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  • 1.
    Kallstrom, Ann-Christine
    et al.
    Helsingborg Hospital.
    Salme, Rebecka
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Ryden, Lisa
    Lund University.
    Nordenskjöld, Bo
    Linköping University, Department of Clinical and Experimental Medicine, Oncology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Jonsson, Per-Ebbe
    Helsingborg Hospital.
    Stål, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Oncology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    17 beta-Hydroxysteroid dehydrogenase type 1 as predictor of tamoxifen response in premenopausal breast cancer2010In: EUROPEAN JOURNAL OF CANCER, ISSN 0959-8049, Vol. 46, no 5, 892-900 p.Article in journal (Refereed)
    Abstract [en]

    17 beta-Hydroxysteroid dehydrogenases (17HSDs) are involved in the local regulation of sex steroids. 17HSD1 converts oestrone (El) to the more potent oestradiol (E2) and 17HSD2 catalyses the reverse reaction. The aim of this study was to investigate the expression of these enzymes in premenopausal breast cancers and to analyse if they have any prognostic or tamoxifen predictive value. Premenopausal patients with invasive breast cancer, stage II (UICC), were randomised to either 2 years of adjuvant tamoxifen (n = 276) or no tamoxifen (n = 288). The median follow-up was 13.9 years (range 10.5-17.5). The expression of 17HSD1 and 17HSD2 was analysed with immunohistochemistry using tissue microarrays. The enzyme expression level (-/+/++/+++) was successfully determined in 396 and 373 tumours, respectively. Women with hormone-receptor positive tumours, with low levels (-/+/++) of 17HSD1, had a 43% reduced risk of recurrence, when treated with tamoxifen (Hazard Ratio (HR) = 0.57; 95% confidence interval (CI), 0.37-0.86; p = 0.0086). On the other hand high expression (+++) of 17HSD1 was associated with no significant difference between the two treatment arms (HR = 0.91; 95% CI, 0.43-1.95; p = 0.82). The interaction between 17HSD1 and tamoxifen was significant during the first 5 years of follow-up (p = 0.023). In the cohort of systemically untreated patients no prognostic importance was observed for 17HSD1. We found no predictive or prognostic value for 17HSD2. This is the first report of 17HSD1 in a cohort of premenopausal women with breast cancer randomised to tamoxifen. Our data suggest that 17HSD1 might be a predictive factor in this group of patients.

  • 2.
    Jansson , Agneta
    Linköping University, Department of Clinical and Experimental Medicine, Oncology . Linköping University, Faculty of Health Sciences.
    17Beta-hydroxysteroid dehydrogenase enzymes and breast cancer2009In: JOURNAL OF STEROID BIOCHEMISTRY AND MOLECULAR BIOLOGY, ISSN 0960-0760 , Vol. 114, no 1-2, 64-67 p.Article in journal (Refereed)
    Abstract [en]

    Sex steroids play an important role in the development and differentiation in several tissues. Biologically active hormones that are locally converted in endocrine organs in the tissue where they exert their effects without release into extracellular space is a field of endocrinology that has been called intracrinology. In pre-menopausal women the ovary is the main source of estrogens, but in post-menopausal women the estrogen production as main site of synthesis moves to peripheral tissues and almost all of the sex steroids are synthesised from precursors of adrenal origin. In breast cancer 60-80% of the tumors express high levels of oestrogen receptor (ER) alpha which gives estrogen a proliferative effect. Breast tumors tend to have a higher intratumoral estrogen concentration than normal breast tissue and plasma, and in situ synthesis and the metabolism of estrogens is believed to be of great importance for the development and progression of the disease. The activity of estrogen metabolizing enzymes in breast are mainly aromatase, estrone sulfatases and 17HSD enzymes. 17HSD1 and 17HSD2 are the family members known to be of main importance in breast cancer. High expression of 17HSD1 has been associated to poor prognosis in breast cancer and late relapse among patients with ER-positive tumors. One of the mechanisms behind high 17HSD1 expression is gene amplification. Low or absent expression of 17HSD2 is associated to decreased survival in ER-positive breast cancer. 17HSD14 is one of the latest discovered 17HSD enzymes, transfection of 17HSD14 in human breast cancer cells significantly decreased the levels of estradiol in the culture medium. Low expression of 17HSD14 mRNA expression in breast cancer was correlated to decreased survival.

    The understanding of intratumoral synthesis of sex steroids in breast cancer is crucial to understand the disease both in pre- and post-menopausal women. Further studies are desirable to state the direct role of these enzymes in breast cancer and which patients that may benefit from new therapeutic strategies targeting 17HSD enzymes. The new inhibitors targeting 17HSD1 have shown promising results in preclinical studies to have clinical potential in the future.

  • 3.
    Sivik, Tove
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences.
    Gunnarsson, Cecilia
    Linköping University, Department of Clinical and Experimental Medicine, Medical Genetics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Pathology and Clinical Genetics.
    Fornander, Tommy
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
    Nordenskjöld, Bo
    Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Skoog, Lambert
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
    Stål, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Jansson, Agneta
    Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences.
    17β-hydroxysteroid dehydrogenase type 14 is a predictive marker for tamoxifen response in oestrogen receptor positive breast cancer2012In: PLoS ONE, ISSN 1932-6203, Vol. 7, no 7, e40568- p.Article in journal (Refereed)
    Abstract [en]

    Introduction: 17β-hydroxysteroid dehydrogenases (17βHSDs) are important enzymes regulating the pool of bioactive steroids in the breast. The current study was undertaken in order to evaluate implications of 17βHSD14 in breast cancer, measuring 17βHSD14 protein expression in breast tumours.

    Methods: An antibody targeting the 17βHSD14 antigen was generated and validated using HSD17B14-transfected cells and a peptide-neutralising assay. Tissue microarrays with tumours from 912 post-menopausal women diagnosed with lymph node-negative breast cancer, and randomised to adjuvant tamoxifen or no endocrine treatment, were analysed for 17βHSD14 protein expression with immunohistochemistry.

    Results: Results were obtained from 847 tumours. Patients with oestrogen positive tumours with high 17βHSD14 expression had fewer local recurrences when treated with tamoxifen (HR 0.38; 95% C.I. 0.19–0.77, p = 0.007) compared to patients with lower tumoural 17βHSD14 expression, for whom tamoxifen did not reduce the number of local recurrences (HR 1.19; 95% C.I. 0.54–2.59; p = 0.66). No prognostic importance of 17βHSD14 was seen for systemically untreated patients.

    Conclusions: Using a highly specific validated antibody for immunohistochemical analysis of a large number of breast tumours, we have shown that tumoural expression levels of 17βHSD14 can predict the outcome of adjuvant tamoxifen treatment in terms of local recurrence-free survival in patients with lymph node-negative ER+ breast cancer. The results need be verified to confirm any clinical relevance.

  • 4.
    Horner, Patrick J
    et al.
    School of Social and Community Medicine, University of Bristol, UK.
    Karla, Blee
    Bristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, UK.
    Falk, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    van der Meijden, W
    Department of Dermatology, New Cross Hospital, UK..
    Moi, H.
    Olafia Clinic, Oslo University Hospital, Institute of Medicine, University of Oslo, Norway.
    2016 European Guideline on the management of non-gonococcal urethritis2016In: International Journal of STD and AIDS (London), ISSN 0956-4624, E-ISSN 1758-1052, Vol. 27, no 11, 928-937 p.Article in journal (Refereed)
    Abstract [en]

    We present the updated International Union against Sexually Transmitted Infections guideline for the management of non-gonococcal urethritis in men. This guideline recommends confirmation of urethritis in symptomatic men before starting treatment. It does not recommend testing asymptomatic men for the presence of urethritis. All men with urethritis should be tested for Chlamydia trachomatis and Neisseria gonorrhoeae and ideally M. genitalium using a NAAT as this is highly likely to improve clinical outcomes. If a NAAT is positive for gonorrhoea, a culture should be performed before treatment. In view of the increasing evidence that azithromycin 1 g may result in the development of antimicrobial resistance in Mycoplasma genitalium azithromycin 1 g is no longer recommended as first line therapy, which should be doxycycline 100 mg bd for 7 days. If azithromycin is to be prescribed an extended of 500 mg, then 250 mg daily for 4 days is to be preferred over 1 g stat. In men with persistent NGU, M. genitalium NAAT testing is recommended if not previously undertaken, as is Trichomonas vaginalis NAAT testing in populations where T. vaginalis is detectable in >2% of symptomatic women.

  • 5.
    Johansson, Ann-Katrin
    et al.
    University of Bergen.
    Johansson, Anders
    University of Bergen.
    Unell, Lennart
    Örebro Cty Council.
    Ekback, Gunnar
    Örebro Cty Council.
    Ordell, Sven
    Carlsson , Gunnar E
    University of Gothenburg.
    A 15-yr longitudinal study of xerostomia in a Swedish population of 50-yr-old subjects2009In: EUROPEAN JOURNAL OF ORAL SCIENCES, ISSN 0909-8836 , Vol. 117, no 1, 13-19 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to determine the changes in prevalence of xerostomia in subjects from 50 to 65 yr of age. Questionnaires were sent to all subjects who were born in 1942 and were living in two Swedish counties in 1992, 1997, 2002, and 2007. The analyses focused on those who answered the questionnaires both in 1992 and in 2007. The response rate was 71.4% (n = 6,346) in 1992 and 73.1% (n = 6,078) in 2007. Of those who answered the questionnaire in 1992, 74.3% (n = 4,714) also responded in 2007. There was an almost linear increase in the prevalence of xerostomia at the four study time-points (i.e. when the subjects were 50, 55, 60, and 65 yr of age). Xerostomia was more prevalent at night than during the day. The pooled prevalence of night-time and daytime xerostomia was 6% at 50 yr of age and 15% at 65 yr of age, and it was higher in women than in men on both occasions. Logistic regression analyses showed that impaired health and smoking were significantly associated with daytime xerostomia but not with night-time xerostomia. Despite the increase in prevalence of xerostomia from 50 to 65 yr of age, there was considerable variation during the observation period. The incidence rate was 13% (507/4,015) and the disappearance rate was 42% (104/250) (dichotomized answers).

  • 6.
    Olsson, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, EMK-endokrin.
    Eriksson, M
    Johnson, O
    Kjellström, T
    Lanke, J
    Lytken Larsen, M
    Pedersen, T
    Tikkanen, MJ
    Wiklund, O
    A 52-week, multicenter, randomized, parallel-group, double-blind, double-dummy study to assess the efficacy of atorvastatin and simvastatin in reaching low-density lipoprotein cholesterol and triglyceride targets: The Treat-to-Target (3T) Study2003In: Clinical Therapeutics, ISSN 0149-2918, Vol. 25, no 1, 119-138 p.Article in journal (Refereed)
    Abstract [en]

    Background: Guidelines for the prevention of coronary heart disease call for low-density lipoprotein cholesterol (LDL-C) reduction as the primary target of treatment and reduction of triglycerides (TG) as an additional target. Objective: The purpose of this study was to investigate the ability of atorvastatin and simvastatin to reduce LDL-C and TG concentrations and to meet 3 target lipid levels: LDL-C =2.6 mmol/L, TG =1.5 mmol/L, and both LDL-C =2.6 mmol/L and TG =1.5 mmol/L. Methods: The Treat-to-Target (3T) Study was a 52-week, multicenter, randomized, parallel-group study. Using the double-blind, double-dummy technique, adult patients aged 35 to 75 years with cardiovascular disease and dyslipidemia, defined as LDL-C concentration =4.0 mmol/L (=155 mg/dL), were randomized in a 1:1 ratio to receive once-daily oral treatment with 20 mg atorvastatin or 20 mg simvastatin. Fasting (12-hour) blood samples for the estimation of lipid levels and clinical laboratory values were collected after 4, 8, 12, 26, and 52 weeks. The dose was doubled after 12 weeks if the target National Cholesterol Education Program level of LDL-C (=2.6 mmol/L [100 mg/dL]) was not reached at 8 weeks. Results: The intent-to-treat analysis included 552 patients (418 men, 134 women) randomized to receive atorvastatin and 535 (404 men, 131 women) randomized to receive simvastatin. The number of patients enrolled in the study allowed the evaluation of the drugs' effects on YG. Patient demographic characteristics were similar for the 2 treatment groups, and there were no differences in baseline lipid values. Compared with simvastatin, atorvastatin produced significantly greater reductions in LDL-C (8 weeks: -46% vs -40%, P < 0.001, 52 weeks: -49% vs -44%, P < 0.001) and in YG (8 weeks: -23% vs -14%, P < 0.001, 52 weeks: -24% vs -16%, P < 0.001). Compared with simvastatin-treated patients, a significantly greater number of atorvastatin-treated patients reached the LDL-C target after 8 weeks (45% vs 24%, P < 0.001). Fewer atorvastatin patients needed to have their dose doubled, nevertheless more atorvastatin patients reached the LDL-C target after 52 weeks (61% vs 41%, P < 0.001). Both statins were well tolerated. Muscular symptoms occurred in 12 patients (2.2%) in the atorvastatin group and in 13 patients (2.4%) in the simvastatin group. Conclusions: Atorvastatin 20 or 40 mg/d for up to 1 year of treatment was significantly more effective than simvastatin 20 or 40 mg/d m reducing LDL-C and YG levels and at achieving recommended lipid targets in this selected patient population with cardiovascular disease and dyslipidemia. Both statins were well tolerated.

  • 7.
    Waller, Niels
    et al.
    Department of Psychology, University of Minnesota, N657 Elliott Hall, 75 East River Road, Minneapolis, MN, 55455, USA.
    John, Mike T.
    Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.
    Feuerstahler, Leah
    Department of Psychology, University of Minnesota, N657 Elliott Hall, 75 East River Road, Minneapolis, MN, 55455, USA.
    Baba, Kazuyoshi
    Department of Prosthodontics, Showa University, Tokyo, Japan.
    Larsson, Pernilla
    Region Östergötland, Public Dental Health Care.
    Peršić, Sanja
    Department of Prosthodontics, School of Dentistry, University of Zagreb, Zagreb, Croatia.
    Kende, Dóra
    Department of Prosthodontics, University of Pécs, Pécs, Hungary.
    Reißmann, Daniel R.
    Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany..
    Rener-Sitar, Ksenija
    Department of Prosthodontics, Dental Division, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Department of Prosthodontics, University Dental Clinics, University Medical Center of Ljubljan, Ljubljan, Slovenia.
    A 7-day recall period for a clinical application of the oral health impact profile questionnaire.2016In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 20, no 1, 91-99 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Aims were to investigate and compare the validity and reliability of Oral Health Impact Profile (OHIP) scores referencing 7-day and 1-month recall periods in international prosthodontic patients.

    MATERIAL AND METHODS: A sample of 267 patients (mean age = 54.0 years, SD = 17.2 years, 58 % women) with stable oral health-related quality of life was recruited from prosthodontic treatment centers in Croatia, Germany, Hungary, Japan, Slovenia, and Sweden. These patients completed the OHIP on two occasions using a new 7-day recall period and the traditional 1-month recall period. OHIP score validity and reliability were investigated with structural equation models (SEMs) that included OHIP(past 7 days) and OHIP(1 month) latent factors and single indicator measures of global oral health status. The SEMs assessed measurement invariance and the relative validities of the two OHIP latent factors (representing the two recall periods).

    RESULTS: The SEMs provided cogent evidence for recall period measurement invariance for the two OHIP forms and equal validities (r = .48) with external measures of global oral health status.

    CONCLUSION: When assessed in international prosthodontic patients, OHIP scores using the new 7-day recall period were as reliable and valid as the scores using the 1-month recall period.

    CLINICAL RELEVANCE: Conceptual advantages make a 7-day recall period a preferred frame of reference in clinical applications of the OHIP questionnaire.

  • 8.
    Agnafors, Sara
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Västra Götalandsregionen, Södra Älvsborgs Sjukhus, Barn- och ungdomspsykiatriska kliniken.
    A Biopsychosocial and Long Term Perspective on Child Behavioral Problems: Impact of Risk and Resilience2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Mental health has become a prominent issue in society. Yet, much remains unknown about the etiology of psychiatric disorders. The aim of the present thesis was to investigate the association between biological, psychological and social factors of risk and resilience and behavioral problems in a birth cohort of Swedish children. 1723 mothers and their children were followed from birth to the age of 12 as part of the South East Sweden Birth Cohort Study (the SESBiC study). Information was gathered through register data, standardized questionnaires and DNA samples.

    In study I, stability of maternal symptoms of depression and the impact on child behavior at age 12 were investigated. The prevalence of depressive symptoms was found to be 12.0 % postpartum. Symptoms of postpartum depression significantly increased the risk for subsequent depressive symptoms 12 years later in women. Children whose mothers reported concurrent symptoms of depression and anxiety had an increased risk for both internalizing and externalizing problems at age 12, but no long term effect on child behavior was seen for postpartum depressive symptoms. The greatest risk was seen for children whose mothers reported symptoms of depression on both occasions. In study II, the impact of gene-environment interaction of 5-HTTLPR and BDNF Val66Met and experience of life events together with symptoms of maternal depression and anxiety on child behavior at age 12 was studied. A main effect of 5-HTTLPR was noticed, but no geneenvironment effects were shown. Similarly to study I, concurrent symptoms of maternal depression and anxiety were an important predictor of child behavioral problems. A high degree of psychosocial stress around childbirth was found to have long lasting detrimental effects on child behavior, increasing the risk for internalizing problems at age 12. Study III investigated the impact of geneenvironment interactions of 5-HTTLPR and BDNF Val66Met and life events together with symptoms of maternal depression and birth characteristics on behavioral problems at age 3. Symptoms of postpartum depression were found to predict internalizing as well as externalizing problems in children three years later. Child experience of life events was a stable predictor of behavioral problems across the scales similar to sociodemographic factors such as parental immigration status and unemployment. No gene-environment interaction effects of 5-HTTLPR or BDNF Val66Met were shown. Study IV used the risk factors identified in studies I-III to investigate factors of resilience to behavioral problems at age 12. The l/l genotype of 5-HTTLPR was associated with a lower risk for behavioral problems at age 12, especially for children facing low adversity. Good social functioning was found to be a general resource factor, independent of the level of risk, while an easy temperament was associated with resilience for children with a high degree of adversity. However, effect sizes were small.

    In summary, the results from the present thesis emphasize the importance of maternal mental health and sociodemographic factors for child mental health at ages 3 and 12, which must be taken into account in clinical settings. Moreover, it adds to the null-findings of the gene-environment effect of 5-HTTLPR and BDNF Val66Met on behavioral problems in children, but indicates a main effect of 5-HTTLPR on internalizing symptoms at age 12.

    List of papers
    1. Symptoms of Depression Postpartum and 12 years Later-Associations to Child Mental Health at 12 years of Age
    Open this publication in new window or tab >>Symptoms of Depression Postpartum and 12 years Later-Associations to Child Mental Health at 12 years of Age
    2013 (English)In: Maternal and Child Health Journal, ISSN 1092-7875, E-ISSN 1573-6628, Vol. 17, no 3, 405-414 p.Article in journal (Refereed) Published
    Abstract [en]

    Children of depressed mothers have been shown to express behaviour problems to a greater extent than children of non-depressed mothers. The purpose of this study was to examine the persistence of depressive symptoms in mothers and to evaluate the relative importance of symptoms of postpartum depression (PPD) and concurrent maternal symptoms of depression, on child behaviour at age 12. A birth cohort of 1,707 children and their mothers was followed from 3 months after birth to 12 years after birth. Self-reported symptoms of depression in mothers were assessed at baseline and 12-year follow-up where 893 mothers (52.3 %) and their children participated. The mothers reports on the behaviour of their children at age 12 were used. Multivariate analysis was used to assess factors that increased the risk of child behaviour problems. At baseline, 10.4 % scored above the cutoff for symptoms of postpartum depression. At follow up, 18.2 % scored above the cutoff for depressive symptoms. Multivariate analysis showed that ongoing maternal symptoms of depression, as distinct from PPD-symptoms, was the strongest predictor of child behaviour problems at age 12. The gender of the child and socio-demographic factors at baseline were additional factors that affected the risk of behaviour problems in the 12 year old children. Children of mothers who reported symptoms of depression, both postpartum and at follow-up, were at a greater risk of behaviour problems compared to children of women with no depressive symptoms on either occasion. Our findings indicate that recurrent and ongoing maternal depressive symptoms significantly increase the risk of child behaviour problems as reported by mothers, while symptoms of PPD do not seem to result in an increased risk of behaviour problems in 12 year olds. High maternal socio-demographic life stress at childbirth constitutes an important risk factor for later child behaviour problems.

    Place, publisher, year, edition, pages
    Springer Verlag (Germany), 2013
    Keyword
    CBCL, Children, Mental health, Postpartum depression, SESBiC-study
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-90750 (URN)10.1007/s10995-012-0985-z (DOI)000316021200003 ()
    Available from: 2013-04-05 Created: 2013-04-05 Last updated: 2016-01-22
    2. Effect of gene, environment and maternal depressive symptoms on pre-adolescence behavior problems - a longitudinal study.
    Open this publication in new window or tab >>Effect of gene, environment and maternal depressive symptoms on pre-adolescence behavior problems - a longitudinal study.
    Show others...
    2013 (English)In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 7, no 1, 10- p.Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Depression is a common and disabling condition with a high relapse frequency. Maternal mental health problems and experience of traumatic life events are known to increase the risk of behavior problems in children. Recently, genetic factors, in particular gene-by-environment interaction models, have been implicated to explain depressive etiology. However, results are inconclusive.

    METHODS: Study participants were members of the SESBiC-study. A total of 889 mothers and their children were followed during the child's age of 3 months to 12 years. Information on maternal depressive symptoms was gathered postpartum and at a 12 year follow-up. Mothers reported on child behavior and traumatic life events experienced by the child at age 12. Saliva samples were obtained from children for analysis of 5-HTTLPR and BDNF Val66Met polymorphisms.

    RESULTS: Multivariate analysis showed a significant association between maternal symptoms of depression and anxiety, and internalizing problems in 12-year-old children (OR 5.72, 95% CI 3.30-9.91). Furthermore, carriers of two short alleles (s/s) of the 5-HTTLPR showed a more than 4-fold increased risk of internalizing problems at age 12 compared to l/l carriers (OR 4.73, 95% CI 2.14-10.48). No gene-by-environment interaction was found and neither depressive symptoms postpartum or traumatic experiences during childhood stayed significant in the final model.

    CONCLUSIONS: Concurrent maternal symptoms of depression and anxiety are significant risk factors for behavior problems in children, which need to be taken into account in clinical practice. Furthermore, we found a main effect of 5-HTTLPR on internalizing symptoms in 12-year-old children, a finding that needs to be confirmed in future studies.

    Place, publisher, year, edition, pages
    BioMed Central, 2013
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:liu:diva-104869 (URN)10.1186/1753-2000-7-10 (DOI)23518193 (PubMedID)
    Available from: 2014-02-28 Created: 2014-02-28 Last updated: 2016-01-22Bibliographically approved
    3. Early predictors of behavioural problems in pre-schoolers: a longitudinal study of constitutional and environmental main and interaction effects
    Open this publication in new window or tab >>Early predictors of behavioural problems in pre-schoolers: a longitudinal study of constitutional and environmental main and interaction effects
    Show others...
    2016 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 16Article in journal (Refereed) Published
    Abstract [en]

    Background: The early environment is important for child development and wellbeing. Gene-by-environment studies investigating the impact of the serotonin transporter genelinked polymorphic region (5-HTTLPR) and the Brain Derived Neurotrophic Factor (BDNF) Val66Met polymorphisms by life events on mental health and behaviour problems have been inconclusive. Methodological differences regarding sample sizes, study population, definitions of adversities and measures of mental health problems obstacle their comparability. Furthermore, very few studies included children. The aim of this study was to examine the associations between a broad range of risk factors covering pregnancy and birth, genetic polymorphism, experience of multiple life events and psychosocial environment, and child behaviour at age three, using a comparably large, representative, population-based sample.

    Methods: A total of 1,106 children, and their mothers, were followed from pregnancy to age three. Information on pregnancy and birth-related factors was retrieved from the Medical Birth Register. Questionnaires on depressive symptoms, child behaviour and child experiences of life events were filled in by the mothers. Child saliva samples were used for genotyping the 5-HTTLPR and BDNF Val66Met polymorphisms. Multiple logistic regression was used to investigate the association between psychological scales and genetic polymorphisms.

    Results: Symptoms of postpartum depression increased the risk of both internalizing and externalizing problems. Experience of multiple life events was also a predictor of behavioural problems across the scales. No gene-by-environment or gene-bygene-by-environment interactions were found. Children of immigrants had an increased risk of internalizing problems and parental unemployment was significantly associated with both internalizing and externalizing type of problems.

    Conclusion: This study shows the importance of the psychosocial environment for psychosocial health in preschool children, and adds to  the literature of null-findings of gene-by-environment effects of 5-HTTLPR and BDNF in children

    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:liu:diva-124207 (URN)10.1186/s12887-016-0614-x (DOI)000377535800002 ()
    Note

    Funding agencies:Funding was obtained from the Swedish Council for Working Life and Social Research (FAS), the Swedish Research Council (VR), the Clas Groschinsky Memorial Foundation, Stockholm, Samariten Foundation, Stockholm, the Hallsten Research Foundation and ALF, County Council of Ostergotland.

    Vid tiden för publicering förelåg publikationen endast som manuskript

    Available from: 2016-01-22 Created: 2016-01-22 Last updated: 2016-07-06Bibliographically approved
    4. A biopsychosocial approach to risk and resilience on behavior in children followed from birth to age twelve
    Open this publication in new window or tab >>A biopsychosocial approach to risk and resilience on behavior in children followed from birth to age twelve
    Show others...
    2016 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    An increasing prevalence of mental health problems calls for more knowledge into factors associated with resilience in the context of child behavior. Biological factors are seldom considered in psychosocial models of resilience. The present study used multiple statistical methodologies to examine a biopsychosocial model of risk and resilience on behavior at preadolescence. Data from 889 children and their mothers were used. A cumulative adversity score was created by combining maternal symptoms of depression, psychosocial risk and children’s experiences of life events. The proposed resilience factors investigated were candidate genetic polymorphisms, child temperament and social functioning, and maternal sense of coherence. Results show that the l/l genotype of the serotonin transporter linked polymorphic region (5-HTTLPR) was associated with lower internalizing scores, especially for children exposed to low adversity. An easy temperament was associated with resilient outcomes for children exposed to high adversity. Child social functioning was found to be more of a general resource variable buffering risk in both high and low adversity groups. The results support a multiple level model of resilience indicating effects, though small, of both biological and psychosocial factors. The present findings call for both preventive actions and further studies on biopsychosocial models in resilience research.

    Keyword
    Child, genotype, longitudinal, mental health, resilience
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:liu:diva-124208 (URN)
    Available from: 2016-01-22 Created: 2016-01-22 Last updated: 2016-01-22Bibliographically approved
  • 9.
    Agnafors, Sara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Oreland, Lars
    Uppsala University, Sweden.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Comasco, Erika
    Uppsala University, Sweden.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    A Biopsychosocial Approach to Risk and Resilience on Behavior in Children Followed from Birth to Age 122017In: Child Psychiatry and Human Development, ISSN 0009-398X, E-ISSN 1573-3327, Vol. 48, no 4, 584-596 p.Article in journal (Refereed)
    Abstract [en]

    An increasing prevalence of mental health problems calls for more knowledge into factors associated with resilience. The present study used multiple statistical methodologies to examine a biopsychosocial model of risk and resilience on preadolescence behavior. Data from 889 children and mothers from a birth cohort were used. An adversity score was created by combining maternal symptoms of depression, psychosocial risk and childrens experiences of life events. The proposed resilience factors investigated were candidate genetic polymorphisms, child temperament, social functioning, and maternal sense of coherence. The l/ l genotype of the serotonin transporter linked polymorphic region was associated with lower internalizing scores, but not mainly related to the level of adversity. An easy temperament was associated with resilience for children exposed to high adversity. Social functioning was found to be promotive independent of the risk level. The results support a multiple-level model of resilience indicating effects, though small, of both biological and psychosocial factors.

  • 10.
    Knutsson, Lena
    Linköping University, Department of Culture and Communication. Linköping University, Faculty of Arts and Sciences.
    A Blueprint for Women’s Fulfilment: A Reading of Three Novels in the Early Fiction of Margaret Drabble2008Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    This essay will argue that Margaret Drabble has developed a pattern, that there is a blueprint for fulfilment in the life of the modern independent woman to be found inher early work. Three of Drabble's novels will be examined, moving from The Millstone(1965) and The Waterfall (1967), with their descriptions of two young heroines'pregnancies and lives with infant children, on to the more mature main character of TheRealms of Gold (1975). These three books form a chronology, both in regard to whenthey were written and, more importantly, to the different stages of a woman’s life thatthey represent. This will make it possible to see how Drabble perceives the demands ofsociety and different relationships influencing a woman's actions, her search foridentity, and the direction and fulfilment of her life. The pattern will be traced throughthree themes which are made visible in the novels in varying degrees. These are singlemotherhood and the role of the family, missing husbands and sexual fulfilment, andcareer and social interaction.The method is an analysis of the texts where the selected novels form the basis andstructure of the essay.

  • 11.
    Bengts, Elin
    Linköping University, Department of Thematic Studies, The Department of Gender Studies.
    A case study of post-earthquake consequences for women within marginalized groups in Nepal: A qualitative case study with the aim to explore the consequences for women within marginalized groups in a post-earthquake society2016Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    This report is the outcome of a case study conducted in Kathmandu, Nepal in April 2016. The purpose of the study is to investigate in the consequences of the 2015 earthquake in Nepal, from the perspective of women within socioeconomically vulnerable groups. The caste system is still practiced nearly all over Nepal and women are still facing multiple forms of discrimination. A woman belonging to the Dalits, which is the group considered to be at the bottom of the hierarchy and below the castes, have no right to control land, housing or money and are exposed to violence and forced sexual labour. The aim of the study is to shed light over how already existing discrimination leads to further examples of discrimination in the aftermath of a natural disaster and the “class-consciousness” of natural disasters. People within a society are living under different conditions and these conditions lead to different consequences when facing a natural disaster. The components of these conditions are often intertwined with each other and should therefore not be examined separately, which is why an intersectional perspective is used for this study. Furthermore, standpoint theory is used as well, to look at these issues from the viewpoint of the marginalized people of the society. Interviews were made with 6 different respondents, who are working for NGOs in and outside of Kathmandu and who through their work are coming on contact with the issues mentioned. My findings show several examples of post-earthquake consequences for women which can be linked to the strong patriarchy, the use of caste system and mistreatment from the government.

  • 12.
    Grundström, Hanna
    et al.
    Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Norrköping. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Kjølhede, Preben
    Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    “A challenge” – healthcare professionals' experiences when meeting women with symptoms that might indicate endometriosis2016In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 7, 65-69 p.Article in journal (Refereed)
    Abstract [en]

    Objective

    The aim of the study was to identify and describe the experiences of healthcare professionals when meeting women with symptoms that might indicate endometriosis.

    Methods

    Semi-structured interviews were conducted with 10 gynecologists, six general practitioners and nine midwives working at one university hospital, one central hospital, one private gynecology clinic and five healthcare centers in south-east Sweden. The interviews were recorded and transcribed verbatim and analyzed using qualitative conventional content analysis.

    Results

    Three clusters were identified: the corroborating encounter, the normal variation of menstruation cycles, and the suspicion of endometriosis. The healthcare professionals tried to make a corroborating encounter by acknowledging the woman, taking time to listen, and giving an explanation for the problems. Healthcare professionals had different ways to determine what was normal as regards menstrual pain, ovulation pain and dyspareunia. They also needed to have the competence to act and react when the symptoms indicated endometriosis.

    Conclusions

    Meeting women with symptoms that might indicate endometriosis is challenging and demands a certain level of competence from healthcare professionals. Sometimes the symptoms are camouflaged as “normal” menstruation pain, making it hard to satisfy the needs of this patient group.

  • 13.
    Fägerskiöld, Astrid
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    A change in life as experienced by first-time fathers2008In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 1, 64-71 p.Article in journal (Refereed)
    Abstract [en]

    Research suggests that the attitude of men towards pregnancy, childbirth and child-caring is different from that of women. Up to now, research has focused mainly on motherhood. The aim of this study was to explore first-time fathers’ experiences during early infancy of their children. Grounded theory and constant comparative method were used and 20 fathers aged 20–48 participated. Interviews were carried out in 2002–2003. ‘Changing life’ emerged as the core category consisting of the categories: becoming a father, alternating between work and home, changing relationship towards partner and developing relationship with their child. Changing life implied that they have left bachelor life and become responsible for a child. Becoming a father was much more fantastic than they could have imagined and they suggested that they performed childcare to the same extent as the mother when both parents were at home. Still fathers viewed the mother as the main parent, partly because of their alternating between work and home and because the mothers breast-feed the infants. Fathers’ attitude towards breast-feeding seemed to be ambiguous; it was a matter of necessity, but made them feel insignificant. Changing relationship towards partner was common but it was not necessarily for the worst and often resulted in a more closely united relationship. However, tiredness because of lack of sleep could result in increased irritability towards problems. Developing relationship with their child implied increasing possibilities to learn to know the infant’s signals. Fathers are one of two parents, and hence are important for their child’s growth and development, emotional health and cognitive development. Knowledge about first-time fathers’ experiences during the early infancy of their children may bring about increased support from midwives and child health nurses.

  • 14.
    Edberg, Andreas
    et al.
    Central Hospital, Karlstad.
    Jurstrand, Margaretha
    University Hospital, Örebro.
    Johansson, Eva
    Central Hospital, Karlstad.
    Wikander, Elisabeth
    Central Hospital, Karlstad.
    Höög, Anna
    Central Hospital, Karlstad.
    Ahlqvist, Thomas
    Central Hospital, Karlstad.
    Falk, Lars
    Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology. Linköping University, Faculty of Health Sciences.
    Skov Jensen, Jørgen
    Statens Serum Institute, Denmark.
    Fredlund, Hans
    University Hospital, Örebro.
    A comparative study of three different PCR assays for detection of Mycoplasma genitalium in urogenital specimens from men and women2008In: Journal of Medical Microbiology, ISSN 0022-2615, Vol. 57, 304-309 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to compare conventional 16S rRNA gene PCR, real-time 16S rRNA gene PCR and real-time Mycoplasma genitalium adhesin protein (MgPa) gene PCR as detection methods for M. genitalium infection. The study also determined the prevalence of M. genitalium in male and female patients attending a sexually transmitted infections clinic in a rural area in the west of Sweden. First void urine (FVU) and/or urethral swabs were collected from 381 men, and FVU and/or cervical swabs and/or urethral swabs were collected from 298 women. A total of 213 specimens were used in the PCR comparative study: 98 consecutively sampled specimens from patients enrolled in the prevalence study, 36 consecutively sampled specimens from patients with symptoms of urethritis and 79 specimens from patients positive for M. genitalium by real-time MgPa gene PCR in the prevalence study. A true-positive M. genitalium DNA specimen was defined as either a specimen positive in any two PCR assays or a specimen whose PCR product was verified by DNA sequencing. The prevalence of M. genitalium infection in men and women was 27/381 (7.1 %) and 23/298 (7.7 %), respectively. In the PCR comparative study, M. genitalium DNA was detected in 61/76 (80.3 %) of true-positive specimens by conventional 16S rRNA gene PCR, in 52/76 (68.4 %) by real-time 16S rRNA gene PCR and in 74/76 (97.4 %) by real-time MgPa gene PCR. Real-time MgPa gene PCR thus had higher sensitivity compared with conventional 16S rRNA gene PCR and had considerably increased sensitivity compared with real-time 16S rRNA gene PCR for detection of M. genitalium DNA. Real-time MgPa gene PCR is well suited for the clinical diagnosis of M. genitalium.

  • 15.
    Wyon, Yvonne
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Nedstrand, Elisabeth
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Hammar, Mats
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    A comparison of acupuncture and oral estradiol treatment of vasomotor symptoms in postmenopausal women2004In: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 7, no 2, 153-164 p.Article in journal (Refereed)
    Abstract [en]

    Objective To compare the effects of electro-acupuncture with oral estradiol and superficial needle insertion on hot flushes in postmenopausal women.

    Material and methods  Forty-five postmenopausal women with vasomotor symptoms were randomized to electro-acupuncture, superficial needle insertion or oral estradiol treatment during 12 weeks, with 6 months' follow-up. The number and severity of flushes were registered daily and the Kupperman index and a general estimate of climacteric symptoms were completed before, during and after therapy.

    Results In the electro-acupuncture group, the mean number of flushes/24 h decreased from 7.3 to 3.5 (ANOVA, p  < 0.001). Eleven of the 15 women had at least a 50% decrease in number of flushes (with a mean decrease of 82%). Superficial needle insertion decreased the number of flushes/24 h from 8.1 to 3.8 (p  < 0.001). In seven out of 13 women, the number of flushes decreased by at least 50% (mean decrease 83%). In the estrogen group, the number of flushes decreased from 8.4 to 0.8 (p < 0.001). The decrease in number of flushes persisted during the 24-week follow-up period in all treatment groups. The Kupperman index and the general climacteric symptom score decreased, and remained unchanged 24 weeks after treatment in all groups (p < 0.001). Electro-acupuncture decreased the number of flushes/24 h significantly over time, but not to the same extent as the estrogen treatment. No significant difference in effect was found between electro-acupuncture and the superficial needle insertion.

    Conclusion We suggest that acupuncture is a viable alternative treatment of vasomotor symptoms in postmenopausal women and cannot recommend superficial needle insertion as an inactive control treatment.

  • 16.
    Lesen, Eva
    et al.
    Nordic School for Public Health.
    Sandstrom, Tatiana Z
    Nordic School for Public Health.
    Carlsten, Anders
    Medical Prod Agency.
    Jönsson, Anna K
    Linköping University, Department of Medical and Health Sciences, Pharmacology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Pharmacology.
    Mardby, Ann-Charlotte
    University of Gothenburg.
    Andersson Sundell, Karolina
    Nordic School for Public Health.
    A comparison of two methods for estimating refill adherence to statins in Sweden: the RARE project2011In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 20, no 10, 1073-1079 p.Article in journal (Refereed)
    Abstract [en]

    Purpose To analyse and compare refill adherence to statins estimated with two different methods with a focus on sensitivity to definitions. less thanbrgreater than less thanbrgreater thanMethods Individuals aged 18-85 years who filled a statin prescription for the first time in 1.5 years during 1 January-30 June 2007 were followed until emigration or death or until 2 years after their first statin purchase. The data were collected via linkage between the Swedish Prescribed Drug Register, the National Patient Register and the Total Population Register. Days supply was estimated based on amount dispensed and prescribed dosage. Refill adherence was estimated with the continuous measure of medication acquisition (CMA) and the maximum gap method (cut-off 45days). The impact of altering definitions, for example, regarding hospitalisations, length of observation period and management of overlapping supply, was analysed. less thanbrgreater than less thanbrgreater thanResults The study included 36661 individuals (mean age 64 years, 47% women). The median proportion of days with statins was 95%, and 76% were classified as adherent with a cut-off at andgt;= 80% with CMA. With the maximum gap method, 65% were adherent. Disregarding hospitalisations did not alter the results. Emigration or death at least one year after statin initiation was associated with a lower adherence with both methods, and a shorter observation period and adding overlapping supply to the subsequent prescription increased the adherence estimates. less thanbrgreater than less thanbrgreater thanConclusions The choice of method and definitions, particularly regarding the management of overlapping supplies and the length of observation period, has a substantial impact on estimates of refill adherence to statins.

  • 17.
    Tagesson (Sonesson), Sofi
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Good, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    A comprehensive rehabilitation program with quadriceps strengthening in closed versus open kinetic chain in patients with anterior cruciate ligament deficiency: a randomized clinical trial evaluating dynamic tibial translation and muscle function2008In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 36, no 2, 298-307 p.Article in journal (Refereed)
    Abstract [en]

    Background: There is no consensus regarding the optimal rehabilitation regimen for increasing quadriceps strength after anterior cruciate ligament (ACL) injury.

    Hypothesis: A comprehensive rehabilitation program supplemented with quadriceps strengthening in open kinetic chain (OKC) exercise will increase quadriceps strength and improve knee function without increasing static or dynamic sagittal tibial translation, compared with the same comprehensive rehabilitation program supplemented with quadriceps strengthening in closed kinetic chain (CKC) exercise, in patients with acute ACL deficiency.

    Study Design: Randomized controlled trial; Level of evidence, 1.

    Methods: Forty-two patients were tested a mean of 43 days (range, 20–96 days) after an ACL injury. Patients were randomized to rehabilitation with CKC quadriceps strengthening (11 men and 9 women) or OKC quadriceps strengthening (13 men and 9 women). Aside from these quadriceps exercises, the 2 rehabilitation programs were identical. Patients were assessed after 4 months of rehabilitation. Sagittal static translation and dynamic tibial translation were evaluated with a CA-4000 electrogoniometer. Muscle strength, jump performance, and muscle activation were also assessed. Functional outcome was evaluated by determining the Lysholm score and the Knee Injury and Osteoarthritis Outcome Score.

    Results: There were no group differences in static or dynamic translation after rehabilitation. The OKC group had significantly greater isokinetic quadriceps strength after rehabilitation (P = .009). The hamstring strength, performance on the 1-repetition-maximum squat test, muscle activation, jump performance, and functional outcome did not differ between groups.

    Conclusions: Rehabilitation with OKC quadriceps exercise led to significantly greater quadriceps strength compared with rehabilitation with CKC quadriceps exercise. Hamstring strength, static and dynamic translation, and functional outcome were similar between groups. Patients with ACL deficiency may need OKC quadriceps strengthening to regain good muscle torque.

  • 18.
    Ahlstrom, G.
    et al.
    Ahlström, G., Department of Health Sciences, University of Örebro, SE-701 82 Örebro, Sweden.
    Lindvall, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Neurology . Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Wenneberg, S.
    Department of Health Sciences, University of Örebro, SE-701 82 Örebro, Sweden.
    Gunnarsson, L.G.
    Department of Neurology and Neurophysiology, Örebro University Hospital, Örebro, Sweden.
    A comprehensive rehabilitation programme tailored to the needs of adults with muscular dystrophy2006In: Clinical Rehabilitation, ISSN 0269-2155, Vol. 20, no 2, 132-141 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To assess if activities of daily living (ADL), coping and quality of life could be improved in adults with muscular dystrophy through a comprehensive rehabilitation programme. Design: Quasi-experimental, controlled clinical study comparing patients with similar age and disease aspects. Setting: Two different counties in Sweden, being either study or control setting. Subjects: The study group comprised 37 adults (21 women, 16 men, mean age 50 years), while the control group comprised 39 people (25 women, 14 men, mean age 46 years). Interventions: Four rehabilitation sessions tailored to different medical, physical and psychosocial needs of the patients, comprising a total of 10 days over a period of 18 months. Main measures: ADL, the Mental Adjustment to Cancer Scale measuring coping strategies, the Sickness Impact Profile measuring health-related quality of life, the Hospital Anxiety and Depression Scale, and the Psychosocial Well-being Questionnaire. Results: No significant differences were found between groups with regard to the outcome measures. There was increased dependence on others in ADL after 18 months in both groups, but it was more pronounced in the control group. Furthermore, a clear trend was observed in the data with regard to coping patterns, the control group using more coping strategies such as 'Helplessness/hopelessness' (P = 0.057), 'Anxious preoccupation' (P = 0.085) and 'Fatalistic' (P = 0.073) when being compared to the study group. Conclusions: No apparent effects on ADL were found from the rehabilitation programme, although there was a tendency of reduction of maladaptive coping patterns in the study group. This initial study may provide the rationale and basis for a randomized controlled trial. © 2006 Edward Arnold (Publishers) Ltd.

  • 19.
    Olsson, Maria
    et al.
    Linköping University, Department of Management and Engineering, Machine Design.
    Larsson, Lina
    Linköping University, Department of Management and Engineering, Machine Design. Linköping University, The Institute of Technology.
    A Conceptual Female Hygiene Product: Developed from Needs and Prerequisites in an Agricultural East African Context2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Menstruation is a large problem for females in development countries today. Studies have shown that around 40 percent of menstruating girls have been absent from school due to their menstruation. One of the challenges that need to be solved is the absence of female hygiene products amongst women, especially in low income and developing countries due to the cost of commercial products. In countries where the national economy is unstable or poorly comes a problem with importing products, it would be better if they could produce their own products so that the national economy is supported. Small factories and production sites that produce female hygiene products have started to form in some areas. This shows that it is possible to produce in the context where the product is going to be sold. One of the advantages of this system is from the environmental perspective, many of the local production sites use environmentally friendly materials and some products are up to 95 percent bio-degradable. The purpose of this thesis is to develop a concept for a sustainable female hygiene product that women in developing countries can afford to buy, this so that social effects can be enabled due to the security that a functioning protection can bring. To be able to do so a field study in Uganda has been conducted. During the study users and local producers were interviewed to find out what demands and prerequisites there are to create a female hygiene product that can be produced and used locally. The field study gave a deeper understanding and knowledge about both the subject as whole and the technical aspects to take into consideration when developing a female hygiene product. The study confirmed that female hygiene products, or rather the lack of them, are a big problem that needs to be solved quickly. It also revealed that the possibilities for producing in the context existed but was not developed enough. Through an analysis of the empirical findings as well as theories about, for example, material and production, six concepts were developed. The concepts and already existing products were evaluated and correlated to requirements collected in the field study. One concept was chosen for further development from this evaluation. This concept consists of a disposable napkin that is fastened by putting it in holders sewn in the panty. The panty can be bought as a product with existing holders or the holders can be sewn into the users own panties. The final concept has taken both technical aspects and social effects into account. Lists of requirements on material for the concept as well as the production of it are also included in the work. A prototype of the concept has been sewn and tested. The final concept in this work is not a finished product and needs further developing before being released as a product. More work need to be done on specifying the production and specific materials to implement the concept. For further developing, it is also important to have in mind in what context the product would be used due to the different possibilities and demands that the setting gives.

  • 20. Willis, M
    et al.
    Ödegaard, K
    Persson, U
    Hedbrant, J
    Mellström, D
    Hammar, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    A cost-effectiveness model of tibolone as treatment for the prevention of osteoporotic fractures in postmenopausal women in Sweden.2001In: Clinical drug investigation, ISSN 1173-2563, Vol. 21, 115-127 p.Article in journal (Refereed)
  • 21.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    A cross-sectional study of factors associated with the number of anatomical pain sites in an actual elderly general population: results from the PainS65+cohort2017In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 10, 2009-2019 p.Article in journal (Refereed)
    Abstract [en]

    Background: Several studies have illustrated that multisite pain is more frequent than single pain site, and it is associated with an array of negative consequences. However, there is limited knowledge available about the potential factors associated with multisite pain in the elderly general population. Objective: This cross-sectional study examines whether the number of anatomical pain sites (APSs) is related to sociodemographic and health-related factors in older adults including oldestold ages using a new method (APSs) to assess the location of pain on the body. Materials and methods: The sample came from the PainS65+ cohort, which included 6,611 older individuals (mean age = 76.0 years; standard deviation [SD] = 7.4) residing in southeastern Sweden. All the participants completed and returned a postal survey that measured sociodemographic data, total annual income, pain intensity and frequency, general well-being, and quality of life. The number of pain sites (NPS) was marked on a body manikin of 45 sections, and a total of 23 APSs were then calculated. Univariable and multivariable models of regression analysis were performed. Results: Approximately 39% of the respondents had at least two painful sites. The results of the regression analysis showed an independent association between the APSs and the age group of 75-79 years, women, married, high pain intensity and frequency, and low well-being and quality of life, after adjustments for consumption of analgesics and comorbidities. The strongest association was observed for the higher frequency of pain. Conclusion: Our results suggest that APSs are highly prevalent with strong relationships with various sociodemographic and health-related factors and concur well with the notion that multisite pain is a potential indicator of increased pain severity and impaired quality of life in the elderly. Our comprehensive method of calculating the number of sites could be an essential part of the clinical presentation, assessment, and treatment of multisite pain.

  • 22.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    A Data-Rich World: Population‐based registers in healthcare research2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Advances and integration of information and communication technologies into healthcare systems offer new opportunities to improve public health worldwide. In Sweden, there are already unique possibilities for epidemiological research from registers because of a long tradition of centralized data collection into population-based registers and their allowance for linkage. The growing efficiency of automated digital storage provides growing volumes of archived data that increases the potential of analyses further.

    The purpose of this thesis can be divided into two parallel themes: illustrations and discussions of the use and usefulness of population-based registers on the one hand, and specific research questions in epidemiology and healthcare research on the other. The research questions are addressed in separate papers.

    From the Swedish Cancer Registry, 25 years of incidence data on testicular cancer was extracted for a large cohort. Record linkage to survey data on serum cholesterol showed a highly significant positive association, suggesting that elevated serum cholesterol concentration is a risk factor for testicular cancer. Since the finding is the first of its kind and because of wide confidence intervals further studies are needed to confirm the association.

    Östergötland County council’s administra-tive database (the Care Data Warehouse in Östergötland (CDWÖ)) provided data for preva-lence estimations of four common chronic diseases.

    The prevalence rate agreed very well with previous estimates for diabetes and fairly well with those for asthma. For hypertension and chronic obstructive pulmonary disease, the observed rates were lower than previous prevalence estimates. Data on several consecutive years covering all healthcare levels are needed to achieve valid prevalence estimates.

    CDWÖ data was also used to analyse the impact of diabetes on the prevalence of ischemic heart disease. Women had higher diabetes/non-diabetes prevalence rate ratios across all ages. The relative gender difference remained up to the age of 65 years and thereafter decreased considerably.

    The age-specific direct healthcare cost of diabetes was explored using data from the CDWÖ, the county council’s Cost Per Patient database and the Swedish Prescribed Drug Register. The cost per patient and the relative magnitude of different cost components varied considerably by age, which is important to consider in the future planning of diabetes management.

    The Cancer Registry was established mainly as a basis for epidemiological surveillance and research, exemplified in this thesis by a study on testicular cancer. In contrast, the newly established and planned healthcare databases in different Swedish counties are mainly for managerial purposes. As is shown in this thesis, these new databases may also be used to address problems in epidemiology and healthcare research.

    List of papers
    1. Serum cholesterol and testicular cancer incidence in 45 000 men followed for 25 years
    Open this publication in new window or tab >>Serum cholesterol and testicular cancer incidence in 45 000 men followed for 25 years
    2005 (English)In: British Journal of Cancer, ISSN 0007-0920, Vol. 92, no 9, 1785-1786 p.Article in journal (Refereed) Published
    Abstract [en]

    In a 25-year follow-up study of 44 864 men with measured serum cholesterol levels, the testicular cancer hazard ratios for the serum cholesterol categories 5.7–6.9 and ≥7.0 mmol l-1 vs the reference category (<5.7 mmol l-1) were 1.3 and 4.5, respectively; P-value for trend=0.005. This highly significant association suggests that high-serum cholesterol is a risk factor for testicular cancer.

    Keyword
    epidemiology, testicular neoplasm, cholesterol
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-12757 (URN)10.1038/sj.bjc.6602539 (DOI)
    Available from: 2007-11-06 Created: 2007-11-06 Last updated: 2011-02-03
    2. Estimating disease prevalence using a population-based administrative healthcare database
    Open this publication in new window or tab >>Estimating disease prevalence using a population-based administrative healthcare database
    2007 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, Vol. 35, no 4, 424-431 p.Article in journal (Refereed) Published
    Abstract [en]

    Aims: In Östergötland County, Sweden, all data on hospital care and primary healthcare (PHC) have been entered in a diagnosis-related administrative database since 1999. This database was used to estimate the prevalence of four chronic diseases and to examine the capture of data in PHC, outpatient hospital care, and inpatient hospital care, considered in different time frames.

    Methods: A case-finding algorithm identified patients with at least one healthcare contact involving a diagnosis of diabetes, hypertension, asthma, or chronic obstructive pulmonary disease (COPD) in 1999—2003. Prevalence rates were calculated as the ratio of the number of identified patients alive to the total number of inhabitants on 31 December 2003 (n~415,000).

    Results: Prevalence rates were 4.4% for diabetes, 10.3% for hypertension, 4.5% for asthma, and 1.2% for COPD. For all four diagnoses, the proportions of patients identified on only one healthcare level were greatest for PHC, reaching rates of 23%, 68%, 53%, and 48%, respectively. The cases identified solely in PHC comprised larger proportions of women and patients over the age of 65 years. Considering the proportion of patients identified in 2003 in relation to the total five-year period gave values of 71%, 50%, 38%, and 58%, respectively, for the four diagnoses.

    Conclusions: The administrative healthcare databases in Sweden today can be important tools in epidemiological research. However, data on several consecutive years and both PHC and hospital data are needed to achieve valid prevalence estimates.

    Keyword
    Asthma, COPD, diabetes mellitus, epidemiology, healthcare, hypertension, inpatients, prevalence, primary outpatients, registries
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-12758 (URN)10.1080/14034940701195230 (DOI)
    Available from: 2007-11-06 Created: 2007-11-06 Last updated: 2009-05-19
    3. Age and Gender Differences in the Impact of Diabetes on the Prevalence of Ischemic Heart Disease: a Population-Based Register Study
    Open this publication in new window or tab >>Age and Gender Differences in the Impact of Diabetes on the Prevalence of Ischemic Heart Disease: a Population-Based Register Study
    2008 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 79, no 3, 497-502 p.Article in journal (Refereed) Published
    Abstract [en]

    Objective: To explore age and gender differences in the impact of diabetes on the prevalence of ischemic heart disease (IHD) in a defined population.

    Methods: Data were obtained from an administrative health care register covering a population of about 415 000. The study included all patients aged 45-74 years diagnosed between 1999-2003 with IHD (n=11 311) and diabetes (n=10 364) by physicians at all primary health care centres (PHCs) and out- and inpatient clinics at all hospitals in the county of Östergötland, Sweden.

    Results: In the 45-54 year-old age group, diabetes was associated with an increase in IHD prevalence equivalent to ageing about 20 years in women and 10 years in men. The diabetes/nondiabetes IHD prevalence rate ratio (IPR) decreased with age in both men and women (trend p-values < 0.001). The IPR was higher among women than men in each age group, though the female relative excess decreased from 75% higher in the 45-54 year-old age group to 33% higher in the 65-74 year-old age group (trend p-value = 0.018).

    Conclusions: The relative gender difference in the impact of diabetes on IHD in younger middle-aged patients remained up to the age of 65 years, decreasing considerably thereafter.

    Place, publisher, year, edition, pages
    Institutionen för medicin och hälsa, 2008
    Keyword
    aging, coronary disease, diabetes mellitus, prevalence, sex differences
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-11241 (URN)10.1016/j.diabres.2007.10.009 (DOI)
    Note
    Original publication: Ann-Britt E. Wiréhn, Carl Johan Östgren and John M. Carstensen, Age and Gender Differences in the Impact of Diabetes on the Prevalence of Ischemic Heart Disease: a Population-Based Register Study, 2008, Diabetes Research and Clinical Practice, (79), 3, 497-502. http://dx.doi.org/10.1016/j.diabres.2007.10.009. Copyright: Elsevier B.V., http://www.elsevier.com/Available from: 2008-03-12 Created: 2008-03-12 Last updated: 2011-02-03
    4. Age-specific direct health care costs attributable to diabetesin a Swedish population: a register-based analysis
    Open this publication in new window or tab >>Age-specific direct health care costs attributable to diabetesin a Swedish population: a register-based analysis
    2008 (English)In: Diabetic Medicine, ISSN 0742-3071, Vol. 25, no 6, 732-737 p.Article in journal (Refereed) Published
    Abstract [en]

    Aims: The aim of this population-based study was to explore the age-specific additional direct healthcare cost for patients with diabetes compared with the non-diabetic population.

    Methods: In 1999-2005, patients with diabetes in the Swedish county of Östergötland (n = 20 876) were identified from an administrative database. Cost data on the healthcare expenditure in primary healthcare, out-patient hospital care and in-patient care for the entire county population (n = ∼415 000) in 2005 were extracted from a cost per patient (CPP) database, which includes information on all utilized healthcare resources in the county. Data on drug sales were obtained from the Swedish Prescribed Drug Register.

    Results: The cost per person was 1.8 times higher in patients with diabetes than in the non-diabetic population, 7.7 times higher in children and 1.3 times higher in subjects aged > 75 years. The additional cost per person for diabetes was €1971; €3930 and €1367, respectively, for children and subjects aged > 75 years. The proportion of total additional diabetes costs attributable to in-patient care increased with age from 25 to 50%; in-patient care was the most expensive component at all ages except in children, for whom visiting a specialist was most expensive. The diabetes-related segment of the total healthcare cost was 6.6%, increasing from 2.0% in children to 10.3% in the age group 65-74 years, declining to 6.2% in the oldest age group.

    Conclusions: The direct medical cost of diabetes varies considerably by age. Knowledge about the influence of age on healthcare costs to society will be important in future planning of diabetes management.

    Keyword
    Diabetes, Economics, Healthcare delivery, Prevalence, Registers
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-12760 (URN)10.1111/j.1464-5491.2008.02444.x (DOI)
    Available from: 2007-11-06 Created: 2007-11-06 Last updated: 2009-08-21
  • 23.
    Nord, Catharina
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    A day to be lived. Elderly peoples' possessions for everyday life in assisted living2013In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 0890-4056, Vol. 27, no 2, 135-142 p.Article in journal (Refereed)
    Abstract [en]

    This study is a qualitative interview study about the household possessions that elderly women and men brought with them when moving into assisted living. The move implied a substantial reduction of their possessions since, in all cases, they had left a larger dwelling than the one they moved to. The study gives a glimpse into the everyday life of the oldest old in assisted living. The things the elderly participants brought were of three types; cherished objects, representations of who they were, and mundane objects. The most important objects indicated by the elderly often belonged to the third type, and were preferred for the significance they had for the everyday life of the individual. These objects revealed a circumscribed but dignified life in their private bed-sitting room, often in solitude, where the elderly individuals pursued various interests and small-scale activities. However, this life was organized and preferred by the individuals themselves, in accordance with the principles of resident autonomy and individual choice that are promoted in assisted living. The author suggests that these self-engaged pursuits can contribute to bridging the gap between disengagement and activity theories. The study results also contribute to making visible the private life of the oldest old in assisted living.

  • 24.
    Ekman, Bertil
    et al.
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Lindström, Torbjörn
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Olsson, Anders
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Toss, Göran
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Arnqvist, Hans
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    A dose titration model for recombinant GH substitution aiming at normal plasma concentrations of IGF-I in hypopituitary adults2002In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 147, no 1, 49-57 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate a dose titration model for recombinant human GH substitution in adult patients with GH deficiency, aiming at normal plasma levels of IGF-I.

    DESIGN AND METHODS: Eighteen patients participated and a start dose of 0.17 mg GH/day was used except by two men who started with 0.33 mg/day. To demonstrate a clear GH effect the patients were first titrated, with steps of 0.17 mg GH/day every 6-8 weeks, to IGF-I levels in the upper range of age-adjusted reference values. The GH dose was then reduced 1 dose step and kept for a further 6 months. For comparison we investigated 17 healthy control subjects.

    RESULTS: Plasma IGF-I was increased after 2 weeks on the start dose and did not increase further for up to 8 weeks. Women had significantly lower GH sensitivity than men measured as net increment of IGF-I on the start dose of GH. GH sensitivity was not changed by age. The plasma IGF-I levels increased from 76.3+/-47.0 (s.d.) to 237+/-97 microg/l at the end of the study (P<0.001), and similar IGF-I levels were obtained in both sexes. The maintenance median GH dose was 0.33 mg/day in males and 0.83 mg/day in females (P=0.017). The GH dose correlated negatively with age in both sexes. Body weight, very low density triglycerides, lipoprotein(a) (Lp(a)), and fasting insulin increased, whereas insulin sensitivity index (QUICKI) decreased significantly. In comparison with the controls, the patients had lower fasting blood glucose, fasting insulin and Lp(a) levels at baseline, but these differences disappeared after GH substitution. The two groups had equal insulin sensitivity (QUICKI), but 2 h oral glucose tolerance test values of blood glucose and insulin were significantly higher in the patients at the end of the study.

    CONCLUSIONS: In conclusion our data suggest that the starting dose of GH substitution and the dose titration steps should be individualised according to GH sensitivity (gender) and the IGF-I level aimed for (age). The reduced insulin sensitivity induced by GH substitution could be viewed as a normalisation if compared with control subjects.

  • 25.
    Eriksson, Katarina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Carlsson, Bodil
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology.
    Forsum, Urban
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology.
    Larsson, P-G
    Department of Obstetrics and Gynecology, Central Hospital of Sko¨vde, Sweden.
    A double-blind treatment study of bacterial vaginosis with normal vaginal lactobacilli after an open treatment with vaginal clindamycin ovules2005In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 85, no 1, 42-46 p.Article in journal (Refereed)
    Abstract [en]

    The expected 4-week cure rate after conventional treatment of bacterial vaginosis are only 65-70%. In an attempt to improve the cure rate by adding probiotic lactobacilli we performed a double-blind placebo-controlled study of adjuvant lactobacilli treatment after an open treatment with vaginal clindamycin ovules. Women with bacterial vaginosis as defined by Amsel's criteria were treated with clindamycin ovules. Vaginal smears were collected and analysed according to Nugent's criteria. During the following menstruation period the women used, as an adjuvant treatment, either lactobacilli-prepared tampons or placebo tampons. The lactobacilli tampons were loaded with a mixture of freeze-dried L. fermentum, L. casei var. rhamnosus and L. gasseri. The cure rate was recorded after the second menstruation period. There was no improvement in the cure rate after treatment with lactobacilli-containing tampons compared to placebo tampons, the cure rates as defined by Amsel's criteria were 56% and 62%, respectively, and 55% and 63%, as defined by Nugent's criteria. This is the first study to report cure rates for women with 'intermediate' wet smear ratings according to Nugent's classification and this group had an overall cure rate of 44%. The cure rate of treatment of bacterial vaginosis was not improved by using lactobacilli-prepared tampons for one menstruation.

  • 26.
    Ockander, Marlene
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    A female lay perspective on health, disease, and sickness absence2001Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Knowledge about a female perspective on health and disease is important to understand what happens in e.g. the medical meeting. A deeper understanding for the phenomenon of health also has social and economic importance. In Sweden women account for about 60% of the long-term cases of sickness absence.

    Aim: To explore and describe women's perceptions of health and disease and their accounts of sickness absence.

    Methods: The chronic diseases mentioned by elderly women in an interview study are compared with those documented in their respective medical records (n=199). The prevalence of positive diagnoses, overall agreement, and the kappa-coefficient were calculated for each group of diagnoses. Semi-stmctnred interviews were conducted with 82 women who had been on sick leave (60 days or more) or who had disability pension. Sixty of these middle-aged women also carried out a Q-sort.

    Results: The lowest overall agreement between the elderly women report during interviews and their medical records was observed for psychiatric diseases, followed by diseases of the gastrointestinal system. Poor chance-adjusted agreement was found concerning diseases of the gastrointestinal system and diseases of the skin (Paper I). Long-term sickness absence can be said to arise in three distinguishable "spaces": the workspace, the medical-legal space, and the mental space. In the beginning, the women were positive about sick leave as such, which they saw as an opportunity for physical rest. But as time went on, they came to regard sick leave as creating a vicious circle of new problems related to inactivity and isolation. Apart from this vicious circle and chronic physical impairments, certain conditions at the workplace, at the hospital, and the social insurance office transformed seemingly trivial sick leaves into long-term and irreversible sickness absences (Paper II). The women's accounts of being sickness absent contained interpretations of what had happened to them, how things were for the moment, and what they thought the future would bring. Three different accounts could be distinguished: the crisis, the breakpoint, and the migration. The perceptions of their own situation and especially what they thought about their future were associated with their feelings of power to initiative and well-being. The descriptions of life on sick leave are connected to a theory of "loss of work" (Paper III). For these women, to be able to get back to work was found to be equivalent to breaking away from the prospect of isolation and loneliness. Five actors were identified along with suggestions for their actions: the woman who is on sick leave herself, the employer, the health care provider, the social insurance official, and the shop-steward. It was found important to take oneself seriously and also to be taken seriously by others. The results are related to a theory of enduring and suffering (Paper IV). Six accounts representing different conceptions of health, illness, and medicine were identified and described (Paper V).

    Conclusions: The results point to the importance of doing research from different perspectives, using different methods and different sources of information to obtain a deeper understanding of a complex phenomenon like health. Above all, the results presented in this thesis point to a large variation at the individual level in perceptions, which implies the need for care in, for example, the planning of rehabilitation programs. The results also highlight the point that sick leave without follow-up from work, health care, and the social insurance office might have negative consequences on health. Implications for practice are suggested along with proposals for future research.

    List of papers
    1. Patient-doctor Concordance in Elderly Women’s Self-reported Health and Medical Records
    Open this publication in new window or tab >>Patient-doctor Concordance in Elderly Women’s Self-reported Health and Medical Records
    2002 (English)In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 41, no 2, 119-124 p.Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVES: To compare the chronic diseases mentioned by elderly women in an interview study with those documented in their respective medical records.

    METHODS: The prevalence of positive diagnoses, overall agreement, and the kappa-coefficient were calculated for each group of diagnoses.

    RESULTS: The lowest overall agreement was observed for psychiatric diseases, followed by diseases of the gastrointestinal system. Poor chance-adjusted agreement was found concerning diseases of the gastrointestinal system and diseases of the skin.

    CONCLUSIONS: The results suggest that a main reason for discordance was that the elderly women feared "losing face" by reporting some diseases.

    Keyword
    diagnosis, women, medical records, patients, medical decision making
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-26291 (URN)12061118 (PubMedID)10807 (Local ID)10807 (Archive number)10807 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2013-09-05Bibliographically approved
    2. A female lay perspective on the establishment of long-term sickness absence
    Open this publication in new window or tab >>A female lay perspective on the establishment of long-term sickness absence
    2001 (English)In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 10, no 1, 74-79 p.Article in journal (Refereed) Published
    Abstract [en]

    In Sweden women account for about 60% of the long-term cases of sickness absence. The aim of this study was to describe women's explanations as to how long-term sickness absence arises and becomes permanent, with reference to their personal experience. Semi-structured interviews were performed with 82 middle-aged women who have personal experience of long-term sickness absence. Long-term sickness absence can be said to arise in three distinguishable “spaces”: the work space, the medico-legal space and the mental space. In the beginning, the women were positive about sick-leave as such, which they saw as an opportunity for physical rest. But as time went on, they came to regard sick-leave as creating a vicious circle of new problems related to inactivity and isolation. Apart from this vicious circle and chronic physical impairments, certain conditions at the workplace, at the hospital and the social insurance office transformed seemingly trivial sick-leaves into long-term and irreversible sickness absences

    Keyword
    sickness absence, lay explanation models, women, phenomenology, interview
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-26067 (URN)10.1111/1468-2397.00154 (DOI)10526 (Local ID)10526 (Archive number)10526 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2013-09-05Bibliographically approved
    3. Women's experiences of long term sickness absence: Is there a "loss of work syndrome"?
    Open this publication in new window or tab >>Women's experiences of long term sickness absence: Is there a "loss of work syndrome"?
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: In most European countries, long-term sickness absence contribute the greatest number of days that are reimbursed due to sickness absence. This group is growing and it is constituted mainly of women.

    Aim: The present study seeks further knowledge about what happens then and there, i.e., how long-term sickness absent women handle and explain, for themselves and others, this interruption in their daily life.

    Methods: Semi-structured interviews were performed with 82 middle-aged women with personal experience from long-term sickness absence.

    Results: The women's accounts of being sickness absent contained interpretations of what had happen to them, how things were for the moment, and what they thought the future would bring. Three different accounts could be distinguished: the crisis, the breakpoint, and the migration. The perception of their own situation and especially what they thought about their future was associated with their feeling of power to initiative and well-being.

    Conclusion: From our study we have found implications for central topics of importance: time elapse, sense of coherence, reorientation/adaptation, and vital goals.

    Keyword
    Vital goal, life plan, sense of coherence, phenomenology, women, sickness absence
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-80264 (URN)
    Available from: 2012-08-23 Created: 2012-08-23 Last updated: 2013-09-05Bibliographically approved
    4. How to avoid the frightening scenario of long-term sickness absence: The advice from women with personal experience
    Open this publication in new window or tab >>How to avoid the frightening scenario of long-term sickness absence: The advice from women with personal experience
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Aims: The aim of this study was to describe women's perceptions of what can be done to avoid long-term sickness absence.

    Methods: Interviews were conducted with 82 women who had been on sickness absence ( 60 days or more) or had disability pensions.

    Results: For these women, to be able to get back to work was found to be equivalent to breaking away from the prospect of isolation and loneliness. Five actors were identified along with suggestions for their actions: the woman who is on sick leave herself, the employer, the healthcare provider, the social insurance official, and the shop-steward.

    Conclusions: It is important to take oneself seriously and also to be taken seriously by others. Thus, it is important to not wait too long to take action which concerns both the individual herself and all those who get involved in her case at work, at hospital or at the social insurance office. Practical advice to reach recovery and avoid sickness absence is presented.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-80265 (URN)
    Available from: 2012-08-23 Created: 2012-08-23 Last updated: 2013-09-05Bibliographically approved
    5. Accounts of health, illness and medicine in women on long-term sickness absence
    Open this publication in new window or tab >>Accounts of health, illness and medicine in women on long-term sickness absence
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Long-term sickness absence has grown to an important social and economic question and it affects women more than men. The specific aim of the study was to identify patterns of association between ideas of health endorsed by groups of women having a close firsthand experience of long-term sickness absence. Using the Q-methodology, in a group of 60 middle-aged women, six accounts representing different conceptions of health, illness, and medicine were identified. Future studies should be implemented to investigate the prospective value of the categorisation identified in this study e.g. to see whether, and in that case how, these conceptions affect sick leave and rehabilitation.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-80266 (URN)
    Available from: 2012-08-23 Created: 2012-08-23 Last updated: 2013-09-05Bibliographically approved
  • 27.
    Ockander, Marlene
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    A female lay perspective on the establishment of long-term sickness absence2001In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 10, no 1, 74-79 p.Article in journal (Refereed)
    Abstract [en]

    In Sweden women account for about 60% of the long-term cases of sickness absence. The aim of this study was to describe women's explanations as to how long-term sickness absence arises and becomes permanent, with reference to their personal experience. Semi-structured interviews were performed with 82 middle-aged women who have personal experience of long-term sickness absence. Long-term sickness absence can be said to arise in three distinguishable “spaces”: the work space, the medico-legal space and the mental space. In the beginning, the women were positive about sick-leave as such, which they saw as an opportunity for physical rest. But as time went on, they came to regard sick-leave as creating a vicious circle of new problems related to inactivity and isolation. Apart from this vicious circle and chronic physical impairments, certain conditions at the workplace, at the hospital and the social insurance office transformed seemingly trivial sick-leaves into long-term and irreversible sickness absences

  • 28.
    Vernqvist, Johanna
    Linköping University, Department of Culture and Communication, Language and Culture. Linköping University, Faculty of Arts and Sciences.
    A Female Voice in Early Modern Love Poetry – Gaspara Stampa2013In: Trans: Revue de Littérature Générale et Comparée, ISSN 1778-3887, Vol. 15Article in journal (Other academic)
    Abstract [en]

    In the 16th century a revolution took place for women poets in Italy and Gaspara Stampa (1523-1554) was one of the strongest voices of the period. She is not only a woman writing within a literary code created by and for men, Petrarchism – she writes her poetry with confidence, takes tone and makes a woman’s voice heard where it traditionally does not exist. She goes against ideals and creates female speaking and loving subject At the same time, she makes man her muse and silent object of her praise. And where the tradition divides love in high and low, heavenly and earthbound, Stampa seeks union of body and soul, a union of the two lovers, because without love life is not even worth living.

  • 29.
    Brüggemann, Jelmer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linnaeus University, Sweden.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    A first online intervention to increase patients perceived ability to act in situations of abuse in health care: reports of a Swedish pre-post study2015In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 16, no 35Article in journal (Refereed)
    Abstract [en]

    Background: Efforts to counteract abuse in health care, defined as patient-experienced abuse, have mainly focused on interventions among caregivers. This study is the first to test an online intervention focusing on how patients can counteract such abuse. The intervention aimed at increasing patients intention and perceived ability to act in future situations where they risk experiencing abuse. Methods: Participants were recruited through a nephrology clinic in Sweden. The intervention consisted of an online program that aimed to stimulate patients to think of possible actions in situations in which they risk experiencing abuse. The program comprised stories and exercises in text and comic form. The participants filled out a questionnaire immediately before and after going through the program, as well as during follow-up four to eight weeks later. Results: Forty-eight patients (39 %) participated in the study and spent, on average, 41 min responding to questions and going through the program. Both men and women, of various ages and educational backgrounds, participated. An increase in participants self-reported ability to identify opportunities to act in a given situation was seen immediately afterwards, as well as during follow up. Conclusion: The current study suggests that it is feasible and most likely useful to a variety of patients to work with the provided material that has the aim of counteracting abuse in health care. It would be of interest to further develop ways of using comics and to test similar interventions in other health care settings.

  • 30.
    Carlsson, Marianne
    et al.
    Uppsala universitet Uppsala.
    Arman, Maria
    Karolinska institutet Stockholm.
    Backman, Maria
    Röda Korsets Högskola Stockholm.
    Flatters, Ursula
    Vidarkliniken Järna.
    Hatschek, Thomas
    Karolinska inst Stockholm.
    Hamrin, Elisabeth
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology .
    A five-year follow-up of quality of life in women with breast cancer in anthroposophic and conventional care2006In: Evidence-based Complementary and Alternative Medicine, ISSN 1741-427X, Vol. 3, no 4, 523-531 p.Article in journal (Refereed)
    Abstract [en]

    Complementary and alternative medicine is used by many cancer patients in most parts of the world, and its use is increasing. The aim of the present study was to examine, over 5 years, the perceived quality of life/life satisfaction in two samples of women with breast cancer who were treated with anthroposophic care or conventional medical treatment only. Data from admission, after 1 year and after 5 years are used for the comparisons. On admission to the study the women in anthroposophic care perceived their quality of life to be lower than that of the women in the conventional treatment group, especially for emotional, cognitive and social functioning and overall quality of life. Sixty women who actively chose treatment with anthroposophic medicine and 60 individually matched women treated with conventional medicine participated. Quality of life was measured by the EORTC QLQ-C30 and the Life Satisfaction Questionnaire. Twenty-six women within anthroposophic care and 31 women within conventional medicine survived the 5 years. Effect size (ES) estimation favored the anthroposophic group in seven of the subscales mostly measuring emotional functioning. The ES for four of the subscales favored the conventional treatment group, mostly concerning physical functioning. After 5 years there were improvements in overall quality of life and in emotional and social functioning compared to admission for the women in anthroposophic care. The improvements took place between admission and 1 year, but not further on. Only minor improvements were found in the matching group. © 2006 The Author (s).

  • 31.
    Liedberg, Gunilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies, Hälsa - utbildning - välfärdsinstitutioner (HUV) .
    A Follow-Up Study in Young women with Fibromyalgia Five Years after Diagnosis2005In: 11th World Congress on Pain.,2005, 2005Conference paper (Refereed)
    Abstract [en]

       

  • 32.
    Josefsson, Ann
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    A follow-up study of postnatal depressed women: Recurrent maternal depressive symptoms and child behaviour after four years2007In: Archives of Women's Mental Health, ISSN 1434-1816, Vol. 10, no 4, 141-145 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the prevalence of depressive symptoms and self reported health of women who have shown previous postpartum depressive symptoms. To examine the behavior of four-year-old children born to mothers affected by postpartum depression.

    Methods: Longitudinal study. The index group (n = 251) constituted of all women with postpartum depressive symptoms on the Edinburgh Postnatal Depression Scale (EPDS), in a population-based study made in the late 1990s. The control group (n = 502) consisted of women without postpartum depressive symptoms on the EPDS at the same occasion. Approximately four years after delivery these women were asked to answer a short questionnaire on general health, the EPDS, and also to assess their child’s behavior with the Richman Pre-School Behaviour Checklist. Results: Women with a history of postpartum depressive symptoms were approximately 6 times more likely to have recurrent depressive symptoms (OR = 5.82, 95% CI: 3.79–8.93), compared to those without postpartum depressive symptoms, and they were also more likely to experience physical and mental illness. Although postpartum depressive symptoms in the mothers were involved in explaining the likelihood of behavioral problems in their four-year-old children, mothers with current depressive symptoms were the most likely to have a child with behavioral problems (OR = 4.71, 95% CI: 1.88–11.78). Conclusion: Postpartum depressive illness constitutes a risk for future illness as well as maternal perceived behavioral problems in offspring. In order to diminish long-term adverse consequences for the mother and the child there is a great need to recognize and treat women with postpartum depressive symptoms as early as possible.

  • 33.
    Sederholm Lawesson, Sofia
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Alfredsson, Joakim
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    A gender perspective on short- and long term mortality in ST-elevation myocardial infarction: a report from the SWEDEHEART register2013In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 18, no 2, 1041-1047 p.Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies of patients admitted for ST-elevation myocardial infarction [STEMI] have indicated that women have a higher risk of early mortality than do men. These studies have presented limited information on gender related differences in the short term and almost no information on the long term. Methods and results: We analysed a prospective, consecutively included STEMI population consisting of 54,146 patients (35% women). This population consists of almost all patients hospitalised in Sweden between January 1, 1995 and December 31, 2006 as recorded in the SWEDEHEART register (formerly RIKS-HIA). Follow-up time ranged from one to 13 years (mean 4.6). Women had a lower probability of being given reperfusion therapy, odds ratio [OR] 0.83 (95% confidence interval [CI] 0.79-0.88). During the time these STEMI patients were in the hospital, 13% of the women and 7% of men died, multivariable adjusted OR 1.21 (95% CI 1.11-1.32). During the follow up period, 46% of the women died as compared with 32% of the men. There was, however, no gender difference in age-adjusted risk of long term mortality (hazard ratio [HR] 0.98, 95% CI 0.95-1.01) whereas the multivariable adjusted risk was lower in women (HR 0.92, 95% CI 0.89-0.96). The long term risk of re-infarction was the same in men and women (HR 0.98, 95% CI 0.93-1.03) whereas men in the youngest group had a higher risk than women in that age group (HR 0.82, 95% CI 0.72-0.94). Conclusion: In STEMI, women had a higher risk of in-hospital mortality but the long-term risk of death was higher in men. More studies are needed in the primary percutaneous coronary intervention (pPCI) era that are designed to determine why women fare worse than men after STEMI during the first phase when they are in hospital

  • 34.
    Edell-Gustafsson, Ulla
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Svanborg, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    A gender perspective on sleeplessness behavior, effects of sleep loss, and coping resources in patients with stable coronary artery disease2006In: Heart & Lung, ISSN 0147-9563, Vol. 35, no 2, 75-89 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The primary aim of this study was to systematically compare perceived sleep quality, sleeplessness behavior, sense of mastery, self-esteem, depression, subjective health, and effects of sleep loss in men and women with stable coronary artery disease (CAD). Further aims were to determine possible predictors of poor sleep quality and sense of mastery, as well as the consequences of too little sleep. METHODS: Comparative-correlation and predictive design were used. Patients with a history of stable angina pectoris scheduled to undergo coronary angiography at Linköping University Hospital in Sweden were included. There were 47 women and 88 men (mean age 62.4 years) with CAD. Structured interviews using validated questionnaires covered sleep quality and sleep habits, effects of sleep loss, psychologic resources, and depression. RESULTS: Multiple stepwise regression analysis showed that sleeplessness behavior, depressed mood, female gender, and pharmacologic treatments with inflammation inhibitors significantly (P < .0001) accounted for the variance of poorer sleep quality. The analysis also showed that the following factors in descending order significantly accounted (P < .0001) for the outcome of sleep quality: inability to feel refreshed by sleep, difficulty in maintaining sleep, gastrointestinal problems, too little sleep, final morning awakening time, sleep onset latency, lying down because of daytime tiredness, and daytime physical tiredness. CONCLUSIONS: Compared with men, women with stable CAD may be especially at risk of experiencing poor sleep quality, even when sleeplessness behavior and pharmacologic treatments with inflammation inhibitors are controlled. It is also possible that they may be more at risk of depressed mood. Copyright © 2006 by Mosby, Inc.

  • 35. Hilden, Malene
    et al.
    Schei, Berit
    Swahnberg, Katarina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Gender and Medicine.
    Halmesmäki, Erja
    Langhoff-Roos, Jens
    Offerdal, Kristin
    Pikarinen, Ulla
    Sidenius, Katrine
    Steingrimsdottir, Tora
    Stoum-Hinsverk, Hildegun
    Wijma, Barbro
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Gender and Medicine. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    A history of sexual abuse and health: A Nordic multicentre study2004In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, Vol. 111, no 10, 1121-1127 p.Article in journal (Refereed)
    Abstract [en]

    Objectives: To determine if a history of sexual abuse is associated with objective and subjective indicators of health and if certain abusive incidents had a stronger impact on health than others. Design: A cross-sectional, multicentre study. Setting: Five gynaecological departments in the five Nordic countries. Sample: Three thousand five hundred and thirty-nine gynaecology patients. Methods: The NorVold Abuse Questionnaire (NorAQ) on abuse history and current health was mailed to all patients who consented to participate. Main outcome measures: Reason for index visit at the gynaecologic clinic as well as several questions on health were recorded. General health status was measured as self-estimated health, psychosomatic symptoms (headache, abdominal pain, muscle weakness, dizziness), number of health care visits and number of periods on sick leave. Result: A history of sexual abuse was reported by 20.7% of respondents. A history of sexual abuse was significantly associated with chronic pelvic pain as reason for index visit (P < 0.01), laparoscopic surgery (P < 0.01), psychosomatic symptoms (P < 0.01), self-estimated poor health (P < 0.01), many health care visits (P < 0.01) and high incidence of sick leave (P < 0.01). Several subgroups within the group of sexually abused women were more likely to report poor health: women abused as both children and adults, women who experienced additional emotional and/or physical abuse and women abused by a person they knew. Conclusion: Sexual abuse has a profound impact on women's health. Taking a history of sexual abuse seems particularly warranted when the patient presents with chronic pelvic pain or symptoms of a vague and diffuse nature.

  • 36.
    Olausson, Hanna
    et al.
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Brismar, K.
    Unit for Endocrinology and Diabetes, Karolinska Institutet, Department of Molecular Medicine, Karolinska Hospital, Stockholm, Sweden.
    Lewitt, M.
    Unit for Endocrinology and Diabetes, Karolinska Institutet, Department of Molecular Medicine, Karolinska Hospital, Stockholm, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Sohlström, Annica
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    A longitudinal study of the insulin-like growth factor system before, during and after pregnancy in healthy womenManuscript (preprint) (Other academic)
    Abstract [en]

    The maternal insulin-like growth factor (IGF)-system is considered to influence fetal growth. In this longitudinal study of 23 healthy women we aimed 1) to assess maternal serum levels of IGF-I, IGF-II, IGF binding protein (IGFBP)-1, IGFBP-3 and protease activity against IGFBP-3 before, during and after pregnancy, and 2) to relate these levels in early and late pregnancy to fetal and birth weight. Serum was collected before pregnancy, in weeks 8, 14, 20, 32 and 35 of pregnancy and 2 weeks postpartum. IGF-I, IGF-II, IGFBP-1, and IGFBP-3 were analyzed with radioimmuno/radiometric assays and protease activity with Western blot. Fetal weight was measured by means of ultrasound (week 31 of pregnancy) and birth weight was recorded. IGF-I was initially decreased during pregnancy, compared to before conception. This early decrease was not correlated with fetal or birth weight. In late pregnancy, IGF-I and protease activity were positively related to fetal weight, whereas from week 20 of pregnancy IGFBP-1 showed an inverse association with birth weight. We suggest that in healthy pregnant women there is a fine-tuned balance within the maternal IGF-system, with components With either promoting or restricting influences on fetal growth. The results indicate that maternal IGFBP-1 cguld be used from mid-pregnancy as a marker for birth weight.

  • 37.
    Lima, LE
    et al.
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Jatene, F
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Buffolo, E
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Vánky, Farkas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Casimir-Ahn, E
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Lohn, U
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Leprince, P
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Pavie, A
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Laczkovics, AMM
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Reichenspurner, H
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Calafiore, A
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Nataf, P
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Mack, M
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    A multicenter initial clinical experience with right heart support and beating heart coronary surgery2001In: Heart Surgery Forum, ISSN 1098-3511, Vol. 4, no 1, 61-64 p.Article in journal (Refereed)
    Abstract [en]

    Background: During coronary surgery without CPB, exposure of posterior vessel via sternotomy can cause deterioration of cardiac hemodynamics requiring inotrope drugs support. Recent animal experiments demonstrate hemodynamic benefit of right heart support (RHS) with the AMED system. The purpose of this study was to evaluate the hemodynamic effects during cardiac manipulation to expose the posterior coronary arteries, and determine the effect of RHS in restoring hemodynamics, increasing anastomotic exposure and reducing inotropic requirements. Material and Methods: From July 28 to December 29, 32 patients (25 men/ 7 women), mean age of 63.4 (+/- 6.2 years, ages: 49 - 78) received coronary revascularization with the A-Med RHS device. They were divided into two groups of 16 patients, A and B. Group A patients had at least one circumflex branch bypassed. The anterior wall was systematically bypassed off-pump without RHS. The right coronary artery (RCA) and the obtuse coronary artery (OM) were completed utilizing RHS. In group B patients, all vessels including anterior vessels were bypassed with the RHS. Mean arterial pressure (MAP), mean pulmonary arterial pressure (PAP), cardiac output (CO) and the average pump flow (APF) were recorded during the OM and RCA bypass for group A, and for group B LAD data was also recorded. Results: Elective beating heart coronary artery bypass graft (CABG) was successfully accomplished in 32 patients with RHS. Data measurements recorded in Group A showed the improved hemodynamic recovery for OM and RCA bypass with RHS. The MAP increased from 44 to 68mmHg (OM) and from 63 to 81mmHg (RCA), the CO from 2.1 to 4.4 L/min (OM) and from 3.3 to 4.7 L/min (RCA). In group B, the data recorded showed the stability of the MAP in all vessels bypassed (LAD, OM and RCA). No device-related patient incidents ocurred. All 32 patients were discharged to their homes. Conclusons: The AMED system, as RHS support, facilitated coronary bypass without CPB to posterior vessels, restoring hemodynamics, providing better exposure to anastomotic sites and apparently reducing inotropes need. Prospective randomize trials are necessary to confirm this initial experience.

  • 38.
    Westin, C.-F.
    et al.
    Surgical Planning Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States, Surgical Planning Laboratory, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, United States.
    Wigström, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Loock, T.
    Sjoqvist, L.
    Kikinis, R.
    Surgical Planning Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
    Knutsson, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    A multielement RF coil for MRI guidance of interventional devices2001In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, Vol. 14, no 1, 56-62 p.Article in journal (Refereed)
    Abstract [en]

    Accurate localization of minimally invasive devices is critical to the success of interventional procedures. Device orientation and tip position are two of the most important pieces of information needed to define device location for magnetic resonance imaging (MRI)-guided interventional procedures. While a single one-element micro coil incorporated into an interventional device has proven to be effective in some applications, it can only supply tip position information. However, multiple positions on the device are necessary to also determine its orientation. For this purpose, a novel single micro coil design with three separate winding elements that provides both the device orientation and tip position is described in this study. Definition of MR scan planes, by using the device orientation and the target tissue location, permits automatic tracking of the insertion of the device. Furthermore, devices that include this coil design are permitted to bend to a limited extent. This makes the micro coil design appropriate for many flexible interventional devices. Reliable near-real-time tracking of three points on an interventional device is demonstrated on a 0.2T MRI system with modest gradient performance. Phantom and in vivo animal experiments are used to demonstrate the utility of this new coil design. © 2001 Wiley-Liss, Inc.

  • 39.
    Hearn, Jeff
    Linköping University, The Tema Institute, The Department of Gender Studies. Linköping University, Faculty of Arts and Sciences.
    A multi-faceted power analysis of mens violence to known women: from hegemonic masculinity to the hegemony of men2012In: Sociological Review, ISSN 0038-0261, E-ISSN 1467-954X, Vol. 60, no 4, 589-610 p.Article in journal (Refereed)
    Abstract [en]

    This article presents a multi-faceted power analysis of mens violence to known women, by way of assessing two main perspectives on research in men and masculinities: first, that founded on hegemonic masculinity, and, second, that based on the hegemony of men. Each perspective is interrogated in terms of understandings of mens violence to known women. These approaches are articulated in relation to empirical research, and conceptual and theoretical analysis. Thus this article addresses to what extent hegemonic masculinity and the hegemony of men, respectively, are useful concepts for explaining and engaging with mens violence to known women? The article concludes with discussion of more general implications of this analysis.

  • 40.
    Dalal, Koustuv
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    A National Study of the Prevalence and Correlates of Domestic Violence Among Women in India2012In: ASIA-PACIFIC JOURNAL OF PUBLIC HEALTH, ISSN 1010-5395, Vol. 24, no 2, 265-277 p.Article in journal (Refereed)
    Abstract [en]

    This article estimates the national prevalence rate of domestic violence in India and examines the demographic and socioeconomic status of the victims of domestic violence. The study used the Indian National Family Health Survey 3, a cross-sectional national survey of 124 385 ever-married women of reproductive age from all the 29 member states. chi(2) Analysis and logistic regression were used. Lifetime experiences of violence among respondents were as follows: emotional violence, 14%; less severe physical violence, 31%; severe physical violence, 10%; and sexual violence, 8%. Women of scheduled castes and Muslim religion were most often exposed to domestic violence. Womens poorer economic background, working status, and husbands controlling behavior emerged as strong predictors for domestic violence in India. Elimination of structural inequalities inherent in the indigenous oppressive institutions of religion, caste, and the traditional male hierarchy in society could prevent domestic violence.

  • 41. Zhang, Q
    et al.
    Lindberg, Lars-Göran
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Kadefors, R
    Styf, Johan
    A non-invasive measure of changes in blood flow in the human anterior tibial muscle2001In: European Journal of Applied Physiology, ISSN 1439-6319, Vol. 84, no 5, 448-452 p.Article in journal (Refereed)
    Abstract [en]

    We used photoplethysmography (PPG) to monitor blood flow changes in the human anterior tibial muscle during arterial occlusion and during isometric and concentric contractions. Single-fibre laser-Doppler flowmetry (LDF) was used as a reference in 12 healthy subjects (5 men, 7 women, mean age 24 years). Post-exercise hyperaemic muscle blood flow (MBF) was measured immediately after isometric dorsiflexion of the ankle joint at maximal contraction for 1 min and full range-of-motion dorsiflexion and plantar flexion of the ankle joint for 1 min. A thigh tourniquet was applied for the evaluation of post-occlusive reactive hyperaemia. The MBF (baseline=100%) was [mean (SD)] 150 (31)% (P = 0.003) by PPG (880 nm) and 182 (66)% (P = 0.012) by LDF. After 1 min of maximal isometric contraction, MBF increased to 150 (51)% (P = 0.003) by PPG (880 nm) and to 169 (43)% (P = 0.005) by LDF. After 1 min of maximal concentric contractions, MBF increased to 158 (59)% (P = 0.003) by PPG (880 nm) and to 170 (99)% (P = 0.008) by LDF. Skin blood flow, PPG (560 nm), did not change significantly after isometric or concentric contractions. The results indicate that reactive hyperaemia after exercise and arterial occlusion can be assessed in the human anterior tibial muscle using PPG.

  • 42.
    Ding, Yuan C
    et al.
    City Hope National Medical Centre, CA, USA .
    McGuffog, Lesley
    University of Cambridge Worts Causeway, England .
    Healey, Sue
    Royal Brisbane Hospital, Australia .
    Friedman, Eitan
    Chaim Sheba Medical Centre, Israel Chaim Sheba Medical Centre, Israel Tel Aviv University, Israel .
    Laitman, Yael
    Chaim Sheba Medical Centre, Israel Chaim Sheba Medical Centre, Israel Tel Aviv University, Israel .
    Paluch-Shimon, Shani
    Chaim Sheba Medical Centre, Israel Chaim Sheba Medical Centre, Israel Tel Aviv University, Israel .
    Kaufman, Bella
    Chaim Sheba Medical Centre, Israel Chaim Sheba Medical Centre, Israel Tel Aviv University, Israel .
    Liljegren, Annelie
    Karolinska University Hospital, Sweden .
    Lindblom, Annika
    Karolinska University Hospital, Sweden .
    Olsson, Hakan
    University of Lund Hospital, Sweden .
    Kristoffersson, Ulf
    University of Lund Hospital, Sweden .
    Stenmark Askmalm, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Pathology and Clinical Genetics.
    Melin, Beatrice
    Umeå University, Sweden .
    Domchek, Susan M
    University of Penn, PA, USA .
    Nathanson, Katherine L
    University of Penn, PA, USA .
    Rebbeck, Timothy R
    University of Penn, PA, USA .
    Jakubowska, Anna
    Pomeranian Medical University, Poland .
    Lubinski, Jan
    Pomeranian Medical University, Poland .
    Jaworska, Katarzyna
    Pomeranian Medical University, Poland .
    Durda, Katarzyna
    Pomeranian Medical University, Poland .
    Gronwald, Jacek
    Pomeranian Medical University, Poland .
    Huzarski, Tomasz
    Pomeranian Medical University, Poland .
    Cybulski, Cezary
    Pomeranian Medical University, Poland .
    Byrski, Tomasz
    Pomeranian Medical University, Poland .
    Osorio, Ana
    Spanish National Cancer Research Centre, Spain Spanish National Cancer Research Centre, Spain Spanish Network Rare Disease CIBERER, Spain .
    Ramony Cajal, Teresa
    Hospital Santa Creu and Sant Pau, Spain .
    Stavropoulou, Alexandra V
    National Centre Science Research Demokritos, Greece .
    Benitez, Javier
    Spanish National Cancer Research Centre, Spain Spanish National Cancer Research Centre, Spain Spanish Network Rare Disease CIBERER, Spain .
    Hamann, Ute
    Deutsch Krebsforschungszentrum DKFZ, Germany .
    Rookus, Matti
    Netherlands Cancer Institute, Netherlands .
    Aalfs, Cora M
    University of Amsterdam, Netherlands .
    de Lange, Judith L
    Netherlands Cancer Institute, Netherlands .
    Meijers-Heijboer, Hanne E J
    Vrije University of Amsterdam Medical Centre, Netherlands .
    Oosterwijk, Jan C
    University of Groningen, Netherlands .
    van Asperen, Christi J
    Leiden University, Netherlands .
    Gomez Garcia, Encarna B
    MUMC, Netherlands .
    Hoogerbrugge, Nicoline
    Radboud University of Nijmegen, Netherlands .
    Jager, Agnes
    Erasmus University, Netherlands .
    van der Luijt, Rob B
    University of Medical Centre Utrecht, Netherlands .
    Easton, Douglas F
    University of Cambridge, England .
    Peock, Susan
    University of Cambridge, England .
    Frost, Debra
    University of Cambridge, England .
    Ellis, Steve D
    University of Cambridge, England .
    Platte, Radka
    University of Cambridge, England .
    Fineberg, Elena
    University of Cambridge, England .
    Evans, D Gareth
    Central Manchester University Hospital NHS Fdn Trust, England .
    Lalloo, Fiona
    Central Manchester University Hospital NHS Fdn Trust, England .
    Izatt, Louise
    Guys and St Thomas NHS Fdn Trust, England .
    Eeles, Ros
    Institute Cancer Research, England Royal Marsden NHS Fdn Trust, England .
    Adlard, Julian
    Yorkshire Regional Genet Serv, England .
    Davidson, Rosemarie
    Yorkhill Hospital, Scotland .
    Eccles, Diana
    University Hospital Southampton NHS Fdn Trust, England .
    Cole, Trevor
    Birmingham Womens Hospital Healthcare NHS Trust, England .
    Cook, Jackie
    Sheffield Childrens Hospital, England .
    Brewer, Carole
    Royal Devon and Exeter Hospital, England .
    Tischkowitz, Marc
    University of Cambridge, England .
    Godwin, Andrew K
    University of Kansas, KS, USA .
    Pathak, Harsh
    University of Kansas, KS, USA .
    Stoppa-Lyonnet, Dominique
    Institute Curie, France Institute Curie, France University of Paris 05, France .
    Sinilnikova, Olga M
    University of Lyon 1, France Centre Hospital University of Lyon, France .
    Mazoyer, Sylvie
    University of Lyon 1, France .
    Barjhoux, Laure
    University of Lyon 1, France .
    Leone, Melanie
    Centre Hospital University of Lyon, France .
    Gauthier-Villars, Marion
    Institute Curie, France .
    Caux-Moncoutier, Virginie
    Institute Curie, France .
    de Pauw, Antoine
    Institute Curie, France .
    Hardouin, Agnes
    Centre Francois Baclesse, France .
    Berthet, Pascaline
    Centre Francois Baclesse, France .
    Dreyfus, Helene
    CHU Grenoble, France University of Grenoble, France .
    Fert Ferrer, Sandra
    Hotel Dieu Centre Hospital, France .
    Collonge-Rame, Marie-Agnes
    CHU Besancon, France .
    Sokolowska, Johanna
    Nancy University, France .
    Buys, Saundra
    University of Utah, UT, USA .
    Daly, Mary
    Fox Chase Cancer Centre, PA, USA .
    Miron, Alex
    Dana Farber Cancer Institute, MA, USA .
    Terry, Mary Beth
    Columbia University, NY, USA .
    Chung, Wendy
    Columbia University, NY, USA .
    John, Esther M
    Cancer Prevent Institute Calif, CA, USA Stanford University, CA, USA Stanford Cancer Institute, CA, USA .
    Southey, Melissa
    University of Melbourne, Australia .
    Goldgar, David
    University of Utah, UT, USA .
    Singer, Christian F
    Medical University of Vienna, Austria .
    Tea, Muy-Kheng Maria
    Medical University of Vienna, Austria .
    Gschwantler-Kaulich, Daphne
    Medical University of Vienna, Austria .
    Fink-Retter, Anneliese
    Medical University of Vienna, Austria .
    Hansen, Thomas V O
    Copenhagen University Hospital, Denmark .
    Ejlertsen, Bent
    Copenhagen University Hospital, Denmark .
    Johannsson, Oskar T
    Landspitali University Hospital, Iceland University of Iceland, Iceland .
    Offit, Kenneth
    Clin Cancer Genet Lab, NY, USA .
    Sarrel, Kara
    Clin Cancer Genet Lab, NY, USA .
    Gaudet, Mia M
    Amer Cancer Soc, GA, USA .
    Vijai, Joseph
    Clin Cancer Genet Lab, NY, USA .
    Robson, Mark
    Mem Sloan Kettering Cancer Centre, NY, USA .
    Piedmonte, Marion R
    Roswell Pk Cancer Institute, NY, USA .
    Andrews, Lesley
    Australia New Zealand Gynaecol Oncology Grp, Australia .
    Cohn, David
    Ohio State University, OH, USA .
    DeMars, Leslie R
    Dartmouth Hitchcock Medical Centre, NH, USA .
    DiSilvestro, Paul
    Brown University, RI, USA .
    Rodriguez, Gustavo
    NorthShore University of Health Syst, IL, USA .
    Ewart Toland, Amanda
    Ohio State University, OH, USA Ohio State University, OH, USA .
    Montagna, Marco
    Ist Oncology Veneto IOV IRCCS, Italy .
    Agata, Simona
    Ist Oncology Veneto IOV IRCCS, Italy .
    Imyanitov, Evgeny
    NN Petrov Oncology Research Institute, Russia .
    Isaacs, Claudine
    Georgetown University, DC, USA .
    Janavicius, Ramunas
    Vilnius University Hospital, Lithuania .
    Lazaro, Conxi
    Institute Catala Oncol, Spain .
    Blanco, Ignacio
    IDIBELL Catalan Institute Oncol, Spain .
    Ramus, Susan J
    University of So Calif, CA, USA .
    Sucheston, Lara
    Roswell Pk Cancer Institute, NY, USA .
    Karlan, Beth Y
    Cedars Sinai Medical Centre, CA, USA .
    Gross, Jenny
    Cedars Sinai Medical Centre, CA, USA .
    Ganz, Patricia A
    University of Calif Los Angeles, CA, USA .
    Beattie, Mary S
    University of Calif San Francisco, CA, USA .
    Schmutzler, Rita K
    University Hospital Cologne, Germany .
    Wappenschmidt, Barbara
    University Hospital Cologne, Germany .
    Meindl, Alfons
    Technical University of Munich, Germany .
    Arnold, Norbert
    University of Kiel, Germany .
    Niederacher, Dieter
    University of Dusseldorf, Germany .
    Preisler-Adams, Sabine
    University of Munster, Germany .
    Gadzicki, Dorotehea
    Hannover Medical Sch, Germany .
    Varon-Mateeva, Raymonda
    Charite, Germany .
    Deissler, Helmut
    University Hospital Ulm, Germany .
    Gehrig, Andrea
    University of Wurzburg, Germany .
    Sutter, Christian
    University of Heidelberg Hospital, Germany .
    Kast, Karin
    Technical University of Dresden, Germany .
    Nevanlinna, Heli
    University of Helsinki, Finland .
    Aittomaki, Kristiina
    Centre Hospital University of Quebec, Canada University of Laval, Canada .
    Spurdle, Amanda B
    Royal Brisbane Hospital, Australia .
    Beesley, Jonathan
    Royal Brisbane Hospital, Australia .
    Chen, Xiaoqing
    Royal Brisbane Hospital, Australia .
    Tomlinson, Gail E
    University of Texas Health Science Centre San Antonio, TX, USA.
    Weitzel, Jeffrey
    City Hope National Medical Centre, CA, USA .
    Garber, Judy E
    Harvard University, MA, USA .
    Olopade, Olufunmilayo I
    University of Chicago, IL, USA .
    Rubinstein, Wendy S
    NorthShore University of HealthSyst, IL, USA .
    Tung, Nadine
    Beth Israel Deaconess Medical Centre, MA, USA .
    Blum, Joanne L
    Baylor Charles A Sammons Cancer Centre, TX, USA .
    Narod, Steven A
    Womens Coll Hospital, Canada .
    Brummel, Sean
    Harvard University, MA, USA .
    Gillen, Daniel L
    University of Calif Irvine, CA USA .
    Lindor, Noralane
    Mayo Clin, MN, USA .
    Fredericksen, Zachary
    Mayo Clin, MN, USA .
    Pankratz, Vernon S
    Mayo Clin, MN, USA .
    Couch, Fergus J
    Mayo Clin, MN, USA .
    Radice, Paolo
    Fdn IRCCS Ist Nazl Tumori INT, Italy Fdn Ist FIRC Oncology Mol, Italy .
    Peterlongo, Paolo
    Fdn IRCCS Ist Nazl Tumori INT, Italy Fdn Ist FIRC Oncology Mol, Italy .
    Greene, Mark H
    NCI, MD, USA .
    Loud, Jennifer T
    NCI, MD, USA .
    Mai, Phuong L
    NCI, MD, USA .
    Andrulis, Irene L
    University of Toronto, Canada .
    Glendon, Gord
    University of Toronto, Canada .
    Gerdes, Anne-Marie
    Odense University Hospital, Denmark .
    Birk Jensen, Uffe
    Skejby Hospital, Denmark .
    Skytte, Anne-Bine
    Vejle Hospital, Denmark .
    Caligo, Maria A
    University of Pisa, Italy University Hospital Pisa, Italy .
    Lee, Andrew
    University of Cambridge Worts Causeway, England .
    Chenevix-Trench, Georgia
    Royal Brisbane Hospital, Australia .
    Antoniou, Antonis C
    University of Cambridge Worts Causeway, England .
    Neuhausen, Susan L
    City Hope National Medical Centre, CA, USA .
    A Nonsynonymous Polymorphism in IRS1 Modifies Risk of Developing Breast and Ovarian Cancers in BRCA1 and Ovarian Cancer in BRCA2 Mutation Carriers2012In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 21, no 8, 1362-1370 p.Article in journal (Refereed)
    Abstract [en]

    Background: We previously reported significant associations between genetic variants in insulin receptor substrate 1 (IRS1) and breast cancer risk in women carrying BRCA1 mutations. The objectives of this study were to investigate whether the IRS1 variants modified ovarian cancer risk and were associated with breast cancer risk in a larger cohort of BRCA1 and BRCA2 mutation carriers. less thanbrgreater than less thanbrgreater thanMethods: IRS1 rs1801123, rs1330645, and rs1801278 were genotyped in samples from 36 centers in the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA). Data were analyzed by a retrospective cohort approach modeling the associations with breast and ovarian cancer risks simultaneously. Analyses were stratified by BRCA1 and BRCA2 status and mutation class in BRCA1 carriers. less thanbrgreater than less thanbrgreater thanResults: Rs1801278 (Gly972Arg) was associated with ovarian cancer risk for both BRCA1 (HR, 1.43; 95% confidence interval (CI), 1.06-1.92; P = 0.019) and BRCA2 mutation carriers (HR, 2.21; 95% CI, 1.39-3.52, P = 0.0008). For BRCA1 mutation carriers, the breast cancer risk was higher in carriers with class II mutations than class I mutations (class II HR, 1.86; 95% CI, 1.28-2.70; class I HR, 0.86; 95%CI, 0.69-1.09; P-difference, 0.0006). Rs13306465 was associated with ovarian cancer risk in BRCA1 class II mutation carriers (HR, 2.42; P = 0.03). less thanbrgreater than less thanbrgreater thanConclusion: The IRS1 Gly972Arg single-nucleotide polymorphism, which affects insulin-like growth factor and insulin signaling, modifies ovarian cancer risk in BRCA1 and BRCA2 mutation carriers and breast cancer risk in BRCA1 class II mutation carriers. less thanbrgreater than less thanbrgreater thanImpact: These findings may prove useful for risk prediction for breast and ovarian cancers in BRCA1 and BRCA2 mutation carriers.

  • 43.
    Persson, Pär
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Kjølhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    A one‐year follow‐up of psychological well‐being after subtotal and total abdominal hysterectomy‐ a randomised study2010In: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, ISSN 1470-0328, Vol. 117, no 4, 479-487 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To compare subtotal abdominal hysterectomy (SH) and total abdominal hysterectomy (TH) regarding influence on postoperative psychological well‐being and surgical outcome measurements.

    Design: A prospective, open, randomised multicenter trial.

    Setting: Seven hospitals and one private clinic in the south‐east of Sweden. Population: 200 women scheduled for abdominal hysterectomy for benign conditions were enrolled in the study; 179 women completed the study (94 SH and 85 TH).

    Methods: Four different psychometric tests measuring general well‐being, depression and anxiety preoperatively, six and 12 months postoperatively. Statistical analysis of variance and covariance were used. Main outcome measures: Effects of operating method on psychological well‐being postoperatively. Analysis of demographic, clinical and surgical data including peri‐ and postoperative complications and complaints at follow‐up.

    Results: No significant differences were observed between the two groups in any of the psychometric tests. Both surgical methods were associated with a significantly higher degree of psychological well‐being six and 12 months postoperatively compared with preoperatively. The operating time was significantly longer for TH than SH. No significant differences were found in the clinical measures including complications. A substantial number of women experienced persistent cyclic vaginal bleedings after SH. Neither minor or major postoperative complications nor serum concentration of sex hormones were associated with the psychological general well‐being 12 months after the operation. Conclusions: General psychological well‐being is equally improved after both SH and TH within 12 months after the operation and does not seem to be associated with occurrence of perioperative complications or serum concentration of sex hormones.

  • 44.
    Tinghög, Petter
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Richt, Bengt
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Eriksson, Mimmi
    Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm, Sweden.
    Nordenfelt, Lennart
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    A phenomenological approach to the study of stress among immigrants: the case of Iraqi and Iranian women in SwedenManuscript (Other academic)
    Abstract [en]

    This study begins with the outlining of a general phenomenological theory of stress, which subsequently is applied to eleven Iraqi and Iranian migrant women’s own accounts of life in Sweden. The analysis of the interviews suggested that domestic disputes and intergenerational conflicts may become particularly stressful in that they are often amplified by incompatible Western and Non‐Western representations. The detected stressful experiences are analysed and structured to elucidate their character. Finally, a typology of stressful experiences in the new environment based on the distinctions between immigrant/minority‐specific and non‐immigrant/‐ minority‐specific stress, as well as between culturogenic and non‐culturogenic stress, is presented and defended.

  • 45.
    Uhlin, Bo
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Hammer, Richard
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Buciuto, Robert
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    A pilot study describing a new device for the fixation of unstable trochanteric fractures of the hip1995In: International Journal of Orthopaedic Trauma, ISSN 0960-2941, Vol. 5, 69-71 p.Article in journal (Refereed)
    Abstract [en]

    A new fixed 120o angled blade-plate with a buttress rod was used in a consecutive series of 27 trochanteric hip-fractures. Twenty fractures were classified as unstable. There were 20 women and seven men. The mean ages was 79 years (range:63-92). There were two intraoperative complications registered at surgery. All patients were allowed full weightbearing from the first day after surgery. Three patients dies and another four were not available for follow-up or were followed-up less than three months. Three cases were considered to be failures, The remaining 17 patients were followed-up at an avarage of 16 months. In these 17 patients, of which 12 were classified as unstable, the fractures healed with no change in position. In conclusion, we have found this new device to be a relatively simple method for the fixation of unstable trochanteric fractures. In addition, and of decisive importance, the mechanical properties seem to be sufficient for early full unaided weightbearing without risk of implant railure or non-union of the fractures.

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

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

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

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

  • 48.
    Olsen Faresjö, Åshild
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Johansson, Saga
    Cardiovascular Institute, University of Gothenburg, Gothenburg, Sweden; and Department of Epidemiology, AstraZeneca R and D, Mölndal, Sweden.
    Wallander, Mari-Ann
    Department of Epidemiology, AstraZeneca R and D, Mölndal, Sweden; and Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Åkerlind, Ingemar
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.
    A population based case control study of work and psychosocial problems in patients with irritable bowel syndrome: women are more seriously affected than men2007In: American Journal of Gastroenterology, ISSN 0002-9270, Vol. 102, no 2, 371-379 p.Article in journal (Refereed)
    Abstract [en]

    Objective: Everyday psychosocial functioning and quality of life are known to be reduced for patients with irritable bowel syndrome (IBS), but few previous studies have analyzed associations with functioning in working life. Accordingly, we examined perceptions of working conditions, functioning in the workplace, quality of life, and psychological complaints among IBS patients compared with age- and sex-matched controls.

    Methods: A case–control study design was used based on 347 IBS patients from Swedish general practice who were compared with age- and sex-matched controls (N = 1,041) randomly selected from the general population. A survey was performed including validated questions concerning job strain, quality of life (SF-36 [Short Form 36]), absence because of illness, depression, anxiety, and sleeping habits.

    Results: The IBS patients reported considerably more often that their daily performance in working life was affected by their gastrointestinal problems (OR [odds ratio] 7.14, 95% CI 5.45–9.36). Male IBS cases only reported less authority regarding decisions on their working pace (OR 5.44, 95% CI 1.28–23.18), while female IBS patients reported less decision authority regarding planning their work (OR 2.29, 95% CI 1.13–4.64), fewer learning opportunities at work (OR 2.12, 95% CI 1.26–3.57), and more long-term sick leave than their controls (OR 3.70, 95% CI 1.94–7.07). The female IBS cases also reported lower quality of life in all dimensions than their controls.

    Conclusion: In particular, female IBS patients reported lower authority over decisions at work and problems in their daily functioning in the workplace. These associations persisted after adjustments for possible confounders such as mood, sleeping problems, and perceived health.

  • 49.
    Silins, Ilvars
    et al.
    Oncology Center of Latvia, Riga, Latvia / Department of Gynecologic Oncology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden / Department of Medical Microbiology, MAS University Hospital, Malmö, Sweden.
    Wang, Xiaodong
    Linköping University, Department of Science and Technology, Physics and Electronics. Linköping University, The Institute of Technology. Department of Medical Microbiology, MAS University Hospital, Malmö, Sweden.
    Tadesse, Amha
    Merck Research Laboratories, West Point, PA 19486, USA.
    Jansen, Kathrin U
    Merck Research Laboratories, West Point, PA 19486, USA.
    Schiller, John T
    Laboratory of Cellular Oncology, The National Cancer Institute, Bethesda, MD 20892, USA.
    Åvall-Lundqvist, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Department of Gynecologic Oncology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden.
    Frankendal, Bo
    Department of Gynecologic Oncology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden.
    Dillner, Joakim
    Department of Medical Microbiology, MAS University Hospital, Malmö, Sweden.
    A population-based study of cervical carcinoma and HPV infection in Latvia.2004In: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 93, no 2, 484-492 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We wished to quantify the population-based importance of cervical carcinoma risk factors in Latvia.

    METHODS: Totally, 223 of 224 eligible cases of incident invasive cervical carcinoma were enrolled during July 1998-February 2001 in Latvia. An age-matched sample of 300 healthy control women was selected from the Latvian population registry and 239 of these women (79%) were enrolled. A demographic and life-style questionnaire was completed, cervical brush samples were analyzed for human papillomavirus (HPV) DNA by PCR and serum samples for HPV antibodies.

    RESULTS: Risk factors for cervical cancer in multivariate analysis were HPV type 16 or 18 DNA positivity (OR = 32.4; CI 95% 16.5-63.6) and living in the capital (OR = 2.4; CI 95% 1.2-4.7). Oral contraceptive use was not a risk factor (OR = 0.4; CI 95% 0.2-1.1). A strong protective effect was found for having had more than three Pap smears in the last 5 years (OR = 0.07 CI 95% 0.03-0.19).

    CONCLUSIONS: Inadequate population coverage of Pap smears, in spite of excessive smear usage, caused 28.4% of cervical cancers in age groups eligible for screening. HPV type 16 infection was the most important risk factor for cervical cancer in Latvia, with a population-attributable risk percent for all ages of 58.5%.

  • 50.
    Sigvant, Birgitta
    et al.
    Central Hospital Karlstad, Sweden.
    Wiberg-Hedman, Katarina
    Central Hospital Karlstad, Sweden.
    Bergqvist, David
    Uppsala University Hospital, Sweden.
    Rolandsson, Olov
    Umeå University, Sweden.
    Andersson, Bob
    Skutskär Health Care Centre, Karolinska University Hospital and Institute, Malmö, Stockholm, Sweden.
    Persson, Elisabeth
    Rosengård Health Care Centre, Karolinska University Hospital and Institute, Malmö, Stockholm, Sweden.
    Wahlberg, Eric
    Karolinska University Hospital and Institute, Malmö, Stockholm, Sweden.
    A population-based study of peripheral arterial disease prevalence with special focus on critical limb ischemia and sex differences.2007In: Journal of Vascular Surgery, ISSN 0741-5214, Vol. 45, no 6, 1185-1191 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: A population-based point-prevalence study was conducted to determine the prevalence of peripheral arterial disease (PAD) in Sweden, with special attention to critical limb ischemia and sex differences.

    METHODS: An age-standardized randomly selected population sample of 8000 women and men, aged 60 to 90 years, from four different regions in Sweden was invited to participate. The sample had the same age and gender distribution as the Swedish population in this age group. Participating subjects completed questionnaires on medical history, present medication, and symptoms, and their ankle-brachial index (ABI) was measured. Subjects were analyzed for presence of PAD according to reported symptoms and an ABI<0.9.

    RESULTS: A total of 5080 subjects were included, giving a participation rate of 64%. The prevalence of any PAD, asymptomatic PAD, intermittent claudication, and severe limb ischemia was, respectively, 18% (95% confidence interval [CI], 16% to 20%) 11% (9% to 13%), 7% (6.5 to 7%) and 1.2% (1% to 1.5%). Women had a higher prevalence than men when PAD was diagnosed with ABI only; that is, asymptomatic PAD (12.6% vs 9.4%, P=.03) and severe limb ischemia (1.5% vs 0.8%, P<.008). The prevalence of any PAD was 7.9% in the age group 60 to 65 years and increased to 47.2% among the age group 85 to 90 years. Severe limb ischemia occurred in 0.3% in the youngest age group, was highest in the age group 80 to 84 years at 3.3%, and declined to 2.5% among the oldest. The prevalence of PAD differed between regions (P<.0001).

    CONCLUSIONS: PAD is common in Sweden, and almost a fifth of all elderly individuals have some stage of this disease. Women are more often afflicted than men. The prevalence of severe ischemia, as a measure of critical limb ischemia, is about 1% the population.

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