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  • 1. Agca, R.
    et al.
    Heslinga, S. C.
    Rollefstad, S.
    Heslinga, M.
    McInnes, B.
    Peters, M. J. L.
    Kvien, T. K.
    Dougados, M.
    Radner, H.
    Atzeni, F.
    Primdahl, J.
    Södergren, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Wållberg Jonsson, Solveig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    van Rompay, J.
    Zabalan, C.
    Pedersen, T. R.
    Jacobsson, L.
    de Vlam, K.
    Gonzalez-Gay, M. A.
    Semb, A. G.
    Kitas, G. D.
    Smulders, Y. M.
    Szekanecz, Z.
    Sattar, N.
    Symmons, D. P. M.
    Nurmohamed, M. T.
    EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no 1, 17-28 p.Article, review/survey (Refereed)
    Abstract [en]

    Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence.

  • 2.
    Ahlgren, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Johansson, Eva E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    The meanings given to gender in studies on multimodal rehabilitation for patients with chronic musculoskeletal pain: a literature review2016In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 23, 2255-2270 p.Article, review/survey (Refereed)
    Abstract [en]

    Purpose: The purpose of this study is to assess and describe the meanings given to "gender" in scientific publications that evaluate multidisciplinary, interdisciplinary or multimodal rehabilitation for patients with chronic musculoskeletal pain.

    Method: A systematic literature search for papers evaluating multimodal rehabilitation was conducted. The PubMed and EBSCO databases were searched from 1995 to 2015. Two or three researchers independently read each paper, performed a quality assessment and coded meanings of gender using qualitative content analysis.

    Results: Twenty-seven papers were included in the review. Gender was used very differently in the MMR studies investigated but primarily it referred to factual differences between men and women. Only one paper provided a definition of the concept of gender and how it had been used in that study. In the content analysis, the meaning of gender formed three categories: "Gender as a factual difference", "The man is the ideal" and "Gender as a result of social role expectations".

    Conclusions: The meaning of the concept of gender in multimodal rehabilitation is undefined and needs to be developed further. The way the concept is used should be defined in the design and evaluation of multimodal rehabilitation in future studies.

    Implications for rehabilitation

    Healthcare professionals should reflect on gender relations in encounters with patients, selection of patients into rehabilitation programs and design of programs. In rehabilitation for chronic pain the patients' social circumstances and cultural context should be given the same consideration as biological sex and pain symptoms.

  • 3. Ahlsson, Anders
    et al.
    Jideus, Lena
    Albage, Anders
    Kallner, Goran
    Holmgren, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Boano, Gabriella
    Hermansson, Ulf
    Kimblad, Per-Ola
    Schersten, Henrik
    Sjogren, Johan
    Stahle, Elisabeth
    Aberg, Bengt
    Berglin, Eva
    A Swedish consensus on the surgical treatment of concomitant atrial fibrillation2012In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, Vol. 46, no 4, 212-218 p.Article, review/survey (Refereed)
    Abstract [en]

    Atrial fibrillation (AF) is a common arrhythmia among patients scheduled for open heart surgery and is associated with increased morbidity and mortality. According to international guidelines, symptomatic and selected asymptomatic patients should be offered concomitant surgical AF ablation in conjunction with valvular or coronary surgery. The gold standard in AF surgery is the Cox Maze III ("cut-and-sew") procedure, with surgical incisions in both atria according to a specified pattern, in order to prevent AF reentry circuits from developing. Over 90% of patients treated with the Cox Maze III procedure are free of AF after 1 year. Recent developments in ablation technology have introduced several energy sources capable of creating nonconducting atrial wall lesions. In addition, simplified lesion patterns have been suggested, but results with these techniques have been unsatisfactory. There is a clear need for standardization in AF surgery. The Swedish Arrhythmia Surgery Group, represented by surgeons from all Swedish units for cardiothoracic surgery, has therefore reached a consensus on surgical treatment of concomitant AF. This consensus emphasizes adherence to the lesion pattern in the Cox Maze III procedure and the use of biatrial lesions in nonparoxysmal AF.

  • 4.
    Alvehus, Malin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Obesity-associated inflammation in adipose tissue2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Excess body fat, particularly in the visceral depot, is linked to increased mortality and morbidity, including the development of diseases such as type 2 diabetes, cardiovascular disease, and cancer. Chronic low-grade inflammation in adipose tissue may be a key mediator of obesity-associated diseases. Importantly, specific pro-inflammatory cytokines have been shown to influence adipose tissue function and could therefore be a link to metabolic disorders. Circulating cytokine levels may also be increased in obesity and metabolic diseases. However, although fat distribution and inflammation are clearly linked to metabolic disorders, inflammatory gene expression in the different abdominal adipose depots has not been investigated in detail. The menopausal transition is followed by a centralization of body fat and increased adiposity. Notably, inflammatory changes in fat during the menopausal transition have not been characterized. Finally, there is a lack of studies investigating the long-term effects of weight loss on low-grade inflammation. The aim of this thesis was to characterize differences between fat depots and investigate putative changes in low-grade inflammation in adipose tissue and circulation following menopause or weight loss.

    Materials & Methods: The expression of inflammation-related genes was investigated in abdominal adipose tissue depots obtained from women with varying adiposity, before and after menopause or weight loss induced by surgery or dietary intervention. Circulating cytokine levels were analyzed using immunoassays.

    Results: Visceral fat displayed a distinct and adverse inflammatory profile compared with subcutaneous adipose tissues, and the higher gene expression in visceral fat was associated with adiposity. Postmenopausal women exhibited a higher expression of pro-inflammatory genes than premenopausal women that associated with central fat accumulation. There was also a menopause-related increase in circulating cytokine levels in postmenopausal women. After surgery-induced weight loss, there was a dramatic reduction in inflammatory gene expression followed by increased insulin sensitivity. We observed no alterations in circulating cytokine levels. Long-term dietary intervention, associated with weight loss, had favorable effects on inflammation in both adipose tissue and serum.

    Conclusion: Fat accumulation is linked to low-grade inflammation in abdominal adipose tissue. The unique inflammatory pattern of visceral fat suggests a distinct role in adipose tissue inflammation that is aggravated with increasing adiposity. In postmenopausal women, the adverse adipose inflammatory profile was associated with central fat accumulation, while higher circulating cytokine levels correlated with menopausal state/age. Our data from severely obese women undergoing surgery-induced weight loss clearly supports a link between adipose inflammation and insulin resistance. The long-term beneficial effects of weight loss were also demonstrated by the improved inflammatory profile after dietary intervention. In summary, excess body fat is clearly linked to adipose tissue inflammation. Long-term weight loss is accompanied by improved metabolic profile and reduced low-grade inflammation in fat.

  • 5.
    Andersson, Christer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wikberg, Agneta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lithner, Folke
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Renal symtomatology in patients with acute intermitent porphyria2000In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 248, 319-325 p.Article in journal (Refereed)
    Abstract [en]

    Objective: Can renal insufficiency in subjects with acute intermittent porphyria (AIP) be due solely to AIP?

    Design: A population-based study.

    Subjects: Subjects with AIP ≥ 18 years of age (n = 386) in the four most northerly counties of Sweden.

    Interventions: Screening with creatinine clearance at 24 h. Patients below the lower reference level underwent a repeat clearance test and, if still low, also chromEDTA clearance.

    Results: 286 (74%) subjects performed the creatinine clearance test and in 57 clearance was low; the second clearance proved normal in 23 who were then excluded. Eighteen subjects with other possible medical reasons for renal insufficiency, ethical reasons or refusing further examinations were also excluded. The 16 remaining subjects with no explanation for their renal insufficiency other than AIP were then studied in detail. All 14 women, mean age 52 years, and two uraemic men, 58 and 67 years, had manifest AIP. Twelve patients had hypertension (HT) and four were normotensive in spite of renal insufficiency. Histological findings of renal biopsies revealed diffuse glomerulosclerotic and interstitial changes with additional ischaemic lesions.

    Conclusion: Protracted vasospasm in attacks of AIP may be a cause of renal lesions. This is discussed.

  • 6.
    Andersson, Jenny
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Genusgörande och läkarblivande: attityder, föreställningar och förväntningar bland läkarstudenter i Sverige2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The inclusion of a gender perspective in medicine has shown that gender is an essential factor in health and disease, in medical encounters and also in medical students’ educational environment. The aim of this study was to explore attitudes, preconceptions and norms regarding gender within medical education and processes of gender bias. First, we explored medical students gendered beliefs about patients. Second, we examined the medical students ideas about their future careers. Third, we compared awareness on gender issues among medical students in Sweden and the Netherlands.

    Method and material

    The analyses were based on data from two different sources: one experimental study based on authentic patient narratives about being diagnosed with cancer and one extensive questionaire exploring different aspects of gender issues in medical education. Both studies had a design which enabled both qualitative and quantitative research and mixed methods was used.

    Study I (Paper I and II): Eighty-one anonymous letters from patients were read by 130 students of medicine and psychology. For each letter the students were asked to state the patient’s sex and explain their choice. In paper I the students’ success rates were analysed statistically and the explanations to four letters were used to illustrate the students’ reasoning. Paper II examined the 87 medical students’ explanations closer to examine gender beliefs about patients.

    Study II (Paper III and IV): The questionaire started with an open question where medical students were asked to describe their ideal future, it also included a validated scale designed to estimate gender awareness. Paper III examined 507 swedish medical students descriptions about their ideal future and compared answers from male and female students in the beginning and at the end of medical school. Paper IV compared gender awareness among 1096 Swedish and Dutch medical students in first term.

    Findings with reflections

    Paper I showed that the patient’s sex was correctly identified in 62% of the cases. There were no difference between the results of male and female students. However, large differences between letters were observed, i.e. there were some letters were almost all students correctly identified the patient´s sex, others were almost all students were incorrect and most letters were found somewhere in the middle. Another significant finding was that the same expressions were interpreted differently depending on which initial guess the medical student had made regarding the sex of the patient.

    Paper II identified 21 categories of justifications within the students’ explanations, twelve of which were significantly associated with an assumption of either a male or female patient. Only three categories led to more correct identifications of the patients’ sex and two were more often associated with incorrect assignments. The results illustrate how beliefs about gender difference, even though they might be recognizable on a group level, are not applicable on individuals. Furthermore, the results show that medical students enter the education with beliefs about male and female patients, which could have consequenses and cause bias in their future work as doctors.

    Paper III found that almost all students, both male and female, were work-oriented. However, the female students even more so than their male counterparts. This result is particularly interesting in regards to the debate about the “feminization of medicine” in which the increasing number of female students has been adressed as a problem. When reflecting on their own lifes and their future its obvious that medical students nowadays, male and female, expect more to life than work, especially those who are on the doorstep to their professional life.

    Paper IV found that the national and cultural setting was the most crucial impact factor in relation to the medical students preconceptions and awareness about gender. The Swedish students expressed less stereotypic thinking about patients and doctors, while the Dutch students were more sensitive to gender difference. In both countries, the students’ sex mattered for gender stereotyping, with male students agreeing more to stereotypes.

    Conclusions

    A gender perspective is important in medical education. Our studies show that such initiatives needs to take cultural aspects, gender attitudes and students’ gender into account. Moreover, reflections on assumptions about men and women, patients as well as doctors, need to be included in medical curricula and the impact of implicit gender beliefs needs to be included in discussions on gender bias in health care. Also, the next generation of doctors want more to life than work. Future Swedish doctors, both female and male, intend to balance work not only with a family but also with leisure. This attitudinal change towards their future work as doctors will provide the health care system with a challenge to establish more adaptive and flexible work conditions.

  • 7.
    Andersson, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Salander, Pär
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Brandstetter-Hiltunen, Marie
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Knutsson, Emma
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Is it possible to identify patient´s sex when reading blinded illness narratives? An experimental study about gender bias.2008In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 7, no 21, 1-9 p.Article in journal (Refereed)
  • 8.
    Andersson, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Salander, Pär
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Using patients' narratives to reveal gender stereotypes among medical students2013In: Academic Medicine, ISSN 1040-2446, E-ISSN 1938-808X, Vol. 88, no 7, 1015-1021 p.Article in journal (Refereed)
    Abstract [en]

    Purpose: Gender bias exists in patient treatment, and, like most people, health care providers harbor gender stereotypes. In this study, the authors examined the gender stereotypes that medical students hold about patients. Method: In 2005, in Umeå, Sweden, the authors collected 81 narratives written by patients who had undergone cancer treatment; all information that might reveal the patients’ gender was removed from the texts. Eighty-seven medical students read 40 or 41 narratives each, guessed the patient’s gender, and explained their guess. The authors analyzed the students’ explanations qualitatively and quantitatively to reveal the students’ gender stereotypes and to determine whether those stereotypes had any predictive value for correctly guessing a patient’s gender. Results: The students’ explanations contained 21 categories of justifications, 12 of which were significantly associated with the students guessing one gender or the other. Only three categories successfully predicted a correct identification of gender; two categories were more often associated with incorrect guesses. Conclusions: Medical students enter their training program with culturally shared stereotypes about male and female patients that could cause bias during their future careers as physicians. To prevent this, medical curricula must address gender stereotypes and their possible consequences. The impact of implicit stereotypes must be included in discussions about gender bias in health care.

  • 9. Andersson, Liselott
    et al.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Sundström Poromaa, Inger
    Increased free androgen index is associated with hypertension in premenopausal women2011In: Open Journal of Obstetrics and Gynecology, ISSN 2160-8792, E-ISSN 2160-8806, Vol. 1, 228-233 p.Article in journal (Refereed)
    Abstract [en]

    Objective: Increased testosterone and decreased sex hormone-binding globulin (SHBG) are associated with a number of adverse cardiovascular risk factors in postmenopausal women. The aim of this popula-tion-based study of women aged 25 to 50 was to as-sess the relationship between free androgen index (FAI) and cardiovascular risk factors in premeno-pausal women.

    Methods: A population-based survey of 396 premenopausal women with no hormonal trea- tment was undertaken as part of the Northern Swe-den MONICA study. The study involved question-naires, anthropometry and assays of testosterone and SHBG.

    Results: Increased FAI was associated with a number of cardiovascular risk factors in premeno-pausal women but this relationship was strongly af-fected by body mass index (BMI). After adjustment for age and BMI, FAI was significantly associated with increased systolic and diastolic blood pressures.

    Conclusion: Hyperandrogenism is associated with increased blood pressure and these findings empha-size the need to assess cardiovascular risk factors in women with hyperandrogenism of all ages.

  • 10. Andrae, Bengt
    et al.
    Andersson, Therese M-L
    Lambert, Paul C
    Kemetli, Levent
    Silfverdal, Lena
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Strander, Björn
    Ryd, Walter
    Dillner, Joakim
    Törnberg, Sven
    Sparén, Pär
    Screening and cervical cancer cure: population based cohort study2012In: BMJ. British Medical Journal, ISSN 0959-535X, E-ISSN 1756-1833, Vol. 344, e900- p.Article in journal (Refereed)
    Abstract [en]

    Objective To determine whether detection of invasive cervical cancer by screening results in better prognosis or merely increases the lead time until death.

    Design Nationwide population based cohort study. Setting Sweden.

    Participants All 1230 women with cervical cancer diagnosed during 1999-2001 in Sweden prospectively followed up for an average of 8.5 years. Main outcome measures Cure proportions and five year relative survival ratios, stratified by screening history, mode of detection, age, histopathological type, and FIGO (International Federation of Gynecology and Obstetrics) stage.

    Results In the screening ages, the cure proportion for women with screen detected invasive cancer was 92% (95% confidence interval 75% to 98%) and for symptomatic women was 66% (62% to 70%), a statistically significant difference in cure of 26% (16% to 36%). Among symptomatic women, the cure proportion was significantly higher for those who had been screened according to recommendations (interval cancers) than among those overdue for screening: difference in cure 14% (95% confidence interval 6% to 23%). Cure proportions were similar for all histopathological types except small cell carcinomas and were closely related to FIGO stage. A significantly higher cure proportion for screen detected cancers remained after adjustment for stage at diagnosis (difference 15%, 7% to 22%).

    Conclusions Screening is associated with improved cure of cervical cancer. Confounding cannot be ruled out, but the effect was not attributable to lead time bias and was larger than what is reflected by down-staging. Evaluations of screening programmes should consider the assessment of cure proportions.

  • 11.
    Andrén, Fabian
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Uncomplicated urinary tract infections –when are antibiotics necessary? Experiences from an observational, prospective pilot study at a primaryhealth care centre in Sundsvall.2015Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 12. Aronsson, Mattias
    et al.
    Persson, Josefine
    Blomstrand, Christian
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden.
    Levin, Lars-Ake
    Cost-effectiveness of endovascular thrombectomy in patients with acute ischemic stroke2016In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 86, no 11, 1053-1059 p.Article in journal (Refereed)
    Abstract [en]

    Objective:To evaluate the cost-effectiveness of adding endovascular thrombectomy to standard care in patients with acute ischemic stroke.Methods:The cost-effectiveness analysis of endovascular thrombectomy in patients with acute ischemic stroke was based on a decision-analytic Markov model. Primary outcomes from ESCAPE, Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial (EXTEND-IA), Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours (REVASCAT), and Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) along with data from published studies and registries were used in this analysis. We used a health care payer perspective and a lifelong time horizon to estimate costs and effects.Results:The model showed that adding thrombectomy with stent retrievers to guideline-based care (including IV thrombolysis) resulted in a gain of 0.40 life-years and 0.99 quality-adjusted life-years along with a cost savings of approximately $221 per patient. The sensitivity analysis showed that the results were not sensitive to changes in uncertain parameters or assumptions.Conclusions:Adding endovascular treatment to standard care resulted in substantial clinical benefits at low costs. The results were consistent throughout irrespective of whether data from ESCAPE, EXTEND-IA, MR CLEAN, REVASCAT, or SWIFT PRIME were used in this model.

  • 13.
    Asklund, Ina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Nyström, E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Sjöström, M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Umefjord, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Samuelsson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Treatment of stress urinary incontinence via a smartphone application: a randomised controlled trial2015In: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 34, no Supplement 3 Meeting Abstract 16, S40-S42 p.Article in journal (Other academic)
  • 14.
    Benckert, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lilja, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Improved metabolic health among the obesein six population surveys 1986 to 2009: the Northern Sweden MONICA study2015In: BMC Obesity, ISSN 2052-9538, Vol. 2, no 7Article in journal (Refereed)
    Abstract [en]

    Background

    The incidence of CVD is decreasing in spite of increasing BMI in the population. We examined trends in metabolic health among overweight and obese individuals and the influence of lifestyle and socioeconomic status. Six cross sectional population surveys in the Northern Sweden MONICA Study between 1986 and 2009. 8 874 subjects 25 to 64 years participated (74% participation rate). Metabolic health was defined as a total cholesterol level below 5.0 mmol/l, blood pressure below 140/90 mmHg and not having diabetes. In 2009 the age span 25 to 74 years was studied.

    Results

    The prevalence of metabolic health among obese subjects increased by 7.9 % per year (95% confidence interval 5.4; 10.5), reaching 21.0% in 2009. The corresponding figures for overweight subjects were 5.9% per year (4.6; 7.3), reaching 18% in 2009, whereas for the normal-weight subjects, the increase was 6.2% per year (5.3; 7.2), reaching 39% in 2009. The prevalence of metabolic health among subjects with abdominal obesity increased by 5.8% (4.6; 7.0) per year, reaching 17.3% in 2009. Among those with no abdominal obesity the increase was 6.2% (5.2; 7.1), reaching 38% in 2009 (p = <0.001 for all groups). Only among non-obese men and obese women did the increase continue between 2004 and 2009. In the other groups a slight decline or levelling off was noted.

    In 2009 women had a 27% higher prevalence of metabolic health than men. The prevalence of metabolic health among the obese was 19.8% which declined to 15.8% if subjects treated for hypertension or hypercholesterolemia were classified as not healthy. Overweight and obese subjects were less often metabolically healthy (odds ratio 0.54 and 0.59 respectively) compared with normal-weight subjects, independent of sex and age as were subjects with abdominal obesity (odds ratio 0.52). Adjustments for smoking, physical activity and education level did not influence any estimates.

    Conclusions

    This report shows a large increase in prevalence of metabolic health from 1986 to 2009 for all anthropometric categories. Metabolic health remains considerably less prevalent among overweight and obese subjects than among those with normal weight.

  • 15.
    Bergdahl, Leif
    Umeå University, Faculty of Medicine.
    Hyperparatyreoidism vid njursjukdom1973Doctoral thesis, comprehensive summary (Other academic)
  • 16. Berghammer, Malin C.
    et al.
    Mattsson, Eva
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Moons, Philip
    Dellborg, Mikael
    Comparison of participants and non-participants in patient-reported outcome surveys: the case of Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study2017In: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107, Vol. 27, no 3, 427-434 p.Article in journal (Refereed)
    Abstract [en]

    Background: The last decade has seen a vast increase in the use of patient-reported outcomes. As patientreported outcomes are used in order to capture patients' perspectives of their health and illness, it is a prerequisite for accurate patient-reported outcome evaluations to use representative samples. In order to evaluate representativeness, the present study focussed on the comparison between participants and non-participants in the Swedish branch of the international study APPROACH-IS (Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study), regarding demographic, clinical, and health status characteristics. Methods: Eligible patients for APPROACH-IS were identified and selected from SWEDCON, the Swedish registry for congenital heart disease (CHD). Overall, 912 eligible patients were identified, of whom 471 participated, 398 did not participate, and 43 were either unreachable or declined to participate in APPROACH-IS. The participants and nonparticipants were compared in terms of statistical significance and effect sizes. Results: Significant differences were observed between participants and non-participants for sex, age, primary diagnosis, number of cardiac operations, and fatigue; however, the effect sizes were in general small, except for the difference in primary diagnosis. No differences between the two groups were found in number of catheterisations, implanted device, the distribution of NYHA functional class, or health status and symptoms. Conclusions: This study shows that participants and non-participants are relatively comparable groups, which confirms the representativeness of the participants. The Swedish data from APPROACH-IS can therefore be reliably generalised to the population of adults with CHD in Sweden.

  • 17. Berk, John L
    et al.
    Suhr, Ole B
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Sekijima, Yoshiki
    Yamashita, Taro
    Heneghan, Michael
    Zeldenrust, Steven R
    Ando, Yukio
    Ikeda, Shu-ichi
    Gorevic, Peter
    Merlini, Giampaolo
    Kelly, Jeffrey W
    Skinner, Martha
    Bisbee, Alice B
    Dyck, Peter J
    Obici, Laura
    The diflunisal trial: study accrual and drug tolerance2012In: Amyloid: Journal of Protein Folding Disorders, ISSN 1350-6129, Vol. 19, no S1, 37-38 p.Article in journal (Refereed)
    Abstract [en]

    Familial amyloidotic polyneuropathy (FAP) is a protein folding disorder that induces neuropathy and cardiomyopathy, leading to death within 7-15 years after onset of clinical disease. In vitro, small ligands binding the thyroid hormone docking site stabilize tetrameric transthyretin, inhibiting amyloid fibril formation. We undertook a randomized, placebo-controlled clinical trial to determine whether diflunisal, a well-known non-steroidal anti-inflammatory drug (NSAID) alters neurologic disease progression in FAP. We enrolled 130 subjects with wide age and FAP mutation representation. To date, few recognized complications of NSAIDs have occurred in the study cohort. Data collection will be completed by November 2012.

  • 18. Björk, Anna-Bell
    et al.
    Sjöström, Malin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Samuelsson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Umefjord, Goran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Women's Experiences of Internet-Based or Postal Treatment for Stress Urinary Incontinence2014In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 24, no 4, 484-493 p.Article in journal (Refereed)
    Abstract [en]

    Stress urinary incontinence is common and sometimes embarrassing. New, simple, and easily accessible treatments are needed. We telephone interviewed 21 women who participated in a randomized controlled study comparing two treatment programs based on instructions for pelvic floor muscle training. One program was Internet-based and included email support by a urotherapist; the other was sent by post. There was no face-to-face contact in either program. Our main aim was to explore the women's experiences of the Internet-based treatment. Grounded theory analysis revealed three categories: hidden but present, at a distance but close, and by myself but not alone. These were incorporated in a core category: acknowledged but not exposed. The leakage was often a well-hidden secret, but the study treatments lowered the barrier for seeking care. In the Internet group, a supportive patient-provider relationship developed despite the lack of face-to-face contact. Internet-based treatment programs can increase access to care and empower women.

  • 19.
    Blomberg, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine.
    Update in environmental and occupational medicine 20112012In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 185, no 11, 1166-1170 p.Article in journal (Refereed)
  • 20.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Departments of Internal Medicine and Geriatric medicine, Skellefteå Hospital, Skellefteå.
    On the clinical use of digitalis: with reference to its prescription, maintenance therapy, intoxication and the patient's knowledge1983Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Digitalis in one of the most frequently prescribed drugs, especially to elderly people. The prescription of cardiac glucosides (1978) was studied by using statistics from Apoteksbolaget (the National Corpora­tion of Swedish Pharmacies). There was a threefold difference in the sales of cardiac glucosides per 1000 inhabitants in the different primary care areas. Digoxin was prescribed to 90-98 per cent of the patients, with considerable variations in the dosages. Many other factors besides the cardio-vascular morbidity were likely to cause these differences.

    Maintenance digitalis therapy has lately been questioned. In a retro­spective study, digitalis was discontinued in 141 geriatric patients without contraindications to digitalis withdrawal. Digoxin treatment seemed to be unnecessary in 108 patients (81 per cent), followed up two months after digoxin withdrawal. A long-term study (mean: 20,5 months) was carried out in these 108 patients. Digitalis therapy was reinstituted in 30 of 99 patients, equally distributed on the basis of clear, possible or uncertain indications. Significantly more patients (p< 0,001) with atrial fibrillation compared with sinus rhythm were restarted. A prospective, randomized, double-blind placebo- controlled study in 39 out of 66 geriatric patients confirmed the results of the retrospective study. During a two-month period 32 of 37 patients (86 per cent) managed without digitalis. Eighteen out of 66 patients (27 per cent) presented contraindications to digoxin with­drawal. Those who needed digitalis were restarted mainly during the first nonth (mean: 18 days) following digoxin withdrawal.

    Digitalis intoxication has been studied earlier, mainly in hospitalized patients. A clinical examination and ECG of a random sample of out­patients treated with digoxin shewed that about 5 per cent were certainly intoxicated and about 2 per cent suspected of being intoxi­cated.

    Elderly patients are said to be more sensitive to digitalis. Eleven per cent of 66 geriatric patients were found, without doubt, to be digitalis intoxicated. The mean serum digoxin concentration was significantly higher in eight toxic patients compared with non-toxic patients, but 75 per cent of the toxic patients had serum digoxin con­centrations within or below therapeutic range. Five of these intoxi­cated patients did not need maintenance digitalis therapy.

    A questionnaire of 361 patients in Skellefteå and Uppsala revealed that about 45 per cent had taken digitalis for more than five years. Approximately 85 per cent took one tablet daily and stated compliance. About one fifth did not know why they were taking digoxin and about half of the patients were uncertain if they were improved, by digitalis therapy. Although digitalis intoxication is such an important clinical problem, some 55 per cent did not know about digitalis's side-effects and some 50 per cent stated that no or insufficient information had been given. Only 15 per cent were satisfied with the information they had received. A significant negative correlation between digoxin dosages and the age of the patients was found.

  • 21.
    Boman, Kurt
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Brenander, Andre
    Gustavsson, Mats
    Furberg, Curt D
    A pilot test of a new tool for remote blood pressure monitoring2014In: Journal of Telemedicine and Telecare, ISSN 1357-633X, Vol. 20, no 5, 239-241 p.Article in journal (Refereed)
    Abstract [en]

    We conducted a pilot trial of a remote blood pressure (BP) monitoring system, in which subjects measured their own BP at a primary healthcare centre. The data were wirelessly transmitted to the general practitioner. A total of 132 subjects with a new or prior diagnosis of hypertension were enrolled. Their mean age was 61 years and 77 were men (58%). They were followed for an average of 487 days (range 19-1110). The median number of BP measurements made was 6 per patient (range 2-49). The mean blood pressure decreased from 137/85 to 132/78 mmHg (P < 0.001) and the percentage of subjects with adequately controlled BP (defined as < 140/90 mmHg) increased from 47 to 66% (P < 0.01). Randomised trials are now required to confirm these findings.

  • 22.
    Brorstad, Alette
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Oscarsson, Kristina Bergstedt
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Ahlm, Clas
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Early diagnosis of hantavirus infection by family doctors can reduce inappropriate antibiotic use and hospitalization2010In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 28, no 3, 179-184 p.Article in journal (Refereed)
    Abstract [en]

    Raised awareness in general practice regarding emerging infections and better diagnostic tools are desirable. This study of a Hantavirus outbreak shows that general practitioners are frontline doctors during outbreaks and through early and correct diagnosis they can reduce antibiotic treatment and hospitalization.

  • 23.
    Burstedt, Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Jonsson, Frida
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Köhn, Linda
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Burstedt, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Kivitalo, Markus
    Golovleva, Irina
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Genotype-phenotype correlations in Bothnia dystrophy caused by RLBP1 gene sequence variations2013In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 91, no 5, 437-444 p.Article in journal (Refereed)
    Abstract [en]

    Purpose: To evaluate phenotypes caused by different RLBP1 mutations in autosomal recessive retinitis pigmentosa of Bothnia type. Methods: Compound heterozygotes for mutations in the RLBP1 gene [c.677T>A]+[c.700C>T] (p.M226K+p.R234W), n=10, aged 7-84years, and homozygotes c.677T>A (p.M226K), n=2, aged 63 and 73years, were studied using visual acuity (VA), low-contrast VA, visual fields (VFs) and optical coherence tomography (OCT). Retrospective VA and VFs, standardized dark adaptation and full-field electroretinograms (ERGs) were analysed and prolonged dark adaptometry and ERG (at 24hr) were performed. Results: Progressive decline of VA and VF areas was age-dependent. Retinal degenerative maculopathy, peripheral degenerative changes and retinitis punctata albescens (RPA) were present. Early retinal thinning in the central foveal, foveal (O 1mm), and inner ring (O 3mm) in the macular region, with homogenous, high-reflectance RPA changes, was visualized in and adjacent to the retinal pigment epithelium/choriocapillaris using OCT. Reduced dark adaptation and affected ERGs were present in all ages. Prolonged dark adaptation and ERG (at 24hr), an increase in final threshold, and ERG rod and mixed rod/cone responses were found. Conclusions: The two RLBP1 genotypes presented a phenotypical and electrophysiological expression of progressive retinal disease similar to that previously described in homozygotes for the c.700C>T (p.R234W) RLBP1 mutation. The uniform phenotypical expression of RLBP1 mutations is relevant information for the disease and of importance in planning future treatment strategies.

  • 24. Byles, Julie E
    et al.
    Dolja-Gore, Xenia
    Loxton, Deborah J
    Parkinson, Lynne
    Stewart Williams, Jennifer A
    Research Centre for Gender, Health & Ageing, Faculty of Health, University of Newcastle, Level 2 David Maddison Building, Callaghan NSW 2308, Australia.
    Women's uptake of Medicare Benefits Schedule mental health items for general practitioners, psychologists and other allied mental health professionals.2011In: The Medical journal of Australia, ISSN 1326-5377, Vol. 194, no 4, 175-179 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To quantify women's uptake of Medicare Benefits Schedule mental health items, compare characteristics of women by mental health service use, and investigate the impact on Medicare costs.

    DESIGN, SETTING AND PARTICIPANTS: Analysis of linked survey data and Medicare records (November 2006 - December 2007) of 14 911 consenting participants of the Australian Longitudinal Study on Women's Health (ALSWH) across three birth cohorts (1921-1926 ["older cohort"], 1946-1951 ["mid-age cohort"], and 1973-1978 ["younger cohort"]).

    MAIN OUTCOME MEASURES: Uptake of mental health items; 36-Item Short Form Health Survey (SF-36) Mental Health Index scores from ALSWH surveys; and patient (out-of-pocket) and benefit (government) costs from Medicare data.

    RESULTS: A large proportion of women who reported mental health problems made no mental health claims (on the most recent survey, 88%, 90% and 99% of the younger, mid-age and older cohorts, respectively). Socioeconomically disadvantaged women were less likely to use the services. SF-36 Mental Health Index scores among women in the younger and mid-age cohorts were lowest for women who had accessed mental health items or self-reported a recent mental health condition. Mental health items are associated with higher costs to women and government.

    CONCLUSION: Although there has been rapid uptake of mental health items, uptake by women with mental health needs is low and there is potential socioeconomic inequity.

  • 25.
    Carlberg, Bo
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Samuelsson, Ola
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Finns möjligen hela bilden om atenolol hos Kent Forsén?2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 3, 151-152 p.Article in journal (Other academic)
  • 26.
    Chorell, Elin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Norrlands University Hospital, Umeå University, Umeå, Sweden .
    Ryberg, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Larsson, Christel
    Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Sandberg, Susanne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Mellberg, Caroline
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Antti, Henrik
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Plasma metabolomic response to postmenopausal weight loss induced by different diets2016In: Metabolomics, ISSN 1573-3882, E-ISSN 1573-3890, Vol. 12, no 5, 85Article in journal (Refereed)
    Abstract [en]

    Background Menopause is associated with increased abdominal fat and increased risk of developing diabetes and cardiovascular disease. Objectives The present study evaluated the plasma metabolic response in relation to insulin sensitivity after weight loss via diet intervention. Methods This work includes two studies; i) Ten women on a 5 weeks Paleolithic-type diet (PD, 30 energy percent (E%) protein, 40 E% fat, 30 E% carbohydrates), ii) 55 women on 6 months of either PD or Nordic Nutrition Recommendations diet (NNR, 15 E% protein, 30 E% fat, and 55 E% carbohydrates). Plasma metabolic profiles were acquired at baseline and post diet using gas chromatography time-of-flight/mass spectrometry and investigated in relation to insulin sensitivity using multivariate bioinformatics. Results Both the PD and NNR diet resulted in significant weight loss, reduced waist circumference, improved serum lipid profiles, and improved insulin sensitivity. We detected a baseline metabolic profile that correlated significantly with insulin sensitivity, and of which components increased significantly in the PD group compared to NNR. Specifically, a significant increase in myo-inositol (MI), a second messenger of insulin action, and beta-hydroxybutyric acid (beta-HB)increased while dihomogamma-linoleic acid (DGLA) decreased in PD compared to NNR, which correlated with improved insulin sensitivity. We also detected a significant decrease in tyrosine and tryptophan, potential markers of insulin resistance when elevated in the circulation, with the PD but not the NNR. Conclusions Using metabolomics, we detected changes in the plasma metabolite profiles associated with weight loss in postmenopausal women by different diets. The metabolic profiles following 6 months of PD were linked to beneficial effects on insulin sensitivity compared to NNR.

  • 27.
    Christianson, Monica
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    What's behind sexual risk taking?: exploring the experiences of chlamydia-positive, HIV-positive, and HIV-tested young women and men in Sweden2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim was to explore the experiences of sexual risk taking among Chlamydia Trachomatis positive (CT+), HIV positive (HIV+), and HIV tested young women and men. The specific aims were to explore, from a gender perspective, the course of events, the norms, considerations and emotions involved in sexual risk taking in CT+, explore the perception of sexual risk taking in HIV+ youth, and their understanding of why they caught HIV and look at how the Law of Communicable Diseases Act impacts their sexuality. Moreover, to investigate why young adults test for HIV, how they construct the HIV risk, and what implications testing has for them.

    42 informants between 17-24 years of age were recruited from a youth clinic in Umeå and from three infection clinics for HIV patients in Sweden.

    In depth interviews and focus group interviews were tape-recorded, transcribed verbatim and analyzed according to a Grounded Theory approach.

    The finding revealed that behind sexual risk taking, there was a drive to go steady, where lust and trust guided if sex would take place. In one-night stands women were expected to be less forward compared with men. We found an uneven responsibility concerning condom use where men expected women to be "condom promoters". By catching CT, women experienced guilt, while men felt content through knowing "the source of contamination".

    Among the HIV+ youth, socio-cultural factors such as; lack of adult supervision, naivité, love, alcohol, drugs, the macho ideal and cultures of silence blinded the informants to the risks and made them vulnerable. By grouping narratives according to degree of consensus in sexual encounters, this demonstrated that sexual risks happened in a context of gendered power relations where the informants had varied agency. The Law of Communicable Diseases Act implied both support and burden for these HIV+ youth. A lot of responsibility was put on them and to be able to handle the infromation duty they tried to switch off lust, switch off the disease, or balance lust and obedience.

    Among the HIV tested youth, HIV was seen a distant threat. Many had event-driven reasons for testing for HIV; multiple partners being one. Risk zones, like bars were perceived to be a milieu that often was expected to include one-night stands. Responsibility for testing was a gendered issue; "natural" for women, while men rather escaped from responsibility and had a testing resistance. Receiving a "green card" confirmed healthiness and provided relief, and made the informants felt "clean". They could restart with new ambitious, including reconsidering risk.

    The findings can be used in public health and in health care sectors that work with young people. We present suggestions on how to decrease the spread of STIs:

    To implement how men could play an equal part in sexual and reproductive health.

    Promote general CT screening for men.

    Liberal HIV testing among both young women and men.

    Promote safer sex behaviour from the uninfected youth, especially focusing on men??.

    Consider the role of gender and social background in the context of risky behaviours.

    Give lots of positive rewards concerning HIV disclosure to diminish the risk for HIV transmission.

  • 28.
    Christianson, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Berglin, Björn
    Johansson, Eva E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    "It should be an ordinary thing": a qualitative study about young people´s experiences of taking the HIV-test and getting the test result2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 4, 678-683 p.Article in journal (Refereed)
    Abstract [en]

    Aim:  Increased HIV-testing has public health benefits, but for youth there is a multitude of barriers against the test. The aim of this study is to explore how young women and men in Sweden experience HIV-testing within primary healthcare.

    Method:  Six focus-group interviews were tape recorded, transcribed verbatim and analysed according to qualitative content analysis.

    Results:  Three themes emerged, describing how the informants were met before, during and after testing; ‘Obstacles accessing the clinic’– describes their perceptions on how to overcome different barriers and enter into primary health care. ‘Quick and easy testing’– describes perceptions of the testing procedure and ‘Conflicting and unclear information about test results’– describes inconsistencies concerning communication of the test result and a concern about ‘what would happen’ in the event of an HIV-positive finding. Most of these youth preferred the HIV-test ‘quick and easy’ and preferred a telephone referral of the test result. A minority of them worried about HIV, and they thought that the staff seemed to be unprepared for an HIV-positive test result.

    Conclusion:  According to these youth, a quick and easy testing procedure together with a short pretest discussion may be sufficient and may also help normalising the testing practice. In a Swedish context, it may be common to see heterosexual youth as a risk-free population, and this perception may act as a barrier for HIV-testing and increase missed opportunities for early diagnose of HIV within primary care.

  • 29. Cohen, Cheryl
    et al.
    Moyes, Jocelyn
    Tempia, Stefano
    Groom, Michelle
    Walaza, Sibongile
    Pretorius, Marthi
    Dawood, Halima
    Chhagan, Meera
    Haffejee, Summaya
    Variava, Ebrahim
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Tshangela, Akhona
    von Gottberg, Anne
    Wolter, Nicole
    Cohen, Adam L.
    Kgokong, Babatyi
    Venter, Marietjie
    Madhi, Shabir A.
    Severe Influenza-associated Respiratory Infection in High HIV Prevalence Setting, South Africa, 2009-20112013In: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 19, no 11, 1766-1774 p.Article in journal (Refereed)
    Abstract [en]

    Data on influenza epidemiology in HIV-infected persons are limited, particularly for sub-Saharan Africa, where HIV infection is widespread. We tested respiratory and blood samples from patients with acute lower respiratory tract infections hospitalized in South Africa during 2009-2011 for viral and pneumococcal infections. Influenza was identified in 9% (1,056/11,925) of patients enrolled; among influenza case-patients, 358 (44%) of the 819 who were tested were infected with HIV. Influenza-associated acute lower respiratory tract infection incidence was 4-8 times greater for HIV-infected (186-228/100,000) than for HIV-uninfected persons (26-54/100,000). Furthermore, multivariable analysis showed HIV-infected patients were more likely to have pneumococcal co-infection; to be infected with influenza type B compared with type A; to be hospitalized for 2-7 days or >7 days; and to die from their illness. These findings indicate that HIV-infected persons are at greater risk for severe illnesses related to influenza and thus should be prioritized for influenza vaccination.

  • 30.
    Danielsson, Ulla E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Träffad av blixten eller långsam kvävning: genuskodade uttryck för depression2010In: Läkartidningen, ISSN 0023-7205, no 23, 1537- p.Article in journal (Other academic)
  • 31.
    Danielsson, Ulla EB
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Träffad av blixten eller långsam kvävning: genuskodade uttryck för depression i en primärvårdskontext2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Depression is a common mental health problem in primary health care. One third of the Swedish population is expected to experience depression at some point in their lives. The understanding of depression has expanded, both from a lay and primary health care perspective. The number of persons considering themselves as depressed, receiving the diagnosis, and getting treatment for it has increased steadily over the last decades.

    Unchanged, however, is that depression is diagnosed twice as often in women as in men, while twice as many men as women commit suicide. These gender differences appear in adolescence. In earlier research biomedical, psychological, and social-cultural explanations of gender differences have been discussed. Patient’s own perspectives have more seldom stood in focus, and men’s narratives in particular are still scarce. In this thesis, gender, i.e. how to be a woman or a man, is considered as a construct, formed and negotiated in social interaction.

    The aim of the study is to explore the gendered face of depression from a patient perspective: How is depression expressed and explained by patients in primary health care, by women and men, adults and adolescents? How are depressed women and men portrayed in the media? How do patient and media accounts of depression compare with the perspective offered in medical research articles?

    Method and material The analyses are based on data from three different sources: patient narratives, newspaper portrayals and scientific medical articles.

    – 37 in-depth interviews were undertaken with primary health care patients diagnosed with depression. Informants were chosen to include both men and women, grown-ups (Studies I + II) and young adults (Study V) of varying occupational and social class backgrounds. Data were analyzed according to grounded theory.

    – 26 articles portraying lay informants with depression (Study III) were drawn from three major Swedish daily newspapers by a search of database Mediearkivet 2002. The articles were analyzed by qualitative content analysis.

    –82 scientific articles concerning depression in relation to gender were identified in a PubMed search 2002. The understanding of depression in these articles was explored and compared with findings in the grown-up patient narratives and in the media portrayals by means of discourse analysis (Study IV).

    Findings Study I captured women’s and men’s formulations of their experiences of depression. To be marked with demands constituted a central experience for both women and men, but the outward manifestations differed in relation to gender as well as to class. Home and work had different priority. Men talked more about physical distress (often chest pain) than about emotions. Women readily verbalized emotional distress – shame and guilt – while physical symptoms were vague and secondary (often about the stomach). Men dealt with insecurity by aggrandizing their previous competence, women by self-effacement.

    Study II disclosed gendered trajectories into depression. Four symbolic illness narratives were identified: struck by lightning, nagging darkness, blackout and slowly suffocating. Most of the men considered their bodies suddenly “struck” by external circumstances beyond their control. The stories of women in the study were more diverse, reflecting all four illness narratives. However, the women had a tendency to blame their own personality and to describe depression as insidious and originating from the inside. The women expressed feelings of guilt and shame but also conveyed a personal responsibility and concern with relationships.

    Study III identified four themes in media portrayals of depression: displaying a successful facade, experiencing a cracking facade, losing and regaining control and explaining the illness. The mediated image of depression both upheld and challenged traditional gender stereotypes. The women’s stories were more detailed, relational, emotionally oriented and embodied. The portrayal of men was less emotional and expressive, and described a more dramatic onset of depression.

    Study IV revealed gaps in how depression in relation to gender is understood by the patients, the media, and the medical research establishment. There were differences in recognition, in understanding of the reasons, and in contextualization of depression. Although women and men described different symptoms and reasons for falling ill, in scientific articles these gendered differences were conceptualized mainly in terms of hormones and other biological markers.

    Study V elucidated the impact of gender on adolescent depression. The young women and men were all striving to be normal, influenced by demanding media images, confronted by identity trouble, and overwhelmed by feelings. They had dreams of an ordinary family and described normative expectations. Getting a safety net of friends and other adults was a way out. Both the young women and men were eager to communicate their distress when given the opportunity. This seemed especially important to some of the young men, who in talking about their emotional problems transgressed gender norms.

    Conclusions Patient perspectives enrich the understanding of gendered expressions of depression by making visible transgressions of and breaks with stereotype gender norms. Gender awareness is an important key in clinical consultation. To recognize gendered narratives of illness might have a salutary potential, making depression more visible among men, and relieving self-blame among women. By re-evaluating restrictive gender patterns, the clinician might encourage development of healthier practices of how to be a man or a woman, a development especially important for adolescents.

    An integrated model for understanding biological, gender and cultural aspects of depression has yet to be developed. As general practitioners we have a unique possibility to see and to study the whole individual in her social and cultural context.

  • 32.
    Danielsson, Ulla EB
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Bengs, Carita
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Samuelsson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    "My greatest dream is to be normal": the impact of gender on depression narratives of young Swedish women and men2011In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 21, no 5, 612-624 p.Article in journal (Refereed)
    Abstract [en]

    Depression is common among young people. Gender differences in diagnosing depression appear during adolescence. The study aim was to explore the impact of gender on depression in young Swedish men and women. Grounded theory was used to analyze interviews with 23 young people aged 17 to 25 years who had been diagnosed with depression. Their narratives were marked by a striving to be normal and disclosed strong gender stereotypes, constructed in interaction with parents, friends, and the media. Gender norms were upheld by feelings of shame, and restricted the acting space of our informants. However, we also found transgressions of these gender norms. Primary health care workers could encourage young men to open up emotionally and communicate their personal distress, and young women to be daring and assertive of their own strengths, so that both genders might gain access to the positive coping strategies practiced respectively by each.

  • 33. Dawed, A. Y.
    et al.
    Franks, Paul
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Lund Univ, Dept Clin Sci, Skane Univ Hosp, Genet & Mol Epidemiol Unit,Diabet Ctr, Malmö, Sweden; Harvard Univ, Sch Publ Hlth, Dept Nutr, Boston, MA 02115 USA.
    Walker, M.
    Mari, A.
    Pearson, E. R.
    Determinants of glucagon-like peptide-1 (GLP-1) response in prediabetes and diabetes: an IMI-DIRECT study2016In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, no Special Issue, Meeting Abstract: A15, 10-10 p.Article in journal (Other academic)
  • 34. Dehghan, Abbas
    et al.
    Bis, Joshua C.
    White, Charles C.
    Smith, Albert Vernon
    Morrison, Alanna C.
    Cupples, L. Adrienne
    Trompet, Stella
    Chasman, Daniel I.
    Lumley, Thomas
    Voelker, Uwe
    Buckley, Brendan M.
    Ding, Jingzhong
    Jensen, Majken K.
    Folsom, Aaron R.
    Kritchevsky, Stephen B.
    Girman, Cynthia J.
    Ford, Ian
    Doerr, Marcus
    Salomaa, Veikko
    Uitterlinden, Andre G.
    Eiriksdottir, Gudny
    Vasan, Ramachandran S.
    Franceschini, Nora
    Carty, Cara L.
    Virtamo, Jarmo
    Demissie, Serkalem
    Amouyel, Philippe
    Arveiler, Dominique
    Heckbert, Susan R.
    Ferrieres, Jean
    Ducimetiere, Pierre
    Smith, Nicholas L.
    Wang, Ying A.
    Siscovick, David S.
    Rice, Kenneth M.
    Wiklund, Per-Gunnar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Taylor, Kent D.
    Evans, Alun
    Kee, Frank
    Rotter, Jerome I.
    Karvanen, Juha
    Kuulasmaa, Kari
    Heiss, Gerardo
    Kraft, Peter
    Launer, Lenore J.
    Hofman, Albert
    Markus, Marcello R. P.
    Rose, Lynda M.
    Silander, Kaisa
    Wagner, Peter
    Benjamin, Emelia J.
    Lohman, Kurt
    Stott, David J.
    Rivadeneira, Fernando
    Harris, Tamara B.
    Levy, Daniel
    Liu, Yongmei
    Rimm, Eric B.
    Jukema, J. Wouter
    Voelzke, Henry
    Ridker, Paul M.
    Blankenberg, Stefan
    Franco, Oscar H.
    Gudnason, Vilmundur
    Psaty, Bruce M.
    Boerwinkle, Eric
    O'Donnell, Christopher J.
    Genome-Wide Association Study for Incident Myocardial Infarction and Coronary Heart Disease in Prospective Cohort Studies: The CHARGE Consortium2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 3, e0144997Article in journal (Refereed)
    Abstract [en]

    Background Data are limited on genome-wide association studies (GWAS) for incident coronary heart disease (CHD). Moreover, it is not known whether genetic variants identified to date also associate with risk of CHD in a prospective setting. Methods We performed a two-stage GWAS analysis of incident myocardial infarction (MI) and CHD in a total of 64,297 individuals (including 3898 MI cases, 5465 CHD cases). SNPs that passed an arbitrary threshold of 5x10(-6) in Stage I were taken to Stage II for further discovery. Furthermore, in an analysis of prognosis, we studied whether known SNPs from former GWAS were associated with total mortality in individuals who experienced MI during follow-up. Results In Stage I 15 loci passed the threshold of 5x10(-6); 8 loci for MI and 8 loci for CHD, for which one locus overlapped and none were reported in previous GWAS meta-analyses. We took 60 SNPs representing these 15 loci to Stage II of discovery. Four SNPs near QKI showed nominally significant association with MI (p-value<8.8x10(-3)) and three exceeded the genome-wide significance threshold when Stage I and Stage II results were combined (top SNP rs6941513: p = 6.2x10(-9)). Despite excellent power, the 9p21 locus SNP (rs1333049) was only modestly associated with MI (HR = 1.09, p-value = 0.02) and marginally with CHD (HR = 1.06, p-value = 0.08). Among an inception cohort of those who experienced MI during follow-up, the risk allele of rs1333049 was associated with a decreased risk of subsequent mortality (HR = 0.90, p-value = 3.2x10(-3)). Conclusions QKI represents a novel locus that may serve as a predictor of incident CHD in prospective studies. The association of the 9p21 locus both with increased risk of first myocardial infarction and longer survival after MI highlights the importance of study design in investigating genetic determinants of complex disorders.

  • 35.
    Diderichsen, Saima
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    It's just a job: a new generation of physicians dealing with career and work ideals2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Today, women constitute about half of medical students. However, women are still underrepresented in prestigious specialties such as surgery. Some suggest that this could be explained by women being more oriented towards work-life balance.

    Aim: The overall aim of this dissertation was to explore aspects of gender in work-life priorities, career plans, clinical experiences and negotiations of professional ideals among medical students and newly graduated doctors, all in a Swedish setting.

    Method: We based the analysis on data from two different sources: an extensive questionnaire exploring gender and career plans among medical students (paper I-III) and interviews with newly graduated doctors (study IV).

    In paper I, four classes of first- and final-year medical (N=507, response rate 85%) answered an open-ended question about their future life, 60% were women. We conducted a mixed methods design where we analyzed the answers qualitatively to create categories that could be analyzed quantitatively in the second stage.

    In paper II, five classes of final-year medical students  were included (N = 372, response rate 89%), and 58% were women. We studied their specialty preference and how they rated the impact that the motivational factors had for their choice. In order to evaluate the independent impact of each motivational factor for specialty preference, we used logistic regression.

    In paper III, final-year medical students answered two open-ended questions: “Can you recall an event that made you interested of working with a certain specialty?” and “Can you recall an event that made you uninterested of working with a certain specialty?”. The response rate was 62% (N = 250),  and 58% were women. The analysis was similar to paper I, but here we focused on the qualitative results.

    In paper IV, thematic interviews were conducted in 2014 and 2015. We made a purposeful sampling of 15 junior doctors, including nine women and six men from eight different hospitals. Data collection and analysis was inspired by constructivist grounded theory methodology.

    Results: When looking at the work-life priorities of medical students and junior doctors it is clear that both men and women want more to life than work in their ideal future. The junior doctors renounced fully devoted and loyal ideal and presented a self-narrative where family and leisure was important to cope and stay empathic throughout their professional lives.

    The specialty preferences and the highly rated motives for choosing them were relatively gender neutral. However, the gender neutrality came to an end when the final-year medical students described clinical experiences that affected their specialty preference. Women were more often deterred by workplace cultures, whereas men were more often deterred by knowledge area, suggesting that it is a male privilege to choose a specialty according to interest.

    Among the newly graduated doctors, another male privilege seemed to be that men were able to pass more swiftly as real doctors, whereas the women experienced more dissonance between their self-understanding and being perceived as more junior and self-doubting.

    Conclusions: The career plans and work-life priorities of doctors-to-be were relatively gender neutral. Both female and male doctors, intended to balance work not only with a family but also with leisure. This challenges the health care system to establish more adaptive and flexible work conditions.

    Gender segregation in specialty choice is not the result of gender-dichotomized specialty preferences starting in medical school. This calls for a re-evaluation of the understanding where gender is seen as a mere background characteristic, priming women and men for different specialties. 

  • 36.
    Diderichsen, Saima
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Andersson, Jenny
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Verdonk, Petra
    VU University Medical Center, Department of Medical Humanities, EMGO Institute for Health and Care Research, Amsterdam, the Netherlands.
    Lagro-Janssen, Toine
    Department of Primary and Community Care, Centre for Family Medicine, Geriatric and Public Helth, Unit Women's Studies, Radboud University Nijmegen Medical Health Centre, The Netherlands .
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Swedish medical students' expectations of their future life2011In: International Journal of Medical Education, ISSN 2042-6372, E-ISSN 2042-6372, Vol. 2, 140-146 p.Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate future life expectations among male and female medical students in their first and final year.

    Methods: The study was cross-sectional and conducted at a Swedish medical school. Out of 600 invited students, 507 (85%) answered an open-ended question about their future life, 298 (59%) first-year students and 209 (41%) last-year students. Women constituted 60% of the respondents. A mixed model design was applied; qualitative content analysis was utilized to create statistically comparable themes and categories.

    Results: Students' written answers were coded, categorized and clustered into four themes: "Work", "Family", "Leisure" and "Quality of personal life". Almost all students included aspects of work in their answers. Female students were more detailed than male ones in their family concerns. Almost a third of all students reflected on a future work-life balance, but considerations regarding quality of personal life and leisure were more common among last-year students.

    Conclusions: Today's medical students expect more of life than work, especially those standing on the doorstep of working life. They intend to balance work not only with a family but also with leisure activities. Our results reflect work attitudes that challenge the health care system for more adaptive working conditions. We suggest that discussions about work-life balance should be included in medical curricula.

  • 37.
    Diderichsen, Saima
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Verdonk, Petra
    Lagro-Janssen, Toine
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Few gender differences in specialty preferences and motivational factors: a cross-sectional Swedish study on last-year medical students2013In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 13, 39Article in journal (Refereed)
    Abstract [en]

    Background: Today, women constitute about half of medical students in several Western societies, yet women physicians are still underrepresented in surgical specialties and clustered in other branches of medicine. Gender segregation in specialty preference has been found already in medical school. It is important to study the career preferences of our future physicians, as they will influence the maintenance of an adequate supply of physicians in all specialties and the future provision of health care. American and British studies dominate the area of gender and medical careers whereas Swedish studies on medical students' reasons for specialty preference are scarce. The aim of this study is to investigate and compare Swedish male and female medical students' specialty preferences and the motives behind them. Methods: Between 2006 and 2009, all last-year medical students at Umea University, Sweden (N = 421), were invited to answer a questionnaire about their future career and family plans. They were asked about their specialty preference and how they rated the impact that the motivational factors had for their choice. The response rate was 89% (N = 372); 58% were women (N = 215) and 42% were men (N = 157). Logistic regression was used to evaluate the independent impact of each motivational factor for specialty preference. Results: On the whole, male and female last-year students opted for similar specialties. Men and women had an almost identical ranking order of the motivational factors. When analyzed separately, male and female students showed both similarities and differences in the motivational factors that were associated with their specialty preference. A majority of the women and a good third of the men intended to work part-time. The motivational factor combining work with family correlated with number of working hours for women, but not for men. Conclusions: The gender similarities in the medical students' specialty preferences are striking and contrast with research from other Western countries where male and female students show more differences in career aspirations. These similarities should be seized by the health care system in order to counteract the horizontal gender segregation in the physician workforce of today.

  • 38.
    Diderichsen, Saima
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Kristoffersson, E.
    Verdonk, P.
    Hamberg, K.
    "You don’t want to disturb, you want to fix it yourself": negotiations of professional identity in newly graduated doctors' narrativesManuscript (preprint) (Other academic)
  • 39. Dimberg, Ivar
    et al.
    Grzymala-Lubanski, Bartosz
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Hägerfelth, Anette
    Rosenqvist, Mårten
    Svensson, Peter
    Själander, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Computerised assistance for warfarin dosage: effects on treatment quality2012In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 23, no 8, 742-744 p.Article in journal (Refereed)
    Abstract [en]

    Background: Well-managed warfarin treatment with a high time in therapeutic range (TTR) corresponds to fewer bleedings or thromboembolic complications. Many small centres manage their warfarin dosing manually, with little or no knowledge of their treatment quality as measured by TTR. AuriculA is a Swedish National web-based anticoagulation dosing system. Our hypothesis was that the web based dosing system, compared to manual dosing, would improve the TTR.

    Methods: Retrospective cohort study of medical records from patients with atrial fibrillation on warfarin treatment from two centres, with previously manual warfarin dosing regimens. Data for calculation of TTR was extracted manually from medical records from the time when using manual dosing and compared with the computerised regimen.

    Results: In centre 1, the mean TTR was significantly increased after the introduction of AuriculA, from 64.3% (95% CI 58.8-69.8) to 71.3% (95% CI 67.7-74.8), p=0.03. In centre 2, a high TTR of 73.6% (95% CI 71.3-75.9) was maintained after the implementation, 74.0% (95% CI 71.6-76.3). INR tests were prescribed significantly more frequent after the introduction of AuriculA in both centres; 20% more often at centre 1 and 21% at centre 2.

    Conclusion: Computerised dosing assistance within the Swedish national quality registry AuriculA improves or maintains a high treatment quality with warfarin as measured by TTR.

    (C) 2012 European Federation of Internal Medicine. Published by Elsevier B. V. All rights reserved.

  • 40. Dugas, Lara R.
    et al.
    Chorell, Elin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Plange-Rhule, Jacob
    Lambert, Estelle V.
    Cao, Guichan
    Cooper, Richard S.
    Layden, Brian T.
    Scholten, Denise
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Luke, Amy
    Goedecke, Julia H.
    Obesity-related metabolite profiles of black women spanning the epidemiologic transition2016In: Metabolomics, ISSN 1573-3882, E-ISSN 1573-3890, Vol. 12, no 3, 45Article in journal (Refereed)
    Abstract [en]

    In developed countries, specific metabolites have been associated with obesity and metabolic diseases, e.g. type 2 diabetes. It is unknown whether a similar profile persists across populations of African-origin, at increased risk for obesity and related diseases. In a cross-sectional study of normal-weight and obese black women (33.3 +/- 6.3 years) from the US (N = 69, 65 % obese), South Africa (SA, N = 97, 49 % obese) and Ghana (N = 82, 33 % obese) serum metabolite profiles were characterized via gas chromatography-time of flight/mass spectrometry. In US and SA women, BMI correlated with branched-chain and aromatic amino acids, as well as dopamine and aminoadipic acid. The relationship between BMI and lipid metabolites differed by site; BMI correlated positively with palmitoleic acid (16: 1) in the US; negatively with stearic acid (18: 0) in SA, and positively with arachidonic acid (20: 4) in Ghana. BMI was also positively associated with sugar-related metabolites in the US; i.e. uric acid, and mannitol, and with glucosamine, glucoronic acid and mannitol in SA. While we identified a common amino acid metabolite profile associated with obesity in black women from the US and SA, we also found site-specific obesity-related metabolites suggesting that the local environment is a key moderator of obesity.

  • 41.
    Edvardsson, Berit
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    "Det är inte mig det är fel på, det är huset": en studie av prognosfaktorer och bemötande med fokus på sjuka hus-syndromet2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Sick Building Syndrome (SBS) is still in 2015 a controversial condition. The set of non-specific symptoms occurring in a particular building and not caused by specific illness such as allergy or infection are questioned. The variousSBS symptoms can be grouped as dermal, mucosal and general and there is no universally accepted clinical definition of SBS. Symptoms normally improve or disappear when people are not exposed in a particular building. SBS is a multifactorial disease and described as a syndrome caused or aggravated by many factors related to indoor environment such as dampness and mould, insufficiency of fresh air, but also psychosocial and individual factors like female gender and personality.

    Objectives: The hypothesis is that personal factors such as previous health, actions taken, time, treatment, personality and coping resources are factors important in influencing the prognosis for SBS patients. The main purpose of this thesis is to explore more about how the symptoms affect work-capability and if SBS patients recover from their symptoms. Another important aim is to explore the experience of the emergence of symptoms and encounters in a group of people with SBS. To find out more about personality and coping resources and their importance for the progress of SBS symptoms comparisons were made with a selection from the general population, a group of patients having hand eczema and a group of patients with perceived sensitivity to electricity.

    Methods: A follow-up questionnaire focusing on current medical and social status, care, treatment, other measures taken, coping and personality traits was sent to 239 patients with non-specific building-related symptoms, assessed during the period between 1986-1998 at the University Hospital in Umeå, Sweden, response rate 79,1%. Prognosis and risk factors for prognosis were calculated for the SBS patients.  Measurement of personality traits like self-image was done using Structural analysis of Social Behaviour, SASB, and coping ability was measured with Coping Resources Inventory, CRI. Similar follow-up questionnaires for patient groups with hand eczema and perceived electrical sensitivity were used and response rates were 68% respectively 73%. Risk factors for prognosis with focus on self-image and coping were calculated for the SBS patients and the group of patients having hand eczema. Comparisons were made between self-image and coping among SBS patients, patients with electrical hypersensitivity, patients with hand eczema and a selection from the general population. To explore the experience of SBS symptoms and encounters a semi-structured interview was performed with 10 informants with symptoms of SBS. Five of them were previously diagnosed and had participated in the earlier follow-up study. The remaining five had had SBS symptoms for a shorter period. The interviews were analysed using qualitative content analysis.   

    Results: The degree and severity of SBS symptoms decreased over time, although nearly half of the SBS patients claimed that symptoms were more or less unchanged after 7 years or more. The risk of having no work capabilities was significantly increased at follow-up if the time from debut to first visit at the hospital clinic was more than one year and this risk was also significantly higher if the patient at the first visit had 5 or more symptoms. Common daily activities, like going by bus, also aggravated the SBS symptoms according to answers in the questionnaires.

    The informants’ experiences of the emerging SBS symptoms are that when they first appear they are often similar to those of flu like runny nose and eyes, hoarseness, cough, and headache. Many of the informants act to change the way they manage the situation as a result of increased symptoms. During this whole process the informants/patients perceived a lack of confirmation and support from e.g. employers, primary health care and occupational health care centres.

    Regarding self-image, all three patient groups scored higher on spontaneous and positive self-image than a comparison group. They were all less controlled. The patients with hand-eczema together with the patients with perceived electrical sensitivity also had a high score on negative self-image. CRI- domains did not differ between patients and comparison group except on CRI cognitive, were the hand eczema patients had a lower score than the comparison group contrary to SBS patients who had a higher score than the comparison group. The patients with perceived electrical sensitivity had a higher score on CRI spiritual. Self-image or coping ability was not associated with SBS symptoms or persistent hand eczema symptoms at follow-up and their personality did not affect their work capability. Previous atopic dermatitis was the only consistent predictor of hand eczema at follow-up.

    Conclusion: Within this group of SBS patients there are long lasting symptoms aggravated by environmental factors. The results support that early and comprehensive measures for rehabilitation are essential for these patients. In the beginning the symptoms of SBS are diffuse and difficult to recognise for all involved. Patients with SBS symptoms experience a lack of confirmation and support. It is important that healthcare personnel confirm the patient and are aware of the possible connection between symptoms and the indoor environment. For employers and facility managers knowledge of their obligations in terms of working environment is important. Differences in personality traits were seen in a well-established condition and not only in patients with medically unexplained symptoms. This can imply that patients with general chronic symptoms can deviate from the general population with respect to self-image and coping ability. Certain personality traits may be potential risk factors that increase the probability of encountering and experiencing stressful work situations.  

     

  • 42.
    Elwer, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Alex, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gender (in)equality among employees in elder care: implications for health2012In: International Journal for Equity in Health, ISSN 1475-9276, Vol. 11, no 1Article in journal (Refereed)
    Abstract [en]

    Introduction: Gendered practices of working life create gender inequalities through horizontal and vertical gender segregation in work, which may lead to inequalities in health between women and men. Gender equality could therefore be a key element of health equity in working life. Our aim was to analyze what gender (in) equality means for the employees at a woman-dominated workplace and discuss possible implications for health experiences.

    Methods: All caregiving staff at two workplaces in elder care within a municipality in the north of Sweden were invited to participate in the study. Forty-five employees participated, 38 women and 7 men. Seven focus group discussions were performed and led by a moderator. Qualitative content analysis was used to analyze the focus groups.

    Results: We identified two themes. "Advocating gender equality in principle" showed how gender (in) equality was seen as a structural issue not connected to the individual health experiences. "Justifying inequality with individualism" showed how the caregivers focused on personalities and interests as a justification of gender inequalities in work division. The justification of gender inequality resulted in a gendered work division which may be related to health inequalities between women and men. Gender inequalities in work division were primarily understood in terms of personality and interests and not in terms of gender.

    Conclusion: The health experience of the participants was affected by gender (in) equality in terms of a gendered work division. However, the participants did not see the gendered work division as a gender equality issue. Gender perspectives are needed to improve the health of the employees at the workplaces through shifting from individual to structural solutions. A healthy-setting approach considering gender relations is needed to achieve gender equality and fairness in health status between women and men.

  • 43. Ericzon, Bo-Goran
    et al.
    Wilczek, Henryk E.
    Larsson, Marie
    Stangou, Arie J.
    Wijayatunga, Priyantha
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Suhr, Ole
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    To transplant or not to transplant - Lessons learned from 20 years global collaboration in liver transplantation for hereditary transthyretin amyloidosis2013In: Hepatology, ISSN 0270-9139, E-ISSN 1527-3350, Vol. 58, 1011A-1011A p.Article in journal (Other academic)
  • 44.
    Eriksson, Carola
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Westman, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Content of childbirth-related fear in Swedish women and men: analysis of an open-ended question2006In: Journal of midwifery & women's health, ISSN 1526-9523, E-ISSN 1542-2011, Vol. 51, no 2, 112-118 p.Article in journal (Refereed)
    Abstract [en]

    The content of childbirth-related fear as described by 308 women and 194 men was analyzed and compared in relation to intensity of fear. The content of fear was similarly described by women and men and concerned the following main categories: the labor and delivery process, the health and life of the baby, the health and life of the woman, own capabilities and reactions, the partner's capabilities and reactions, and the professionals' competence and behavior. Among women, the labor and delivery process was the most frequently reported among the 6 categories of fears, whereas the health and life of the baby was the most frequent among the men. Fears related to own capabilities and reactions were described significantly more often by women with intense fear than by women with mild to moderate fear. The greatest difference between men with intense versus mild to moderate fear was a more frequent expression of concern for the health and life of the woman. Both women and men had fears related to not being treated with respect and not receiving sufficient medical care. This finding suggests that part of the problem with childbirth-related fear is located within the health care system itself.

  • 45.
    Fhärm, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    ‘Aiming for the stars’—GPs’ dilemmas in the prevention of cardiovascular disease in type 2 diabetes patients: focus group interviews2009In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, no 26, 109-114 p.Article in journal (Refereed)
    Abstract [en]

    Background

    Studies have revealed low adherence to guidelines for treatment of diabetes and cardiovascular risk factors.

    Objective

    To explore general practitioners’ experiences regarding treatment practice in type 2 diabetes with specific focus on the prevention of cardiovascular disease.

    Methods

    Fourteen experienced general practitioners from nine health care centres with group practices were interviewed in focus groups. The interviews were digitally recorded, transcribed verbatim and analysed by qualitative content analysis.

    Results

    The overall theme was “dilemmas” in GPs´ treatment practice for type 2 diabetes patients. Five main dilemma categories were identified. First, the GPs were hesitant about labelling someone who feels healthy as ill. Secondly, regarding communicating a diabetes diagnosis and its consequences; should the patient be frightened or comforted? Thirdly, the GPs experienced uncertainty in their role; were they to take responsibility for the care or not? Fourthly, the GPs expressed a conflict between lifestyle changes and drug treatment. Fifthly, the GPs described difficulties in integrating science into reality.

    Conclusions

    The five dilemmas in the general practitioners’ approach to diabetes patients and the treatment of their cardiovascular risk were related to the GPs´ professional role and communication with the patient. To consider these dilemmas in educational efforts is probably essential to achieve improved diabetes care and guideline adherence. 

  • 46.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Apropå mammografiscreening. Informerat samtycke: även i Sverige?2010In: Läkartidningen, ISSN 0023-7205, Vol. 107, no 1-2, 9- p.Article in journal (Other academic)
  • 47.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Kan begreppet positionerade kunskaper användas för att granska och utveckla (allmän)medicinsk kunskap?2004In: Medicinsk genusforskning: teori och begreppsutveckling, Stockholm: Vetenskapsrådet , 2004, 138-145 p.Chapter in book (Other academic)
  • 48.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Klimakteriet och vetenskapen: en historia att lära av?2010Conference paper (Other academic)
  • 49.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Livslopp och barnafödande: viktiga aspekter i patient-läkarmötet2004In: Kropp och genus i medicinen / [ed] Birgitta Hovelius, Eva E Johansson, Lund: Studentlitteratur, 2004, 127-135 p.Chapter in book (Other academic)
  • 50.
    Forssén, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Carlstedt, Gunilla
    Feminism som vetenskapligt perspektiv - ett exempel2008In: Tillämpad kvalitativ forskning inom hälso- och sjukvård / [ed] Granskär & Höglund-Nielsen, Lund: Studentlitteratur , 2008, 1, 57-72 p.Chapter in book (Other academic)
12345 1 - 50 of 237
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