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Forssen, Annika
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Publications (10 of 57) Show all publications
Waller Lidström, M., Wennberg, P., Lundqvist, R., Forssén, A. & Waller, G. (2017). Time trends of comparative self-rated health in adults aged 25–34 in the Northern Sweden MONICA study, 1990–2014. PLoS ONE, 12(11), Article ID e0187896.
Open this publication in new window or tab >>Time trends of comparative self-rated health in adults aged 25–34 in the Northern Sweden MONICA study, 1990–2014
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 11, article id e0187896Article in journal (Refereed) Published
Abstract [en]

Self-rated health (SRH) accounts comprehensively for many health domains. The aim of this paper was to investigate time trends and associations between age-comparative self-rated health and some known determinants in a general population aged 24-34 years. Population- based cross-sectional surveys were performed in 1990, 1994, 1999, 2004, 2009 and 2014 in Northern Sweden. Out of 3500 invited persons, 1811 responded. Comparative SRH was measured on a three-grade ordinal scale by the question: "How would you assess your general health condition compared to persons of your own age?" with the alternatives-better/worse/similar". Over the period 1990 to 2014, the percentage of women rating comparative SRH as "worse" increased steadily, from 8.5% in 1990 reaching 20% in 2014 (p for trend 0.007). Among men, this pattern was almost the opposite, with increasing proportions rating "better" (p for trend <0.000). Time trends for physical activity in leisure time; length of education; Body Mass Index; anxiety; depressive emotions and satisfaction with economy showed a similar pattern for men and women. Factors that might contribute to the development of time trends for comparative SRH are discussed.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-143015 (URN)10.1371/journal.pone.0187896 (DOI)000415756700022 ()
Available from: 2017-12-14 Created: 2017-12-14 Last updated: 2018-06-09Bibliographically approved
Bergstedt Oscarsson, K., Brorstad, A., Baudin, M., Lindberg, A., Forssén, A., Evander, M., . . . Ahlm, C. (2016). Human Puumala hantavirus infection in northern Sweden: increased seroprevalence and association to risk and health factors. BMC Infectious Diseases, 16, Article ID 566.
Open this publication in new window or tab >>Human Puumala hantavirus infection in northern Sweden: increased seroprevalence and association to risk and health factors
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2016 (English)In: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 16, article id 566Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The rodent borne Puumala hantavirus (PUUV) causes haemorrhagic fever with renal syndrome in central and northern Europe. The number of cases has increased and northern Sweden has experienced large outbreaks in 1998 and 2006-2007 which raised questions regarding the level of immunity in the human population.

METHODS: A randomly selected population aged between 25 and 74 years from northern Sweden were invited during 2009 to participate in a WHO project for monitoring of trends and determinants in cardiovascular disease. Health and risk factors were evaluated and sera from 1,600 participants were available for analysis for specific PUUV IgG antibodies using a recombinant PUUV nucleocapsid protein ELISA.

RESULTS: The overall seroprevalence in the investigated population was 13.4 %, which is a 50 % increase compared to a similar study only two decades previously. The prevalence of PUUV IgG increased with age, and among 65-75 years it was 22 %. More men (15.3 %) than women (11.4 %) were seropositive (p < 0.05). The identified risk factors were smoking (OR = 1.67), living in rural areas (OR = 1.92), and owning farmland or forest (OR = 2.44). No associations were found between previous PUUV exposure and chronic lung disease, diabetes, hypertension, renal dysfunction, stroke or myocardial infarction.

CONCLUSIONS: PUUV is a common infection in northern Sweden and there is a high life time risk to acquire PUUV infection in endemic areas. Certain risk factors as living in rural areas and smoking were identified. Groups with increased risk should be targeted for future vaccination when available, and should also be informed about appropriate protection from rodent secreta.

Keywords
Emerging infection, Hantavirus, Haemhorrhagic fever with renal syndrome, Puumala, seroepidemiology, Risk factors
National Category
Infectious Medicine
Identifiers
urn:nbn:se:umu:diva-127441 (URN)10.1186/s12879-016-1879-2 (DOI)000385447000001 ()27737653 (PubMedID)
Available from: 2016-11-12 Created: 2016-11-12 Last updated: 2018-06-09Bibliographically approved
Waller, G., Janlert, U., Norberg, M., Lundqvist, R. & Forssen, A. (2016). Self-Rated Health and Standard Risk Factors for Myocardial Infarction: A Cohort Study. Journal of Psychosomatic Research, 85, 87-88
Open this publication in new window or tab >>Self-Rated Health and Standard Risk Factors for Myocardial Infarction: A Cohort Study
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2016 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 85, p. 87-88Article in journal, Meeting abstract (Other academic) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-123990 (URN)10.1016/j.jpsychores.2016.03.218 (DOI)000377627200101 ()
Note

Meeting Abstract: 92

Available from: 2016-08-19 Created: 2016-07-07 Last updated: 2018-06-07Bibliographically approved
Waller, G., Janlert, U., Hamberg, K. & Forssén, A. (2016). What does age-comparative self-rated health measure?: A cross-sectional study from the Northern Sweden MONICA Project. Scandinavian Journal of Public Health, 44(3), 233-239
Open this publication in new window or tab >>What does age-comparative self-rated health measure?: A cross-sectional study from the Northern Sweden MONICA Project
2016 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 3, p. 233-239Article, review/survey (Refereed) Published
Abstract [en]

Aims: Self-rated health comprehensively accounts for many health domains. Using self-ratings and a knowledge of associations with health domains might help personnel in the health care sector to understand reports of ill health. The aim of this paper was to investigate associations between age-comparative self-rated health and disease, risk factors, emotions and psychosocial factors in a general population. Methods: We based our study on population-based cross-sectional surveys performed in 1999, 2004 and 2009 in northern Sweden. Participants were 25-74 years of age and 5314 of the 7500 people invited completed the survey. Comparative self-rated health was measured on a three-grade ordinal scale by the question How would you assess your general health condition compared to persons of your own age?' with the alternatives better', worse' or similar'. The independent variables were sex, age, blood pressure, cholesterol, body mass index, self-reported myocardial infarction, stroke, diabetes, physical activity, smoking, risk of unemployment, satisfaction with economic situation, anxiety and depressive emotions, education and Karasek scale of working conditions. Odds ratios using ordinal regression were calculated. Results: Age, sex, stroke, myocardial infarction, diabetes, body mass index, physical activity, economic satisfaction, anxiety and depressive emotions were associated with comparative self-rated health. The risk of unemployment, a tense work situation and educational level were also associated with comparative self-rated health, although they were considerably weaker when adjusted for the the other variables. Anxiety, depressive emotions, low economic satisfaction and a tense work situation were common in the population. Conclusions:Emotions and economic satisfaction were associated with comparative self-rated health as well as some medical variables. Utilization of the knowledge of these associations in health care should be further investigated.

Place, publisher, year, edition, pages
London: Sage Publications, 2016
Keywords
cardiovascular disease, comparative self-rated health, diabetes, emotions, ordinal regression analysis, population based study, psychosocial factors, risk factors
National Category
General Practice
Research subject
Family Medicine
Identifiers
urn:nbn:se:umu:diva-109147 (URN)10.1177/1403494815618554 (DOI)000373591600003 ()26644159 (PubMedID)
Note

Originally published in manuscript form.

Available from: 2015-09-21 Created: 2015-09-21 Last updated: 2018-06-07Bibliographically approved
Waller, G., Hamberg, K. & Forssén, A. (2015). GPs asking patients to self-rate their health: a qualitative study. British Journal of General Practice, 65(638), e624-e629
Open this publication in new window or tab >>GPs asking patients to self-rate their health: a qualitative study
2015 (English)In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 65, no 638, p. e624-e629Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In epidemiological research, self-rated health is an independent predictor of mortality, cardiovascular diseases, and other critical outcomes. It is recommended for clinical use, but research is lacking.

AIM: To investigate what happens in consultations when the question 'How would you assess your general health compared with others your own age?' is posed.

DESIGN AND SETTING: Authentic consultations with GPs at health centres in Sweden.

METHOD: Thirty-three planned visits concerning diabetes, pain, or undiagnosed symptoms were voice-recorded. Dialogue regarding self-rated health was transcribed verbatim and analysed using a systematic text condensation method. Speaking time of patients and doctors was measured and the doctors' assessment of the value of the question was documented in a short questionnaire.

RESULTS: Two overarching themes are used to describe patients' responses to the question. First, there was an immediate reaction, often expressing strong emotions, setting the tone of the dialogue and influencing the continued conversation. This was followed by reflection regarding their functional ability, management of illnesses and risks, and/or situation in life. The GPs maintained an attitude of active listening. They sometimes reported a slight increase in consultation time or feeling disturbed by the question, but mostly judged it as valuable, shedding additional light on the patients' situation and making it easier to discuss difficulties and resources. The patients' speaking time increased noticeably during this part of the consultation.

CONCLUSION: Asking patients to comparatively self-rate their health is an effective tool in general practice.

Place, publisher, year, edition, pages
British Journal of General Practice, 2015
National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-108085 (URN)10.3399/bjgp15X686557 (DOI)000361840400009 ()26324500 (PubMedID)
Note

Funding: County Council of Norrbotten (references NLL-302621; NLL-363851; NLL-300901).

Available from: 2015-09-03 Created: 2015-09-03 Last updated: 2018-06-07Bibliographically approved
Waller, G., Janlert, U., Norberg, M., Lundquist, R. & Forssén, A. (2015). Self-rated health and standard risk factors for myocardial infarction: a cohort study. BMJ Open, 5, Article ID e006589.
Open this publication in new window or tab >>Self-rated health and standard risk factors for myocardial infarction: a cohort study
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2015 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, article id e006589Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the relationship between self-rated health, adjusted for standard risk factors, and myocardial infarction.

Design: Population-based prospective cohort study.

Setting: Enrolment took place between 1990 and 2004 in Västerbotten County, Sweden

Participants: Every year, persons in the total population, aged 40, 50 or 60 were invited. Participation rate was 60%. The cohort consisted of 75 386 men and women. After exclusion for stroke or myocardial infarction before, or within 12 months after enrolment or death within 12 months after enrolment, 72 530 persons remained for analysis. Mean follow-up time was 13.2 years.

Outcome measures: Cox regression analysis was used to estimate HRs for the end point of first non-fatal or fatal myocardial infarction. HR were adjusted for age, sex, systolic blood pressure, total cholesterol, smoking, diabetes, body mass index, education, physical activity and self-rated health in the categories very good; pretty good; somewhat good; pretty poor or poor.

Results: In the cohort, 2062 persons were diagnosed with fatal or non-fatal myocardial infarction. Poor selfrated health adjusted for sex and age was associated with the outcome with HR 2.03 (95% CI 1.45 to 2.84). All categories of self-rated health worse than very good were statistically significant and showed a dose–response relationship. In a multivariable analysis with standard risk factors (not including physical activity and education) HR was attenuated to 1.61 (95% CI 1.13 to 2.31) for poor self-rated health. All categories of self-rated health remained statistically significant. We found no interaction between self-rated health and standard risk factors except for poor self-rated health and diabetes.

Conclusions: This study supports the use of self-rated health as a standard risk factor among others for myocardial infarction. It remains to demonstrate whether self-rated health adds predictive value for myocardial infarction in combined algorithms with standard risk factors.

Keywords
Self-rated Health, Cox regression, Cohort, Risk Factors, Myocardial Infarction
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Family Medicine
Identifiers
urn:nbn:se:umu:diva-100224 (URN)10.1136/bmjopen-2014-006589 (DOI)000363455400020 ()25681313 (PubMedID)
Available from: 2015-02-26 Created: 2015-02-26 Last updated: 2018-06-07Bibliographically approved
Rexvid, D., Evertsson, L., Forssén, A. & Nygren, L. (2015). The precarious character of routine practice in social and primary health care. Journal of Social Work, 15(3), 317-336
Open this publication in new window or tab >>The precarious character of routine practice in social and primary health care
2015 (English)In: Journal of Social Work, ISSN 1468-0173, E-ISSN 1741-296X, Vol. 15, no 3, p. 317-336Article in journal (Refereed) Published
Abstract [en]

Summary: This article presents a description and analysis of the written narratives of problematic situations given by social workers and general practitioners (GPs) within the framework of the sociology of professions and organisations. The narratives were collected from 28 social workers and 24 GPs, working in several Swedish counties.

Findings: Our findings show that the professionals rarely described lack of knowledge or difficulties choosing the right intervention or treatment as problematic. Rather, the problematic situations contained encounters with clients perceived as disruptive to professional routine practice. We conclude that there were three different types of problematic situations where the professional routine practice was disrupted: (1) Situations related to ‘client-making work’, where the professionals perceived it difficult to, e.g., gather enough information about the client to make a diagnosis, set a timetable or decide on adequate interventions; (2) Situations related to ‘wicked work’, where the professionals experienced clients unable to articulate their problems or understand and follow the interventions suggested by the professionals; (3) Situations related to ‘dirty work’ were only present in GPs’ narratives and typically occurred when GPs perceived that they were dealing with clients who endangered their profes- sional status. 

Applications: Contrary to previous studies, this study indicates that problematic situ- ations are not necessarily connected with traits and characteristic of the client or a lack of professional competence. Instead, they might be connected to situations where professional routine practice is disrupted. Furthermore, it is questionable to what extent problematic situations connected to such disruption can be managed by evi- dence-based methods, manualisation and standardisation. 

Keywords
Social work, dirty work, wicked work, evidence based practice, critical incident analysis, decision making, human services
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-95035 (URN)10.1177/1468017314548121 (DOI)000353474000005 ()
Projects
Hur använder socialarbetare och läkare kunskap i praktiken? En jämförelse mellan två professioner
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, Dnr 2009-0251
Available from: 2014-10-20 Created: 2014-10-20 Last updated: 2018-06-07Bibliographically approved
Forssén, A. (2013). Medical training and the "risk epidemic" in preventative medicine. In: AMEE (An International Association for Medical Education) 2013. Colouring outside the lines. International Conference in Medical Education. Prague 24-28 August, 2013: . Paper presented at AMEE 2013. Colouring outside the lines. International Conference in Medical Education, Prague 24-28 August, 2013.
Open this publication in new window or tab >>Medical training and the "risk epidemic" in preventative medicine
2013 (English)In: AMEE (An International Association for Medical Education) 2013. Colouring outside the lines. International Conference in Medical Education. Prague 24-28 August, 2013, 2013Conference paper, Oral presentation only (Other academic)
Abstract [en]

BACKGROUND: In Sweden and other Western societies, preventive medicine based on risk-factor investigation of individuals and population screening, is given increasing priority by doctors and politicians. But has a medically induced "risk epidemic" now replaced earlier infectious and cardiovascular epidemics? More and more people are labelled "at-risk", even in countries with the highest life expectancy in the world. The Hippocratic Oath for physicians includes the promise "to abstain from doing harm", but any medical intervention can be harmful. Investigation of healthy people, as part of preventive medicine, is no exception. SUMMARY OF WORK: I discuss these issues in a lecture on Family Medicine to Term 8 medical students at Umeå University, aiming to promote critical thinking around a problem I regard as crucial for the future. I also emphasize people/patient-empowering approaches in research and practice, introducing concepts such as “salutogenesis” and “personal health resources”. SUMMARY OF RESULTS: Like most medical students approaching graduation, my students appreciate “hard facts” and “how-to-do-knowledge”. This lecture has caused some hostility among students as well as the teaching-staff, for rocking the students’ earlier learning in a critical period of their training, but I have also been awarded a pedagogical prize from the students – for elucidating the complexity in health care-work. CONCLUSIONS: The negative effects of preventive measures, risk-focusing and medicalisation of everyday problems are difficult to discuss professionally, but such a discussion is also longed for by medical students. TAKE-HOME MESSAGES: Critical thinking about the “risk epidemic” in medicine, and a discussion about empowering and sustainable medicine, should be introduced into medical training

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-79849 (URN)
Conference
AMEE 2013. Colouring outside the lines. International Conference in Medical Education, Prague 24-28 August, 2013
Available from: 2013-09-03 Created: 2013-09-03 Last updated: 2018-06-08Bibliographically approved
Waller, G., Thalén, P., Janlert, U., Hamberg, K. & Forssén, A. (2012). A cross-sectional and semantic investigation of self-rated health in the northern Sweden MONICA-study. BMC Medical Research Methodology, 12, Article ID 154.
Open this publication in new window or tab >>A cross-sectional and semantic investigation of self-rated health in the northern Sweden MONICA-study
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2012 (English)In: BMC Medical Research Methodology, ISSN 1471-2288, E-ISSN 1471-2288, Vol. 12, article id 154Article in journal (Refereed) Published
Abstract [en]

Background: Self-Rated Health (SRH) correlates with risk of illness and death. But how are different questions of SRH to be interpreted? Does it matter whether one asks: “How would you assess your general state of health?”(General SRH) or “How would you assess your general state of health compared to persons of your own age?”(Comparative SRH)? Does the context in a questionnaire affect the answers? The aim of this paper is to examine the meaning of two questions on self-rated health, the statistical distribution of the answers, and whether the context of the question in a questionnaire affects the answers.

Methods: Statistical and semantic methodologies were used to analyse the answers of two different SRH questions in a cross-sectional survey, the MONICA-project of northern Sweden.

Results: The answers from 3504 persons were analysed. The statistical distributions of answers differed. The most common answer to the General SRH was “good”, while the most common answer to the Comparative SRH was “similar”. The semantic analysis showed that what is assessed in SRH is not health in a medical and lexical sense but fields of association connected to health, for example health behaviour, functional ability, youth, looks, way of life. The meaning and function of the two questions differ – mainly due to the comparing reference in Comparative SRH. The context in the questionnaire may have affected the statistics.

Conclusions: Health is primarily assessed in terms of its sense-relations (associations) and Comparative SRH and General SRH contain different information on SRH. Comparative SRH is semantically more distinct. The context of the questions in a questionnaire may affect the way self-rated health questions are answered. Comparative SRH should not be eliminated from use in questionnaires. Its usefulness in clinical encounters should be investigated.

Place, publisher, year, edition, pages
BioMed Central, 2012
National Category
General Practice Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-64328 (URN)10.1186/1471-2288-12-154 (DOI)000313577600001 ()
Available from: 2013-01-23 Created: 2013-01-23 Last updated: 2018-06-08Bibliographically approved
Rexvid, D., Blom, B., Evertsson, L. & Forssén, A. (2012). Allmänläkares och socialarbetares respons på riskreduceringsteknologier: en litteraturstudie. In: “Partnership in social work – active collaboration withdifferent actors”,9th Forsa Nordic conference, 4th-6th oct-2012 in Trondheim. Paper presented at “Partnership in social work – active collaboration withdifferent actors”,9th Forsa Nordic conference, 4th-6th oct-2012 in Trondheim.
Open this publication in new window or tab >>Allmänläkares och socialarbetares respons på riskreduceringsteknologier: en litteraturstudie
2012 (Swedish)In: “Partnership in social work – active collaboration withdifferent actors”,9th Forsa Nordic conference, 4th-6th oct-2012 in Trondheim, 2012Conference paper, Published paper (Other academic)
Abstract [sv]

Bakgrund: Allmänläkare och socialarbetare utgör exempel på välfärdsprofessioner vars villkor anses ha förändrats i det så kallade risk- och granskningssamhället. Minskad autonomi, inskränkt diskretion och försvagad jurisdiktion lyfts i professionsforskningen fram som några av uttrycksformerna för de förändrade villkoren.  

Syfte: Att beskriva och analysera allmänläkares och socialarbetares respons på evidensbaserade och organisatoriska riskreduceringsteknologier (ERRT och ORRT).

Metod: Artikeln är baserad på en innehållsanalys av resultatet från en litteraturöversikt av referee-granskade empiriska artiklar, publicerade i vetenskapliga tidskrifter, om dessa professioners kunskapsanvändning i form av respons på RRT.

Resultat: Det framkommer att båda professionerna, trots en i grunden positiv inställning till ERRT, intar en ambivalent inställning till dessa. Ambivalensen är såväl patient- och klientrelaterad som expertisrelaterad. Professionernas respons på ORRT skiljer sig dock i den bemärkelsen att allmänläkare ställer sig skeptiska till ORRT medan socialarbetare förhåller sig mer pragmatiskt till ORRT.

Keywords
profession, risk, socialarbetare, allmänläkare, riskreduceringsteknologier
National Category
Social Work General Practice
Identifiers
urn:nbn:se:umu:diva-60471 (URN)
Conference
“Partnership in social work – active collaboration withdifferent actors”,9th Forsa Nordic conference, 4th-6th oct-2012 in Trondheim
Available from: 2012-10-19 Created: 2012-10-15 Last updated: 2018-06-08Bibliographically approved
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