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Nordstrom, Anna
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Publications (10 of 66) Show all publications
Nordström, P., Gustafson, Y., Michaëlsson, K. & Nordström, A. (2015). Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden. BMJ. British Medical Journal, 350, Article ID h696.
Open this publication in new window or tab >>Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden
2015 (English)In: BMJ. British Medical Journal, ISSN 1756-1833, Vol. 350, article id h696Article in journal (Refereed) Published
Abstract [en]

Objective To investigate relation between inpatient length of stay after hip fracture and risk of death after hospital discharge. Setting Population >= 50 years old living in Sweden as of 31 December 2005 with a first hip fracture the years 2006-12. Participants 116 111 patients with an incident hip fracture from a closed nationwide cohort. Main outcome measure Death within 30 days of hospital discharge in relation to hospital length of stay after adjustment for multiple covariates. Results Mean inpatient length of stay after a hip fracture decreased from 14.2 days in 2006 to 11.6 days in 2012 (P<0.001). The association between length of stay and risk of death after discharge was non-linear (P<0.001), with a threshold for this non-linear effect of about 10 days. Thus, for patients with length of stay of <= 10 days (n=59 154), each 1-day reduction in length of stay increased the odds of death within 30 days of discharge by 8% in 2006 (odds ratio 1.08 (95% confidence interval 1.04 to 1.12)), which increased to16% in 2012 (odds ratio 1.16 (1.12 to 1.20)). In contrast, for patients with a length of stay of >= 11 days (n=56 957), a 1-day reduction in length of stay was not associated with an increased risk of death after discharge during any of the years of follow up. Limitations No accurate evaluation of the underlying cause of death could be performed. Conclusion Shorter length of stay in hospital after hip fracture is associated with increased risk of death after hospital discharge, but only among patients with length of stay of 10 days or less. This association remained robust over consecutive years.

National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-102289 (URN)10.1136/bmj.h696 (DOI)000349911800005 ()25700551 (PubMedID)
Available from: 2015-06-24 Created: 2015-04-23 Last updated: 2018-01-11Bibliographically approved
Gustafsson, H., Aasly, J., Stråhle, S., Nordström, A. & Nordstrom, P. (2015). Low muscle strength in late adolescence and Parkinson disease later in life. Neurology, 84(18), 1862-1869
Open this publication in new window or tab >>Low muscle strength in late adolescence and Parkinson disease later in life
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2015 (English)In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 84, no 18, p. 1862-1869Article in journal (Refereed) Published
Abstract [en]

Objective:To evaluate maximal isometric muscle force at 18 years of age in relation to Parkinson disease (PD) later in life.Methods:The cohort consisted of 1,317,713 men who had their muscle strength measured during conscription (1969-1996). Associations between participants' muscle strength at conscription and PD diagnoses, also in their parents, were examined using multivariate statistical models.Results:After adjustment for confounders, the lowest compared to the highest fifth of handgrip strength (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.06-1.79), elbow flexion strength (HR 1.34, 95% CI 1.02-1.76), but not knee extension strength (HR 1.24, 95% CI 0.94-1.62) was associated with an increased risk of PD during follow-up. Furthermore, men whose parents were diagnosed with PD had reduced handgrip (fathers: mean difference [MD] -5.7 N [95% CI -7.3 to -4.0]; mothers: MD -5.0 N [95% CI -7.0 to -2.9]) and elbow flexion (fathers: MD -4.3 N [95% CI -5.7 to -2.9]; mothers: MD -3.9 N [95% CI -5.7 to -2.2]) strength, but not knee extension strength (fathers: MD -1.1 N [95% CI -2.9 to 0.8]; mothers: MD -0.7 N [95% CI -3.1 to 1.6]), than those with no such familial history.Conclusions:Maximal upper extremity voluntary muscle force was reduced in late adolescence in men diagnosed with PD 30 years later. The findings suggest the presence of subclinical motor deficits 3 decades before the clinical onset of PD.

National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-106274 (URN)10.1212/WNL.0000000000001534 (DOI)000354104100011 ()25841033 (PubMedID)
Available from: 2015-07-10 Created: 2015-07-09 Last updated: 2018-03-15Bibliographically approved
Gustafsson, H., Nordström, P., Strahle, S. & Nordström, A. (2015). Parkinsons Disease: A population-based investigation of life satisfaction and employment. Journal of Rehabilitation Medicine, 47(1), 45-51
Open this publication in new window or tab >>Parkinsons Disease: A population-based investigation of life satisfaction and employment
2015 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, no 1, p. 45-51Article in journal (Refereed) Published
Abstract [en]

Objective:

To investigate relationships between individuals' socioeconomic situations and quality of life in working-aged subjects with Parkinson's disease.

Methods:

A population-based cohort comprising 1,432 people with Parkinson's disease and 1,135 matched controls, who responded to a questionnaire. Logistic regression analysis was performed to identify factors associated with life satisfaction and likelihood of employment.

Results:

In multivariate analyses, Parkinson's disease was associated with an increased risk of dissatisfaction with life (odds ratio (OR) = 5.4, 95% confidence interval (95% CI) = 4.2-7.1) and reduced likelihood of employment (OR = 0.30, 95% CI = 0.25-0.37). Employers' support was associated with greater likelihood of employment (p < 0.001). Twenty-four percent of people with Parkinson's disease for ≥ 10 years remained employed and 6% worked full-time. People with Parkinson's disease also more frequently experienced work demands that exceeded their capacity; this factor and unemployment independently correlated with greater risk of dissatisfaction with life (both p < 0.05).

Conclusion:

People with Parkinson's disease have an increased risk of dissatisfaction with life. Employment situation is important for general life satisfaction among working-aged individuals. People with Parkinson's disease appear to find it difficult to meet the challenge of achieving a balanced employment situation.

Keyword
Parkinson's disease, life satisfaction, work
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:umu:diva-95063 (URN)10.2340/16501977-1884 (DOI)000347761600007 ()25268547 (PubMedID)
Available from: 2014-10-21 Created: 2014-10-21 Last updated: 2018-03-15Bibliographically approved
Högström, G., Nordström, A., Eriksson, M. & Nordström, P. (2015). Risk factors assessed in adolescence and the later risk of stroke in men: a 33-year follow-up study. Cerebrovascular Diseases, 39(1), 63-71
Open this publication in new window or tab >>Risk factors assessed in adolescence and the later risk of stroke in men: a 33-year follow-up study
2015 (English)In: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 39, no 1, p. 63-71Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Stroke is a common cause of death, and a leading contributor to long-term disability. The cost associated with the disease is great. Several modifiable risk factors for stroke have been found in older cohorts; however, no study to date has investigated the effects of these risk factors from late adolescence.

METHODS: The study cohort comprised 811,579 Swedish men (mean age, 18 years) that participated in the mandatory military conscription service in Sweden between 1969 and 1986. Some risk factors for stroke, such as body mass index, systolic and diastolic blood pressure, and cognitive function, were assessed at conscription. Aerobic fitness was also assessed at conscription, using a braked ergometer cycle test. Other risk factors for stroke, including stroke in subjects' parents, and socioeconomic factors including highest achieved level of education and annual income 15 years after conscription, were collected through national register linkage using the personal identification number. Stroke diagnosis among the study participants was tracked in the National Hospital Discharge Patient Register.

RESULTS: During a median follow-up period of 33 years 6,180 ischemic strokes and 2,104 hemorrhagic strokes were diagnosed in the cohort at a mean age of 47.9 years. Strong independent risk factors (all p <1.0 × 10-(6)) for ischemic stroke included low aerobic fitness (hazard ratio [HR], 0.84 per standard deviation [SD] increase), high BMI (HR, 1.15 per SD increase), diabetes (HR, 2.85), alcohol intoxication (HR, 1.93), low annual income (HR, 0.85 per SD decrease), and stroke in the mother (HR, 1.31). Similar risk factors were found for hemorrhagic stroke including low aerobic fitness (HR, 0.82 per SD increase), high BMI (HR, 1.18 per SD increase) alcohol intoxication (HR, 2.92), diabetes (HR, 2.06), and low annual income (HR, 0.75). The population attributable risks associated with all evaluated risk factors were 69% for ischemic stroke and 88% for hemorrhagic stroke (p < 0.001 for both).

CONCLUSIONS: In the present study we have shown that several known risk factors for stroke are present already in late adolescence, and that they are independent of each other. The strongest risk factors were low physical fitness, high BMI, diabetes, low annual income and a maternal history of stroke. Several of the aforementioned risk factors are potentially modifiable.

National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-99250 (URN)10.1159/000369960 (DOI)000348213700008 ()25547343 (PubMedID)2-s2.0-84920838888 (Scopus ID)
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2017-12-05Bibliographically approved
Högström, G., Nordström, A. & Nordström, P. (2014). High aerobic fitness in late adolescence is associated with a reduced risk of myocardial infarction later in life: a nationwide cohort study in men. European Heart Journal, 35(44), 3133-3140
Open this publication in new window or tab >>High aerobic fitness in late adolescence is associated with a reduced risk of myocardial infarction later in life: a nationwide cohort study in men
2014 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no 44, p. 3133-3140Article in journal (Refereed) Published
Abstract [en]

AIMS: Cardiovascular disease is the leading cause of morbidity and mortality worldwide, and signs of atherosclerosis are present in all large arteries already in adolescence. We investigated the association between high physical fitness in late adolescence and myocardial infarction (MI) later in life.

METHODS AND RESULTS: The study cohort comprised 743 498 Swedish men examined at the age of 18 years during conscription 1969-84. Aerobic fitness (Wmax) and muscle strength at conscription were measured using standardized methods. Myocardial infarctions occurring in the cohort were tracked through national registers. During a median follow-up period of 34 years, 11 526 MIs were registered in the cohort. After adjusting for age, body mass index (BMI), diseases, education, blood pressure, and socio-economic factors, one standard deviation increase in the level of physical fitness (Wmax) was associated with an 18% decreased risk of later MI [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.80-0.85]. The beneficial effects of Wmax were significant across all recognized BMI groups, ranging from lean (BMI < 18.5) to obese (BMI > 30) (P < 0.05 for all). However, obese men (BMI > 30) in the highest fourth of Wmax had a higher risk of MI than did lean men (BMI < 18.5) in the highest (HR 4.6, 95% CI 1.9-11.2), and lowest (HR 1.7, 95% CI 1.2-2.6) fourth of Wmax.

CONCLUSIONS: We report a significant graded association between aerobic fitness in late adolescence and MI later in life in men. However, obese men with a high aerobic fitness had a higher risk of MI than lean men with a low aerobic fitness.

Place, publisher, year, edition, pages
Oxford University Press, 2014
Keyword
Treatment, Interdisciplinary Health Team, Chronic Pain, Program Evaluation, Myocardial infarction, Physical fitness, Adolescent men
National Category
Cardiac and Cardiovascular Systems Sport and Fitness Sciences
Identifiers
urn:nbn:se:umu:diva-86981 (URN)10.1093/eurheartj/eht527 (DOI)000345378300015 ()24398666 (PubMedID)
Available from: 2014-03-17 Created: 2014-03-17 Last updated: 2017-12-05Bibliographically approved
Michaëlsson, K., Nordström, P., Nordström, A., Garmo, H., Byberg, L., Pedersen, N. L. & Melhus, H. (2014). Impact of hip fracture on mortality: a cohort study in hip fracture discordant identical twins. Journal of Bone and Mineral Research, 29(2), 424-431
Open this publication in new window or tab >>Impact of hip fracture on mortality: a cohort study in hip fracture discordant identical twins
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2014 (English)In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 29, no 2, p. 424-431Article in journal (Refereed) Published
Abstract [en]

Several studies have shown a long-lasting higher mortality after hip fracture but the reasons of the excess risk is not well understood. We aimed to determine whether there exists a higher mortality after hip fracture when controlling for genetic constitution, shared environment, comorbidity and lifestyle by use of a nation-wide cohort study in hip fracture discordant monozygotic twins. All 286 identical Swedish twin pairs discordant for hip fracture (1972-2010) were identified. Comorbidity and lifestyle information was retrieved by registers and questionnaire information. We used intrapair Cox regression to compute multivariable-adjusted hazard ratios (HRs) for death. During follow-up, 143 twins with a hip fracture died (50%) compared to 101 twins (35%) without a hip fracture. Through the first year after hip fracture, the rate of death increased four-fold in women (HR 3.71; 95% confidence interval (CI) 1.32-10.40) and seven-fold in men (HR 6.67; 95% CI 1.47-30.13). The increased rate in women only persisted during the first year after hip fracture (HR after 1 year 0.99; 95% CI 0.66-1.50), whereas the corresponding HR in men was 2.58 (95% CI 1.02-6.62). The higher risk in men after the hip fracture event was successively attenuated during follow-up. After 5 years, the hazard ratio in men with a hip fracture was 1.19 (95% CI 0.29-4.90). On average, the hip fracture contributed to 0.9 years of life lost in women (95% CI 0.06-1.7) and 2.7 years in men (95% CI 1.7-3.7). The potential years of life lost associated with the hip fracture was especially pronounced in older men (>75 years), with an average loss of 47% (95% CI 31-61) of the expected remaining lifetime. We conclude that both women and men display a higher mortality after hip fracture independent of genes, comorbidity and lifestyle.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
Keyword
genetic research, epidemiology, hip fracture, mortality, twin
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-79212 (URN)10.1002/jbmr.2029 (DOI)000329773500017 ()23821464 (PubMedID)
Funder
Swedish Research Council
Available from: 2013-08-13 Created: 2013-08-13 Last updated: 2018-02-12Bibliographically approved
Tervo, T. & Nordström, A. (2014). Science of flooball: a systematic review. Open Access Journal of Sports Medicine, 2014(5), 249-255
Open this publication in new window or tab >>Science of flooball: a systematic review
2014 (English)In: Open Access Journal of Sports Medicine, ISSN 1179-1543, E-ISSN 1179-1543, Vol. 2014, no 5, p. 249-255Article in journal (Refereed) Published
Abstract [en]

Background: 

The purpose of this study was to comprehensively review the scientific research on floorball at the competitive and recreational levels according to field of study.

Methods: 

Full articles containing original data on floorball that had been published in English in peer-reviewed journals were considered for inclusion.

Results: 

Of 75 articles screened, 19 were included in this systematic review. One article each was identified in the fields of sports management and sports psychology, and the remaining 17 articles were in the field of sports medicine. Injury epidemiology in floorball players was the most thoroughly examined topic of research. To date, no research has been performed on the incidence of floorball-related injury, or any aspect of the sport, in children and adolescents.

Conclusion: 

Collaborative research among sports science disciplines is needed to identify strategies to reduce the incidence of injury and enhance the performance of licensed floorball players. Despite the increasing popularity of floorball in recent years, surprisingly little research has examined this sport.

Keyword
floorball, unihockey, review
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-96552 (URN)10.2147/OAJSM.S60490 (DOI)
Available from: 2014-11-21 Created: 2014-11-21 Last updated: 2017-12-05Bibliographically approved
Nordström, A., Nordström, P. & Ekstrand, J. (2014). Sports-related concussion increases the risk of subsequent injury by about 50% in elite male football players. British Journal of Sports Medicine, 48(19), 1447-1450
Open this publication in new window or tab >>Sports-related concussion increases the risk of subsequent injury by about 50% in elite male football players
2014 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, no 19, p. 1447-1450Article in journal (Refereed) Published
Abstract [en]

Background Little is known about the short-term and long-term sequelae of concussion, and about when athletes who have sustained such injuries can safely return to play. Purpose To examine whether sports-related concussion increases the risk of subsequent injury in elite male football players. Study design Prospective cohort study. Methods Injuries were registered for 46 male elite football teams in 10 European countries in the 2001/ 2002-2011/ 2102 seasons. Two survival models were used to analyse whether concussion increased the subsequent risk of an injury in the first year. Results During the follow-up period, 66 players sustained concussions and 1599 players sustained other injuries. Compared with the risk following other injuries, concussion was associated with a progressively increased risk of a subsequent injury in the first year (0 to <3 months, HR=1.56, 95% CI 1.09 to 2.23; 3 to <6 months, HR=2.78, 95% CI 1.58 to 4.89; 6-12 months, HR=4.07, 95% CI 2.14 to 7.76). In the second model, after adjustment for the number of injuries in the year preceding the concussion, this injury remained significantly associated with the risk of subsequent injury in the first year (HR=1.47, 95% CI 1.05 to 2.05). Conclusions Concussion was a risk factor for sustaining subsequent injury within the following year. In-depth medical evaluation, which includes neurological and cognitive assessment, is warranted within the concussion management and return-to-play process.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2014
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-94940 (URN)10.1136/bjsports-2013-093406 (DOI)000341947200011 ()
Available from: 2014-11-12 Created: 2014-10-20 Last updated: 2017-12-05Bibliographically approved
Nordström, P., Michaelsson, K., Gustafson, Y. & Nordström, A. (2014). Traumatic brain injury and young onset dementia: a nationwide cohort study. Annals of Neurology, 75(3), 374-381
Open this publication in new window or tab >>Traumatic brain injury and young onset dementia: a nationwide cohort study
2014 (English)In: Annals of Neurology, ISSN 0364-5134, E-ISSN 1531-8249, Vol. 75, no 3, p. 374-381Article in journal (Refereed) Published
Abstract [en]

Objective To investigate the association between traumatic brain injuries (TBIs) and the risk of young onset dementia (YOD), that is, dementia before 65 years of age. Methods The study cohort comprised 811,622 Swedish men (mean age = 18 years) conscripted for military service between 1969 and 1986. TBIs, dementia, and covariates were extracted from national registers. Time-dependent exposures using Cox proportional hazard regression models were evaluated. Results During a median follow-up period of 33 years, there were 45,249 men with at least 1 TBI in the cohort. After adjustment for covariates, 1 mild TBI (hazard ratio [HR] = 1.0, 95% confidence interval [CI] = 0.5-2.0), at least 2 mild TBIs (HR = 2.5, 95% CI = 0.8-8.1), or 1 severe TBI (HR = 0.7, 95% CI = 0.1-5.2) were not associated with Alzheimer dementia (AD). Other types of dementia were strongly associated with the risk of 1 mild TBI (HR = 3.8, 95% CI = 2.8-5.2), at least 2 mild TBIs (HR = 10.4, 95% CI = 6.3-17.2), and 1 severe TBI (HR = 11.4, 95% CI = 7.4-17.5) in age-adjusted analysis. However, these associations were largely attenuated after adjustment for covariates (1 mild TBI: HR = 1.7; at least 2 mild TBIs: HR = 1.7; 1 severe TBI: HR = 2.6; p < 0.05 for all). Interpretation In the present study, we found strong associations between YOD of non-AD forms and TBIs of different severity. These associations were, however, markedly attenuated after multivariate adjustment.

National Category
Neurology
Research subject
Neurology
Identifiers
urn:nbn:se:umu:diva-88409 (URN)10.1002/ana.24101 (DOI)000333547000008 ()
Available from: 2014-05-07 Created: 2014-05-05 Last updated: 2017-12-05Bibliographically approved
Toss, F., Nordström, A. & Nordström, P. (2013). Association between hematocrit in late adolescence and subsequent myocardial infarction in Swedish men. International Journal of Cardiology, 168(4), 3588-3593
Open this publication in new window or tab >>Association between hematocrit in late adolescence and subsequent myocardial infarction in Swedish men
2013 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, no 4, p. 3588-3593Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Hematocrit is an independent predictor of cardiovascular risk in middle and old age, but whether hematocrit is also a predictor at younger ages is presently not known. In this study, we examined whether hematocrit measured in adolescence was associated with the risk of myocardial infarction later in life. METHODS: During Swedish national conscription tests conducted between 1969 and 1978, the hematocrit was measured in 417,099 young Swedish men. The cohort was followed for subsequent myocardial infarction events through December 2010. Associations between hematocrit and myocardial infarction were accessed using Cox regression models. RESULTS: During a median follow-up period of 36years, 9322 first-time myocardial infarctions occurred within the study cohort. After adjusting for relevant confounders and potential risk factors for myocardial infarction, men with a hematocrit≥49% had a 1.4-fold increased risk of myocardial infarction compared with men with a hematocrit≤44%. This relationship was dose dependent (p<0.001 for trend) and remained consistent throughout the follow-up period. CONCLUSIONS: In this cohort of young Swedish men, hematocrit was associated with the risk of myocardial infarction later in life after controlling for other coronary risk factors. The study findings indicate that hematocrit may aid future risk assessments in young individuals.

Place, publisher, year, edition, pages
Elsevier, 2013
Keyword
Hematocrit, Blood rheology, Erythrocyte sedimentation rate, Risk factor, Adolescence, Myocardial infarction
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-79213 (URN)10.1016/j.ijcard.2013.05.065 (DOI)23735337 (PubMedID)
Available from: 2013-08-13 Created: 2013-08-13 Last updated: 2017-12-06Bibliographically approved
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