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  • 101.
    Fagerlind Ståhl, Anna-Carin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Live long and prosper: Health-promoting conditions at work2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis is to contribute with knowledge concerning health-promoting conditions at work, and to investigate how individual, workplace and organisational conditions are interrelated. In the thesis, work-related flow, i.e. an experience of motivation, absorption and work enjoyment, is used as a holistic notion of occupational health. In Paper I, work-related flow is investigated in relation to decision latitude, social capital and an innovative learning climate at work. Paper II investigates whether the use of tools inspired by lean production, such as standardisation and value stream mapping, is positively associated with conditions for innovative learning in organisations. The aim of Paper III is to identify conditions for health and performance in organisation and at work; further, to investigate the association between work-related flow and performance. Paper IV reports on a longitudinal investigation of workrelated flow in relation to lean tool use and conditions at the workplace. The empirical material is based on data from 10 organisations, including 4442 employees. Papers I-III are cross-sectional, whereas Paper IV is longitudinal. Papers II-IV utilise multilevel analyses.

    The results show that decision latitude, social capital and an innovative learning climate are associated with an increase in work-related flow (Papers I, III & IV), and with performance (Paper III). Individuals’ decision latitude enables an increased benefit from the social capital and innovative learning climate at work (Paper I). The effect of tools inspired by lean production on work-related flow (Papers III & IV), and on conditions for innovative learning (Paper II) differs, depending on which tools are used, and on workplace conditions. These tools enable innovative learning mainly where decision latitude is low (Paper II), and it is primarily the lean tool value stream mapping which has the potential to create an arena for innovative learning (Paper II) and work-related flow (Paper IV).

    It is concluded that the individual is embedded in a social work context that has the potential to strengthen the ability to act with motivation, absorption and enjoyment. In order to utilise collective healthpromoting conditions at work, individuals need to have authority to make their own decisions and use their skills. The effect of tools inspired by lean production depends on the specific tools that are used, and on individuals’ decision latitude at work. Their potential to enable innovative learning is most evident for employees who  have few opportunities for autonomous decision-making and skill use in their work. For those with a high degree of decision latitude, the use of lean tools has a smaller effect. Work-related flow may in itself serve as a resource that improves performance and increases engagement in health-promoting work conditions. In order to promote health as well as performance, work needsto be organised so that employees have opportunities to decide over their own work, and utilise their skills, individually and collectively within the workgroup.

    List of papers
    1. Experience of work-related flow: Does high decision latitude enhance benefits gained from job resources?
    Open this publication in new window or tab >>Experience of work-related flow: Does high decision latitude enhance benefits gained from job resources?
    2013 (English)In: Journal of Vocational Behavior, ISSN 0001-8791, E-ISSN 1095-9084, Vol. 83, no 2, p. 161-170Article in journal (Refereed) Published
    Abstract [en]

    Flow is an experience of enjoyment, intrinsic motivation and absorption, which may occur in situations involving high challenges and high skill utilization. This study investigated the likelihood of experiencing work-related flow in relation to the job strain categories of the demand–control model, and to job resources such as social capital and an innovative learning climate. A questionnaire was sent out to employees in nine Swedish organizations (n = 3667, 57% response rate). Binary logistic regression analysis was performed. The results show that active jobs, low-strain jobs, a high degree of social capital and innovative learning climate increased the likelihood of experiencing work-related flow. In jobs with high decision latitude, regardless of demands, there was an increased likelihood to benefit from social capital and an innovative learning climate. The results emphasize the importance of autonomy and skill utilization, to enable the use of additional job resources in order to promote work-related flow and well-being at work.

    Place, publisher, year, edition, pages
    Elsevier, 2013
    Keywords
    Work-related flow, Job resources, Demand-control model, Employee health, Health promoting organizations, Innovative learning climate
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-95813 (URN)10.1016/j.jvb.2013.03.010 (DOI)000320484100005 ()
    Available from: 2013-07-26 Created: 2013-07-26 Last updated: 2017-12-06
    2. Lean production tools and decision latitude enable conditions for innovative learning in organizations: a multilevel analysis
    Open this publication in new window or tab >>Lean production tools and decision latitude enable conditions for innovative learning in organizations: a multilevel analysis
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    2015 (English)In: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 47, p. 285-291Article in journal (Refereed) Published
    Abstract [en]

    The effect of lean production on conditions for learning is debated. This study aimed to investigate how tools inspired by lean production (standardization, resource reduction, visual monitoring, housekeeping, value flow analysis) were associated with an innovative learning climate and with collective dispersion of ideas in organizations, and whether decision latitude contributed to these associations. A questionnaire was sent out to employees in public, private, production and service organizations (n = 4442). Multilevel linear regression analyses were used. Use of lean tools and decision latitude were positively associated with an innovative learning climate and collective dispersion of ideas. A low degree of decision latitude was a modifier in the association to collective dispersion of ideas. Lean tools can enable shared understanding and collective spreading of ideas, needed for the development of work processes, especially when decision latitude is low. Value flow analysis played a pivotal role in the associations.

    Place, publisher, year, edition, pages
    Elsevier, 2015
    Keywords
    psychosocial work conditions, job resources, learning climate
    National Category
    Other Health Sciences Learning
    Identifiers
    urn:nbn:se:liu:diva-112552 (URN)10.1016/j.apergo.2014.10.013 (DOI)000347663600033 ()
    Available from: 2014-12-02 Created: 2014-12-02 Last updated: 2017-12-05Bibliographically approved
    3. Associations between organisation of work, work conditions, work-relatedf low and performance: a multilevel analysis
    Open this publication in new window or tab >>Associations between organisation of work, work conditions, work-relatedf low and performance: a multilevel analysis
    Show others...
    2015 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this study is to investigate how organisation of work in terms of sociotechnical characteristics and use of tools inspired by lean production, and psychosocial conditions at the workplace, are associated with work-related flow and performance.

    A questionnaire including questions concerning work organisation, psychosocial work conditions, work-related flow and self-rated performance was sent to employees in ten Swedish organisations; 4442 people (56%) responded. Multilevel logistic regression analyses were used in order to investigate organisation of work and work conditions in relation to work-related flow and performance. In addition, the association between work-related flow and performance was investigated.

    Our results show that a high degree of lean tool use in combination with a low degree of sociotechnical characteristics was negatively associated with work-related flow but positively associated with performance. When decision latitude, social capital, and innovative learning climate were included in the model, the association was no longer significant in relation to work-related flow, but remained and was strengthen in relation to performance. Work-related flow had a positive association with performance.

    The conclusion is that work-related flow and work conditions that enable individual and collective skill use are important for increased performance. When lean tools are used to a high degree, good decision latitude, social capital and innovative learning climate buffer negative effects on health, and increase performance.

    Keywords
    Job resources; health; well-being; job design
    National Category
    Learning Work Sciences Other Medical Sciences
    Identifiers
    urn:nbn:se:liu:diva-117062 (URN)
    Available from: 2015-04-15 Created: 2015-04-15 Last updated: 2015-04-15Bibliographically approved
    4. The effect of lean tool use and work conditions on employee health: a longitudinal multilevel study
    Open this publication in new window or tab >>The effect of lean tool use and work conditions on employee health: a longitudinal multilevel study
    2015 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: Although lean production is an increasingly common approach to increase the efficiency of organisations, its effect on employee health is not clear. This longitudinal study investigates the effect of lean tool use and work conditions on work-related flow. Flow is a measure of health that reflects the experience of intrinsic motivation, absorption and work enjoyment.

    Methods: A questionnaire was sent to employees in seven organisations on two occasions with an interval of two years (n =1722). Multilevel linear regression analyses were used in order to investigate the association between the use of lean tools (i.e. standardisation, value stream mapping, visual monitoring, housekeeping and resource reduction), decision latitude, social capital, and innovative learning climate at baseline, and work-related flow at follow-up.

    Results: In multivariate analyses, adjusted for flow at baseline, use of lean tools was positively associated with work-related flow at follow-up. When the tools were investigated separately, only value stream mapping remained significant after adjustment for work conditions and flow at baseline. Social capital and decision latitude were positively associated with flow at follow-up. Flow at baseline and follow-up were strongly associated.

    Conclusions: The extent to which lean tool use has an effect on employee health depends on which tools are used. Work conditions that support learning, such as decision latitude and social capital, are associated with a longitudinal increase in the experience of work-related flow, and are important for gaining health-promoting benefits from the use of lean tools.

    Keywords
    Work-related flow, job resources, psychosocial work conditions, control, learning
    National Category
    Learning Work Sciences Other Medical Sciences
    Identifiers
    urn:nbn:se:liu:diva-117063 (URN)
    Available from: 2015-04-15 Created: 2015-04-15 Last updated: 2015-04-15Bibliographically approved
  • 102.
    Fahlstedt, Lillan
    Linköping University, Department of Medical and Health Sciences.
    Besvär av vanligt förekommande sjukdomar och dess påverkan på den självskattade hälsan2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Introduktion Personer med en låg självskattad hälsa har en ökad risk för att utveckla sjukdom samt att dö i förtid i jämförelse med personer med en hög självskattad hälsa. Faktorer som påverkar den självskattade hälsan är ålder, kön, sjukdom och levnadsvanor.

    Syfte Syftet med studien är att undersöka hur den självskattade hälsan påverkas av besvär av folksjukdomarna hjärt- och kärlsjukdom, cancer, astma och allergi, mag- och tarmsjukdomar, muskel- och ledsjukdomar och depression samt om detta eventuella samband kvarstår efter kontroll av kön, ålder och levnadsvanor.

    Metod Detta är en tvärsnittsstudie med data insamlat från Hälsolyftet och LSH-studien i Östergötland och Jönköpings län. För att undersöka om den självskattade hälsan påverkades av besvär i sjukdomar genomfördes logistiska regressioner.

    Resultat Personer med besvär i sin sjukdom hade högre oddskvoter (OR) för låg självskattad hälsa än personer utan besvär i sin sjukdom. Personer med depression och besvär var de som visade på högst OR för låg självskattad hälsa i de binära analyserna. Efter kontroll för kön, ålder och levnadsvanor visade resultatet att personer med hjärt- och kärlsjukdom med besvär hade högst OR för låg självskattad hälsa, tätt följt av depression med besvär. Astma och allergi var den sjukdom som visade på lägst OR för låg självskattad hälsa.

    Konklusion: Personer som upplever besvär i sin sjukdom har högre OR för låg självskattad hälsa än de utan besvär i sin sjukdom vilket indikerar att upplevelsen besvär har en större roll vid självskattning av hälsan än enbart sjukdom.

  • 103.
    Faresjö, Åshild
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Jullander, Miriam
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Götmalm, Sara
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Higher perceived stress and poorer health reflected in elevated cortisol concentrtions measured in extracts of hair from middle-aged healthy women2014In: BMC Psychology, ISSN 2050-7283, Vol. 2, no 30, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Background

    The prevalence of mental strain and stress has increased in modern societies, resulting in increased public health problems. Stress can be measured either by biomarkers or by self-reports. A new biomarker that measures long-term biological stress is cortisol measured in timed hair extracts. Hair grows at approximately 1 cm per month, and retrospectively reflects average stress levels. However, the plausible relationship between perceived stress and self-reported health and this novel biomarker is yet not firmly established. The objective of this study was to investigate the possible relationship between perceived stress, self-reported health, and cortisol in hair extracts in healthy middle-aged women from two different occupations.

    Method

    A cross-sectional study was conducted in 112 middle-aged women working as nurses or librarians in a county in southeast Sweden. The women were invited to fill in a questionnaire covering stress, health, and life situation. The questionnaire included questions on health and disease symptoms, the Perceived Stress Scale (PSS), and the Hospital Anxiety and Depression (HAD) scale. A piece of hair was cut from the vertex posterior area of the head an analysed by a competitive radioimmunoassay method.

    Results

    Middle-aged women who reported high perceived stress (p = 0.031) or lower health (p = 0.029), or had signs of depressiveness (p = 0.016) had significantly higher cortisol concentrations adjusted for age. There were no significant differences in cortisol in hair concentrations or perceived stress between nurses and librarians. Two women with extremely high cortisol concentrations were considered as outliers, but during the interview at follow-up they reported experiences of serious life events in their work or social life during the retrospective time of the sample taken for cortisol measurement.

    Conclusions

    Higher cortisol concentrations measured in the hair of healthy and working middle-aged women were associated with higher perceived stress and generally poorer health and with depressiveness. These findings lend support to the general applicability of cortisol measured in hair extracts as a biomarker in population-based epidemiological studies.

  • 104.
    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, ISSN 1932-6203, 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.

  • 105.
    Forsberg, Anna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    West, C. E.
    World University of Network, Sweden; Umeå University, Sweden.
    Prescott, S. L.
    World University of Network, Sweden; University of Western Australia, Australia; Princess Margaret Hospital Children, Australia.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. World University of Network, Sweden.
    Pre- and probiotics for allergy prevention: time to revisit recommendations?2016In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 46, no 12, p. 1506-1521Article, review/survey (Refereed)
    Abstract [en]

    Reduced intensity and diversity of microbial exposure is considered a major factor driving abnormal postnatal immune maturation and increasing allergy prevalence, particularly in more affluent regions. Quantitatively, the largest important source of early immunemicrobial interaction, the gut microbiota, is of particular interest in this context, with variations in composition and diversity in the first months of life associated with subsequent allergy development. Attempting to restore the health consequences of the ` dysbiotic drift in modern society, interventions modulating gut microbiota for allergy prevention have been evaluated in several randomized placebo-controlled trials. In this review, we provide an overview of these trials and discuss recommendations from international expert bodies regarding prebiotic, probiotic and synbiotic interventions. Recent guidelines from the World Allergy Organization recommend the use of probiotics for the primary prevention of eczema in pregnant and breastfeeding mothers of infants at high risk for developing allergy and in high-risk infants. It is however stressed that these recommendations are conditional, based on very low-quality evidence and great heterogeneity between studies, which also impedes specific and practical advice to consumers on the most effective regimens. We discuss how the choice of probiotic strains, timing and duration of administration can critically influence the outcome due to different effects on immune modulation and gut microbiota composition. Furthermore, we propose strategies to potentially improve allergy-preventive effects and enable future evidence-based implementation.

  • 106.
    Forslund Frykedal, Karin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Barimani, Mia
    Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden.
    Rosander, Michael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Berlin, Anita
    Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.
    ”I Didn’T Fit In” – Reasons For Not Attending Parental Education Groups In Antenatal And Child Health Care2019In: The 21st Congress of the Nordic Federation of Midwives - Midwifery Across Borders - in Reykjavik, Iceland, 2-4 May 2019, 2019Conference paper (Refereed)
    Abstract [en]

    Background – In Sweden expectant and new parents are offered parental education groups (PE) during pregnancy in Antenatal Care (AC) and after delivery in Child health Care (CHC) with the goal of preparing for childbirth and parenthood. Parents also seek information from  other sources such as the webb and magazines to gain information. Nevertheless, many parents feel unprepared for parenthood. During pregnancy and the time closest to childbirth is an important part of the transition to parenting and parents are very receptive to advice and information. To gain more knowledge about parents’ participation in PE the aim of this study was to explore expectant and new parents’ reasons to participate or not participate in PE.

     

    Method – A web questionnaire including open questions was answered by 915 parents with children aged 0 to 21 months. Open questions about (a) reasons to not participate, (b) anything that could change their mind and (c) parenting support instead of the PE was analyses using content analysis.

     

    Findings – The parents expressed reasons not to attend on an individual, group and organizational level. At an individual level they expressed personal reasons or that they had other forms of support. When it came to the group level the parents asked for more heterogeneity and openness regarding both the groups’ content and methods, not excluding parents and that parents’ different interests could be accommodated within the group. Reasons for not attending PE at organizational level were due to lack of information or invitation from AC or CHC, or that  PE was not available.

     

    Conclusion

    Parents ask for more nonconformity and diversity in PE. Despite of different approaches or attitudes all parents should be able to feel included in a way that would be relevant for them to participate in PE.

     

  • 107.
    Forsman, Jonas
    et al.
    Karolinska Inst, Sweden.
    Masterman, Thomas
    Karolinska Inst, Sweden.
    Ahlner, Johan
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Isacsson, Goran
    Karolinska Inst, Sweden.
    Hedstrom, Anna Karin
    Karolinska Inst, Sweden.
    Selective serotonin re-uptake inhibitors and the risk of violent suicide: a nationwide postmortem study2019In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 75, no 3, p. 393-400Article in journal (Refereed)
    Abstract [en]

    PurposeWe endeavored to investigate whether previous findings of an association between antemortem exposure to selective serotonin re-uptake inhibitors (SSRI) and method of suicide could be replicated.MethodsUsing the Swedish National Board of Forensic Medicines toxicology database and the Swedish National Board of Health and Welfares national registries of causes of death and prescriptions, 10,002 incidents of suicide were retrieved. Risks of violent suicide conferred by SSRIs, expressed as odds ratios (ORs) with 95% confidence intervals (CIs), were estimated using logistic regression. In accordance with previous work, suicide by violent meanscaseswere defined as death attributable to causes designated by ICD-10 codes X70-X83 and Y20-Y33; and suicide by non-violent meanscontrolsby codes X60-X69 and Y10-Y19.ResultsOur results imply that SSRI exposure confers a risk of violent suicide for shorter treatment durations; and that antemortem exposure to other substances (including illegal drugs) confounds estimates of risk. After adjustment for age, sex, and other substances, SSRIs treatment not exceeding 28days conferred an almost fourfold risk of violent suicide (OR 3.6 [95% CI 1.9-6.8]), a finding partly in line with a recent Swedish study that employed a case-crossover design.ConclusionsAlthough risks associated with shorter treatment duration may reflect latencies to onset of therapeutic effect, it is unclear how latencies would influence the choice of suicide method, unless conditions for which SSRIs are prescribed are themselves associated with violent suicide. Finally, in the total dataset, SSRIs were not associated with an increased risk of violent suicide; however, by adjusting for other substances, we avoided the spurious conclusion that the effect of medications in this regard is protective.

  • 108.
    Fredlund, Cecilia
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Adolescents Selling Sex and Sex as Self-Injury2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    There are today only a few population-based studies in the world investigating the prevalence of and associated risk-factors with adolescents selling sex and so far no earlier population-based study has been found investigating adolescents motives for selling sex. Further, to use sex in means of self-injury (SASI) is a behaviour that has been highlighted in Sweden the last years but it is a new field of research and a behaviour in need of conceptualization.

    The aim of this thesis was to investigate the prevalence of, associated risk factors with, motives for and manifestations of adolescents selling sex and the use of sex as self-injury (SASI). For the thesis, two nationally representative cross-sectional population surveys with third year students at Swedish high schools were collected in 2009 (n = 3498, mean age 18.3 +/- 0.6 years, response rate 60.4%) and in 2014 (n = 5839, mean age 18.0 +/- 0.6 years, response rate 59.7%). Further, the motives and manifestations of SASI were investigated in an anonymous self-selected, open-ended questionnaire published on websites of non-governmental organizations offering help and support to women and adolescents (n = 199, mean age 27.9 +/- 9.3 years). Quantitative and qualitative methods were used for data analyses.

    In the 2009 population-based survey, 1.5% (n = 51) of the adolescents reported having sold sex on at least one occasion, but in 2014 the prevalence was slightly lower at 0.9% (n = 51). SASI was reported by 3.2% of girls (n = 100) and 0.8% of boys (n = 20). Both selling sex and SASI were associated with various adverse factors such as experience of sexual abuse, emotional and physical abuse, poor mental health and self-injury. Adolescents selling sex had sought help and support for different problems and worries to a greater extent compared to peers. Contact with healthcare for various psychiatric problems such as suicide attempts, depression and eating disorders was common for adolescents using SASI. Further analysis showed that adolescents selling sex are a heterogeneous group in regard to underlying motives for selling sex, which included emotional and material reasons as well as pleasure. Depending on their underlying motives, adolescents selling sex were found to differ in regard to compensation received, age of the buyer, means of contact with the buyer, sexual orientation, experience of sexual abuse and the use of SASI. By using data from an open-ended questionnaire, SASI was described as deliberate or self-inflicted sexual situations that could include psychological and physical harm. SASI was used as a way to regulate negative feelings, such as anxiety, or to get positive or negative confirmation and the behaviour could be hard to stop.

    In conclusion, selling sex and SASI occurs among Swedish adolescents and the behaviours are associated with sexual, physical and emotional abuse and poor mental health, including trauma symptoms. In regard of the motives and manifestations of SASI, the behaviour could be compared to direct self-injurious behaviours. Data from this thesis suggest that more attention should be paid in healthcare to recognizing adolescents selling sex and SASI in order to prevent further traumatization and victimization.

    List of papers
    1. Adolescents selling sex: Exposure to abuse, mental health, self-harm behaviour and the need for help and support - a study of a Swedish national sample
    Open this publication in new window or tab >>Adolescents selling sex: Exposure to abuse, mental health, self-harm behaviour and the need for help and support - a study of a Swedish national sample
    Show others...
    2013 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 67, no 2, p. 81-88Article in journal (Refereed) Published
    Abstract [en]

    Selling sex is not uncommon among adolescents and we need to increase our knowledge of how this affects them. The aim of this study was to investigate adolescents who sell sex regarding sexual, mental and physical abuse, mental health as estimated by using the Hopkins Symptom Check List-25 (HSCL-25), self-harm behaviour and the adolescents' experience of receiving help and support. The study was carried out on a national representative sample of adolescents (mean age 18.3 years) in Swedish high schools in the final year of their 3-year programme. The study had 3498 participants and a response rate of 60.4%. Of the adolescents, 1.5% stated that they had sold sexual services. The selling of sex was associated with a history of sexual, mental and physical abuse. Poorer mental health and a higher degree of self-harm behaviour were reported among the adolescents who had sold sex. Help and support was sought to a greater extent by adolescents who had sold sex but these adolescents were not as satisfied with this help and support as the other adolescents. Adolescents that sell sex are a group especially exposed to sexual, mental and physical abuse. They have poorer metnal health and engage in more self-harm behaviour than other adolescents. They are in need of more help and support than other adolescents ant it is reasonable to assert that more resources, research and attention should be directed to this group to provide better help and support in the future.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2013
    Keywords
    adolescents, child abuse, help and support, mental health, self-harm behaviour, selling sex
    National Category
    Other Medical Sciences
    Identifiers
    urn:nbn:se:liu:diva-91850 (URN)10.3109/08039488.2012.679968 (DOI)000316956800001 ()
    Available from: 2013-05-03 Created: 2013-05-03 Last updated: 2018-12-21Bibliographically approved
    2. Adolescents motives for selling sex in a welfare state - A Swedish national study
    Open this publication in new window or tab >>Adolescents motives for selling sex in a welfare state - A Swedish national study
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    2018 (English)In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 81, p. 286-295Article in journal (Refereed) Published
    Abstract [en]

    In addition to money or other compensation, other motives for selling sex may be important in a welfare country such as Sweden. The aim of this study was to carry out an exploratory investigation of adolescents motives for selling sex in a population-based survey in Sweden. A total of 5839 adolescents from the third year of Swedish high school, mean age 18.0 years, participated in the study. The response rate was 59.7% and 51 students (0.9%) reported having sold sex. Exploratory factor analysis and hierarchical cluster analysis were used to identify groups of adolescents according to underlying motives for selling sex. Further analyses were carried out for characteristics of selling sex and risk factors. Three groups of adolescents were categorized according to their motives for selling sex: Adolescents reporting; 1) Emotional reasons, being at a greater risk of sexual abuse, using sex as a means of self-injury and having a non-heterosexual orientation. 2) Material but no Emotional reasons, who more often receive money as compensation and selling sex to a person over 25 years of age, and 3) Pleasure or no underlying motive for selling sex reported, who were mostly heterosexual males selling sex to a person under 25 years of age, the buyer was not known from the Internet, the reward was seldom money and this group was less exposed to penetrative sexual abuse or using sex as a means of self-injury. In conclusion, adolescents selling sex are a heterogeneous group in regard to underlying motives.

    Place, publisher, year, edition, pages
    PERGAMON-ELSEVIER SCIENCE LTD, 2018
    Keywords
    Selling sex; Adolescent; Child sexual exploitation; Motives; Prostitution
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:liu:diva-149697 (URN)10.1016/j.chiabu.2018.04.030 (DOI)000436375800026 ()29775872 (PubMedID)
    Note

    Funding Agencies|Ministry of Health and Social Affairs/the Childrens Welfare Foundation Sweden; County of Stockholm, Sweden

    Available from: 2018-07-24 Created: 2018-07-24 Last updated: 2019-05-01
    3. Self-reported frequency of sex as self-injury (SASI) in a national study of Swedish adolescents and association to sociodemographic factors, sexual behaviors, abuse and mental health
    Open this publication in new window or tab >>Self-reported frequency of sex as self-injury (SASI) in a national study of Swedish adolescents and association to sociodemographic factors, sexual behaviors, abuse and mental health
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    2017 (English)In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 11, no 1Article in journal (Refereed) Published
    Abstract [en]

    Sex as self-injury has become a concept in Swedish society; however it is a largely unexplored area of research, not yet conceptualized and far from accepted in the research field. The use of sex as a way of affect regulation is known in the literature and has, in interviews with young women who sell sex, been compared to direct self-injury, such as cutting or burning the skin. The aim of this study was to investigate the self-reported frequency of sex as self-injury and the association to sociodemographic factors, sexual orientation, voluntary sexual experiences, sexual risk-taking behaviors, sexual, physical and mental abuse, trauma symptoms, healthcare for psychiatric disorders and non-suicidal self-injury.

    Place, publisher, year, edition, pages
    BioMed Central, 2017
    National Category
    Neurosciences Rheumatology and Autoimmunity Psychiatry
    Identifiers
    urn:nbn:se:liu:diva-134927 (URN)10.1186/s13034-017-0146-7 (DOI)000395328600001 ()
    Available from: 2017-03-02 Created: 2017-03-02 Last updated: 2018-12-21Bibliographically approved
  • 109.
    Fredriksson, Carin
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Att lära sig leva med förvärvad hörselnedsättning sett ur par-perspektiv: om anpassningsstrategiers funktionella och sociala innebörder2001Doctoral thesis, monograph (Other academic)
    Abstract [en]

    The aim of the present thesis was to describe the everyday life of couples where one of the spouses has an acquired hearing loss. The main focus was on how they perceived their communicative possibilities in relation to the hearing loss and the role of acceptance in the process of learning to live with acquired hearing loss. The thesis is a longitudinal study based on the perspectives of couples. A combination of data sources was used; interviews, functional auditory assessments, a rating-scale and diary, the main source of information being the interviews.

    The main results of the thesis are; that the adjustment was a mutual process, and couples developed different patterns of responsibility for the adjustment process over time. The adjustment strategies were functional as well as social in their significance. The main strategy was prioritisation. Several situational strategies were also found. They showed a variation in communicative activities and participation. The habits and routines of everyday life played an important role for the manifestation of the disability and at times as a hindrance for acting strategically. The habits and routines call for special treatment for inclusion, special treatment in the sense of accommodating to the needs of the individual. The process of accepting played a mediating role between the individual needs and the needs of social flexibility. Some common features of the consequences of the hearing loss were crystallised despite different ways of examining the phenomenon. Finally implications for rehabilitation based on a couple-perspective were discussed.

  • 110.
    Fältström, Anne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Gauffin, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Football Research Group, Linköping University, Linköping, Sweden.
    Female Soccer Players With Anterior Cruciate Ligament Reconstruction Have a Higher Risk of New Knee Injuries and Quit Soccer to a Higher Degree Than Knee-Healthy Controls2019In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 47, no 1, p. 31-40Article in journal (Refereed)
    Abstract [en]

    Background:

    Many patients with anterior cruciate ligament (ACL) reconstruction who return to sport suffer new ACL injuries or quit sports soon after returning.

    Purpose:

    To prospectively follow a cohort of female soccer players with primary unilateral ACL reconstruction and matched knee-healthy controls from the same soccer teams to compare (1) the rate of new traumatic and nontraumatic knee injuries and other injuries, (2) the proportion of players who quit soccer, and (3) player-reported activity level and satisfaction with activity level and knee function.

    Study Design:

    Cohort study; Level of evidence, 2.

    Methods:

    A total of 117 active female soccer players (mean ± SD age, 19.9 ± 2.5 years) 18.9 ± 8.7 months after ACL reconstruction and 119 knee-healthy female soccer players (19.5 ± 2.5 years) matched from the same teams were prospectively followed for 2 years for new knee injuries, other injuries, soccer playing level, activity level according to the Tegner Activity Scale, and satisfaction with activity level and knee function.

    Results:

    Players with ACL reconstruction had a higher rate of new ACL injuries (n = 29 vs 8; 19 vs 4 per 100 player years; rate ratio [RR], 4.82; 95% CI, 2.20-10.54; P < .001), other traumatic knee injuries (29 vs 16 per 100 player years; RR, 1.84; 95% CI, 1.16-2.93; P < .01), and nontraumatic knee injuries (33 vs 9 per 100 player years; RR, 3.62; 95% CI, 2.11-6.21; P < .001) as compared with controls. There was no difference in the rate of other (not knee) injuries (43 vs 48 per 100 player years; RR, 0.90; 95% CI, 0.65-1.23; P = .494). During the 2-year follow-up, 72 (62%) players with ACL reconstruction quit soccer, as opposed to 43 (36%) controls (P = .001). The median Tegner Activity Scale score decreased in both groups (P < .001) but more for the ACL-reconstructed group (P < .015).

    Conclusion:

    Female soccer players with ACL reconstruction had nearly a 5-fold-higher rate of new ACL injuries and a 2- to 4-fold-higher rate of other new knee injuries, quit soccer to a higher degree, and reduced their activity level to a greater extent as compared with knee-healthy controls.

  • 111.
    Garpenby, Peter
    et al.
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Bilaga 6. Mot bättre vetande: Statens roll vid kunskapsstyrning av hälso- och sjukvården1999In: God vård på lika villkor? : underlag till slutbetänkande: Ingår i: God vård på lika villkor? om statens styrning av hälso- och sjukvården : slutbetänkande från Kommittén om hälso- och sjukvårdens finansiering och organisation, Stockholm: Fakta info direkt , 1999, p. 217-337Chapter in book (Other academic)
    Abstract [sv]

    Syftet med denna rapport är att beskriva och analysera statens1 styrning av hälso- och sjukvården, särskilt sådana styrformer där sammanställning av information (t ex om aktuellt forskningsläge och om god klinisk praxis) och informationsspridning utgör centrala inslag. Sådana aktiviteter är inte nya i sjukvården, men betraktade som inslag i statens styrning av hälso- och sjukvårdssektorn är de under stark utveckling. Av allt att döma kommer intresset för att nyttja systematiskt sammanställd information som ett inslag i styrningen av hälso- och sjukvården att öka, vilket även medför behov av aktiviteter som stärker förutsättningarna att lokalt tillgodogöra sig information. Avsikten med rapporten är att tydliggöra statens roll vid ”kunskapsstyrning” av hälso- och sjukvården.2 Möjligheten att utveckla en nationell strategi för ett mer kunskapsbaserat beslutsfattande i hälso- och sjukvården diskuteras.

    Analysen har genomförts med hjälp av våra tidigare studier inom området, vilka har kompletterats med litteratur, utredningar m.m. som belyser olika aspekter i anslutning till kunskapsstyrning. Vår beskrivning av relevanta aktörer och pågående aktiviteter inom den svenska sjukvårdssektorn har varit föremål för kommentarer från berörda parter.

  • 112.
    Gerdle, Björn
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Ernberg, Malin
    Karolinska Institute, Department of Dental Medicine, Section of Orofacial Pain and Jaw Function / Scandinavian Centre for Orofacial Neuroscience (SCON), Stockholm, Sweden.
    Mannerkorpi, Kaisa
    Section of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, Gothenburg, Sweden.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Kosek, Eva
    Department of Clinical Neuroscience and Osher Centre for Integrative Medicine, Karolinska Institute, Stockholm, Sweden.
    Christidis, Nikolaos
    Karolinska Institute, Department of Dental Medicine, Section of Orofacial Pain and Jaw Function / Scandinavian Centre for Orofacial Neuroscience (SCON), Stockholm, Sweden.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Increased Interstitial Concentrations of Glutamate and Pyruvate in Vastus Lateralis of Women with Fibromyalgia Syndrome Are Normalized after an Exercise Intervention: a Case-Control Study2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 10, p. 14article id e0162010Article in journal (Refereed)
    Abstract [en]

    Background Fibromyalgia syndrome (FMS) is associated with central alterations, but controversies exist regarding the presence and role of peripheral factors. Microdialysis (MD) can be used in vivo to study muscle alterations in FMS. Furthermore for chronic pain conditions such as FMS, the mechanisms for the positive effects of exercise are unclear. This study investigates the interstitial concentrations of algesics and metabolites in the vastus lateralis muscle of 29 women with FMS and 28 healthy women before and after an exercise intervention. Methods All the participants went through a clinical examination and completed a questionnaire. In addition, their pressure pain thresholds (PPTs) in their upper and lower extremities were determined. For both groups, MD was conducted in the vastus lateralis muscle before and after a 15-week exercise intervention of mainly resistance training of the lower limbs. Muscle blood flow and interstitial muscle concentrations of lactate, pyruvate, glutamate, glucose, and glycerol were determined. Results FMS was associated with significantly increased interstitial concentrations of glutamate, pyruvate, and lactate. After the exercise intervention, the FMS group exhibited significant decreases in pain intensity and in mean interstitial concentrations of glutamate, pyruvate, and glucose. The decrease in pain intensity in FMS correlated significantly with the decreases in pyruvate and glucose. In addition, the FMS group increased their strength and endurance. Conclusion This study supports the suggestion that peripheral metabolic and algesic muscle alterations are present in FMS patients and that these alterations contribute to pain. After an exercise intervention, alterations normalized, pain intensity decreased (but not abolished), and strength and endurance improved, all findings that suggest the effects of exercise are partially peripheral.

  • 113.
    Gerdle, Björn
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Ernberg, Malin
    Karolinska Institute, Department of Dental Medicine, Section of Orofacial Pain and Jaw Function / Scandinavian Centre for Orofacial Neuroscience (SCON), Stockholm, Sweden.
    Mannerkorpi, Kaisa
    Section of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, Gothenburg, Sweden.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Kosek, Eva
    Department of Clinical Neuroscience and Osher Centre for Integrative Medicine, Karolinska Institute, Stockholm, Sweden.
    Christidis, Nikolaos
    Karolinska Institute, Department of Dental Medicine, Section of Orofacial Pain and Jaw Function / Scandinavian Centre for Orofacial Neuroscience (SCON), Stockholm, Sweden.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Increased Interstitial Concentrations of Glutamate and Pyruvate in Vastus Lateralis of Women with Fibromyalgia Syndrome Are Normalized after an Exercise Intervention: a Case-Control Study2016Data set
  • 114.
    Gerdle, Björn
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Molander, Peter
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Stenberg, Gunilla
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Stålnacke, Britt-Marie
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Enthoven, Paul
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. 5 Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
    Weak outcome predictors of multimodal rehabilitation at one-year follow-up in patients with chronic pain-a practice based evidence study from two SQRP centres.2016In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, no 1, article id 490Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: For patients with chronic pain, the heterogeneity of clinical presentations makes it difficult to identify patients who would benefit from multimodal rehabilitation programs (MMRP). Yet, there is limited knowledge regarding the predictors of MMRP's outcomes. This study identifies predictors of outcome of MMRPs at a 12-month follow-up (FU-12) based on data from the Swedish Quality Registry for Pain Rehabilitation (SQRP).

    METHODS: Patients with chronic pain from two clinical departments in Sweden completed the SQRP questionnaires-background, pain characteristics, psychological symptoms, function, activity/participation, health and quality of life-on three occasions: 1) during their first visit; 2) immediately after the completion of their MMRP; and 3) 12 months after completing the MMRP (n = 227). During the FU-12, the patients also retrospectively reported their global impressions of any changes in their perception of pain and their ability to handle their life situation in general.

    RESULTS: Significant improvements were found for pain, psychological symptoms, activity/participation, health, and quality of life aspects with low/medium strong effects. A general pattern was observed from the analyses of the changes from baseline to FU-12; the largest improvements in outcomes were significantly associated with poor situations according to their respective baseline scores. Although significant regressors of the investigated outcomes were found, the significant predictors were weak and explained a minor part of the variation in outcomes (15-25%). At the FU-12, 53.6% of the patients reported that their pain had decreased and 80.1% reported that their life situation in general had improved. These improvements were associated with high education, low pain intensity, high health level, and work importance (only pain perception). The explained variations were low (9-11%).

    CONCLUSIONS: Representing patients in real-world clinical settings, this study confirmed systematic reviews that outcomes of MMRP are associated with broad positive effects. A mix of background and baseline variables influenced the outcomes investigated, but the explained variations in outcomes were low. There is still a need to develop standardized and relatively simple outcomes that can be used to evaluate MMRP in trials, in clinical evaluations at group level, and for individual patients.

  • 115.
    Grahn Kronhed, Ann-charlotte
    Region Östergötland, Local Health Care Services in West Östergötland, Department of Rehabilitation in Motala. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Would the first fragility fracture be tha last one: a physiotherapeutic perspective2017In: Physical Medicine and Rehabilitation Research, ISSN 2398-3353, Vol. 2, no 3, p. 1-2Article in journal (Other academic)
  • 116.
    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.
    Eriksson, Hans-Georg
    Uppsala University, Sweden.
    Molarius, Anu
    Regional Västmanland, Sweden; Karlstad University, Sweden.
    Economic stress and condescending treatment in childhood and adult self-rated health: results from a population study in Sweden2017In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, article id 489Article in journal (Refereed)
    Abstract [en]

    Background: Even today, 12% of the children in Sweden live in poverty and many children are exposed to adverse experiences, such as being bullied, which may have long-term consequences on public health. This study examined the associations between economic stress and condescending treatment in childhood and self-rated health (SRH) in adulthood. Methods: The study is based on 26,706 persons who responded to a postal survey questionnaire sent to a random sample of men and women aged 25-84 years in 2012 (response rate 53%). The associations between childhood circumstances and adult SRH were analysed by logistic regression, adjusting for sex, age, economic stress in adulthood, condescending treatment in adulthood, socioeconomic status and several other known material, behavioural and psychosocial risk factors. Results: In total, 39% of both men and women reported economic stress in their family during childhood. 36% of the men and 41% of the women indicated that they had been treated in a condescending manner, e.g. in school or at home, during childhood. Both economic stress in childhood and condescending treatment in childhood were strongly associated with adult SRH. The associations attenuated, but were still statistically significant after adjustment for adulthood circumstances and other risk factors. Conclusion: Economic stress in childhood and condescending treatment in childhood were associated with SRH in adulthood, both independently and through adulthood circumstances. The results underline the importance of taking into account both material and psychosocial circumstances over the whole life course when developing public health measures.

  • 117.
    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.

  • 118.
    Grimby-Ekman, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Health Metrics, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden .
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Sandén, H
    Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden..
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Different DHEA-S Levels and Response Patterns in Individuals with Chronic Neck Pain, Compared with a Pain Free Group-a Pilot Study.2017In: Pain medicine (Malden, Mass.), ISSN 1526-2375, E-ISSN 1526-4637, Vol. 18, no 5, p. 846-855Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To test, in this pilot study, whether DHEA-S (Dehydroepiandrosterone, sulfated form) plasma levels are lower among persons with chronic neck pain, compared to control persons, and to investigate the DHEA-S response after a physical exercise.

    SUBJECTS: Included were 12 persons with chronic neck pain and eight controls without present pain, all 18 and 65 years of age. Exclusion criteria for both groups were articular diseases or tendinosis, fibromyalgia, systemic inflammatory and neuromuscular diseases, pain conditions due to trauma, or severe psychiatric diseases.

    DESIGN AND METHODS: The participants arm-cycled on an ergometer for 30 minutes. Blood samples were taken before, 60 minutes, and 150 minutes after this standardized physical exercise.

    RESULTS: The estimated plasma DHEA-S levels at baseline were 2.0 µmol/L (95% confidence interval [CI] 1.00; 4.01) in the pain group and 4.1 µmol/L (95% CI2.0; 8.6) in the control group, adjusted for sex, age, body mass index (BMI), and Shirom-Melamed Burnout Questionnaire (SMBQ), with a ratio of 0.48 (P = 0.094).The total DHEA-S (AUCG) in the pain group were 183 min*µmol/L lower than in the control group (P = 0.068). For the response to the exercise (AUCI), the difference between the pain group and the control group was 148 min*µmol/L (P = 0.011).

    CONCLUSIONS: In this pilot study, the plasma DHEA-S levels appeared to be lower among the persons with chronic neck pain, compared with the control group. It was indicated that DHEA-S decreased during the physical exercise in the control group, and either increased or was unaffected in the chronic pain group.

  • 119.
    Grip, Björn
    Linköping University, Department for Studies of Social Change and Culture, Department of Culture Studies – Tema Q. Linköping University, Faculty of Arts and Sciences.
    Den ojämlika dödligheten: Hjärtdödlighet och samhällsutveckling i två städer2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Unequal Mortality is primarily a study of coronary heart disease mortality and its consequences during the period 1950–2010 in the twin cities Linköping and Norrköping. The difference in mortality between the two cities was great. During the 1970s, when there was a focus on equality, these differences declined. As economic policies and social values were adapted to a global monetary policy, inequality in mortality between the two cities increased.

    Large changes took place in the respective cities as far as mortality in coronary heart disease was concerned. In both cities the low cost housing projects became poorer and were increasingly influenced by the influx of refugees, at the same time that the city centres became gentrified, not least in Linköping. The differences in mortality between the out-lying areas and the city centres increased during the 1990s and the first decade of the 21st century. This is true to a greater extent in Linköping than in Norrköping.

    The dissertation consists of three parts. The licentiate thesis analyses the development of the cities from the 1950s until 2006. The study also attempts to trace the reasons for the differences in health and premature death. Article 1 deals with what happened on the way from a highly industrial to a post-industrial society. It has especially focused on studying the differences in coronary heart disease morbidity among various neighbourhoods in both the twin cities. Article 2 analyses differences in coronary heart disease mortality during the period from 1976 to 2010.

    List of papers
    1. PERSPECTIVES ON THE RISE AND FALL OF SWEDISH CARDIAC EPIDEMICS: The cases of Linköping and Norrköping
    Open this publication in new window or tab >>PERSPECTIVES ON THE RISE AND FALL OF SWEDISH CARDIAC EPIDEMICS: The cases of Linköping and Norrköping
    2016 (English)In: Scandinavian Journal of History, ISSN 0346-8755, E-ISSN 1502-7716, Vol. 41, no 1, p. 32-53Article in journal (Refereed) Published
    Abstract [en]

    Morbidity and mortality in cardiovascular diseases (CVD) can be described as an ongoing epidemic, although a very protracted one, lasting more than 100 years. Cardiovascular diseasesstill top mortality rates in the world today, accounting for about 30% of all deaths around the globe. But it is in the industrialized world that CVD dominate, although differences are great among various regions. Myocardial infarctions are significantly more common in Sweden than in southern Europe, but less common than in Eastern Europe. The overall question concerns the consequences for health in areas on the road to a post-industrial society. Over the years a clearer link has become visible between lifestyle and health. In Sweden, infectious diseases diminished as result of rising living standards. At the same time cardiovascular diseases were beginning their upward phase, reaching a peak in the 1960s. Deaths due to CVD bring to light significant discrepancies related to socio-economic and cultural factors. A comparison of the Swedish twin cities Linkoping and Norrkoping show considerable differences in death rates in favour of Linkoping, amounting to about 30% fewer in the 1920s with a tendency toward rising differences thereafter. A preliminary investigation of diagnoses has shown that links commonly made between health and socio-economic patterns need revision. The differences in cardiovascular morbidity show another pattern than was expected. It is obvious that the neighbourhood environments themselves have significance, and that the inequalities need additional research based on complementary explanatory models.

    Place, publisher, year, edition, pages
    ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2016
    Keywords
    Sweden; health; demography; cardiac epidemics
    National Category
    History and Archaeology
    Identifiers
    urn:nbn:se:liu:diva-125831 (URN)10.1080/03468755.2015.1108930 (DOI)000369289500003 ()
    Available from: 2016-03-08 Created: 2016-03-04 Last updated: 2017-11-30
  • 120.
    Grip, Björn
    Linköping University, Department for Studies of Social Change and Culture, Centre for Municipality Studies – CKS. Linköping University, Faculty of Arts and Sciences.
    Vårdcentralen och det ömtåliga hjärtat2015Report (Other academic)
    Abstract [sv]

    Föreliggande studie tar sin utgångspunkt i de skillnader i ohälsa mellan tvillingstäderna Linköping och Norrköping som tidigare dokumenterats i en rapport som publicerades i CKS skriftserie år 2012. Skillnaderna är stora till Norrköpings nackdel, visade den rapporten. Överdödligheten i Norrköping är påtaglig, inte minst när det gäller hjärt-kärlsjukdomar, den diagnosgrupp som fortfarande orsakar flest dödsfall i Sverige. Sjukdomstypen står därför i centrum för denna studie, som är en studie som bygger på kvalitativa intervjuer huvudsakligen med distriktsläkare på ett antal utvalda vårdcentraler.

    Boendesegregeringen har ökat i bägge städerna under de senaste trettio åren, vilket sannolikt förstärker ojämlikheten i ohälsa mellan olika  ocioekonomiska områden. Att ökade klyftor leder till större ohälsoskillnader är väldokumenterat när det gäller olika städer och kommuner. Hur ohälsan ser ut på stadsdelsnivå har emellertid inte undersökts. Olikheterna på stadsdelsnivå när det gäller den dominerande dödsorsaken, hjärtsjukdomar och hjärtdödlighet, blev därför intressant att undersöka. Här samverkar socioekonomiska förhållanden knutna till befolkningen med den fysiska miljön i respektive stadsdel, men också med den vård som erbjuds genom vårdcentralerna. Eftersom hjärtdödligheten enstaka år är begränsad i små geografiska områden och skillnader kan hänföras till slumpen valde forskargruppen att undersöka hjärtsjukligheten i stället, med statistiskt underlag från vårddatalagret, en särskild databas som landstinget i Östergötland byggt upp (det s.k. vårddatalagret) och som är ett etablerat statistiskt underlag.

    Skillnaderna mellan vårdcentralsområdena visade sig vara uppseendeväckande stora. I Norrköping dock inte i överensstämmelse med att socio-ekonomiskt mera utsatta och fattigare områden skulle ha ett högre antal diagnoser inom hjärt-kärlområdet. Den förhållandevis välbärgade förorten Åby exempelvis, sticker ut med ovanligt många sjukdomsdiagnoser när det gäller hjärtkärlsjukdomar och högt blodtryck. Vad kunde vara orsaken? Berodde det på vårdcentralens organisation och arbetssätt, skillnader i diagnossättning eller kunde det finnas andra förklaringar?

    Utifrån dessa frågor knöts undersökningens fokus till vad som händer på vårdcentralerna och i mötet mellan läkare och patient. Urvalet av vårdcentraler har delvis skett eftersom detta är vårdcentraler som förklarat sig intresserade av ett samarbete med forskargruppen Twincities Research Group. Men de representerar också tydligt socio-ekonomiskt olika miljöer.

    Syftet med studien är att för åren 2005-2009 undersöka hur arbetsvillkoren på ett antal vårdcentraler påverkar vården och diagnossättningen när det gäller hjärt-kärlrelaterade sjukdomar.

    Undersökningen baseras på fjorton kvalitativa intervjuer, i huvudsak med distriktsläkare som arbetar på de berörda vårdcentralerna.

    De centrala frågorna som ligger till grund för intervjuerna är:

    • Hur uppfattas arbetsvillkoren av informanterna ute på de olika vårdcentralerna?
    • Vilken betydelse bedöms arbetsförhållandena ha för vården och mera specifikt diagnosernas tillförlitlighet?
    • Hur säker anser informanterna att diagnossättningen är avseende sjukdomsförekomst när det gäller hjärt-kärlsjukdomar?

    Det framgår av intervjuerna att läkarförsörjningen och kontinuiteten när det gäller läkare på vårdcentralerna är centralt för vårdkvalitén. Förekomsten av hyrläkare leder till ökad belastning för den ordinarie personalen och med sämre kvalitét på vården som följd.

    Ledningsfunktionens betydelse, liksom graden av inflytande för den egna vårdcentralen är andra företeelser som lyfts fram i intervjuerna.

    Ersättningssystemen påverkar, men inte enligt uttalade intentioner. Det förekommer såväl över- som underrapportering när det gäller diagnoser, delvis som en följd av stress, men också som en följd av ersättningssystemens utformning, vilket gör sjukdomsstatistiken otillförlitlig ur forskningssynpunkt, hävdas det av flera informanter.

    Det numera lagstadgade kravet på bättre tillgänglighet för nybesök har inneburit att uppföljningen av multisjuka och kroniska patienter har fått stå tillbaka. Uppföljningen av patienter med hjärtkärldiagnos eller förstadier till hjärtkärlsjukdomar har därmed ofta fått längre väntetider än tidigare, påpekas det också i flera intervjuer.

    En underliggande frågeställning i föreliggande studie var att ge svar på frågan: Varför följer inte den diagnostiserade hjärtsjukligheten i vårdcentralsområdena socioekonomiska gradienter?

    Enligt informanterna, som intervjuats för den här artikeln, beror detta delvis på att arbetsvillkor och vårdtyngd är olika mellan vårdcentralerna. Det framkommer tydligt av intervjuerna att läkarnas och annan vårdpersonals arbetsvillkor upplevs ha betydelse för kvalitén på vården.

    Av de här representerade åtta stadsdelarna, är hjärt-kärldiagnoserna allra flest i det område, Skäggetorp i Linköping, som har en befolkning med svårast socio-ekonomiska omständigheter. Som god tvåa kommer emellertid Åby vårdcentral i Norrköping, där befolkningen generellt har det betydligt bättre.

    Det som också framgår tydligt av intervjuerna är att statistiken över diagnostiserade hjärtkärlsjukdomar inte anses vara ett tillförlitligt mått på förekomsten av hjärtkärlsjukdomar. Det förekommer såväl över- som underrapportering.

    Hjärt-kärldiagnoserna är något fler i Linköpings olika stadsdelar än i deras motsvarigheter i Norrköping. En möjlig förklaring till att diagnoserna är fler i Linköping, kan vara att det funnits och finns en bättre läkarförsörjning sammantaget. Därmed upptäcks fler hjärtsjukdomar och dessa blir bättre dokumenterade. Även den specifika diagnosen hjärtinfarkt utgör en större andel i Linköping än i grannstaden. Det kan alltså vara så att det finns fler dokumenterade hjärtinfarkter i Linköpings olika stadsdelar, samtidigt som betydligt fler hjärtinfarktpatienter dör i Norrköping utan att dessa tidigare dokumenterats!

    Den här studien har också tydligt visat att arbetsförhållandena på vårdcentralerna är viktiga för vårdens kvalitét. Besvärliga arbetsvillkor på vårdcentralen – bristande läkarbemanning på fasta tjänster, osäker och otydlig arbetsledning, vårdens styrning – kan ge betydande försämringar i vården, inte minst för kroniskt sjuka. Detta är fallet oavsett socio-ekonomisk status på området där vårdcentralen är belägen. Konsekvensen kan bli att hjärt-kärlsjukdomar inte följs upp systematiskt och i tid. Därmed riskerar människor att dö i förtid i dessa åtgärdbara sjukdomar.

  • 121.
    Grodzinsky, Ewa
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Assessment of Fever: Physiology, Immunology and Measurement in Clinical Practice2015 (ed. 1)Book (Other academic)
    Abstract [en]

    When we say that someone has a fever, what do we really mean? Most people only take their temperature when they have a fever, and with good reason: fever is part of a larger response in the body.

    Assessment of Fever, a problem-based learning (PBL) textbook, uses inter-professional discussions of scenarios from clinical practice to examine the question of body temperature. The authors start by examining the historical perspective and go on to consider technical measurement accuracy and thermoregulation from a physiological and immunological perspective. They address evaluations of body temperature and inflammatory activity in various conditions. They end by discussing how evidence-based knowledge can inform clinical practice, looking at different scenarios in the shape of case histories and realistic situations from clinical practice. These clinical scenarios are pertinent both in an inter-professional perspective in clinical practice and in the advanced education of health-care professionals, research scientists, and technicians. Each chapter concludes with a number of reflections and additional questions that the reader will be able to answer using the material presented in the book.

  • 122.
    Grossmann, Benjamin
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Procedural sedation: Aspects on methods, safety and effectiveness2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Safety and effectiveness are fundamental principles within the healthcare sector to provide quality of care and health improvement for patients. By ensuring that care is provided based on evidence-based knowledge, risks and complications can be minimised and the use of scarce resources optimised. An increasing demand for diagnostic and therapeutic procedures challenges the traditional methods for sedation regarding safety and effectiveness. It is desirable that the fundamental principles are improved when refining existing or developing new sedation methods. In this doctoral thesis, safety and effectiveness were evaluated for adult patient-controlled sedation (PCS) using propofol during two endoscopic procedures: endoscopic retrograde cholangiopancreaticography (ERCP) and flexible bronchoscopy (FB); and different doses of rectal racemic ketamine for paediatric (< 4 years) burn wound care.

    Methods: Data on vital functions, sedation level, safety interventions, procedure feasibility, patient-reported outcome and experience measures, and recovery, from three clinical randomised controlled trials were collected. Costs of sedation for the endoscopic procedures were compiled in a cost-analysis study.

    Results: PCS with propofol and bedside anaesthetic personnel was shown to be a safe and effective alternative method of sedation during ERCP and FB compared with intravenous sedation with midazolam. The PCS method gives stable cardiorespiratory conditions with few adverse events and interventions, with a low risk of oversedation. PCS offers similar (FB) or better (ERCP) procedure feasibility and patient satisfaction during the procedures than midazolam. Recovery after PCS is quick, minimises the risk for prolonged hospitalisation and is thereby a potential cost-saving sedation method. The optimal dose of rectal racemic ketamine, 6 mg/kg with the addition of 0.5 mg/kg midazolam during severely painful procedures, gives minimal risk for outbreaks of pain, offers stable vital signs conditions and allows rapid recovery without affecting procedure feasibility.

    Conclusions: The sedation method can be adjusted to type of procedure and patient population. PCS with propofol offers an alternative and reliable method for adult sedation during endoscopic procedures, whereas rectal racemic ketamine combined with midazolam provides good conditions for burn care dressing procedures in young children.

    List of papers
    1. Sedation during endoscopic retrograde cholangiopancreatography: A randomised controlled study of patient-controlled propofol sedation and that given by a nurse anaesthetist
    Open this publication in new window or tab >>Sedation during endoscopic retrograde cholangiopancreatography: A randomised controlled study of patient-controlled propofol sedation and that given by a nurse anaesthetist
    Show others...
    2015 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 50, no 10, p. 1285-1292Article in journal (Refereed) Published
    Abstract [en]

    Objective: Different regimens are used for sedation during ERCP (endoscopic retrograde cholangiopancreatography). Our objectives were to compare safety, ease of treatment, time to recovery and patients’ experiences using PCS (patient-controlled sedation) with propofol as well as sedation given by a nurse anaesthetist (ACS) with propofol or midazolam during ERCP.

    Material and methods: The study included 281 adults in 301 procedures. The PCS group (n=101) delivered bolus doses of 5 mg of propofol according to their need for sedation. The ACS group (n=100) had 2-8 mg/kg/hour of propofol infused, with the target for sedation being Level 3 of the Observer’s Assessment of Alertness/Sedation scale (OAA/S). The control group was given 2-3 mg of midazolam for induction and additional 1 mg if required.

    Results: PCS and ACS increased the ease of the procedure and reduced the numbers of sedation failures compared to midazolam sedation (ACS n=0; PCS n=4; midazolam n=20). The ACS group had more deeply sedated patients (OAA/S Level 2), desaturations and obstructed airways than the PCS and midazolam groups. Over 90% of all patients had recovered (Aldrete score≥9) by the time they returned to the ward. PCS resulted in the least fatigue and pain after the procedure. Patients’ preference for PCS and ACS were the same.

    Conclusion: PCS with propofol is superior to midazolam and comparable to ACS. PCS resulted in a rapid recovery, tended to be the safest and was almost as effective as ACS in ensuring a successful examination.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2015
    Keywords
    Conscious sedation, propofol, Cholangiopancreatography, Endoscopic Retrograde
    National Category
    Anesthesiology and Intensive Care
    Identifiers
    urn:nbn:se:liu:diva-112371 (URN)10.3109/00365521.2015.1038848 (DOI)000361324600013 ()
    Available from: 2014-11-24 Created: 2014-11-24 Last updated: 2019-05-13Bibliographically approved
    2. Patient-controlled Sedation During Flexible Bronchoscopy: A Randomized Controlled Trial
    Open this publication in new window or tab >>Patient-controlled Sedation During Flexible Bronchoscopy: A Randomized Controlled Trial
    2019 (English)In: Journal of Bronchology & Interventional Pulmonology, ISSN 1944-6586, E-ISSN 1948-8270Article in journal (Refereed) Epub ahead of print
    Abstract [en]

    Background: Patient-controlled sedation (PCS) is a documented method for endoscopic procedures considered to facilitate early recovery. Limited data have been reported, however, on its use during flexible bronchoscopy (FB).

    Materials and Methods: This study hypothesized that PCS with propofol during FB would facilitate early recovery, with similar bronchoscopist and patient satisfaction compared with nurse-controlled sedation (NCS) with midazolam. A total of 150 patients were randomized 1:1:1 into a control group (premedication with morphine-scopolamine and NCS with midazolam), PCS-MS group (premedication with morphine-scopolamine and PCS with propofol), and PCS-G group (premedication with glycopyrronium and PCS with propofol).

    Results: The procedures included transbronchial biopsy, transbronchial needle aspiration, cryotherapy/biopsy, and/or multistation endobronchial ultrasound. FB duration values in median (range) were 40 (10 to 80), 39 (12 to 68), and 44 (10 to 82) minutes for the groups NCS, PCS-MS, and PCS-G, respectively. An overall 81% of the patients in the combined PCS groups were ready for discharge (modified Post Anaesthetic Discharge Scoring System, score 10) 2 hours after bronchoscopy compared with 40% in the control group (P<0.0001). Between PCS groups, 96% of the PCS-G group patients were ready for discharge compared with 65% in the PCS-MS group (P=0.0002) at 2 hours. Bronchoscopists’ and patients’ satisfaction scores were high in all groups. Postdischarge quality scores showed no differences among the groups.

    Conclusion: PCS with propofol during FB is feasible, as it shortened recovery time without compromising procedure conditions for bronchoscopists or patients. A rapid postsedation stabilization of vital signs facilitates surveillance before the patient leaves the hospital.

    Place, publisher, year, edition, pages
    Lippincott Williams & Wilkins, 2019
    Keywords
    analgesia, patient-controlled, conscious sedation, anesthesia, intravenous, bronchoscopy, propofol
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-161081 (URN)10.1097/LBR.0000000000000610 (DOI)31478938 (PubMedID)2-s2.0-85072015123 (Scopus ID)
    Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2019-10-28Bibliographically approved
    3. Patient-controlled sedation with propofol for endoscopic procedures: A cost analysis
    Open this publication in new window or tab >>Patient-controlled sedation with propofol for endoscopic procedures: A cost analysis
    Show others...
    2019 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Article in journal (Refereed) Epub ahead of print
    Abstract [en]

    Background

    Patient‐controlled sedation (PCS) with propofol accompanied by a bedside nurse anaesthetist is an alternative sedation method for endoscopic procedures compared with midazolam administered by a nurse or endoscopist. Increasing costs in health care demands an economic perspective when introducing alternative methods. We applied a hospital perspective on a cost analysis comparing different methods of sedation and the resource use that were expected to affect cost differences related to the sedation.

    Methods

    Based on two randomised previous studies, the direct costs were determined for different sedation methods during two advanced endoscopic procedures: endoscopic retrograde cholangiopancreatography (ERCP) and flexible bronchoscopy including endobronchial ultrasound. ERCP comparisons were made between midazolam sedation by the endoscopic team, PCS with a bedside nurse anaesthetist and propofol sedation administered by a nurse anaesthetist. Bronchoscopy comparisons were made between midazolam sedation by the endoscopic team and PCS with a bedside nurse anaesthetist, categorised by premedication morphine‐scopolamine or glycopyrronium.

    Results

    Propofol PCS with a bedside nurse anaesthetist resulted in lower costs per patient for sedation for both ERCP (233 USD) and bronchoscopy (premedication morphine‐scopolamine 267 USD, premedication glycopyrronium 269 USD) compared with midazolam (ERCP 425 USD, bronchoscopy 337 USD). Aborted procedures that needed to be repeated and prolonged hospital stays significantly increased the cost for the midazolam groups.

    Conclusion

    Propofol PCS with a bedside nurse anaesthetist reduces the direct sedation costs for ERCP and bronchoscopy procedures compared with midazolam sedation.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2019
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-161080 (URN)10.1111/aas.13463 (DOI)31436310 (PubMedID)
    Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2019-10-28Bibliographically approved
    4. Rectal ketamine during paediatric burn wound dressing procedures: a randomised dose-finding study
    Open this publication in new window or tab >>Rectal ketamine during paediatric burn wound dressing procedures: a randomised dose-finding study
    2019 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 5, p. 1081-1088Article in journal (Refereed) Published
    Abstract [en]

    Background

    Worldwide, ketamine is used during paediatric procedures, but no recommendations are available regarding a suitable dose for rectal administration during procedures involving high levels of pain and/or anxiety such as burn wound dressing change.

    Methods

    We evaluated three different single doses of rectally administered racemic ketamine mixed with a fixed dose of 0.5 mg/kg of midazolam. In total, 90 children – aged 6 months to 4 years – were randomised 1:1:1 to receive 4 mg/kg (K-4 group), 6 mg/kg (K-6 group) or 8 mg/kg (K-8 group) of racemic ketamine for a maximum of three consecutive procedures. Primary outcome measure was procedural pain evaluated by Face, Legs, Activity, Cry, Consolability (FLACC) behavioural scale. Secondary outcome included feasibility and recovery time. Patient safety was evaluated using surrogate outcomes.

    Results

    In total, 201 procedures in 90 children aged 19 ± 8 months were completed. The median maximum pain was FLACC 0 in all groups (p = 0.141). The feasibility was better for groups K-6 (p = 0.049) and K-8 (p = 0.027) compared with K-4, and the mean recovery time was the longest for group K-8 (36 ± 22 min) compared with groups K-4 (25 ± 15 min; p = 0.003) and K-6 (27 ± 20 min; p = 0.025). Median maximum sedation measured by the University of Michigan Sedation Scale (UMSS) was higher in group K-8 compared with group K-4 (p < 0.0001) and K-6 (p = 0.023). One child in group K-8 had a study drug-related serious adverse event — laryngospasm/airway obstruction. No rescue analgosedative medication was administered for group K-6.

    Conclusions

    A rectally administered mixture of racemic ketamine (6 mg/kg) and midazolam (0.5 mg/kg) during paediatric burn dressing procedures with a duration of approximately 30 min provides optimal conditions regarding pain relief, feasibility, recovery time and patient safety, with no need for rescue analgosedative medication.

    Place, publisher, year, edition, pages
    Pergamon Press, 2019
    National Category
    Anesthesiology and Intensive Care Public Health, Global Health, Social Medicine and Epidemiology Surgery
    Identifiers
    urn:nbn:se:liu:diva-156837 (URN)10.1016/j.burns.2018.12.012 (DOI)000470856100010 ()31060760 (PubMedID)2-s2.0-85065014700 (Scopus ID)
    Note

    Funding agencies: County Council of Ostergotland, Sweden

    Available from: 2019-05-14 Created: 2019-05-14 Last updated: 2019-07-15Bibliographically approved
  • 123.
    Grossmann, Benjamin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Nilsson, Andreas
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Nilsson, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Rectal ketamine during paediatric burn wound dressing procedures: a randomised dose-finding study2019In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 5, p. 1081-1088Article in journal (Refereed)
    Abstract [en]

    Background

    Worldwide, ketamine is used during paediatric procedures, but no recommendations are available regarding a suitable dose for rectal administration during procedures involving high levels of pain and/or anxiety such as burn wound dressing change.

    Methods

    We evaluated three different single doses of rectally administered racemic ketamine mixed with a fixed dose of 0.5 mg/kg of midazolam. In total, 90 children – aged 6 months to 4 years – were randomised 1:1:1 to receive 4 mg/kg (K-4 group), 6 mg/kg (K-6 group) or 8 mg/kg (K-8 group) of racemic ketamine for a maximum of three consecutive procedures. Primary outcome measure was procedural pain evaluated by Face, Legs, Activity, Cry, Consolability (FLACC) behavioural scale. Secondary outcome included feasibility and recovery time. Patient safety was evaluated using surrogate outcomes.

    Results

    In total, 201 procedures in 90 children aged 19 ± 8 months were completed. The median maximum pain was FLACC 0 in all groups (p = 0.141). The feasibility was better for groups K-6 (p = 0.049) and K-8 (p = 0.027) compared with K-4, and the mean recovery time was the longest for group K-8 (36 ± 22 min) compared with groups K-4 (25 ± 15 min; p = 0.003) and K-6 (27 ± 20 min; p = 0.025). Median maximum sedation measured by the University of Michigan Sedation Scale (UMSS) was higher in group K-8 compared with group K-4 (p < 0.0001) and K-6 (p = 0.023). One child in group K-8 had a study drug-related serious adverse event — laryngospasm/airway obstruction. No rescue analgosedative medication was administered for group K-6.

    Conclusions

    A rectally administered mixture of racemic ketamine (6 mg/kg) and midazolam (0.5 mg/kg) during paediatric burn dressing procedures with a duration of approximately 30 min provides optimal conditions regarding pain relief, feasibility, recovery time and patient safety, with no need for rescue analgosedative medication.

  • 124.
    Gulcan, Ferda
    et al.
    Univ Bergen, Norway.
    Ekback, Gunnar
    Örebro Cty Council, Sweden; Örebro Univ, Sweden.
    Ordell, Sven
    Region Östergötland, Public Dental Health Care.
    Klock, Kristin S.
    Univ Bergen, Norway.
    Lie, Stein Atle
    Univ Bergen, Norway.
    Astrom, Anne Nordrehaug
    Univ Bergen, Norway.
    Exploring the association of dental care utilization with oral impacts on daily performances (OIDP) - a prospective study of ageing people in Norway and Sweden2018In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, no 1, p. 21-29Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore the association of dental health care utilization with oral impacts on daily performances (OIDP) across time focusing ageing Norwegian and Swedish adults adjusting for predisposing, enabling, and need related-factors as defined by Andersens model. Methods: Data were based on Norwegian and Swedish 1942 birth-cohorts conducted in 2007 (age 65) and 2012 (age 70). In Norway, the response rates ranged from 54% to 58%. Corresponding figures in Sweden were from 72% to 73%. Self-administered questionnaires assessed OIDP, dental care utilization and predisposing, enabling and need related factors. Logistic regression with robust variance estimation was used to adjust for clustering in repeated data. Results: Significant covariates of OIDP were satisfaction with dental services, dental care avoidance due to financial constraints, frightening experience with dental care during childhood and patient initiated dental visiting. Frequency and regularity of dental attendance were associated with OIDP in the Swedish cohort, only. Conclusions: In spite of country differences in the public co-financing of dental care, dental care utilization indicators were associated with OIDP across time in both cohorts. Encouraging regular and dentist initiated visiting patterns and strengthening beliefs in keeping own teeth could be useful in attempts to reduce poor oral health related quality of life in ageing people.

  • 125.
    Guldbrand, Hans
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Trials of Diets for Treatment of Diabetes: A comparison of diets for treatment of type 2 diabetes, aspects on long and short term effects2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Type 2 diabetes is a common disease and the prevalence has increased in large parts of the world. In treatment of diabetes the type of diet is of great importance considering metabolic factors such as glucose level and blood lipids. Which diet that is most beneficial to avoid diabetic complications has been heavily debated in recent decades. This thesis is based on two clinical studies designed to compare the effects of different macronutrients.

    Methods

    A clinical trial was designed to compare a low-carbohydrate diet (LCD) to a low-fat diet (LFD) in treatment of patients with type 2 diabetes. Sixty-one patients at two health care centres were included and randomized to get advice to eat a LCD or a LFD. The LCD had an energy content where 50 energy percent (E%) where from fat, 20 E% from carbohydrates and 30 E% from protein. For the LFD the nutrient composition was similar to what is traditionally recommended for treatment of type 2 diabetes in Sweden. Metabolic factors, anthropometrics and questionnaires were analysed.

    To study postprandial effects a trial was designed to compare three different diets. Twentyone patients with type 2 diabetes were included to in randomized order test the three types of diets on separate test days. On each test day the patients were served breakfast and lunch and blood samples were taken at six times these days. Glucose, lipids and hormones were analysed.

    Results

    There were equal weight reduction in the two groups in the first trial during the two-year study period. At six month when compliance was good according to diet-records, the glucose level (HbA1c) was lowered and the HDL-cholesterol was increased in the LCD group. The inflammatory markers IL-6 and IL-1Ra were significantly lower in the LCD group than in the LFD group. At 12 months the physical function, bodily pain and general health  scores improved within the LCD group only.

    In the second trial the postprandial glucose and insulin levels were lower on the LCD compared to the LFD. However, the LCD resulted in a tendency to higher postprandial triglyceride levels. The Mediterranean type of diet with all energy intake at lunch resulted in a more pronounced insulin response and a glucose level at lunch similar to that of the low-fat diet. The increase-ratio of insulin correlated to the elevation of the incretin glucose-dependent insulinotropic peptide (GIP).

    Conclusions

    In the two-year study we found benefits for the LCD group regarding glucose control and insulin doses. Furthermore, only the LCD was found to improve the subclinical inflammatory state and there were some aspects of improved well-being in this group. Aiming for 20% of energy intake from carbohydrates is safe with respect to cardiovascular risk factors  compared with the traditional LFD and this approach could constitute a treatment alternative.

    In the postprandial state, the LCD induced lower insulin and glucose excursions than the LFD but at the same time a tendency of higher triglycerides. The long-term significance needs to be further examined. The accumulation of caloric intake from breakfast to lunch to a single large Mediterranean-style lunch-meal in type 2 diabetes might be advantageous from a metabolic perspective.

    List of papers
    1. In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss
    Open this publication in new window or tab >>In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss
    Show others...
    2012 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 55, no 8, p. 2118-2127Article in journal (Refereed) Published
    Abstract [en]

    AIMS/HYPOTHESIS: The study aimed to compare the effects of a 2 year intervention with a low-fat diet (LFD) or a low-carbohydrate diet (LCD), based on four group meetings to achieve compliance. METHODS: This was a prospective randomised parallel trial involving 61 adults with type 2 diabetes consecutively recruited in primary care and randomised by drawing ballots. Patients that did not speak Swedish could not be recruited. The primary outcomes in this non-blinded study were weight and HbA(1c). Patients on the LFD aimed for 55-60 energy per cent (E%) and those on LCD for 20 E% from carbohydrate. RESULTS: The mean BMI and HbA(1c) of the participants were 32.7 ± 5.4 kg/m(2) and 57.0 ± 9.2 mmol/mol, respectively. No patients were lost to follow-up. Weight loss did not differ between groups and was maximal at 6 months: LFD -3.99 ± 4.1 kg (n = 31); LCD -4.31 ± 3.6 kg (n = 30); p < 0.001 within groups. At 24 months, patients on the LFD had lost -2.97 ± 4.9 kg and those on LCD -2.34 ± 5.1 kg compared with baseline (p = 0.002 and p = 0.020 within groups, respectively). HbA(1c) fell in the LCD group only (LCD at 6 months -4.8 ± 8.3 mmol/mol, p = 0.004, at 12 months -2.2 ± 7.7 mmol/mol, p = 0.12; LFD at 6 months -0.9 ± 8.8 mmol/mol, p = 0.56). At 6 months, HDL-cholesterol had increased with the LCD (from 1.13 ± 0.33 mmol/l to 1.25 ± 0.47 mmol/l, p = 0.018) while LDL-cholesterol did not differ between groups. Insulin doses were reduced in the LCD group (0 months, LCD 42 ± 65 E, LFD 39 ± 51 E; 6 months, LCD 30 ± 47 E, LFD 38 ± 48 E; p = 0.046 for between-group change). CONCLUSIONS/INTERPRETATION: Weight changes did not differ between the diet groups, while insulin doses were reduced significantly more with the LCD at 6 months, when compliance was good. Thus, aiming for 20% of energy intake from carbohydrates is safe with respect to cardiovascular risk compared with the traditional LFD and this approach could constitute a treatment alternative. TRIAL REGISTRATION: ClinicalTrials.gov NCT01005498 FUNDING: University Hospital of Linköping Research Funds, Linköping University, the County Council of Östergötland, and the Diabetes Research Centre of Linköping University.

    Place, publisher, year, edition, pages
    Springer, 2012
    Keywords
    Blood glucose – Dietary intervention – HDL-cholesterol – LDL-cholesterol – Low-carbohydrate diet – Type 2 diabetes
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-78537 (URN)10.1007/s00125-012-2567-4 (DOI)000306122600006 ()22562179 (PubMedID)
    Available from: 2012-06-14 Created: 2012-06-14 Last updated: 2017-12-07Bibliographically approved
    2. Advice to follow a low-carbohydrate diet has a favourable impact on low-grade inflammation in type 2 diabetes compared with advice to follow a low-fat diet
    Open this publication in new window or tab >>Advice to follow a low-carbohydrate diet has a favourable impact on low-grade inflammation in type 2 diabetes compared with advice to follow a low-fat diet
    2014 (English)In: Annals of Medicine, ISSN 0785-3890, E-ISSN 1365-2060, Vol. 46, no 3, p. 182-187Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Inflammation may play an important role in type 2 diabetes. It has been proposed that dietary strategies can modulate inflammatory activity.

    METHODS: We investigated the effects of diet on inflammation in type 2 diabetes by comparing a traditional low-fat diet (LFD) with a low-carbohydrate diet (LCD). Patients with type 2 diabetes were randomized to follow either LFD aiming for 55-60 energy per cent (E%) from carbohydrates (n = 30) or LCD aiming for 20 E% from carbohydrates (n = 29). Plasma was collected at baseline and after 6 months. C-reactive protein (CRP), interleukin-1 receptor antagonist (IL-1Ra), IL-6, tumour necrosis factor receptor (TNFR) 1 and TNFR2 were determined.

    RESULTS: Both LFD and LCD led to similar reductions in body weight, while beneficial effects on glycaemic control were observed in the LCD group only. After 6 months, the levels of IL-1Ra and IL-6 were significantly lower in the LCD group than in the LFD group, 978 (664-1385) versus 1216 (974-1822) pg/mL and 2.15 (1.65-4.27) versus 3.39 (2.25-4.79) pg/mL, both P < 0.05.

    CONCLUSIONS: To conclude, advice to follow LCD or LFD had similar effects on weight reduction while effects on inflammation differed. Only LCD was found significantly to improve the subclinical inflammatory state in type 2 diabetes.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2014
    National Category
    General Practice
    Identifiers
    urn:nbn:se:liu:diva-107718 (URN)10.3109/07853890.2014.894286 (DOI)000335584000011 ()24779961 (PubMedID)
    Available from: 2014-06-19 Created: 2014-06-19 Last updated: 2018-01-11Bibliographically approved
    3. Randomization to a low-carbohydrate diet advice improves health related quality of life compared with a low-fat diet at similar weight-loss in Type 2 diabetes mellitus
    Open this publication in new window or tab >>Randomization to a low-carbohydrate diet advice improves health related quality of life compared with a low-fat diet at similar weight-loss in Type 2 diabetes mellitus
    Show others...
    2014 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 106, no 2, p. 221-227Article in journal (Refereed) Published
    Abstract [en]

    Aims

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

    Methods

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

    Results

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

    Conclusions

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

     

    Place, publisher, year, edition, pages
    Elsevier, 2014
    Keywords
    Type 2 diabetes mellitus; Dietary intervention; Low-carbohydrate diet; SF-36
    National Category
    Clinical Medicine Basic Medicine
    Identifiers
    urn:nbn:se:liu:diva-112690 (URN)10.1016/j.diabres.2014.08.032 (DOI)000346060500019 ()25271116 (PubMedID)
    Available from: 2014-12-08 Created: 2014-12-08 Last updated: 2018-01-11Bibliographically approved
    4. A Randomized Cross-Over Trial of the Postprandial Effects of Three Different Diets in Patients with Type 2 Diabetes
    Open this publication in new window or tab >>A Randomized Cross-Over Trial of the Postprandial Effects of Three Different Diets in Patients with Type 2 Diabetes
    Show others...
    2013 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 11, p. e79324-Article in journal (Refereed) Published
    Abstract [en]

    Background: In the clinic setting both fasting levels of glucose and the area under the curve (AUC) of glucose, by determination of HbA1c levels, are used for risk assessments, in type 2 diabetes (NIDDM). However little is known about postprandial levels, and hence AUC, regarding other traditional risk factors such as insulin and blood-lipids and how this is affected by different diets. less thanbrgreater than less thanbrgreater thanObjective: To study postprandial effects of three diets, during a single day, in NIDDM. less thanbrgreater than less thanbrgreater thanMethods: A low-fat diet (45-56 energy-% from carbohydrates), and a low-carbohydrate diet (16-24 energy-% from carbohydrates) was compared with a Mediterranean-style diet (black coffee for breakfast and the same total-caloric intake as the other two diets for lunch with red wine, 32-35 energy-% from carbohydrates) in a randomized cross-over design. Total-caloric intake/test-day at the clinic from food was 1025-1080 kCal in men and 905-984 kCal in women. The test meals were consumed at a diabetes ward under supervision. less thanbrgreater than less thanbrgreater thanResults: Twenty-one participants were recruited and 19 completed the studies. The low-carbohydrate diet induced lower insulin and glucose excursions compared with the low-fat diet (pandlt;0.0005 for both AUC). The insulin-response following the single Mediterranean-style lunch-meal was more pronounced than during the low-fat diet lunch (insulin increase-ratio of the low-fat diet: 4.35 +/- 2.2, of Mediterranean-style diet: 8.12 +/- 5.2, p=0.001) while postprandial glucose levels were similar. The increase-ratio of insulin correlated with the elevation of the incretin glucose-dependent insulinotropic-polypeptide following the Mediterranean-style diet lunch (Spearman, r = 0.64, p = 0.003). less thanbrgreater than less thanbrgreater thanConclusions: The large Mediterranean-style lunch-meal induced similar postprandial glucose-elevations as the low-fat meal despite almost double amount of calories due to a pronounced insulin-increase. This suggests that accumulation of caloric intake from breakfast and lunch to a single large Mediterranean style lunch-meal in NIDDM might be advantageous from a metabolic perspective.

    Place, publisher, year, edition, pages
    Public Library of Science, 2013
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-102850 (URN)10.1371/journal.pone.0079324 (DOI)000327652100009 ()
    Available from: 2014-01-07 Created: 2014-01-02 Last updated: 2017-12-06
  • 126.
    Gurevich-Panigrahi, Tatiana
    et al.
    BioApplication Enterprises, Winnipeg, Canada.
    Wiechec, Emilia
    Manitoba Institute of Cell Biology, CancerCare Manitoba; Department of Human Genetics, University of Aarhus, Aarhus, Denmark.
    Panigrahi, Soumya
    Department of Immunology, Lerner Research Institute, Cleveland, USA.
    Los, Marek Jan
    Interfaculty Institute for Biochemistry, University of Tübingen, Germany; BioApplications Enterprises, Winnipeg, MB, Canada.
    Obesity: Pathophysiology and Clinical2009In: Current Medicinal Chemistry, ISSN 0929-8673, E-ISSN 1875-533X, Vol. 16, no 4, p. 506-521Article in journal (Refereed)
    Abstract [en]

    Obesity is an increasingly serious socioeconomic and clinical problem. Between 1/4 - 1/3 of population in the developed countries can be classified as obese. Four major etiological factors for development of obesity are genetic determinants, environmental factors, food intake and exercise. Obesity increases the risk of the development of various pathologic conditions including: insulin-resistant diabetes mellitus, cardiovascular disease, non-alcoholic fatty liver disease, endocrine problems, and certain forms of cancer. Thus, obesity is a negative determinant for longevity. In this review we provide broad overview of pathophysiology of obesity. We also discuss various available, and experimental therapeutic methods. We highlight functions of adipocytes including fat storing capacity and secretory activity resulting in numerous endocrine effects like leptin, IL-6, adiponectin, and resistin. The anti-obesity drugs are classified according to their primary action on energy balance. Major classes of these drugs are: appetite suppressants, inhibitors of fat absorption (i.e. orlistat), stimulators of thermogenesis and stimulators of fat mobilization. The appetite suppressants are further divided into noradrenergic agents, (i.e. phentermine, phendimetrazine, benzphetamine, diethylpropion), serotoninergic agents (i.e. dexfenfluramine), and mixed noradrenergic-serotoninergic agents (i.e. sibutramine). Thus, we highlight recent advances in the understanding of the central neural control of energy balance, current treatment strategies for obesity and the most promising targets for the development of novel anti-obesity drugs.

  • 127.
    Gustafsson, Britt
    et al.
    Huddinge Hospital, Karolinska Institute.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Oncology Centre.
    Evidence of space-time clustering of childhood acute lymphoblastic leukaemia in Sweden1999In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 79, no 3/4, p. 655-657Article in journal (Refereed)
    Abstract [en]

    We have examined 645 recorded cases of childhood acute lymphatic leukaemia (ALL) in Sweden during 1973–89 to identify space–time clustering by using the close-pair method of Knox. The records included date of birth and of diagnosis as well as addresses at birth and at diagnosis. There was a significant excess of case pairs close in date of birth and place of birth in the 5- to 15-year age group.

  • 128.
    Gustavsson, Erik
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Sandman, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Etisk analys av pre-expositionsprofylax (PrEP) för hiv2018Report (Other academic)
    Abstract [sv]

    Föreliggande etiska analys rör pre- expositionsprofylax (PrEP) mot hiv som en hivnegativ person kan ta för att minska risken för att drabbas av en hivinfektion. Om PrEP tas som ordinerat ger det en ungefärlig skyddsgrad mot hiv på 85 % jämfört med en kontrollgrupp. Eftersom PrEP inte ger 100 % skydd och inte heller skyddar mot andra sexuellt överförbara sjukdomar så är rekommendationen att det tas i kombination med praktiserandet av säkert sex.

    Den här etiska analysen har gjorts på uppdrag av NT-rådet och behandlar följande två frågeställningar: 1) finns det etiska skäl som talar emot förskrivning av PrEP; (2) hur bör PrEP prioriteras i relation till den etiska plattformen med ett särskilt fokus på huruvida PrEP bör egenfinanseras. Det finns starka skäl att minska smittspridningen av hiv utifrån såväl ett individ- som ett samhällsperspektiv vilket talar för förskrivning av PrEP. I diskussionen kring PrEP har det dock framförts att PrEP skiljer sig från annan preventiv behandling för att minska smittspridning på ett sätt som talar emot att PrEP förskrivs. Den etiska analysen diskuterar ett antal sådana argument: att friska personer utan medicinskt behov behandlas, att det handlar om ett socialt riskbeteende, att individer själva bör ta ansvar för smittspridning genom att ändra sitt beteende, samt risken för resistensproblematik. Slutsatsen är att inte något av dessa motargument är tillräckligt starkt för att tala emot förskrivningen av PrEP.

    När det gäller prioritering av PrEP i relation till den etiska plattformen dras slutsatsen att PrEP hamnar i den lägre delen av prioriteringsskalan baserat på svårighetsgraden hos tillståndet som PrEP riktar sig emot. Det innebär att PrEP skulle kunna vara en kandidat för egenfinansiering.

    Eftersom den etiska plattformen säger mycket lite om vilka åtgärder som bör egenfinaiseras så har analysen utgått från två ramverk presenterade i den internationella literaturen. Trots att flera aspekter av dessa ramverk talar för att PrEP skulle vara passande för egenfinansiering så väger aspekten av minskad smittspridning tungt. Dessa positiva externa effekter tillsammans med svårigheten att bedöma huruvida patientpopulationen skulle kunna egenfinansiera PrEP bidrar till bedömningen att PrEP bör finansieras inom ramen för det offentliga åtagandet.

  • 129.
    Hagström, Hannes
    et al.
    Karolinska Institute, Sweden.
    Nasr, Patrik
    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 Gastroentorology.
    Ekstedt, Mattias
    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 Gastroentorology.
    Kechagias, Stergios
    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 Gastroentorology.
    Onnerhag, Kristina
    Skåne University Hospital, Sweden.
    Nilsson, Emma
    Skåne University Hospital, Sweden.
    Rorsman, Fredrik
    University of Uppsala Hospital, Sweden.
    Sheikhi, Reza
    University of Uppsala Hospital, Sweden.
    Marschall, Hanns-Ulrich
    University of Gothenburg, Sweden.
    Hultcrantz, Rolf
    Karolinska University Hospital, Sweden; Karolinska Institute, Sweden.
    Stal, Per
    Karolinska University Hospital, Sweden; Karolinska Institute, Sweden.
    Low to moderate lifetime alcohol consumption is associated with less advanced stages of fibrosis in non-alcoholic fatty liver disease2017In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 2, p. 159-165Article in journal (Refereed)
    Abstract [en]

    Background and aim: Moderate alcohol consumption has been associated with a lower risk of disease severity in non-alcoholic fatty liver disease (NAFLD). It is unclear if this reflects current or lifetime drinking, or can be attributed to confounders such as diet and exercise. We evaluated the impact of lifetime alcohol consumption on fibrosis severity in NAFLD. Methods: We prospectively enrolled 120 subjects with biopsy-proven NAFLD and through detailed questionnaires examined lifetime alcohol consumption, diet and physical activity. Main outcome measures were odds ratios (OR) for fibrosis stage, calculated through ordinal regression after adjustment for body mass index, diabetes mellitus type 2, smoking and age at biopsy. A biomarker for recent alcohol consumption, phosphatidyl ethanol (PEth) was sampled. Results: An increase in median weekly alcohol consumption to a maximum of 13 drinks per week was associated with lower fibrosis stage (adjusted OR for each incremental unit, 0.86; 95% CI, 0.76-0.97; p = .017). The lowest risk for fibrosis was found with the lowest odds seen in the top quartile of alcohol consumption (aOR 0.23; 95% CI 0.08-0.66; p = .006). Adding soft drink and coffee consumptions, and physical activity to the model did not change the estimates. Subjects with PEth amp;gt;= 0.3 mu mol/L had higher ORs for a higher fibrosis stage (aOR 2.77; 95% CI 1.01-7.59; p = .047). Conclusion: Lifetime alcohol consumption with up to 13 units per week is associated with lower fibrosis stage in NAFLD. Elevated PEth is associated with higher stages of fibrosis.

  • 130.
    Hallert, Eva
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Kalkan, Almina
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Allergy Center.
    Rheumatoid arthritis is still expensive in the new decade: a comparison between two early RA cohorts, diagnosed 1996-98 and 2006-092016In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 45, no 5, p. 371-378Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    To calculate total costs during the first year after diagnosis in 463 patients with early rheumatoid arthritis (RA) included during 2006-09 (T2) and compare the results with a similar cohort included in 1996-98 (T1).

    METHOD:

    Clinical and laboratory data were collected regularly in both cohorts, and patients completed biannual questionnaires reporting health care utilization and number of days lost from work.

    RESULTS:

    Disease activity was similar in both cohorts T1 and T2 at inclusion. Significant improvements were seen during the first year in both cohorts but were more pronounced in T2. Outpatient care increased and hospitalization decreased in T2 compared with T1. Almost 3% of patients had surgery in both cohorts, but in T2, only women had surgery. Drug costs were higher in T2 than in T1 (EUR 689 vs. EUR 435). In T2, 12% of drug costs were direct costs and 4% were total costs. The corresponding values for T1 were 9% and 3%. In T1, 50% were prescribed disease-modifying anti-rheumatic drugs (DMARDs) at inclusion, compared to T2, where prescription was > 90%. Direct costs were EUR 5716 in T2 and EUR 4674 in T1. Costs for sick leave were lower in T2 than in T1 (EUR 5490 vs. EUR 9055) but disability pensions were higher (EUR 4152 vs. EUR 2139), resulting in unchanged total costs. In T1, direct costs comprised 29% and indirect costs 71% of the total costs. The corresponding values for T2 were 37% and 63%.

    CONCLUSIONS:

    The earlier and more aggressive treatment of RA with traditional DMARDs in T2 resulted in better outcomes compared to T1. Direct costs were higher in T2, partly offset by decreased sick leave, but total costs remained unchanged.

  • 131.
    Hammarström, Sofia
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Narhalsan Knowledge Ctr Sexual Hlth, Sweden.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Lindroth, Malin
    Jonkoping Univ, Sweden; Malmo Univ, Sweden.
    Stenqvist, Karin
    Narhalsan Knowledge Ctr Sexual Hlth, Sweden; Univ Gothenburg, Sweden.
    Bernhardsson, Susanne
    Narhalsan Res and Dev Primary Hlth Care, Sweden; Univ Gothenburg, Sweden.
    Identifying young people exposed to or at risk of sexual ill health: pilot implementation of an evidence-informed toolkit (SEXIT) at Swedish youth clinics2019In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 24, no 1, p. 45-53Article in journal (Refereed)
    Abstract [en]

    Objectives: We aimed to develop and pilot-implement an evidence-informed toolkit (SEXual health Identification Tool; SEXIT) for identifying young people exposed to or at risk of sexual ill health, at Swedish youth clinics, and to investigate SEXITs potential to identify young people in need of special care and monitoring. Methods: The SEXIT toolkit was developed, validated and pilot-implemented at three Swedish youth clinics. Pre-implementation staff readiness was assessed and youth clinic visitors responses to SEXIT were analysed. Results: All staff perceived a need for screening for sexual risk-taking and exposure. The response rate from 268 youth clinic visitors (aged 15-24 years) was 86%. Half of the visitors had one or no variable associated with sexual ill health, a third had two or three, and 15% reported between four and seven variables. The most common variables were alcohol use, three or more sexual partners in the past year and previous chlamydia. Visitors rated SEXIT as important and not uncomfortable or difficult to answer. Conclusions: The SEXIT toolkit was found to be feasible and highly acceptable in a clinical setting. The use of SEXIT may facilitate important questions on sexual risk-taking and sexual ill health to be raised with youth clinic visitors.

  • 132.
    Hedberg, Berith
    et al.
    Jonkoping Univ, Sweden; Futurum, Sweden.
    Malm, Dan
    Jonkoping Univ, Sweden; Ryhov Cty Hosp, Sweden.
    Karlsson, Jan-Erik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Jonkoping Univ, Sweden.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Linnaeus Univ, Sweden.
    Broström, Anders
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonkoping Univ, Sweden.
    Factors associated with confidence in decision making and satisfaction with risk communication among patients with atrial fibrillation2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 5, p. 446-455Article in journal (Refereed)
    Abstract [en]

    Background: Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making. Aim: The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms. Methods: A cross-sectional design was used and 322 patients (34% women), mean age 66.1 years (SD 10.5 years) with atrial fibrillation were included in the south of Sweden. Clinical examinations were done post an atrial fibrillation episode. Self-rating scales for communication (Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness), uncertainty in illness (Mishel Uncertainty in Illness Scale-Community), mastery of daily life (Mastery Scale), depressive symptoms (Hospital Anxiety and Depression Scale) and vitality, physical health and mental health (36-item Short Form Health Survey) were used to collect data. Results: Decreased vitality and mastery of daily life, as well as increased uncertainty in illness, were independently associated with lower confidence in decision making. Absence of hypertension and increased uncertainty in illness were independently associated with lower satisfaction with risk communication. Clinical atrial fibrillation variables or depressive symptoms were not associated with satisfaction with confidence in decision making or satisfaction with risk communication. The final models explained 29.1% and 29.5% of the variance in confidence in decision making and satisfaction with risk communication. Conclusion: Confidence in decision making is associated with decreased vitality and mastery of daily life, as well as increased uncertainty in illness, while absence of hypertension and increased uncertainty in illness are associated with risk communication satisfaction.

  • 133.
    Hedin, Kristina
    et al.
    Unit of R&D, Kronoberg County Council, Växjö and Department of Clinical Science in Malmö, Sweden.
    André, Malin
    Centre for Clinical Research, Dalarna, Falun, Sweden.
    Hakansson, Anders
    Department of Clinical Science in Malmö — General Practice/Family Medicine, Lund University, Sweden.
    Mölstad, Sigvard
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Unit of R&D in Primary Health Care, Jönköping.
    Rodhe, Nils
    Centre for Clinical Research, Dalarna, Falun, Sweden.
    Petersson, Christer
    Unit of R&D, Kronoberg County Council, Växjö and Department of Clinical Science in Malmö, Sweden.
    A population-based study of different antibiotic prescribing in different areas2006In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 56, no 530, p. 680-685Article in journal (Refereed)
    Abstract [en]

    Background Respiratory tract infections are the most common reason for antibiotic prescription in Sweden as in other countries. The prescription rates vary markedly in different countries, counties and municipalities. The reasons for these variations in prescription rate are not obvious.

    Aim To find possible explanations for different antibiotic prescription rates in children.

    Design of study Prospective population based study.

    Setting All child health clinics in four municipalities in Sweden which, according to official statistics, had high antibiotic prescription rates, and all child health clinics in three municipalities which had low antibiotic prescription rates.

    Method During one month, parents recorded all infectious symptoms, physician consultations and antibiotic treatments, from 848 18-month-old children in a log book. The parents also answered a questionnaire about socioeconomic factors and concern about infectious diseases.

    Results Antibiotics were prescribed to 11.6% of the children in the high prescription area and 4.7% in the low prescription area during the study month (crude odds ratio [OR] = 2.67; 95% confidence interval [CI] = 1.45 to 4.93). After multiple logistic regression analyses taking account of socioeconomic factors, concern about infectious illness, number of symptom days and physician consultations, differences in antibiotic prescription rates remained (adjusted OR = 2.61; 95% CI = 1.14 to 5.98). The variable that impacted most on antibiotic prescription rates, although it was not relevant to the geographical differences, was a high level of concern about infectious illness in the family.

    Conclusions The differences in antibiotic prescription rates could not be explained by socioeconomic factors, concern about infectious illness, number of symptom days and physician consultations. The differences may be attributable to different prescription behaviour.

  • 134.
    Hedman, Kristofer
    et al.
    Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA / Department of Medicine, Stanford Cardiovascular Institute, Stanford, California, USA.
    Moneghetti, Kegan J.
    Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA / Stanford University, Stanford Sports Cardiology, Stanford, California, USA .
    Christle, Jeffrey W.
    Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA / Stanford University, Stanford Sports Cardiology, Stanford, California, USA.
    Bagherzadeh, Shadi P.
    Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA / Department of Medicine, Stanford Cardiovascular Institute, Stanford, California, USA .
    Amsallem, Myriam
    Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA / Department of Medicine, Stanford Cardiovascular Institute, Stanford, California, USA .
    Ashley, Euan
    Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA / Stanford University, Stanford Sports Cardiology, Stanford, California, USA.
    Froelicher, Victor
    Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA / Stanford University, Stanford Sports Cardiology, Stanford, California, USA.
    Haddad, Francois
    Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA / Department of Medicine, Stanford Cardiovascular Institute, Stanford, California, USA.
    Blood pressure in athletic preparticipation evaluation and the implication for cardiac remodelling2019In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 105, no 16, p. 1223-1230Article in journal (Refereed)
    Abstract [en]

    Objectives To explore blood pressure (BP) in athletes at preparticipation evaluation (PPE) in the context of recently updated US and European hypertension guidelines, and to determine the relationship between BP and left ventricular (LV) remodelling.Methods In this retrospective study, athletes aged 13–35 years who underwent PPE facilitated by the Stanford Sports Cardiology programme were considered. Resting BP was measured in both arms; repeated once if >=140/90 mm Hg. Athletes with abnormal ECGs or known hypertension were excluded. BP was categorised per US/European hypertension guidelines. In a separate cohort of athletes undergoing routine PPE echocardiography, we explored the relationship between BP and LV remodelling (LV mass, mass/volume ratio, sphericity index) and LV function.Results In cohort 1 (n=2733, 65.5% male), 34.3% of athletes exceeded US hypertension thresholds. Male sex (B=3.17, p&lt;0.001), body mass index (BMI) (B=0.80, p&lt;0.001) and height (B=0.25, p&lt;0.001) were the strongest independent correlates of systolic BP. In the second cohort (n=304, ages 17–26), systolic BP was an independent correlate of LV mass/volume ratio (B=0.002, p=0.001). LV longitudinal strain was similar across BP categories, while higher BP was associated with slower early diastolic relaxation.Conclusion In a large contemporary cohort of athletes, one-third presented with BP levels above the current US guidelines’ thresholds for hypertension, highlighting that lowering the BP thresholds at PPE warrants careful consideration as well as efforts to standardise measurements. Higher systolic BP was associated with male sex, BMI and height and with LV remodelling and diastolic function, suggesting elevated BP in athletes during PPE may signify a clinically relevant condition.

  • 135.
    Hedna, Khedidja
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Inappropriate prescribing, non-adherence to long-term medications and related morbidities: Pharmacoepidemiological aspects2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Inappropriate use of medications (IUM), in particular inappropriate prescribing and non-adherence to prescribed medications, are important causes of drug-related morbidities (DRMs). They are increasing problems with the ageing populations and the growing burden of chronic conditions. However, research is needed on the association of IUMs with DRMs in outpatient settings and in the general population.

    Aim: The aim of this thesis is to estimate and analyse the burden of potentially inappropriate prescriptions (PIPs) in the elderly and non-adherence to long-term medications among adults across care settings, and to investigate how IUM is associated to DRMs.

    Methods: A meta-analysis summarised the previous evidence on the percentage of adverse drug reactions (ADRs) associated to IUM across healthcare settings (Study I). From a cohort in the general population, using medical records and register data, the prevalence of PIPs in the elderly and its association with ADRs were estimated retrospectively (Study II). From the same cohort, the factors associated with refill non-adherence to antihypertensive therapy, considering the use of multiple medications, and the association between non-adherence and sub-therapeutic effects (STEs) were investigated (Study III). A survey assessed the refill behaviour to antihypertensive, lipid lowering and oral antidiabetic medications (undersupply, adequate supply and oversupply), and its association with perceived ADRs and STEs (Study IV).

    Results: IUM was the cause 52% and 45% of ADRs occurring in adult outpatients and inpatients respectively. Across healthcare settings, 46% of the elderly refilled PIPs over a 6-month period; PIPs were considered the cause of 30% of all ADRs; and the elderly who were prescribed PIPs had increased odds to experience ADRs (OR 2.47, 95% CI 1.65-3.69). In total, 35% was nonadherent to the full multidrug therapy and 13% was non-adherent to any medication (complete non-adherence).  Sociodemographic factors (working age and lower income) were associated with non-adherence to any medication, while clinical factors (use of specialised care, use of multiple medications, and being a new user) with non-adherence to the full multidrug therapy. STEs were associated with non-adherence to any medication a month prior to a healthcare visit (OR 3.27, 95% CI 1.27-8.49), but not with long-term measures of non-adherence. Among survey respondents, 22% of the medications were oversupplied and 12% were undersupplied. Inadequate refill behaviour was not associated with reporting ADRs or STEs (p<0.05).

    Conclusions: A large proportion of ADRs occurring in hospital is caused by IUM, but more knowledge is needed in other settings. PIPs are common in the elderly general population and associated with ADRs. Therefore decreasing PIPs could contribute towards ADR prevention. Considering the use of multiple medications may help to better understand the factors associated with non-adherence to a multidrug therapy for tailoring the interventions to patient needs. Monitoring the adherence prior to a healthcare visit may facilitate interpreting STEs. Yet, the absence of an association between long-term measures of refill non-adherence with clinical and perceived DRMs suggest the need to enhance the knowledge of this association in clinical practice. In summary, this thesis shows a significant potential for improvements of medication use and outcomes.

    List of papers
    1. Percentage of patients with preventable adverse drug reactions and preventability of adverse drug reactions - a meta-analysis
    Open this publication in new window or tab >>Percentage of patients with preventable adverse drug reactions and preventability of adverse drug reactions - a meta-analysis
    2012 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 3, p. 1-9, article id e33236Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Numerous observational studies suggest that preventable adverse drug reactions are a significant burden in healthcare, but no meta-analysis using a standardised definition for adverse drug reactions exists. The aim of the study was to estimate the percentage of patients with preventable adverse drug reactions and the preventability of adverse drug reactions in adult outpatients and inpatients.

    METHODS: Studies were identified through searching Cochrane, CINAHL, EMBASE, IPA, Medline, PsycINFO and Web of Science in September 2010, and by hand searching the reference lists of identified papers. Original peer-reviewed research articles in English that defined adverse drug reactions according to WHO's or similar definition and assessed preventability were included. Disease or treatment specific studies were excluded. Meta-analysis on the percentage of patients with preventable adverse drug reactions and the preventability of adverse drug reactions was conducted.

    RESULTS: Data were analysed from 16 original studies on outpatients with 48797 emergency visits or hospital admissions and from 8 studies involving 24128 inpatients. No studies in primary care were identified. Among adult outpatients, 2.0% (95% confidence interval (CI): 1.2-3.2%) had preventable adverse drug reactions and 52% (95% CI: 42-62%) of adverse drug reactions were preventable. Among inpatients, 1.6% (95% CI: 0.1-51%) had preventable adverse drug reactions and 45% (95% CI: 33-58%) of adverse drug reactions were preventable.

    CONCLUSIONS: This meta-analysis corroborates that preventable adverse drug reactions are a significant burden to healthcare among adult outpatients. Among both outpatients and inpatients, approximately half of adverse drug reactions are preventable, demonstrating that further evidence on prevention strategies is required. The percentage of patients with preventable adverse drug reactions among inpatients and in primary care is largely unknown and should be investigated in future research.

    Place, publisher, year, edition, pages
    Public Library of Science, 2012
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-76102 (URN)10.1371/journal.pone.0033236 (DOI)000303309000014 ()22438900 (PubMedID)
    Available from: 2012-03-27 Created: 2012-03-27 Last updated: 2017-12-07
    2. Potentially inappropriate prescribing and adverse drug reactions in the elderly: a population-based study
    Open this publication in new window or tab >>Potentially inappropriate prescribing and adverse drug reactions in the elderly: a population-based study
    Show others...
    2015 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 71, no 12, p. 1525-1533Article in journal (Refereed) Published
    Abstract [en]

    Purpose

    Potentially inappropriate prescriptions (PIPs) criteria are widely used for evaluating the quality of prescribing in elderly. However, there is limited evidence on their association with adverse drug reactions (ADRs) across healthcare settings. The study aimed to determine the prevalence of PIPs, defined by the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria, in the Swedish elderly general population and to investigate the association between PIPs and occurrence of ADRs.

    Method

    Persons ≥65 years old were identified from a random sample of 5025 adults drawn from the Swedish Total Population Register. A retrospective cohort study was conducted among 813 elderly with healthcare encounters in primary and specialised healthcare settings during a 3-month period in 2008. PIPs were identified from the Swedish Prescribed Drug Register, medical records and health administrative data. ADRs were independently identified by expert reviewers in a stepwise manner using the Howard criteria. Multivariable logistic regression examined the association between PIPs and ADRs.

    Results

    Overall, 374 (46.0 %) persons had ≥1 PIPs and 159 (19.5 %) experienced ≥1 ADRs during the study period. In total, 29.8 % of all ADRs was considered caused by PIPs. Persons prescribed with PIPs had more than twofold increased odds of experiencing ADRs (OR 2.47; 95 % CI 1.65–3.69). PIPs were considered the cause of 60 % of ADRs affecting the vascular system, 50 % of ADRs affecting the nervous system and 62.5 % of ADRs resulting in falls.

    Conclusion

    PIPs are common among the Swedish elderly and are associated with increased odds of experiencing ADRs. Thus, interventions to decrease PIPs may contribute to preventing ADRs, in particular ADRs associated with nervous and vascular disorders and falls.

    Place, publisher, year, edition, pages
    Springer, 2015
    Keywords
    Inappropriate prescribing – Elderly – Adverse drug reactions – Retrospective study – Medical records – Registries
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-121823 (URN)10.1007/s00228-015-1950-8 (DOI)000365179600013 ()26407684 (PubMedID)
    Available from: 2015-10-08 Created: 2015-10-08 Last updated: 2017-12-01Bibliographically approved
    3. Adherence to Antihypertensive Therapy and Elevated Blood Pressure: Should We Consider the Use of Multiple Medications?
    Open this publication in new window or tab >>Adherence to Antihypertensive Therapy and Elevated Blood Pressure: Should We Consider the Use of Multiple Medications?
    Show others...
    2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 9, article id e0137451Article in journal (Refereed) Published
    Abstract [en]

    Background

    Although a majority of patients with hypertension require a multidrug therapy, this is rarely considered when measuring adherence from refill data. Moreover, investigating the association between refill non-adherence to antihypertensive therapy (AHT) and elevated blood pressure (BP) has been advocated.

    Objective

    Identify factors associated with non-adherence to AHT, considering the multidrug therapy, and investigate the association between non-adherence to AHT and elevated BP.

    Methods

    A retrospective cohort study including patients with hypertension, identified from a random sample of 5025 Swedish adults. Two measures of adherence were estimated by the proportion of days covered method (PDC≥80%): (1) Adherence to any antihypertensive medication and, (2) adherence to the full AHT regimen. Multiple logistic regressions were performed to investigate the association between sociodemographic factors (age, sex, education, income), clinical factors (user profile, number of antihypertensive medications, healthcare use, cardiovascular comorbidities) and non-adherence. Moreover, the association between non-adherence (long-term and a month prior to BP measurement) and elevated BP was investigated.

    Results

    Non-adherence to any antihypertensive medication was higher among persons < 65 years (Odds Ratio, OR 2.75 [95% CI, 1.18–6.43]) and with the lowest income (OR 2.05 [95% CI, 1.01–4.16]). Non-adherence to the full AHT regimen was higher among new users (OR 2.04 [95% CI, 1.32–3.15]), persons using specialized healthcare (OR 1.63, [95% CI, 1.14–2.32]), and having multiple antihypertensive medications (OR 1.85 [95% CI, 1.25–2.75] and OR 5.22 [95% CI, 3.48–7.83], for 2 and ≥3 antihypertensive medications, respectively). Non-adherence to any antihypertensive medication a month prior to healthcare visit was associated with elevated BP.

    Conclusion

    Sociodemographic factors were associated with non-adherence to any antihypertensive medication while clinical factors with non-adherence to the full AHT regimen. These differing findings support considering the use of multiple antihypertensive medications when measuring refill adherence. Monitoring patients' refill adherence prior to healthcare visit may facilitate interpreting elevated BP.

    Place, publisher, year, edition, pages
    ´PLoS, 2015
    National Category
    Social and Clinical Pharmacy
    Identifiers
    urn:nbn:se:liu:diva-121822 (URN)10.1371/journal.pone.0137451 (DOI)000361043100040 ()26359861 (PubMedID)
    Available from: 2015-10-08 Created: 2015-10-08 Last updated: 2018-01-11
    4. Refill adherence and self-reported adverse drug reactions and sub-therapeutic effects: a population-based study
    Open this publication in new window or tab >>Refill adherence and self-reported adverse drug reactions and sub-therapeutic effects: a population-based study
    Show others...
    2013 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 22, no 12, p. 1317-1325Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE: To assess refill adherence to dispensed oral long-term medications among the adult population and to investigate whether the percentages of self-reported adverse drug reactions (ADRs) and sub-therapeutic effects (STEs) differed for medications with adequate refill adherence, oversupply, and undersupply.

    METHOD: Survey responses on self-reported ADRs and STEs were linked to the Swedish Prescribed Drug Register in a cross-sectional population-based study. Refill adherence to antihypertensive, lipid-lowering, and oral anti-diabetic medications was measured using the continuous measure of medication acquisition (CMA). The percentages of self-reported ADRs and STEs were compared between medications with adequate refill adherence (CMA 0.8-1.2), oversupply (CMA > 1.2), and undersupply (CMA < 0.8).

    RESULTS: The study included 1827 persons, and the refill adherence was measured for 3014 antihypertensive, 839 lipid lowering, and 253 oral anti-diabetic medications. Overall, 65.7% of the medications had adequate refill adherence, 21.9% oversupply, and 12.4% undersupply. The percentages of self-reported ADRs and STEs were respectively 2.6%, 2.7%, and 2.1% (p > 0.5) for ADRs and 1.1%, 1.6%, and 1.5% (p > 0.5) for STEs.

    CONCLUSIONS: Adequate refill adherence was found in two thirds of the medication therapies. ADRs and STEs were unexpectedly equally commonly reported for medications with adequate refill adherence, oversupply, and undersupply. These results suggest that a better understanding of patients' refill behaviors and their perceived medication adverse outcomes is needed and should be considered in improving medication management. The impact of individual and healthcare factors that may influence the association between refill adherence and reported medication adverse outcomes should be investigated in future studies. Copyright © 2013 John Wiley & Sons, Ltd.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2013
    Keywords
    adverse drug reaction, oversupply, pharmacoepidemiology, refill adherence, self-report, therapeutic failure, undersupply
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-99892 (URN)10.1002/pds.3528 (DOI)000327446700010 ()24127242 (PubMedID)
    Available from: 2013-10-23 Created: 2013-10-23 Last updated: 2017-12-06
  • 136.
    Hemmingsson, Helena
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Delaktighet i skolmiljön2016In: Arbetsterapi för barn och ungdom / [ed] Ann-Christin Eliasson, Helene Lidström, Marie Peny-Dahlstrand, Lund: Studentlitteratur AB, 2016, p. 179-191Chapter in book (Other academic)
  • 137.
    Henfridsson, Pia
    et al.
    Univ Gothenburg, Sweden.
    Laurenius, Anna
    Univ Gothenburg, Sweden.
    Wallengren, Ola
    Univ Gothenburg, Sweden.
    Beamish, Andrew J.
    Univ Gothenburg, Sweden.
    Dahlgren, Jovanna
    Univ Gothenburg, Sweden.
    Flodmark, Carl-Erik
    Skane Univ Hosp, Sweden.
    Marcus, Claude
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Olbers, Torsten
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping. Univ Gothenburg, Sweden.
    Gronowitz, Eva
    Univ Gothenburg, Sweden.
    Ellegard, Lars
    Univ Gothenburg, Sweden.
    Micronutrient intake and biochemistry in adolescents adherent or nonadherent to supplements 5 years after Roux-en-Y gastric bypass surgery2019In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 15, no 9, p. 1494-1502Article in journal (Refereed)
    Abstract [en]

    Background: Roux-en-Y gastric bypass (RYGB) is an effective obesity treatment in adults and has become established in adolescents. Lower adherence to supplementation in adolescents confers a risk for long-term nutritional deficiencies. Objectives: To assess adherence to supplementation, micronutrient intake, and biochemistry in adolescents through 5 years after RYGB. Setting: University hospitals, multicenter study, Sweden. Methods: Micronutrient intake and adherence to supplementation were assessed by diet history interviews and biochemistry preoperatively, 1, 2, and 5 years after RYGB in 85 adolescents (67% females), aged 16.5 years (+/- 1.2) with a body mass index of 45.5 kg/m(2) (+/- 6.0). Adherence was defined as taking prescribed supplements amp;gt;= 3 times a week. Micronutrient intake and biochemistry were compared with matched controls at 5 years. Results: Over 75% completed the dietary assessments across 5 years after RYGB. Adherence ranged between 44-61% through 5 years. At 5 years, ferritin and hemoglobin decreased (P amp;lt; .04) and 61% had iron deficiency (P amp;lt;= .001). Among females with iron deficiency, most did not adhere to supplementation (P = .005), and 59% of these had anemia (P amp;lt; .001). Vitamin D insufficiency continued after surgery and 80% of participants who did not adhere to supplementation had insufficiency (P = .002). Adolescents not adhering had lower levels of vitamin D, B-12, and fern tin (females) compared with both adhering adolescents and the control group (all P amp;lt; .04). Conclusions: Half of adolescents after RYGB reported sufficient long-term adherence to supplementation. Adhering to supplements and reporting a higher micronutrient intake were associated with more favorable biochemistry. Results support the recommendations for monitoring micronutrient intake and biochemistry in all patients who have undergone RYGB surgery, and the recommendation of higher preventive supplementation of vitamin D and iron in both sexes. As hypothesized, adolescents not adhering had a higher prevalence of long-term micronutrient deficiencies. (C) 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  • 138.
    Henriksson, Hanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Development of body composition and its relationship with physical activity in healthy Swedish children: A longitudinal study until 4.5 years of age including evaluation of methods to assess physical activity and energy intake2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Childhood obesity according to the World Health Organization is one of the most serious public health challenges of the 21st century. The proportion of childhood obesity is high both globally and in Sweden. This is of great concern since obese children tend to stay obese in adulthood. In order to develop strategies to prevent early childhood obesity more knowledge is needed regarding factors explaining why children become overweight and obese. Preventive strategies require accurate and easy-to-use methods to assess physical activity in response to energy expenditure as well as energy intake in young children, but such methods are largely lacking or have shown limited accuracy. The aims of this thesis were: 1) to describe the longitudinal development of body composition from 1 week to 4.5 years of age; 2) to study relationships between measures of body composition and the physical activity level (PAL) at 1.5 and 3 years of age; 3) to evaluate if heart rate recording and movement registration using Actiheart can capture variations in total energy expenditure (TEE) and activity energy expenditure (AEE) at 1.5 and 3 years; 4) to evaluate the potential of a 7-day activity diary to assess PAL at 1.5 and 3 years of age; 5) to evaluate a new tool (TECH) using mobile phones for assessing energy intake at 3 years of age.

    Healthy children were investigated at 1 and 12 weeks (n=44), at 1.5 (n=44), 3 (n=33) and 4.5 (n=26) years of age. Body composition was measured using air-displacement plethysmography at 1 and 12 weeks and at 4.5 years of age. At 1.5 and 3 years, body composition, TEE, PAL and AEE were assessed using the doubly labelled water method and indirect calorimetry. Heart rate and movements were recorded using Actiheart (four days) and physical activities were registered using the 7-day diary. Energy intake was assessed using TECH during one complete 24-hour period.

    Average percentage of total body fat (TBF) and average fat mass index (FMI) were higher (+3 to +81 %), while fat-free mass index (FFMI) was slightly lower (-2 to -9 %), in children in the study from 12 weeks until 4.5 years of age when compared to corresponding reference values. A relationship between TBF% and PAL was found both at 1.5 and 3 years of age. At 3 years, but not at 1.5 years, this could be explained by a relationship between PAL and FFMI. Actiheart recordings explained a significant but small fraction (8%) of the variation in free-living TEE at 1.5 and 3 years, and in AEE (6 %) at 3 years, above that explained by body composition variables. At 1.5 and 3 years of age, PAL estimated by means of the activity diary using metabolic equivalent (MET) values by Ainsworth et al. was not significantly different from reference PAL, but the accuracy for individuals was low. Average energy intake assessed by TECH was not significantly different from TEE. However, the accuracy for individuals was poor.

    The results of this thesis suggest that 1) The higher body fatness of the children in the study compared to the corresponding reference values may indicate the presence of a secular trend in body composition development characterized by a high body fatness. 2) Body fatness might counteract physical activity at 1.5 years of age when the capacity to perform physical activity is limited, but not at 3 years of age when such a capacity has been developed. 3) Actiheart recordings explained a significant but small fraction of the variation in TEE at 1.5 and 3 years, and in AEE at 3 years of age, above that explained by body composition variables. 4) The activity diary and TECH produced mean values in agreement with reference PAL and TEE, respectively, but the accuracy for individual children was low.

    In conclusion, the results of this thesis suggest the presence of a secular trend in body composition development in healthy Swedish children, from infancy up to 4.5 years of age, which is characterized by a high body fatness. Methods to assess physical activity and energy intake at 1.5 and 3 years of age provided some promising results on a group level, although further research is needed to increase the accuracy of these methods in individual children.

    List of papers
    1. Body-composition development during early childhood and energy expenditure in response to physical activity in 1.5-y-old children
    Open this publication in new window or tab >>Body-composition development during early childhood and energy expenditure in response to physical activity in 1.5-y-old children
    Show others...
    2012 (English)In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 96, no 3, p. 567-573Article in journal (Refereed) Published
    Abstract [en]

    Background: The prevalence of childhood overweight and obesity has increased recently, but the mechanisms involved are incompletely known. Previous research has shown a correlation between the percentage of total body fat (TBF) and physical activity level (PAL). However, the PAL values used may involve a risk of spurious correlations because they are often based on predicted rather than measured estimates of resting energy metabolism. less thanbrgreater than less thanbrgreater thanObjectives: We studied the development of body composition during early childhood and the relation between the percentage of TBF and PAL on the basis of the measured resting energy metabolism. less thanbrgreater than less thanbrgreater thanDesign: Body composition was previously measured in 108 children when they were 1 and 12 wk old. When 44 of these children (21 girls and 23 boys) were 1.5 y old, their total energy expenditure and TBF were assessed by using the doubly labeled water method. Resting energy metabolism, which was assessed by using indirect calorimetry, was used to calculate PAL. less thanbrgreater than less thanbrgreater thanResults: Significant correlations were shown for TBF (r = 0.32, P = 0.035) and fat-free mass (r = 0.34, P = 0.025) between values (kg) assessed at 12 wk and 1.5 y of age. For TBF (kg) a significant interaction (P = 0.035) indicated a possible sex difference. PAL at 1.5 y was negatively correlated with the percentage of TBF (r = -0.40, P = 0.0076) and the increase in the percentage of TBF between 12 wk and 1.5 y (r = 0.38, P = 0.0105). less thanbrgreater than less thanbrgreater thanConclusions: The results indicate that body fatness and physical activity interact during early childhood and thereby influence obesity risk. Our results are based on a small sample, but nevertheless, they motivate additional studies in boys compared with girls regarding the development of body composition during early life.

    Place, publisher, year, edition, pages
    American Society for Nutrition, 2012
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-84341 (URN)10.3945/ajcn.111.022020 (DOI)000307863800016 ()
    Note

    Funding Agencies|Swedish Research Council|15402|AFA Insurance||Medical Faculty, Linkoping University||County Council of Ostergotland||Crown Princess Lovisa Foundation||

    Available from: 2012-10-05 Created: 2012-10-05 Last updated: 2019-06-28
    2. Development of body composition and its relationship with physical activity: A longitudinal study of Swedish children until 4·5 years of age
    Open this publication in new window or tab >>Development of body composition and its relationship with physical activity: A longitudinal study of Swedish children until 4·5 years of age
    Show others...
    2015 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    In order to develop strategies to prevent early childhood obesity more knowledge about longitudinal body composition development is needed. Previous studies have shown that there is a negative relationship between the physical activity level (PAL) and total body fat (TBF) in children. The aims of this study were: 1) To describe the longitudinal development of body composition from 1 week to 4·5 years of age. 2) To study the relationships between measures of body composition and PAL at 3 years of age. 3) To compare the relationships between body composition measures and PAL at 3 years of age to the corresponding relationships at 1·5 years of age. Body composition was measured using air-displacement plethysmography at 1 week, 12 weeks and at 4·5 years of age. At 1·5 and 3 years body composition and PAL were assessed using the doubly labelled water method and indirect calorimetry. The results showed that TBF% and fat mass index (FMI) were higher than corresponding reference values, during infancy and childhood. We found a relationship between TBF% and PAL at 3 years of age but this was explained by a relationship between PAL and fat-free mass index (FFMI). The corresponding relationship at 1·5 years of age could not be explained by a relationship between PAL and FFMI. In conclusion, the children in this study had higher body fatness compared to the corresponding reference values. This may indicate an identification of a secular trend in body composition development which is characterized by a high body fatness. Our findings also suggest that body fatness might counteract physical activity at 1·5 years of age when the capacity to perform physical activity is limited, however this result was not observed at 3 years of age when such a capacity has been developed.

    Keywords
    Body composition, energy expenditure, physical activity, children, doubly labelled water
    National Category
    Clinical Science Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-117418 (URN)
    Available from: 2015-04-27 Created: 2015-04-27 Last updated: 2019-06-28Bibliographically approved
    3. Evaluation of Actiheart and a 7d activity diary for estimating free-living total and activity energy expenditure using criterion methods in 1 center dot 5- and 3-year-old children
    Open this publication in new window or tab >>Evaluation of Actiheart and a 7d activity diary for estimating free-living total and activity energy expenditure using criterion methods in 1 center dot 5- and 3-year-old children
    2014 (English)In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 111, no 10, p. 1830-1840Article in journal (Refereed) Published
    Abstract [en]

    Accurate and easy-to-use methods to assess free-living energy expenditure in response to physical activity in young children are scarce. In the present study, we evaluated the capacity of (1) 4d recordings obtained using the Actiheart (mean heart rate (mHR) and mean activity counts (mAC)) to provide assessments of total energy expenditure (TEE) and activity energy expenditure (AEE) and (2) a 7d activity diary to provide assessments of physical activity levels (PAL) using three sets of metabolic equivalent (MET) values (PAL(Torun), PAL(Adolph) and PAL(Ainsworth)) in forty-four and thirty-one healthy Swedish children aged 1 center dot 5 and 3 years, respectively. Reference TEE, PAL(ref) and AEE were measured using criterion methods, i.e. the doubly labelled water method and indirect calorimetry. At 1 center dot 5 years of age, mHR explained 8% (P=0 center dot 006) of the variation in TEE above that explained by fat mass and fat-free mass. At 3 years of age, mHR and mAC explained 8 (P=0 center dot 004) and 6 (P=0 center dot 03)% of the variation in TEE and AEE, respectively, above that explained by fat mass and fat-free mass. At 1 center dot 5 and 3 years of age, average PAL(Ainsworth) values were 1 center dot 44 and 1 center dot 59, respectively, and not significantly different from PAL(ref) values (1 center dot 39 and 1 center dot 61, respectively). By contrast, average PAL(Torun) (1 center dot 5 and 3 years) and PAL(Adolph) (3 years) values were lower (Pless than0 center dot 05) than the corresponding PAL(ref) values. In conclusion, at both ages, Actiheart recordings explained a small but significant fraction of free-living energy expenditure above that explained by body composition variables, and our activity diary produced mean PAL values in agreement with reference values when using MET values published by Ainsworth.

    Place, publisher, year, edition, pages
    Cambridge University Press (CUP), 2014
    Keywords
    Heart rate recording; Activity diary; Doubly labelled water; Accelerometer
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-106669 (URN)10.1017/S0007114513004406 (DOI)000334172400012 ()
    Available from: 2014-05-21 Created: 2014-05-19 Last updated: 2019-06-28
    4. A New Mobile Phone-Based Tool for Assessing Energy and Certain Food Intakes in Young Children: A Validation Study
    Open this publication in new window or tab >>A New Mobile Phone-Based Tool for Assessing Energy and Certain Food Intakes in Young Children: A Validation Study
    Show others...
    2015 (English)In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 3, no 2, article id e38Article in journal (Refereed) Published
    Abstract [en]

    Background: Childhood obesity is an increasing health problem globally. Obesity may be established already at pre-school age. Further research in this area requires accurate and easy-to-use methods for assessing the intake of energy and foods. Traditional methods have limited accuracy, and place large demands on the study participants and researchers. Mobile phones offer possibilities for methodological advancements in this area since they are readily available, enable instant digitalization of collected data, and also contain a camera to photograph pre- and post-meal food items. We have recently developed a new tool for assessing energy and food intake in children using mobile phones called the Tool for Energy Balance in Children (TECH). Objective: The main aims of our study are to (1) compare energy intake by means of TECH with total energy expenditure (TEE) measured using a criterion method, the doubly labeled water (DLW) method, and (2) to compare intakes of fruits and berries, vegetables, juice, and sweetened beverages assessed by means of TECH with intakes obtained using a Web-based food frequency questionnaire (KidMeal-Q) in 3 year olds. Methods: In this study, 30 Swedish 3 year olds were included. Energy intake using TECH was compared to TEE measured using the DLW method. Intakes of vegetables, fruits and berries, juice, as well as sweetened beverages were assessed using TECH and compared to the corresponding intakes assessed using KidMeal-Q. Wilcoxon matched pairs test, Spearman rank order correlations, and the Bland-Altman procedure were applied. Results: The mean energy intake, assessed by TECH, was 5400 kJ/24h (SD 1500). This value was not significantly different (P=.23) from TEE (5070 kJ/24h, SD 600). However, the limits of agreement (2 standard deviations) in the Bland-Altman plot for energy intake estimated using TECH compared to TEE were wide (2990 kJ/24h), and TECH overestimated high and underestimated low energy intakes. The Bland-Altman plots for foods showed similar patterns. The mean intakes of vegetables, fruits and berries, juice, and sweetened beverages estimated using TECH were not significantly different from the corresponding intakes estimated using KidMeal-Q. Moderate but statistically significant correlations (ρ=.42-.46, P=.01-.02) between TECH and KidMeal-Q were observed for intakes of vegetables, fruits and berries, and juice, but not for sweetened beverages. Conclusion: We found that one day of recordings using TECH was not able to accurately estimate intakes of energy or certain foods in 3 year old children.

    Place, publisher, year, edition, pages
    JMIR publications, 2015
    Keywords
    Cell phone, digital camera, food intake, energy intake, child, DLW, FFQ
    National Category
    Clinical Science Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-117419 (URN)10.2196/mhealth.3670 (DOI)25910494 (PubMedID)
    Available from: 2015-04-27 Created: 2015-04-27 Last updated: 2019-06-28Bibliographically approved
  • 139.
    Henriksson, Hanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Bonn, E. Stephanie
    Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Bergström, Anna
    Karolinska Institutet, Institute of Enviromental Medicine, Stockholm, Sweden.
    Bälter, Katarina
    Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Bälter, Olle
    Royal Institute of Technology, School of Computer Science and Communication, Stockholm, Sweden.
    Delisle, Christine
    Karolinska Institutet, Department of Biosciences and Nutrition, Huddinge, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Karolinska Institutet, Department of Biosciences and Nutrition, Huddinge, Sweden.
    A New Mobile Phone-Based Tool for Assessing Energy and Certain Food Intakes in Young Children: A Validation Study2015In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 3, no 2, article id e38Article in journal (Refereed)
    Abstract [en]

    Background: Childhood obesity is an increasing health problem globally. Obesity may be established already at pre-school age. Further research in this area requires accurate and easy-to-use methods for assessing the intake of energy and foods. Traditional methods have limited accuracy, and place large demands on the study participants and researchers. Mobile phones offer possibilities for methodological advancements in this area since they are readily available, enable instant digitalization of collected data, and also contain a camera to photograph pre- and post-meal food items. We have recently developed a new tool for assessing energy and food intake in children using mobile phones called the Tool for Energy Balance in Children (TECH). Objective: The main aims of our study are to (1) compare energy intake by means of TECH with total energy expenditure (TEE) measured using a criterion method, the doubly labeled water (DLW) method, and (2) to compare intakes of fruits and berries, vegetables, juice, and sweetened beverages assessed by means of TECH with intakes obtained using a Web-based food frequency questionnaire (KidMeal-Q) in 3 year olds. Methods: In this study, 30 Swedish 3 year olds were included. Energy intake using TECH was compared to TEE measured using the DLW method. Intakes of vegetables, fruits and berries, juice, as well as sweetened beverages were assessed using TECH and compared to the corresponding intakes assessed using KidMeal-Q. Wilcoxon matched pairs test, Spearman rank order correlations, and the Bland-Altman procedure were applied. Results: The mean energy intake, assessed by TECH, was 5400 kJ/24h (SD 1500). This value was not significantly different (P=.23) from TEE (5070 kJ/24h, SD 600). However, the limits of agreement (2 standard deviations) in the Bland-Altman plot for energy intake estimated using TECH compared to TEE were wide (2990 kJ/24h), and TECH overestimated high and underestimated low energy intakes. The Bland-Altman plots for foods showed similar patterns. The mean intakes of vegetables, fruits and berries, juice, and sweetened beverages estimated using TECH were not significantly different from the corresponding intakes estimated using KidMeal-Q. Moderate but statistically significant correlations (ρ=.42-.46, P=.01-.02) between TECH and KidMeal-Q were observed for intakes of vegetables, fruits and berries, and juice, but not for sweetened beverages. Conclusion: We found that one day of recordings using TECH was not able to accurately estimate intakes of energy or certain foods in 3 year old children.

  • 140.
    Henriksson, Hanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Britt
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Flinke Carlsson, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Development of body composition and its relationship with physical activity: A longitudinal study of Swedish children until 4·5 years of age2015Manuscript (preprint) (Other academic)
    Abstract [en]

    In order to develop strategies to prevent early childhood obesity more knowledge about longitudinal body composition development is needed. Previous studies have shown that there is a negative relationship between the physical activity level (PAL) and total body fat (TBF) in children. The aims of this study were: 1) To describe the longitudinal development of body composition from 1 week to 4·5 years of age. 2) To study the relationships between measures of body composition and PAL at 3 years of age. 3) To compare the relationships between body composition measures and PAL at 3 years of age to the corresponding relationships at 1·5 years of age. Body composition was measured using air-displacement plethysmography at 1 week, 12 weeks and at 4·5 years of age. At 1·5 and 3 years body composition and PAL were assessed using the doubly labelled water method and indirect calorimetry. The results showed that TBF% and fat mass index (FMI) were higher than corresponding reference values, during infancy and childhood. We found a relationship between TBF% and PAL at 3 years of age but this was explained by a relationship between PAL and fat-free mass index (FFMI). The corresponding relationship at 1·5 years of age could not be explained by a relationship between PAL and FFMI. In conclusion, the children in this study had higher body fatness compared to the corresponding reference values. This may indicate an identification of a secular trend in body composition development which is characterized by a high body fatness. Our findings also suggest that body fatness might counteract physical activity at 1·5 years of age when the capacity to perform physical activity is limited, however this result was not observed at 3 years of age when such a capacity has been developed.

  • 141.
    Henriksson, Pontus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Body composition of parents and their infants: methodological, anthropometric, metabolic and genetic studies2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Body composition in infancy may be of importance for later health. In particular, infant body composition may be relevant regarding obesity risk in childhood. Recent advances in body composition methodology using air displacement plethysmography (ADP) have provided possibilities to accurately measure body composition of infants in a quick and non-invasive manner. The aims of this thesis were to study associations of parental body composition using ADP, glucose homeostasis during pregnancy and infant genetics with infant body composition also using ADP. When using ADP in adults, a correction for the thoracic gas volume (TGV) is needed and TGV can be predicted using equations developed in nonpregnant adults. Thus another aim was to study the validity of using such equations during pregnancy.

    Parent couples were invited to this study at a routine visit to a maternity clinic in Linköping between September 2008 and October 2010. When the mother was in gestational week 32, parental body composition using ADP and maternal glucose homeostasis variables were assessed. Size and body composition of healthy, singleton and full term (≥ 37 gestational weeks) infants were measured at 1 and 12 weeks of age and a total of 211 infants  were included in the studies. Weight and length at 1 year of age were reported by parents. Saliva samples were collected from the infants to obtain DNA for genotyping of the fat mass and obesity associated (FTO) gene.

    Body composition results calculated using measured and predicted TGV were compared in 27 women. Results showed that predicted TGV yields a very marginal overestimation (0.5 %) of fat mass (FM). Further, each kg increase in maternal and paternal fat-free mass (FFM) was associated with 15.6 g (P=0.001) and 9.1 g (P=0.007), respectively, more FFM in their 1-week old infants. FM of fathers was not related to infant FM. However, maternal FM was positively associated with FM of daughters (5.8 g/kg, P=0.007), but not of sons (P=0.79) at 1 week of age. Similarly, each standard deviation increase in maternal HOMA-IR (homeostatic model assessment-insulin resistance) was related to 52.7 more g of FM (P<0.001) in 1-weekold daughters, but no such relationship was found for sons (P=0.79). The number of risk alleles at the FTO locus rs9939609 was not associated with infant body mass index (BMI) or infant FM at 1 or 12 weeks of age. However, the number of risk alleles was positively associated (P≤0.033) with infant length at 1 and 12 weeks of age, and the results suggested that this association was stronger in boys than in girls.

    The results presented in this thesis show that: i) The use of predicted TGV when applying ADP in gestational week 32 overestimated % FM only slightly. ii) Associations between parental and infant body composition are present early in life. Thus, parental FFM was positively related to FFM in 1-week-old infants. Furthermore, maternal FM and insulin resistance (HOMA-IR) were positively related to FM of 1-week-old daughters, but no such relationships were observed for sons. iii) The FTO genotype is not associated with infant body fatness at 1 or 12 weeks of age. However, the results suggested that the number of FTO risk alleles is positively associated with infant length, especially in boys.

    In conclusion, parental and genetic factors were associated with infant size and body composition and these relationships may be of importance for future body composition and health.

    List of papers
    1. Assessment and prediction of thoracic gas volume in pregnant women: an evaluation in relation to body composition assessment using air displacement plethysmography
    Open this publication in new window or tab >>Assessment and prediction of thoracic gas volume in pregnant women: an evaluation in relation to body composition assessment using air displacement plethysmography
    2013 (English)In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 109, no 1, p. 111-117Article in journal (Refereed) Published
    Abstract [en]

    Assessment of body fat (BF) in pregnant women is important when investigating the relationship between maternal nutrition and offspring health. Convenient and accurate body composition methods applicable during pregnancy are therefore needed. Air displacement plethysmography, as applied in Bod Pod, represents such a method since it can assess body volume (BV) which, in combination with body weight, can be used to calculate body density and body composition. However, BV must be corrected for the thoracic gas volume (TGV) of the subject. In non-pregnant women, TGV may be predicted using equations, based on height and age. It is unknown, however, whether these equations are valid during pregnancy. Thus, we measured the TGV of women in gestational week 32 (n 27) by means of plethysmography and predicted their TGV using equations established for non-pregnant women. Body weight and BV of the women was measured using Bod Pod. Predicted TGV was significantly (P = 0.033) higher than measured TGV by 6% on average. Calculations in hypothetical women showed that this overestimation tended to be more pronounced in women with small TGV than in women with large TGV. The overestimation of TGV resulted in a small but significant (P = 0.043) overestimation of BF, equivalent to only 0.5% BF, on average. A Bland-Altman analysis showed that the limits of agreement were narrow (from -1.9 to 2.9% BF). Thus, although predicted TGV was biased and too high, the effect on BF was marginal and probably unimportant in many situations.

    Place, publisher, year, edition, pages
    Cambridge University Press (CUP), 2013
    Keywords
    Air displacement plethysmography, Body composition, Pregnancy, Thoracic gas volume
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-87956 (URN)10.1017/S0007114512000906 (DOI)000312998200014 ()
    Note

    Funding Agencies|Swedish Research Council|15402|FORMAS||Magnus Bergvall Foundation||Thuring Foundation||Swedish Society of Medicine||Medical Faculty, Linkoping University||County Council of Ostergotland||

    Available from: 2013-01-28 Created: 2013-01-28 Last updated: 2019-06-28
    2. Parental fat-free mass is related to the fat-free mass of infants and maternal fat mass is related to the fat mass of infant girls
    Open this publication in new window or tab >>Parental fat-free mass is related to the fat-free mass of infants and maternal fat mass is related to the fat mass of infant girls
    2015 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 5, p. 491-497Article in journal (Refereed) Published
    Abstract [en]

    Aim: Existing studies suggest that weight and body composition of parents influence the size and body composition of their offspring, but are often inconclusive and conducted by means of inappropriate body composition methodology. Our aim was to study infant size and body composition variables in relation to body composition variables of their mothers and fathers in a well-nourished population using an accurate methodology.

    Methods: Between 2008 and 2011, we used air displacement plethysmography to measure the body composition of 209 parent–infant units. Parents were measured when women were in gestational week 32. Their healthy, singleton, full-term infants were measured at 1 week.

    Results: Infant fat-free mass in grams was positively related (p ≤ 0.007) to the fat-free mass in kilograms of the mothers (15.6 g/kg) and the fathers (9.1 g/kg). Furthermore, the fat mass of the daughters, but not of the sons, was positively related to the fat mass of the mothers (5.8 g/kg, p = 0.007).

    Conclusion: This study found associations between the fat-free mass of parents and infants and an association between the fat mass of mothers and their infant girls. These findings may help to understand early life factors behind overweight and obesity.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2015
    Keywords
    Body composition, Father, Infant, Mother, Sex difference
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Clinical Science
    Identifiers
    urn:nbn:se:liu:diva-117430 (URN)10.1111/apa.12939 (DOI)000353643400023 ()25645821 (PubMedID)
    Available from: 2015-04-27 Created: 2015-04-27 Last updated: 2019-06-28Bibliographically approved
    3. Glucose, insulin, and the insulin-like growth factor binding protein 1 in the circulation of pregnant women in relation to their own body composition and to that of their infants
    Open this publication in new window or tab >>Glucose, insulin, and the insulin-like growth factor binding protein 1 in the circulation of pregnant women in relation to their own body composition and to that of their infants
    2015 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Aim: Intrauterine factors influence infant size and body composition but the mechanisms involved are incompletely known. We studied relationships between the body composition of pregnant women and variables related to their glucose homeostasis, i.e. glucose, insulin, HOMA-IR (homeostasis model assessment-insulin resistance), haemoglobin A1c and IGFBP-1 (insulin-like growth factor binding protein 1), in their circulation and related these variables to the body composition of their infants.

    Methods: Body composition of 209 women in gestational week 32 and of their healthy, singleton and full-term one-week-old infants was measured using air displacement plethysmography. Glucose homeostasis variables were assessed in gestational week 32.

    Results: Insulin/HOMA-IR were positively related to body mass index, fat mass index and fat mass (r2=0.32-0.36, P<0.001) of the women. Their glucose, insulin and HOMA-IR values were positively (P≤0.009) associated, while IGFBP-1was negatively (P=0.001) associated, with infant fat mass. Insulin and HOMA-IR were positively associated with fat mass of daughters (P<0.001), but not of sons (P≥0.65) (Sex-interaction: P≤ 0.042).

    Conclusion: Glucose homeostasis variables of pregnant women are related to their own body composition and to that of their infants. The results suggested that a previously identified relationship between fat mass of mothers and daughters is mediated by insulin resistance.

    Keywords
    Body composition, infant, insulin resistance, mother, sex difference
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Clinical Science
    Identifiers
    urn:nbn:se:liu:diva-117431 (URN)
    Available from: 2015-04-27 Created: 2015-04-27 Last updated: 2019-06-28Bibliographically approved
    4. Variation in the fat mass and obesity-related (FTO) genotype is not associated with body fatness in infants, but possibly with their length
    Open this publication in new window or tab >>Variation in the fat mass and obesity-related (FTO) genotype is not associated with body fatness in infants, but possibly with their length
    2014 (English)In: Pediatric Obesity, ISSN 2047-6302, E-ISSN 2047-6310, Vol. 9, no 5, p. E112-E115Article in journal (Refereed) Published
    Abstract [en]

    BackgroundData relating variation at the fat mass and obesity-related (FTO) locus (rs9939609) to fat mass in infancy are inconclusive. ObjectiveTo study relationships between FTO genotype and infant size (at 1 and 12 weeks and at 1 year of age) and body composition (at 1 and 12 weeks). MethodsBody composition was assessed using air displacement plethysmography in 207 infants. FTO was genotyped using the TaqMan assay. ResultsThe number of risk alleles was related to length at 1 and 12 weeks (P=0.007-0.033) but not to fat mass. The relationship to length was stronger in boys than in girls. ConclusionsOur results suggest that the FTO genotype is not related during infancy to fat mass but is related to length in boys but not in girls.

    Place, publisher, year, edition, pages
    Wiley, 2014
    Keywords
    Body composition; fat mass; FTO; infant
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-112052 (URN)10.1111/ijpo.231 (DOI)000342991900009 ()24846219 (PubMedID)
    Note

    Funding Agencies|Swedish Research Council [15402]; County Council of Ostergotland

    Available from: 2014-11-17 Created: 2014-11-13 Last updated: 2019-06-28
  • 142.
    Henriksson, Pontus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Department of Biosciences and Nutrition, Karolinska Institute, NOVUM, Huddinge, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Glucose, insulin, and the insulin-like growth factor binding protein 1 in the circulation of pregnant women in relation to their own body composition and to that of their infants2015Manuscript (preprint) (Other academic)
    Abstract [en]

    Aim: Intrauterine factors influence infant size and body composition but the mechanisms involved are incompletely known. We studied relationships between the body composition of pregnant women and variables related to their glucose homeostasis, i.e. glucose, insulin, HOMA-IR (homeostasis model assessment-insulin resistance), haemoglobin A1c and IGFBP-1 (insulin-like growth factor binding protein 1), in their circulation and related these variables to the body composition of their infants.

    Methods: Body composition of 209 women in gestational week 32 and of their healthy, singleton and full-term one-week-old infants was measured using air displacement plethysmography. Glucose homeostasis variables were assessed in gestational week 32.

    Results: Insulin/HOMA-IR were positively related to body mass index, fat mass index and fat mass (r2=0.32-0.36, P<0.001) of the women. Their glucose, insulin and HOMA-IR values were positively (P≤0.009) associated, while IGFBP-1was negatively (P=0.001) associated, with infant fat mass. Insulin and HOMA-IR were positively associated with fat mass of daughters (P<0.001), but not of sons (P≥0.65) (Sex-interaction: P≤ 0.042).

    Conclusion: Glucose homeostasis variables of pregnant women are related to their own body composition and to that of their infants. The results suggested that a previously identified relationship between fat mass of mothers and daughters is mediated by insulin resistance.

  • 143.
    Henriksson, Pontus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Department of Biosciences and Nutrition, Karolinska Institute, NOVUM, Huddinge, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Parental fat-free mass is related to the fat-free mass of infants and maternal fat mass is related to the fat mass of infant girls2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 5, p. 491-497Article in journal (Refereed)
    Abstract [en]

    Aim: Existing studies suggest that weight and body composition of parents influence the size and body composition of their offspring, but are often inconclusive and conducted by means of inappropriate body composition methodology. Our aim was to study infant size and body composition variables in relation to body composition variables of their mothers and fathers in a well-nourished population using an accurate methodology.

    Methods: Between 2008 and 2011, we used air displacement plethysmography to measure the body composition of 209 parent–infant units. Parents were measured when women were in gestational week 32. Their healthy, singleton, full-term infants were measured at 1 week.

    Results: Infant fat-free mass in grams was positively related (p ≤ 0.007) to the fat-free mass in kilograms of the mothers (15.6 g/kg) and the fathers (9.1 g/kg). Furthermore, the fat mass of the daughters, but not of the sons, was positively related to the fat mass of the mothers (5.8 g/kg, p = 0.007).

    Conclusion: This study found associations between the fat-free mass of parents and infants and an association between the fat mass of mothers and their infant girls. These findings may help to understand early life factors behind overweight and obesity.

  • 144.
    Hjelm, Katarina
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Apelqvist, J.
    Lund University, Sweden.
    Influence of beliefs about health and illness on self-care and care-seeking in foreign-born people with diabetic foot ulcers: dissimilarities related to origin2016In: Journal of Wound Care, ISSN 0969-0700, E-ISSN 2052-2916, Vol. 25, no 11, p. 602-616Article in journal (Refereed)
    Abstract [en]

    Objective: To describe beliefs about health and illness among foreign-born people with diabetic foot ulcers that might affect self-reported self-care and health-care seeking and to study whether there are dissimilarities related to origin. Method: Qualitative descriptive study. Semi-structured interviews with people aged 38-86 years; 13 born in European and 13 in non-European countries (all except one in the Middle East). All resident in Sweden for 7-60 years (median: 18.5years). Results: Most believed foot ulcers were unavoidable and difficult to detect. Foot problems were mainly believed to be due to internal factors (diabetes), sometimes combined with external factors (inappropriate footwear, hot water, or barefoot walking). Health was described as freedom from illness and health professionals were seen as important sources of information. Perceived health deteriorated after the onset of the foot problems due to immobility and pain. People from the Middle East differed from other respondents as they discussed the importance of adapting to the will of Allah, leading to even poorer quality of life and a more negative view of future health. They also described more foot problems and perceived religion (Islam) with ritual washing of the feet to be important for health. However, they were regularly monitored to a lesser extent than European migrants. Economy affected health, more so in Europeans, due to expenses for medications and shoes. Many described limited activity in self-care, few had sought help for their problems and then solely among professionals, and had limited knowledge about the influence of glycaemic control on diabetes and foot status. Conclusion: Foreign-born people felt unable to prevent the incidence of foot ulcers, experienced problems with detection, and had limited knowledge of self-care. Dissimilarities in beliefs related to origin negatively influenced self-care of the feet, so it is important to assess individual beliefs and plan care and education accordingly. Declaration of interest: None to declare.

  • 145.
    Hjelm, Katarina
    et al.
    Uppsala Univ, Sweden.
    Bard, Karin
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Medicine and Health Sciences.
    Apelqvist, Jan
    Lund Univ, Sweden.
    A qualitative study of developing beliefs about health, illness and healthcare in migrant African women with gestational diabetes living in Sweden2018In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 18, article id 34Article in journal (Refereed)
    Abstract [en]

    Background: Gestational diabetes (GDM) is associated with health risks for both mother and child, and is particularly relevant to migrant women and women of African origin. With todays extensive global migration, contact with the new society and health system confronts the migrants culture of origin with the culture of the host country. The question is whether immigrants patterns of beliefs about health, illness, and health-related behaviour change over time, as no previous studies have been found on this topic. The purpose was to explore development over time, during and after pregnancy, of beliefs about health, illness and healthcare in migrant women with GDM born in Africa living in Sweden, and study the influence on self-care and care seeking. Methods: Qualitative prospective study. Semi-structured interviews, with 9 women (23-40 years), on three different occasions: during pregnancy (gestational weeks 34-38), and 3 and 14 months after delivery managed at an in-hospital diabetes specialist clinic in Sweden. Results: Beliefs were rather stable over time and mainly related to individual and social factors. GDM was perceived as a transient condition as health professionals had informed about it, which made them calm. None, except one, expressed worries about relapse and the health of the baby. Instead women worried about being unable to live an ordinary life and being bound to lifestyle changes, particularly diet, developing diabetes and needing insulin injections. Over time knowledge of appropriate diet improved, although no advice was experienced given by the clinic after delivery. The healthcare model was perceived as well functioning with easy access but regular follow-ups were requested as many (decreasing over time) were unsure whether they still had GDM and lacked information about GDM and diet. During pregnancy information was also requested about the healthcare system before/after delivery. Conclusions: Beliefs changed to a limited extent prospectively, indicated low risk awareness, limited knowledge of GDM, irrelevant worries about future health, and being unable to live a normal life, associated with problematic lifestyle changes. Beliefs about the seriousness of GDM in health professionals influenced patients beliefs and health-related behaviour. The healthcare organisation urgently needs to be improved to deliver appropriate and timely information through competent staff.

  • 146.
    Holm, Angelika
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Aquaporins in Infection and Inflammation2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The ability of eukaryotic cells to change their shape and to migrate directionally is highly dependent on active volume regulation in cells building up tissues as well as in individual cells. Transmembrane fluxes of water via specialized water channels, called aquaporins (AQPs), facilitate the changes of volume and shape, which additionally require a complex interplay between the plasma membrane and the cytoskeleton. AQPs have been shown to be involved in the development of inflammatory processes and diseases. The aims of the studies underlying this thesis were to further elucidate the expression and function of AQPs in both bacterial and viral infections as well as in the inflammatory disease, microscopic colitis. For this, molecular techniques qPCR, immunoblotting and live, holographic, confocal and super-resolution imaging were used.

    When cells of the innate immune system encounter pathogens they need to respond and prepare for migration and phagocytosis and do so through volume regulatory processes. The Gramnegative bacterium Pseudomonas aeruginosa utilizes a small molecule-based communication system, called quorum sensing (QS) to control the production of its virulence factors and biofilms. We found that P. aeruginosa with a complete QS system elicits a stronger phagocytic response in human blood-derived macrophages compared to its lasI-/rhlI- mutant lacking the production of the QS molecules N-butyryl-L-homoserine lactone (C4-HSL) and N-3-oxododecanoyl-L-homoserine lactone (3O-C12-HSL). Infection with P. aeruginosa further increases the expression of AQP9 and induces re-localisation of AQP9 to the front and trailing ends of macrophages. Moreover, the 3O-C12-HSL alone elevates the expression of AQP9, redistribute the water channel to the front and rear ends and increases the cell area and volume of macrophages. Both infection with the wild type P. aeruginosa and the treatment with 3OC12-HSL change the nano-structural architecture of the AQP9 distribution in macrophages.

    Viruses use the intracellular machinery of the invaded cells to produce and assemble new viral bodies. Intracellular AQPs are localised in a membranes of cellular organelles to regulate their function and morphology. C3H10T1/2 fibroblasts transiently expressing green fluorescent protein (GFP)-AQP6 show a reduced expression of AQP6 after Hazara virus infection and an increased cell area. Overexpressing AQP6 in C3H10T1/2 cells reduces the infectivity of Hazara virus indicating that AQP6 expression has a protective role in virus infections.

    Ion and water channels in the epithelial cell lining tightly regulate the water homeostasis. In microscopic colitis (MC), patients suffer from severe watery diarrhoeas. For the first time, we have shown that the expression of AQP1, 8 and 11 and the sodium/hydrogen exchanger NHE1 are reduced in colonic biopsies from MC patients compared to healthy control individuals. Following treatment with the glucocorticoid budesonide the patients experienced a rapid recovery and we observed a restored or increased expression of the AQPs and NHE1 during treatment, suggesting a role for AQPs in the diarrhoeal mechanisms in MC.

    Taken together, this thesis provides new evidence on the importance of water homeostasis regulation through AQPs during infections and inflammation and opens up a door for further investigations of roles for AQPs in inflammatory processes.

    List of papers
    1. Pseudomonas aeruginosa lasI/rhlI quorum sensing genes promote phagocytosis and aquaporin 9 redistribution to the leading and trailing regions in macrophages
    Open this publication in new window or tab >>Pseudomonas aeruginosa lasI/rhlI quorum sensing genes promote phagocytosis and aquaporin 9 redistribution to the leading and trailing regions in macrophages
    2015 (English)In: Frontiers in Microbiology, ISSN 1664-302X, E-ISSN 1664-302X, Vol. 6, no 915Article in journal (Refereed) Published
    Abstract [en]

    Pseudomonas aeruginosa controls production of its multiple virulence factors and biofilm development via the quorum sensing (QS) system. QS signals also interact with and affect the behavior of eukaryotic cells. Host water homeostasis and aquaporins (AQP) are essential during pathological conditions since they interfere with the cell cytoskeleton and signaling, and hereby affect cell morphology and functions. We investigated the contribution of F? aeruginosa QS genes lasl/rhIl to phagocytosis, cell morphology, AQP9 expression, and distribution in human macrophages, using immunoblotting, confocal, and nanoscale imaging. Wild type F? aeruginosa with a functional QS system was a more attractive prey for macrophages than the lasl/rhIl mutant lacking the production of QS molecules, 30-C-12-HSL, and C-4 -HSL, and associated virulence factors. The F? aeruginosa infections resulted in elevated AQP9 expression and relocalization to the leading and trailing regions in macrophages, increased cell area and length; bacteria with a functional QS system lasl/rhIl achieved stronger responses. We present evidence for a new role of water fluxes via AQP9 during bacteria macrophage interaction and for the QS system as an important stimulus in this process. These novel events in the interplay between F? aeruginosa and macrophages may influence on the outcome of infection, inflammation, and development of disease.

    Place, publisher, year, edition, pages
    FRONTIERS MEDIA SA, 2015
    Keywords
    host-bacteria relationship; quorum sensing; N-acylhomoserine lactone; innate immunity; macrophage; water homeostasis; aquaporin
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-122056 (URN)10.3389/fmicb.2015.00915 (DOI)000360626200001 ()26388857 (PubMedID)
    Note

    Funding Agencies|Swedish Research Council [2010-3045]; European Science foundation (TraPPs Euromembrane project); Euro-BioImaging Proof-of Concept Studies; Magnus Bergvalls Foundation; Faculty of Health Sciences, Linkoping University

    Available from: 2015-12-18 Created: 2015-10-19 Last updated: 2017-12-01
    2. Pseudomonas aeruginosa N-3-oxo-dodecanoyl-homoserine Lactone Elicits Changes in Cell Volume, Morphology, and AQP9 Characteristics in Macrophages
    Open this publication in new window or tab >>Pseudomonas aeruginosa N-3-oxo-dodecanoyl-homoserine Lactone Elicits Changes in Cell Volume, Morphology, and AQP9 Characteristics in Macrophages
    2016 (English)In: Frontiers in Cellular and Infection Microbiology, E-ISSN 2235-2988, ISSN 2235-2988, Vol. 6, no 32Article in journal (Refereed) Published
    Abstract [en]

    Quorum sensing (QS) communication allows Pseudomonas aeruginosa to collectively control its population density and the production of biofilms and virulence factors. QS signal molecules, like N-3-oxo-dodecanoyl-L-homoserine lactone (30-C-12-HSL), can also affect the behavior of host cells, e.g., by modulating the chemotaxis, migration, and phagocytosis of human leukocytes. Moreover, host water homeostasis and water channels aquaporins (AQP) are critical for cell morphology and functions as AQP interact indirectly with the cell cytoskeleton and signaling cascades. Here, we investigated how P aeruginosa 30-C-12-HSL affects cell morphology, area, volume and AQP9 expression and distribution in human primary macrophages, using quantitative PCR, immunoblotting, two- and three-dimensional live imaging, confocal and nanoscale imaging. Thus, 30-C-12-HSL enhanced cell volume and area and induced cell shape and protrusion fluctuations in macrophages, processes tentatively driven by fluxes of water across cell membrane through AQP9, the predominant AQP in macrophages. Moreover, 30-C-12-HSL upregulated the expression of AQP9 at both the protein and mRNA levels. This was accompanied with enhanced whole cell AQP9 fluorescent intensity and redistribution of AQP9 to the leading and trailing regions, in parallel with increased cell area in the macrophages. Finally, nanoscopy imaging provided details on AQP9 dynamics and architecture within the lamellipodial area of 30-C-12-HSL-stimulated cells. We suggest that these novel events in the interaction between P aeruginosa and macrophage may have an impact on the effectiveness of innate immune cells to fight bacteria, and thereby resolve the early stages of infections and inflammations.

    Place, publisher, year, edition, pages
    FRONTIERS MEDIA SA, 2016
    Keywords
    host-bacteria interactions; quorum sensing; N-acylhomoserinelactone; innate immunity; macrophage; water homeostasis; aquaporin
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-127262 (URN)10.3389/fcimb.2016.00032 (DOI)000372710500001 ()27047801 (PubMedID)
    Note

    Funding Agencies|Swedish Research Council [2010-3045]; European Science foundation (TraPPs Euromembrane project); Magnus Bergvall Foundation; Faculty of Medicine and Health Sciences, Linkoping University

    Available from: 2016-04-20 Created: 2016-04-19 Last updated: 2018-05-14
    3. Protective role of host aquaporin 6 against Hazara virus, a model for Crimean–Congo hemorrhagic fever virus infection
    Open this publication in new window or tab >>Protective role of host aquaporin 6 against Hazara virus, a model for Crimean–Congo hemorrhagic fever virus infection
    Show others...
    2016 (English)In: FEMS Microbiology Letters, ISSN 0378-1097, E-ISSN 1574-6968, Vol. 363, no 8, article id fnw058Article in journal (Refereed) Published
    Abstract [en]

    Crimean–Congo hemorrhagic fever virus (CCHFV) is an arthropod-borne pathogen that causes infectious disease with severe hemorrhagic manifestations in vascular system in humans. The proper function of the cells in the vascular system is critically regulated by aquaporins (AQP), water channels that facilitate fluxes of water and small solutes across membranes. With Hazara virus as a model for CCHFV, we investigated the effects of viruses on AQP6 and the impact of AQP6 on virus infectivity in host cells, using transiently expressed GFP-AQP6 cells, immunofluorescent assay for virus detection, epifluorescent imaging of living cells and confocal microscopy. In GFP-AQP6 expressing cells, Hazara virus reduced both the cellular and perinuclear AQP6 distribution and changed the cell area. Infection of human cell with CCHFV strain IbAR 10200 downregulated AQP6 expression at mRNA level. Interestingly, the overexpression of AQP6 in host cells decreased the infectivity of Hazara virus, speaking for a protective role of AQP6. We suggest the possibility for AQP6 being a novel player in the virus–host interactions, which may lead to less severe outcomes of an infection.

    Place, publisher, year, edition, pages
    Oxford University Press, 2016
    Keywords
    Host–virus interactions; Nairovirus; Crimean–Congo hemorrhagic fever virus; aquaporin; virus infectivity; water homeostasis
    National Category
    Cell and Molecular Biology Microbiology in the medical area
    Identifiers
    urn:nbn:se:liu:diva-127499 (URN)10.1093/femsle/fnw058 (DOI)000377970600013 ()26976854 (PubMedID)
    Funder
    Swedish Research Council, 2010-3045European Science Foundation (ESF)Magnus Bergvall FoundationSwedish Research Council, 214–7495Linköpings universitet
    Note

    Funding agencies: Swedish Research Council [2010-3045]; European Science foundation; Magnus Bergvall Foundation; Faculty of Medicine and Health Sciences, Linkoping University; Infect-ERA Second Call (Swedish Research Council) [214-7495]

    Available from: 2016-04-28 Created: 2016-04-28 Last updated: 2018-01-10Bibliographically approved
  • 147.
    Holm, Anna
    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.
    Acute coronary syndrome: bleeding, platelets and gender2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    BACKGROUND

    Bleeding complications increase mortality in patients with acute coronary syndrome (ACS). Potential gender difference in bleeding regarding prevalence, location, severity and prognostic impact is still controversial and not well investigated. In regard to this aspect the relevance of triple antithrombotic therapy (TAT) is questioned. There is an ongoing debate on the clinical implications of TAT and furthermore assumed that bleeding complications, except impact on outcome, also are associated with great influence on health economy.

    The main focus of this thesis was to further investigate the incidence and impact of bleeding complications in patients treated for ACS, with special reference to gender disparities, TAT and health economics. The thesis will highlight the importance of improved bleeding prevention strategies for both men and women.

    METHOD

    Paper I, II and III

    Observational studies from the SWEDEHEART register.

    In paper I we investigated patients hospitalised with myocardial infarction (MI) during 2006–2008. Outcomes were in-hospital bleedings, in-hospital mortality and one-year mortality in hospital survivors.

    In paper II, all patients with MI, in the County of Östergötland, Sweden during 2010 were included and followed for one year. The patients' medical records were evaluated, in relation to short and long-term bleeding complications, bleeding location, withdrawal of platelet inhibiting drugs and nonfatal MI and death.

    Paper III included all patients discharged with (TAT) in the County of Östergötland 2009-2015. Information about bleeds and ischemic complications during one-year follow-up were retrieved from the medical records. Estimation of the health care costs associated with bleeding episodes were added to the evaluation.

    Paper IV

    Patients with MI, scheduled for coronary angiography were recruited. All patients received clopidogrel and aspirin. A subgroup of patients received GP IIb/IIIa-inhibitor. Outcomes were platelet aggregation assessed at several time points, using a Multiplate impedance aggregometer, measurement of P-selectin in plasma, evaluation of high residual platelet reactivity (HRPR) and low residual platelet reactivity (LRPR) respectively and incidence of bleeding complications. A comparison between women and men was performed.

    RESULTS

    Paper I

    A total number of 50.399 patients were included, 36.6% women. In-hospital bleedings were more common in women (1.9% vs. 3.1%, p<0.001) even after multivariable adjustment (OR 1.17, 95%, CI 1.01–1.37). The increased risk for women was found in STEMI (OR 1.46, 95% CI 1.10–1.94) and in those who underwent PCI (OR 1.80, 95% CI 1.45–2.24).

    In contrast the risk was lower in medically treated women (OR 0.79, 95% CI 0.62–1.00). After adjustment, in-hospital bleeding was associated with higher risk of oneyear mortality in men (OR 1.35, 95% CI 1.04–1.74), whereas this was not the case in women (OR 0.97, 95% CI 0.72–1.31).

    Paper II

    In total 850 consecutive patients were included. The total incidence of bleeding events was 24.4% (81 women and 126 men, p=ns). The incidence of all in hospital bleeding events was 13.2%, with no gender difference. Women had significantly more minor nonsurgery related bleeding events than men (5% vs 2.2%, p=0.02). During follow-up, 13.5% had a bleeding, with more non-surgery related bleeding events among women, 14.7% vs 9.7% (p=0.03). The most common bleeding localisation was the gastrointestinal tract, more in women than men (12.1% vs 7.6%, p=0.03). Women also had more access site bleeding complications (4% vs 1.7%, p=0.04), while men had more surgery related bleeding complications (6.4% vs 0.9%, p≤0.001). Increased mortality was found only in men with non-surgery related bleeding events (p=0.008).

    Paper III

    Among 272 identified patients, 156 bleeds occurred post-discharge, of which 28.8% were of gastrointestinal origin. In total 54.4% had at least one bleed during or after the index event and 40.1% bled post-discharge of whom 28.7% experienced a TIMI major or minor bleeding. Women discontinued TAT prematurely more often than men (52.9 vs 36.1%, p=0.01) and bled more (48.6 vs. 37.1%, p=0.09). One-year mean health care costs were EUR 575 and EUR 5787 in non-bleeding and bleeding patients, respectively.

    Paper IV

    We recruited 125 patients (37 women and 88 men). We observed significantly more inhospital bleeding events in women as compared to men (18.9% vs 6.8%, p=0.04). There were no differences in platelet aggregation using three different agonists, reflecting treatment of GPIIb/IIIa inhibitors, clopidogrel and aspirin, at four different time-points nor were there any differences in p-selectin in plasma 3 days after admission.

    CONCLUSION

    There is a remarkably high bleeding incidence among patients treated with DAPT and even more so if treated with TAT. Female gender is an independent risk factor of inhospital bleeding after myocardial infarction, this higher bleeding risk in women appears to be restricted to invasively treated patients and STEMI patients. Even if women had higher short- and long-term mortality, there was no difference between the genders among those who bled. After multivariable adjustment the prognostic impact of bleeding complications was higher in men

    Women seem to experience more minor/minimal bleeding complications than men, predominantly GI bleeding events and access site bleeding events, with no apparent impact on outcome.

    In contrast men with non-surgery related bleeding complications had higher mortality. There is a lack of differences between the genders concerning platelet aggregation. Our results do not support gender disparities in platelet reactivity and excess dosing as a major explanation for increased bleeding risk in women. Improved bleeding prevention strategies are warranted for both men and women.

    List of papers
    1. Gender difference in prognostic impact of in-hospital bleeding after myocardial infarction - data from the SWEDEHEART registry.
    Open this publication in new window or tab >>Gender difference in prognostic impact of in-hospital bleeding after myocardial infarction - data from the SWEDEHEART registry.
    2016 (English)In: European heart journal. Acute cardiovascular care, ISSN 2048-8734, Vol. 6, p. 463-472Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Bleeding complications increase mortality in myocardial infarction patients. Potential gender difference in bleeding regarding prevalence and prognostic impact is still controversial.

    OBJECTIVES: Gender comparison regarding incidence and prognostic impact of bleeding in patients hospitalised with myocardial infarction during 2006-2008.

    METHODS: Observational study from the SWEDEHEART register. Outcomes were in-hospital bleedings, in-hospital mortality and one-year mortality in hospital survivors.

    RESULTS: A total number of 50,399 myocardial infarction patients were included, 36.6% women. In-hospital bleedings were more common in women (1.9% vs. 3.1%, p<0.001) even after multivariable adjustment (odds ratio (OR) 1.17, 95% confidence interval (CI) 1.01-1.37). The increased risk for women was found in ST-elevation myocardial infarction (OR 1.46, 95% CI 1.10-1.94) and in those who underwent percutaneous coronary intervention (OR 1.80, 95% CI 1.45-2.24). In contrast the risk was lower in medically treated women (OR 0.79, 95% CI 0.62-1.00). After adjustment, in-hospital bleeding was associated with higher risk of one-year mortality in men (OR 1.35, 95% CI 1.04-1.74), whereas this was not the case in women (OR 0.97, 95% CI 0.72-1.31).

    CONCLUSIONS: Female gender is an independent risk factor of in-hospital bleeding after myocardial infarction. A higher bleeding risk in women appeared to be restricted to invasively treated patients and ST-elevation myocardial infarction patients. Even though women have higher short- and long-term mortality, there was no difference between the genders among bleeders. After multivariable adjustment the prognostic impact of bleeding complications was higher in men.

    Place, publisher, year, edition, pages
    Sage Publications, 2016
    Keywords
    Myocardial infarction; bleeding; gender; prognosis
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:liu:diva-124287 (URN)10.1177/2048872615610884 (DOI)000385817800008 ()26450782 (PubMedID)
    Available from: 2016-01-25 Created: 2016-01-25 Last updated: 2019-01-10
    2. Bleeding complications after myocardial infarction in a real world population - An observational retrospective study with a sex perspective
    Open this publication in new window or tab >>Bleeding complications after myocardial infarction in a real world population - An observational retrospective study with a sex perspective
    Show others...
    2018 (English)In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 167, p. 156-163Article in journal (Refereed) Published
    Abstract [en]

    Introduction: The aim of the current study was to assess bleeding events, including severity, localisation and prognostic impact, in a real world population of men and women with myocardial infarction (MI). Methods and results: In total 850 consecutive patients were included during 2010 and followed for one year. Bleeding complications were identified by searching of each patients medical records and characterised according to the TIMI criteria. For this analysis, only the first event was calculated. The total incidence of bleeding events was 24.4% (81 women and 126 men, p=ns). The incidence of all inhospital bleeding events was 13.2%, with no sex difference. Women had significantly more minor non-surgery related bleeding events than men (5% vs 2.2%, p=0.02). During follow-up, 13.5% had a bleeding, with more non-surgery related bleeding events among women, 14.7% vs 9.7% (p=0.03). The most common bleeding localisation was the gastrointestinal tract, more in women than men (12.1% vs 7.6%, p=0.03). Women had also more access site bleeding complications (4% vs 1.7%, p=0.04), while men had more surgery related bleeding complications (6.4% vs 0.9%, p=0.001). Increased mortality was found only in men with non-surgery related bleeding events (p=0.008). Conclusions: Almost one in four patients experienced a bleeding complication through 12 months follow-up after a myocardial infarction. Women experienced more non-surgery related minor/minimal bleeding complications than men, predominantly GI bleeding events and access site bleeding events, with no apparent impact on outcome. In contrast men with non-surgery related bleeding complications had higher mortality. Improved bleeding prevention strategies are warranted for both men and women.

    Place, publisher, year, edition, pages
    PERGAMON-ELSEVIER SCIENCE LTD, 2018
    Keywords
    Myocardial infarction; Bleeding; Sex; Mortality
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:liu:diva-149865 (URN)10.1016/j.thromres.2018.05.023 (DOI)000437845800027 ()29857272 (PubMedID)
    Note

    Funding Agencies|Ostergotland County Council [LIO610841]

    Available from: 2018-08-02 Created: 2018-08-02 Last updated: 2019-04-12
  • 148.
    Hua, Håkan
    et al.
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Lyxell, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Ny metod för att analysera bullerpåverkan2012In: Buller i arbetslivet, Stockholm: afa Försäkring , 2012, p. 27-29Chapter in book (Other (popular science, discussion, etc.))
    Abstract [sv]

    Hur ser samspelet ut mellan en individs hörförmåga, typ av arbetsuppgift, arbetsrelaterade ljudmiljöoch kognitiva förmåga? Det ville Linköpingsforskarna Björn Lyxell och Håkan Hua ta redapå i sin studie. Med sin breda approach utvecklade de en helt ny metod för att analysera kopplingenmellan arbete och buller.

  • 149.
    Husberg, Magnus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Hallert, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Non-medical costs during the first year after diagnosis in two cohorts of patients with early rheumatoid arthritis, enrolled 10 years apart2017In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 36, no 3, p. 499-506Article in journal (Refereed)