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  • 1. Andersson, E
    et al.
    Hagberg, SA
    Nilsson, T
    Persson, Bodil
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Östergötlands Läns Landsting, Pain and Occupational Centre, Occupational and Environmental Medicine Centre.
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Torén, K
    A case-referent study of cancer mortality among sulfate mill workers in Sweden.2001In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 58, p. 321-324Article in journal (Refereed)
  • 2.
    Andersson, Eva
    et al.
    Sahlgrens Univ Hosp, Dept Occupat & Environm Med, SE-40530 Gothenburg, Sweden .
    Persson, Bodil
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Bryngelsson, Ing-Liss
    Magnuson, Anders
    Orebro Univ Hosp, Clin Res Ctr, Stat & Epidemiol Unit, Orebro, Sweden .
    Toren, Kjell
    Sahlgrens Univ Hosp, Dept Occupat & Environm Med, SE-40530 Gothenburg, Sweden .
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine .
    Westberg, Hakan
    Cohort mortality study of Swedish pulp and paper mill workers - nonmalignant diseases2007In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 33, no 6, p. 470-478Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of this study was to determine mortality among pulp and paper mill workers according to the main mill pulping process, department, and gender, particular reference being given to diseases of the circulatory and respiratory systems. Methods The cohort of 18 163 men and 2291 women employed between 1939 and 1999 and with >1 year of employment was followed for mortality from 1952 to 2001 (acute myocardial infarction from 1969). Standardized mortality ratios (SMR) with 95% confidence intervals (95% CI) were estimated by comparing the observed number of deaths with the expected number for the entire Swedish population. Exposure was assessed from personnel files in the mills. Data from an exposure measurement database are also presented. Results There were 5898 deaths in the cohort. Total mortality had an SMR of 1.02 (95% CI 0.98-1.06) for the men in the sulfate mills and an SMR of 0.93 (95% CI 0.90-0.97) for the men in the sulfite mills. Mortality from acute myocardial infarction was increased among the men in both the sulfate and sulfite mills [SMR 1.22 (95% CI 1.12-1.32) and SMR 1.11 (95% CI 1.02-1.21), respectively] and by department in sulfate pulping (SMR 1.29, 95% CI 1.07-1.54), paper production (SMR 1.26, 95% CI 1.06-1.49), and maintenance (SMR 1.16, 95% CI 1.02-1.30). Mortality from cerebrovascular disease, diabetes mellitus, and nonmalignant respiratory diseases was not increased. Conclusions Death from acute myocardial infarction, but not cerebrovascular diseases, was increased in this cohort and was probably related to a combination of different occupational exposures (eg, dust, sulfur compounds, shift work, and noise).

  • 3.
    Angbratt, Marianne
    et al.
    Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Blomberg, Carina
    Vadstena Primary Health Care Centre, Vadstena, Sweden.
    Grahn Kronhed, Ann-Charlotte
    Vadstena Primary Health Care Centre, Vadstena, Sweden.
    Waller, John
    Vadstena Primary Health Care Centre, Vadstena, Sweden.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Möller, Margareta
    Research and Development Unit, Primary Health Care, Borås, Sweden.
    Calcium intake in a Swedish adult population: relationship to life-style factors and bone mineral density. A descriptive studyManuscript (preprint) (Other academic)
    Abstract [en]

    Background. This study is part of a community-based intervention programme dealing with the prevention of osteoporosis. The study aims were to estimate the calcium intake from dairy products and calcium supplements within a general population, and thereafter to study associations between calcium intake, relevant lifestyle factors, and forearm bone mineral density.

    Methods. A randomised sample of 15 % of the inhabitants aged 20 - 79 years ( = 1510) from two Swedish municipalities answered a questionnaire, and a selected sub-sample (n=448) had their forearm bone mineral density measured.

    Results. The mean consumption of calcium from dairy products was 878 mg/day. Men consumed more than women, and calcium intake decreased with increasing age. Twelve percent of the youngest age group in the study population and 31 % of the oldest age group did not meet the recommended daily intake. Associations were found between calcium intake and both residence and physical activity. There was a tendency towards an association between calcium intake and forearm bone mineral density. No other associations with lifestyle factors were observed.

    Conclusion. Calcium intake is in general well attained in an adult Swedish population, although the intake range is wide (55 to 3213 mg/day from dairy products). Women aged 50-59 years and older people are at increased risk of not meeting the recommended daily intake.

  • 4.
    Angbratt, Marianne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Blomberg, C.
    Kronhed, A.-C.
    Waller, J.
    Vadstena Primary Care Centre, Vadstena, Sweden.
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine.
    Moller, M.
    Möller, M., Centre for Caring Sciences, ÖrebroCountyCouncil, Örebro, Sweden.
    Prevalence and correlates of insufficient calcium intake in a Swedish population: Populations at risk across the lifespan2007In: Public Health Nursing, ISSN 0737-1209, E-ISSN 1525-1446, Vol. 24, no 6, p. 511-517Article in journal (Refereed)
    Abstract [en]

    To examine associations between calcium intake in the diet, lifestyle factors, and forearm bone mineral density (BMD) in order to identify population subgroups for targeting by screening programs. A questionnaire was sent to a random sample of 15 of the inhabitants aged 20-79 years from 2 Swedish municipalities, and the subsample from one of the municipalities was invited to measurement of BMD. The survey response rate was 74 (n=1,1121,510) and participation in BMD measurements was 68 (n=448659). Only a tendency (p=.085) toward direct association between calcium intake and forearm BMD was found, and the best multiple regression model was retained to explain BMD excluded calcium intake. Low calcium intake was, instead, in complementary analyses, found to be correlated with the factors old age, female sex, and urban residence in the best multiple regression model. Population subgroups whose calcium intake is in a range that justifies preventive action could be identified. Screening programs staffed by public health nurses can thereby be informed regarding the subgroups of the population that are at the highest risk of insufficient calcium intake. © 2007, Blackwell Publishing, Inc.

  • 5.
    Annerbäck, Eva-Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Sahlqvist, L.
    Research and Development Centre, Sörmlands County Council, S-631 88 Eskilstuna, Sweden.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Work and Environmental Science. Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Child Physical Abuse and concurrence of other types of Child Abuse: associations with health and risk behaviors2012In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 36, no 7-8, p. 585-595Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the associations between child physical abuse and health problems/risk-taking behaviors among teen-agers. Further to evaluate concurrence of other types of abuse and how these alone and in addition to child physical abuse were associated with bad health status and risk-taking behaviors.

    Methods: A population-based survey was carried out in 2008 among all the pupils in two different grades (15 respectively 17 years old) in Södermanland County, Sweden (N=7 262). The response rate was 81.8 %. The pupils were asked among other things about their exposure to child physical abuse, exposure to parental intimate violence, bullying and exposure to being forced to engage in sexual acts. Adjusted analyses were conducted to estimate associations between exposure and illhealth/risk-taking behaviors.

    Results: Child physical abuse was associated with poor health and risk-taking behaviors with adjusted Odds Ratios (OR) ranging from 1.6 to 6.2. The associations were stronger when the pupils reported repeated abuse with OR ranging from 2.0 to 13.2. Also experiencing parental intimate partner violence, bullying and being forced to engage in sexual acts was associated with poor health and risk-taking behaviors with the same graded relationship to repeated abuse. Finally there was a cumulative effect of multiple abuse in the form of being exposed to child physical abuse plus other types of abuse and the associations increase with the number of concurrent abuse.

    Conclusions: This study provides strong indications that child abuse is a serious public health problem based on the clear links seen between abuse and poor health and behavioral problems. Consistent with other studies showing a graded relationship between experiences of abuse and poor health/risk-taking behaviors our study shows poorer outcomes for repeated and multiple abuse. Thus, our study calls for improvement of methods of comprehensive assessments, interventions and treatment in all settings where professionals meet young people.

  • 6.
    Annerbäck, Eva-Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Centre for Clinical Research in Sörmland, Uppsala University, Sweden .
    Sahlqvist, Lota
    Centre for Clinical Research in Sörmland, Uppsala University, Sweden .
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    A cross-sectional study of victimisation of bullying among schoolchildren in Sweden: Background factors and self-reported health complaints2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 3, p. 270-277Article in journal (Refereed)
    Abstract [en]

    AIM:

    To examine background factors for bullying and associations between bullying victimisation and health problems.

    METHODS:

    A cross-sectional study on all pupils in grades 7 and 9 in a Swedish county was conducted in 2011 (n=5248). Data have been analysed with bi- and multivariate models.

    RESULTS:

    14% of the children reported that they had been bullied during the past 2 months. Background factors for bullying were: gender (girls more often); age (younger students more often); disability/disease; high body mass index, and having parents born abroad. There were strong associations between being bullied and poor health and self-harm. Associations with poor general health for boys and girls and mental health problems for girls showed stronger associations with higher frequency of bullying than with lower. For boys, physical bullying had stronger correlations with poor general health than written-verbal bullying.

    CONCLUSIONS:

    Bullying is a serious public health problem among young people and healthcare professionals have an important task in identifying exposed children. Children who are "different" are more exposed to bullying, which implies that school personnel, parents, and other adults in these children's social networks can play an important role in paying attention to and preventing the risk of bullying.

    .

  • 7.
    Annerbäck, Eva-Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine . Linköping University, Faculty of Health Sciences.
    Göran Svedin, Carl
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Prevalence and characteristics of child physical abuse in Sweden - findings from a population-based youth survey2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 8, p. 1229-1236Article in journal (Refereed)
    Abstract [en]

    Aim: To examine prevalence rates of child physical abuse perpetrated by a parent/caretaker, abuse characteristics and the extent of disclosures. Methods: A population-based survey was carried out in 2008 amongst all the pupils in three different grades (n = 8494) in schools in Sodermanland County, Sweden. The pupils were asked about their exposure to violence and their experiences of parental intimate-partner violence. Data were analysed with bi- and multivariate models and a comparison between means of accumulating risk factors between three groups were performed. Results: A total of 15.2% of the children reported that they had been hit. There were strong associations between abuse and risk factors and there was a dose-response relationship between risks and reported abuse. It was shown that children who reported parental intimate-partner violence were at a considerably higher risk for abuse than other children and that only 7% of the children exposed to violence had disclosed this to authorities. Conclusion: Even though child abuse in Sweden has decreased markedly during the last 40 years, violence against children is still a considerable problem. It is a challenge to develop methods of assessment and interventions that will ensure that the violence and its underlying causes are directly addressed.

  • 8. Bosette, C
    et al.
    Negri, E
    Kolonel, L
    Ron, E
    Franceschi, S
    preston-Martin, S
    McTiernan, A
    Dal Maso, L
    Mark, SD
    Mabuchi, K
    Land, C
    Jin, F
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Galanti, MR
    Hallquist, A
    Glattre, E
    Lund, E
    Levi, F
    Linos, D
    La Vecchia, C
    A pooled analysis of case-control studies of thyroid cancer. VII. Cruciferous and other vegetables (International)2002In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 13, no 8, p. 765-775Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the association between cruciferous and other vegetables and thyroid cancer risk we systematically reanalyzed the original data from 11 case-control studies conducted in the US, Asia, and Europe. Methods: A total of 2241 cases (1784 women, 457 men) and 3716 controls (2744 women, 972 men) were included. Odds ratios (OR) and the corresponding 95% confidence intervals (CI) were estimated for each study by logistic regression models, conditioned on age and sex, and adjusted for history of goiter, thyroid nodules or adenomas, and radiation. Summary ORs for all studies combined were computed as the weighted average of the estimates from each study. Results: A decreased risk for the highest level of cruciferous vegetable intake, as compared to the lowest, was observed in Los Angeles, Hawaii, Connecticut, southeastern Sweden, Troms°, and Switzerland, the OR were above unity in Japan and Uppsala, whereas no material association was found in northern Sweden, Italy, or Greece. The OR values for all studies combined were 0.87 (95% CI 0.75-1.01) for moderate and 0.94 (95% CI 0.80-1.10) for high cruciferous vegetables intake. The results were similar in studies from iodine-rich areas and endemic goiter areas, and were consistent when the analysis was restricted to papillary carcinomas and women. The summary OR values for vegetables other than cruciferous were 1.04 (0.88-1.22) for moderate and 0.82 (0.69-0.98) for high consumption. Conclusions: This combined analysis indicates that cruciferous vegetables are not positively related to thyroid cancer risk. Their effect does not seem to be substantially different from that of other vegetables, which appear to be protective on this cancer.

  • 9. Bosetti, C
    et al.
    Kolonel, L
    Negri, E
    Ron, E
    Franceschi, S
    Dal Maso, L
    Galanti, MR
    Mark, SD
    Preston-Martin, S
    McTiernan, A
    Land, C
    Jin, F
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Hallquist, A
    Glattre, E
    Lund, E
    Levi, F
    Linos, D
    La Vecchia, C
    A pooled analysis of case-control studies of thyroid cancer. VI. Fish and shellfish consumption2001In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 12, no 4, p. 375-382Article in journal (Refereed)
    Abstract [en]

    Objective: To better understand the role of fish and shellfish on thyroid cancer risk, we systematically re-analyzed the original data from 13 case-control studies conducted in the US, Japan, China, and Europe. Methods: A total of 2497 cases (2023 women, 474 men) and 4337 controls (3268 women, 1069 men) were considered. Odds ratio (OR) and corresponding 95% confidence interval (CI) were estimated for each study by logistic regression models, conditioned on age and sex, and adjusted for history of goiter, thyroid nodules or adenomas, and radiation. Combined ORs were computed as the weighted average of the estimates from each study. Results: The ORs for the highest level of total fish consumption (three or more times per week) as compared to the lowest one (less than once per week) was above unity in Hawaii, Connecticut, Japan, Norway, Troms°, and Vaud. Conversely, the ORs for the studies in Los Angeles, Shanghai, southeastern Sweden, Uppsala, northern Sweden, northern Italy, and Athens were below one. The pattern of risk for salt water fish and shellfish was not substantially different from that of total fish. Fish was not associated with thyroid cancer risk in all studies combined (OR = 0.99, 95% CI 0.85-1.2 for moderate, and OR=0.88, 95% CI 0.71-1.1 for high total fish consumption), but there was a suggestion of a protective effect in endemic goiter areas (OR = 0.65, 95% CI 0.48-0.88). Conclusion: This combined analysis indicates that relatively elevated fish consumption does not appreciably increase thyroid cancer risk, and may have a favorable influence in areas where iodine deficiency is, or was, common.

  • 10.
    Brohede, Sabina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Prevalence of body dysmorphic disorder among Swedish women: A population-based study2015In: Comprehensive Psychiatry, ISSN 0010-440X, E-ISSN 1532-8384, Vol. 58, p. 108-115Article in journal (Refereed)
    Abstract [en]

    Background: Body dysmorphic disorder (BDD) is characterized by a highly distressing and impairing preoccupation with nonexistent or slight defects in appearance. Patients with BDD present to both psychiatric and non-psychiatric physicians. A few studies have assessed BDD prevalence in representative samples of the general population and have demonstrated that this disorder is relatively common. Our primary objective was to assess the prevalence of BDD in the Swedish population because no data are currently available. Methods: In the current cross-sectional study, 2891 randomly selected Swedish women aged 18-60 years participated. The occurrence of BDD was assessed using the Body Dysmorphic Disorder Questionnaire (BDDQ), which is a validated self-report measure derived from the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria for BDD. In addition, symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Results: The prevalence of BDD among Swedish women was 2.1%. The women with BDD had significantly more symptoms of depression and anxiety than the women without BDD. Depression (HADS depression score greater than= 8) and anxiety (HADS anxiety score greater than= 8) were reported by 42% and 72% of the women with BDD, respectively. Conclusions: The results of the present study indicate that BDD is relatively common among Swedish women (2.1%) and that it is associated with significant morbidity.

  • 11.
    Brohede, Sabina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Validation of the Body Dysmorphic Disorder Questionnaire in a community sample of Swedish women2013In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 210, no 2, p. 647-652Article in journal (Refereed)
    Abstract [en]

    Body Dysmorphic Disorder (BDD) is characterized by a distressing and impairing preoccupation with a nonexistent or slight defect in appearance. Patients with the disorder present to both psychiatric and non-psychiatric physicians. A few studies have assessed BDD prevalence in the general population and have shown that the disorder is relatively common. To date, no BDD assessment instruments have been validated in the general population. Our aim was to validate a brief self-screening instrument, the Body Dysmorphic Disorder Questionnaire (BDDQ), in a female community sample. The BDDQ was translated into Swedish and filled out by 2891 women from a randomly selected community sample. The questionnaire was validated in a subsample of 88 women, using the Structured Clinical Interview for DSM-IV (SCID) together with clinical assessment as the gold standard. In the validation subsample, the BDDQ showed good concurrent validity, with a sensitivity of 94%, a specificity of 90% and a likelihood ratio of 9.4. The questionnaire can therefore be of value when screening for BDD in female populations.

  • 12.
    Brohede, Sabina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Wyon, Yvonne
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Body dysmorphic disorder in female Swedish dermatology patients2017In: International Journal of Dermatology, ISSN 0011-9059, E-ISSN 1365-4632, Vol. 56, no 12, p. 1387-1394Article in journal (Refereed)
    Abstract [en]

    BackgroundIndividuals with body dysmorphic disorder (BDD) are highly distressed and impaired owing to perceived defects in their physical appearance that are not noticeable to others. They are frequently concerned about their skin and often present to dermatologists rather than psychiatrists. However, BDD patients attending dermatology clinics may be at risk of not receiving an appropriate assessment and beneficial treatment. The aims of this study were to estimate the BDD prevalence rate among Swedish female dermatology patients and to assess the psychological condition of BDD patients compared to that of other dermatology patients. MethodsThe occurrence of BDD was estimated using the Body Dysmorphic Disorder Questionnaire (BDDQ), a validated self-report measure for BDD. Symptoms of depression and anxiety were measured by the Hospital Anxiety and Depression Scale (HADS), and quality of life was assessed using the Dermatology Life Quality Index (DLQI). ResultsThe prevalence rate of BDD among female Swedish dermatology patients was 4.9% (95% CI 3.2-7.4). Anxiety (HADS A11) was 4-fold more commonly reported by patients with positive BDD screening (48% vs. 11%), and depression (HADS D11) was over 10-fold more common in patients with positive BDD screening (19% vs. 1.8%) (Pamp;lt;0.001). The median DLQI score was 18 in the BDD group, compared to a score of 4 in the non-BDD group (Pamp;lt;0.001). ConclusionsOur results indicate that BDD is fairly common among female Swedish dermatology patients (4.9%) and that BDD patients have high levels of depression and anxiety and severely impaired quality of life.

    The full text will be freely available from 2018-09-27 09:39
  • 13. Dal Maso, L
    et al.
    La Vecchia, C
    Franceschi, S
    Preston-Martin, S
    Ron, E
    Levi, F
    Mack, W
    Mark, SD
    McTiernan, A
    Kolonel, L
    Mabuchi, K
    Jin, F
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Galanti, MR
    Hallquist, A
    Glattre, E
    Lund, E
    Linos, D
    Negri, E
    A pooled analysis of thyroid cancer studies. V. Anthropometric factors2000In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 11, no 2, p. 137-144Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the relation between anthropometric factors and thyroid cancer risk in a pooled analysis of individual data from 12 case-control studies conducted in the US, Japan, China and Europe. Methods: 2056 female and 417 male cases, 3358 female and 965 male controls were considered. Odds ratios (OR) were derived from logistic regression, conditioning on age, A-bomb exposure (Japan) and study, and adjusting for radiotherapy. Results: Compared to the lowest tertile of height, the pooled OR was 1.2 for females for the highest one, and 1.5 for males, and trends in risk were significant. With reference to weight at diagnosis, the OR for females was 1.2 for the highest tertile, and the trend in risk was significant, whereas no association was observed in males. Body mass index (BMI) at diagnosis was directly related to thyroid cancer risk in females (OR = 1.2 for the highest tertile), but not in males. No consistent pattern of risk emerged with BMI during the late teens. Most of the associations were observed both for papillary and follicular cancers, and in all age groups. However, significant heterogeneity was observed across studies. Conclusions: Height and weight at diagnosis are moderately related to thyroid cancer risk.

  • 14. Franceschi, S
    et al.
    Preston-Martin, S
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    A pooled analysis of case-control studies of thyroid cancer. IV. Benign thyroid diseases.1999In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 10, p. 583-595Article in journal (Refereed)
  • 15. Guénel, Pascal
    et al.
    Cyr, Diane
    Sabroe, Svend
    Lynge, Elsebeth
    Merletti, Franco
    Ahrens, Wolfgang
    Baumgardt-Elms, Cornelia
    Ménégoz, Francois
    Olsson, Håkan
    Paulsen, Stein
    Simonato, Lorenzo
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Alcohol drinking may increase risk of breast cancer in men: A European population-based case-control study2004In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 15, no 6, p. 571-580Article in journal (Refereed)
    Abstract [en]

    Objective: It has been estimated that alcohol drinking increases the risk of breast cancer in women by approximately 7% for each increment of 10 g alcohol per day. However, the few studies conducted on breast cancer among men have failed to detect an association with quantitative measures of alcohol drinking, even if the alcohol intake is generally higher in men than in women. On the other hand, increased risks of male breast cancer were inconsistently reported in alcoholics or patients with liver cirrhosis. We have investigated the role of alcohol drinking in male breast cancer using data collected in a population-based case-control study on seven rare cancers, conducted in Denmark, France, Germany, Italy, and Sweden. Methods: The cases were 74 histologically verified male breast cancer patients aged 35-70 years. The controls (n = 1432) were selected from population registers, and frequency-matched to the cases by age group and geographic area. To check for consistency, a separate analysis was conducted using as controls the patients with a rare cancer other than male breast recruited simultaneously in the European study (n = 519 men). Results: Based on population controls, the risk of developing breast cancer in men increased by 16% (95% CI: 7-26%) per 10 g alcohol /day (p < 0.001). An odds ratio of 5.89 (95% CI: 2.21-15.69) was observed for alcohol intake greater than 90 g per day, as compared with light consumers ( < 15 g per day). Similar associations were observed when other rare cancers patients were used as controls. Conclusion: We found that the relative risk of breast cancer in men is comparable to that in women for alcohol intakes below 60 g per day. It continues to increase at high consumption levels not usually studied in women.

  • 16.
    Helmfrid, Ingela
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Occupational and Environmental Medicine Centre.
    Berglund, Marika
    Karolinska Institutet, Stockholm, Sweden.
    Lofman, Owe
    Norwegian University of Life Sciences, Ås, Norway.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Work and Environmental Science. Linköping University, Faculty of Health Sciences.
    Health effects and exposure to polychlorinated biphenyls (PCBs) and metals in a contaminated community2012In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 44, p. 53-58Article in journal (Refereed)
    Abstract [en]

    Environmental measurements carried out by local authorities during the 1970s, 80s and 90s in an area contaminated by hundreds of years of industrial activities have revealed high levels of zinc (Zn), copper (Cu), lead (Pb) and cadmium (Cd) in soil, vegetables, root crops, berries and mushrooms. In 1972, a large quantity of oil contaminated with polychlorinated biphenyls (PCBs) was accidentally spilled into the river running through the village. To investigate the possible health effects of exposure from local sources, all cancer diagnoses, registered in 1960-2003 for individuals living in the study area, were collected from the regional cancer register of southeast Sweden. The total cancer incidence was non-significantly decreased both among males and females as compared to national rates (SIR = 0.91) for each gender. Among males, increased risks, of border-line significance, were seen for testicular cancer and lymphomas as well as significantly decreased risks for cancer in the rectum, respiratory system and brain. Information on lifetime residence, occupation, smoking habits, diseases, childbirth and food consumption, was collected via questionnaires from cancer cases and randomly selected controls. In both genders combined, significant associations were found for total cancer and high consumption of local perch, and for lymphomas and high consumption of both perch and pikeperch. Female breast cancer was significantly associated with high consumption of local perch and pike as well as with work in metal production. Mothers residing in the parish before the age of five reported significantly more preterm child deliveries. In spite of study limitations, the results indicate that residing in a rural contaminated area may contribute to the development of certain cancers and reproductive effects. In females, high consumption of local fish was shown to be the strongest determinant for total cancer, while in males, the strongest determinant was residing in the study area the first five years of life. Further research including validation of exposure using biomarkers is required to verify the findings as well as future studies in other polluted areas in Sweden with larger population bases.

  • 17.
    Helmfrid, Ingela
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Salihovic, Samira
    Örebro University.
    van Bavel, Bert
    Örebro University.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Berglund, Marika
    Karolinska institutet, Stockholm.
    Exposure and body burden of polychlorinated biphenyls (PCB) and metals in a historically contaminated community.2015In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 76, p. 41-8Article in journal (Refereed)
    Abstract [en]

    There are many small villages where environmental contamination is substantial due to historical industrial activities. The aim of the present study was to investigate if long-term or current consumption of local foods, as reported in food frequency questionnaires, co-vary with measured concentrations of polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), lead (Pb), cadmium (Cd) and mercury (Hg) in blood, urine and hair from a population living in a historically contaminated village. Blood, urine and hair were provided by men (n=38) and women (n=57), who had participated in a previous case-control study in the contaminated area, and were analyzed for PCB, OCPs, Pb, Cd and Hg. A detailed food frequency questionnaire, used in the previous epidemiological study, was repeated, and up-dated information of life-style, exposure factors and other covariates was collected. Associations between reported consumption of local foods and exposure biomarkers were explored in relation to age, gender, life-style factors and other covariates. A large part of the population in the area reported consumption of local food, and thus, was potentially exposed to the contaminants. Despite the limited number of participants and other weaknesses described, it was possible to link reported consumption of different foods to biomarker concentrations. Reported consumption of local vegetables, forest berries and mushrooms co-varied with urinary Cd, indicating an influence from the contaminated area on the Cd exposure. We found no associations between PCB plasma concentrations with reported consumption of local fish, but with consumption of herring (non-local sea fish) which is typically high in PCB. Pesticide (HCB, p,p'-DDE, trans-nonachlor) exposure was mainly associated with agricultural work and having a private well the first five years of life, but we found no associations between pesticide concentrations in plasma and consumption of local vegetables or fish. Exposure to Hg was associated with consumption of fish, both local and non-local, and Pb exposure was associated with the consumption of game. Overall, the contaminant concentrations measured in blood, urine and hair varied substantially among study participants, but on average, the concentrations were similar to concentrations measured in other groups of the general Swedish population in the same age range. Larger studies are needed to evaluate health risks (and causality) associated with historical environmental contamination.

  • 18.
    Kastbom, Alf
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rheumatology. Linköping University, Faculty of Health Sciences.
    Verma, Deepti
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Eriksson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Rheumatology. Linköping University, Faculty of Health Sciences.
    Skogh, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Rheumatology. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Söderkvist, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Genetic variation in proteins of the cryopyrin inflammasome influences susceptibility and severity of rheumatoid arthritis (the Swedish TIRA project)2008In: Rheumatology, ISSN 1462-0324, Vol. 47, no 4, p. 415-417Article in journal (Refereed)
    Abstract [en]

    Objectives: The genetic background to RA is incompletely understood.As new cytokine-targeted therapies emerge, early predictorsof disease severity are becoming increasingly important. Theinflammasomes are essential regulators of cytokine production.We investigated whether two polymorphisms in the genes encodingcryopyrin (CIAS1) and TUCAN (CARD8) influence susceptibilityand disease course in RA.

    Methods: Genotype frequencies were assessed in 174 Swedish patientswith early RA and 360 population-based controls without rheumaticdisease. Genotypes were categorized according to the presence(+) or absence (–) of two wild-type alleles and comparedbetween patients and controls. In the RA patients, antibodiestowards cyclic citrullinated peptides (anti-CCP) and the ‘sharedepitope’ (SE) were assessed, and medication and measuresof disease activity were monitored regularly during 3 yrs.

    Results: The combination of CIAS1/TUCAN/–, ascompared with CIAS1/TUCAN +/+, was significantly more commonamong patients than in controls [odds ratio (OR) 2.2, 95% CI1.03–4.6]. This association was strengthened when patientswere divided into anti-CCP+ [OR 2.8 (1.1–6.7)] or presenceof 1 SE copy [OR 2.8 (1.3–6.2)]. At most time-points duringthe 3-yr follow-up, patients with CIAS1/TUCAN/–showed significantly higher disease activity. Furthermore, CIAS1/TUCAN/– patients proved to be much more likely to receiveTNF-blocking therapy [relative risk 20 (2.6–149)].

    Conclusions: Compound polymorphisms in CIAS1 and TUCAN associatewith RA susceptibility and severity. The cryopyrin inflammasomeneeds further attention regarding a possible aetiopathogeneticconnection with RA.

  • 19.
    Kjölhede, Preben
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Wahlström, Johan
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Pelvic floor dysfunction after Burch colposuspension - A comprehensive study. Part I2005In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 84, no 9, p. 894-901Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate the occurrence of voiding dysfunction and symptoms of genital prolapse at long-term follow-up after Burch colposuspension (Bc) in relation to the occurrence of the symptoms in an age-matched normal population. Materials and methods. A follow-up study of the 190 patients who underwent Bc in 1980-88 and 305 age-matched control women randomly selected from the general population. The participants answered a questionnaire in 1998 with detailed questions about the pelvic floor function. Univariate and multivariate analyses were performed. Results. The prevalence and frequency of urinary incontinence were significantly higher in the patient group compared with those in the control group as were urge incontinence, difficulty to start voiding, time needed at the toilet for voiding, the need to return to the toilet for emptying the bladder, feeling of incomplete emptying of the bladder, and limitation of social life because of the leakage. The symptoms of genital prolapse were significantly more common in the patient group in spite of a significantly larger proportion of genital prolapse surgery in this group. Parity, high body mass index, heavy lifting work, chronic pulmonary diseases, hiatus hernias, and hysterectomy were significantly more common in the patient group than among the controls. Conclusions. At long-term follow-up, patients exhibit substantial symptoms of pelvic floor dysfunction (PFD) concerning voiding dysfunction and symptoms of genital prolapse compared with a normal population. This highlights the importance and need of treating pelvic floor disorders in a comprehensive way. Scientific works with comprehensive studies of PFD are needed. © Acta Obstet Gynecol Scand 2005.

  • 20.
    Kjölhede, Preben
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Wahlström, Johan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine .
    Pelvic floor dysfunction after Burch colposuspension - A comprehensive study. Part II2005In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 84, no 9, p. 902-908Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate the prevalence of pelvic floor dysfunction (PFD) concerning bowel function at long-term follow-up after Burch colposuspension (Bc) in relation to the bowel function in an age-matched sample of women in the general population. Methods and material. This is a follow-up study of a cohort of 190 patients who underwent Bc in 1980-1988 and 305 age-matched control women without urinary anti-incontinence surgery, randomly selected from the general population. The participants answered a postal questionnaire with detailed questions about the pelvic floor function in 1998. Univariate and multivariate analyses were performed. Results. The patients showed considerable signs of bowel dysfunction compared with the general population in the following aspects: they used the fingers to help emptying the bowel [odds ratio (OR) 3.25 (1.35-7.86)], had feeling of incomplete emptying of the bowel [OR 2.29 (1.11-4.73)], felt no warning before passing a motion [OR 3.04 (1.20-7.71)], had gas incontinence [OR 1.98 (1.17-3.37), had loose stool incontinence [OR 3.67 (1.43-9.42)], used protection against fecal leakage during daytime [OR 3.22 (1.30-7.95)], and experienced that the bowel function affected the general well-being adversely [OR 2.15 (1.30-3.56)]. Conclusion. The patients who have undergone colposuspension for stress urinary incontinence have more symptoms of PFD concerning the bowel function than women without urinary anti-incontinence surgery in the general population. This affects the general well-being. A comprehensive concept of multidisciplinary assessment and treatment of PFD should be encouraged. © Acta Obstet Gynecol Scand 2005.

  • 21.
    Kristenson, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Jarkman, Kristina
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Göransson, Anne
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Wärnberg Gerdin, E
    Vang, Johannes
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Häggström, Anita
    Problembaserad inlärning som modell för utbildning i folkhälsovetenskap.2000In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 2, p. 154-159Article in journal (Other academic)
  • 22. La Vecchia, C
    et al.
    Ron, E
    Franceschi, S
    Dal Maso, L
    Mark, SD
    Chatenoud, L
    Braga, C
    Preston-Martin, S
    McTiernan, A
    Kolonel, L
    Mabuchi, K
    Jin, F
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Galanti, MR
    Hallquist, A
    Lund, E
    Levi, F
    Linos, D
    Negri, E
    A pooled analysis of case-control studies of thyroid cancer. III. Oral contraceptives, menopausal replacement therapy and other female hormones.  1999In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 10, p. 157-166Article in journal (Refereed)
  • 23.
    Ljunggren, Stefan A
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Helmfrid, Ingela
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Salihovic, Samira
    Örebro University, Sweden.
    van Bavel, Bert
    Örebro University, Sweden.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Lindahl, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Karlsson, Helen
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Persistent organic pollutants distribution in lipoprotein fractions in relation to cardiovascular disease and cancer.2014In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 65, p. 93-9Article in journal (Refereed)
    Abstract [en]

    Persistent organic pollutants (POPs) are lipophilic environmental toxins that have been associated with cardiovascular disease (CVD) and cancer. The aim of this study was to investigate the concentrations of POPs in human high and low/very low-density lipoproteins (HDL and LDL/VLDL) and the possible association with CVD and cancer occurrence in individuals living in a contaminated area. Lipoproteins from 28 individuals (7 healthy controls, 8 subjects with cancer, 13 subjects with CVD) were isolated and the fraction-specific concentration of 20 different POPs was analyzed by high resolution gas chromatography/high resolution mass spectrometry. The activity of Paraoxonase 1 (PON1), an anti-oxidant in HDL, was determined in plasma of these 28 subjects and additional 50 subjects from the same area excluding diseases other than cancer or CVD. Fourteen polychlorinated biphenyls (PCBs) and three organochlorine pesticides were detected, and especially highly chlorinated PCBs were enriched in lipoproteins. Significantly higher concentrations of POPs were found among individuals with CVD or cancer compared to controls. Principal component analyses showed that POP concentrations in HDL were more associated with CVD, while POP concentrations in LDL/VLDL were more associated with cancer. PON1 activity was negatively correlated to sumPCB and a co-variation between decreased arylesterase-activity, increased PCB concentrations and CVD was found. This study shows that POPs are present in lipoproteins and were more abundant in individuals with CVD or cancer compared to healthy controls. The results also indicate that PCB exposure is accompanied by reduced PON1 activity that could impair the HDL function to protect against oxidation.

  • 24.
    Ljunggren, Stefan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Helmfrid, Ingela
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Norinder, Ulf
    Swedish Toxicol Science Research Centre, Sweden.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Karlsson, Helen
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Lindahl, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Alterations in high-density lipoprotein proteome and function associated with persistent organic pollutants2017In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 98, p. 204-211Article in journal (Refereed)
    Abstract [en]

    There is a growing body of evidence that persistent organic pollutants (POPs) may increase the risk for cardiovascular disease (CVD), but the mechanisms remain unclear. High- density lipoprotein (HDL) acts protective against CVD by different processes, andwe have earlier found that HDL from subjects with CVD contains higher levels of POPs than healthy controls. In the present study, we have expanded analyses on the same individuals living in a contaminated community and investigated the relationship between the HDL POP levels and protein composition/ function. HDL from17 subjectswas isolated by ultracentrifugation. HDL protein composition, using nanoliquid chromatography tandemmass spectrometry, and antioxidant activity were analyzed. The associations of 16 POPs, including polychlorinated biphenyls (PCBs) and organochlorine pesticides, with HDL proteins/functionswere investigated by partial least square and multiple linear regression analysis. Proteomic analyses identified 118 HDL proteins, of which ten were significantly (p b 0.05) and positively associated with the combined level of POPs or with highly chlorinated PCB congeners. Among these, cholesteryl ester transfer protein and phospholipid transfer protein, as well as the inflammatory marker serum amyloid A, were found. The serum paraoxonase/arylesterase 1 activity was inversely associated with POPs. Pathway analysis demonstrated that up- regulated proteinswere associatedwith biological processes involving lipoproteinmetabolism, while down- regulated proteinswere associatedwith processes such as negative regulation of proteinases, acute phase response, platelet degranulation, and complement activation. These results indicate an association between POP levels, especially highly chlorinated PCBs, and HDL protein alterations that may result in a less functional particle. Further studies are needed to determine causality and the importance of other environmental factors. Nevertheless, this study provides a first insight into a possible link between exposure to POPs and risk of CVD. (C) 2016 Elsevier Ltd. All rights reserved.

  • 25. Mack, WJ
    et al.
    Preston-Martin, S
    Dal Maso, L
    Galanti, R
    Xiang, M
    Franceschi, S
    Hallquist, A
    Jin, F
    Kolonel, L
    La Vecchia, C
    Levi, F
    Linos, A
    Lund, E
    McTiernan, A
    Mabuchi, K
    Negri, E
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Ron, E
    A pooled analysis of case-control studies of thyroid cancer: Cigarette smoking and consumption of alcohol, coffee, and tea2003In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 14, no 8, p. 773-785Article in journal (Refereed)
    Abstract [en]

    Objective: To analyze the role of smoking, alcohol, coffee and tea in relation to thyroid cancer, we conducted a pooled analysis of 14 case-control studies conducted in the United States, Europe, and Asia. Methods: The sample consisted of 2725 thyroid cancer cases (2247 females, 478 males) and 4776 controls (3699 females, 1077 males). Conditional logistic regression with stratification on study, age at diagnosis, and gender was used to compute odds ratios and 95% confidence intervals. Results: Thyroid cancer risk was reduced in persons who had ever smoked. The relationship was more pronounced in current smokers (OR = 0.6, 95% CI = 0.6-0.7) than former smokers (OR = 0.9, 95% CI = 0.8-1.1). There were significant trends of reduced risk with greater duration and frequency of smoking. For consumption of wine and beer, there was a significant trend of decreasing thyroid cancer risk (p = 0.02) that was not maintained after adjustment for current smoking (p = 0.12). Thyroid cancer risk was not associated with consumption of coffee or tea. These findings were consistent in both gender-specific and histology-specific (papillary and follicular) analyses. Conclusions: Pooled analyses of these geographically diverse case-control data indicate a reduced thyroid cancer risk associated with current smoking. A reduced risk associated with alcohol was eliminated after adjustment for smoking, and caffeinated beverages did not alter thyroid cancer risk.

  • 26. Morales, MM
    et al.
    Olsen, J
    Johansen, P
    Kaerlev, L
    Guénel, P
    Arveux, P
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Hardell, L
    Ahrens, W
    Stang, A
    Llopis, A
    Merletti, F
    Villanueva, MA
    Viral infection, atopy and mycosis fungoides: A European multicentre case-control study2003In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 39, no 4, p. 511-516Article in journal (Refereed)
    Abstract [en]

    Mycosis fungoides (MF) is a rare disease with an unknown aetiology, although it has been suggested that infections may play a role. The present study investigates whether infections, atopic disorders and some other diseases are risk indicators for MF. A European multicentre case-control study involving seven rare cancers, including MF, was conducted from 1995 to 1998. Patients between 35 and 69 years of age diagnosed with MF (n=140) were recruited, and the diagnoses were verified by a reference pathologist, who classified 83 cases as definitive and 35 cases as possible, 22 cases were not accepted. Of the 118 accepted cases, 104 patients were interviewed (including 76 definitive cases and 28 possible cases). These 76 definitive cases were used for this study. A common set of controls to serve all case groups were interviewed, representing a total of 4574 controls. The latter included 1008 colon cancer patients and 3566 subjects selected from population registers. Information on infections, skin pathology and clinical history 5 years before the diagnosis of MF was used to estimate odds ratios (ORs) derived from logistic regression-modelling, which included gender, age and country. The highest ORs for MF were found in patients who reported a history of psoriasis 5 years before MF was diagnosed (OR 7.2, 95% CI: 3.6-14.5). Urticaria had an OR of 1.4 (95% CI: 0.6-3.6). Infections and atopic diseases were not closely associated with MF. Some diseases correlate to MF. Whether this has a causal background or reflects early diagnostic uncertainty is not known.

  • 27. Morales Suarez-Varela, MM
    et al.
    Olsen, J
    Kaerlev, L
    Guénel, P
    Arveux, P
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Hardell, L
    Stang, A
    Llopis-Gonzalez, A
    Merletti, F
    Guillén, F
    Johansen, P
    Are alcohol intake and smoking associated with mycosis fungoides? A European multicentre case-control study.2001In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 37, p. 392-397Article in journal (Refereed)
  • 28.
    Morales-Suarez-Varela, M.M.
    et al.
    Morales-Suárez-Varela, M.M., Department of Preventive Medicine, Unit of Public Health and Environmental Care, University of Valencia, Spain, Unit of Clinical Epidemiology, Dr. Peset University Hospital, Valencia, Spain, Department of Preventive Medicine, Unit of Public Health and Environmental Care, University of Valencia, Avda, Vicente Andres Estelles s/n, 46100 Burjasot, Valencia, Spain.
    Olsen, J.
    Danish Epidemiology Science Centre, University of Aarhus, Denmark.
    Johansen, P.
    Institute of Pathology, Aalborg Hospital, Aalborg, Denmark.
    Kaerlev, L.
    Danish Epidemiology Science Centre, University of Aarhus, Denmark.
    Guenel, P.
    Guénel, P., INSERM Unité, 170, Villejuif, France.
    Arveux, P.
    Registre des Cancers du Doubs, France.
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine .
    Hardell, L.
    Department of Oncology, Orebro Medical Centre, Sweden.
    Ahrens, W.
    Division of Biometry and Data Processing, Bremen Institute for Prevention Research and Social Medicine, Bremen, Germany, Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, Germany.
    Stang, A.
    Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, Germany.
    Llopis, A.
    Department of Preventive Medicine, Unit of Public Health and Environmental Care, University of Valencia, Spain.
    Merletti, F.
    Unit of Cancer Epidemiology, CERMS and Centre for Oncologic Prevention, University of Turin, Italy.
    Aurrekoetxea, J.J.
    Department of Preventive Medicine and Public Health, University of the Basque Country, Spain.
    Masala, G.
    Molecular and Nutritional Epidemiology Unit, CSPO, Scientific Institute of Tuscany, Florence, Italy.
    Occupational exposures and Mycosis Fungoides. A European multicentre case-control study (Europe)2005In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 16, no 10, p. 1253-1259Article in journal (Refereed)
    Abstract [en]

    Objectives: Mycosis Fungoides (MF) is a rare disease with an occurrence indicating that occupational exposures may play a role. To estimate the association between MF and occupational exposures as measured by means of an job-exposure matrix (JEM). Methods: A European multicenter case-control study was conducted from 1995 to 1997 and included seven rare cancers, one of which was MF. Patients between 35 and 69 years of age, diagnosed with MF (n = 140), were recruited and the diagnoses were checked by a reference pathologist who classified 83 cases as definite, 35 cases as possible and 22 cases as not accepted. Among the 118 accepted cases, 104 cases were interviewed, of which 76 were definite cases. We selected population controls and colon cancer controls to serve all seven case groups. Altogether 833 colon cancer controls and 2071 population controls were interviewed. Based on the reported occupational experiences, a team of industrial hygiene specialists identified five potential exposures and developed an JEM. This JEM was used to estimate the odds ratios (OR) for MF as a function of these exposures. The JEM included aromatic and/or halogenated hydrocarbons (AAHs), chrome (VI) and its salts, electromagnetic radiations, silica and pesticides. Results: Exposures to AHHs (OR 6.3, C.I 2.4-16.7 for male) were associated with a high MF risk. Conclusions: The study supports the hypothesis that some MFs have an occupational etiology but only a small fraction of exposed workers are apparently susceptible since the disease is so rare. © Springer 2005.

  • 29.
    Morales-Suarez-Varela, M.M.
    et al.
    Morales-Suárez-Varela, M.M., Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Spain, Unit of Clinical Epidemiology, Dr Peset University Hospital, Valencia, Spain, Molecular and Nutritional Epidemiology Unit, CSPO, Scientific Institute of Tuscany, Florence, Italy, Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Avda. Vicente Andres Estelles s/n, 46100 Burjasot, Valencia, Spain.
    Olsen, J.
    Danish Epidemiology Science Centre, University of Aarhus, Denmark.
    Johansen, P.
    Institute of Pathology, Aalborg Hospital, Reberbansgade, Aalborg, Denmark.
    Kaerlev, L.
    Kaerlev, L..
    Guenel, P.
    Guénel, P., INSERM Unité 170, Villejuif, France.
    Arveux, P.
    Registre des Cancers du Doubs, France.
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine .
    Hardell, L.
    Department of Oncology, University Hospital, Orebro, Sweden.
    Ahrens, W.
    Bremen Institute for Prevention Research and Social Medicine, Division of Biometry and Data Processing, Bremen, Germany.
    Stang, A.
    Bremen Institute for Prevention Research and Social Medicine, Division of Biometry and Data Processing, Bremen, Germany.
    Llopis, A.
    Llopis, A..
    Merletti, F.
    Institute for Medical Informatics, Biometry and Epidemiology University Clinic Essen, Germany.
    Guillen-Grima, F.
    Unit of Cancer Epidemiology, CERMS Centre for Oncologic Prevention, University of Turin, Italy.
    Masala, G.
    Department of Health Sciences, Public University of Navarre, Spain.
    Occupational sun exposure and mycosis fungoides: A european multicenter caseg-control study2006In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 48, no 4, p. 390-393Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: We sought to study the association between occupational sun exposure and mycosis fungoides (MF), a peripheral T-cell lymphoma. SUBJECTS and METHODS: A European multicenter case-control study including seven rare cases (one being MF) was conducted between 1995 and 1997. From the 118 accepted cases, 104 were interviewed, of which 76 were definite cases. Population controls were selected randomly from the regions of case ascertainment. Information based on occupational experiences was coded according to industry types. A job exposure matrix was created according to the expected exposure to sunlight. RESULTS: Once exposures to aromatic halogenated hydrocarbons were eliminated (odds ratio = 2.3, 95% confidence interval = 0.9-6.2), a high MF risk was associated with exposures to solar radiation. CONCLUSION: It would appear that workers exposed to sunlight have a higher risk of MF. However, this factor is not the only one involved. Copyright © 2006 by American College of Occupational and Environmental Medicine.

  • 30. Morales-Suárez-Varela, Maria M
    et al.
    Olsen, Jorn
    Johansen, Preben
    Kaerlev, Linda
    Guénel, Pascal
    Arveux, Patrick
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Hardell, Lennart
    Örebro.
    Ahrens, Wolfgang
    Stang, Andreas
    Llopis, Agustin
    Merletti, Franco
    Aurrekoetxea, Juan Jose
    Masala, Giovanna
    Occupational risk factors for mycosis fungoides: A European multicenter case-control study.2004In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 46, p. 205-211Article in journal (Refereed)
  • 31.
    Morales-Suárez-Varela, Maria
    et al.
    University of Valencia, Spain.
    Olsen, Jorn
    University of Southern Denmark, Odense.
    Villeneuve, Sara
    Inserm, CESP Center for research in Epidemiology and Population Health, Villejuif, France.
    Johansen, Preben
    Aalborg Hospital, Denmark.
    Kaerlev, Linda
    University of Southern Denmark, Odense.
    Llopis-González, Agustin
    University of Valencia, Spain.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Hardell, Lennart
    University Hospital, Örebro, Sweden.
    Ahrens, Wolfgang
    Bremen Institute for Prevention Research and Social Medicine, Germany.
    Stang, Andreas
    Institute for Medical Informatics, University Clinic Essen, Germany.
    Merletti, Franco
    University of Turin, Italy.
    Gorini, Giuseppe
    Cancer Prevention & Research Institute, Florence, Italy.
    Aurrekoetxea, Juan José
    University of the Basque Country, Spain.
    Févotte, Joëlle
    University Claude Bernard Lyon 1, France.
    Cyr, Diane
    Inserm, CESP Center for research in Epidemiology and Population Health, Villejuif, France; University Versailles–Saint-Quentin en Yvelines, France.
    Guénel, Pascal
    Inserm, CESP Center for research in Epidemiology and Population Health, Villejuif, France.
    Occupational exposure to chlorinated and petroleum solvents and Mycosis Fungoides2013In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 55, no 8, p. 924-931Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the potential association between occupational exposure to chlorinated and petroleum solvents and mycosis fungoides (MF).

    Methods: A questionnaire on lifetime job history was administered to 100 patients diagnosed with MF and 2846 controls. Odds ratios (ORs) were calculated as the measure of the association between exposure to each specific solvent and MF.

    Results: In the total sample and in men, cases and controls did not differ in relation to exposure to any of the solvents studied. In women, an association with MF was seen for the highest level of estimated exposure to perchloroethylene (OR = 11.38; 95% confidence interval: 1.04 to 124.85) and for exposure less than the median to kerosene/fuel/gasoil (OR = 8.53; 95% confidence interval: 1.11 to 65.62).

    Conclusions: These results do not provide conclusive evidence that exposure to solvents may increase risk of MF because they were not found in men.

  • 32. Negri, E
    et al.
    Dal Maso, L
    Ron, E
    La Vecchia, C
    Mark, SD
    Preston-Martin, S
    McTiernan, A
    Kolonel, L
    Yoshimoto, Y
    Jin, F
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Galanti, MR
    Hardell, L
    Glattre, E
    Lund, E
    Levi, F
    Linos, D
    Braga, C
    Franceschi, S
    A pooled analysis of case-control studies of thyroid cancer II. Menstrual and reproductive factors.  1999In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 10, p. 143-155Article in journal (Refereed)
  • 33. Negri, E
    et al.
    Ron, E
    Franceschi, S
    Dal Maso, L
    Mark, SD
    McTiernan, A
    Kolonel, L
    Kleinerman, R
    Land, C
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Galanti, MR
    Hallquist, A
    Glattre, E
    Lund, E
    Levi, F
    Linos, D
    Braga, C
    La Vecchia, C
    Preston-Martin, SA
    Jin, F
    A pooled analysis of case-control studies of thyroid cancer. I. Methods.  1999In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 10, p. 131-142Article in journal (Refereed)
  • 34. Negri, E
    et al.
    Ron, E
    Franceschi, S
    La Vecchia, C
    Preston-Martin, S
    Kolonel, L
    Kleinerman, RA
    Mabuchi, K
    Jin, F
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Hallquist, A
    Levi, F
    Linos, A
    Fraumeni Jr, JF
    Risk factors for medullary thyroid carcinoma: a pooled analysis.2002In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 13, p. 365-372Article in journal (Refereed)
  • 35.
    Nyqvist, Fredrik
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Helmfrid, Ingela
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Augustsson, Anna
    Linneaus University, Sweden.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Increased Cancer Incidence in the Local Population Around Metal-Contaminated Glassworks Sites2017In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 59, no 5, p. E84-E90Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to examine mortality causes and cancer incidence in a population cohort that have resided in close proximity to highly metal-contaminated sources, characterized by contamination of, in particular, arsenic (As), cadmium (Cd), and lead (Pb). Methods: Data from Swedish registers were used to calculate standardized mortality and cancer incidence ratios. An attempt to relate cancer incidence to metal contamination levels was made. Results: Significantly elevated cancer incidences were observed for overall malignant cancers in both genders, cancer in the digestive system, including colon, rectum, and pancreas, and cancers in prostate among men. Dose-response relationships between Cd and Pb levels in soil and cancer risks were found. Conclusions: Cancer observations made, together with previous studies of metal uptake in local vegetables, may imply that exposure to local residents have occurred primarily via oral intake of locally produced foodstuffs.

  • 36.
    Persson, Bodil
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Östergötlands Läns Landsting, Pain and Occupational Centre, Occupational and Environmental Medicine Centre.
    Magnusson, Anders
    Westberg, Håkan
    Andersson, Eva
    Torén, Kjell
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Axelson, Olav
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Östergötlands Läns Landsting, Pain and Occupational Centre, Occupational and Environmental Medicine Centre.
    Cardiovascular mortality among Swedish pulp and paper mill workers2007In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 50, no 3, p. 221-226Article in journal (Refereed)
    Abstract [en]

    Background: Malignant diseases but also cardiovascular and respiratory disorders and diabetes mellitus have been associated with work in pulp and paper production. The present cohort focuses on cardiovascular mortality in relation to various exposures in this industry. Methods: The cohort, followed-up for mortality, includes 7,107 workers, 6,350 men and 757 women, from three major old mills in the middle of Sweden. Results: Instead of a healthy-worker effect, a slightly increased risk for death in diseases of the circulatory system was found for male workers. Notably, work with sulfate digestion, steam and power generation and maintenance was associated with significantly increased risks. Cerebrovascular diseases showed non-significantly increased risks for maintenance and paper and paperboard production and manufacture. Conclusions: The differences in risk among various parts of the production are striking although it is hard to pinpoint any specific exposures. Dust and small particles along with sulfur compounds might be suspected. © 2007 Wiley-Liss, Inc.

  • 37.
    Reckner Olsson, Åsa
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Skogh, Thomas
    Linköping University, Department of Molecular and Clinical Medicine, Rheumatology. Linköping University, Faculty of Health Sciences.
    Axelson, Olav
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Occupations and exposures in the work environment as determinants for rheumatoid arthritis2004In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 61, no 3, p. 233-238Article in journal (Refereed)
    Abstract [en]

    Background and Aims: Several occupational categories have been associated with rheumatoid arthritis (RA); this study was conducted to further evaluate these associations.

    Methods: Lifelong occupational history together with exposure experiences were collected through a postal questionnaire answered by 293 incident cases and 1346 population based referents. Occupational determinants were evaluated through stratified and multivariate analyses; pooled analyses with previously gathered data on 422 prevalent cases and 858 referents were also performed.

    Results: In both materials, significantly increased logistic odds ratios (LORs) were seen for male conductors, freight and transport workers (LOR 17.8, 95% CI 1.5 to 207.8 and LOR 4.7, 95% CI 1.4 to 16.3, respectively), and farmers and farm workers (LOR 2.4, 95% CI 1.1 to 5.2, and LOR 2.2, 95% CI 1.3 to 3.5, respectively). Among women, increased LORs were seen in the separate and the pooled material for printmakers and process engravers (LOR 5.5, 95% CI 0.9 to 32.6, and LOR 3.0, 95% CI 0.9 to 10.3, respectively). Increased risks were seen in both materials for men exposed to asbestos (LOR 2.5, 95% CI 1.0 to 6.8, and LOR 1.6, 95% CI 0.8 to 3.3, respectively), and vibrations (LOR 2.0, 95% CI 0.9 to 4.4, and LOR 2.2, 95% CI 1.3 to 3.8, respectively). The risk for RA increased with increasing duration of exposure to vibrations and mineral dust, respectively.

    Conclusions: There was evidence of a causal relation between exposures to vibrations and mineral dust and development of RA among men. Occupational factors seem to be aetiologically more important for men, and most occupations at risk involve multiple exposures. Several exposures associated with an increased risk for RA are frequent among farmers, and some of the occupations at risk include exposure to organic dust.

  • 38.
    Reckner Olsson, Åsa
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Skogh, Thomas
    Linköping University, Department of Molecular and Clinical Medicine, Rheumatology. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Aetiological factors of importance for the development of rheumatoid arthritis2004In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 33, no 5, p. 300-306Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate exposure to external factors associated with risk or prevention of rheumatoid arthritis (RA).

    Methods: Two hundred and ninety‐three incident cases of RA and 1346 population‐based referents were included in a case‐referent study, in which previous exposure experiences were collected through a postal questionnaire.

    Results: An inverse association between RA and additional schooling after compulsory school was seen for men. Current smoking was associated with significantly increased risks of RA for men and women [odds ratio (OR) 2.9, 95% confidence interval (CI) 1.4–6.4, and OR 1.8, 95% CI 1.1–2.9, respectively], as was previous smoking for men (OR 2.3, 95% CI 1.2–4.4). There were also indications of relationships between previous use of a private well and RA in both men and women.

    Conclusion: Several previously published associations have been reproduced in the present study, which also generates some new hypotheses that suggest further research.

  • 39.
    Reckner Olsson, Åsa
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Skogh, Thomas
    Linköping University, Department of Molecular and Clinical Medicine, Rheumatology. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Comorbidity and lifestyle, reproductive factors, and environmental exposures associated with rheumatoid arthritis2001In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 60, no 10, p. 934-939Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE To evaluate the influence of lifestyle, reproduction, and some external factors on the development of rheumatoid arthritis (RA) and to describe its comorbidity.

    METHODS Cases were identified retrospectively from 1980 to 1995 at the University Hospital in Linköping, Sweden. The study comprised 422 cases and 859 randomly selected population referents. Data on possible aetiological factors and comorbidity were collected by postal questionnaire.

    RESULTS The response rates were 67% among cases and 59% among referents. A decrease in the occurrence of atopic allergy was seen in the cases (odds ratio (OR) 0.6, 95% confidence interval (CI) 0.4 to 1.0). There was a positive association between RA and insulin treatment (OR 10.2, 95% CI 1.7 to 60.8) in women, and women with a short fertile period had an increased risk of RA (OR 2.5, 95% CI 1.1 to 5.4). Current and previous smoking were associated with increased risks for RA in both sexes, and in men a dose-response relationship was found with number of tobacco pack years (p for trend <0.005). The risk for RA decreased with increasing level of education in both men and women. Increased risks were seen in men born into households with private wells (OR 2.8, 95% CI 1.5 to 5.2), residentially exposed to mould (OR 4.6, 95% CI 1.1 to 20.2), or exposed to farm animals (OR 3.3, 95% CI 0.7 to 16.6). In women there were positive associations between RA and reporting a previous joint injury (OR 2.5, 95% CI 1.0 to 6.6) and prolonged exposure to hair dyes (OR 1.9, 95% CI 0.8 to 4.5).

    CONCLUSIONS RA, a disease with features of T helper 1 (Th1) dominated immune response, was inversely associated with atopic allergy, a Th2 dominated condition, while there were indications of a strong positive association with Th1 related diabetes mellitus. The results support a causal relationship between smoking and RA. The level of education was inversely associated with RA, while there was a positive association between RA and certain residential factors in men and a short fertile period in women.

  • 40.
    Reckner Olsson, Åsa
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Department of Molecular and Clinical Medicine, Rheumatology. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Skogh, Thomas
    Linköping University, Department of Molecular and Clinical Medicine, Rheumatology. Linköping University, Faculty of Health Sciences.
    Svernell, Olle
    Department of Internal Medicine, Västervik Hospital, Västervik.
    Ernerudh, Jan
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Allergic manifestations in patients with rheumatoid arthritis2003In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 111, no 10, p. 940-944Article in journal (Refereed)
    Abstract [en]

    A functional dichotomy between Th1- and Th2-type immune responses has been suggested. This study was performed to investigate whether rheumatoid arthritis (RA), a disease with indications of Th1-deviated immune activation, is inversly related to atopic conditions which are Th2-mediated. Two hundred and sixty-three adult cases of RA, fulfilling the American Rheumatism Association (ARA) 1987 Revised Classification Criteria for RA, were identified in 1995 and compared with 541 randomly selected population referents. The presence of atopic manifestations was established through a postal questionnaire and by demonstrating circulating IgE antibodies to common allergens. RA was inversely associated with certain manifestations of rhinitis, which were regarded as the most reliable indicators of atopic disease in the present study. However, no negative association was seen between RA and asthma and eczema, respectively. The main results give some support for an inverse relationship between RA and rhinitis. The prevalence of circulating IgE antibodies was however similar in cases and controls, suggesting that the T-cell commitment mainly occurs in the affected organs.

  • 41.
    Reckner, Åsa
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Skogh, Thomas
    Linköping University, Department of Molecular and Clinical Medicine, Rheumatology. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Occupational determinants for rheumatoid arthritis2000In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 26, no 3, p. 243-249Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of the present study was to evaluate possible occupational determinants for rheumatoid arthritis according to lifetime occupational history.

    Methods The cases were identified retrospectively from 1980 to 1995 at the University Hospital in Linköping, Sweden. The study comprised 422 cases and 859 randomly selected referents. Exposure data were collected through a postal questionnaire.

    Results For men, occupations with increased, although nonsignificant, odds ratios (OR) were farmers or farm workers [OR 1.8, 95% confidence interval (95% CI) 1.0-3.5], textile workers (OR 2.0, 95% CI 0.3-16.2), asphalters (OR 14.0, 95% CI 1.2-799.0 without latency requirement), and employees at service stations (OR 2.2, 95% CI 0.5-9.5). Among the women, hairdressers and beauticians (OR 2.7, 95% CI 0.8-8.6) had an increased risk for rheumatoid arthritis, as well as those exposed to hairdressing chemicals (OR 3.0, 95% CI 1.0-9.4) and meat products (OR 2.0, 95% CI 1.0-4.0).

    Conclusion Several of the findings in this study are in accordance with those of previous studies. The increased risks of rheumatoid arthritis for asphalters and employees at service stations are however new associations previously not described in the literature.

  • 42.
    Samelius, Charlotta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Lifetime history of abuse, suffering, and psychological health2010In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 64, no 4, p. 227-232Article in journal (Refereed)
    Abstract [en]

    Background: In a representative Swedish sample, we investigated lifetime prevalence of physical, sexual and psychological abuse of women and their current suffering. The relationship between current suffering from abuse and psychological health problems was also studied. Method: The study was cross-sectional and population-based. The Abuse Screening Inventory (ASI), measuring experiences of physical, sexual and psychological abuse and including questions on health and social situation, was sent by mail to 6000 women, randomly selected from the population register. The questionnaire was completed and returned by 4150 (70%) of 5896 eligible women. Results: 27.5% of the women reported abuse of any kind. Of those, 69.5% reported current suffering from abuse. Abused suffering women reported more anxiety, depression and sleep disturbances, and a less advantageous social situation than both non-abused and abused non-suffering women. Also, abused non-suffering women reported more depression than non-abused women. Somatization was reported more often by both abused suffering and non-suffering women than by non-abused women, with no difference between suffering and non-suffering women when adjusted for possible confounders. Conclusion: A majority of abused women, when investigating lifetime history of abuse, report current suffering thereof, which warrants considering abuse an important societal problem. Suffering could be a valuable construct, possibly useful to assess psychological health problems normally not captured by existing diagnostic instruments, although further investigations of the concept are needed.

  • 43.
    Samelius, Charlotta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Post-traumatic stress and somatization in abused women2009In: Traumatology, ISSN 1534-7656, E-ISSN 1085-9373, Vol. 15, no 1, p. 103-112Article in journal (Refereed)
    Abstract [en]

    This study examines the relationship between posttraumatic stressdisorder (PTSD) and somatization in abused women; 213 abusedwomen were assessed for PTSD, somatization, health care contacts,and abuse-related variables. The main analyses in this exploratorystudy are based on the 91 respondents reporting either PTSDor somatization. We found no association between the occurrenceof PTSD and somatization in abused women. Women with PTSD reportedhigher total magnitude of abuse and a larger number of perpetratorsthan women with somatization. Sexually abused women with PTSDmore often described their experience as an act of abuse comparedwith sexually abused women with somatization. Results suggestthat PTSD might not be a necessary mediator between abuse andsomatization and that variables other than abuse magnitude aredecisive for the development of somatization in abused women.

  • 44.
    Samelius, Charlotta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Wimja, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Somatization in abused women2007In: Journal of Women's Health, ISSN 1059-7115, E-ISSN 2168-7668, Vol. 16, no 6, p. 909-918Article in journal (Refereed)
    Abstract [en]

    Background: The association between abuse and somatization has been less systematically investigated than other abuse-related outcomes. Moreover, such studies have given inconsistent results. Therefore, the aim of the present study was to investigate the relation between somatization and lifetime exposure to physical, sexual, and psychological abuse.

    Methods: A total of 800 women, 400 reporting abuse and 400 reporting no abuse in a previous randomized, population-based study, were sent two questionnaires: SOMAT, a questionnaire on somatization, and the Abuse Inventory (AI). Of 781 eligible women, 547 participated (70% response rate).

    Results: Psychological abuse of both limited (6 months–2 years) and prolonged duration (>2 years) was associated with somatization (OR = 2.45, 95% CI 1.37-4.40 and OR = 3.09, 95% CI 1.52-6.30, respectively). Sexual abuse without penetration was associated with somatization (OR = 2.47, 95% CI 1.17-5.20), but sexual abuse with penetration was not. Physical abuse was not associated with somatization when adjustments for other kinds of abuse were made. Being abused in adulthood and in both adulthood and childhood was associated with somatization (OR = 4.20, 95% CI 2.45-7.20 and OR = 2.90, 95% CI 1.69-4.90, respectively), whereas being abused in childhood only was not.

    Conclusions: Abuse of women is associated with somatization. Other factors than severity of abuse, such as whether the abused woman herself perceives her experience as abuse, seem to be more decisive for developing somatization in abused women. Abuse should be taken into account when meeting women with somatization symptoms as patients.

  • 45.
    Swahnberg, Katarina
    et al.
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Schei, Berit
    Department of Gynecology, St Olav Hospital, Trondheim, Norway.
    Hilden, Malene
    The Center for Victims of Sexual Assault, Rigshospitalet, Copenhagen University Hospital, Denmark.
    Irminger, Kirstine
    Department of Obstetrics and Gynecology, Ryhov Hospital, Jönköping, Sweden.
    Wingren, Gun
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Are sociodemographic and regional and sample factors associated with prevalence of abuse?2004In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, no 3, p. 276-288Article in journal (Refereed)
    Abstract [en]

    Background.  The aims of the present study were: 1) to estimate the prevalence of emotional, physical and sexual abuse and abuse in the health care system, and 2) to study the associations between prevalence of abuse and sociodemographic and sample variables.

    Methods.  This cross-sectional study used a validated postal questionnaire in four Swedish samples; patients at three gynecologic clinics with different character and in different regions (n = 2439) and women in one randomized population sample (n = 1168).

    Results.  Any lifetime emotional abuse was reported by 16.8–21.4% of the women; physical abuse by 32.1–37.5%; sexual abuse by 15.9–17.0%; and abuse in the health care system by 14.0–19.7%. For 7–8% abuse had included life threats and 9–20% of all women in the study currently suffered from their experiences of abuse. Most women had not disclosed their background of abuse to the gynecologist.

    There were differences in sociodemographic variables between the four samples. Generally, in the multivariate analyses we found associations between prevalence of abuse and age, educational level, civil status and occupation, but no consistent association between prevalence of abuse and sample variables.

    Conclusion.  Lifetime prevalence rates of the four kinds of abuse were high in all samples as measured by the NorVold Abuse Questionnaire (NorAQ), and 1/10–1/5 women in the study suffered currently from abusive experiences. In multivariate analyses prevalence of abuse was consistently associated with sociodemographic but not to sample variables.

  • 46.
    Swahnberg, Katarina
    et al.
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Wingren, Gun B.
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Hilden, Malene
    Centre for Victims of Sexual Assault, Rigshospitalet, Copenhagen University Hospital, Denmark.
    Schei, Berit
    The Department of Gynaecology, St Olav Hospital, Trondheim, Norway.
    Have adults victims of abuse in the health care system been exposed to emotional, physical and/or sexual abuse as children more often than non-victims?Manuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: The aim of this study was to find out if there was an association between any lifetime abuse and abuse in the health care system. Furthermore we wanted to analyse if adult victims of abuse in the health care system reported exposure to emotional, physical and/or sexual abuse as children more often than non-victims did.

    Design: A cross-sectional questionnaire study. Our first hypothesis was tested in the total sample, and the second one in a case-control analysis. The cases were those women who reported experiences of abuse in the health care system as adults. Exposure was defined as emotional, physical and/or sexual abuse in childhood.

    Settings: Data were gathered from patients visiting three Swedish gynaecological clinics.

    Sample: 2439 gynaecology patients (response rate 81%).

    Method: The NorVold Abuse Questionnaire (NorAQ) sent out by post.

    Main outcome measure: Associations between experiences of emotional, physical and/or sexual abuse, and abuse in the health care system; operationalised in NorAQ.

    Results: A general association was found between lifetime emotional, physical and/or sexual abuse and abuse in the health care system in all three samples. Adult victims of abuse in the health care system reported emotional, physical and/or sexual abuse in childhood more often than non-victims did. These fmdings also held after adjustment for age and educational level.

    Conclusions: There is a general association between lifetime experiences of abuse and abuse in the health care system. Adult victimisation in the health care system is associated with childhood exposure to emotional, physical and/or sexual abuse. These associations call for attention and need to be further investigated.

  • 47.
    Swahnberg, Katarina
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Gender and Medicine.
    Wijma, Barbro
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Gender and Medicine. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Hilden, Malene
    Schei, Berit
    Women's perceived experiences of abuse in the health care system: Their relationship to childhood abuse2004In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 111, no 12, p. 1429-1436Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to determine whether there was an association between any lifetime experiences of emotional, physical and/or sexual abuse and perceived abuse in the health care system. Furthermore, we wanted to ascertain if adult victims of perceived abuse in the health care system reported exposure to childhood emotional, physical and/or sexual abuse more often than non-victims did. Design: A cross sectional questionnaire study. The first hypothesis was tested in the total sample, and the second hypothesis in a case-control analysis. The cases were those women who reported perceived experiences of abuse in the health care system as adults. Exposure was defined as experience of emotional, physical and/or sexual abuse in childhood. Settings: Three Swedish gynaecological clinics. Sample: A total of 2439 gynaecology patients (response rate 81%). Methods Postal questionnaire: Main outcome measure: Associations between experiences of emotional, physical and/or sexual abuse, and perceived abuse in the health care system, all operationalised in The NorVold Abuse Questionnaire (NorAQ). Results: A general association was found between lifetime experiences of emotional, physical and/or sexual abuse and perceived abuse in the health care system. Adult victims of abuse in the health care system reported experiences of emotional, physical and/or sexual abuse in childhood more often than non-victims did. These findings also held after adjustment for age and educational level. Conclusions: We found associations between experiences of any lifetime abuse and perceived abuse in the health care system. Adult victimisation in the health care system was associated with childhood exposure to emotional, physical and/or sexual abuse. These associations call for attention and need to be further investigated.

  • 48.
    Uustal Fornell, Eva
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Kjölhede, Preben
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Prevalence of urinary and fecal incontinence and symptoms of genital prolapse in women2003In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 82, no 3, p. 280-286Article in journal (Refereed)
    Abstract [en]

    Background. Urinary incontinence is common in women. How often incontinence occurs has been only briefly investigated. Studies on the prevalence of fecal incontinence are few. The epidemiology of genital prolapse symptoms is unknown. This epidemiological study describes a general population of women aged 40 and 60 years with regard to the prevalence and frequency of urinary and fecal incontinence and the prevalence of genital prolapse symptoms.

    Methods. A questionnaire on medical background, urinary and fecal incontinence, and genital prolapse symptoms was sent to 1000 40-year-old and 1000 60-year-old randomly selected women.

    Results. Sixty-seven per cent answered: 53% were continent for urine; 9% of the 40-year-olds and 19% of the 60-year-olds had urinary incontinence weekly or more often. Detrusor instability score was significantly higher in the 60-year-olds. Incontinence of flatus, weekly or more often, was reported by 9% and 19%, loose feces by 5% and 8%, and solid feces by 0.3% and 1.7% according to the 40- and 60-year-olds, respectively. Fifty-three per cent reported no flatus incontinence. Of the prolapse symptoms investigated, 15% of the females reported pelvic heaviness, 4% genital bulge, and 12% use of fingers in the vagina or perineum by defecation.

    Conclusions. Incontinence of urine is common in this population. Flatus incontinence is as common, but the concept must be operationalized if used as an endpoint in research. The International Continence Society's (ICS) definition of urinary incontinence is unpractical for use in epidemiological research. We suggest leakage weekly or more often as a criterion for significant incontinence in epidemiological research.

  • 49.
    Uustal Fornell, Eva
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Kjølhede, Preben
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study2004In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, no 4, p. 383-389Article in journal (Refereed)
    Abstract [en]

    Objective.  To describe a general population of women with regard to factors associated with urinary and fecal incontinence and genital prolapse symptoms.

    Methods.  A questionnaire about medical background, urinary and fecal incontinence and genital prolapse symptoms was mailed to 1000 40-year-old and 1000 60-year-old Swedish women. Associations were described by odds ratios (ORs) with 95% confidence intervals (CIs).

    Results.  Sixty-seven percent answered the questionnaire. Multivariate analysis showed urinary incontinence to be associated with anal sphincter rupture [OR 4.4 (95%  CI 1.0–18.8)], pelvic heaviness [3.8 (2.1–7.0)], body mass index (BMI) ≥30 kg/m2[3.7 (2.0–6.7)], multiparity [1.8 (1.0–3.4)], varicose veins surgery [1.9 (1.2–3.2)] and age [1.9 (1.2–3.2)]. Univariate analyses revealed statistically significant associations between urinary incontinence and incontinence for flatus [4.8 (3.0–7.8)], for liquid stool [5.0 (2.9–8.6)] and for solid stool [5.9 (2.4–14.2)]. Chronic bronchitis [5.7 (1.7–18.9)] was strongly associated with urinary incontinence but was only reported by the older age group. Prolapse symptoms were strongly associated with both urinary and fecal incontinence. Prolapse symptoms as opposed to urinary and fecal incontinence seemed to be associated more with injuries at delivery than with chronic pelvic floor strain.

    Conclusions.  Women with urinary incontinence are also likely to suffer from fecal incontinence and prolapse and vice versa. Other associated factors for pelvic floor dysfunction were overweight, and especially obesity, chronic bronchitis, vaginal delivery and multiparity, age, heredity and diseases suggestive of collagen disorders. A multidisciplinary management of women with pelvic floor symptoms is suggested and possible prevention is discussed.

  • 50.
    Wijma, Klaas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Samelius, Charlotta
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    The association between ill-health and abuse: a cross-sectional population-based study2007In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 48, no 6, p. 567-575Article in journal (Refereed)
    Abstract [en]

    The lifetime prevalence of physical, sexual and psychological abuse was studied cross-sectionally in a representative sample of Swedish women. The association between the three kinds of abuse and ill-health, and the relation between magnitude of abuse and various health problems were also investigated. The Abuse Screening Inventory (ASI), measuring experiences of physical, sexual and psychological abuse and including questions on health and social situation, was sent by mail to 6,000 women, randomly selected from the population register. The questionnaire was completed and returned by 4,150 (70%) of 5,896 eligible women. Various kinds of abuse were reported by 1,142 women (27.5%). The prevalence rates were 19.4% for physical abuse, 9.2% for sexual abuse and 18.2% for psychological abuse. Abused women reported more ill-health and a less advantageous social situation than non-abused women. There was an association between magnitude of abuse and health problems. Also a low magnitude of abuse was substantially associated with ill-health.

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