LS7, although LE8 had slightly higher prediction capacity of any stenosis. This study provides novel evidence that the LE8 score may be a useful tool for monitoring cardiovascular health.

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  • 22.
    Higueras-Fresnillo, Sara
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Herraiz-Adillo, Ángel
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Ahlqvist, Viktor H.
    Karolinska Inst, Sweden.
    Berglind, Daniel
    Karolinska Inst, Sweden; Ctr Epidemiol & Community Med, Sweden.
    Lenander, Cecilia
    Lund Univ, Sweden.
    Daka, Bledar
    Univ Gothenburg, Sweden.
    Syrjälä, Maria Brännholm
    Umea Univ, Sweden.
    Sundström, Johan
    Uppsala Univ, Sweden; Univ New South Wales, Australia.
    Östgren, Carl Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ekholmen. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna. Univ New South Wales, Australia.
    Henriksson, Pontus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Low prevalence of ideal cardiovascular health in the general Swedish population: Results from the Swedish CArdioPulmonary bioImage Study (SCAPIS)2023In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 51, no 4, p. 527-530Article in journal (Refereed)
    Abstract [en]

    The aim of the current study was to examine the prevalence of ideal cardiovascular health (iCVH) in the general Swedish middle-aged population. To address this aim, we utilised data from the Swedish CArdioPulmonary bioImage Study (SCAPIS) which is a large Swedish population-based study (N=30,154) that combined comprehensive state-of-the-art imaging technology with clinical examinations and included all iCVH components. A total iCVH score was calculated as the number of iCVH metrics at an ideal level for the seven components and classified as: ideal (&gt; 5 ideal components), intermediate (3-4 ideal components) and poor (&lt;= 2 ideal components). Our results showed that only 18.2% of the population reached ideal status (i.e. &gt; 5 components at the ideal level), whereas 51.9% were classified as intermediate status and 29.9% as poor status of iCVH. Women had a higher prevalence of iCVH status (23.9% vs. 12.0%) and a lower prevalence of poor iCVH status (23.5% vs. 36.8%). Our data may serve as benchmarks for future national and international comparisons and motivate efforts to promote cardiovascular health in the general population, given the strong link between iCVH with all-cause and cardiovascular disease mortality and morbidity.

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  • 23.
    Holmbom, Martin
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Andersson, Maria
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Berg, Sören
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Eklund, Dan
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Sobczynski, Pernilla
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Wilhelms, Daniel
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Emergency Medicine in Linköping.
    Moberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Fredrikson, Mats
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences, Forum Östergötland.
    Balkhed Östholm, Åse
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Hanberger, Håkan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Prehospital delay is an important risk factor for mortality in community-acquired bloodstream infection (CA-BSI): a matched case–control study2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 11, article id e052582Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of this study was to identify prehospital and early hospital risk factors associated with 30-day mortality in patients with blood culture-confirmed community-acquired bloodstream infection (CA-BSI) in Sweden.

    Methods A retrospective case–control study of 1624 patients with CA-BSI (2015–2016), 195 non-survivors satisfying the inclusion criteria were matched 1:1 with 195 survivors for age, gender and microorganism. All forms of contact with a healthcare provider for symptoms of infection within 7 days prior CA-BSI episode were registered. Logistic regression was used to analyse risk factors for 30-day all-cause mortality.

    Results Of the 390 patients, 61% (115 non-survivors and 121 survivors) sought prehospital contact. The median time from first prehospital contact till hospital admission was 13 hours (6–52) for non-survivors and 7 hours (3–24) for survivors (p&amp;lt;0.01). Several risk factors for 30-day all-cause mortality were identified: prehospital delay OR=1.26 (95% CI: 1.07 to 1.47), p&amp;lt;0.01; severity of illness (Sequential Organ Failure Assessment score) OR=1.60 (95% CI: 1.40 to 1.83), p&amp;lt;0.01; comorbidity score (updated Charlson Index) OR=1.13 (95% CI: 1.05 to 1.22), p&amp;lt;0.01 and inadequate empirical antimicrobial therapy OR=3.92 (95% CI: 1.64 to 9.33), p&amp;lt;0.01. In a multivariable model, prehospital delay &amp;gt;24 hours from first contact remained an important risk factor for 30-day all-cause mortality due to CA-BSI OR=6.17 (95% CI: 2.19 to 17.38), p&amp;lt;0.01.

    Conclusion Prehospital delay and inappropriate empirical antibiotic therapy were found to be important risk factors for 30-day all-cause mortality associated with CA-BSI. Increased awareness and earlier detection of BSI in prehospital and early hospital care is critical for rapid initiation of adequate management and antibiotic treatment.All data relevant to the study are included in the article or uploaded as supplemental information.

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  • 24.
    Karlsson, Elias
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Huebner, Inga-Marie
    Assoc Dermatol Prevent ADP, Germany.
    Haluza, Daniela
    Med Univ Vienna, Austria.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Validation of SEPI in German-A German Translation of the Sun Exposure and Protection Index2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 17, article id 6172Article in journal (Refereed)
    Abstract [en]

    The Sun Exposure and Protection Index (SEPI) is a brief instrument for scoring of sun exposure habits and propensity to increase sun protection, previously validated in English and in Swedish, as well as in two different outdoor sun intensity environments (Australia and Northern Europe). The aim of the present study was to study reliability and validity of a German translated version of the SEPI to be used in German-speaking populations. Data was collected at University of Flensburg and at Hamburg University of Applied Sciences from November 2018 to April 2019. Participants (n = 205) filled out the SEPI and also a selection of corresponding questions from the Austrian Vienna UV Questionnaire in German. After three weeks, the participants filled out the SEPI once again in order to assess test-retest stability. Of the 205 participants completing the baseline questionnaire, 135 participants completed it once again after three weeks. Internal consistency, by Cronbachs alpha, for the baseline responses was 0.70 (95% C.I: 0.63-0.76) for SEPI part 1 (sun exposure habits) and 0.72 (95% C.I: 0.66-0.78) for part 2 (propensity to increase sun protection). Test-retest stability was high, with weighted Kappa &gt;0.6 for all items but one, and the instrument correlated well with the previously validated German-language UV Skin Risk Survey Questionnaire. In conclusion, the German version of SEPI can reliably be used for mapping of individual sun exposure patterns.

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  • 25.
    Karlsson, Karin
    et al.
    Uppsala Univ, Sweden.
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna. Univ New South Wales, Australia.
    Dunford, Elizabeth
    Univ New South Wales, Australia; Univ N Carolina, NC USA.
    Wu, Jason H. Y.
    Univ New South Wales, Australia; Univ New South Wales, Australia.
    Neal, Bruce
    Univ New South Wales, Australia.
    Sundstrom, Johan
    Uppsala Univ, Sweden; Univ New South Wales, Australia.
    Sodium content in processed food items in Sweden compared to other countries: a cross-sectional multinational study2023In: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, article id 1182132Article in journal (Refereed)
    Abstract [en]

    BackgroundDietary sodium has a dose-response relationship with cardiovascular disease, and sodium intake in Sweden exceeds national and international recommendations. Two thirds of dietary sodium intake comes from processed foods, and adults in Sweden eat more processed foods than any other European country. We hypothesized that sodium content in processed foods is higher in Sweden than in other countries. The aim of this study was to investigate sodium content in processed food items in Sweden, and how it differs from Australia, France, Hong Kong, South Africa, the United Kingdom and the United States. MethodsData were collected from retailers by trained research staff using standardized methods. Data were categorized into 10 food categories and compared using Kruskal-Wallis test of ranks. Sodium content in the food items was compared in mg sodium per 100 g of product, based on the nutritional content labels on the packages. ResultsCompared to other countries, Sweden had among the highest sodium content in the "dairy" and "convenience foods" categories, but among the lowest in "cereal and grain products," "seafood and seafood products" and "snack foods" categories. Australia had the overall lowest sodium content, and the US the overall highest. The highest sodium content in most analyzed countries was found in the "meat and meat products" category. The highest median sodium content in any category was found among "sauces, dips, spreads and dressings" in Hong Kong. ConclusionThe sodium content differed substantially between countries in all food categories, although contrary to our hypothesis, processed foods overall had lower sodium content in Sweden than in most other included countries. Sodium content in processed food was nonetheless high also in Sweden, and especially so in increasingly consumed food categories, such as "convenience foods".

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  • 26.
    Kastbom, Lisa
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kisa.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Karlsson, Marit
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Närvårdskliniken. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology.
    Tengblad, Anders
    Primary Hlth Care Ctr Wetterhalsan, Sweden.
    Milberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Advanced Home Care in Norrköping.
    Prevalence, content and significance of advance care planning in nursing home patients2022In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 40, no 1, p. 29-38Article in journal (Refereed)
    Abstract [en]

    Objective Studies on advance care planning in nursing homes are rare, and despite their demonstrated favourable effects on end-of-life care, advance care plans are often lacking. Therefore, we wished to explore: (i) the prevalence of advance care plans in a Swedish nursing home setting using two different definitions, (ii) the content of advance care plans, (iii) adherence to the content of care plans and (iv) possible associations between the presence of advance care planning and background characteristics, physician attendance and end-of-life care. Design Retrospective chart review. Setting Twenty-two nursing homes in Sweden. Subjects A total of 367 deceased patients (included between 1 June 2018 and 23 May 2020) who had lived in nursing homes. Main outcome measures Electronic health record data on the prevalence of advance care plans with two different definitions and variables regarding background characteristics, physician attendance and end-of-life care, were collected. Results Of the study population, 97% had a limited care plan (ACP I) documented. When using the comprehensive definition (ACP II), also including patients preferences and involvement of family members in advance care planning, the prevalence was 77%. Patients with dementia more often had care plans, and a higher physician attendance was associated with presence of advance care plans. Prescription of palliative drugs and information to family members of the patients deterioration and impending death were more common in patients with care plans compared to those where such plans were missing. There was adherence to the care plan content. Conclusion In contrast to previous research, this study showed a high prevalence of advance care plans in nursing home patients. Patients with care plans more frequently received prescriptions of palliative drugs and their family members were informed to a greater extent about the patients deterioration and impending death compared to those without care plans. These aspects are often seen as vital components of good palliative care.

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  • 27.
    Kastbom, Lisa
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ljungsbro.
    Karlsson, Marit
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Närvårdskliniken.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Milberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Advanced Home Care in Norrköping.
    Elephant in the room-Family members perspectives on advance care planning2020In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 38, no 4, p. 421-429Article in journal (Refereed)
    Abstract [en]

    Objective To explore family members experiences of advance care planning in nursing homes. Design Individual interviews. Thematic analysis. Setting Four nursing homes in Sweden. Subjects Eighteen family members of deceased nursing home patients. Main outcome measures Family members experiences of advance care planning in nursing homes. Results Family members experiences of advance care planning in a nursing home context involved five themes: Elephant in the room, comprising end-of-life issues being difficult to talk about; Also silent understanding, e.g. patients preferences explicitly communicated, but also implicitly conveyed. In some cases family members had a sense of the patients wishes although preferences had not been communicated openly; Significance of small details, e.g. family members perceive everyday details as symbols of staff commitment; Invisible physician, supporting nurse, e.g. nurse being a gatekeeper, providing a first line assessment in the physicians absence; and Feeling of guilt, e.g. family members wish to participate in decisions regarding direction of care and treatment limits, and need guidance in the decisions. Conclusion Our study stresses the significance of staff involving the patient and family members in the advance care planning process in nursing homes, thereby adapting the care in line with patients wishes, and for the patient to share these preferences with family members. Education in communication related to the subject may be important to shape advance care planning.

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  • 28.
    Knipping, Sofie
    et al.
    Radboud Univ Nijmegen Med Ctr, Netherlands.
    Ter Haar, Elke
    Radboud Univ Nijmegen Med Ctr, Netherlands.
    Alkemade, Hans
    Canisius Wilhelmina Hosp, Netherlands.
    Bronkhorst, Ewald
    Radboud Univ Nijmegen Med Ctr, Netherlands.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Hueskes, Kevin
    Hlth Ctr Hazenkamp, Netherlands.
    Bijvank, Carla Nij
    Hlth Ctr Vuursteen, Netherlands.
    Spillekom-van Koulil, Saskia
    Radboud Univ Nijmegen Med Ctr, Netherlands.
    Lubeek, Satish
    Radboud Univ Nijmegen Med Ctr, Netherlands.
    Translation and Validation of the Dutch Version of the Sun Exposure and Protection Index (SEPI)2023In: Dermatology, ISSN 1018-8665, E-ISSN 1421-9832Article in journal (Refereed)
    Abstract [en]

    Introduction: Skin cancer is currently the most common cancer type worldwide, and numbers are rapidly increasing. To improve primary prevention, individualised prevention strategies may be of interest as this enhances the chance of long-term behavioural change. The Sun Exposure and Protection Index (SEPI), previously validated in multiple languages, is a tool that could help identify individuals with risky behaviour and tailor interventions to the persons propensity to change. The aim of the present study was to investigate the reliability and validity of a Dutch version of the SEPI for both usage in daily clinical practice and research. Methods: Patients were included at primary care settings and dermatology outpatient settings in a 1:1 ratio. Participants were asked to fill out the SEPI together with some baseline characteristics and the previously validated FACE-Q Skin Cancer - Sun Protection module. Construct validity was tested by comparing SEPI part I and the FACE-Q module using Spearmans Rho. Internal consistency was assessed with Cronbachs Alpha for both SEPI parts separately. To assess test-retest reliability, the SEPI was again filled out three weeks later, and scores were compared with Cohens weighted Kappa. Results: Of the 171 participants completing the first questionnaire, 147 (86.0%) participants also completed the follow-up questionnaire. Comparison between the corresponding SEPI part I and FACE-Q module questions showed good correlations regarding sun exposure habits (correlation coefficients ranging from 0.61 to 0.85). Internal consistency of SEPI part I was 0.63 and SEPI part II was 0.65. The test-retest analysis indicated reproducibility over time (weighted Kappa ranging from 0.38 to 0.76). Conclusion: In conclusion, the Dutch version of the SEPI is shown to be a valid and reliable tool for both usage in daily clinical practice and research to evaluate individual UV exposure and measure a persons propensity to limit it.

  • 29.
    Lappi, Veli-Matti
    et al.
    Karolinska Inst, Sweden.
    Mottas, Antoine
    Karolinska Inst, Sweden.
    Sundstroem, Johan
    Uppsala Univ, Sweden; Univ New South Wales, Australia.
    Neal, Bruce
    Univ New South Wales, Australia; Imperial Coll London, England.
    Löf, Marie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna. Univ New South Wales, Australia.
    A Comparison of the Nutritional Qualities of Supermarkets Own and Regular Brands of Bread in Sweden2020In: Nutrients, E-ISSN 2072-6643, NUTRIENTS, Vol. 12, no 4, article id 1162Article in journal (Refereed)
    Abstract [en]

    Processed food is associated with unhealthy qualities such as higher content of harmful fats, sugars and salt. The aim of our study was to compare the nutritional qualities of supermarkets own brands and regular brands of bread sold in Sweden. Additionally, we compared the nutritional qualities of gluten-free and gluten-containing bread. We collected information from the labels of 332 bread products available in the largest grocery store chains. The Australian Health Star Rating (HSR) system was used to quantify the nutritional quality of each bread product. We compared all supermarkets own brand products to regular brand products, and gluten-free to gluten-containing bread. The mean HSR for the supermarkets own brands was lower than the regular brands (3.6 vs. 3.7; p = 0.046). For the regular brand products, the fibre, sugar and total fat content were greater (p &lt; 0.001, p = 0.002 and p = 0.021, respectively), while less protein (p = 0.009) compared to regular bread products. Gluten-free bread had a lower HSR than gluten-containing bread (mean 3.5 vs. 3.8, respectively; p &lt; 0.001). The regular brand products were slightly healthier than the supermarkets own brands, primarily as a result of a higher fibre content. Gluten-free bread products were slightly unhealthier due to a lower protein content.

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  • 30.
    Lenander, Cecilia
    et al.
    Lunds universitet, Sweden.
    Myleus, Anna
    Umeå universitet, Sweden.
    Björkelund, Cecilia
    Göteborgs universitet, Sweden.
    Daka, Bledar
    Göteborgs universitet, Sweden.
    Hedin, Katarina
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine.
    Sundvall, Pär-Daniel
    Göteborgs universitet, Sweden.
    Östgren, Carl Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ekholmen.
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Tioårsuppföljning av Nationella forskarskolan i allmänmedicin: [120 Swedish PhD candidates in general practice have been admitted to the Swedish National Research School in General Practice during the first 10-year period]2022In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 119, article id 22022Article in journal (Refereed)
    Abstract [en]

    Since the start of the Swedish National Research School in General Practice, 120 Swedish PhD candidates in general practice have been admitted to the school, out of whom 89 during the first 10-year period. We have evaluated the academic achievements of the 53 (60%) PhD candidates that finished their thesis 2011-2020 by a questionnaire and bibliometric data collected from the Web of Science Core Collection. The questionnaire was answered by 52 (98%) and showed that 45 (87%) had continued with research work after their dissertation. Ten (19%) had done a post doc and four (8%) had become associate professors, out of whom one (2%) was a full professor. We found 519 peer-reviewed scientific publications authored by the alumni. The co-authors of these publications were affiliated all around the world, mainly in Sweden, followed by Australia and Germany. The National Research School will continue to strive towards increased quality of primary care research.

  • 31.
    Lyth, Johan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Falk, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna, Linköping.
    Maroti, M.
    County Hospital Ryhov, Sweden.
    Eriksson, H.
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Ingvar, C.
    Lund University, Sweden.
    Prognostic risk factors of first recurrence in patients with primary stages I-II cutaneous malignant melanoma - from the population-based Swedish melanoma register2017In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 31, no 9, p. 1468-1474Article in journal (Refereed)
    Abstract [en]

    Background Prognostic factors in patients with localized primary cutaneous malignant melanoma (CMM) are well described. However, prognostic factors for recurrence are less documented. Objectives The aim of this study was to identify prognostic risk factors for first recurrence in patients with localized stages I-II CMM using population-based data. Methods This study included 1437 CMM patients registered in one region of Sweden during 1999-2012 follow-up through 31 December 2012. To identify first recurrence of CMM disease, data from a care data warehouse, the pathology and radiology department registries were used. Patients were also followed through a census register and the national Cause of Death Register. Results The 5- and 10-year recurrence-free survival (RFS) were 85.7% and 81.2%, respectively. The most common site of first recurrence was regional lymph node metastasis closely followed by distant metastasis. After adjusting for all prognostic factors, women had 50% lower risk of recurrence than men (HR = 0.5, 95% CI 0.4-0.7) and patients = 70 had higher risk compared to patients 55-69 years (HR = 1.7, 95% CI 1.2-2.5). Other significant prognostic factors for risk of recurrence were tumour thickness, presence of ulceration, Clarks level of invasion and histogenetic type. Conclusion Tumour thickness was found to be the predominant risk factor for recurrence. The prognostic factors for recurrence coincided with prognostic factors for CMM death. The most common site of first recurrence in stages I-II CMM is regional lymph node (42.8%) closely followed by distant metastases (37.6%), a fact which has to be taken into consideration when choosing follow-up strategies.

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  • 32.
    Magnusson, Henrik
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Guorgis, Ghassan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Anderson, Chris D
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Dermatology and Venerology.
    Falk, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna, Linköping.
    Sustainable effect of individualised sun protection advice on sun protection behaviour: a 10-year follow-up of a randomised controlled study in primary care.2019In: BJGP open, ISSN 2398-3795, Vol. 3, no 3, article id bjgpopen19X101653Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In the light of increasing skin cancer incidences worldwide, preventive measures to promote sun protection in individuals with risky sun habits have continued relevance and importance.

    AIM: To report the long-term effect of individualised sun protection advice given in primary health care (PHC), on sun habits and sun protection behaviour.

    DESIGN & SETTING: In 2005, 309 PHC patients were enrolled in a randomised controlled study performed in a Swedish PHC setting.

    METHOD: At baseline, the study participants completed a Likert scale-based questionnaire, mapping sun habits, propensity to increase sun protection, and attitudes towards sun exposure, followed by randomisation into three intervention groups, all receiving individualised sun protection advice: in Group 1 (n = 116) by means of a letter, and in Group 2 (n = 97) and 3 (n = 96) communicated personally by a GP. In Group 3, participants also underwent a skin ultraviolet-sensitivity phototest, with adjusted sun protection advice based on the result. A repeated questionnaire was administered after 3 and 10 years.

    RESULTS: Statistically significant declines were observed in all groups for sun exposure mean scores over time. When using a cumulative score, according to the Sun Exposure and Protection Index (SEPI), significantly greater decrease in SEPI mean score was observed in Groups 2 and 3 (GP), compared to Group 1 (letter); P<0.01. The addition of a phototest did not enhance the effect of the intervention.

    CONCLUSION: Individualised sun protection advice mediated verbally by the GP can lead to sustained improvement of sun protective behaviour.

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  • 33. Order onlineBuy this publication >>
    Moberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Diagnosing pneumonia in primary care: Aspects of the value of clinical and laboratory findings and the use of chest X-ray2020Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    It is important to identify patients with pneumonia because it is potentially a serious disease, often of bacterial origin, that should be treated with antibiotics. It is equally important to identify those with acute bronchitis, a self-limiting disease, that should not be treated with antibiotics. Because bacterial resistance is increasing, over-prescribing of antibiotics should be avoided. However, it is sometimes difficult to differentiate between the two diagnoses, and guidelines concerning the assessment do not conform.  

    The general aim of this thesis was to investigate if diagnostics of pneumonia in primary care can be improved and whether this could contribute to reduced prescription of antibiotics.  

    As a first step, different anamnestic, clinical and laboratory findings and the doctor’s degree of suspicion of pneumonia in primary care were compared with chest X-ray (CXR) findings. The doctor’s degree of suspicion of pneumonia was shown to be a good predictor. When the physician was sure of the diagnosis, the likelihood for radiographic pneumonia was high and when quite sure, CXR was positive in less than half of the cases.  

    To further improve the diagnostics of pneumonia, and thus reduce antibiotic prescriptions, patients were referred for CXR when the physician was unsure or quite sure of a pneumonia diagnosis. The intervention did not result in any decrease in antibiotic prescriptions compared with a control group. However, it emerged that the physicians did not fully trust the CXR outcome, but prescribed antibiotics even when the results were negative.  

    To gain insight into the contribution of C-reactive protein (CRP) levels to the degree of suspicion, physicians were asked to estimate their degree of suspicion of pneumonia before and after CRP testing. CRP affected the degree of suspicion to a great extent, and most often resulted in a lowered degree of suspicion and thereby in the clinical decision of dismissing the diagnosis of pneumonia.  

    The use of different diagnostic tests and prescription of antibiotics in the assessment of acute bronchitis and pneumonia over time was evaluated in a register-based study. The study showed that the use of diagnostic tests for both diagnoses has increased, and that there has been a reduction in antibiotic prescriptions for acute bronchitis.  

    In conclusion, the doctor’s degree of suspicion of pneumonia seems to be a good predictor of the condition. When the physician is sure of the diagnosis, no further investigation is needed, and antibiotics can be prescribed on reliable grounds. CRP testing affects the degree of suspicion and is most valuable when unsure of the diagnosis where it can be helpful to exclude pneumonia. In contrast, more extensive use of CXR does not contribute to a decrease in antibiotic prescriptions in the diagnostics of pneumonia.

    List of papers
    1. Community-acquired pneumonia in primary care: clinical assessment and the usability of chest radiography
    Open this publication in new window or tab >>Community-acquired pneumonia in primary care: clinical assessment and the usability of chest radiography
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    2016 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 34, no 1, p. 21-27Article in journal (Refereed) Published
    Abstract [en]

    Objectives: To investigate the diagnostic value of different clinical and laboratory findings in pneumonia and to explore the association between the doctors degree of suspicion and chest X-ray (CXR) result and to evaluate whether or not CXR should be used routinely in primary care, when available. Design: A three-year prospective study was conducted between September 2011 and December 2014. Setting: Two primary care settings in Linkoping, Sweden. Subjects: A total of 103 adult patients with suspected pneumonia in primary care. Main outcome measures: The physicians recorded results of a standardized medical physical examination, including laboratory results, and rated their suspicion into three degrees. The outcome of the diagnostic variables and the degree of suspicion was compared with the result of CXR. Results: Radiographic pneumonia was reported in 45% of patients. When the physicians were sure of the diagnosis radiographic pneumonia was found in 88% of cases (p&lt;0.001), when quite sure the frequency of positive CXR was 45%, and when not sure 28%. Elevated levels of C-reactive protein (CRP)50mg/L were associated with the presence of radiographic pneumonia when the diagnosis was suspected (p&lt;0.001). Conclusion: This study indicates that CXR can be useful if the physician is not sure of the diagnosis, but when sure one can rely on ones judgement without ordering CXR.

    Place, publisher, year, edition, pages
    TAYLOR & FRANCIS LTD, 2016
    Keywords
    Chest radiography; clinical assessment; community-acquired pneumonia; C-reactive protein; general practice; primary care; Sweden
    National Category
    Basic Medicine
    Identifiers
    urn:nbn:se:liu:diva-127062 (URN)10.3109/02813432.2015.1132889 (DOI)000372023200005 ()26849394 (PubMedID)
    Note

    Funding Agencies|County Council of ostergotland

    Available from: 2016-04-13 Created: 2016-04-13 Last updated: 2020-10-02
    2. Use of chest X-ray in the assessment of community acquired pneumonia in primary care - an intervention study
    Open this publication in new window or tab >>Use of chest X-ray in the assessment of community acquired pneumonia in primary care - an intervention study
    Show others...
    2020 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 38, no 3, p. 323-329Article in journal (Refereed) Published
    Abstract [en]

    Objectives The aim of this study was to explore if consequent use of chest X-ray (CXR), when the physician is not sure of the diagnosis of pneumonia after clinical examination and CRP-testing, favors a more restrictive prescribing of antibiotics. Design This was an intervention study conducted between September 2015 and December 2017. Setting Two intervention primary health care centers (PHCCs) and three control PHCCs in the southeast of Sweden. Intervention All patients were referred for CXR when the physician s suspicion of pneumonia was unsure, or quite sure after CRP-testing. Control units managed patients according to their usual routine after clinical examination and CRP-testing. Subjects A total of 104 patients were included in the intervention group and 81 patients in the control group. The inclusion criteria of the study were clinically suspected pneumonia in patients &gt;= 18 years, with respiratory symptoms for more than 24 h. Main outcome measure:Antibiotic prescribing rate. Results In the intervention group, 85% were referred for CXR and 69% were prescribed antibiotics, as compared to 26% and 77% in the control group. The difference in antibiotic prescribing rate was not statistically significant, unadjusted OR 0.68 [0.35-1.3] and adjusted OR 1.1 [CI 0.43-3.0]. A total of 24% of patients with negative CXR were prescribed antibiotics. Conclusion This study could not prove that use of CXR when the physician was not sure of the diagnosis of pneumonia results in lowered antibiotic prescribing rate in primary care. In cases of negative findings on CXR the physicians do not seem to rely on the outcome when it comes to antibiotic prescribing.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2020
    Keywords
    Family practice; pneumonia; chest X-ray; antibiotics; general practice; intervention; primary care
    National Category
    General Practice
    Identifiers
    urn:nbn:se:liu:diva-168549 (URN)10.1080/02813432.2020.1794404 (DOI)000551614000001 ()32705941 (PubMedID)2-s2.0-85088535684 (Scopus ID)
    Available from: 2020-08-26 Created: 2020-08-26 Last updated: 2021-05-04Bibliographically approved
    3. Change in the use of diagnostic tests in the management of lower respiratory tract infections: a register-based study in primary care
    Open this publication in new window or tab >>Change in the use of diagnostic tests in the management of lower respiratory tract infections: a register-based study in primary care
    2020 (English)In: BJGP Open, ISSN 2398-3795, Vol. 4, no 1Article in journal (Refereed) Published
    Abstract [en]

    Background Differentiating between pneumonia and acute bronchitis is often difficult in primary care. There is no consensus regarding clinical decision rules for pneumonia, and guidelines differ between countries. Use of diagnostic tests and change of management over time is not known.

    Aim To calculate the proportion of diagnostic tests in the management of lower respiratory tract infections (LRTIs) in a low antibiotic prescribing country, and to evaluate if the use and prescription pattern has changed over time.

    Design & setting A register-based study on data from electronic health records from January 2006 to December 2014 in the Kronoberg county of south east Sweden.

    Method Data regarding use of C-reactive protein (CRP), chest x-rays (CXRs), microbiological tests, and antibiotic prescriptions were assessed for patients aged 18–79 years, with the diagnosis pneumonia, acute bronchitis, or cough.

    Results A total of 54 229 sickness episodes were analysed. Use of CRP increased during the study period from 61.3% to 77.5% for patients with pneumonia (P<0.001), and from 53.4% to 65.7% for patients with acute bronchitis (P<0.001). Use of CXR increased for patients with acute bronchitis from 3.1% to 5.1% (P<0.001). Use of microbiological tests increased for patients with pneumonia, from 1.8% to 5.1% (P<0.001). The antibiotic prescription rate decreased from 18.6 to 8.2 per 1000 inhabitants per year for patients with acute bronchitis, but did not change for patients with pneumonia.

    Conclusion Use of CRP and microbiological tests in the diagnostics of LRTIs increased despite the fact that the incidence of pneumonia and acute bronchitis was stable.

    Place, publisher, year, edition, pages
    London, United Kingdom: Royal College of General Practitioners, 2020
    Keywords
    community-acquired pneumonia, Primary care, management, C-reactive protein, chest X-ray, antibiotics, anti-bacterial agents
    National Category
    Infectious Medicine
    Identifiers
    urn:nbn:se:liu:diva-170219 (URN)10.3399/bjgpopen20X101015 (DOI)2-s2.0-85087083720 (Scopus ID)
    Note

    Forskningsfinansiär: Medical Research Council of Southeast Sweden (reference number: FORSS-931097)

    Available from: 2020-10-02 Created: 2020-10-02 Last updated: 2020-10-20Bibliographically approved
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  • 34.
    Moberg, Anna
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna, Linköping.
    Cronberg, Olof
    Växjöhälsan Primary Healthcare Center and Department of Research and Development, Region Kronoberg, Växjö, Sweden; Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden .
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna, Linköping.
    Hedin, Katarina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department of Clinical Sciences Malmö, Family Medicine, Lund University, Malmö, Sweden; GP, Futurum, Region Jönköping County .
    Change in the use of diagnostic tests in the management of lower respiratory tract infections: a register-based study in primary care2020In: BJGP Open, ISSN 2398-3795, Vol. 4, no 1Article in journal (Refereed)
    Abstract [en]

    Background Differentiating between pneumonia and acute bronchitis is often difficult in primary care. There is no consensus regarding clinical decision rules for pneumonia, and guidelines differ between countries. Use of diagnostic tests and change of management over time is not known.

    Aim To calculate the proportion of diagnostic tests in the management of lower respiratory tract infections (LRTIs) in a low antibiotic prescribing country, and to evaluate if the use and prescription pattern has changed over time.

    Design & setting A register-based study on data from electronic health records from January 2006 to December 2014 in the Kronoberg county of south east Sweden.

    Method Data regarding use of C-reactive protein (CRP), chest x-rays (CXRs), microbiological tests, and antibiotic prescriptions were assessed for patients aged 18–79 years, with the diagnosis pneumonia, acute bronchitis, or cough.

    Results A total of 54 229 sickness episodes were analysed. Use of CRP increased during the study period from 61.3% to 77.5% for patients with pneumonia (P<0.001), and from 53.4% to 65.7% for patients with acute bronchitis (P<0.001). Use of CXR increased for patients with acute bronchitis from 3.1% to 5.1% (P<0.001). Use of microbiological tests increased for patients with pneumonia, from 1.8% to 5.1% (P<0.001). The antibiotic prescription rate decreased from 18.6 to 8.2 per 1000 inhabitants per year for patients with acute bronchitis, but did not change for patients with pneumonia.

    Conclusion Use of CRP and microbiological tests in the diagnostics of LRTIs increased despite the fact that the incidence of pneumonia and acute bronchitis was stable.

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  • 35.
    Moberg, Anna
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Kling, Moa
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kungsgatan.
    Paues, Jakob
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Fransson, Sven Göran
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Use of chest X-ray in the assessment of community acquired pneumonia in primary care - an intervention study2020In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 38, no 3, p. 323-329Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of this study was to explore if consequent use of chest X-ray (CXR), when the physician is not sure of the diagnosis of pneumonia after clinical examination and CRP-testing, favors a more restrictive prescribing of antibiotics. Design This was an intervention study conducted between September 2015 and December 2017. Setting Two intervention primary health care centers (PHCCs) and three control PHCCs in the southeast of Sweden. Intervention All patients were referred for CXR when the physician s suspicion of pneumonia was unsure, or quite sure after CRP-testing. Control units managed patients according to their usual routine after clinical examination and CRP-testing. Subjects A total of 104 patients were included in the intervention group and 81 patients in the control group. The inclusion criteria of the study were clinically suspected pneumonia in patients &gt;= 18 years, with respiratory symptoms for more than 24 h. Main outcome measure:Antibiotic prescribing rate. Results In the intervention group, 85% were referred for CXR and 69% were prescribed antibiotics, as compared to 26% and 77% in the control group. The difference in antibiotic prescribing rate was not statistically significant, unadjusted OR 0.68 [0.35-1.3] and adjusted OR 1.1 [CI 0.43-3.0]. A total of 24% of patients with negative CXR were prescribed antibiotics. Conclusion This study could not prove that use of CXR when the physician was not sure of the diagnosis of pneumonia results in lowered antibiotic prescribing rate in primary care. In cases of negative findings on CXR the physicians do not seem to rely on the outcome when it comes to antibiotic prescribing.

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  • 36.
    Moberg, Anna
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Ravell Jensen, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kungsgatan.
    Paues, Jakob
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    C-reactive protein influences the doctors degree of suspicion of pneumonia in primary care: a prospective observational study2020In: European Journal of General Practice, ISSN 1381-4788, E-ISSN 1751-1402, Vol. 26, no 1, p. 210-216Article in journal (Refereed)
    Abstract [en]

    Background In primary care, the diagnosis of pneumonia is often based on history and clinical examination alone. However, a previous study showed that the general practitioners degree of suspicion correlates well with findings on chest X-ray, when the C-reactive protein (CRP) value is known. Objectives The present study aimed to investigate to what extent the physicians degree of suspicion is affected by the CRP level when community-acquired pneumonia is suspected in primary care. Methods A prospective observational study was conducted at five primary health care centres in Sweden between October 2015 and December 2017. Adult patients (n = 266) consulting their health care centre with symptoms of lower respiratory tract infection, where the physician suspected pneumonia, were included consecutively. Anamnestic information and findings from clinical examination were documented in a case report form. All patients were tested for CRP. The physicians rated their degree of suspicion as unsure, quite sure, and sure before and after the CRP result. Results The degree of suspicion of pneumonia changed in 69% of the cases; most often to a lower degree (40%). In 28% of the cases, there was no longer any suspicion of pneumonia after CRP. Conclusion Our results indicate that CRP testing highly influences the physicians degree of suspicion of pneumonia in primary care and that it seems to be of most value when not sure of the diagnosis.

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  • 37.
    Mottas, Antoine
    et al.
    Karolinska Inst, Sweden.
    Lappi, Veli-Matti
    Karolinska Inst, Sweden.
    Sundström, Johan
    Uppsala Univ, Sweden; Univ New South Wales, Australia.
    Neal, Bruce
    Univ New South Wales, Australia; Imperial Coll London, England.
    Mhurchu, Cliona Ni
    Univ New South Wales, Australia; Univ Auckland, New Zealand.
    Löf, Marie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna. Univ New South Wales, Australia.
    Measuring the Healthiness of Ready-to-Eat Child-Targeted Cereals: Evaluation of the FoodSwitch Platform in Sweden2021In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 9, no 7, article id e17780Article in journal (Refereed)
    Abstract [en]

    Background: Childhood obesity is a major public health issue. The increase in the consumption of foods with poor nutritional value, such as processed foods, contributes to this. Breakfast cereals are often advertised as a healthy way to start the day, but the healthiness of these products varies greatly. Objective: Our main objective was to gather information about the nutritional characteristics of ready-to-eat breakfast cereals in Sweden and to investigate the healthiness of products targeted at children compared to other cereals by use of the FoodSwitch platform. A secondary objective was to evaluate the alignment between the Keyhole symbol and the Health Star Rating. Methods: The FoodSwitch app is a mobile health (mHealth) tool used to present nutrition data and healthier alternative products to consumers. Ready-to-eat breakfast cereals from the largest Swedish grocery retailers were collected using the FoodSwitch platform. Products were defined as targeting children if they presented features addressing children on the package. Results: Overall, information on 261 ready-to-eat cereals was examined. Of this total, 8% (n=21) were targeted at children. Child-targeted cereals were higher in sugar (22.3 g/100 g vs 12.8 g/100 g, P&lt;.001) and lower in fiber (6.2 g/100 g vs 9.8 g/100 g, P&lt;.001) and protein (8.1 g/100 g vs 10.5 g/100 g, P&lt;.001). Total fat (3 g/100 g vs 10.5 g/100 g, P&lt;.001) and saturated fat (0.8 g/100 g vs 2.6 g/100 g, P&lt;.001) were also lower. No difference was found in salt content (P=.61). Fewer child-targeted breakfast cereals displayed an on-pack Keyhole label (n=1, 5% vs n=53, 22%; P=.06), and the mean Health Star Rating value was 3.5 for child-targeted cereals compared to others (mean 3.8, P=.07). A correlation was found between the Keyhole symbol and the Health Star Rating. Conclusions: Ready-to-eat breakfast cereals targeted at children were less healthy in terms of sugar and fiber content compared to products not targeted at children. There is a need to improve the nutritional quality of child-targeted cereals.

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  • 38.
    Nasr, Patrik
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Mag- tarmmedicinska kliniken.
    Iredahl, Fredrik
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Åby.
    Dahlström, Nils
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Henriksson, Pontus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Cedersund, Gunnar
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Dahlqvist Leinhard, Olof
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). AMRA Med AB, Linkoping, Sweden.
    Ebbers, Tino
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Alfredsson, Joakim
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Region Östergötland, Heart Center, Department of Cardiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Carlhäll, Carljohan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Lundberg, Peter
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Medical radiation physics. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Kechagias, Stergios
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Mag- tarmmedicinska kliniken.
    Ekstedt, Mattias
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Mag- tarmmedicinska kliniken. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Evaluating the prevalence and severity of NAFLD in primary care: the EPSONIP study protocol2021In: BMC Gastroenterology, ISSN 1471-230X, E-ISSN 1471-230X, Vol. 21, no 1, article id 180Article in journal (Refereed)
    Abstract [en]

    BackgroundNon-alcoholic fatty liver disease (NAFLD) affects 20-30% of the general adult population. NAFLD patients with type 2 diabetes mellitus (T2DM) are at an increased risk of advanced fibrosis, which puts them at risk of cardiovascular complications, hepatocellular carcinoma, or liver failure. Liver biopsy is the gold standard for assessing hepatic fibrosis. However, its utility is inherently limited. Consequently, the prevalence and characteristics of T2DM patients with advanced fibrosis are unknown. Therefore, the purpose of the current study is to evaluate the prevalence and severity of NAFLD in patients with T2DM by recruiting participants from primary care, using the latest imaging modalities, to collect a cohort of well phenotyped patients.MethodsWe will prospectively recruit 400 patients with T2DM using biomarkers to assess their status. Specifically, we will evaluate liver fat content using magnetic resonance imaging (MRI); hepatic fibrosis using MR elastography and vibration-controlled transient elastography; muscle composition and body fat distribution using water-fat separated whole body MRI; and cardiac function, structure, and tissue characteristics, using cardiovascular MRI.DiscussionWe expect that the study will uncover potential mechanisms of advanced hepatic fibrosis in NAFLD and T2DM and equip the clinician with better diagnostic tools for the care of T2DM patients with NAFLD.Trial registration: Clinicaltrials.gov, identifier NCT03864510. Registered 6 March 2019, https://clinicaltrials.gov/ct2/show/NCT03864510.

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  • 39.
    Norlin, Anna-Karin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ekholmen, Linköping.
    Olsen Faresjö, Åshild
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Falk, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna, Linköping.
    Jones, Michael P.
    Macquarie Univ, Australia.
    Walter, Susanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Gastroentorology.
    Primary healthcare utilisation and self-rated health among patients with Irritable Bowel Syndrome: What are the impacts of comorbidities, gastrointestinal symptom burden, sense of coherence and stress?2019In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 119Article in journal (Refereed)
    Abstract [en]

    Objectives: Irritable Bowel Syndrome (IBS) is a chronic gastrointestinal disease associated with impaired quality of life and an increased use of healthcare services. Self-ratings of health have proven a powerful predictor of health outcomes. The aim of this study was to evaluate the unique impacts of comorbidities, gastrointestinal symptoms, perceived stress and sense of coherence on the number of healthcare contacts and self-rated health of IBS patients in Swedish primary care. Methods: In this cross-sectional study, 186 primary-care IBS patients and 360 non-IBS patients (as a reference group) were administrated a test battery of validated questionnaires. Data on comorbidities and healthcare-seeking frequency were obtained from a registry. Results: In the reduced multivariable logistic regression model, average days of abdominal pain/week (OR = 0.83, 95% CI = 0.72-0.96), age (OR = 0.95, 95% CI = 0.92-0.97) and sense of coherence (OR = 1.07, 95% CI = 1.03-1.11) remained independent, statistically significant predictors of IBS (and non-IBS) patients reporting good health. Only the number of comorbidities in general (OR = 1.22, 95% CI = 1.14-1.32) and sleep disorders in particular (OR = 5.40, 95% CI = 1.85-15.76) independently predicted high levels of primary healthcare utilisation among IBS patients. Conclusion: Lack of gastrointestinal symptoms, a high sense of coherence and younger age were associated with better self-rated health in both IBS and non-IBS patients. The number of comorbidities in general and sleep disorders in particular were associated with frequent PHC contacts in IBS patients. The association between frequent primary-care contacts and sleep disorders was not seen in the control group, indicating a unique association with IBS patients.

  • 40.
    Rendek, Zlatica
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Grodzinsky, Ewa
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Kechagias, Stergios
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Mag- tarmmedicinska kliniken.
    Hjortswang, Henrik
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Mag- tarmmedicinska kliniken.
    Diagnostic value of fecal calprotectin in primary care patients with gastrointestinal symptoms: A retrospective Swedish cohort study2023In: JGH OPEN, ISSN 2397-9070Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate the diagnostic accuracy of fecal calprotectin (FC) for inflammatory bowel disease (IBD) and organic gastrointestinal disease (OGID) in primary care. To examine the association with demographic factors, symptoms and concomitant medical therapy.Methods: A retrospective analysis of data on all semiquantitative FC tests from individuals =18 years conducted in primary care in ostergotland County in 2010. A 5-year follow-up with inclusion of new gastrointestinal diagnoses.Results: A total of 1293 eligible patients were included. IBD was found in 8.8% and other OGID in 30.8% of patients with positive FC. Positive FC was associated with diarrhea, age &gt;60 years, duration &lt;3 months, use of nonsteroidal anti-inflammatory drug (NSAID), and proton pump inhibitor (PPI). Predictors of IBD were positive FC, diarrhea, rectal bleeding, and male sex; predictors of OGID positive FC, age &gt;35 years, abnormal clinical findings, and duration &lt;3 months. FC yielded the highest sensitivity and negative predictive value compared with demographic factors, symptoms, and duration. Use of NSAID and PPI showed a marginal increase in the sensitivity, positive predictive value, and decrease in the specificity of FC. Within 5 years, 4.0% had a new gastrointestinal diagnosis among patients with positive FC (0.6% IBD).Conclusions: FC reliably rules out IBD and contradicts the presence of other OGID in primary care patients. Positive FC test together with other predictors, such as diarrhea, rectal bleeding, short duration, or age &gt;35 years, should encourage a prioritized investigation. Use of NSAID, PPI, and ASA may affect the diagnostic accuracy of FC for IBD and OGID.

  • 41.
    Rendek, Zlatica
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Grodzinsky, Ewa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences.
    Kechagias, Stergios
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Mag- tarmmedicinska kliniken.
    Hjortswang, Henrik
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Mag- tarmmedicinska kliniken.
    Oral omeprazole and diclofenac intake is associated with increased faecal calprotectin levels: a randomised open-label clinical trial2023In: European Journal of Gastroenterology and Hepathology, ISSN 0954-691X, E-ISSN 1473-5687, Vol. 35, no 1, p. 52-58Article in journal (Refereed)
    Abstract [en]

    Background and aimNonsteroidal anti-inflammatory drugs and proton pump inhibitors are known to affect the diagnostics of gastrointestinal disorders. The aim of this study was to investigate to what extent omeprazole, diclofenac or co-administration of these affects faecal calprotectin levels and the normalisation interval after cessation. MethodsParticipants received 20 mg omeprazole daily for 2 weeks in the first sequence, 50 mg oral diclofenac three times daily for 2 weeks in the second and co-administration of these for 2 weeks in the third, with washout periods in between. The first two sequences were randomised to a different order. Faecal calprotectin was measured on days 0, 4, 7, 14, 21, 28 and 35 and thereafter at 7-day intervals until normalisation in each sequence. ResultsThirty-two healthy volunteers were included. During drug intake, 39% on diclofenac (median 70.8 mu g/g; range 50.2-1080 mu g/g), 53% on omeprazole (median 85.3 mu g/g; range 51.1-249 mu g/g) and 69% on omeprazole + diclofenac (median 101.5 mu g/g; range 51.5-532 mu g/g) had faecal calprotectin levels above normal. In the diclofenac sequence, faecal calprotectin returned to normal in all participants within 2 weeks of cessation and in the omeprazole and co-administration sequences, within 3 weeks of cessation. No statistical significant difference was found with respect to drug order. ConclusionShort-term intake of omeprazole, diclofenac or co-administration appears to increase faecal calprotectin levels. In patients with increased faecal calprotectin on omeprazole alone or in combination with diclofenac, a repeated faecal calprotectin test is recommended at least 3 weeks after cessation. On diclofenac alone, it is sufficient to repeat the faecal calprotectin test 2 weeks after cessation.

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  • 42.
    Rådholm, Karin
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna. The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
    af Geijerstam, Peder
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum.
    Woodward, Mark
    The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia ; School of Public Health, Imperial College London, London, United Kingdom.
    Chalmers, John
    The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
    Hellgren, Margareta
    Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden ; The Skaraborg Institute, Skövde, Sweden.
    Jansson, Stefan
    School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden ; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Rolandsson, Olov
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
    Dog ownership, glycaemic control and all-cause death in patients with newly diagnosed type 2 diabetes: a national cohort study2023In: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, article id 1265645Article in journal (Refereed)
    Abstract [en]

    Aims: To evaluate whether dog ownership from the time of type 2 diabetes diagnosis improved glycaemic control, increased achievement of major guideline treatment goals or reduced the risk of all-cause death.

    Methods: Patients diagnosed with type 2 diabetes were followed by linkage of four Swedish national registers covering diabetes, dog ownership, socioeconomics, and mortality. Linear regression was used to estimate the mean yearly change in glycated haemoglobin (HbA1c). Cox survival analysis and logistic regression were used to analyse associations between dog ownership and all-cause death and achievement of treatment goals, respectively.

    Results: Of 218,345 individuals included, 8,352 (3.8%) were dog-owners. Median follow-up was 5.2 years. Dog-owners had worse yearly change in HbA1c, and were less likely to reach HbA1c, low-density lipoprotein (LDL), and systolic blood pressure (SBP) treatment goals than non-dog-owners (adjusted odds ratios [95% CI] of 0.93 [0.88–0.97], 0.91 [0.86–0.95], and 0.95 [0.90–1.00], respectively). There was no difference in the risk of all-cause death (adjusted hazard ratio [95% CI] 0.92 [0.81–1.04], dog owners versus not).

    Conclusion: Owning a dog when diagnosed with diabetes did not lead to better achievement of treatment goals or reduced mortality, but was in fact associated with a smaller reduction in HbA1c and reduced likelihood of achieving treatment goals.

  • 43.
    Rådholm, Karin
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna. Univ New South Wales, Australia.
    Zhou, Zien
    Univ New South Wales, Australia; Shanghai Jiao Tong Univ, Peoples R China.
    Clemens, Kristin
    Western Univ, Canada; Western Univ, Canada; Lawson Hlth Res Inst, Canada.
    Neal, Bruce
    Univ New South Wales, Australia; Univ New South Wales, Australia; Imperial Coll London, England.
    Woodward, Mark
    Univ New South Wales, Australia; Univ Oxford, England; Johns Hopkins Univ, MD USA.
    Effects of sodium-glucose co-transporter-2 inhibitors in type 2 diabetes in women versus men2020In: Diabetes, obesity and metabolism, ISSN 1462-8902, E-ISSN 1463-1326, Vol. 22, no 2, p. 263-266Article in journal (Refereed)
    Abstract [en]

    Sodium-glucose co-transporter-2 (SGLT2) inhibitors prevent cardiovascular complications in type 2 diabetes. We aimed to study whether they have similar effects in women and men by summarizing the effects of SGLT2 inhibitors compared to placebo on vascular and safety outcomes stratified by sex. We included patients with type 2 diabetes enrolled in the EMPA-REG OUTCOME, CANVAS Program, DECLARE TIMI-58 and CREDENCE trials. There were no differences in the risk ratios between men and women, SGLT2 versus control (placebo), for vascular efficacy outcomes or death (all P for interaction amp;gt;=.12), with clear protection shown against major adverse cardiovascular events, heart failure, vascular death and total mortality. SGLT2 inhibitor treatment was also associated with similar relative risks in women and men for the safety outcomes of amputation, fracture, genital infection and urinary tract infection (all P for interaction amp;gt;=.17). SGLT2 inhibition provided similar protection against vascular risks and death, and similar risks of serious adverse events, for women and men.

  • 44.
    Syrjälä, M. B.
    et al.
    Umea Univ, Sweden.
    Bennet, L.
    Lund Univ, Sweden; Reg Skane, Sweden; Lund Univ, Sweden; Lund Univ Hosp, Sweden.
    Dempsey, P. C.
    Baker Heart & Diabet Inst, Australia; Univ Cambridge, England; Univ Leicester, England.
    Fharm, E.
    Umea Univ, Sweden.
    Hellgren, M.
    Skaraborg Inst, Sweden.
    Jansson, S.
    Orebro Univ, Sweden; Uppsala Univ, Sweden.
    Nilsson, S.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Nordendahl, M.
    Umea Univ, Sweden.
    Rolandsson, O.
    Umea Univ, Sweden.
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna. Univ New South Wales, Australia.
    Ugarph-Morawski, A.
    Reg Stockholm, Sweden; Karolinska Inst, Sweden.
    Wändell, P.
    Karolinska Inst, Sweden.
    Wennberg, P.
    Umea Univ, Sweden.
    Health effects of reduced occupational sedentary behaviour in type 2 diabetes using a mobile health intervention: a study protocol for a 12-month randomized controlled trial - the ROSEBUD study2022In: Trials, E-ISSN 1745-6215, Vol. 23, no 1, article id 607Article in journal (Refereed)
    Abstract [en]

    Background: Short-term trials conducted in adults with type 2 diabetes mellitus (T2DM) showed that reducing sedentary behaviour by performing regular short bouts of light-intensity physical activity enhances health. Moreover, support for reducing sedentary behaviour may be provided at a low cost via mobile health technology (mHealth). There are a wide range of mHealth solutions available including SMS text message reminders and activity trackers that monitor the physical activity level and notify the user of prolonged sitting periods. The aim of this study is to evaluate the effects of a mHealth intervention on sedentary behaviour and physical activity and the associated changes in health in adults with T2DM. Methods: A dual-arm, 12-month, randomized controlled trial (RCT) will be conducted within a nationwide Swedish collaboration for diabetes research in primary health care. Individuals with T2DM (n = 142) and mainly sedentary work will be recruited across primary health care centres in five regions in Sweden. Participants will be randomized (1:1) into two groups. A mHealth intervention group who will receive an activity tracker wristband (Garmin Vivofit4), regular SMS text message reminders, and counselling with a diabetes specialist nurse, or a comparator group who will receive counselling with a diabetes specialist nurse only. The primary outcomes are device-measured total sitting time and total number of steps (activPAL3). The secondary outcomes are fatigue, health-related quality of life and musculoskeletal problems (self-reported questionnaires), number of sick leave days (diaries), diabetes medications (clinical record review) and cardiometabolic biomarkers including waist circumference, mean blood pressure, HbA1c, HDL-cholesterol and triglycerides. Discussion: Successful interventions to increase physical activity among those with T2DM have been costly and long-term effectiveness remains uncertain. The use of mHealth technologies such as activity trackers and SMS text reminders may increase awareness of prolonged sedentary behaviour and encourage increase in regular physical activity. mHealth may, therefore, provide a valuable and novel tool to improve health outcomes and clinical management in those with T2DM. This 12-month RCT will evaluate longer-term effects of a mHealth intervention suitable for real-world primary health care settings.

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  • 45.
    Szalo, Gabor
    et al.
    Univ Gothenburg, Sweden.
    Hellgren, Margareta I.
    Univ Gothenburg, Sweden; Skaraborg Inst, Sweden.
    Allison, Matthew
    Univ Calif San Diego, CA USA.
    Li, Ying
    Univ Gothenburg, Sweden.
    Rastam, Lennart
    Lund Univ, Sweden.
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Bollano, Entela
    Sahlgrens Univ Hosp, Sweden.
    Duprez, Daniel A.
    Univ Minnesota, MN 55455 USA.
    Jacobs, David R.
    Univ Minnesota, MN USA.
    Lindblad, Ulf
    Univ Gothenburg, Sweden.
    Daka, Bledar
    Univ Gothenburg, Sweden.
    Impaired artery elasticity predicts cardiovascular morbidity and mortality- A longitudinal study in the Vara-Skövde Cohort2023In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527Article in journal (Refereed)
    Abstract [en]

    It is still debated whether arterial elasticity provides prognostic information for cardiovascular risk beyond blood pressure measurements in a healthy population. To investigate the association between arterial elasticity obtained by radial artery pulse wave analysis and risk for cardiovascular diseases (CVD) in men and women. In 2002-2005, 2362 individuals (men=1186, 50.2%) not taking antihypertensive medication were included. C2 (small artery elasticity) was measured using the HDI/Pulse Wave CR2000. Data on acute myocardial infarction or stroke, fatal or non-fatal, was obtained between 2002-2019. Cox- regression was used to investigate associations between C2 and future CVD, adjusting for confounding factors such as age, sex, systolic blood pressure, heart rate, HOMA-IR (Homeostatic Model Assessment for Insulin Resistance), LDL- cholesterol, CRP (C-Reactive Protein), alcohol consumption, smoking and physical activity. At baseline, the mean age of 46 +/- 10.6 years and over the follow-up period, we observed 108 events 70 events in men [event rate: 5.9%], 38 in women [event rate: 3.2%]. In the fully adjusted model, and for each quartile decrease in C2, there was a significant increase in the risk for incident CVD by 36%. (HR = 1.36, 95% CI: 1.01-1.82, p = 0.041). The results were accentuated for all men (HR = 1.74, 95% CI: 1.21-2.50, p = 0.003) and women over the age of 50 years (HR = 1.70, 95% CI: 0.69-4.20). We showed a strong and independent association between C2 and CVD in men. In women after menopause, similar tendencies and effect sizes were observed.

  • 46.
    Viktorsson, Lisa
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Forskningsstrategiska enheten.
    Törnvall, Eva
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Övr Regionledningskontoret.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Wåhlin, Ingrid
    Reg Kalmar Cty, Sweden; Linnaeus Univ, Sweden.
    Yngman Uhlin, Pia
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Forskningsstrategiska enheten.
    Young adults needs when seeking first-line healthcare: A grounded theory design2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 2, article id e0263963Article in journal (Refereed)
    Abstract [en]

    Background Healthcare outpatient visits have increased in recent years, and young adults are often given as an explanatory factor for many avoidable visits. Objective The objective of this study was to explore how young adults perceive seeking first-line healthcare. Design and setting The study utilized a grounded theory design with data collection at primary healthcare centres and emergency departments in southeast Sweden. Method Data were collected during individual interviews and patient observations with subsequent interviews during the years 2017-2018. The analysis was performed using grounded theory. Results The main concern when young adults are seeking healthcare is that their worries are taken seriously. It is a four-part process: becoming aware of, verifying, communicating, and receiving an opinion about ones symptoms. The process includes external factors, clarity of symptoms, behavioural approaches, healthcare know-how, enabling self-management, and prior healthcare experience(s). When communicating symptoms, the clearer the symptoms, the less there needs to be communicated. When symptoms are unclear, the importance of different behavioural approaches and healthcare know-how increases. When receiving a medical opinion about symptoms, young adults want to learn how to self-manage their symptoms. Depending on previous healthcare experience, the healthcare visit can either harm or help the patient in their healthcare-seeking process. Conclusion This study reflects several insights in the healthcare-seeking process from a young adult perspective. Based on the results, we suggest that healthcare providers focus on the final step in the healthcare-seeking process when giving their medical opinion about symptoms. Having extra minutes to give support for future self-care regardless of diagnosis could increase positive healthcare experiences and increase future self-care among young adults.

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  • 47.
    Viktorsson, Lisa
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Forskningsstrategiska enheten.
    Törnvall, Eva
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Övr Regionledningskontoret.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Wåhlin, Ingrid
    Res Sect, Sweden; Linnaeus Univ, Sweden.
    Yngman-Uhlin, Pia
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Forskningsstrategiska enheten.
    Young adults healthcare utilisation and healthcare needs: Perceptions and experiences of healthcare providers2022In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 25, no 1, p. 245-253Article in journal (Refereed)
    Abstract [en]

    Background Health care in many countries entails long waiting times. Avoidable healthcare visits by young adults have been identified as one probable cause. Objective The aim of this study was to explore healthcare providers experiences and opinions about young adults healthcare utilisation in the first line of care. Method This study used latent qualitative conventional content analysis with focus groups. Four healthcare units participated: two primary healthcare centres and two emergency departments. This study included 36 participants, with 4-7 participants in each group, and a total of 21 registered nurses and 15 doctors. All interviews followed an interview guide. Results Data were divided into eight categories, which all contained the implicit theme of distribution of responsibility between the healthcare provider and the healthcare user. Young adult healthcare consumers were considered to be highly influenced by external resources, often greatly concerned with small/vague symptoms they had difficulty explaining and unable to wait with. The healthcare providers role was much perceived as being part of a healthcare structure-a large organisation with multiple units-and having to meet different priorities while also considering ethical dilemmas, though feeling supported by experience. Conclusion Healthcare personnel view young adults as transferring too much of the responsibility of staying healthy to the healthcare system. The results of this study show that the discussion of young adults unnecessarily seeking health care includes an underlying discussion of scarcity of resources. Patient or Public Contribution The conduct of this study is based on interviews with young adult patients about their experiences of seeking healthcare.

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  • 48.
    Viktorsson, Lisa
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Operations management Region Östergötland, Research and Development Unit.
    Yngman Uhlin, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Operations management Region Östergötland, Research and Development Unit.
    Törnvall, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Operations management Region Östergötland, Övrig enhet.
    Falk, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna, Linköping.
    Healthcare utilisation and health literacy among young adults seeking care in Sweden: findings from a cross-sectional and retrospective study with questionnaire and registry-based data2019In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 20, article id PII S1463423619000859Article in journal (Refereed)
    Abstract [en]

    Aim: The objective of this study was to examine young adults healthcare utilisation and its possible association with health literacy. Background: Many countries struggle with insufficient accessibility at emergency departments (EDs) and primary healthcare centres (PHCs). Young adults, aged 20-29 years old, account for a substantial number of unnecessary doctor visits where health literacy could be an explanatory factor. Method: This study incorporated a combined retrospective and cross-sectional study design with analysis of registry data, including all registered outpatient doctor visits between 2004 and 2014 (n = 1 086 432), and strategic sample questionnaire data (n = 207), focusing on socio-demographics, symptoms and information-seeking behaviour. Mean differences between first-year and last-year doctor visits for each age group were calculated using registry data. Fischers exact test was applied to questionnaire data to analyse group differences between ED and PHC visitors as well as between patients with sufficient health literacy and insufficient health literacy. Binary logistic regression was used to investigate covariation. Findings: Healthcare utilisation has increased among young adults during the past decade, however, not comparatively more than for other age groups. ED patients (n = 49) compared to PHC patients (n = 158) were more likely to seek treatment for gastrointestinal symptoms (P = 0.001), had shorter duration of symptoms (P = 0.001) and sought care more often on the recommendation of a healthcare professional (P = 0.001). Insufficient/problematic health literacy among young adults was associated with having lower reliance on the healthcare system (P = 0.03) and with a greater likelihood of seeking treatment for psychiatric symptoms (P = 0.002). Conclusion: Young adults do not account for the increase in healthcare utilisation during the last decade to a greater extent than other age groups. Young adults reliance on the healthcare system is associated with health literacy, an indicator potentially important for consideration when studying health literacy and its relationship to more effective use of healthcare services.

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  • 49.
    Villa, Ricardo Tadeu
    et al.
    Federal University of Maranhão, Brazil.
    Villa, Ana Carolina Fortes Braga Brederodes
    Federal University of Maranhão, Brazil.
    da Silva Ramos Costa, Maria do Rosário
    Federal University of Maranhão, Brazil.
    Brito, Ana Beatriz Costa
    Federal University of Maranhão, Brazil.
    Braga, Brenna Carolina Sousa
    Federal University of Maranhão, Brazil.
    Yamaguchi, Eliana Mika
    Federal University of São Paulo, Brazil.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Photoprotection and skin self-examination in primary attention users: The impact of smartphone as a tool for education2020In: Journal of Dermatology & Cosmetology, E-ISSN 2574-9943, Vol. 4, no 4, p. 92-97Article in journal (Refereed)
    Abstract [en]

    Introduction: “mobile health” consists in using electronic devices to support health.

    Objectives: observe photoprotection, skin self-examination and compare the impact of multimedia presentation to Whatsapp messages on these habits in primary attention.

    Methodology: experimental study, envolving 300 users. First moment: SEPI (Sun Exposure and Protection Index) and SSEAS (Self Skin-Examination Attitudes Scale) were applied and a presentation was performed. Second moment (8 weeks):150 users received photoprotection and self-examination messages. Third moment:300 re-answered questionnaires. Differences were analysed using t test andlinear regression.

    Results: 39.66% used sunscreen always/frequently and, in intervention, ascended to 47.91% (p=0.0014) without change in control. Self-examination was a priority for 48.67% and increased to 73.91% in control (p=0.0179) and 69.8% (p=0.0001) in intervention, without difference.

    Conclusion: photoprotection remained low and self-examination became priority for twothirds (without difference between groups).

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  • 50.
    Waagaard, Lovisa
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Herraiz-Adillo, Ángel
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Ahlqvist, Viktor H.
    Karolinska Inst, Sweden.
    Higueras-Fresnillo, Sara
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Autonoma Madrid, Spain.
    Berglind, Daniel
    Karolinska Inst, Sweden; Ctr Epidemiol & Community Med, Sweden; Ctr Wellbeing Welf & Happiness, Sweden.
    Wennberg, Patrik
    Umea Univ, Sweden.
    Daka, Bledar
    Univ Gothenburg, Sweden.
    Lenander, Cecilia
    Lund Univ, Sweden.
    Sundstrom, Johan
    Uppsala Univ, Sweden; Univ New South Wales, Australia.
    Östgren, Carl Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ekholmen. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Rådholm, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna. Univ New South Wales, Australia.
    Henriksson, Pontus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Body mass index and weight gain in pregnancy and cardiovascular health in middle age: A cohort study2023In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528Article in journal (Refereed)
    Abstract [en]

    Objective: To examine associations between body mass index (BMI) in early pregnancy and gestational weight gain (GWG) with cardiovascular health in middle age using the 'Life's Essential 8' (LE8) concept of the American Heart Association (AHA).Design: Population-based cohort study.Setting: Swedish CardioPulmonary bioImage Study (SCAPIS).Population: A total of 8871 women from SCAPIS were included.Methods: Information on cardiovascular health in middle age was collected from SCAPIS and linked to pregnancy weight data obtained from the Swedish Medical Birth Register, with an average follow-up time of 24.5 years. An LE8 score between 0 and 100 was determined, where a score under 60 points was defined as poor cardiovascular health. Binary logistic regression and restricted cubic splines were used.Main outcome measures: Cardiovascular health according to LE8 in middle age.Results: The odds of having poor cardiovascular health in middle age were significantly higher in women who had overweight (adjusted odds ratio, aOR 3.30, 95% CI 2.82-3.88) or obesity (aOR 7.63, 95% CI 5.86-9.94), compared with women classified as being of normal weight in pregnancy. Higher odds were also found for excessive GWG (aOR 1.31, 95% CI 1.09-1.57), compared with women who gained weight within the recommendations.Conclusions: A high BMI in early pregnancy and excessive GWG were associated with greater odds of poor cardiovascular health in middle age. Although further studies are needed, our results highlight pregnancy as an important period to support long-term cardiovascular health.

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