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  • 1.
    Abbott, Allan
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping. Bond University, Gold Coast, Australia.
    Allard, Michael
    Bond University, Gold Coast, Australia.
    Kierkegaard, Marie
    Karolinska University Hospital, Stockholm, Sweden; Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden; Karolinska Institutet, Huddinge, Sweden.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Dedering, Åsa
    Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden.
    What biopsychosocial factors are associated with work ability in conservatively managed patients with cervical radiculopathy?: A cross-sectional analysis2020Ingår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, PM R, Vol. 12, nr 1, s. 64-72Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    No previous studies have investigated what biopsychosocial factors are associated with self‐reported work ability in conservatively managed patients with cervical radiculopathy.

    Objective

    To develop a theoretical model of factors and potential processes associated with variation in work ability based on a thorough assessment of biopsychosocial variables in conservatively managed patients with cervical radiculopathy.

    Design

    Cross‐sectional observational study.

    Setting

    Tertiary neurosurgery clinic.

    Patients

    A total of 144 conservatively managed patients with cervical pain and radiculopathy participated in the study.

    Methods

    From 64 biopsychosocial candidate variables, significant (P < .05) bivariate correlators with Work Ability Index (WAI) were entered as independent variables in a categorical regression. Elastic net regularization maintained the most parsimonious set of independent variables significantly associated with variation in WAI as the dependent variable. Process analysis of significant independent variable associations with WAI was performed.

    Main Outcome Measurement

    WAI.

    Results

    From 42 bivariate correlates of WAI, multivariate regression displayed a total of seven variables that were significantly (F [25,98] = 5.74, P < .05) associated with 65.8% of the variation in WAI. The Neck Disability Index (NDI) and Fear‐Avoidance Beliefs Questionnaire Work subscale (FABQ‐W) were significant individual factors within the final regression model. Process analysis displayed FABQ‐W having a significant specific indirect association with the direct association between NDI and WAI, with the model associated with 77% of the variability in WAI (F [2,84] = 141.17, P < .001).

    Conclusion

    Of 64 candidate biopsychosocial factors, NDI and FABQ‐W were the most significant multivariate correlates with work ability. FABQ‐W has a significant indirect association with baseline NDI scores and perceived work ability. This warrants future research trialing work‐related fear avoidance interventions in conservatively managed patients with cervical radiculopathy.

    Level of Evidence

    III

  • 2.
    Abbott, Allan
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Gustafsson, Kristin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Ryhov Cty Hosp, Sweden.
    Zhou, Caddie
    Ctr Registries Vastra Gotaland, Sweden.
    Rolfson, Ola
    Univ Gothenburg, Sweden.
    Svensson, Gunilla Limbäck
    Univ Gothenburg, Sweden; Ctr Registries, Sweden.
    Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking2022Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 93, s. 51-58Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and purpose - Swedish clinical guidelines for osteoarthritis (OA) prioritize patient education, exercise, and-if necessary-weight reduction before considering adjunct pharmacological intervention. Contrariwise, we investigated the proportion and type of dispensed analgesic prescriptions in Sweden received by patients during 3 years before commencing non-pharmacological primary care interventions for OA (2008-2016) compared with the general population. Furthermore, we analyzed the proportion of analgesic prescriptions dispensed before (2008-2012) compared with after (2012-2016) guideline publication in terms of concordance with clinical guideline recommendations. Patients and methods - Patients with hip or knee OA (n = 72,069) from the Better Management of OA national quality register receiving non-pharmacological interventions in primary care between 2008 and 2016 were included (OA cohort). An age, sex, and residence matched reference cohort (n = 216,207) was formed from the Swedish Total Population Register. Based on a period 3 years prior to inclusion in the OA cohort, Swedish Prescribed Drug Register data was linked to both the OA and reference cohorts. Results - Compared with the reference cohort, a distinctly larger proportion of the OA cohort had dispensed prescriptions for most types of analgesics, increasing exponentially each year prior to commencing non-pharmacological intervention. Since guideline publication, the proportion of the OA cohort having no dispensed prescription analgesics prior to non-pharmacological primary care intervention concordantly increased by 5.0% (95% CI 4.2-5.9). Furthermore, dispensed prescriptions concordantly decreased for non-selective NSAIDs -8.6% (CI -9.6 to -7.6), weak opioids -6.8% (CI -7.7 to -5.9), glucosamine -9.5% (CI -9.8 to -8.8). and hyaluronic acid -1.6% (CI -1.8 to -1.5) but discordantly increased for strong opioids 2.8% (CI 2.1-3.4) and glucocorticoid intra-articular injection for hip OA 2.1% (CI 1.0-3.1). Interpretation - In Sweden, dispensed prescription of analgesics commonly occurred before initiating non-pharmacological primary care interventions for OA but reduced modestly after guideline publication, which prioritizes non-pharmacological before pharmacological interventions. Additional modest improvements occurred in the stepped-care prioritization of analgesic prescription types. However, future strategies are required to curb an increase of strong opioids prescription for OA and glucocorticoid intra-articular injection for hip OA.

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  • 3.
    Abbott, Allan
    et al.
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård.
    Limbäck-Svensson, Gunilla
    Västra Götalandsregionen, Gothenburg, Sweden.
    Zhou, Caddie
    Västra Götalandsregionen, Gothenburg, Sweden.
    Gustafsson, Kristin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Rolfson, Ola
    Västra Götalandsregionen, Gothenburg, Sweden.
    Dispenced prescriptions of analgesics prior to entering an osteoarthritis care program. a national registry linkage study2020Ingår i: Osteoarthritis and Cartilage, ISSN 1063-4584, E-ISSN 1522-9653, Vol. 28, s. S59-S60Artikel i tidskrift (Refereegranskat)
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  • 4.
    Abdelrahman, Islam
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Plastic Surgery Unit, Suez Canal University, Egypt.
    Elmasry, Moustafa
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Plastic Surgery Unit, Suez Canal University, Egypt.
    Steinvall, Ingrid
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Turesson, Christina
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Hansson, Thomas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Needle Fasciotomy or Collagenase Injection in the Treatment of Dupuytren’s Contracture: A Retrospective Study2020Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 8, nr 1Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Dupuytren’s contracture is common among older people in Sweden. Previous studies comparing the treatment with an injection of collagenase with percutaneous needle fasciotomy found no differences. Methods: We retrospectively compared the degree of improvement in the deficit in extension of the joints in 2 groups of patients who had been treated with collagenase (71 fingers) or needle fasciotomy (109 fingers) before and 1 year after treatment. We compared the improvement of the extension deficit among the metacarpophalangeal (MCP) and proximal interphalangeal joints before and after the intervention; additionally, the level of improvement was classified into 3 levels (mild = 0° to 29°; moderate = 30° to 60°; considerable = 61° and more). Results: The degree of improvement of extension in the MCP joints was 11° greater in the collagenase group (P = 0.001). The number of patients who had an improvement of >60° (considerable) in extension was greater in the collagenase group (P = 0.02). Conclusion: Collagenase was more effective than needle fasciotomy in treating extension deficits of the MCP joints in Dupuytren’s contracture in this retrospective analysis. Further prospective studies are required to confirm the finding.

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  • 5.
    Abou Ghayda, Ramy
    et al.
    Case Western Reserve Univ, OH 44106 USA.
    Lee, Keum Hwa
    Yonsei Univ, South Korea.
    Han, Young Joo
    Inje Univ, South Korea.
    Ryu, Seohyun
    Yonsei Univ, South Korea.
    Hong, Sung Hwi
    Yonsei Univ, South Korea.
    Yoon, Sojung
    Yonsei Univ, South Korea.
    Jeong, Gwang Hum
    Gyeongsang Natl Univ, South Korea.
    Yang, Jae Won
    Yonsei Univ, South Korea.
    Lee, Hyo Jeong
    Yonsei Univ, South Korea.
    Lee, Jinhee
    Yonsei Univ, South Korea.
    Lee, Jun Young
    Yonsei Univ, South Korea.
    Effenberger, Maria
    Med Univ Innsbruck, Austria.
    Eisenhut, Michael
    Luton & Dunstable Univ Hosp NHS Fdn Trust, England.
    Kronbichler, Andreas
    Med Univ Innsbruck, Austria.
    Solmi, Marco
    Univ Ottawa, Canada; Ottawa Hosp, Canada; Univ Ottawa, Canada; Univ Ottawa, Canada.
    Li, Han
    Univ Florida, FL USA.
    Jacob, Louis
    Univ Versailles St Quentin En Yvelines, France; CIBERSAM, Spain.
    Koyanagi, Ai
    CIBERSAM, Spain; ICREA, Spain.
    Radua, Joaquim
    Inst Invest Biomed August Pi & Sunyer IDIBAPS, Spain; Kings Coll London, England; Karolinska Inst, Sweden.
    Park, Myung Bae
    Pai Chai Univ, South Korea.
    Aghayeva, Sevda
    Azerbaijan Med Univ, Azerbaijan.
    Ahmed, Mohamed L. C. B.
    Univ Nouakchott Al Aasriya, Mauritania.
    Al Serouri, Abdulwahed
    Yemen Field Epidemiol Training Program, Yemen.
    Al-Shamsi, Humaid O.
    Univ Sharjah, U Arab Emirates; Burjeel Canc Inst, U Arab Emirates.
    Amir-Behghadami, Mehrdad
    Tabriz Univ Med Sci, Iran; Tabriz Univ Med Sci, Iran; Tabriz Univ Med Sci, Iran.
    Baatarkhuu, Oidov
    Mongolian Natl Univ Med Sci, Mongolia.
    Bashour, Hyam
    Damascus Univ, Syria.
    Bondarenko, Anastasiia
    Shupyk Natl Healthcare Univ Ukraine, Ukraine.
    Camacho-Ortiz, Adrian
    Univ Autonoma Nuevo Leon, Mexico.
    Castro, Franz
    Gorgas Mem Inst Hlth Studies, Panama.
    Cox, Horace
    Minist Hlth Guyana, Guyana.
    Davtyan, Hayk
    TB Res & Prevent Ctr NGO, Armenia.
    Douglas, Kirk
    Univ West Indies, Barbados.
    Dragioti, Elena
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Ebrahim, Shahul
    Univ Sci Tech & Technol, Mali.
    Ferioli, Martina
    IRCCS Azienda Osped Univ Bologna, Italy.
    Harapan, Harapan
    Univ Syiah Kuala, Indonesia.
    Mallah, Saad I
    Royal Coll Surg Ireland Bahrain, Indonesia.
    Ikram, Aamer
    Natl Inst Hlth, Pakistan.
    Inoue, Shigeru
    Tokyo Med Univ, Japan.
    Jankovic, Slobodan
    Univ Kragujevac, Serbia.
    Jayarajah, Umesh
    Univ Colombo, Sri Lanka.
    Jesenak, Milos
    Comenius Univ, Slovakia.
    Kakodkar, Pramath
    Natl Univ Galway Ireland, Ireland.
    Kebede, Yohannes
    Jimma Univ, Ethiopia.
    Kifle, Meron
    Univ Oxford, England.
    Koh, David
    Natl Univ Singapore, Singapore.
    Males, Visnja K.
    Sch Med Split, Croatia.
    Kotfis, Katarzyna
    Pomeranian Med Univ, Poland.
    Lakoh, Sulaiman
    Univ Sierra Leone, Sierra Leone.
    Ling, Lowell
    Chinese Univ Hong Kong, Peoples R China.
    Llibre-Guerra, Jorge
    Washington Univ, MO USA.
    Machida, Masaki
    Tokyo Med Univ, Japan.
    Makurumidze, Richard
    Univ Zimbabwe, Zimbabwe.
    Mamun, Mohammed
    Chinese Univ Hong Kong, Peoples R China; Jahangirnagar Univ, Bangladesh; Daffodil Int Univ, Bangladesh; CHINTA Res Bangladesh, Bangladesh.
    Masic, Izet
    Acad Med Sci Bosnia & Herzegovina, Bosnia & Herceg.
    Van Minh, Hoang
    Hanoi Univ Publ Hlth, Vietnam.
    Moiseev, Sergey
    Sechenov First Moscow State Med Univ, Russia.
    Nadasdy, Thomas
    St Parascheva Clin Hosp Infect Dis, Romania.
    Nahshon, Chen
    Carmel Hosp, Israel.
    Namendys-Silva, Silvio A.
    Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Mexico.
    Yongsi, Blaise N.
    Univ Yaounde II, Cameroon.
    Nielsen, Henning B.
    Zealand Univ Hosp Roskilde, Denmark.
    Nodjikouambaye, Zita A.
    Mobile Lab Hemorrhag & Resp Viruses Ndjamena, Chad.
    Ohnmar, Ohnmar
    Myanmar Hlth Minist, Myanmar.
    Oksanen, Atte
    Tampere Univ, Finland.
    Owopetu, Oluwatomi
    Univ Coll Hosp, Nigeria.
    Parperis, Konstantinos
    Univ Cyprus Med Sch, Cyprus.
    Perez, Gonzalo E.
    Clin Olivos, Argentina.
    Pongpirul, Krit
    Chulalongkorn Univ, Thailand.
    Rademaker, Marius
    Auckland Univ Med Sch, New Zealand.
    Rosa, Sandro
    Fed Fluminense Univ, Brazil; Natl Inst Ind Property, Brazil.
    Sah, Ranjit
    Natl Publ Hlth Lab, Nepal.
    Sallam, Dina
    Ain Shams Univ, Egypt.
    Schober, Patrick
    Vrije Univ Amsterdam, Netherlands.
    Singhal, Tanu
    Kokilaben Dhirubhai Ambani Hosp & Med Res Inst, India.
    Tafaj, Silva
    Univ Hosp Shefqet Ndroqi, Albania.
    Torres, Irene
    Fdn Octaedro, Ecuador.
    Smith Torres-Roman, J.
    Univ Cient Sur, Peru.
    Tsartsalis, Dimitrios
    Hippokrateion Hosp, Greece.
    Tsolmon, Jadamba
    Mongolian Natl Univ Med Sci, Mongolia.
    Tuychiev, Laziz
    Tashkent Med Acad, Uzbekistan.
    Vukcevic, Batric
    Univ Montenegro, Montenegro.
    Wanghi, Guy
    Univ Kinshasa, DEM REP CONGO.
    Wollina, Uwe
    Stadt Klinikum Dresden, Germany.
    Xu, Ren-He
    Univ Macau, Peoples R China.
    Yang, Lin
    Alberta Hlth Serv, Canada; Univ Calgary, Canada; Univ Calgary, Canada.
    Zaidi, Zoubida
    Univ Ferhat Abbas, Algeria.
    Smith, Lee
    Anglia Ruskin Univ, England.
    Shin, Jae Il
    Yonsei Univ, South Korea.
    The global case fatality rate of coronavirus disease 2019 by continents and national income: A meta-analysis2022Ingår i: Journal of Medical Virology, ISSN 0146-6615, E-ISSN 1096-9071, Vol. 94, nr 6, s. 2402-2413Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study is to provide a more accurate representation of COVID-19s case fatality rate (CFR) by performing meta-analyses by continents and income, and by comparing the result with pooled estimates. We used multiple worldwide data sources on COVID-19 for every country reporting COVID-19 cases. On the basis of data, we performed random and fixed meta-analyses for CFR of COVID-19 by continents and income according to each individual calendar date. CFR was estimated based on the different geographical regions and levels of income using three models: pooled estimates, fixed- and random-model. In Asia, all three types of CFR initially remained approximately between 2.0% and 3.0%. In the case of pooled estimates and the fixed model results, CFR increased to 4.0%, by then gradually decreasing, while in the case of random-model, CFR remained under 2.0%. Similarly, in Europe, initially, the two types of CFR peaked at 9.0% and 10.0%, respectively. The random-model results showed an increase near 5.0%. In high-income countries, pooled estimates and fixed-model showed gradually increasing trends with a final pooled estimates and random-model reached about 8.0% and 4.0%, respectively. In middle-income, the pooled estimates and fixed-model have gradually increased reaching up to 4.5%. in low-income countries, CFRs remained similar between 1.5% and 3.0%. Our study emphasizes that COVID-19 CFR is not a fixed or static value. Rather, it is a dynamic estimate that changes with time, population, socioeconomic factors, and the mitigatory efforts of individual countries.

  • 6.
    Abrandt Dahlgren, Madeleine
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Valeskog, Karin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i östra Östergötland, Rehab Öst.
    Edelbring, Samuel
    Orebro Univ, Sweden.
    Understanding clinical reasoning: A phenomenographic study with entry-level physiotherapy students2022Ingår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 38, nr 13, s. 2817-2826Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Entry-level students conceptualizations of clinical reasoning can provide a starting point for program planning related to clinical reasoning development with a focus on patient-centered care Objective The aim of the study is to explore how physiotherapy students understand clinical reasoning midway through their education. Nine physiotherapy students were interviewed at the end of their third semester Methods Semi-structured individual interviews were conducted, recorded and transcribed verbatim. A phenomenographic approach to qualitative data analysis, seeking to explore variations in students conceptions was applied Results The students ways of understanding clinical reasoning could be described as: 1) the cognitive process of the physiotherapist; and 2) the relational process of the collaborative partnership between the physiotherapist and the patient. A contrastive analysis shows how the cognitive and relational perspectives are developed through the relationships among three dimensions of clinical reasoning: 1) problem-solving; 2) context of working; and 3) own learning Conclusion By identifying the critical variation in students conceptions of clinical reasoning, focus can be placed on pedagogical arrangements to facilitate students progression toward a person-centered approach.

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  • 7. Beställ onlineKöp publikationen >>
    af Geijerstam, Peder
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Home Blood Pressure in Health and Disease2024Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    Förhöjt blodtryck (hypertoni) är den huvudsakliga orsaken till förtida död, främst genom hjärtkärlsjukdom. Flera mekanismer och riskfaktorer som kan förklara hypertoni har identifierats. Individer med förhöjt blodsocker, inklusive diabetes och dess förstadier, lö-per ökad risk för hjärtkärlsjukdom, och förhöjt blodsocker samexisterar ofta med hypertoni. Lakritsintag höjer blodtrycket genom dess beståndsdel glycyrrhizinsyra (GA), och även om både Europeiska unionen och Världshälsoorganisationen har föreslagit att ett intag av upp till 100 mg per dag sannolikt är säkert att förtära för de flesta individer, är den gränsnivån osäker.  

    Jämfört med blodtryck som mäts på mottagningen av medicinskt utbildad personal har hemblodtryck flera fördelar, inklusive starkare koppling till framtida hjärtkärlsjukdom. Genom att kombinera mottagnings- och hemblodtryck går det att diagnosticera maskerad hypertoni (MH), då hemblodtrycket är förhöjt trots normalt mottagningsblodtryck, och vitrockhypertoni (WCH), då mottagningsblodtrycket men inte hemblodtrycket är förhöjd. Syftet med denna avhandling var att vidare utforska hemblodtryck i relation till förhöjt blodsocker, markörer för hjärtkärlsjukdom, och lakritsintag.  

    Avhandlingens fyra arbeten baseras på två studier. I de första tre arbetena analyserades data från Linköpings-kohorten i the Swedish CArdioPulmonary bioImage Study (SCAPIS), en prospektiv studie av män och kvinnor i åldrarna 50-64 år. I det sista arbetet analyserades data från en lottad överkorsningsstudie. Data i studierna bestod av enkätsvar, blodprover, samt mottagnings- och hemblodtrycksmätningar. I studie I-III ingick även pulsvågshastighet, kalkhalt i kranskärlen vid skiktröntgen (CACS) och plack-förekomst i halspulsådrorna vid ultraljudsundersökning som markörer på hjärtkärlsjukdom.  

    I det första delarbetet undersökte vi data för 5025 individer avseende blodtryck och förhöjt blodsocker. Både mottagnings- och hemblodtryck var associerat med förhöjt blodsocker. Deltagare med förhöjt blodsocker hade oftare MH jämfört med de med normalt blodsocker, och skillnaden mellan mottagnings- och hemblodtrycket var omvänt associerat med långtidsblodsocker. Fynden var i linje med tidigare forskning, och stärkte kända kopplingar mellan MH och förhöjt blodsocker. Förklaringarna till detta samband är okända, men möjliga sådana inkluderar selektiva effekter av blodtryckssänkande läkemedel hos individer med förhöjt blodsocker, samsjukligheter såsom fetma, och aktivering av det sympatiska nervsystemet.  

    I det andra delarbetet analyserade vi förekomst av och associationer för MH hos 4122 individer utan pågående blodtryckssänkande läkemedelsbehandling. Av dessa hade 4.2% MH, och dessa var oftare män och hade högre BMI än de med normalt blodtryck. Deltagare med MH hade också högre pulsvågshastighet och oftare förhöjt CACS. Associationen mellan MH och markörer för hjärt-kärlsjukdom var tidigare känd och styrktes av våra resultat.  

    I det tredje delarbetet undersökte vi 4548 deltagare avseende två blodprovsmarkörer: en för blodplättsaktivitet, lösligt P-selektin i blodet, och en för inflammation, högkänsligt C-reaktivt protein (hsCRP). Både P-selektin och hsCRP var högre vid hypertoni, oavsett typ, jämfört med vid normalt blodtryck. Den kvartil av deltagarna som hade högst P-selektin hade oftare WCH och hypertoni både hemma och på mottagningen, jämfört med normalt blodtryck, och oftare förhöjt CACS och plack i halspulsådrorna. Associationen mellan P-selektin och högt blodtryck både hemma och på mottagningen var inte tidigare känd, och påverkades inte av justering för hsCRP, vilket antydde att den inte enbart förklarades av inflammation.  

    I det fjärde och sista delarbetet inkluderas 28 friska individer i åldrarna 18 till 30 år. I en överkorsningsstudie bad vi deltagarna att dagligen under 2 veckor inta antingen lakrits med ett innehåll av 100 mg GA eller en kontrollprodukt utan lakrits. Deltagarna undersöktes med avseende på hemblodtryck, liksom hormonnivåer i blodet. Under lakrits- jämfört med kontrollperioden steg det systoliska hemblodtrycket med 3,1 mmHg, och hormonnivåerna påverkades på ett sätt som talade för att GA påverkade blodtrycket.  

    Sammanfattningsvis stärker studiernas resultat kunskapen om att blodtrycksmätning både på mottagningen och i hemmet är värdefullt både var för sig och tillsammans, och att hemblodtryck är särskilt värdefullt hos individer med förhöjt blodsocker eller övervikt, samt hos män. Slutligen visade sig små mängder lakrits påverka kroppen mer än tidigare känt, och ökad medvetenhet och bättre etikettering av lakritsprodukter kan vara befogad.  

    Delarbeten
    1. Home Blood Pressure Compared With Office Blood Pressure in Relation to Dysglycemia
    Öppna denna publikation i ny flik eller fönster >>Home Blood Pressure Compared With Office Blood Pressure in Relation to Dysglycemia
    Visa övriga...
    2022 (Engelska)Ingår i: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 35, nr 9, s. 810-819Artikel i tidskrift (Refereegranskat) Published
    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.

    Ort, förlag, år, upplaga, sidor
    Oxford, United Kingdom: Oxford University Press, 2022
    Nyckelord
    blood pressure, cardiovascular disease, diabetes, dysglycemia, HbA1c, home blood pressure monitoring, hypertension, white coat effect
    Nationell ämneskategori
    Allmänmedicin Endokrinologi och diabetes
    Identifikatorer
    urn:nbn:se:liu:diva-187063 (URN)10.1093/ajh/hpac082 (DOI)000826969200001 ()35849046 (PubMedID)
    Anmärkning

    Funding: The main funding body of The Swedish CArdioPulmonary bioImage Study(SCAPIS) is the Swedish Heart and Lung Foundation [2016-0315]. The study is also funded by the Knut and Alice Wallenberg Foundation [2014-0047], the Swedish Research Council [822-2013-2000], VINNOVA (Sweden’s Innovation agency) [2012-04476], the University of Gothenburg and Sahlgrenska University Hospital, Karolinska Institutet and Stockholm county council, Linköping University and University Hospital, Lund University and Skåne University Hospital, Umeå University and University Hospital, Uppsala University and University Hospital, the Swedish state under the agreement between the Swedish government and the county councils (the ALF-agreement), and the King Gustaf V and Queen Victoria’s Foundation of Freemasons.

    Tillgänglig från: 2022-07-20 Skapad: 2022-07-20 Senast uppdaterad: 2024-07-08Bibliografiskt granskad
    2. Masked hypertension in a middle-aged population and its relation to manifestations of vascular disease
    Öppna denna publikation i ny flik eller fönster >>Masked hypertension in a middle-aged population and its relation to manifestations of vascular disease
    Visa övriga...
    2023 (Engelska)Ingår i: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 41, nr 7, s. 1084-1091Artikel i tidskrift (Refereegranskat) Published
    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.

    Ort, förlag, år, upplaga, sidor
    Wolters Kluwer, 2023
    Nyckelord
    blood pressure, cardiovascular disease, carotid artery plaques, coronary artery calcium score, home blood pressure, masked hypertension, pulse wave velocity
    Nationell ämneskategori
    Kardiologi
    Identifikatorer
    urn:nbn:se:liu:diva-192987 (URN)10.1097/hjh.0000000000003431 (DOI)001000477000005 ()37016927 (PubMedID)
    Anmärkning

    Funding: Swedish Heart and Lung Foundation [20160315]; Knut and Alice Wallenberg Foundation [20140047]; Swedish Research Council [82220132000]; VINNOVA (Swedens Innovation agency) [201204476]; University of Gothenburg; Sahlgrenska University Hospital; Karolinska Institutet; Stockholm County council; Linkoping University; Linkoping University Hospital; Lund University; Skane University Hospital; Umea~University; Umea University Hospital; Uppsala University; Uppsala University Hospital; Strategic Research Network in Circulation and Metabolism at Linkoping University (LiU-CircM); King Gustaf V and Queen Victoria Freemason Foundation

    Tillgänglig från: 2023-04-07 Skapad: 2023-04-07 Senast uppdaterad: 2024-07-08
    3. P-selectin and C-reactive protein in relation to home blood pressure and coronary calcification: a SCAPIS substudy
    Öppna denna publikation i ny flik eller fönster >>P-selectin and C-reactive protein in relation to home blood pressure and coronary calcification: a SCAPIS substudy
    Visa övriga...
    2024 (Engelska)Ingår i: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598Artikel i tidskrift (Refereegranskat) Epub ahead of print
    Abstract [en]

    Background: Soluble P-selectin (sP-selectin) and high-sensitivity C-reactive protein (hsCRP) have previously been associated with hypertension, but the relation with out-of-office blood pressure (BP) and coronary artery calcification score is unknown. We aimed to examine the relationship between sP-selectin, hsCRP and home BP, as well as coronary artery calcification score and carotid artery plaques.

    Methods: In the Swedish CArdioPulmonary bioImage Study (SCAPIS), 5057 randomly selected participants were evaluated with office and home BP using the semi-automatic Omron M10-IT device. For this cross-sectional study, participants with sP-selectin <4 standard deviations above mean and hsCRP <5 mg/l, representing low-grade inflammation, were included. Using generalized linear models, these inflammatory markers were evaluated in relation to BP classifications, as well as coronary artery calcification score and carotid artery plaques.

    Results: Of participants, 4548 were included in the analyses. The median age was 57.2 (53.4–61.2) years, and 775 (17.0%) reported taking medication for hypertension. Participants in the highest quartile of sP-selectin [odds ratio (OR) 1.67, 95% confidence interval (CI) 1.40–1.98, P < 0.001] and hsCRP [OR 2.25, (95% CI 1.89–2.60), P < 0.001] were more likely to have sustained hypertension. Participants in the highest quartile of hsCRP were also more likely to have masked hypertension, OR (95% CI) 2.31 (1.72–3.10), P < 0.001 and carotid artery plaques, OR (95% CI) 1.21 (1.05–1.38), P = 0.007.

    Conclusion: Increased sP-selectin and hsCRP were independently associated with sustained hypertension. These findings indicate an association between hypertension and platelet activity, as expressed by sP-selectin.

    Ort, förlag, år, upplaga, sidor
    Lippincott Williams & Wilkins, 2024
    Nyckelord
    Blood pressure, selectin, CRP, inflammation, hypertension, cardiovascular disease, CACS, carotid artery plaques, masked hypertension
    Nationell ämneskategori
    Klinisk medicin
    Identifikatorer
    urn:nbn:se:liu:diva-203174 (URN)10.1097/HJH.0000000000003718 (DOI)38690927 (PubMedID)
    Tillgänglig från: 2024-05-01 Skapad: 2024-05-01 Senast uppdaterad: 2024-07-08Bibliografiskt granskad
    4. A low dose of daily licorice intake affects renin, aldosterone, and home blood pressure in a randomized crossover trial
    Öppna denna publikation i ny flik eller fönster >>A low dose of daily licorice intake affects renin, aldosterone, and home blood pressure in a randomized crossover trial
    2024 (Engelska)Ingår i: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 119, nr 3, s. 682-691Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background

    Licorice, 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.

    Ort, förlag, år, upplaga, sidor
    ELSEVIER SCIENCE INC, 2024
    Nyckelord
    aldosterone, glycyrrhizic acid, home blood pressure, licorice, renin, aldosteron, glycyrrhizinsyra, hemblodtryck, lakrits, renin
    Nationell ämneskategori
    Endokrinologi och diabetes
    Identifikatorer
    urn:nbn:se:liu:diva-200860 (URN)10.1016/j.ajcnut.2024.01.011 (DOI)001209261000001 ()38246526 (PubMedID)
    Forskningsfinansiär
    Svenska Sällskapet för Medicinsk Forskning (SSMF)Konung Gustaf V:s och Drottning Victorias FrimurarestiftelseHjärt-LungfondenSvenska läkaresällskapetRegion Östergötland, RÖ 988832, RÖ 2021/3845,RÖ 2022/13418
    Anmärkning

    Funding Agencies|Strategic Research Network in Circulation and Metabolism at Linkoping University (LiU-CircM); National Research School in General Practice; Swedish Society of Medicine; Swedish Society for Medical Research; King Gustaf V and Queen Victoria Freemason Foundation; Swedish Heart Lung Foundation; Region Ostergotland; Primary Health Care Centers Research Fund, Region Ostergotland, Sweden;  [RO 988832];  [RO 2021/3845];  [RO 2022/13418]

    Tillgänglig från: 2024-02-12 Skapad: 2024-02-12 Senast uppdaterad: 2024-07-08
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  • 8.
    af Geijerstam, Peder
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Pre-PhD vid The George Institute for Global Health2023Ingår i: Vaskulär Medicin, ISSN 2000-3188, Vol. 39, nr 4, s. 6-7Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 9.
    af Geijerstam, Peder
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Engvall, Jan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Region Östergötland, Primärvårdscentrum, Vårdcentralen Ekholmen.
    Nyström, Fredrik
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Rådholm, Karin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen 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 Dysglycemia2022Ingår i: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 35, nr 9, s. 810-819Artikel i tidskrift (Refereegranskat)
    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.

    Ladda ner fulltext (pdf)
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  • 10.
    af Geijerstam, Peder
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Engvall, Jan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Region Östergötland, Primärvårdscentrum, Vårdcentralen Ekholmen.
    Rådholm, Karin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Kärna.
    Nyström, Fredrik
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin.
    Masked hypertension in a middle-aged population and its relation to manifestations of vascular disease2023Ingår i: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 41, nr 7, s. 1084-1091Artikel i tidskrift (Refereegranskat)
    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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  • 11.
    af Geijerstam, Peder
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum. The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
    Falster, Michael O
    School of Population Health, University of New South Wales, Sydney, Australia.
    Chalmers, John
    The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    McLachlan, Andrew J
    Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
    Rodgers, Anthony
    The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Schutte, Aletta E.
    The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Prescription and dispensing duration of medicines for hypertension and other chronic conditions: a review of international policies and evidence to inform the Australian setting2024Ingår i: Hypertension Research, ISSN 0916-9636, E-ISSN 1348-4214Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The duration of treatment for which a physician may prescribe a medicine, ‘prescription duration’, is often dispensed at the pharmacy on multiple occasions of shorter time periods, ‘dispensing duration’. These durations vary significantly between and within countries. In Australia, the quantity of medication supplied at each dispensing has recently been extended from 30 to 60 days for a selection of medicines used for chronic health conditions, such as diabetes and hypertension. Dispensing durations vary between countries, with 30, 60 or 90 days being the most common—with 90 days aligning with the recommendation of the 2023 Global Report on Hypertension from the World Health Organization. The full impact of shorter vs longer prescription durations on health costs and outcomes is unknown, but current evidence suggests that 90-day dispensing could reduce costs and improve patient convenience and adherence. More rigorous research is needed.

  • 12.
    af Geijerstam, Peder
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum. The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Harris, Katie
    The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Johansson, Maria M.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Rörelse och Hälsa. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken.
    Chalmers, John
    The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Nägga, Katarina
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken.
    Rådholm, Karin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Kärna. The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Orthostatic Hypotension and Cognitive Function in Individuals 85 Years of Age: A Longitudinal Cohort Study in Sweden2024Ingår i: Aging and Disease, ISSN 2152-5250Artikel i tidskrift (Refereegranskat)
    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.

  • 13.
    af Geijerstam, Peder
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Janryd, Fredrik
    Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Nyström, Fredrik
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin.
    Smoking and cardiovascular disease in patients with type 2 diabetes: a prospective observational study2023Ingår i: Journal of Cardiovascular Disease, ISSN 2330-4596, E-ISSN 2330-460X, Vol. 24, nr 11, s. 802-807Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Cigarette smoking is a major risk factor for cardiovascular disease. In type 2 diabetes mellitus (T2D), medications such as antihypertensives and statins can reduce the increased cardiovascular risk. The aim of this study was to evaluate the impact of cigarette smoking on major adverse cardiovascular event (MACE) and all-cause mortality in patients with T2D in a relatively well treated Swedish cohort.

    Methods

    Seven hundred and sixty-one patients with T2D aged 55–66 years were followed in the prospective observational CArdiovascular Risk factors in patients with DIabetes – a Prospective study in Primary care (CARDIPP) study. Baseline data included blood samples of markers of dysglycemia and inflammation, blood pressure as well as questionnaire responses regarding cigarette smoking. Participants were followed for incidence of MACE and all-cause mortality.

    Results

    Of the included 663 participants, the mean age was 60.6 (SD 3.1) years and 423 (63.8%) were men. Levels of C-reactive protein and vitamin D, as well as the proportion of participants treated with antihypertensives, acetylic salicylic acid, statins, and diabetes medications, were similar between smokers and nonsmokers. Median follow-up time was 11.9 (Q1–Q3 10.8–12.7) years. Cigarette smoking was associated with all-cause mortality [hazard ratio 2.24 (95% confidence interval, 95% CI 1.40–3.56), P < 0.001], but not MACE [hazard ratio 1.30 (95% CI 0.77–2.18), P = 0.328].

    Conclusion

    In patients with T2D, cigarette smoking was not associated with an increased risk of MACE. This raises the question of whether cardioprotective drugs in individuals with T2D to some degree mitigate the cardiovascular harm of smoking, even though they do not affect other dire consequences of smoking.

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  • 14.
    af Geijerstam, Peder
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Joelsson, Annelie
    Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Rådholm, Karin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Kärna. The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Nyström, Fredrik H
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin.
    A low dose of daily licorice intake affects renin, aldosterone, and home blood pressure in a randomized crossover trial2024Ingår i: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 119, nr 3, s. 682-691Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Licorice, 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.

  • 15.
    af Geijerstam, Peder
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum. The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Rådholm, Karin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Kärna. The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Jonasson, Lena
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Lindahl, Tomas
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk kemi. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi.
    Engvall, Jan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Nyström, Fredrik H.
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin.
    Alfredsson, Joakim
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    P-selectin and C-reactive protein in relation to home blood pressure and coronary calcification: a SCAPIS substudy2024Ingår i: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Soluble P-selectin (sP-selectin) and high-sensitivity C-reactive protein (hsCRP) have previously been associated with hypertension, but the relation with out-of-office blood pressure (BP) and coronary artery calcification score is unknown. We aimed to examine the relationship between sP-selectin, hsCRP and home BP, as well as coronary artery calcification score and carotid artery plaques.

    Methods: In the Swedish CArdioPulmonary bioImage Study (SCAPIS), 5057 randomly selected participants were evaluated with office and home BP using the semi-automatic Omron M10-IT device. For this cross-sectional study, participants with sP-selectin <4 standard deviations above mean and hsCRP <5 mg/l, representing low-grade inflammation, were included. Using generalized linear models, these inflammatory markers were evaluated in relation to BP classifications, as well as coronary artery calcification score and carotid artery plaques.

    Results: Of participants, 4548 were included in the analyses. The median age was 57.2 (53.4–61.2) years, and 775 (17.0%) reported taking medication for hypertension. Participants in the highest quartile of sP-selectin [odds ratio (OR) 1.67, 95% confidence interval (CI) 1.40–1.98, P < 0.001] and hsCRP [OR 2.25, (95% CI 1.89–2.60), P < 0.001] were more likely to have sustained hypertension. Participants in the highest quartile of hsCRP were also more likely to have masked hypertension, OR (95% CI) 2.31 (1.72–3.10), P < 0.001 and carotid artery plaques, OR (95% CI) 1.21 (1.05–1.38), P = 0.007.

    Conclusion: Increased sP-selectin and hsCRP were independently associated with sustained hypertension. These findings indicate an association between hypertension and platelet activity, as expressed by sP-selectin.

    Publikationen är tillgänglig i fulltext från 2025-03-19 00:00
  • 16.
    af Geijerstam, Peder
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Rådholm, Karin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Kärna.
    Nyström, Fredrik
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin.
    Liten mängd lakrits ökar hemblodtrycket2024Ingår i: Vaskulär Medicin, ISSN 2000-3188, Vol. 40, nr 1, s. -24Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 17.
    Agreus, Lars
    et al.
    Institutionen för neurobiologi, vårdvetenskap och samhälle, Karolinska institutet, Stockholm, Sverige; Öregrunds vårdcentral, Sverige.
    Borgquist, Lars
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Tsoposidis, Alexandros
    Avdelningen för kirurgi, institutionen för kliniska vetenskaper, Göteborgs universitet, Sverige; Sahlgrenska universitetssjukhuset/Östra, Göteborg, Sverige.
    Wallenius, Ville
    Avdelningen för kirurgi, institutionen för kliniska vetenskaper, Göteborgs universitet, Sverige; Sahlgrenska universitetssjukhuset/Östra, Göteborg, Sverige.
    Kostic, Srdjan
    Avdelningen för kirurgi, institutionen för kliniska vetenskaper, Göteborgs universitet, Sverige; Sahlgrenska universitetssjukhuset/Östra, Göteborg, Sverige.
    Lundell, Lars
    Avdelningen för kirurgi, CLINTEC, Karolinska institutet, Stockholm, Sverige.
    Lindberg, Greger
    Institutionen för medicin Huddinge, Karolinska institutet, Sverige; PF mag- och tarmsjukdomar, Karolinska universitetssjukhuset, Stockholm, Sverige.
    Stor överförskrivning och ökat bruk av protonpumpshämmare: Utbildning och information är en nyckel till att vägleda läkare och allmänhet till rätt användning [Significant over- and misuse of PPIs]2021Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Protonpumpshämmare är den bästa behandlingen försyrarelaterade störningar.

    De viktigaste indikationerna för protonpumpshämmare är gastroesofageal refluxsjukdom (GERD), eradikationav H pylori-infektion i kombination med antibiotika, H pylori-negativa magsår och läkning av och profylax mot NSAID-/coxib-inducerade magsår, hypersekretoriska sjukdomstillstånd som Zollinger–Ellisons syndrom.

    Marknaden för protonpumpshämmare fortsätter attväxa i de flesta länder.

    Ett stort antal internationella publikationer dokumenterar att överförskrivning av protonpumpshämmarefortsätter att vara mycket utbredd, både inom och utanför sjukhus, och utan tendens att minska.

    De främsta orsakerna till överförskrivning av protonpumpshämmare är väl kända och tydligt definierade.

    De två viktigaste konsekvenserna av överförskrivning är skenande läkemedelskostnader och risk för biverkningar.

    Utbildning och information är nyckeln till att vägledasjukhusläkare, primärvårdsläkare och allmänhet till rättanvändning av protonpumpshämmare.

  • 18.
    Ahlstrom, Christer
    et al.
    Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Anund, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Fors, Carina
    Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Akerstedt, Torbjorn
    Stockholm Univ, Sweden; Karolinska Inst, Sweden.
    The effect of daylight versus darkness on driver sleepiness: a driving simulator study2018Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27, nr 3, artikel-id e12642Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Driver sleepiness studies are often carried out with alert drivers during daytime and sleep-deprived drivers during night-time. This design results in a mixture of different factors (e.g. circadian effects, homeostatic effects, light conditions) that may confound the results. The aim of this study was to investigate the effect of light conditions on driver sleepiness. Thirty young male drivers (23.6 +/- 1.7years old) participated in a driving simulator experiment where they drove on a rural road. A 2x2 design was used with the conditions daylight versus darkness, and daytime (full sleep) versus night-time (sleep deprived). The results show that light condition had an independent effect on the sleepiness variables. The subjective sleepiness measured by Karolinska Sleepiness Scale was higher, lateral position more left-oriented, speed lower, electroencephalogram alpha and theta higher, and blink durations were longer during darkness. The number of line crossings did not change significantly with light condition. The day/night condition had profound effects on most sleepiness indicators while controlling for light condition. The number of line crossings was higher during night driving, Karolinska Sleepiness Scale was higher, blink durations were longer and speed was lower. There were no significant interactions, indicating that light conditions have an additive effect on sleepiness. In conclusion, Karolinska Sleepiness Scale and blink durations increase primarily with sleep deprivation, but also as an effect of darkness. Line crossings are mainly driven by the need for sleep and the reduced alertness at the circadian nadir. Lane position is, however, more determined by light conditions than by sleepiness.

  • 19.
    Ahlstrom, Christer
    et al.
    Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Lovgren, Maria Gink
    Volvo Bus Corp, Denmark.
    Nilsson, Mats
    Volvo Bus Corp, Denmark.
    Willstrand, Tania Dukic
    Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Anund, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Rehabiliteringsmedicinska kliniken. Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    The effect of an active steering system on city bus drivers muscle activity2019Ingår i: International Journal of Occupational Safety and Ergonomics, ISSN 1080-3548, E-ISSN 2376-9130, Vol. 25, nr 3, s. 377-385Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    City bus drivers spend hours driving under time pressure, in congested traffic and in a monotonous sitting position. This leads to unhealthy working conditions, especially in terms of physical and psychological stress. The aim of this study is to investigate whether an active steering system can alleviate the musculoskeletal stress involved in manoeuvring a bus. Twenty bus drivers drove a city bus equipped with the Volvo dynamic steering (VDS) support system in real traffic. Steering effort was evaluated with electromyography and with a questionnaire. Compared to baseline, VDS significantly reduced the required muscle activity by on average 15-25% while turning, and up to 68% in the part of the manoeuvre requiring maximum effort. The bus drivers believed that VDS will help reduce neck and shoulder problems, and they expressed a desire to have VDS installed in their own bus.

  • 20.
    Ahlström, Christer
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten. Swedish Natl Rd & Transport Res Inst, S-58195 Linkoping, Sweden.
    Anund, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Rehabiliteringsmedicinska kliniken. Swedish Natl Rd & Transport Res Inst, S-58195 Linkoping, Sweden.
    Development of sleepiness in professional truck drivers: Real-road testing for driver drowsiness and attention warning (DDAW) system evaluation2024Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    All new vehicle types within the European Union must now be equipped with a driver drowsiness and attention warning system starting from 2022. The specific requirements for the test procedure necessary for type approval are defined in the Annex of EU Regulation C/2021/2639. The objectives of this study were to: (i) investigate how sleepiness develops in professional truck drivers under real-road driving conditions; and (ii) assess the feasibility of a test procedure for validating driver drowsiness and attention warning systems according to the EU regulation. Twenty-four professional truck drivers participated in the test. They drove for 180 km on a dual-lane motorway, first during daytime after a normal night's sleep and then at nighttime after being awake since early morning. The results showed higher sleepiness levels during nighttime driving compared with daytime, with a faster increase in sleepiness with distance driven, especially during the night. Psychomotor vigilance task results corroborated these findings. From a driver drowsiness and attention warning testing perspective, the study design with sleep-deprived drivers at night was successful in inducing the targeted sleepiness level of a Karolinska Sleepiness Scale score of &gt;= 8. Many drivers who reported a Karolinska Sleepiness Scale &gt;= 8 during the drives also acknowledged feeling sleepy in the post-drive questionnaire. Reaching high levels of sleepiness on real roads during daytime is more problematic, not the least from legal and ethical perspectives as higher traffic densities during the daytime lead to increased risks.

  • 21.
    Ahlström, Christer
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten. Swedish Natl Rd & Transport Res Inst VTI, S-58195 Linkoping, Sweden.
    van Leeuwen, Wessel
    Stockholm Univ, Sweden.
    Krupenia, Stas
    Scania CV AB, Sweden.
    Jansson, Herman
    Smart Eye AB, Sweden.
    Finer, Svitlana
    Smart Eye AB, Sweden.
    Anund, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Swedish Natl Rd & Transport Res Inst VTI, S-58195 Linkoping, Sweden; Stockholm Univ, Sweden.
    Kecklund, Goran
    Stockholm Univ, Sweden.
    Real-Time Adaptation of Driving Time and Rest Periods in Automated Long-Haul Trucking: Development of a System Based on Biomathematical Modelling, Fatigue and Relaxation Monitoring2022Ingår i: IEEE transactions on intelligent transportation systems (Print), ISSN 1524-9050, E-ISSN 1558-0016, Vol. 23, nr 5, s. 4758-4766Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Hours of service regulations govern the working hours of commercial motor vehicle drivers, but these regulations may become more flexible as highly automated vehicles have the potential to afford periods of in-cab rest or even sleep while the vehicle is moving. A prerequisite is robust continuous monitoring of when the driver is resting (to account for reduced time on task) or sleeping (to account for the reduced physiological drive to sleep). The overall aims of this paper are to raise a discussion of whether it is possible to obtain successful rest during automated driving, and to present initial work on a hypothetical data driven algorithm aimed to estimate if it is possible to gain driving time after resting under fully automated driving. The presented algorithm consists of four central components, a heart rate-based relaxation detection algorithm, a camera-based sleep detection algorithm, a fatigue modelling component taking time awake, time of day and time on task into account, and a component that estimates gained driving time. Real-time assessment of driver fitness is complicated, especially when it comes to the recuperative value of in-cab sleep and rest, as it depends on sleep quality, time of day, homeostatic sleep pressure and on the activities that are carried out while resting. The monotony that characterizes for long-haul truck driving is clearly interrupted for a while, but the long-term consequences of extended driving times, including user acceptance of the key stakeholders, requires further research.

  • 22.
    Ahlström, Christer
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten. Swedish Natl Rd & Transport Res Inst VTI, Olaus Magnus Vag 35, SE-58330 Linkoping, Sweden.
    Zemblys, Raimondas
    SmartEye AB, Sweden.
    Jansson, Herman
    SmartEye AB, Sweden.
    Forsberg, Christian
    Autol Dev AB, Sweden.
    Karlsson, Johan
    Autol Dev AB, Sweden.
    Anund, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Swedish Natl Rd & Transport Res Inst VTI, Olaus Magnus Vag 35, SE-58330 Linkoping, Sweden; Stockholm Univ, Sweden.
    Effects of partially automated driving on the development of driver sleepiness2021Ingår i: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 153, artikel-id 106058Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The objective of this study was to compare the development of sleepiness during manual driving versus level 2 partially automated driving, when driving on a motorway in Sweden. The hypothesis was that partially auto-mated driving will lead to higher levels of fatigue due to underload. Eighty-nine drivers were included in the study using a 2 ? 2 design with the conditions manual versus partially automated driving and daytime (full sleep) versus night-time (sleep deprived). The results showed that night-time driving led to markedly increased levels of sleepiness in terms of subjective sleepiness ratings, blink durations, PERCLOS, pupil diameter and heart rate. Partially automated driving led to slightly higher subjective sleepiness ratings, longer blink durations, decreased pupil diameter, slower heart rate, and higher EEG alpha and theta activity. However, elevated levels of sleepiness mainly arose from the night-time drives when the sleep pressure was high. During daytime, when the drivers were alert, partially automated driving had little or no detrimental effects on driver fatigue. Whether the negative effects of increased sleepiness during partially automated driving can be compensated by the positive effects of lateral and longitudinal driving support needs to be investigated in further studies.

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  • 23.
    Akerblom, Sophia
    et al.
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Cervin, Matti
    Lund Univ, Sweden.
    Perrin, Sean
    Lund Univ, Sweden.
    Fischer, Marcelo Rivano
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Gerdle, Björn
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    McCracken, Lance M.
    Uppsala Univ, Sweden.
    A Network Analysis of Clinical Variables in Chronic Pain: A Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)2021Ingår i: Pain medicine, ISSN 1526-2375, E-ISSN 1526-4637, Vol. 22, nr 7, s. 1591-1602Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Efforts to identify specific variables that impact most on outcomes from interdisciplinary pain rehabilitation are challenged by the complexity of chronic pain. Methods to manage this complexity are needed. The purpose of the study was to determine the network structure entailed in a set of self-reported variables, examine change, and look at potential predictors of outcome, from a network perspective. Methods. In this study we apply network analysis to a large sample of people seeking interdisciplinary pain treatment (N = 2,241). Variables analyzed include pain intensity, pain interference, extent of pain, depression, anxiety, insomnia, and psychological variables from cognitive behavioral models of chronic pain. Results. We found that Acceptance, Pain Interference, and Depression were key, "central," variables in the pretreatment network. Interestingly, there were few changes in the overall network configuration following treatment, specifically with respect to which variables appear most central relative to each other. On the other hand, Catastrophizing, Depression, Anxiety, and Pain Interference each became less central over time. Changes in Life Control, Acceptance, and Anxiety were most strongly related to changes in the remainder of the network as a whole. Finally, no network differences were found between treatment responders and non-responders. Conclusions. This study highlights potential future targets for pain treatment. Further application of a network approach to interdisciplinary pain rehabilitation data is recommended. Going forward, it may be better to next do this in a more comprehensive theoretically guided fashion, and ideographically, to detect unique individual differences in potential treatment processes.

  • 24.
    Aktaa, Suleman
    et al.
    Univ Leeds, England; Univ Leeds, England; Leeds Teaching Hosp NHS Trust, England.
    Gencer, Baris
    Geneva Univ Hosp, Switzerland; Univ Bern, Switzerland.
    Arbelo, Elena
    Univ Barcelona, Spain; Inst Invest August Pi i Sunyer IDIBAPS, Spain; Ctr Invest Biomed Enfermedades Cardiovasc CIBERCV, Spain.
    Davos, Constantinos H.
    Acad Athens, Greece.
    Desormais, Ileana
    Dupuytren Univ Hosp, France.
    Hollander, Monika
    Univ Utrecht, Netherlands.
    Abreu, Ana
    Ctr Hosp Univ Lisboa Norte CHULN Lisboa, Portugal.
    Ambrosetti, Marco
    Rivolta Dadda Hosp, Italy.
    Bäck, Maria
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Carballo, David
    Univ Hosp Geneva, Switzerland.
    Crawford, Carolyn
    ESC Patient Forum, France.
    Deaton, Christi
    Univ Cambridge, England.
    Dendale, Paul
    Hasselt Univ, Belgium; Hasselt Univ, Belgium.
    Eijsvogels, Thijs M. H.
    Radboud Univ Nijmegen, Netherlands.
    Galbraith, Mary
    ESC Patient Forum, France.
    Piepoli, Massimo Francesco
    Guglielmo da Saliceto Hosp, Italy; Univ Pof Parma, Italy.
    Salzwedel, Annett
    Univ Potsdam, Germany.
    Smulders, Yvo
    Amsterdam UMC, Netherlands.
    Wilhelm, Matthias
    Univ Bern, Switzerland.
    Biondi-Zoccai, Giuseppe
    Sapienza Univ Rome, Italy; Mediterranea Cardioctr, Italy.
    Mach, Francois
    Geneva Univ Hosp, Switzerland.
    Visseren, Frank L. J.
    Univ Utrecht, Netherlands.
    Gale, Chris P.
    Univ Leeds, England; Univ Leeds, England; Leeds Teaching Hosp NHS Trust, England.
    European Society of Cardiology Quality Indicators for Cardiovascular Disease Prevention: developed by the Working Group for Cardiovascular Disease Prevention Quality Indicators in collaboration with the European Association for Preventive Cardiology of the European Society of Cardiology2022Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, nr 7, s. 1060-1071Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims To develop a set of quality indicators (QIs) for the evaluation of the care and outcomes for atherosclerotic cardiovascular disease (ASCVD) prevention. Methods and results The Quality Indicator Committee of the European Society of Cardiology (ESC) formed the Working Group for Cardiovascular Disease Prevention Quality Indicators in collaboration with Task Force members of the 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice and the European Association of Preventive Cardiology (EAPC). We followed the ESC methodology for QI development, which involved (i) the identification of the key domains of care for ASCVD prevention by constructing a conceptual framework of care, (ii) the development of candidate QIs by conducting a systematic review of the literature, (iii) the selection of the final set of QIs using a modified Delphi method, and (iv) the evaluation of the feasibility of the developed QIs. In total, 17 main and 14 secondary QIs were selected across six domains of care for ASCVD prevention: (i) structural framework, (ii) risk assessment, (iii) care for people at risk for ASCVD, (iv) care for patients with established ASCVD, (v) patient education and experience, and (vi) outcomes. Conclusion We present the 2021 ESC QIs for Cardiovascular Disease Prevention, which have been co-constructed with EAPC using the ESC methodology for QI development. These indicators are supported by evidence from the literature, underpinned by expert consensus and aligned with the 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice to offer a mechanism for the evaluation of ASCVD prevention care and outcomes.

  • 25.
    Alalawi, Ahmed
    et al.
    Univ Birmingham, England; Umm Al Qura Univ, Saudi Arabia.
    Evans, David W.
    Univ Birmingham, England.
    Liew, Bernard
    Univ Essex, England.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Arbets- och miljömedicin.
    Heneghan, Nicola
    Univ Birmingham, England.
    Rushton, Alison
    Univ Birmingham, England.
    Peterson, Gunnel
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Uppsala Univ, Sweden.
    Barbero, Marco
    Univ Appl Sci & Arts Southern Switzerland, Switzerland.
    Falla, Deborah
    Univ Birmingham, England.
    Does Pain Extent Predict Ongoing Pain and Disability in Patients with Chronic Whiplash-Associated Disorders?2022Ingår i: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 11, nr 3, artikel-id 555Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study investigates whether baseline pain extent, extracted from an electronic pain drawing, is an independent predictive factor of pain and disability measured 1 year and 2 years later in people with chronic WAD. Participants completed questionnaires assessing neck pain intensity, disability via the Neck Disability Index (NDI), psychological features, and work ability. Participants also completed electronic pain drawings from which their pain extent was extracted. A two-step modelling approach was undertaken to identify the crude and adjusted association between pain extent and NDI measured at 1-year and 2-year follow-ups. A total of 205 participants were included in the analysis. The univariate analysis showed that pain extent was significantly associated with the NDI score at the 1-year (p = 0.006, 95% CI: 0.159-0.909) and 2-year (p = 0.029, 0.057-0.914) follow-ups. These associations were not maintained when we introduced perceived disability, psychological health, and work ability into the model after 1 year (p = 0.56, 95%CI: -0.28-0.499) and 2 years (p = 0.401, -0.226-0.544). Pain extent, as an independent factor, was significantly associated with perceived pain and disability in patients with chronic WAD for up to 2 years. This association was masked by neck disability, psychological health, and work ability.

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  • 26.
    Alfredson, Hakan
    et al.
    Umea Univ, Sweden; Capio Ortho Ctr Skane, Sweden.
    Roberts, David
    Capio Ortho Ctr Skane, Sweden.
    Spang, Christoph
    Umea Univ, Sweden; Wurzburg Univ, Germany; Private Orthopaed Spine Ctr, Germany.
    Walden, Markus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Capio Ortho Ctr Skane, Sweden.
    Ultrasound- and Doppler-Guided WALANT Arthroscopic Surgery for Patellar Tendinopathy with Partial Rupture in Elite Athletes-A 2-Year Follow-Up of a Prospective Case Series2024Ingår i: Medicina, ISSN 1010-660X, E-ISSN 1648-9144, Vol. 60, nr 4, artikel-id 541Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and Objectives: Patellar tendinopathy is difficult to treat, and when combined with partial rupture, there are additional challenges. The aim of this study was to evaluate the subjective outcome and return-to-sport status after ultrasound (US)- and colour doppler (CD)-guided wide awake local anaesthetic no tourniquet (WALANT) arthroscopic shaving in elite athletes. Material and Methods: Thirty Swedish and international elite athletes (27 males) with a long duration (&gt;1 year) of persistent painful patellar tendinopathy in 35 patellar tendons, not responding to non-surgical treatment, were included. All patients were treated with the same protocol of arthroscopic shaving, including bone removal and debridement of partial rupture, followed by at least 3 months of structured rehabilitation. The VISA-P score and a study-specific questionnaire evaluating physical activity level and subjective satisfaction with the treatment were used for evaluation. Results: At the 2-year follow-up (mean 23, range 8-38 months), 25/30 patients (29/35 tendons) were satisfied with the treatment result and had returned to their pre-injury sport. The mean VISA-P score increased from 37 (range 7-69) before surgery to 80 (range 44-100) after surgery (p &lt; 0.05). There was one drop-out (one tendon). There were no complications. Conclusions: US- and CD-guided WALANT arthroscopic shaving for persistent painful patellar tendinopathy, including bone removal and debridement of partial rupture, followed by structured rehabilitation showed good clinical results in the majority of the elite-level athletes.

  • 27.
    Alfredson, Hakan
    et al.
    Umea Univ, Sweden; Capio Ortho Ctr Skane, Sweden.
    Walden, Markus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Capio Ortho Ctr Skane, Sweden.
    Roberts, David
    Capio Ortho Ctr Skane, Sweden.
    Spang, Christoph
    Umea Univ, Sweden; Private Orthopaed Spine Ctr, Germany; Wurzburg Univ, Germany.
    Tendinopathic Plantaris but Normal Achilles Tendon Found in About One-Fifth of Patients Not Responding to Conservative Achilles Tendon Management - Results from a Prospective WALANT Surgical Case Series on 105 Tendons2024Ingår i: Open Access Journal of Sports Medicine, E-ISSN 1179-1543, Vol. 15, s. 41-45Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Midportion Achilles tendinopathy is a relatively common condition. This study aimed to investigate the presence of a normal Achilles tendon, but a tendinopathic plantaris tendon, in a large and consecutive prospective sample of patients referred to a specialised tendon clinic for midportion Achilles tendon pain not responding to non-surgical treatment. Patients and Methods: A total of 105 consecutive tendons were operated on in 81 patients (62 males) suffering from painful midportion Achilles tendon pain. Clinical examination, ultrasound (US) and colour Doppler (CD) examination, and wide awake local anaesthetic no tourniquet (WALANT) surgery were performed in all patients. Results: For 19/105 (18%) tendons from 14 patients, clinical examination suspected plantaris tendinopathy alone as there was a distinct tenderness on the medial side, but no thickening of the Achilles tendon. US examination followed by surgery confirmed the diagnosis. Conclusion: Midportion Achilles tendon pain is not always related to Achilles tendinopathy since pain related to the plantaris tendon alone was found in almost every fifth patient. Consequently, there is an obvious need for proper examination to identify the pain source and establish a correct diagnosis before treatment.

  • 28.
    Alfredson, Hakan
    et al.
    Umea Univ, Sweden; Capio Ortho Ctr Skane, Sweden.
    Waldén, Markus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Capio Ortho Ctr Skane, Sweden.
    Roberts, David
    Capio Ortho Ctr Skane, Sweden.
    Spang, Christoph
    Univ Wurzburg, Germany; Umea Univ, Sweden.
    Combined Midportion Achilles and Plantaris Tendinopathy: A 1-Year Follow-Up Study after Ultrasound and Color-Doppler-Guided WALANT Surgery in a Private Setting in Southern Sweden2023Ingår i: Medicina, ISSN 1010-660X, E-ISSN 1648-9144, Vol. 59, nr 3, artikel-id 438Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and Objectives: Chronic painful midportion Achilles combined with plantaris tendinopathy can be a troublesome condition to treat. The objective was to prospectively follow patients subjected to ultrasound (US)- and color doppler (CD)-guided wide awake, local anesthetic, no-tourniquet (WALANT) surgery in a private setting. Material and Methods: Twenty-six Swedish patients (17 men and 9 women, mean age 50 years (range 29-62)) and eight international male patients (mean age of 38 years (range 25-71)) with combined midportion Achilles and plantaris tendinopathy in 45 tendons altogether were included. All patients had had &gt;6 months of pain and had tried non-surgical treatment with eccentric training, without effect. US + CD-guided surgical scraping of the ventral Achilles tendon and plantaris removal under local anesthesia was performed on all patients. A 4-6-week rehabilitation protocol with an immediate full-weight-bearing tendon loading regime was used. The VISA-A score and a study-specific questionnaire evaluating physical activity level and subjective satisfaction with the treatment were used for evaluation. Results: At the 1-year follow-up, 32/34 patients (43 tendons) were satisfied with the treatment result and had returned to their pre-injury Achilles tendon loading activity. There were two dropouts (two tendons). For the Swedish patients, the mean VISA-A score increased from 34 (0-64) before surgery to 93 (61-100) after surgery (p &lt; 0.001). There were two complications, one wound rupture and one superficial skin infection. Conclusions: For patients suffering from painful midportion Achilles tendinopathy and plantaris tendinopathy, US + CD-guided surgical Achilles tendon scraping and plantaris tendon removal showed a high satisfaction rate and good functional results 1 year after surgery.

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  • 29.
    Alfredsson Ågren, Kristin
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård.
    Internet och delaktighet: Hur unga med intellektuell funktionsnedsättning använder internet2021Bok (Övrigt vetenskapligt)
    Abstract [sv]

    Vad handlar boken om?

    Den här boken är en lättläst version och handlar om hur unga med IF i Sverige använder internet. IF betyder intellektuell funktionsnedsättning eller utvecklingsstörning. Kunskapen i boken kommer från forskning. Jag som har forskat heter Kristin Alfredsson Ågren. Jag har också haft två handledare som har hjälpt mig med forskningen.

    Sammanfattning: Unga med IF använder internet ganska mycket

     Vår forskning visar att unga med IF använder internet ganska mycket. Men andra ungdomar använder internet mer. Många unga med IF spelar spel på internet. De använder oftast mobil eller surfplatta. Föräldrar till unga med IF är inte så oroliga för att det kan finnas risker med internet.

    Många behöver mer stöd för att delta på internet

    Många unga med IF tycker ändå det är svårt att till exempel använda dator. De kan också ha svårt att hitta information på internet. De flesta unga med IF behöver stöd för att använda internet. Ungdomar, föräldrar och personal kan tillsammans skapa nya stöd som gör det enklare att använda internet. Internet måste bli mer tillgängligt och information måste bli enklare att förstå. Då kan ungdomar med IF bli mer delaktiga i samhället.

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  • 30. Beställ onlineKöp publikationen >>
    Alfredsson Ågren, Kristin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Internet use and digital participation in everyday life: Adolescents and young adults with intellectual disabilities2020Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    Bakgrund till avhandlingen: Internetanvändning är en integrerad del av vardagen i dagens samhälle, särskilt bland ungdomar. Internet används för att utföra en mängd aktiviteter i vardagen av alltfler personer. Dock är kunskapen om tillgång till, samt användning av internet i vardagliga aktiviteter för ungdomar med intellektuell funktionsnedsättning (IF) bristfällig. Ökad kunskap behövs om digitala kompetenser och digital delaktighet i vardagen för ungdomar och unga vuxna med IF.

    Syftet med avhandlingen: Det övergripande syftet med denna avhandling var att utforska och beskriva tillgång till och användning av internet och digital delaktighet i vardagen bland ungdomar och unga vuxna med IF.

    Hur studierna genomfördes: Avhandlingen bygger på resultat från tre delstudier. I studie I samlades data in via observationer av och uppföljande intervjuer med 15 deltagare med IF, i åldern 13–24 år. Fokus låg på tillgång till och användning av internet i deras vardagliga miljöer: skola/arbete, hemma eller på fritiden. Data analyserades med kvalitativ innehållsanalys. I studie II och III var designen jämförande tvärsnittsstudier. Nationella enkäter från Statens Medieråd om medie- och internetanvändning användes där jämförande data från referensgrupper kunde erhållas. I studie II gjordes kognitiva anpassningar av den nationella enkäten om medie- och internetanvändning i flera steg för målgruppen ungdomar med IF i åldern 13–20 år. Anpassningen till en lättläst version av enkäten, med bildstöd för de som behövde det, gjorde den möjlig att skicka till ett totalurval av elever från alla särskolor i fyra olika kommuner i två olika regioner i Sverige. I studie III användes den nationella enkäten till föräldrar om möjligheter och risker med internet- och medieanvändning för deras ungdomar. Enkäterna skickades till ett urval av n = 318 ungdomar med IF och deras vårdgivare/förälder. Antalet svar var fler från ungdomarna (n = 114) jämfört med föräldrarna (n = 99), och svarsfrekvensen för ungdomar med IF var i paritet med referensgruppens, med 36% för ungdomar med IF, jämfört med 38% i referensgruppen. I studie II användes chi-två tester och vid behov Fisher’s exakta test, för analys av data. I studie III genomfördes analyser med Fisher’s exakta test och logistisk regression för att kontrollera för confounding faktorer dvs övriga faktorer som kan påverka.

    Resultaten som framkom i studierna: Resultaten av studierna visar att tillgången till enheter för internetanvändning är lägre för ungdomar med IF än för ungdomar generellt, med undantag för surfplattor (studie II). Alla internet-aktiviteter, utom att spela spel, utförs av en lägre andel ungdomar med IF jämfört med referensgruppen (studie II) och tiden som spenderas på internet-aktiviteterna är lägre för ungdomar med IF (studie III). Utmaningar i den omgivande miljön, såväl som personliga förmågor leder till svårigheter med internetuppkoppling och internetanvändning (studie I), och påverkar digital delaktighet för ungdomarna och de unga vuxna med IF. Möjligheter och risker med att använda internet visade att en signifikant högre andel föräldrar till ungdomar med IF uppfattar möjligheter förknippade med internetanvändning och att spela spel, och en lägre andel upplever risker med negativa konsekvenser, eller oroar sig för risker med internet jämfört med referensgruppen (studie III). Signifikant fler föräldrar till ungdomar med IF uppfattar dock att deras ungdomar aldrig använder smartphones och sociala medier jämfört med referensgruppen. Strategier, som ungdomar och unga vuxna med både lindrig och måttlig IF använder för att hantera den digitala miljön och delta i internet aktiviteter identifierades (studie I). Strategierna innebär; att få stöd från andra; att minska andelen enheter som används för internetanvändning och att främsta använda enheter som är utformade för/av person; samt att använda stödstrategier som är baserade på ord- bild- och röststöd för att kunna utföra internet-aktiviteter.

    Kunskapen som avhandlingen har bidragit med: Sammantaget visar resultaten en eftersläpning i tillgång till och användning av internet, liksom i digital delaktighet för ungdomar och unga vuxna med IF. Även om deltagarna har tillgång till och använder internet, är det i lägre utsträckning än referensgruppen. Faktorer i miljön tillsammans med deltagarnas personliga förmågor gör utvecklingen av digital kompetens svår för deltagarna. Resultatet att fler föräldrar till ungdomar med IF uppfattar möjligheter och färre uppfattar risker med internet är ny kunskap som kan stödja positivt risktagande i internetanvändning och möjliggöra digital delaktighet för ungdomar med IF. Stöd kan utvecklas i samarbete mellan ungdomar, deras föräldrar och personal, i både skola och kommunal omsorgsverksamhet, och involvera anpassningar av såväl fysisk, som social och digital miljö för utveckling av digitala kompetenser. Genom detta kan eftersläpningen i digital delaktighet i vardagen minimeras, vilket krävs för delaktighet i dagens digitaliserade samhälle

    Delarbeten
    1. Access to and Use of the Internet among Adolscents and Young Adults with Intellectual Disabilities in Everyday Settings.
    Öppna denna publikation i ny flik eller fönster >>Access to and Use of the Internet among Adolscents and Young Adults with Intellectual Disabilities in Everyday Settings.
    2020 (Engelska)Ingår i: Journal of Intellectual & Developmental Disability, ISSN 1366-8250, E-ISSN 1469-9532, nr 1, s. 89-98Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background: The aim is to explore and describe access to the internet and how it is used among adolescents and young adults with mild and moderate intellectual disabilities in their everyday settings. Method: Data were collected through observations of and interviews with 15 participants with intellectual disabilities, aged 13-25, on access and use of the internet in school or work and at home or in their free time. A qualitative content analysis was used. Results: Main findings were categorised into: Access to the internet in different settings, Challenges when using the internet and Strategies to handle the digital environment and take part in internet activities.Conclusions: This study revealed that participants had access to internet connections and to a high number of internet-enabled devices. Participants use the internet through strategies when doing internet activities, for example using pictures and reducing the number of internet-enabled devices used in their everyday settings.

    Ort, förlag, år, upplaga, sidor
    Taylor & Francis, 2020
    Nyckelord
    Intellectual disability, accessibility, internet use, digital divide, youth, developmental disabilities
    Nationell ämneskategori
    Arbetsterapi Annan medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-151985 (URN)10.3109/13668250.2018.1518898 (DOI)000510209300011 ()
    Tillgänglig från: 2018-10-12 Skapad: 2018-10-12 Senast uppdaterad: 2023-10-18
    2. Digital participation? Internet use among adolescents with and without intellectual disabilities: A comparative study
    Öppna denna publikation i ny flik eller fönster >>Digital participation? Internet use among adolescents with and without intellectual disabilities: A comparative study
    2020 (Engelska)Ingår i: New Media and Society, ISSN 1461-4448, E-ISSN 1461-7315, Vol. 22, nr 12, s. 2128-2145Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Internet use is an integrated part of everyday life, especially among young people. However, knowledge of this for young people with disabilities is scarce. This study investigates digital participation of adolescents with intellectual disabilities by comparing aspects of Internet use among adolescents with and without intellectual disabilities. Cross-sectional comparative design was used and a national survey from the Swedish Media Council was cognitively adapted for adolescents with intellectual disabilities aged 13-20 years. The results reveal that a significantly lower proportion of the 114 participating adolescents with intellectual disabilities had access to Internet-enabled devices and performed Internet activities, except for playing games, than the reference group (n = 1161). The greatest difference was found in searching for information. Analyses indicate that adolescents with intellectual disabilities are following a similar pattern of Internet use as the reference group, but a digital lag is prevalent, and a more cognitively accessible web could be beneficial.

    Ort, förlag, år, upplaga, sidor
    SAGE PUBLICATIONS LTD, 2020
    Nyckelord
    Accessibility; digital divide; digital inequality; digital participation; intellectual disability; Internet use; online risks; questionnaire designs; survey method; youth
    Nationell ämneskategori
    Människa-datorinteraktion (interaktionsdesign)
    Identifikatorer
    urn:nbn:se:liu:diva-162754 (URN)10.1177/1461444819888398 (DOI)000498737100001 ()
    Anmärkning

    Funding Agencies|Linkoping University, Sweden; Foundation Solstickan, Stockholm, Sweden; Swedish Association of Occupational Therapy, Stockholm, Sweden

    Tillgänglig från: 2019-12-18 Skapad: 2019-12-18 Senast uppdaterad: 2021-05-01
    3. Internet opportunities and risks for adolescents with intellectual disabilities: a comparative study of parents' perceptions.
    Öppna denna publikation i ny flik eller fönster >>Internet opportunities and risks for adolescents with intellectual disabilities: a comparative study of parents' perceptions.
    2020 (Engelska)Ingår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 27, nr 8, s. 601-613Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background: In contemporary society internet and digital competencies are used to perform activities.

    Aim: The aim of this study is to investigate opportunities and risks of internet use as perceived by the parents of adolescents with intellectual disabilities (ID) in comparison with a national reference group of parents of adolescents.

    Methods: This was a cross-sectional study with group comparisons using a national survey. Analyses were carried out using Fisher's exact test and logistic regression to control for confounding factors.

    Results: A significantly higher proportion of parents of adolescents with ID perceive opportunities associated with internet use and playing games, and a lower proportion perceive risks with negative consequences, compared with the reference group. Significantly more parents of adolescents with ID perceive their adolescent never use smartphones and social media compared with the reference group. Fewer parents of adolescents with ID have concerns about online risks for their adolescents compared with the reference group.

    Conclusion and Significance: The results provide new knowledge for occupational therapists to support positive risk-taking in internet-use for adolescents with ID, in collaboration with their parents, to enable the development of digital competencies and digital participation in everyday life in a digitalised society.

    Ort, förlag, år, upplaga, sidor
    Taylor & Francis, 2020
    Nyckelord
    Digitalisation, digital competence, digital participation, intellectual disability, internet use, online risks, parents, participation, positive risk-taking, youths
    Nationell ämneskategori
    Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Identifikatorer
    urn:nbn:se:liu:diva-168057 (URN)10.1080/11038128.2020.1770330 (DOI)000545335500001 ()32538241 (PubMedID)
    Anmärkning

    Funding: Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden

    Tillgänglig från: 2020-08-13 Skapad: 2020-08-13 Senast uppdaterad: 2021-03-22Bibliografiskt granskad
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  • 31.
    Alfredsson Ågren, Kristin
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Hemmingsson, Helena
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Department of Special Education, Stockholm University, Sweden .
    Kjellberg, Anette
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Access to and Use of the Internet among Adolscents and Young Adults with Intellectual Disabilities in Everyday Settings.2020Ingår i: Journal of Intellectual & Developmental Disability, ISSN 1366-8250, E-ISSN 1469-9532, nr 1, s. 89-98Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The aim is to explore and describe access to the internet and how it is used among adolescents and young adults with mild and moderate intellectual disabilities in their everyday settings. Method: Data were collected through observations of and interviews with 15 participants with intellectual disabilities, aged 13-25, on access and use of the internet in school or work and at home or in their free time. A qualitative content analysis was used. Results: Main findings were categorised into: Access to the internet in different settings, Challenges when using the internet and Strategies to handle the digital environment and take part in internet activities.Conclusions: This study revealed that participants had access to internet connections and to a high number of internet-enabled devices. Participants use the internet through strategies when doing internet activities, for example using pictures and reducing the number of internet-enabled devices used in their everyday settings.

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  • 32.
    Alfredsson Ågren, Kristin
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Hemmingsson, Helena
    Stockholm Univ, Sweden.
    Kjellberg, Anette
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Internet activities and social and community participation among young people with learning disabilities2023Ingår i: British Journal of Learning Disabilities, ISSN 1354-4187, E-ISSN 1468-3156, Vol. 51, nr 2, s. 125-134Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundA digital lag has been reported on access to the internet and performing internet activities for young people with learning disabilities in everyday life. AimThe aim of this study is to explore environmental opportunities and challenges when performing internet activities and how internet use influences social and community participation for young people with learning disabilities from the perspectives of the target group. MethodsAn inductive design was applied, with focused observations and follow-up interviews of 15 internet-using young persons with learning disabilities in their everyday settings. The data was analysed interpretatively using open coding. FindingsThe environment offered both opportunities and challenges in terms of the design of digital devices and digital support. Support from peers was often preferred. All participants performed internet activities related to social participation although not all used social media. Searching for information was performed, however, finding the information or understanding it was challenging and led to restricted participation in the community. ConclusionMore examples of internet use positively influencing social participation were found, contrary to community participation. It is indicated that concrete learning situations when using the internet for social participation were more adapted to the participants and promoted this type of participation, contrary to situations of internet use influencing community participation.

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  • 33.
    Alfredsson Ågren, Kristin
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård.
    Hemmingsson, Helena
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten.
    Kjellberg, Anette
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten.
    Internet use among adolescents with intellectual disabilities at home and school2016Ingår i: Abstract book: International Conference on Cerebral Palsy and other Childhood-onset Disabilities Stockholm 1–4 June 2016, 2016Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Background: Today everyday life depends on having access to, understand and use internet inorder to participate and take part in societal resources. This understanding can be complex forpersons with intellectual disabilities (ID) due to their cognitive impairments. It is even statedthat internet-use can be yet another part of daily life activities they are excluded from. Internet-use is claimed to involve risks, but also benefits for persons with ID, but there is a shortage inempirical studies with the target group ́s own opinion regarding this. Broader knowledge isacquired of internet-use in everyday life for adolescents with ID, as a precondition toparticipation. 

    Aim: This study aims to explore and describe internet-use and doing internet activities at homeand at school among adolescents with mild and moderate intellectual disabilities. Method: The study has a qualitative inductive design using observations and interviews in thetwo settings; at home and at school. Participants are six adolescents with mild and moderate ID,from special schools in the middle-region of Sweden, between the ages 13-20, that use internetto some extent. Data was collected at 2 occasions/participant for about 2hours/participant/setting. The analysis was done using a qualitative content analysis.

    Result: Preliminary results show that adolescents with mild and moderate ID use internet both athome and in school, to a greater extent than was expected, but the doings of internet-activitiesvaries in the different settings. Both facilitating and hindering aspects are described by theparticipants. Pictures on the internet seem to be of support when using and navigating theinternet.

    Conclusion: Deeper knowledge regarding internet-use from the target groups own perspectivehas been gained. The results can be used in the different occupational settings and in furtherresearch to survey internet use and participation in internet-activities

  • 34.
    Alfredsson Ågren, Kristin
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård.
    Holstein, Jane
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten.
    Hur kan ett entreprenöriellt förhållningssätt främjas hos studenter på arbetsterapeutprogrammet?2015Konferensbidrag (Övrigt vetenskapligt)
    Abstract [sv]

    Bakgrund: Strukturerna för den offentliga sektorn och hälso- och sjukvården förändras ständigt, och folkhälsorelaterade problem ökar. Exempel på detta är en ökad andel äldre i befolkningen, eller fetma och psykisk ohälsa hos unga människor. För att möta dessa förändringar och behoven hos klienter i arbetsterapeutisk verksamhet måste nya förhållningssätt användas. Ett sätt att under utbildningen utveckla studenters handlingsberedskap inför framtida insatser kan vara att medvetandegöra och främja ett entreprenöriellt förhållningssättgenom olika lärmoment. Entreprenöriellt förhållningssätt definieras som"ett sätt att se möjligheterna och göra något av dem".

    Syfte: Syftet är att beskriva och utvärdera lärmoment för att främja entreprenöriellt förhållningssätt hos studenter på Arbetsterapeutprogrammet.

    Metod: Två huvudsakliga lärmoment användes för studenterna, och uppföljande utvärderingar genomfördes via enkät med öppna och slutna frågor. Utöver detta anordnades workshop för lärare, som följdes av utvärdering.

    Resultat/preliminärt resultat: Lärmomenten för studenter innebar att arbeta i projektform i gruppmed ett aktivitetsproblem för en specifik målgrupp utifrån Design för alla under handledning. Uppföljande seminarium utifrån specifik litteratur genomfördes. Studenternas utvärdering visar vikten av att ha lärmoment om design och entreprenörskap i utbildningen. Många studenteruppgav att de kunde använda denna kunskap i arbetsterapeutisk verksamhet. Workshop genomfördes med lärare där begrepp inom entreprenörskap diskuterades och kreativa sätt att utveckla lärmoment för studenter inom detta lyftes. I utvärderingen uppgav merparten av lärarna entreprenöriellt förhållningssätt som viktigt inom utbildningen.

    Slutsats: Vikten av lärares förståelse för entreprenöriellt förhållningssätt identifierades. Entreprenöriellt förhållningssätt kan främjas genom att kombinera fler lärmoment för studenter. Genom detta kan studenter utveckla handlingsberedskap gällande utmaningar i ett föränderligt samhälle.

  • 35.
    Alfredsson Ågren, Kristin
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Kjellberg, Anette
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Hemmingsson, Helena
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Stockholm Univ, Sweden.
    Digital participation? Internet use among adolescents with and without intellectual disabilities: A comparative study2020Ingår i: New Media and Society, ISSN 1461-4448, E-ISSN 1461-7315, Vol. 22, nr 12, s. 2128-2145Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Internet use is an integrated part of everyday life, especially among young people. However, knowledge of this for young people with disabilities is scarce. This study investigates digital participation of adolescents with intellectual disabilities by comparing aspects of Internet use among adolescents with and without intellectual disabilities. Cross-sectional comparative design was used and a national survey from the Swedish Media Council was cognitively adapted for adolescents with intellectual disabilities aged 13-20 years. The results reveal that a significantly lower proportion of the 114 participating adolescents with intellectual disabilities had access to Internet-enabled devices and performed Internet activities, except for playing games, than the reference group (n = 1161). The greatest difference was found in searching for information. Analyses indicate that adolescents with intellectual disabilities are following a similar pattern of Internet use as the reference group, but a digital lag is prevalent, and a more cognitively accessible web could be beneficial.

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  • 36.
    Alfredsson Ågren, Kristin
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Kjellberg, Anette
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Hemmingsson, Helena
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Stockholm University, Sweden.
    Internet opportunities and risks for adolescents with intellectual disabilities: a comparative study of parents' perceptions.2020Ingår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 27, nr 8, s. 601-613Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In contemporary society internet and digital competencies are used to perform activities.

    Aim: The aim of this study is to investigate opportunities and risks of internet use as perceived by the parents of adolescents with intellectual disabilities (ID) in comparison with a national reference group of parents of adolescents.

    Methods: This was a cross-sectional study with group comparisons using a national survey. Analyses were carried out using Fisher's exact test and logistic regression to control for confounding factors.

    Results: A significantly higher proportion of parents of adolescents with ID perceive opportunities associated with internet use and playing games, and a lower proportion perceive risks with negative consequences, compared with the reference group. Significantly more parents of adolescents with ID perceive their adolescent never use smartphones and social media compared with the reference group. Fewer parents of adolescents with ID have concerns about online risks for their adolescents compared with the reference group.

    Conclusion and Significance: The results provide new knowledge for occupational therapists to support positive risk-taking in internet-use for adolescents with ID, in collaboration with their parents, to enable the development of digital competencies and digital participation in everyday life in a digitalised society.

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  • 37.
    Alijagic, Andi
    et al.
    Örebro University, Örebro, Sweden.
    Engwall, Magnus
    Örebro University, Örebro, Sweden.
    Särndahl, Eva
    Örebro University, Örebro, Sweden.
    Karlsson, Helen
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Region Östergötland, Medicincentrum, Arbets- och miljömedicin.
    Hedbrant, Alexander
    Örebro University, Örebro, Sweden.
    Andersson, Lena
    Örebro University, Örebro, Sweden.
    Karlsson, Patrik
    Örebro University, Örebro, Sweden.
    Dalemo, Magnus
    Absolent AB, Lidköping, Sweden.
    Scherbak, Nikolai
    Örebro University, Örebro, Sweden.
    Färnlund, Kim
    AMEXCI AB, Karlskoga, Sweden.
    Larsson, Maria
    Örebro University, Örebro, Sweden.
    Persson, Alexander
    Örebro University, Örebro, Sweden.
    Particle Safety Assessment in Additive Manufacturing: From Exposure Risks to Advanced Toxicology Testing.2022Ingår i: Frontiers in Toxicology, E-ISSN 2673-3080, Vol. 4, artikel-id 836447Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Additive manufacturing (AM) or industrial three-dimensional (3D) printing drives a new spectrum of design and production possibilities; pushing the boundaries both in the application by production of sophisticated products as well as the development of next-generation materials. AM technologies apply a diversity of feedstocks, including plastic, metallic, and ceramic particle powders with distinct size, shape, and surface chemistry. In addition, powders are often reused, which may change the particles' physicochemical properties and by that alter their toxic potential. The AM production technology commonly relies on a laser or electron beam to selectively melt or sinter particle powders. Large energy input on feedstock powders generates several byproducts, including varying amounts of virgin microparticles, nanoparticles, spatter, and volatile chemicals that are emitted in the working environment; throughout the production and processing phases. The micro and nanoscale size may enable particles to interact with and to cross biological barriers, which could, in turn, give rise to unexpected adverse outcomes, including inflammation, oxidative stress, activation of signaling pathways, genotoxicity, and carcinogenicity. Another important aspect of AM-associated risks is emission/leakage of mono- and oligomers due to polymer breakdown and high temperature transformation of chemicals from polymeric particles, both during production, use, and in vivo, including in target cells. These chemicals are potential inducers of direct toxicity, genotoxicity, and endocrine disruption. Nevertheless, understanding whether AM particle powders and their byproducts may exert adverse effects in humans is largely lacking and urges comprehensive safety assessment across the entire AM lifecycle-spanning from virgin and reused to airborne particles. Therefore, this review will detail: 1) brief overview of the AM feedstock powders, impact of reuse on particle physicochemical properties, main exposure pathways and protective measures in AM industry, 2) role of particle biological identity and key toxicological endpoints in the particle safety assessment, and 3) next-generation toxicology approaches in nanosafety for safety assessment in AM. Altogether, the proposed testing approach will enable a deeper understanding of existing and emerging particle and chemical safety challenges and provide a strategy for the development of cutting-edge methodologies for hazard identification and risk assessment in the AM industry.

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  • 38.
    Alin, Christina Kaijser
    et al.
    Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Solna, Sweden.
    Grahn Kronhed, Ann-Charlotte
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Rehab Väst.
    Uzunel, Elin
    Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Solna, Sweden.
    Salminen, Helena
    Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Solna, Sweden; Academic Primary Healthcare Centre Stockholm, Stockholm, Sweden.
    Wearing an Activating Spinal Orthosis and Physical Training in Women With Osteoporosis and Back Pain: A Postintervention Follow-Up Study2021Ingår i: Archives of Rehabilitation Research and Clinical Translation, E-ISSN 2590-1095, Vol. 3, nr 4, artikel-id 100154Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To assess the duration of benefits on back pain and back extensor strength in women with osteoporosis who had previously participated in a randomized controlled trial (RCT) involving either exercise or wearing a spinal orthosis.

    Design: A 6-month postintervention follow-up of women who were involved in the interventions in the RCT.SettingThe study was conducted in a primary health care center in Stockholm, Sweden.ParticipantsIn this follow-up study 31 women participated in the spinal orthosis group, and 31 women participated in the exercise group, with a median age of 76 years in both groups (N=62). All women were diagnosed as having osteoporosis, had back pain with or without vertebral fracture, and were 60 years or older, which were the inclusion criteria in the RCT.

    Interventions: The participants received no controlled supervision. The spinal orthosis group was asked to wear the orthosis, and the training group was asked to follow an exercise program for another 6 months voluntarily.

    Main Outcome Measures: Back extensor strength was measured with a computerized device; back pain was estimated by the visual analog scale and by Borg CR-10.

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  • 39.
    Allen, K. D.
    et al.
    Univ North Carolina Chapel Hill, NC 27599 USA; Univ North Carolina Chapel Hill, NC 27599 USA; Durham Dept Vet Affairs Hlth Care Syst, NC 27705 USA.
    Huffman, K.
    Univ North Carolina Chapel Hill, NC 27599 USA; Univ North Carolina Chapel Hill, NC 27599 USA.
    Cleveland, R. J.
    Univ North Carolina Chapel Hill, NC 27599 USA; Univ North Carolina Chapel Hill, NC 27599 USA.
    van der Esch, M.
    Amsterdam Univ Appl Sci, Netherlands.
    Abbott, J. H.
    Univ Otago, New Zealand.
    Abbott, Allan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Bennell, K.
    Univ Melbourne, Australia.
    Bowden, J. L.
    Univ Sydney, Australia; Royal North Shore Hosp, Australia.
    Eyles, J.
    Univ Sydney, Australia; Royal North Shore Hosp, Australia.
    Healey, E. L.
    Keele Univ, England.
    Holden, M. A.
    Keele Univ, England.
    Jayakumar, P.
    Univ Texas Austin, TX 78712 USA.
    Koenig, K.
    Univ Texas Austin, TX 78712 USA.
    Lo, G.
    Baylor Coll Med, TX 77030 USA; Michael E DeBakey VA Med Ctr, TX USA.
    Losina, E.
    Harvard Med Sch, MA 02115 USA.
    Miller, K.
    Univ Wisconsin Madison, WI USA.
    Osteras, N.
    Diakonhjemmet Hosp, Norway.
    Pratt, C.
    Royal North Shore Hosp, Australia.
    Quicke, J. G.
    Chancery Exchange, England; Keele Univ, England.
    Sharma, S.
    Univ New South Wales, Australia; Ctr Pain IMPACT, Australia.
    Skou, S. T.
    Univ Southern Denmark, Denmark; Naestved Slagelse Ringsted Hosp, Denmark.
    Tveter, A. T.
    Diakonhjemmet Hosp, Norway.
    Woolf, A.
    Royal Cornwall Hosp, England.
    Yu, S. P.
    Univ Sydney, Australia; Royal North Shore Hosp, Australia.
    Hinman, R. S.
    Univ Melbourne, Australia.
    Evaluating Osteoarthritis Management Programs: outcome domain recommendations from the OARSI Joint Effort Initiative2023Ingår i: Osteoarthritis and Cartilage, ISSN 1063-4584, E-ISSN 1522-9653, Vol. 31, nr 7, s. 954-965Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To develop sets of core and optional recommended domains for describing and evaluating Osteoarthritis Management Programs (OAMPs), with a focus on hip and knee Osteoarthritis (OA). Design: We conducted a 3-round modified Delphi survey involving an international group of researchers, health professionals, health administrators and people with OA. In Round 1, participants ranked the importance of 75 outcome and descriptive domains in five categories: patient impacts, implementation outcomes, and characteristics of the OAMP and its participants and clinicians. Domains ranked as "important" or "essential" by & GE;80% of participants were retained, and participants could suggest addi-tional domains. In Round 2, participants rated their level of agreement that each domain was essential for evaluating OAMPs: 0 = strongly disagree to 10 = strongly agree. A domain was retained if & GE;80% rated it & GE;6. In Round 3, participants rated remaining domains using same scale as in Round 2; a domain was recommended as "core" if & GE;80% of participants rated it & GE;9 and as "optional" if & GE;80% rated it & GE;7. Results: A total of 178 individuals from 26 countries participated; 85 completed all survey rounds. Only one domain, "ability to participate in daily activities", met criteria for a core domain; 25 domains met criteria for an optional recommendation: 8 Patient Impacts, 5 Implementation Outcomes, 5 Participant Characteristics, 3 OAMP Characteristics and 4 Clinician Characteristics. Conclusion: The ability of patients with OA to participate in daily activities should be evaluated in all OAMPs. Teams evaluating OAMPs should consider including domains from the optional recommended set, with representation from all five categories and based on stakeholder priorities in their local context. Published by Elsevier Ltd on behalf of Osteoarthritis Research Society International.

  • 40.
    Alm Mårtensson, Anna
    et al.
    Länsstyrelsen i Jönköping, Sverige.
    Boström, Anita
    Institutionen för hälsovetenskaper, Karlstads universitet, Sverige.
    Lindmark, Ulrika
    Jönköping University, HHJ, Avd. för naturvetenskap och biomedicin, Sverige.
    Lundgren, Charlie
    Länsstyrelsen Västerbotten, Sverige.
    Ludvigsson, Mikael
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Centrum för social och affektiv neurovetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Psykiatricentrum, Psykiatriska kliniken i Linköping. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård.
    Simmons, Johanna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken.
    Att möta våldsutsatta äldre personer2022Ingår i: Äldre personers utsatthet för våld i nära relationer: Interprofessionella perspektiv / [ed] Lena Östlund, Lund: Studentlitteratur AB , 2022, s. 183-220Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 41.
    Alme, Tomas Nordheim
    et al.
    Akershus Univ Hosp, Norway.
    Andreasson, Anna
    Karolinska Inst, Sweden.
    Asprusten, Tarjei Torre
    Vear Gen Practitioner Grp, Norway.
    Bakken, Anne Karen
    VID Specialized Univ, Norway; St Olavs Hosp, Norway.
    Beadsworth, Michael B. J.
    Liverpool Univ Hosp Fdn Trust, England.
    Boye, Birgitte
    Univ Oslo, Norway; Oslo Univ Hosp, Norway.
    Brodal, Per Alf
    Univ Oslo, Norway.
    Brodwall, Elias Myrstad
    Akershus Univ Hosp, Norway; Univ Oslo, Norway.
    Brurberg, Kjetil Gundro
    Norwegian Inst Publ Hlth, Norway.
    Bugge, Ingrid
    Oslo Univ Hosp, Norway.
    Chalder, Trudie
    Inst Psychiat, England.
    Due, Reidar
    Akershus Univ Hosp, Norway.
    Eriksen, Hege Randi
    Western Norway Univ Appl Sci, Norway.
    Fink, Per Klausen
    Aarhus Univ Hosp, Denmark.
    Flottorp, Signe Agnes
    Norwegian Inst Publ Hlth, Norway; Univ Oslo, Norway.
    Fors, Egil Andreas
    Norwegian Univ Sci & Technol NTNU, Norway.
    Jensen, Bard Fossli
    Kreftregisteret, Norway.
    Fundingsrud, Hans Petter
    Univ Hosp North Norway, Norway.
    Garner, Paul
    Univ Liverpool Liverpool Sch Trop Med, England.
    Havdal, Lise Beier
    Akershus Univ Hosp, Norway.
    Helgeland, Helene
    Lovisenberg Diakonale Hosp, Norway.
    Jacobsen, Henrik Borsting
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Johnson, Georg Espolin
    Univ Oslo, Norway.
    Jonsjoe, Martin
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Knoop, Hans
    Amsterdam Univ Med Ctr, Netherlands.
    Landmark, Live
    NTNU, Norway; Univ Oslo, Norway.
    Launes, Gunvor
    Univ Bergen, Norway.
    Lekander, Mats
    Karolinska Inst, Sweden.
    Linnros, Hannah
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Lindsaeter, Elin
    Karolinska Inst, Sweden.
    Liira, Helena
    Helsinki Univ Hosp, Finland.
    Linnestad, Lina
    Genok, Norway.
    Loge, Jon Hvard
    Univ Oslo, Norway.
    Lyby, Peter Solvoll
    CatoSenteret Rehabil Ctr, Norway.
    Malik, Sadaf
    Akershus Univ Hosp, Norway.
    Malt, Ulrik Fredrik
    Univ Oslo, Norway.
    Moe, Trygve
    Norsk Sykepleierforbund, Norway.
    Norlin, Anna-Karin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Pedersen, Maria
    Akershus Univ Hosp, Norway; Univ Oslo, Norway.
    Pignatiello, Siv Elin
    Oslo Univ Hosp, Norway.
    Rask, Charlotte Ulrikka
    Aarhus Univ Hosp, Denmark.
    Reme, Silje Endresen
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Roksund, Gisle
    Vear Gen Practitioner Grp, Norway.
    Sainio, Markku
    HUS Helsinki Univ Hosp, Finland.
    Sharpe, Michael
    Univ Oxford, England.
    Thorkildsen, Ruth Foseide
    Diakonhjemmet Hosp, Norway.
    van Roy, Betty
    Akershus Univ Hosp, Norway.
    Vandvik, Per Olav
    Lovisenberg Diaconal Hosp, Norway.
    Vogt, Henrik
    Univ Oslo, Norway.
    Wyller, Hedda Bratholm
    Oslo Univ Hosp, Norway.
    Wyller, Vegard Bruun Bratholm
    Akershus Univ Hosp, Norway; Univ Oslo, Norway.
    Chronic fatigue syndromes: real illnesses that people can recover from2023Ingår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 41, nr 4, s. 372-376Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Oslo Chronic Fatigue Consortium consists of researchers and clinicians who question the current narrative that chronic fatigue syndromes, including post-covid conditions, are incurable diseases. Instead, we propose an alternative view, based on research, which offers more hope to patients. Whilst we regard the symptoms of these conditions as real, we propose that they are more likely to reflect the brains response to a range of biological, psychological, and social factors, rather than a specific disease process. Possible causes include persistent activation of the neurobiological stress response, accompanied by associated changes in immunological, hormonal, cognitive and behavioural domains. We further propose that the symptoms are more likely to persist if they are perceived as threatening, and all activities that are perceived to worsen them are avoided. We also question the idea that the best way to cope with the illness is by prolonged rest, social isolation, and sensory deprivation.Instead, we propose that recovery is often possible if patients are helped to adopt a less threatening understanding of their symptoms and are supported in a gradual return to normal activities. Finally, we call for a much more open and constructive dialogue about these conditions. This dialogue should include a wider range of views, including those of patients who have recovered from them.

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  • 42.
    Almquist, Martin
    et al.
    Skånes universitetssjukhus Lund, Sverige.
    Pétursson, Hálfdán
    Omtanken vårdcentral, Kållered, Sverige.
    Hultberg, Josabeth
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Region Östergötland, Primärvårdscentrum, Vårdcentralen Åby.
    Holm, Herman
    överläkare, Psykiatri Skåne, Malmö, Sverige.
    Axelsson, Mathias
    Karolinska universitetssjukhuset, Sverige.
    Cizinsky, Stella
    Universitetssjukhuset Örebro, Sverige.
    Pukk Härenstam, Karin
    Astrid Lindgrens barnsjukhus, Stockholm, Sverige.
    Bergh, Christina
    Sahlgrenska universitetssjukhuset, Sverige.
    Serrander, Martin
    Nyköpings lasarett, Sverige.
    Kloka kliniska val – att avstå det som inte gör nytta för patienten: [Choosing Wisely in Sweden]2023Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 120Artikel, forskningsöversikt (Refereegranskat)
    Abstract [sv]

    Överdiagnostik och överbehandling har uppmärksammats allt mer både i Sverige och internationellt [1], framför allt på grund av stigande vårdkostnader [2]. Noggranna beräkningar från USA visar att 20‒30 procent av sjukvårdsutgifterna går till åtgärder utan patientnytta [3]. Liknande resultat rapporteras från and­ra utvecklade länder [4], och även i Sverige går sjukvårdsutgifter till åtgärder som saknar patientnytta [2]. Förutom ökande kostnader leder överdiagnostik och överbehandling, så kallad lågvärdevård (low-value care), till undanträngningseffekter och risk för patientskada [5]. Behovet av att minska åtgärder med liten, tveksam eller ingen patientnytta har blivit ännu tydligare under coronapandemin [6]. 

    »Choosing wisely« är en internationell kampanj som syftar till att identifiera åtgärder i sjukvården som saknar patientnytta och underlätta utmönstringen  av dem. Kampanjen lanserades av American Board of Internal Medicine 2012 [7] och är i dag spridd till fler än 20 länder [8]. Sverige har ännu inte startat någon formell kampanj, även om Choosing wisely beskrevs i Läkartidningen redan 2013 [9].

  • 43.
    Almstrand, Ann-Charlotte
    et al.
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Bredberg, Anna
    Res Inst Sweden, Sweden.
    Eden, Gunilla Runstrom
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Karlsson, Helen
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Arbets- och miljömedicin.
    Assenhöj, Maria
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Arbets- och miljömedicin.
    Koca, Hatice
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Olin, Anna-Carin
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Tinnerberg, Hakan
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    An explorative study on respiratory health among operators working in polymer additive manufacturing2023Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, artikel-id 1148974Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Additive manufacturing (AM), or 3D printing, is a growing industry involving a wide range of different techniques and materials. The potential toxicological effects of emissions produced in the process, involving both ultrafine particles and volatile organic compounds (VOCs), are unclear, and there are concerns regarding possible health implications among AM operators.The objective of this study was to screen the presence of respiratory health effects among people working with liquid, powdered, or filament plastic materials in AM. MethodsIn total, 18 subjects working with different additive manufacturing techniques and production of filament with polymer feedstock and 20 controls participated in the study. Study subjects filled out a questionnaire and underwent blood and urine sampling, spirometry, impulse oscillometry (IOS), exhaled NO test (FeNO), and collection of particles in exhaled air (PEx), and the exposure was assessed. Analysis of exhaled particles included lung surfactant components such as surfactant protein A (SP-A) and phosphatidylcholines. SP-A and albumin were determined using ELISA. Using reversed-phase liquid chromatography and targeted mass spectrometry, the relative abundance of 15 species of phosphatidylcholine (PC) was determined in exhaled particles. The results were evaluated by univariate and multivariate statistical analyses (principal component analysis). ResultsExposure and emission measurements in AM settings revealed a large variation in particle and VOC concentrations as well as the composition of VOCs, depending on the AM technique and feedstock. Levels of FeNO, IOS, and spirometry parameters were within clinical reference values for all AM operators. There was a difference in the relative abundance of saturated, notably dipalmitoylphosphatidylcholine (PC16:0_16:0), and unsaturated lung surfactant lipids in exhaled particles between controls and AM operators. ConclusionThere were no statistically significant differences between AM operators and controls for the different health examinations, which may be due to the low number of participants. However, the observed difference in the PC lipid profile in exhaled particles indicates a possible impact of the exposure and could be used as possible early biomarkers of adverse effects in the airways.

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  • 44.
    Alriksson, Stina
    et al.
    Linnaeus Univ, Sweden.
    Voxberg, Elin
    Linnaeus Univ, Sweden.
    Karlsson, Helen
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Arbets- och miljömedicin.
    Ljunggren, Stefan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Arbets- och miljömedicin.
    Augustsson, Anna
    Linnaeus Univ, Sweden.
    Temporal risk assessment-20th century Pb emissions to air and exposure via inhalation in the Swedish glass district2023Ingår i: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 858, artikel-id 159843Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The objective of the present study was to assess historical emissions of Pb to air around a number of glassworks sites in southeastern Sweden, and the possible implications for human exposure. To do so, a four-step method was applied. First, emissions of Pb to air around 10 glassworks were modelled for the 20th century. Second, an assessment of the resulting exposure was made for a number of scenarios. Third, the number of people potentially exposed at different times was estimated, and fourth, measurements of "current" Pb concentrations in PM10 material from four sites were conducted in 2019. The results show that the highest emissions, and exposures, occurred from 1970 to1980. It coincides with the time period when the highest number of people resided in the villages. At this time, the average Pb concentration in air around the six largest factories was about 2.4 mu g Pb/m3, i.e. 16 times the present US national ambient air quality standard (NAAQS) of 0.15 mu g Pb/m3. By year 2000 the modelled average concentration had dropped to 0.05 mu g Pb/m3, a level that is normal for urban regions today. The PM10 measurements from 2019 indicate a further decline, now with a mean value of about 0.02 mu g Pb/m3. Over the entire study period, inhalation hazard quotients (HQs) exceeded the dietary HQ by many orders of magnitude, indicating that inhalation has been the most prevalent exposure pathway in the past. At present, both pathways are judged to be associated with low exposures. Even if only roughly approximated, a picture of the historical exposure can increase our understanding of the connection between exposure and disease, and can be valuable when risks are to be communicated to residents near contaminated areas.

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  • 45.
    Anderson Åhlfeldt, Douglas
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård. Linköpings universitet, Medicinska fakulteten.
    Vixner, Linda
    School of Health and Welfare, Dalarna University, Falun, Sweden.
    Stålnacke, Britt-Marie
    Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
    Boersma, Katja
    The Center for Health and Medical Psychology, School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
    Löfgren, Monika
    Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden.
    Fischer, Marcelo Rivano
    Department of Health Sciences, Research Group Rehabilitation Medicine, Lund University, SE-221 00 Lund, Sweden; Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden.
    Enthoven, Paul
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Healthcare Professionals' Perceptions of and Attitudes towards a Standardized Content Description of Interdisciplinary Rehabilitation Programs for Patients with Chronic Pain-A Qualitative Study2023Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 20, nr 9, artikel-id 5661Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Interdisciplinary pain rehabilitation (IPR) is a recommended treatment for people with chronic pain. An inadequate description of the content of IPR programs makes it difficult to draw conclusions regarding their effects. The purpose of this study was to describe the perceptions and attitudes of healthcare professionals toward a content description of IPR programs for patients with chronic pain. Individual interviews with healthcare professionals (n = 11) working in IPR teams in Sweden were conducted between February and May 2019. Analysis of the interviews resulted in a theme: interdisciplinary pain rehabilitation is a complex intervention, with three categories: limitations in the description of IPR programs; lack of knowledge about IPR and chronic pain; and facilitating and hindering factors for using the content description of IPR programs. Conclusion: Healthcare professionals perceived that IPR programs could be described through a general content description. A general content description could enhance the quality of IPR programs through a better understanding of their content and a comparison of different IPR programs. Healthcare professionals also expressed the importance of a content description being a guide rather than a steering document.

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  • 46.
    Andersson, Jonny K.
    et al.
    Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
    Bengtsson, Håkan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Waldén, Markus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Hassleholm Kristianstad Hosp, Sweden.
    Karlsson, Jon
    Linköpings universitet, Medicinska fakulteten. Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Ekstrand, Jan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Hand, Wrist, and Forearm Injuries in Male Professional Soccer Players: A Prospective Cohort Study of 558 Team-Seasons From 2001-2002 to 2018-20192021Ingår i: The Orthopaedic Journal of Sports Medicine, ISSN 2325-9671, Vol. 9, nr 1, artikel-id 2325967120977091Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The literature on upper extremity injuries in professional soccer players is scarce, and further insight into the onset and cause of these injuries as well as potential differences between goalkeepers and outfield players is important. Purpose: To investigate the epidemiology of hand, wrist, and forearm injuries in male professional soccer players between 2001 and 2019. Study Design: Descriptive epidemiology study. Methods: Between the 2001-2002 and 2018-2019 seasons, 120 European male soccer teams were followed prospectively for a varying number of seasons (558 team-seasons in total). Time-loss injuries and player-exposures to training sessions and matches were recorded on an individual basis in 6754 unique players. Injury incidence was reported as the number of injuries per 1000 player-hours, and between-group differences were analyzed using Z statistics and rate ratios (RRs) with 95% CIs. Between-group differences in layoff time were analyzed. Results: In total, 25,462 injuries were recorded, with 238 (0.9%) of these affecting the hand (71.4%; n = 170), wrist (16.8%; n = 40), and forearm (11.8%; n = 28), producing an incidence of 0.065 injuries per 1000 hours. A majority of the injuries were traumatic with an acute onset (98.7%; n = 235). Fractures were the most common injuries recorded (58.8%; n = 140), often involving the metacarpal bones (25.2%; n = 60) and phalanges (10.1%; n = 24). The injury incidence was significantly higher for goalkeepers (115 injuries; 0.265 per 1000 hours) compared with outfield players (123 injuries; 0.038 per 1000 hours) (RR, 7.0 [95% CI, 5.4-9.0]). Goalkeepers also had a significantly longer mean layoff time than outfield players (23 +/- 27 vs 15 +/- 27 days; P = .016). Conclusion: Injuries to the hand, wrist, and forearm constituted less than 1% of all time-loss injuries in male professional soccer players. Fractures were most common and constituted more than half of all injuries. Goalkeepers had a 7-fold higher incidence and an over 1-week longer mean layoff time compared with outfield players.

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  • 47.
    Andersson, Konny
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård. Linköpings universitet, Medicinska fakulteten. Univ Queensland, Australia.
    van Driel, Mieke
    Univ Queensland, Australia.
    Hedin, Katarina
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Lund Univ, Sweden.
    Hollingworth, Samantha
    Univ Queensland, Australia.
    Merlo, Gregory
    Univ Queensland, Australia.
    Antibiotic use in Australian and Swedish primary care: a cross-country comparison2022Ingår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 40, nr 1, s. 95-103Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective Antimicrobial resistance is a growing worldwide problem and is considered to be one of the biggest threats to global health by the World Health Organization. Insights into the determinants of antibiotic prescribing may be gained by comparing the antibiotic usage patterns of Australia and Sweden. Design Publicly available data on dispensed use of antibiotics in Australia and Sweden between 2006 and 2018. Medicine use was measured using defined daily dose per 1,000 inhabitants per day (DDD/1000/day) and the number of dispensed prescriptions per 1000 inhabitants (prescriptions/1000). Results The use of antibiotics increased over the study period in Australia by 1.8% and decreased in Sweden by 26.3%. Use was consistently higher in Australia, double that of Sweden in 2018. Penicillin with extended spectrum was the most used class of antibiotics in Australia followed by penicillin with beta lactamase inhibitors. In Sweden, the most used class was beta lactamase-sensitive penicillin and the least used class was penicillin with beta lactamase inhibitors. Conclusion Antibiotic use in Australia is higher than in Sweden, with a higher proportion of broad-spectrum penicillin, including combinations with beta lactamase inhibitors, and cephalosporins. Factors that may contribute to these differences in antibiotic use include differences in guidelines, the duration of national antimicrobial stewardship programs, and differences in funding mechanisms.

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  • 48.
    Andersson, Martin
    et al.
    Reg Kronoberg, Sweden.
    Pallon, Jon
    Reg Kronoberg, Sweden; Lund Univ, Sweden.
    Cronberg, Olof
    Reg Kronoberg, Sweden; Lund Univ, Sweden.
    Sundqvist, Martin
    Orebro Univ, Sweden.
    Hedin, Katarina
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Lund Univ, Sweden; Reg Jönköping Cty, Sweden.
    Seasonal variations in use and outcome of rapid antigen detection tests and cultures in pharyngotonsillitis: a register study in primary care2021Ingår i: BMC Infectious Diseases, E-ISSN 1471-2334, Vol. 21, nr 1, artikel-id 1104Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Diagnosis and treatment of pharyngotonsillitis are commonly focused on group A streptococci (GAS), although the disease is often associated with other pathogens. While the incidence of pharyngotonsillitis is known to vary with season, seasonal variations in the prevalence of potential pathogens are sparsely explored. The aim of this study was to explore any seasonal variations in the use and outcome of rapid antigen detection tests (RADTs) for GAS and throat cultures among patients diagnosed with pharyngotonsillitis in primary care. Methods We retrieved and combined retrospective data from the electronic medical record system and the laboratory information system in Kronoberg County, Sweden. Primary care visits resulting in a diagnosis of tonsillitis or pharyngitis were included, covering the period 2013-2016. The monthly rate of visits was measured, along with the use and outcome of RADTs for GAS and throat cultures obtained on the date of diagnosis. The variations between calendar months were then analysed. Results We found variations between calendar months, not only in the mean rate of visits resulting in a diagnosis of pharyngotonsillitis (p &lt; 0.001), but in the mean proportion of RADTs being positive for GAS among the diagnosed (p &lt; 0.001), and in the mean proportion of visits associated with a throat culture (p &lt; 0.001). A lower mean rate of visits in August and September coincided with a lower proportion of RADTs being positive for GAS among them, which correlated with a higher proportion of visits associated with a throat culture. Conclusions This study suggests that the role of GAS in pharyngotonsillitis in Sweden is less prominent in August and September than during the rest of the year.

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  • 49. Beställ onlineKöp publikationen >>
    Andersson White, Pär
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Social Inequalities in Child Health: Type 1 Diabetes, Obesity, Cardiovascular Risk Factors and the Role of Self-control2024Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    Hälsoojämlikhet definierades av den Svenska kommissionen för jämlik hälsa som "systematiska skillnader i hälsa mellan samhällsgrupper med olika social position." Debatten om de bakomliggande orsakerna till hälsoojämlikhet tog fart efter att rapporten "the Black Report" kom ut i Storbritannien på 1980-talet. I denna rapport konstaterades att ojämlikheten i hälsa hade ökat mellan socioekonomiska grupper trots införandet av fri sjukvård och andra samhällsförbättringar. Orsakerna till den ökande ojämlikheten har sedan dess debatterats och ett antal teorier har lagts fram för att förklara fenomenet. Fortfarande råder det dock oenighet kring hur de olika bakomliggande faktorerna leder fram till skillnaderna i hälsa. Internationella organisationer har samtidigt arbetat för att minska skillnaderna, bland annat WHO som 2008 bildades "the Commission on Social Determinants of Health". Denna kommission slog fast i sin rapport att vi alla har en moralisk plikt att minska skillnaderna i hälsa; "Att ställa dessa skillnader till rätta handlar om social rättvisa. Att minska hälsoojämlikhet är för kommissionen ett etiskt imperativ". Rätten till bästa möjliga hälsa slås också fast i Barnkonventionen, artikel 24. För att kunna minska hälsoojämlikheter behöver man studera inom vilka områden/sjukdomar skillnader uppstår och varför, med målet att utforma åtgärder för att minska skillnaderna.

    Denna avhandling syftar till att studera socioekonomiska skillnader i barns hälsa. Avhandlingen baseras på data från den svenska prospektiva födelsekohortstudien Alla Barn i Sydöstra Sverige (ABIS). Social ojämlikhet i övervikt och obesitas jämförs även med den sociala ojämlikheten i motsvarande data från födelsekohorter i fem andra höginkomstländer; Nederländerna, Kanada, Storbritannien, Australien och USA.

    Resultaten från Studie 1 visade att socioekonomiska skillnader i risken att utveckla obesitas kan upptäckas redan vid 2 års ålder och att denna skillnad i risk ökade under uppväxten. I tonåren framkom socioekonomiska skillnader gällande övervikt/obesitas samt för utvecklingen av högt blodtryck och lågt HDL-kolesterol (delar av det metabola syndromet).

    Socioekonomisk ojämlikhet i förekomsten av obesitas i ABIS var mindre än i de övriga kohorterna i EPOCH-samarbetet (Studie 2). Detta gällde både i absoluta och relativa mått när socioekonomisk status mättes med hushållsinkomst. När socioekonomisk status baserades på moderns utbildningsnivå var skillnaderna mindre i ABIS i absoluta men inte i relativa mått. Fynden tyder på att samhällspolitiska åtgärder i Sverige tycks minska ojämlikhet i obesitas under barnaåren. Subventionerad förskola och gratis skolmat i förskola och skola är exempel på åtgärder som visat sig ha en effekt på socioekonomiska skillnader i obesitas.

    Vi har även studerat socioekonomiska skillnader i risk att utveckla autoimmuna sjukdomar (studie 3). Typ 1 Diabetes visade sig vara mer vanligt förekommande hos barn vars mödrar enbart hade förgymnasial utbildning. Denna skillnad kunde delvis förklaras av ett i genomsnitt högre BMI under barndomen och en ökad risk för allvarliga livshändelser i denna grupp. För övriga studerade autoimmuna sjukdomar fanns inga statistiskt signifikanta socioekonomiska skillnader.

    I avhandlingens sista studie prövades hypotesen att den sociala ojämlikheten (mätt med moderns utbildningsnivå) och risken att utveckla obesitas medierades av skillnader i självkontroll hos mor och barn. Självkontroll hos modern estimerades genom följande beteendevariabler; rökning under graviditeten, rökning under barnets första levnadsår, amningsduration och grad av deltagande i ABIS-studiens datainsamling med biologisk provtagning. Barnets grad av självkontroll uppskattades genom analys av svar i frågeformuläret SDQs subskala om impulsivitet. Resultatet av studien visade att mor och barns självkontroll medierade 87,5 % av sambandet mellan moderns utbildningsnivå och barnets risk att ha utvecklat obesitas vid 19 års ålder. Sambandet stärktes ytterligare om även moderns BMI vid barnets 1 års ålder adderades till analysen. Den medierade effekten ökade då till 93 % av den totala.

    En av avhandlingens slutsatser är att begreppet självkontroll bör ha en central roll i teorin om hälsoojämlikhetens orsaker. En sådan teori förutser att hälsoojämlikheten kommer att öka succesivt om inga interventioner görs. Hälsan hos barn och ungdomar kommer påverkas negativt av en miljö med ökande tillgång till allt fler stimuli av hjärnans belöningssystem, stimuli vilka också har negativa långtidseffekter för hälsan (s.k. Limbiska fällor ex. sociala medier). På grund av kopplingen mellan socioekonomisk status och självkontroll, kommer barn med låg socioekonomisk status drabbas i högre uträckning av denna ohälsa vilket kommer att leda till ökad hälsoojämlikhet.

    Slutligen diskuteras vilka implikationer för hälso- och sjukvården, liksom för hälsopolitiken, som resultaten i avhandlingen kan få och hur man kan minska den sociala ojämlikheten i hälsa. Sådana hälsopolitiska åtgärder bör reducera barn och ungdomars risk för skadliga beteenden/limbiska fällor. Exempel på åtgärder inkluderar förskola för alla barn (oavsett om föräldrarna yrkesarbetar eller ej), fria hälsosamma måltider i förskola och skola, ökad möjlighet till aktiviteter efter skoltid, förlängda skoldagar för äldre barn med mer skolgymnastik, musik och estetiska ämnen, restriktioner för mobilanvändning för att motverka överanvändande av mobiltelefoner i hemmet och skolan, samt policys för att motverka boende och skolsegregation i samhället.

    Delarbeten
    1. Inequalities in cardiovascular risks among Swedish adolescents (ABIS): a prospective cohort study
    Öppna denna publikation i ny flik eller fönster >>Inequalities in cardiovascular risks among Swedish adolescents (ABIS): a prospective cohort study
    2020 (Engelska)Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 10, nr 2, artikel-id e030613Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objectives To investigate if socioeconomic status (SES) is predictive of cardiovascular risk factors among Swedish adolescents. Identify the most important SES variable for the development of each cardiovascular risk factor. Investigate at what age SES inequality in overweight and obesity occurs. Design Longitudinal follow-up of a prospective birth cohort. Setting All Babies in Southeast Sweden (ABIS) study includes data from children born between October 1997 and October 1999 in five counties of south east Sweden. Participants A regional ABIS-study subsample from three major cities of the region n=298 adolescents aged 16-18 years, and prospective data from the whole ABIS cohort for overweight and obesity status at the ages 2, 5, 8 and 12 years (n=2998-7925). Outcome measures Blood pressure above the hypertension limit, overweight/obesity according to the International Obesity Task Force definition, low high-density lipoproteins (HDL) or borderline-high low-density lipoproteins according to National Cholesterol Education Program expert panel on cholesterol levels in children. Results For three out of four cardiovascular risk outcomes (elevated blood pressure, low HDL and overweight/obesity), there were increased risk in one or more of the low SES groups (p&lt;0.05). The best predictor was parental occupational class (Swedish socioeconomic classification index) for elevated blood pressure (area under the receiver operating characteristic (ROC) curve 0.623), maternal educational level for overweight (area under the ROC curve 0.641) and blue-collar city of residence for low HDL (area under the ROC curve 0.641). SES-related differences in overweight/obesity were found at age 2, 5 and 12 and for obesity at age 2, 5, 8 and 12 years (all p&lt;0.05). Conclusions Even in a welfare state like Sweden, SES inequalities in cardiovascular risks are evident already in childhood and adolescence. Intervention programmes to reduce cardiovascular risk based on social inequality should start early in life.

    Ort, förlag, år, upplaga, sidor
    BMJ PUBLISHING GROUP, 2020
    Nationell ämneskategori
    Pediatrik
    Identifikatorer
    urn:nbn:se:liu:diva-165977 (URN)10.1136/bmjopen-2019-030613 (DOI)000527786700022 ()32086351 (PubMedID)
    Anmärkning

    Funding Agencies|Swedish Research CouncilSwedish Research Council [K2005-72X-11242-11A, K2008-69X-20826-01-4]; Swedish Child Diabetes Foundation (Barndiabetesfonden); JDRF Wallenberg Foundation [K 98-99D-12813-01A]; Medical Research Council of Southeast Sweden (FORSS); Swedish Council for Working Life and Social ResearchSwedish Research CouncilSwedish Research Council for Health Working Life & Welfare (Forte) [FAS2004-1775]; Ostgota Brandstodsbolag; Research and PhD studies Committee (FUN), Linkoping University, Sweden (LiU-)

    Tillgänglig från: 2020-06-04 Skapad: 2020-06-04 Senast uppdaterad: 2023-12-22
    2. Household income and maternal education in early childhood and risk of overweight and obesity in late childhood: Findings from seven birth cohort studies in six high-income countries
    Öppna denna publikation i ny flik eller fönster >>Household income and maternal education in early childhood and risk of overweight and obesity in late childhood: Findings from seven birth cohort studies in six high-income countries
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    2022 (Engelska)Ingår i: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 46, s. 1703-1711Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background/objectives This study analysed the relationship between early childhood socioeconomic status (SES) measured by maternal education and household income and the subsequent development of childhood overweight and obesity. Subjects/methods Data from seven population-representative prospective child cohorts in six high-income countries: United Kingdom, Australia, the Netherlands, Canada (one national cohort and one from the province of Quebec), USA, Sweden. Children were included at birth or within the first 2 years of life. Pooled estimates relate to a total of N = 26,565 included children. Overweight and obesity were defined using International Obesity Task Force (IOTF) cut-offs and measured in late childhood (8-11 years). Risk ratios (RRs) and pooled risk estimates were adjusted for potential confounders (maternal age, ethnicity, child sex). Slope Indexes of Inequality (SII) were estimated to quantify absolute inequality for maternal education and household income. Results Prevalence ranged from 15.0% overweight and 2.4% obese in the Swedish cohort to 37.6% overweight and 15.8% obese in the US cohort. Overall, across cohorts, social gradients were observed for risk of obesity for both low maternal education (pooled RR: 2.99, 95% CI: 2.07, 4.31) and low household income (pooled RR: 2.69, 95% CI: 1.68, 4.30); between-cohort heterogeneity ranged from negligible to moderate (p: 0.300 to &lt; 0.001). The association between RRs of obesity by income was lowest in Sweden than in other cohorts. Conclusions There was a social gradient by maternal education on the risk of childhood obesity in all included cohorts. The SES associations measured by income were more heterogeneous and differed between Sweden versus the other national cohorts; these findings may be attributable to policy differences, including preschool policies, maternity leave, a ban on advertising to children, and universal free school meals.

    Ort, förlag, år, upplaga, sidor
    Springer Nature, 2022
    Nationell ämneskategori
    Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Identifikatorer
    urn:nbn:se:liu:diva-187410 (URN)10.1038/s41366-022-01171-7 (DOI)000823341900001 ()35821522 (PubMedID)
    Anmärkning

    Funding Agencies|Canadian Institutes of Health Research [OCO-79897, MOP-89886, MSH-95353, ROG-110537]; Linkoping University

    Tillgänglig från: 2022-08-22 Skapad: 2022-08-22 Senast uppdaterad: 2023-12-22Bibliografiskt granskad
    3. Low maternal education increases the risk of Type 1 Diabetes, but not other autoimmune diseases: a mediating role of childhood BMI and exposure to serious life events
    Öppna denna publikation i ny flik eller fönster >>Low maternal education increases the risk of Type 1 Diabetes, but not other autoimmune diseases: a mediating role of childhood BMI and exposure to serious life events
    2023 (Engelska)Ingår i: Scientific Reports, E-ISSN 2045-2322, Vol. 13, nr 1Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The objective of this paper was to investigate if socioeconomic status (SES), measured by maternal education and household income, influenced the risk of developing autoimmune disease (Type 1 Diabetes, Celiac disease, Juvenile Idiopathic Arthritis, Crohns disease, Ulcerative colitis, and autoimmune thyroid disease), or age at diagnosis, and to analyse pathways between SES and autoimmune disease. We used data from the All Babies in Southeast Sweden (ABIS) study, a population-based prospective birth cohort, which included children born 1997-1999. Diagnoses of autoimmune disease was collected from the Swedish National Patient Register Dec 2020. In 16,365 individuals, low maternal education, but not household income, was associated with increased risk of Type 1 Diabetes; middle education RR 1.54, 95% CI 1.06, 2.23; P 0.02, low education RR 1.81, 95% CI 1.04, 3.18; P 0.04. Maternal education and household income was not associated with any other autoimmune disease and did not influence the age at diagnosis. Part of the increased risk of Type 1 Diabetes by lower maternal education was mediated by the indirect pathway of higher BMI and higher risk of Serious Life Events (SLE) at 5 years of age. The risk of developing Type 1 Diabetes associated to low maternal education might be reduced by decreasing BMI and SLE during childhood.

    Ort, förlag, år, upplaga, sidor
    NATURE PORTFOLIO, 2023
    Nationell ämneskategori
    Allmänmedicin
    Identifikatorer
    urn:nbn:se:liu:diva-195339 (URN)10.1038/s41598-023-32869-x (DOI)000985906700031 ()37061552 (PubMedID)
    Anmärkning

    Funding Agencies|Linkoeping University; County Council of Ostergot-land, Forskningsradet i Sydoestra Sverige, Vetenskapsradet [K2005-72X-11242-11A]; Knut och Alice Wallenbergs Stiftelse [K 98-99D-12813-01A]; Forskningsradet foer Arbetsliv och Socialvetenskap [FAS20041775]; Barndiabetesfonden; Juvenile Diabetes Research Foundation International; Ostgota Brandstodsbolag

    Tillgänglig från: 2023-06-21 Skapad: 2023-06-21 Senast uppdaterad: 2023-12-22
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  • 50.
    Andersson White, Pär
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Abu Awad, Yara
    Concordia Univ, Canada.
    Gauvin, Lise
    Ctr Hosp Univ Montreal, Canada; Univ Montreal, Canada.
    Spencer, Nicholas James
    Univ Warwick, England.
    McGrath, Jennifer J.
    Concordia Univ, Canada.
    Clifford, Susan A.
    Murdoch Childrens Res Inst, Australia; Univ Melbourne, Australia.
    Nikiema, Beatrice
    Univ Montreal, Canada; Cree Board Hlth & Social Serv James Bay, Canada.
    Yang-Huang, Junwen
    Erasmus MC, Netherlands; Erasmus MC, Netherlands.
    Goldhaber-Fiebert, Jeremy D.
    Stanford Univ, CA 94305 USA.
    Markham, Wolfgang
    Univ Warwick, England.
    Mensah, Fiona K.
    Murdoch Childrens Res Inst, Australia; Univ Melbourne, Australia.
    van Grieken, Amy
    Erasmus MC, Netherlands.
    Raat, Hein
    Erasmus MC, Netherlands.
    Jaddoe, V. W. V.
    Erasmus MC, Netherlands; Erasmus MC, Netherlands; Erasmus MC, Netherlands.
    Ludvigsson, Johnny
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Faresjö, Tomas
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Household income and maternal education in early childhood and risk of overweight and obesity in late childhood: Findings from seven birth cohort studies in six high-income countries2022Ingår i: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 46, s. 1703-1711Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background/objectives This study analysed the relationship between early childhood socioeconomic status (SES) measured by maternal education and household income and the subsequent development of childhood overweight and obesity. Subjects/methods Data from seven population-representative prospective child cohorts in six high-income countries: United Kingdom, Australia, the Netherlands, Canada (one national cohort and one from the province of Quebec), USA, Sweden. Children were included at birth or within the first 2 years of life. Pooled estimates relate to a total of N = 26,565 included children. Overweight and obesity were defined using International Obesity Task Force (IOTF) cut-offs and measured in late childhood (8-11 years). Risk ratios (RRs) and pooled risk estimates were adjusted for potential confounders (maternal age, ethnicity, child sex). Slope Indexes of Inequality (SII) were estimated to quantify absolute inequality for maternal education and household income. Results Prevalence ranged from 15.0% overweight and 2.4% obese in the Swedish cohort to 37.6% overweight and 15.8% obese in the US cohort. Overall, across cohorts, social gradients were observed for risk of obesity for both low maternal education (pooled RR: 2.99, 95% CI: 2.07, 4.31) and low household income (pooled RR: 2.69, 95% CI: 1.68, 4.30); between-cohort heterogeneity ranged from negligible to moderate (p: 0.300 to &lt; 0.001). The association between RRs of obesity by income was lowest in Sweden than in other cohorts. Conclusions There was a social gradient by maternal education on the risk of childhood obesity in all included cohorts. The SES associations measured by income were more heterogeneous and differed between Sweden versus the other national cohorts; these findings may be attributable to policy differences, including preschool policies, maternity leave, a ban on advertising to children, and universal free school meals.

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