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  • 1.
    Engberg, Isak
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Segerstedt, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Waller, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Fatigue in the general population-associations to age, sex, socioeconomic status, physical activity, sitting time and self-rated health: the northern Sweden MONICA study 20142017In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, article id 654Article in journal (Refereed)
    Abstract [en]

    Background: Fatigue is widespread in the population and a common complaint in primary care. Little is known about prevalence of fatigue in the population and its predictors. We aimed to describe the pattern of fatigue in the general population and to explore the associations with age, sex, socioeconomic status, self-reported physical activity, sitting time and self-rated health.

    Methods: One thousand, five hundred and fifty-seven out of 2500 invited subjects in the Northern Sweden MONICA Study 2014, aged 25-74 years, filled out the Multidimensional Fatigue Inventory (MFI-20), consisting of four subscales: General fatigue (GF), Physical fatigue (PF), Reduced activity (RA) and Mental fatigue (MF). Questions regarding age, sex, socioeconomic status, physical activity, sitting time and self-rated health were also included.

    Results: Higher age correlated significantly with lower fatigue scores for the GF and MF subscales. Women had higher fatigue scores than men on all subscales (p < 0.05). Among men, higher socioeconomic status was related to lower fatigue for the GF, PF and RA subscales (age adjusted p < 0.05). Among women, higher socioeconomic status was related to lower fatigue for the PF and MF subscales (age adjusted p < 0.05). Higher physical activity was connected to lower levels of fatigue for all subscales (age and sex adjusted p < 0.001) except for MF. Longer time spent sitting was also related to more fatigue on all subscales (age and sex adjusted p < 0.005) except for MF. Better self-rated health was strongly associated with lower fatigue for all subscales (age and sex adjusted p < 0.001).

    Conclusion: Older, highly educated, physically active men, with little sedentary behavior are generally the least fatigued. Self-rated health is strongly related to fatigue. Interventions increasing physical exercise and reducing sedentary behavior may be important to help patients with fatigue and should be investigated in prospective studies.

  • 2.
    Waller, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Etik, prioriteringar och värdegrund2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 34, p. 2072-2074Article in journal (Other academic)
  • 3.
    Waller, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Self-rated health: from epidemiology to patient encounter2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: In epidemiology self-rated health is often measured as people’s subjective answer to a question “How is your health in general?” or “How is your general health compared to persons of your own age?”. The answers have a strong association with significant medical outcomes such as death, diabetes, coronary heart disease, functional ability and depression, medical diagnoses and how these are perceived. The overarching aim of this thesis was to investigate if and how a use of the epidemiologists’ tool of self-rated health might aid GPs in practising medicine with a holistic perspective, contextually sensitive and taking into account the patients’ medical and personal histories.

    Methods: In Paper I, I used semantics to elucidate the meaning of self-rated health. Data came from the Northern Sweden Monica Project 1990–1999. In Paper II, with data from the MONICA Project in 1999–2009, I used ordinal regression to investigate associations between self-rated health, medical factors, psychosocial factors and emotions. In Paper III, I used data from the Västerbotten Intervention Programme 1990–2004 in Cox regression analyses to investigate the relationship between self-rated health and standard risk factors for the outcome myocardial infarction. Paper IV is a qualitative study from seven primary care health centres. Actual consultations were audio-recorded and analysed with systematic text condensation, measuring apportionment of speaking time and by taking into account GPs’ assessments of using a question about comparative self-rated health in a consultation.

    Results: In Paper I, I found “health” in questionnaires being understood not through definitions of health but through associations of the word “health” with “sense relations”, that are important connotations of the word “health”. Age-comparative self-rated health was semantically clearer as it pointed towards comparison with a reference group. In Paper II, emotions of anxiety or depression and discontent with personal economy were associated with lower self-rated health and were common in the population. Paper III established self-rated health as an independent risk factor for myocardial infarction when adjusted for standard risk factors. In the qualitative Paper IV, self-rated health affected consultations, increased patients’ speaking time in relation to doctors’ when discussing self-rated health and elicited reactions, sometimes with strong language. Reflections ensued that could give vivid descriptions of function, life circumstances and resources or obstacles in handling symptoms and illnesses.

    Conclusion: Comparative self-rated health constitutes a feasible tool in general practice, particularly in taking account of patients’ medical and personal histories. It is holistic, sensitive to psychosocial factors. It is useful to solicit information on risk and the patient’s feelings related to an illness/disease, and to encourage the patient’s active reflection on functional abilities, life situation, health and health strategies. However, self-ratings are not to be seen as a standard procedure in all consultations.

  • 4.
    Waller, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Self-rated health in general practice: a plea for subjectivity2015In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 65, no 632, p. 110-112Article in journal (Other academic)
  • 5.
    Waller, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Vitamin B12-brist kartlagd vid två vårdcentraler1998In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 95, p. 3802-3804Article in journal (Refereed)
  • 6.
    Waller, Göran
    et al.
    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.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    GPs asking patients to self-rate their health: a qualitative study2015In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 65, no 638, p. e624-e629Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

  • 7.
    Waller, Göran
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    What does age-comparative self-rated health measure?: A cross-sectional study from the Northern Sweden MONICA Project2016In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 3, p. 233-239Article, review/survey (Refereed)
    Abstract [en]

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

  • 8.
    Waller, Göran
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Norberg, M.
    Lundqvist, R.
    Forssen, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Self-Rated Health and Standard Risk Factors for Myocardial Infarction: A Cohort Study2016In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 85, p. 87-88Article in journal (Other academic)
  • 9.
    Waller, Göran
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lundquist, Robert
    Research Unit, County Council of Norrbotten, Luleå, Sweden.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Self-rated health and standard risk factors for myocardial infarction: a cohort study2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, article id e006589Article in journal (Refereed)
    Abstract [en]

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

    Design: Population-based prospective cohort study.

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

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

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

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

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

  • 10.
    Waller, Göran
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Thalén, P
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Do not dismiss comparative self-rated health2011Conference paper (Other academic)
  • 11.
    Waller, Göran
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Thalén, Peder
    Department for Cultural Studies, Religious Studies and Educational Sciences, University of Gävle, Gävle, Sweden.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    A cross-sectional and semantic investigation of self-rated health in the northern Sweden MONICA-study2012In: BMC Medical Research Methodology, ISSN 1471-2288, E-ISSN 1471-2288, Vol. 12, article id 154Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 12. Waller Lidström, Mattias
    et al.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lundqvist, Robert
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Waller, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Time trends of comparative self-rated health in adults aged 25–34 in the Northern Sweden MONICA study, 1990–20142017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 11, article id e0187896Article in journal (Refereed)
    Abstract [en]

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

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