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  • 1.
    Andersen, Pia
    et al.
    Department of Research and Development, Region Kronoberg, Sweden.
    Holmberg, Sara
    Region Kronoberg, Sweden.
    Lendahls, Lena
    Department of Research and Development, Region Kronoberg, Sweden.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Physical Activity on Prescription with Counsellor Support: A 4-Year Registry-Based Study in Routine Health Care in Sweden2018In: Healthcare, E-ISSN 2227-9032, Vol. 6, no 2, article id E34Article in journal (Refereed)
    Abstract [en]

    Background: Public health gains from physical activity on prescription (PAP) depend on uptake in routine care. We performed an evaluation of the implementation, in a Swedish county council, of counsellors who give personalized support to PAP recipients aimed at facilitating PAP delivery. The aim was to compare characteristics between PAP recipients and the health care population as well as between PAP recipients who used and did not use counsellor support. We also investigated professional belonging and health care setting of health care professionals who prescribed PAP. 

    Methods: All patients’ ≥18 years who received PAP during 2009–2012 in primary and secondary care in the County Council of Kronoberg were included (n = 4879). Data were retrieved from electronic medical records. Main outcome measures were patient and professional characteristics. 

    Results: A third of the PAP recipients had diseases in ≥5 diagnostic groups and more than half had ≥11 office visits the year before receiving PAP. Counsellor support was used by one-third and PAP recipients who used counsellor support had more multiple diagnoses and office visits compared with non-users. Physicians issued 44% of prescriptions and primary care was the predominant setting. The amount of PAP did not change over time, but the proportion of physicians’ prescriptions decreased while the proportion of nurses’ prescriptions increased. 

    Conclusions: PAP recipients had high morbidity and were frequent health care attenders, indicating that PAP was predominantly used for secondary or tertiary prevention. PAP rates did not increase as intended after the implementation of counsellor support. View Full-Text

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  • 2.
    Bendtsen, Preben
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Leijon, M
    Sommer, Ann-Sofie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Pulmonary Medicine. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Respiratory Medicine UHL.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    A s6-monthcontrolled naltrexonestudy: combined effect with cognitive behavioral therapy in outpatient treatment of alcohol dependence2003In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 11Article in journal (Other (popular science, discussion, etc.))
  • 3.
    Bendtsen, Preben
    et al.
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    Leijon, Margareta
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    Sommer, Ann Sofie
    Linköping University, Department of Medicine and Care, Pulmonary Medicine. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    Measuring health-related quality of life in patients with chronic obstructive pulmonary disease in a routine hospital setting: Feasibility and perceived value2003In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 1, no 5Article in journal (Refereed)
    Abstract [en]

    Background

    Assessment of health-related quality of life is so far mainly used in specific research settings and not widely accepted in the routine care of patients. Lack of trust in accuracy and reliability and lack of knowledge concerning the questionnaires used, methods, terminology, are just some of the perceived barriers for a more widespread dissemination of these instruments into routine health care. The present study was undertaken in order to test the feasibility of a computerised system for collecting and analysing health-related quality of life in a routine clinical setting and to examine the thoughts and attitudes among physicians concerning the value of these measurements.

    Methods

    Seventy-four patients with chronic pulmonary lung disease were asked to assess their health-related quality of life with a computerised version of the SF-36 questionnaire before a regular the visit to a physician. The results were immediately available for the physician during the consultation for comparison of information given by the patients and the physician's evaluation of the patients overall health status. A focus group interview with the physicians was performed before and after the implementation of routine measurements of health-related quality of life.

    Results

    The systematic assessment concept worked satisfactorily. All patients approached agreed to participate and completed the assessment on the touch screen computer. A weak correlation was found between patients' self-rated health and pulmonary function and between physicians' evaluation and pulmonary function. The physicians appreciated the SF-36 assessments and the value of the patients' perspective although only a few could pinpoint new clinical decisions based upon this new information.

    Conclusion

    Physicians' clinical evaluation and patients' self-rating of health status offer unique and important information that are complementary.

  • 4. Bobak, M
    et al.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Pikhart, H
    Marmot, M
    Life span and disability: a cross sectional comparison of Russian and Swedish community based data2004In: The BMJ, E-ISSN 1756-1833, Vol. 329, no 7469, p. 767-770Article in journal (Refereed)
    Abstract [en]

    Objectives To compare levels of disability (in terms of physical function and self rated health) among middle aged and elderly people in Russia and Sweden, a country with high life expectancy. Design Cross sectional study. Setting General population of the Russian Federation and of two counties in southern Sweden. Participants Randomly selected men and women in Sweden (n = 9489) and Russia (n = 1599). Main outcome measures Official life table data, self rated health and physical functioning (subscale of the SF-36). Results The official life table data showed large differences in mortality-for example, 36% of Russian men aged 45-49 years would survive the next 25 years compared with 75% of Swedish men. The survey data showed, for both sexes, similar levels of self rated health and physical functioning in the two countries up to the age of about 45 years, but after that, the age related decline in both outcomes was much faster in Russia than in Sweden. By combining the national life tables with survey data on physical functioning we estimated that in the age group 45-49 years, 99% of Russian and 97% of Swedish men would be free of disability, of these, if these data were for a cohort, only 17% of Russians would be alive and free of disability 25 years later compared with 65% of Swedes. The difference in survival was similar in women. Conclusions Large differences exist in survival without disability between elderly Russians and Swedes. The short life span in Russia reflects high levels of ill health and disability and is associated with a rapid age related decline in physical functioning.

  • 5.
    Carlfjord, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Lindberg, Malou
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Experiences of Working with the Tobacco Issue in the Context of Health Promoting Hospitals and Health Services: A Qualitative Study2011In: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, ISSN 1660-4601, Vol. 8, no 2, p. 498-513Article in journal (Refereed)
    Abstract [en]

    The worldwide Health Promoting Hospital and Health Services (HPH) network was initiated by the World Health Organizations in the late 1980s. The goal of the network is to change the focus of health services from curing patients to also embrace disease prevention and health promotion. In Sweden the network started in 1996, and involves mainly hospitals and primary care. The network members collaborate in task forces, one of which is working on the tobacco issue. There is limited evidence on the value of working within an HPH organization. The aim of this study was to investigate the experiences of members of the Swedish HPH network tobacco task force. Focus group interviews with task force members were analyzed using implementation theory. Three themes, overall experiences of working with tobacco issues, experiences of working with. free from tobacco in connection with surgery., and experiences of work in the HPH tobacco task force, emerged from the interviews. The results show that working with the tobacco issue in the context of health-promoting hospitals and health services met with difficulties involving the following important factors: evidence, context, facilitation and adopter characteristics. Leadership, one contextual factor, at national and local level, seems to be crucial if the work is going to succeed. The tobacco task force of the HPH network is an important facilitator supporting the task.

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  • 6.
    Dyar, Oliver J.
    et al.
    Uppsala Univ, Sweden.
    Haglund, Bo J. A.
    Karolinska Inst, Sweden.
    Melder, Cecilia
    Univ Coll Stockholm, Sweden.
    Skillington, Tracey
    Univ Coll Cork, Ireland.
    Kristenson, Margareta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Sarkadi, Anna
    Uppsala Univ, Sweden.
    Rainbows over the worlds public health: determinants of health models in the past, present, and future2022In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 50, no 7, p. 1047-1058Article in journal (Refereed)
    Abstract [en]

    The need to visualise the complexity of the determinants of population health and their interactions inspired the development of the rainbow model. In this commentary we chronicle how variations of this model have emerged, including the initial models of Haglund and Svanstrom (1982), Dahlgren and Whitehead (1991), and the ostgota model (2014), and we illustrate how these models have been influential in both public health and beyond. All these models have strong Nordic connections and are thus an important Nordic contribution to public health. Further, these models have underpinned and facilitated other examples of Nordic leadership in public health, including practical efforts to address health inequalities and design new health policy approaches. Apart from documenting the emergence of rainbow models and their wide range of contemporary uses, we examine a range of criticisms levelled at these models - including limitations in methodological development and in scope. We propose the time is ripe for an updated generic determinants of health model, one that elucidates and preserves the core value in older models, while recognising the developments that have occurred over the past decades in our understanding of the determinants of health. We conclude with an example of a generic model that fulfills the general purposes of a determinants of health model while maintaining the necessary scope for further adjustments to be made in the future, as well as adjustments to location or context-specific purposes, in education, research, health promotion and beyond.

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  • 7.
    Elwing, B
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Kullberg, C
    Kucinskiene, Z
    Björegren, M
    Abaravicius, A
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment.
    A comparative study of food intake between Lithuanian and Swedish middle-aged men: The LiVicordia study2001In: Scandinavian Journal of Nutrition/Næringsforskning, ISSN 1102-6480, E-ISSN 1651-2359, Vol. 45, no 3, p. 126-130Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    Background: In 1994, the mortality in coronary heart disease was four times higher among Lithuanian middle-aged men than among Swedish men. Over the period 1993-1995, the LiVicordia study investigated possible causes for this difference. We have earlier reported lower serum levels of cholesterol and higher susceptibility of low-density lipoprotein cholesterol for oxidation among Lithuanian men. Objective: In this part of the study, the aim was to compare mean estimates of food intake. Design: Cross-sectional study of random samples of 50-year-old men from each of the cities of Link÷ping, Sweden and Vilnius, Lithuania (n=150). The volunteers were interviewed about their food intake with the 24-hour recall method. Results: We found no differences in total energy intake, but Vilnius men had a higher energy intake from fat. Vilnius men consumed more fat from meat and less vegetable fat, while fat intake from dairy products was almost the same. Also, Vilnius men had a higher intake of vegetables, while Link÷ping men had a higher intake of fruit and berries. Conclusion: The observed differences in food consumption and dietary composition are partly consistent with the higher CHD mortality among Lithuanian men. However, data on biomarkers indicate that other dietary and lifestyle factors play a role.

  • 8.
    Festin, Karin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Thomas, Kristin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ekberg, Joakim
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Business support and Development, Department of Health and Care Development.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Choice of measure matters: A study of the relationship between socioeconomic status and psychosocial resources in a middle-aged normal population2017In: PLOS ONE, E-ISSN 1932-6203, Vol. 12, no 8, article id e0178929Article in journal (Refereed)
    Abstract [en]

    Psychosocial resources may serve as an important link to explain socioeconomic differences in health. Earlier studies have demonstrated that education, income and occupational status cannot be used interchangeably as indicators of a hypothetical latent social dimension. In the same manner, it is important to disentangle the effect of measuring different constructs of psychosocial resources. The aim of this study was therefore to analyse if associations between socioeconomic status (SES) and psychosocial resources differ depending on the measures used. A cross-sectional population-based study of a random sample (n = 1007) of middle-aged individuals (45-69 years old, 50% women) in Sweden was performed using questionnaire and register data. SES was measured as education, occupation, household income and self-rated economy. Psychosocial resources were measured as social integration, social support, mastery, self-esteem, sense of coherence (SOC) and trust. Logistic regression models were applied to analyse the relationships controlling for the effects of possible confounders. The measures of SES were low or moderately correlated to each other as were the measures of psychosocial resources. After controlling for age, sex, country of birth and employment status, household income and self-rated economy were associated with all six psychosocial resources; occupation was associated with three (social integration, self-esteem and trust) and education with two (social integration and self-esteem). Social integration and self-esteem showed a significant and graded relationship with all SES measures; trust was associated with all SES measures except education, whereas SOC and mastery were only associated with household income and self-rated economy. After controlling for other SES measures, no associations with psychosocial resources remained for education or occupation. In conclusion, associations between SES and psychosocial resources did differ depending on the measures used. The findings illustrate the importance of the choice of measure when investigating SES as well as psychosocial resources.

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  • 9.
    Garvin, Peter
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Jonasson, Lena
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Nilsson, Lennart
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Association between ambulatory saliva cortisol levels and plasma levels of matrix metalloproteinase-9 in a normal populationManuscript (Other academic)
    Abstract [en]

    Background: Psychosocial strain has been demonstrated to be a risk factor for coronary artery disease (CAD) and also to be associated with a dysfunctional HPA-axis. Based on a proposal on cortisol resistance in maladaptive monocytes as a potential mechanism linking psychosocial strain with CAD, this study aimed at testing the association between levels of salivary cortisol and matrix metalloproteinase-9 (MMP-9) in a normal population.

    Methods: 359 participants (50 % women) aged 45-69 were enrolled to this study, randomly drawn from a normal population in Sweden. Saliva samples were collected thrice per day (at awakening, 30 minutes after awakening, and just before going to bed) during three consecutive days. Cortisol levels at awakening and 30 minutes after awakening were used to estimate the diurnal peak. Cortisol was analyzed using a radioimmunoassay method. MMP-9 was measured in plasma using an ELISA-method.

    Results: After adjustment for age and sex, significant trends regarding MMP-9 were found both for cortisol peak quintiles (beta +1.9 ng/mL per quintile, p=0.029) and cortisol evening values (beta +2.1 ng/ml per quintile, p=0.017). These findings were consistent in regressions either excluding participants with known diagnoses of myocardial infarction, angina pectoris, rheumatoid arthritis, diabetes, cancer with ongoing treatment, chronic obstructive lung disease, osteoporosis and hypothyroidism, or adjusting for these diseases, also after adjustment for cardiovascular risk factors.

    Conclusions: The associations found between cortisol levels and MMP-9 in a normal population hint at a potential pathway linking prolonged psychosocial strain with cardiovascular events.

  • 10.
    Garvin, Peter
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Kristenson, Margareta
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Pooling ambulatory saliva cortisol samples over consecutive days – as reliable as arithmetic means2008In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 68, no 6, p. 508-512Article in journal (Refereed)
    Abstract [en]

    Objective: When cortisol measurements are to be studied in large populations, cost-effective analyses are needed. This study aimed at testing whether one pooled cortisol value over three consecutive days is as reliable as using the arithmetic mean of the samples from the same measure points.

    Material and methods: Thirty participants aged between 45 and 69 collected saliva in salivettes immediately after awakening (t1), 30 min after awakening (t2) and in the evening (t3) during 3 consecutive days. A fixed volume from each of the samples (t1, t2 and t3) was pooled prior to laboratory analysis. Mean levels over 3 days for t1, t2 and t3 were compared to corresponding levels of pooled vials. Cortisol levels were analysed using a radio immunoassay.

    Results: All measures tested had high correlations between mean values and pooled samples, exemplified with diurnal deviation rdif t2–t350.974 (CI 0.946;0.987), and awakening response rdif t2–t150.982 (CI 0.963;0.991). There were no statistical differences between the pooled values and the arithmetic means.

    Conclusion: Pooling samples gave as reliable results as arithmetic means did. Pooling samples prior to laboratory analysis is a cost-effective method for measuring general diurnal cortisol variation in field research projects.

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  • 11.
    Garvin, Peter
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Jonasson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Carstensen, John
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Nilsson, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology.
    Ernerudh, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Levels of circulating matrix metallo proteinase-9 is associated to psychosocial factors and lifestyle2006In: XIV International Symposium on Atherosclerosis,2006, 2006Conference paper (Other academic)
  • 12.
    Garvin, Peter
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Jonasson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Nijm, Johnny
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology.
    Nilsson, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology.
    Olsson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Psychosocial factors in atherosclerosis2006In: XIV International Symposium on Atherosclerosis,2006, 2006Conference paper (Other academic)
  • 13.
    Garvin, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Jonasson, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Nilsson, Lennart
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Falk, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Plasma Matrix Metalloproteinase-9 Levels Predict First-Time Coronary Heart Disease: An 8-Year Follow-Up of a Community-Based Middle Aged Population2015In: PLOS ONE, E-ISSN 1932-6203, Vol. 10, no 9, p. e0138290-Article in journal (Refereed)
    Abstract [en]

    Background The enzyme in matrix metalloproteinase (MMP)-9 has been suggested to be an important determinant of plaque degradation. While several studies have shown elevated levels in patients with coronary heart disease, results in prospective population based studies evaluating MMP-9 in relation to first time coronary events have been inconclusive. As of today, there are four published studies which have measured MMP-9 in serum and none using plasma. Measures of MMP-9 in serum have been suggested to have more flaws than measures in plasma. Aim To investigate the independent association between plasma levels of MMP-9 and first-time incidence of coronary events in an 8-year follow-up. Material and Methods 428 men and 438 women, aged 45-69 years, free of previous coronary events and stroke at baseline, were followed-up. Adjustments were made for sex, age, socioeconomic position, behavioral and cardiovascular risk factors, chronic disease at baseline, depressive symptoms, interleukin-6 and C-reactive protein. Results 53 events were identified during a risk-time of 6 607 person years. Hazard ratio (HR) for MMP-9 after adjustment for all covariates were HR = 1.44 (1.03 to 2.02, p = 0.033). Overall, the effect of adjustments for other cardiovascular risk factors was low. Conclusion Levels of plasma MMP-9 are independently associated with risk of first-time CHD events, regardless of adjustments. These results are in contrast to previous prospective population-based studies based on MMP-9 in serum. It is essential that more studies look at MMP-9 levels in plasma to further evaluate the association with first coronary events.

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  • 14.
    Garvin, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Evalill
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    The joint subclinical elevation of CRP and IL-6 is associated with lower health-related quality of life in comparison with no elevation or elevation of only one of the biomarkers2016In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 25, no 1, p. 213-221Article in journal (Refereed)
    Abstract [en]

    Measures of health-related quality of life (HRQoL), like the Short Form (SF)-36, have been suggested to correlate with inflammatory biomarkers. It is, however, unclear whether a joint measure of two inflammatory biomarkers would bring additional information in comparison with evaluation of one inflammatory biomarker. To evaluate associations between SF-36 and low-grade inflammation in a Swedish population, with emphasis on a combined measure of C-reactive protein (CRP) and interleukin-6 (IL-6) as a proxy for low-grade inflammation. In a randomly selected sample of a middle-aged Swedish general population (n = 905; aged 45-69 years, 50 % women), relations between SF-36 parameters and the biomarkers were tested. Regression and correlation analyses were adjusted for sex, age, presence of disease, lifestyle, and psychological factors. After adjustment for sex and age, HRQoL was significantly lower in the group with a joint elevation of CRP and IL-6 in comparison with either the group with no elevation or the groups showing elevation of one of the two biomarkers. Also after full adjustments, the combined measure of elevated CRP and IL-6, with few exceptions, was associated with significantly lower HRQoL in comparison with elevations in one of them, difference ranging from 4 (Mental Health scale) to 18 scale steps (Role-Physical scale). This study confirms that there is a relationship between HRQoL and low-grade inflammation. In particular, SF-36 scores are significantly lower in a group with joint elevation of IL-6 and CRP, in comparison with elevation of either one of them.

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  • 15.
    Garvin, Peter
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science.
    Nilsson, Lennart
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Jonasson, Lena
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Circulating Matrix Metalloproteinase-9 Is Associated with Cardiovascular Risk Factors in a Middle-Aged Normal Population2008In: PLoS ONE, ISSN 1932-6203, Vol. 3, no 3, p. e1774-Article in journal (Refereed)
    Abstract [en]

    Background: Elevated levels of circulating matrix metalloproteinase-9 (MMP-9) have been demonstrated in patients with established coronary artery disease (CAD). The aim of this study was to analyse levels of MMP-9 in a population free from symptomatic CAD and investigate their associations with cardiovascular (CV) risk factors, including C-reactive protein (CRP).

     

    Methods: A cross-sectional study was performed in a population based random sample aged 45–69 (n = 345, 50% women). MMP-9 levels were measured in EDTA-plasma using an ELISA-method. CV risk factors were measured using questionnaires and standard laboratory methods.

    Results: Plasma MMP-9 was detectable in all participants, mean 38.9 ng/mL (SD 22.1 ng/mL). Among individuals without reported symptomatic CAD a positive association (p<0.001) was seen, for both men and women, of MMP-9 levels regarding total risk load of eight CV risk factors i.e. blood pressure, dyslipidemia, diabetes, obesity, smoking, alcohol intake, physical activity and fruit and vegetable intake. The association was significant also after adjustment for CRP, and was not driven by a single risk factor alone. In regression models adjusted for age, sex, smoking, alcohol intake and CRP, elevated MMP-9 levels were independently positively associated with systolic blood pressure (p = 0.037), smoking (p<0.001), alcohol intake (p = 0.003) and CRP (p<0.001). The correlation coefficient between MMP-9 and CRP was r = 0.24 (p<0.001).

     

    Conclusions: In a population without reported symptomatic CAD, MMP-9 levels were associated with total CV risk load as well as with single risk factors. This was found also after adjustment for CRP

     

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  • 16.
    Garvin, Peter
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsson, Lennart
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Carstensen, John
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Jonasson, Lena
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Plasma Levels of Matrix Metalloproteinase-9 are Independently Associated With Psychosocial Factors in a Middle-Aged Normal Population2009In: PSYCHOSOMATIC MEDICINE, ISSN 0033-3174, Vol. 71, no 3, p. 292-300Article in journal (Refereed)
    Abstract [en]

    Objective: To test the association between psychosocial factors and circulating levels of matrix metalloproteinase-9 (MMP-9) in a normal population sample. Psychosocial factors have been associated with inflammatory markers and are of prognostic significance for coronary artery disease (CAD). The degrading enzyme MMP-9 is upregulated in inflammatory processes and hypothesized to play a role in the rupture of atherosclerotic plaques. Methods: A total of 402 participants (50% women), aged 45 to 69 years, were drawn randomly from a normal population. Psychosocial instruments covered depression (Center for Epidemiological Studies Depression Questionnaire, CES-D), vital exhaustion, hostile affect, cynicism, mastery, self-esteem, sense of coherence (SOC), emotional support, and social integration. Plasma MMP-9 was measured by an enzyme-linked immunosorbent assay method. Linear regression models were adjusted for age, sex, known CAD, rheumatoid arthritis, cancer, cardiovascular risk factors including C-reactive protein and ongoing medication. Results: After full adjustment, there were independent associations of elevated MMP-9 levels with CES-D (+2.9 ng/ml per SD, p=.02), hostile affect (+3.0 ng/ml per SD, p=.02), cynicism (+3.5 ng/ml per SD, p=.006), and SOC (-2.5 ng/ml per SD, p=.046). A principal component analysis extracted three components. The first was mainly extracted from CES-D, vital exhaustion, self-esteem, mastery, and SOC; the second was mainly extracted from hostile affect and cynicism. Both were independently associated with MMP-9 (p=.02, p=.04) when run in the same model. Conclusions: MMP-9 levels were associated with psychosocial factors in a middle-aged normal population sample, independently of traditional risk factors. The findings may constitute a possible link between psychosocial factors and cardiovascular risk.

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  • 17.
    Garvin, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Suska, Anke
    Linköping University, Department of Physics, Chemistry and Biology, Applied Physics. Linköping University, The Institute of Technology.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Lundström, Ingemar
    Linköping University, Department of Physics, Chemistry and Biology, Applied Physics. Linköping University, The Institute of Technology.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    SALIVARY ALPHA-AMYLASE IN A POPULATION BASED SAMPLE. ASSOCIATIONS WITH PSYCHOSOCIAL FACTORS, SELF RATED HEALTH AND INFLAMMATORY MARKERS2010In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 17, no 1 Supplement, p. S181-S181Article in journal (Other academic)
    Abstract [en]

    Objective: In recent years, salivary alpha-amylase (sAA) has beenproposed as a reliable proxy for sympathetic activity. This study aimed at testing the association between sAA to a broad range of psychosocial factors, self rated health, cardiovascular risk factors and inflammatory markers in a normal population sample.

    Methods: 30 participants, all men between 50 and 54 years old, were randomly selected from a normal population based study. Saliva samples were collected at awakening, 30 minutes after awakening and just before going to bed. sAA was measured by a calorimetric method using Phadebas amylase test. Linear regression models were used to test associations between sAA levels and a broad spectrum of psychosocial factors (e.g. depressive symptamology, vital exhaustion, mastery and sense of coherence) self rated health and inflammatory markers (e.g. C-reactive protein). Adjustments were made for physical exercise, smoking, blood  lipids and  time point  when  sample was collected.

    Results: sAA levels at awakening were positively associated with depressive symptamology (p = 0.046), vital exhaustion (p = 0.025) and negatively associated with sense of coherence (p = 0.034). It was further associated positively associated with levels of C-reactive protein (p = 0.024)  and  negatively associated with  self  reported general health (p = 0.010). Samples taken just before going to bed were showing similar results, whereas samples taken 30 minutes after awakening only showed a few significant associations.

    Conclusions: The associations found give further support for the use of salivary alpha amylase as a psychoneuroendocrinological bio- marker. Assessment just after awakening or just before going to bed seems to be more reliable than samples 30 minutes after awakening.

  • 18.
    Granström, Fredrik
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    Garvin, Peter
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Forskningsstrategiska enheten.
    Molarius, A.
    Centre for Clinical Research, Region Värmland, Karlstad, Sweden; Department of Public Health, Karlstad University, Karlstad, Sweden.
    Kristenson, Margareta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Distinguishing independent and shared effects of material/structural conditions and psychosocial resources on educational inequalities in self-rated health: results from structural equation modelling2021In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 196, p. 10-17Article in journal (Refereed)
    Abstract [en]

    Objectives

    The aim of this study was to distinguish independent and shared effects of material/structural factors and psychosocial resources in explaining educational inequalities in self-rated health (SRH) by using structural equation modelling.

    Study design

    Cross-sectional survey.

    Methods

    Data were derived from a questionnaire sent to a random sample of the population in five counties in Sweden in 2008. The study population (aged 25–75 years) included 15,099 men and 17,883 women. Exploratory structural equation modelling was used to analyse the pathways from educational level to SRH.

    Results

    The pathway including both material/structural factors (e.g. financial buffer and unemployment) and psychosocial resources (e.g. sense of coherence and social participation) explained about 40% of educational differences in SRH for both men and women. The pathways including only the independent effects of psychosocial resources (14% in men and 20% in women) or material/structural factors (9% and 18%, respectively) explained substantial but smaller proportions of the differences.

    Conclusions

    The major pathway explaining educational inequalities in SRH included both material/structural factors and psychosocial resources. Therefore, to reduce educational inequalities in SRH, interventions need to address both material/structural conditions and psychosocial resources across educational groups.

  • 19.
    Granström, Fredrik
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Uppsala University, Sweden.
    Molarius, Anu
    Vastmanland County Council, Sweden.
    Garvin, Peter
    Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Elo, Sirkka
    Örebro County Council, Sweden.
    Feldman, Inna
    Uppsala County Council, Sweden; Uppsala University, Sweden.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Exploring trends in and determinants of educational inequalities in self-rated health2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 7, p. 677-686Article in journal (Refereed)
    Abstract [en]

    Aims: Educational inequalities in self-rated health (SRH) in European welfare countries are documented, but recent trends in these inequalities are less well understood. We examined educational inequalities in SRH in different age groups, and the contribution of selected material, behavioural and psychosocial determinants from 2000 to 2008. Methods: Data were derived from cross-sectional surveys conducted in 2000, 2004 and 2008 including 37,478, 34,876 and 32,982 respondents, respectively, aged 25-75 in mid-Sweden. Inequalities were analysed by age-standardized and age-stratified rate ratios of poor SRH and age-standardized prevalence of determinants, and contribution of determinants by age-adjusted logistic regression. Results: Relative educational inequalities in SRH increased among women from 2000 (rate ratio (RR) 1.70, 95% CI 1.55-1.85) to 2008 (RR 2.07, 95% CI 1.90-2.26), but were unchanged among men (RR 1.91-2.01). The increase among women was mainly due to growing inequalities in the age group 25-34 years. In 2008, significant age differences emerged with larger inequalities in the youngest compared with the oldest age group in both genders. All determinants were more prevalent in low educational groups; the most prominent were lack of a financial buffer, smoking and low optimism. Educational differences were unchanged over the years for most determinants. In all three surveys, examined determinants together explained a substantial part of the educational inequalities in SRH. Conclusions: Increased relative educational health inequalities among women, and persisting inequalities among men, were paralleled by unchanged, large differences in material/structural, behavioural and psychosocial factors. Interventions to reduce these inequalities need to focus on early mid-life.

  • 20.
    Hammaréus, Filip
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Lennart
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ong, Kwok-Leung
    Faculty of Medicine and Health, NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia.
    Kristenson, Margareta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Festin, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Lundberg, Anna K.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Chung, Rosanna W. S.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Swahn, Eva
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Alfredsson, Joakim
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Holm Nielsen, Signe
    Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark; Nordic Bioscience, Herlev, Denmark.
    Jonasson, Lena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Plasma type I collagen α1 chain in relation to coronary artery disease: findings from a prospective population-based cohort and an acute myocardial infarction prospective cohort in Sweden.2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 9, article id e073561Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the association between type I collagen α1 chain (COL1α1) levels and coronary artery disease (CAD) by using absolute quantification in plasma. Also, to investigate the correlates of COL1α1 to clinical characteristics and circulating markers of collagen metabolism.

    DESIGN: Life conditions, Stress and Health (LSH) study: prospective cohort study, here with a nested case-control design.Assessing Platelet Activity in Coronary Heart Disease (APACHE) study: prospective cohort study.

    SETTING: LSH: primary care setting, southeast Sweden.APACHE: cardiology department, university hospital, southeast Sweden.

    PARTICIPANTS: LSH: 1007 randomly recruited individuals aged 45-69 (50% women). Exclusion criteria was serious disease. After 13 years of follow-up, 86 cases with primary endpoint were identified and sex-matched/age-matched to 184 controls.

    APACHE: 125 patients with myocardial infarction (MI), 73 with ST-elevation MI and 52 with non-ST-elevation MI.

    EXCLUSION CRITERIA: Intervention study participation, warfarin treatment and short life expectancy.

    PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was the association between baseline COL1α1 and first-time major event of CAD, defined as fatal/non-fatal MI or coronary revascularisation after 13 years. Secondary outcomes were the association between the collagen biomarkers PRO-C1 (N-terminal pro-peptide of type I collagen)/C1M (matrix metalloproteinase-mediated degradation of type I collagen) and CAD; temporal change of COL1α1 after acute MI up to 6 months and lastly, correlates between COL1α1 and patient characteristics along with circulating markers of collagen metabolism.

    RESULTS: COL1α1 levels were associated with CAD, both unadjusted (HR=0.69, 95% CI=0.56 to 0.87) and adjusted (HR=0.55, 95% CI=0.41 to 0.75). PRO-C1 was associated with CAD, unadjusted (HR=0.62, 95% CI=0.47 to 0.82) and adjusted (HR=0.61, 95% CI=0.43 to 0.86), while C1M was not. In patients with MI, COL1α1 remained unchanged up to 6 months. COL1α1 was correlated to PRO-C1, but not to C1M.

    CONCLUSIONS: Plasma COL1α1 was independently and inversely associated with CAD. Furthermore, COL1α1 appeared to reflect collagen synthesis but not degradation. Future studies are needed to confirm whether COL1α1 is a clinically useful biomarker of CAD.

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  • 21.
    Hollman Frisman, Gunilla
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Psychosocial status and health related quality of life in relation to the metabolic syndrome in a Swedish middle-aged population2009In: EUROPEAN JOURNAL OF CARDIOVASCULAR NURSING, ISSN 1474-5151, Vol. 8, no 3, p. 207-215Article in journal (Refereed)
    Abstract [en]

    Background: The Metabolic Syndrome (MS) is a combination of risk factors related to increased risk of cardiovascular disease. Psychosocial factors and stress have been suggested to be important determinants. Aim: To analyse how psychosocial factors, perceived stress and health related quality of life are related to MS, and assess if observed associations are dependent of life-style. Methods: A cross-sectional study of a random sample of 502 men and 505 women aged 45-69, front southeast Sweden, including fasting blood samples, blood pressure, anthropometrics, self-reported data of life-style, psychosocial status and health related quality of life (SF-36). Linear regression models were adjusted for age and, in a second step, also for life-style. Results: Men and women with MS reported lower levels of physical activity, lower scores on physical and social dimensions of SF-36, and women with MS reported stronger effect of social change compared to those without MS (p andlt; 0.05), but we found no differences for mental health or perceived stress. The major part of observed associations was lost after adjustment for effects of life-style. Conclusion: Our data speak against a direct effect of social stress on MS via psychological strain but suggest an indirect pathway via a sedentary life-style.

  • 22.
    Hollman, Gunilla
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Is the prevalence of the metabolic syndrome increasing among middle-aged Swedes?2006Conference paper (Other academic)
    Abstract [en]

       

  • 23.
    Hollman, Gunilla
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Metabolt syndrom i en svensk medelålders population, prevalens och relation till psykosociala faktorer2005Conference paper (Other academic)
  • 24.
    Hollman, Gunilla
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Psychosocial factors and health related to quality of life among middle-aged individuals with and without the metabolic syndrome2006Conference paper (Other academic)
  • 25.
    Hollman, Gunilla
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Psychosocialfactors and healthrelated quality of life among middle-aged individuals with and without the metabolic syndrome2006In: International symposium on Atherosclerosis,2006, 2006Conference paper (Other academic)
  • 26.
    Hollman, Gunilla
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    The prevalence of the metabolic syndrome and its risk factors in a middle-aged Swedish population - mainly a function of overweight?2008In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, no 1, p. 21-26Article in journal (Refereed)
    Abstract [en]

    Background: The prevalence of obesity, one risk factor for developing the metabolic syndrome (MS), has increased during the last decades. It has therefore been assumed that the prevalence of MS would also increase.

    Aims: The aim was to analyse the prevalence of MS and its risk factors in a middle-aged Swedish population.

    Methods: Data were obtained between 2003 and 2004 from a random population based sample of 502 men and 505 women, 45-69 years old. Measures of plasma glucose, serum lipids, blood pressure, weight, height, waist circumference and self-reported data concerning presence of disease, medication and lifestyle were obtained.

    Results: The prevalence of MS was 14.8 % among men and 15.3 % among women, with an increase by age among women only, 10 % to 25 % (p=0.029). Among individuals with MS the most frequent risk factor was large waist circumference, present in 85 % of men and 99 % of women, followed by high blood pressure, high triglycerides, high glucose and HDL cholesterol (38 % and 47 % respectively).

    Conclusion: The prevalence of MS was 15 %, increasing with age only among women.

    Overweight was a dominant characteristic, and only half of the individuals with MS had glucose/HDL cholesterol levels beyond defined cut points of the syndrome.

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  • 27.
    Holmer, Hampus
    et al.
    Karolinska Institutet, Sweden.
    Hurtig, Anna-Karin
    Umeå universitet, Socialmedicin.
    Irestig, Robert
    Capio Psykiatri AB, Stockholm, Sweden.
    Kosidou, Kyriaki
    Region Stockholm, Sweden.
    Kristenson, Margareta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Lönnroth, Knut
    Karolinska Institutet, Sweden.
    Lövestad, Solveig
    Göteborgs Universitet, Sweden.
    Nejat, Sahar
    Region Stockholm, Sweden.
    Stafström, Martin
    Lunds Universitet, Sweden.
    Sarkadi, Anna
    Uppsala Universitet, Sweden; Svensk Förening för Socialmedicin och Folkhälsa, Sweden.
    Nu ses en ljusnande framtid för socialmedicinen2020In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 117, no 46-47, p. 1508-1509Article in journal (Other academic)
  • 28.
    Johansson, Lisbeth M.
    et al.
    Unit for Research and Development in Primary Health Care, Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden.
    Lingfors, Hans
    Linköping University. Unit for Research and Development in Primary Health Care, Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden.
    Golsäter, Marie
    Linköping University. Child Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden; Unit for Research and Development in Primary Health Care, Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Business support and Development, Department of Health and Care Development.
    Fransson, Eleonor I.
    Linköping University. Unit for Research and Development in Primary Health Care, Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden; The A.D.U.L.T Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden; The A.D.U.L.T Research Group, Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Can physical activity compensate for low socioeconomic status with regard to poor self-rated health and low quality-of-life?2019In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 17, article id 33Article in journal (Refereed)
    Abstract [en]

    Background

    Both high socioeconomic status (SES) and high physical activity (PA) are associated with better self-rated health (SRH) and higher quality-of-life (QoL).

    Aim

    To investigate whether high levels of PA may compensate for the association between low SES and subjective health outcomes in terms of poorer SRH and lower QoL.

    Method

    Data from a cross-sectional, population-based study (n = 5326) was utilized. Multiple logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between indicators of SES (economic situation and educational level), SRH and QoL, as well as between the combination of SES and PA in relation to SRH and QoL.

    Result

    Participants with high PA and economic problems had approximately the same OR for good SRH as those with low PA and without economic problems (OR 1.75 [95% CI 1.20–2.54] and 1.81 [1.25–2.63] respectively). Participants with high PA and low education had higher odds for good SRH (OR 3.34 [2.96–5.34] compared to those with low PA and high education (OR 1.46 [0.89–2.39]).Those with high PA and economic problems had an OR of 2.09 [1.42–3.08], for high QoL, while the corresponding OR for those with low PA and without economic problems was 4.38 [2.89–6.63].

    Conclusion

    Physically active people with low SES, had the same or even better odds to report good SRH compared to those with low PA and high SES. For QoL the result was not as consistent. The findings highlight the potential for promotion of PA to reduce SES-based inequalities in SRH.

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  • 29.
    Johansson, Lisbeth M.
    et al.
    Linköping University. Futurum Acad Hlth & Care, Sweden; Jonkoping Univ, Sweden.
    Lingfors, Hans
    Linköping University. Futurum Acad Hlth & Care, Sweden.
    Golsäter, Marie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Jonkoping Univ, Sweden; Futurum Acad Hlth & Care, Sweden.
    Kristenson, Margareta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Fransson, Eleonor I
    Jonkoping Univ, Sweden.
    Physical activity related to mastery and vitality in a Swedish adult population with economic difficulties2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 2193Article in journal (Refereed)
    Abstract [en]

    Background People with low socio-economic status report lower levels of physical activity (PA). There is insufficient knowledge about the availability of psychological resources for those who are physically active despite having a low socio-economic status. The aim of this study is to investigate the association between PA level and mastery and vitality, respectively, within an adult population with self-reported economic difficulties. Method Data from a cross-sectional, population-based study (n = 817) were used. Linear regression was used to estimate the unstandardised regression coefficient (beta) with 95% confidence intervals (95% CI), describing associations between PA levels (independent variable) and scale scores of psychological resources in terms of mastery and vitality (outcome variables). Three models were constructed: Model I unadjusted; Model II adjusted for sex and age; and Model III adjusted for sex, age, smoking and food quality. Result After adjusting for sex, age, smoking and food quality and using low-level PA as the reference, high-level PA, but not intermediate-level PA, was related to higher scale scores of mastery (beta = 0.72 [95% CI 0.08 to 1.37]). For vitality, both high-level PA and intermediate-level PA were related to higher scale scores (beta = 9.30 [95% CI 5.20 to 13.40] and beta = 6.70 [95% CI 1.40 to 12.00] respectively). Conclusion In an adult population with self-reported economic difficulties, higher levels of physical activity were related to higher mastery and vitality. Our results support that the association between physical activity and psychological resources in terms of mastery and vitality should be considered in the context of targeted health dialogues.

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  • 30.
    Jonasson, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hjärtinfarkt2019In: Somatisk sjukdom: biopsykosocialt perspektiv / [ed] Ali Sarkohi, Gerhard Andersson, Lund: Studentlitteratur AB, 2019, Vol. Sidorna 65-91, p. 65-91Chapter in book (Other academic)
  • 31.
    Jonsson, Åsa
    et al.
    Department of Medicine, Division of Cardiology, County Hospital Ryhov, 551 85, Jönköping, Sweden.
    Orwelius, Lotti
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Dahlström, Ulf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Kristenson, Margareta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Evaluation of the usefulness of EQ-5D as a patient-reported outcome measure using the Paretian classification of health change among patients with chronic heart failure2020In: Journal of patient-reported outcomes, ISSN 2509-8020, Vol. 4, no 1, article id 50Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate the usefulness of EQ-5D as a patient-reported outcome measure using different analytical methods. Especially we used the Paretian Classification of Health Change, to see if this gave better information compared to measures that are more traditional. For the evaluation we used data from patients with chronic heart failure (HF).

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  • 32. Kaminskas, A
    et al.
    Ziedén, Bo
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Elving, B
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Abaravicius, A
    Bergdahl, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Olsson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Kucinskiene, Z
    Adipose tissue fatty acids in men from two populations with different cardiovascular risk - the LiVicordia study.1999In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 59, p. 227-232Article in journal (Refereed)
  • 33.
    Karlsson, Nadine
    et al.
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Skargren, Elisabeth
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Emotional support predicts more sickness absence and poorer self assessed work ability: a two-year prospective cohort study2010In: BMC Public Health, E-ISSN 1471-2458, Vol. 10, no 1, p. 648-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: While back pain and stressful work environment are shown to be important causes of sickness absence the effect of psychosocial resources on sickness absence, and on self assessed work ability, is less commonly investigated. The aim of this study was to assess these associations in a two-year follow-up study.

    METHODS: 341 working people aged 45 to 64, randomly drawn from the population, responded to a questionnaire at baseline and at a two-year follow-up. Poisson regression was used to analyse the association of psychosocial factors (psychosocial instruments on work environment, emotional support and psychological resources) and previous back pain (low back and/or neck) at baseline with sickness absence (spells and days) at follow-up, controlling for effects of age, sex, BMI, smoking, alcohol, occupation, disease and previous sickness absence. Logistic regression was used to study the associations of psychosocial factors and previous back pain at baseline with self assessed prognosis of poor work ability six months from follow-up. Finally, a multivariate analysis tested the independent effects of previous back pain and 3 psychosocial factors derived in a factor analysis: 1. work environment; 2. emotional support; 3. psychological resources, on work ability and absence days and spells.

    RESULTS: 80% of the sickness absence spells within the last 12 months before follow-up were short-term (<= 14 days). In the final model, high emotional support predicted more sickness absence spells (RR 1.36; 1.11-1.67) and days (RR 1.68, 1.22-2.31). Previous back pain (OR 2.56; 1.13-5.81), high emotional support (OR 1.58; 1.02-2.46), and low psychological resources (OR 0.62; 0.44-0.89) were related to poorer self assessed prognosis of work ability at follow up.

    CONCLUSIONS: In a general middle aged working population high emotional support was related to more sickness absence and also poorer self assessed prognosis of work ability. Our findings suggest that both sickness absence and self assessed work ability are dependent of life outside work and can be affected by a person's close community.

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  • 34.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Impact of socioeconomic determinants on psychosocial factors and lifestyle - implications for health service: The Swedish experience2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 74, no 5, p. 661-664Article in journal (Refereed)
    Abstract [en]

    n/a

  • 35.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    LEVELS OF SALIVA CORTISOL AS PREDICTOR FOR SOMATIC OUTCOMES in INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, vol 17, issue , pp 207-2072010In: INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, Springer Science Business Media , 2010, Vol. 17, p. 207-207Conference paper (Refereed)
    Abstract [en]

    n/a

  • 36.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Rethinking health promotion: a global approach.2001In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 11, no 3, p. 354-354Article, book review (Other academic)
  • 37.
    Kristenson, Margareta
    Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med. Linköping University, Faculty of Health Sciences.
    The LiVcordia Study: Possible causes for the differences in coronary heart disease mortality between Lithuania and Sweden1998Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: In recent decades coronary heart disease (CHD) mortality has declined in Western Europe and increased in Central and Eastern Europe. A large difference in CHD mortality has developed and the causes are not known. Lithuania and Sweden had similar CHD mortality rates for middle-aged men twenty years ago but in 1994 this mortality was four times higher in Lithuania than in Sweden. Also within countries CHD mortality is higher in low socioeconomic groups.

    Aim of the study: The LiVicordia (Linköping-Vilnius-coronary-artery-disease-risk-assessment) study aimed at identifying possible explanations for the different CHD mortality rates in the two countries.

    Method: This cross-sectional study concomitantly compared 150 randomly sampled 50-year-old men in each of the cities Vilnius, Lithuania and Linköping, Sweden from October 1993 nntil March 1995 using identical, standardised methodology. Investigations included a broad range of traditional and psychosocial risk factors for CHD, measures of oxidative stress, a standardised laboratory stress test and ultrasound measures of Peripheral atherosclerosis.

    Results: The differences found in traditional risk factors for CHD were small. Systolic blood pressure (SBP) was higher in Vilnius men, smoking was similar and plasma LDL cholesterol levels higher in Linköping men. Lower serum levels of the lipid soluble antioxidant vitamins carotene, lycopene and ytocopherol were found in Vilnius men, and also a higher susceptibility of LDL to oxidation in vitro. An unfavourable pattern of psychosocial risk factors for CHD: job strain, social isolation, depression and vital exhaustion characterised Vilnins men, who also showed an attenuated cortisol response to the laboratory stress test. This stress response has earlier been shown in states of chronic stress; loss of dynamic capacity to respond to new demands may be a predisposing factor for disease. Vilnius men had more peripheral atherosclerosis; thicker intima media, more and larger plaques and greater stiffness. Measures of atherosclerosis related to SBP, smoking, LDL cholesterol arrl P-carotene. The same unfavourable profile of risk factors for CHD, which characterised Vilnius men, was also found in underprivileged groups withip the cities. There were few differences in traditional risk factors.

    Conclusions: Thus, based on our survey on risk factors for CHD, it can be stated that traditional risk factors seem not to explain the different CHD mortality rates between Lithuania and Sweden. Possible alternative explanations are psychosocial strain and oxidative stress. These factors were also found among men in underprivileged groups within the cities. Therfore the influence of the risk factors studied may be relevant also for socioeconomic inequalities in CHD mortality within countries.

  • 38.
    Kristenson, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Eriksen, H R
    Biological and Medical Psychology University of Bergen.
    Sluiter, J K
    Academic Medical Center University of Amsterdam.
    Starke, D
    Medical Sociology University of Duesseldorf.
    Ursin, H
    Biological and Medical Psychology University of Bergen.
    Psychobiological mechanisms of socioeconomic differences in health2004In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 58, no 8, p. 1511-1522Article in journal (Refereed)
    Abstract [en]

    The association between low socioeconomic status and poor health is well established. Empirical studies suggest that psychosocial factors are important mediators for these effects, and that the effects are mediated by psychobiological mechanisms related to stress physiology. The objective of this paper is to explore these psychobiological mechanisms. Psychobiological responses to environmental challenges depend on acquired expectancies (learning) of the relations between responses and stimuli. The stress response occurs whenever an individual is faced with a challenge. It is an essential element in the total adaptive system of the body, and necessary for adaptation, performance and survival. However, a period of recovery is necessary to rebalance and to manage new demands. Individuals with low social status report more environmental challenges and less psychosocial resources. This may lead to vicious circles of learning to expect negative outcomes, loss of coping ability, strain, hopelessness and chronic stress. This type of learning may interfere with the recovery processes, leading to sustained psychobiological activation and loss of dynamic capacity to respond to new challenges. Psychobiological responses and health effects in humans and animals depend on combinations of demands and expected outcomes (coping, control). In studies of humans with chronic psychosocial stress, and low SES, cortisol baseline levels were raised, and the cortisol response to acute stress attenuated. Low job control was associated with insufficient recovery of catecholamines and cortisol, and a range of negative health effects. Biological effects of choice of lifestyle, which also depends on the acquired outcome expectancies, reinforce these direct psychobiological effects on health. The paper concludes that sustained activation and loss of capacity to respond to a novel stressor could be a cause of the higher risk of illness and disease found among people with lower SES.

  • 39.
    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)
  • 40.
    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.
    Kucinskiene, Z
    Bergdahl, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Tagesson, C
    Orth-Gomer, K
    Olsson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Self-rated health and biological mechanisms: experiences from the LiVicordia study.2000In: Self-rated health in a European perspective / [ed] Peter Nilsson and Kristina Orth-Gomér, Linköping: Linköpings universitet , 2000, p. 167-175Chapter in book (Other academic)
  • 41.
    Kristenson, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment.
    Kucinskiene, Zita
    Vilnius, Lithuania.
    Bergdahl, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Orth-Gomér, Kristina
    Karoliska inst Stockholm.
    Risk factors for coronary heart disease in different socioeconomic groups of Lithuania and Sweden - The LiVicordia study2001In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 29, no 2, p. 140-150Article in journal (Refereed)
    Abstract [en]

    Aims: Lithuanian middle-aged men have a fourfold higher risk for coronary heart disease (CHD) mortality compared with Swedish men. In Sweden, CHD mortality is twice as high in blue- compared with white-collar workers. Whether the same risk factors that characterized Lithuanian men, compared with Swedish men, could be found in low socioeconomic groups within the cities was investigated. Methods: The LiVicordia study compared both traditional and new possible risk factors for CHD among 150 50-year-old men in Link÷ping, Sweden and Vilnius, Lithuania. A comparison was made of the prevalence of these risk factors in high and low socioeconomic groups within the cities and, after controlling for the city, variations across socioeconomic groups in the total sample. Results: Small differences were found in traditional risk factors between cities. However, Vilnius men were shorter, had lower serum levels of antioxidant vitamins, more psychosocial strain, and lower cortisol response to a standardized laboratory stress test. These characteristics were also found among men in low social classes in both cities. In linear regression models, short stature, low serum ▀-carotene, low social integration, coping and self-esteem, high vital exhaustion, high baseline and low cortisol response to stress were related to low social class. Conclusions: The same set of risk factors, mainly relating to oxidative and psychosocial stress, that characterized Vilnius men was also found in men in low social classes within the cities. The results suggest that a common set of risk factors may help to explain health differences both between and within countries. ⌐ Taylor & Francis 2001.

  • 42.
    Kristenson, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Socialmed FHVC.
    Kucinskiené, Zita
    Schäfer-Elinder, Liselotte
    Leanderson, Per
    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.
    Tagesson, Christer
    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.
    Lower serum levels of beta-carotene in Lithuanian men are accompanied by higher urinary excretion of the oxidative DNA adduct, 8-hydroxydeoxyguanosine: The LiVicordia study.2003In: Nutrition (Burbank, Los Angeles County, Calif.), ISSN 0899-9007, E-ISSN 1873-1244, Vol. 19, no 1, p. 11-15Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In 1995, middle-aged Lithuanian men had a four-fold higher risk than Swedish men of dying from coronary heart disease. The cross-sectional LiVicordia study had reported significantly lower levels of the lipid-soluble antioxidants lycopene, ▀-carotene, and ?-tocopherol among Lithuanian men than among Swedish men. We examined whether there were differences in urinary 8-hydroxydeoxyguanosine (8OHdG), a marker of oxidative stress, between these groups of men. METHODS: Using automated coupled column high-performance liquid chromatography with electrochemical detection, we examined 50-y-old men randomly sampled from Link÷ping, Sweden (n = 99) and Vilnius, Lithuania (n = 109) with regard to urinary concentrations of 8-OHdG. RESULTS: Levels of 8-OHdG were higher in the Lithuanian men than in the Swedish men (20.9 ▒ 0.91 versus 14.9 ▒ 0.75 nM/L, P < 0.001), and this difference was evident in smokers (P < 0.01) and non-smokers (P < 0.001). Serum levels of a- and ▀-carotene were inversely correlated to urinary 8-OHdG levels (P < 0.05 in both cases). Habitual smoking and low levels of ▀-carotene contributed significantly to higher oxidative DNA damage expressed as urinary 8-OHdG. CONCLUSIONS: These findings indicate that increased urinary 8-OHdG levels accompany lower serum levels of antioxidants in Lithuanian men. They supported previous suggestions that increased oxidative stress may be one factor behind the higher mortality in Lithuanian men. ⌐ Elsevier Science Inc. 2003.

  • 43.
    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.
    Lassvik, Claes
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Bergdahl, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Kucinskiene, Z
    Aizieniene, L
    Ziedén, Bo
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Schäfer Elinder, Liselott
    Olsson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Ultrasound determined carotid and femoral atherosclerosis in Lithuanian and Swedish men: The LiVicordia study2000In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 151, no 2, p. 501-508Article in journal (Refereed)
    Abstract [en]

    Coronary heart disease mortality is four times higher in Lithuanian compared to Swedish middle-aged men. Using the same equipment (Acuson XP10 with 5 MHz linear transducer) and staff, we compared the amount of atherosclerosis in carotid and femoral arteries in 100 randomly sampled 50-year-old men in each of the cities Vilnius, Lithuania and Linköping, Sweden. Atherosclerotic plaques were more abundant in Vilnius men compared to Linköping men (53 versus 28% in the common carotid artery, 73 versus 37% in the common femoral artery, P<0.001 for both). Plaques were thicker and more extended in arteries of Vilnius men, and an ultrasound atherosclerosis score was higher in both carotid and femoral arteries (P<0.001 for all). More Vilnius men had a maximal intima-media thickness of the common femoral artery above 1 mm (P<0.005). Stiffness in the common carotid artery was higher in Vilnius men (P<0.001). In a linear regression model of the pooled material, after adjustment for city was made, smoking, systolic blood pressure, low density lipoprotein cholesterol and β-carotene (inversely) significantly contributed to a high total ultrasound score (r2=0.32). These findings show that the higher coronary mortality noted in Lithuanian men goes together with a higher prevalence of early peripheral atherosclerosis.

  • 44.
    Kristenson, Margareta
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Lindfors, Petra
    Stockholm University.
    Lundberg, Ulf
    Stockholm University.
    Harris, Anette
    University of Bergen.
    Hansen, Ase M
    University of Copenhagen.
    Garvin, Peter
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ursin, Holger
    University of Bergen.
    THE ROLE OF SALIVA CORTISOL MEASUREMENTS IN HEALTH AND DISEASE - A MATTER OF THEORY AND METHODOLOGY in INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, vol 17, issue , pp 206-2062010In: INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, Springer Science Business Media , 2010, Vol. 17, p. 206-206Conference paper (Refereed)
    Abstract [en]

    n/a

  • 45.
    Kristenson, Margareta
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lundberg, Johanna
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Garvin, Peter
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Socioeconomic differences in outpatient healthcare utilisation are mainly seen for musculoskeletal problems in groups with poor self-rated health2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 8, p. 805-812Article in journal (Refereed)
    Abstract [en]

    Aim: To assess whether there are socioeconomic (SES) differences in outpatient visits within groups of comparable morbidity (medical disease and self-rated health) and whether psychosocial factors can explain these differences. Methods: Baseline data for SES, presence of disease, self-rated health (SRH), and psychosocial factors were collected during 2003-04 from 923 men and women aged 45-69 years in southeast Sweden. Outcome data were all registered outpatient healthcare visits to physicians during 2004-08. Cumulative incidences and standardised rate ratios (SSR) were calculated for strata of comparable morbidity for all visits, for visits due to cardiovascular disorders (CVD)/diabetes and for musculoskeletal problems. Results: Low SES was associated with more outpatient visits due to musculoskeletal problems (SRR for education 1.52, 95% CI 1.35-1.73; for occupation 1.40, 95% CI 1.26-1.56) and accentuated in groups with poor SRH. The SES effect was significant for visits to primary care and to hospitals, for men and women, and independent of present disease, SRH, and psychosocial factors. Low SES was significantly associated with more total outpatient visits at primary healthcare centres. In contrast, for outpatient visits due to CVD/diabetes, high SES was related to more visits to hospitals among people with good SRH at baseline. Conclusions: We found a consistent pattern for outpatient visits related to musculoskeletal problems where people with low SES counted more visits and this was most prominent in groups of poor SRH. The results demonstrate the need to apply different morbidity measures when studying inequalities in healthcare utilisation.

  • 46.
    Kristenson, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Nikku, Nina
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, Sociology.
    Ethics and opportunistic health promotion. The example of alcohol information at the emergency clinic1995In: Health Gain Measurements as a Tool for Hospital Management and Health Policy,1995, Linköping: Health Promoting Hospitals , 1995, p. 148-Conference paper (Refereed)
  • 47.
    Kristenson, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Olsson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Kucinskiene, Zita
    Vilnius University, Lithuania.
    Good self-rated health is related to psychosocial resources and a strong cortisol response to acute stress: The LiVicordia study of middle-aged men2005In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 12, no 3, p. 153-160Article in journal (Refereed)
    Abstract [en]

    Self-rated health (SRH) is a strong predictor for disease and death. The relations among SRH, psychosocial factors, and cortisol dynamics were tested using pooled data from the LiVicordia study of 50-year-old men in Lithuania (n = 94) and Sweden (n = 89), controlling for effect of residence. SRH was assessed by " How would you assess your own health?" A standardized laboratory stress test included measures of cortisol in serum and saliva. Good SRH related to high scale scores of decision latitude, social support at work, coping, self-esteem, and sense of coherence, to low scores of overcommitment (all p < .01) and vital exhaustion (r = -0.40, p < 0.001), to low concentrations of saliva baseline cortisol (r = -.26, p = .001), and to a strong cortisol response to stress (r = .27, p = .001). Findings that good SRH related to favorable psychosocial characteristics and to a dynamic cortisol stress response indicate a possible explanation for observed lower risk for disease and death in this state. Copyright © 2005 by Lawrence Erlbaum Associates, Inc.

  • 48.
    Kristenson, Margareta
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Sarkadi, Anna
    Uppsala Univ, Sweden.
    The specialty of social medicine and public health in Sweden: Challenges and future directions2023In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Other academic)
  • 49.
    Kälvegren, Hanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Pharmacology . Linköping University, Faculty of Health Sciences.
    Fridfeldt (Berggren), Jonna
    Linköping University, Department of Medicine and Health Sciences, Pharmacology . Linköping University, Faculty of Health Sciences.
    Garvin, Peter
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Wind, Lena
    Leanderson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine . Linköping University, Faculty of Health Sciences.
    Kristenson, Margaretha
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Kihlström, Erik
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences.
    Bengtsson, Torbjörn
    Linköping University, Department of Medicine and Health Sciences, Pharmacology . Linköping University, Faculty of Health Sciences.
    Richter, Arina
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Correlation between rises in Chlamydia pneumoniae-specific antibodies, platelet activation and lipid peroxidation after percutaneous coronary intervention.2008In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 27, no 7, p. 503-511Article in journal (Refereed)
    Abstract [en]

    We recently showed that Chlamydia pneumoniae activates platelets in vitro, with an associated oxidation of low-density lipoproteins. The aim of this study was to investigate whether C. pneumoniae is released during percutaneous coronary intervention (PCI) and, thereby, causes platelet activation and lipid peroxidation. Seventy-three patients undergoing coronary angiography and following PCI or coronary artery bypass graft (CABG) and 57 controls were included in the study. C. pneumoniae antibodies, serotonin and lipid peroxidation were measured before and 24 h, 1 month and 6 months after angiography. The results show that serum C. pneumoniae IgA concentrations were significantly higher in patients than in the controls. Furthermore, in 38% of the C. pneumoniae IgG positive patients, the C. pneumoniae IgG concentration increased 1 month after PCI. The levels of C. pneumoniae IgG antibodies 1 month after PCI correlated with plasma-lipid peroxidation (r = 0.91, P < 0.0001) and platelet-derived serotonin (r = 0.62, P = 0.02). There was no elevation in the total serum IgG 1 month after PCI. In conclusion, the present results suggest that PCI treatment of coronary stenosis releases C. pneumoniae from the atherosclerotic lesions, which leads to platelet activation and lipid peroxidation.

  • 50.
    Lundberg, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Jönsson, Simon
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Stenmark, Jonathan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Jonasson, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Stress-induced release of matrix metalloproteinase-9 in patients with coronary artery disease: The possible influence of cortisol2016In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 73, p. 117-124Article in journal (Refereed)
    Abstract [en]

    Stress and inflammation are both important risk factors for coronary artery disease (CAD). However, the susceptibility to stress-induced inflammation and its determinants have been little explored in patients with CAD. Here, our aim was to study the stress-induced inflammatory response, more precisely the early release of matrix metalloproteinase (MMP)-9, and its association with cortisol response in patients with CAD. Sixty-four patients underwent a standardized laboratory stress test. The stress-induced release of MMP-9 was closely associated with the release of other neutrophil-associated proteins, MMP-8 and myeloperoxidase (MPO). It also showed a large variation among patients, as did cortisol. Twenty minutes after stress, a negative association between changes in MMP-9 and cortisol was seen (p amp;lt; 0.01). In vitro, dexamethasone reduced the IL-8-mediated release of MMP-9 from neutrophils, indicating that glucocorticoids may exert rapid effects on neutrophil activation. Further characterization of patients revealed that stress-induced release of MMP-9 was related to leukocyte telomere shortening and increased ultrasound assessed plaque occurrence in the carotid arteries, but not to other characteristics such as age, gender or psychological background factors. The susceptibility to stress-induced release of MMP-9 may thus have impact on disease phenotype. Stress tests can be useful to identify CAD patients in need of novel prevention and treatment strategies. (C) 2016 Published by Elsevier Ltd.

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