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  • 301.
    Nordström, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Cognitive Performance in Late Adolescence and the Subsequent Risk of Subdural Hematoma: An Observational Study of a Prospective Nationwide Cohort2011Inngår i: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 8, nr 12, s. e1001151-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: There are few identified risk factors for traumatic brain injuries such as subdural hematoma (SDH). The aim of the present study was to investigate whether low cognitive performance in young adulthood is associated with SDH later in life. A second aim was to investigate whether this risk factor was associated with education and physical fitness. Methods and Findings: Word recollection, logical, visuospatial, and technical performances were tested at a mean age of 18.5 years in a prospective nation-wide cohort of 440,742 men. An estimate of global intelligence was calculated from these four tests. Associations between cognitive performance, education, physical fitness, and SDH during follow-up were explored using Cox regression analyses. During a median follow-up of 35 years, 863 SDHs were diagnosed in the cohort. Low global intelligence was associated with an increased risk of SDH during follow-up (hazard ratio [HR]: 1.33, per standard deviation decrease, 95% CI = 1.25-1.43). Similar results were obtained for the other measures of cognitive performance (HR: 1.24-1.33, p<0.001 for all). In contrast, a high education (HR: 0.27, comparing more than 2 years of high school and 8 years of elementary school, 95% CI = 0.19-0.39), and a high level of physical fitness (HR: 0.76, per standard deviation increase, 95% CI = 0.70-0.83), was associated with a decreased risk of suffering from a SDH. Conclusions: The present findings suggest that reduced cognitive function in young adulthood is strongly associated with an increased risk of SDH later in life. In contrast, a higher level of education and a higher physical fitness were associated with a decreased risk of SDH.

  • 302.
    Nordström, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Ett bensäkert råd för framtiden2011Inngår i: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, nr 2, s. 58-60Artikkel i tidsskrift (Annet vitenskapelig)
  • 303.
    Nordström, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Prevention of bone loss with exercise2012Inngår i: Diet, nutrients and bone health, CRC Press, 2012, s. 493-508Kapittel i bok, del av antologi (Fagfellevurdert)
  • 304.
    Nordström, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    The effect of detraining on bone2011Inngår i: Open Bone Journal, ISSN 1876-5254, nr 3, s. 22-30Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Physical activity has been recommended for the treatment and even prevention of osteoporosis. This is because physical activity can potentially increase bone mass and strength in the early years of life and reduce the risk of falling in older populations. However, a key question that remains to be answered is whether a high bone mineral density (BMD) resulting from physical activity is sustained despite decreased activity. The aim of this review is to describe the effects of decreased levels of physical activity on bone.A comprehensive search of Medline, EMBASE, and the Cochrane controlled trials register was conducted. Previous studies have reported that benefits from prior physical activity seem to be eroded after cessation of this activity, at least for bone sites that are rich in trabecular bone such as the clinically important proximal femur. In bone sites rich in cortical bone, there appeared to be long-term beneficial effects of physical activity.In conclusion, bone gain through physical activity is lost in bone sites rich in trabecular bone if the activity is not maintained. However, current knowledge is limited and further prospective research into the effect of detraining is recommended.

  • 305.
    Nordström, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. School of Sports Science, UiT The Arctic University of Norway, Tromsø, Norway..
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Traumatic brain injury and the risk of dementia diagnosis: A nationwide cohort study2018Inngår i: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 15, nr 1, artikkel-id e1002496Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Traumatic brain injury (TBI) has been associated with dementia. The questions of whether the risk of dementia decreases over time after TBI, whether it is similar for different TBI types, and whether it is influenced by familial aggregation are not well studied.

    METHODS AND FINDINGS: The cohort considered for inclusion comprised all individuals in Sweden aged ≥50 years on December 31, 2005 (n = 3,329,360). Diagnoses of dementia and TBI were tracked through nationwide databases from 1964 until December 31, 2012. In a first cohort, individuals diagnosed with TBI (n = 164,334) were matched with up to two controls. A second cohort consisted of subjects diagnosed with dementia during follow-up (n = 136,233) matched with up to two controls. A third cohort consisted of 46,970 full sibling pairs with discordant TBI status. During a mean follow-up period of 15.3 (range, 0-49) years, 21,963 individuals in the first cohort (6.3% with TBI, 3.6% without TBI) were diagnosed with dementia (adjusted odds ratio [OR], 1.81; 95% confidence interval [CI], 1.75-1.86). The association was strongest in the first year after TBI (OR, 3.52; 95% CI, 3.23-3.84), but the risk remained significant >30 years (OR, 1.25; 95% CI, 1.11-1.41). Single mild TBI showed a weaker association with dementia (OR, 1.63; 95% CI, 1.57-1.70) than did more severe TBI (OR, 2.06; 95% CI, 1.95-2.19) and multiple TBIs (OR, 2.81; 95% CI, 2.51-3.15). These results were in general confirmed in the nested case-control cohort. TBI was also associated with an increased risk of dementia diagnosis in sibling pairs with discordant TBI status (OR, 1.89; 95% CI, 1.62-2.21). A main limitation of the present study is the observational design. Thus, no causal inferences can be made based on the associations found.

    CONCLUSIONS: The risk of dementia diagnosis decreased over time after TBI, but it was still evident >30 years after the trauma. The association was stronger for more severe TBI and multiple TBIs, and it persisted after adjustment for familial factors.

  • 306.
    Nordström, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Ekstrand, Jan
    Football Research Group, Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Sports-related concussion increases the risk of subsequent injury by about 50% in elite male football players2014Inngår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, nr 19, s. 1447-1450Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 307.
    Nordström, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Bone gained from physical activity and lost through detraining: a longitudinal study in young males.2005Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 16, nr 7, s. 835-841Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to investigate the effect of training and detraining on bone mineral density of both weight-bearing and non-weight-bearing bone in a cohort of young males who participated in ice hockey training. Forty-three healthy adolescent ice hockey players (16.7+/-0.6 years) training for a mean of 9.7+/-2.4 h/week and 25 control subjects (16.8+/-0.3 years) training for 2.1+/-2.7 h/week, were included in this longitudinal study. Bone mineral density (BMD, g/cm2) of the arms, the dominant and non-dominant humerus, dominant and non-dominant femur, and the right femoral neck, total hip, and bone area of the femur, humerus and hip were measured at baseline and again after 30 and 70 months using dual-energy X-ray absorptiometry. From baseline to the first follow-up, athletes gained significantly more BMD in the femoral neck (0.07 versus 0.03 g/cm2) and arms (0.09 versus 0.06 g/cm2) compared with the controls (P = 0.04 for both). Between the first and the second follow-up, 21 ice hockey players stopped their active sports career. These men lost significantly more BMD at the femoral neck (-0.02 versus -0.10 g/cm2, P < 0.001), total hip (-0.05 versus -0.09, P = 0.04), dominant (0.02 versus -0.03 g/cm2, P = 0.009) and non-dominant humerus (0.03 versus -0.01 g/cm2, P = 0.03) than the still active ice hockey players (n = 22). At the second follow-up examination, at 22 years of age, the former ice hockey players still had significantly higher BMD at the non-dominant humerus than the controls (P < 0.01). During the total study period, the still active athletes (n = 22) gained significantly more BMD compared with the controls at the femoral neck (0.09 g/cm2; P = 0.008), total hip (0.05 g/cm2, P = 0.04) and arms (0.07 g/cm2; P = 0.01). No differences were seen in bone areas when comparing the different groups. In conclusion, training associated with ice hockey is related to continuous accumulation of BMD after puberty in males. Reduced activity is followed by BMD loss within 3 years of cessation of sports career at predominantly weight-bearing sites. The effects are confined to bone density and not bone size.

  • 308.
    Nordström, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Sustained benefits from previous physical activity on bone mineral density in males.2006Inngår i: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 91, nr 7, s. 2600-2604Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Context: The effect of physical activity on bone mineral density (BMD) is not well investigated longitudinally after puberty in men.

    Objective: Our objective was to evaluate the effect of exercise and reduced exercise on BMD after puberty in men.

    Design: We conducted a longitudinal study.

    Participants: Sixty-three healthy young athletes and 27 male controls, both with a mean age of 17 yr at baseline, participated. Also, 136 of the participants’ parents were investigated to evaluate heritable influences.

    Main Outcome Measures: Total body, total hip, femoral neck, and humerus BMD (grams per square centimeter) were measured at baseline and after mean periods of 27, 68, and 94 months in the young cohort.

    Results: BMDs of control parents and athlete parents were equal, suggesting absence of selection bias. The 23 athletes that remained active throughout the study increased BMD at all sites when compared with controls (mean difference, 0.04–0.12 g/cm2; P < 0.05) during the study period. After an average of 3 yr, 27 athletes ended their active careers. Although this group initially lost BMD at the hip compared with active athletes, the former athletes still had higher BMD than controls at the femoral neck (0.12 g/cm2; P = 0.007), total hip (0.11 g/cm2; P = 0.02), and humerus (0.10 g/cm2; P = 0.02) at the final follow-up.

    Conclusions: High sensitivity to physical loading persists after puberty in men. Reduced physical activity is associated with BMD loss in the first 3 yr in weight-bearing bone. Sustained benefits in BMD are preserved 5 yr after intensive training ends.

  • 309.
    Nordström, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Thorsen, Kim
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    A 3-year longitudinal study of the effect of physical activity on the accrual of bone mineral density in healthy adolescent males.2003Inngår i: Calcified Tissue International, ISSN 0171-967X, E-ISSN 1432-0827, Vol. 73, nr 2, s. 108-114Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    It has previously been suggested that physical activity predominantly influences the accumulation of bone density before puberty. The purpose of the present study was to examine the effect of physical activity on the accumulation of bone mass in male athletes between 16 and 19 years of age. The cohort studied consisted of 12 badminton players (aged 16.1 +/- 0.5), 20 ice hockey players (aged 16.1 +/- 0.5), and 24 age-matched controls (aged 16.1 +/- 0.6). The bone mineral density (BMD, g/cm2) of the total body, spine, dominant and nondominant humerus, head and femoral neck was measured twice with a 3-year interval by dual energy X-ray absorptiometry (DXA). In addition, at the femoral neck, volumetric bone mineral density (vBMD, mg/cm3) was estimated. At baseline, the athletes as a whole group had significantly higher BMD at the total body (P = 0.03), dominant (P = 0.006) and nondominant humerus (P = 0.009) and femoral neck (P = 0.007) compared to the controls. At the 3-year followup, the athletes had significantly higher BMD at all sites (total body; P = 0.003, spine; P = 0.02, dominant humerus; P = 0.001, nondominant humerus; P = < 0.001, femoral neck; P = 0.001) except for the head (P = 0.91) compared with controls. The athletes also had higher vBMD at the femoral neck compared with the controls (P = 0.01). Furthermore, to be an athlete was found to be independently associated with a higher increase in nondominant humerus BMD (beta = 0.24; P < 0.05) and femoral neck BMD (beta = 0.30; P < 0.05) compared with the controls, during the study period. In summary, these results suggests that it is possible to achieve continuous gains in bone mass in sites exposed to osteogenic stimulation after puberty in males by engaging in weight-bearing physical activity.

  • 310.
    Nordström, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Protetik. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Oral health and dietary habits in an elderly city population: a report from the Umeå longitudinal study1995Doktoravhandling, med artikler (Annet vitenskapelig)
  • 311.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Alzheimer's drugs linked to reduced risk of myocardial infarct2013Inngår i: British Journal of Hospital Medicine, ISSN 1750-8460, Vol. 74, nr 7, s. 368-368Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 312.
    Nordström, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Eklund, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Sievänen, Harri
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Do both areal BMD and injurious falls explain the higher incidence of fractures in women than in men?2011Inngår i: Calcified Tissue International, ISSN 0171-967X, E-ISSN 1432-0827, Vol. 89, nr 3, s. 203-210Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The higher incidence of fractures in women than in men is generally attributed to the lower areal bone mineral density (areal BMD, g/cm(2)) of the former. The purpose of the present study was to investigate both areal BMD and injurious falls as risk factors for fractures. In a first cohort, areal BMD was measured in 5,131 men and women (age range 40-95 years). In a second cohort, consisting of 26,565 men and women (age range 40-69 years), a health survey was conducted including questions about lifestyle and medication. Main outcome measures included validated prospective injurious falls and fractures in both cohorts. The higher areal BMD and femoral neck BMD in men compared to women (P < 0.001) were explained by a higher diameter of the femoral neck. Importantly, the diameter of the femoral neck was not associated with fractures in either sex (hazard ratio [HR] 0.94-1.04, P > 0.05 for all), suggesting that a higher areal BMD and lower incidence of osteoporosis in men do not explain their lower incidence of fractures. In contrast, women were more prone to sustain injurious falls than men in both cohorts investigated (HR for women = 1.61 and 1.84, P < 0.001 for both), resulting in a higher incidence of fractures (HR for women = 2.24 and 2.36, P < 0.001 for both). The number of injurious falls and fractures occurring each month during the study period showed a very strong correlation in both women (r = 0.95, P < 0.00001) and men (r = 0.97, P < 0.00001). In summary, low areal BMD, and thus osteoporosis, may not explain the higher fracture incidence in women than in men. Instead, a higher incidence of injurious falls in women was strongly associated with the higher fracture risk.

  • 313.
    Nordström, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Franks, Paul
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Cognitive function in young men and the later risk of fractures2012Inngår i: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 27, nr 11, s. 2291-2297Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Dementia has been associated with an increased risk of fractures. These associations may be explained by an impaired cognitive function, as well as comorbid illness and toxic reaction from drugs. To investigate whether cognitive function in young, healthy individuals already affects the risk of fractures, overall cognitive function scores were calculated from four cognitive tests accomplished during a national conscriptions test in 960,956 men with a mean age of 18 years. Incident fractures were searched in national registers. During a median follow-up of 30 years (range 0 to 41 years), 65,313 men had one fracture and 2589 men had a hip fracture. Compared with men with no fracture, overall cognitive function at baseline was 3.5% lower for men sustaining one fracture and 5.5% lower for men sustaining a hip fracture (p < 0.001 for both). When comparing the lowest and the highest decile, low overall cognitive function scores increased the risk one fracture (hazard ratio [HR] = 1.55, 95% confidence interval [CI] 1.50-1.61) and a hip fracture (HR = 2.12, 95% CI 1.77-2.55), after adjustment for confounders. A higher education (university level versus elementary school) was associated with a decreased risk of a fracture (HR = 0.67, 95% CI 0.65-0.69) and a hip fracture (HR = 0.51, 95% CI 0.45-0.57). The effects of education and cognitive function were reduced when also adjusting for total income and disability pension. In summary, low cognitive function and education in young men were associated with the later risk of especially hip fractures. These associations may partly be mediated by socioeconomic factors. © 2012 American Society for Bone and Mineral Research.

  • 314.
    Nordström, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Michaëlsson, Karl
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden2015Inngår i: BMJ. British Medical Journal, ISSN 1756-1833, Vol. 350, artikkel-id h696Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 315.
    Nordström, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Michaelsson, Karl
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Traumatic brain injury and young onset dementia: a nationwide cohort study2014Inngår i: Annals of Neurology, ISSN 0364-5134, E-ISSN 1531-8249, Vol. 75, nr 3, s. 374-381Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 316.
    Nordström, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Michaëlsson, Karl
    Hommel, Ami
    Norrman, Per Ola
    Thorngren, Karl-Göran
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Geriatric Rehabilitation and Discharge Location After Hip Fracture in Relation to the Risks of Death and Readmission2016Inngår i: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, nr 1, artikkel-id UNSP 91.e1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To investigate the effects of geriatric rehabilitation on short-term risk of death and readmission after a hip fracture were investigated in a nationwide cohort. In addition, the association of discharge location (nursing home or patient's home) with the short-term risk of death was assessed.

    DESIGN, SETTING, AND PARTICIPANTS: The cohort consisted of 89,301 individuals at least 50 years of age, with a first hip fracture registered in the Swedish quality register RIKSHÖFT, the years 2004-2012.

    MEASURES: Short-term risk of death and readmission to hospital after discharge was compared at 8 hospitals, where most patients received inpatient care in geriatric wards, and those treated at 71 regular hospitals.

    RESULTS: The risks of death within 30 days of admission were 7.1% in patients admitted to geriatric ward hospitals and 7.4% in those treated at regular hospitals (multivariable-adjusted hazard ratio [HR] 0.91, 95% CI 0.85-0.97), whereas the odds of readmission within 30 days of discharge were 8.7% and 9.8%, respectively (multivariable-adjusted odds ratio 0.86, 95% CI 0.81-0.91). The risk of death was influenced by discharge location and inpatient length of stay (LOS). Thus, for patients discharged to short-term nursing homes with a LOS of at most 10 days, each additional day of LOS reduction increased the risk of death within 30 days of discharge by 13% (HR 1.13, 95% CI 1.08-1.18). This association was reduced in patients discharged to permanent nursing homes (HR 1.04, 95% CI 1.02-1.07), and not significant in those discharged to their own home (OR 1.00, 95% CI 0.91-1.10).

    CONCLUSION: The risks of death and readmission were lower in patients with hip fracture who received care in hospitals with geriatric wards. The risk of death after discharge increased with shorter LOS, especially in patients discharged to short-term nursing homes.

  • 317.
    Nordström, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Decreased mortality during inpatient care in The Netherlands: what are the keys to further improve health care for elderly patients?2016Inngår i: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 45, nr 1, s. 4-5Artikkel i tidsskrift (Fagfellevurdert)
  • 318.
    Nordström, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Hälsosamt fet av träning2011Inngår i: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, nr 1, s. 66-68Artikkel i tidsskrift (Annet vitenskapelig)
  • 319.
    Nordström, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. School of Sports Science, UiT The Arctic University of Norway, Tromsö, Norway..
    Use of short-acting and long-acting hypnotics and the risk of fracture: a critical analysis of associations in a nationwide cohort2019Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 30, nr 10, s. 1983-1993Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Summary: Numerous observational studies suggest that hypnotics increase the risk of fractures, and long-acting hypnotics are suggested to be especially harmful. This study showed that the highest risk of fracture was found before start of treatment and remained after end of therapy, suggesting that the increased risk during treatment is influenced by other factors, such as underlying disease.

    Introduction: The purpose of this study was to evaluate associations between the use of short-acting and long-acting hypnotics and the risk of fracture.

    Methods: Four cohorts were formed from all individuals living in Sweden aged ≥ 50 years in 2005 (n = 3,341,706). In the first cohort, individuals prescribed long-acting propiomazine (n = 233,609) were matched 1:1 with controls. In the second cohort, individuals prescribed short-acting z-drugs (zopiclone, zolpidem, and zaleplon, n = 591,136) were matched 1:1 with controls. The third and fourth cohorts consisted of full sibling pairs with discordant propiomazine (n = 83,594) and z-drug (n = 153,314) use, respectively.

    Results: The risk of fracture was greatest among users of hypnotics in the 90 days before the initiation of treatment, both for propiomazine (odds ratio [OR], 2.52; 95% confidence interval [CI], 2.28–2.79) and z-drugs (OR, 4.10; 95% CI, 3.86–4.35) compared with that in matched controls. Furthermore, this risk was significantly reduced after the initiation of treatment with propiomazine (OR, 1.42; 95% CI, 1.27–1.60) and z-drugs (OR, 1.67; 95% CI, 1.56–1.80) and remained the first year following the last prescribed dose both for propiomazine (OR, 1.28, 95% CI, 1.21–1.36) and z-drugs (OR, 1.19, 95% CI, 1.16–1.23). The pattern was similar in the sibling cohorts, with the greatest risk of fracture seen in the 90 days before treatment with hypnotics was initiated.

    Conclusion: The use of short-acting and long-acting hypnotics is associated with an increased risk of fracture. This risk was highest before initiation of treatment and remained after end of therapy. The results suggest that the increased risk during treatment is influenced by other factors such as underlying disease.

  • 320.
    Nordström, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Eriksson, Marie
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Wahlund, Lars-Olof
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Risk factors in late adolescence for young-onset dementia in men: a nationwide cohort study2013Inngår i: JAMA internal medicine, ISSN 2168-6114, Vol. 173, nr 17, s. 1612-1618Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    IMPORTANCE: Young-onset dementia (YOD), that is, dementia diagnosed before 65 years of age, has been related to genetic mutations in affected families. The identification of other risk factors could improve the understanding of this heterogeneous group of syndromes.

    OBJECTIVE: To evaluate risk factors in late adolescence for the development of YOD later in life.

    DESIGN: We identified the study cohort from the Swedish Military Service Conscription Register from January 1, 1969, through December 31, 1979. Potential risk factors, such as cognitive function and different physical characteristics, were assessed at conscription. We collected other risk factors, including dementia in parents, through national register linkage.

    PARTICIPANTS: All Swedish men conscripted for mandatory military service (n = 488 484) with a mean age of 18 years.

    SETTING: Predominantly Swedish men born from January 1, 1950, through December 31, 1960.

    EXPOSURE: Potential risk factors for dementia based on those found in previous studies, data available, and quality of register data.

    MAIN OUTCOMES AND MEASURE: All forms of YOD.

    RESULTS: During a median follow-up of 37 years, 487 men were diagnosed as having YOD at a median age of 54 years. In multivariate Cox regression analysis, significant risk factors (all P &lt; .05) for YOD included alcohol intoxication (hazard ratio, 4.82 [95% CI, 3.83-6.05]); population-attributable risk, 0.28), stroke (2.96 [2.02-4.35]; 0.04), use of antipsychotics (2.75 [2.09-3.60]; 0.12), depression (1.89 [1.53-2.34]; 0.28), father's dementia (1.65 [1.22-2.24]; 0.04), drug intoxication other than alcohol (1.54 [1.06-2.24]; 0.03), low cognitive function at conscription (1.26 per 1-SD decrease [1.14-1.40]; 0.29), low height at conscription (1.16 per 1-SD decrease [1.04-1.29]; 0.16), and high systolic blood pressure at conscription (0.90 per 1-SD decrease [0.82-0.99]; 0.06). The population-attributable risk associated with all 9 risk factors was 68%. Men with at least 2 of these risk factors and in the lowest third of overall cognitive function were found to have a 20-fold increased risk of YOD during follow-up (hazard ratio, 20.38 [95% CI, 13.64-30.44]).

    CONCLUSIONS AND RELEVANCE: In this nationwide cohort, 9 independent risk factors were identified that accounted for most cases of YOD in men. These risk factors were multiplicative, most were potentially modifiable, and most could be traced to adolescence, suggesting excellent opportunities for early prevention.

  • 321.
    Nordström, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Pedersen, Nancy L
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Michaëlsson, Karl
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Risks of Myocardial Infarction, Death, and Diabetes in Identical Twin Pairs With Different Body Mass Indexes2016Inngår i: JAMA Internal Medicine, ISSN 2168-6106, E-ISSN 2168-6114, Vol. 176, nr 10, s. 1522-1529Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    IMPORTANCE Observational studies have shown that obesity is a major risk factor for cardiovascular disease and death. The extent of genetic confounding in these associations is unclear. OBJECTIVE To compare the risk of myocardial infarction (MI), type 2 diabetes, and death in monozygotic (MZ) twin pairs discordant for body mass index (BMI). DESIGN, SETTING, AND PARTICIPANTS A cohort of 4046 MZ twin pairs with discordant BMIs (difference >0.01) was identified using the nationwide Swedish twin registry. The study was conducted from March 17, 1998, to January 16, 2003, with follow-up regarding incident outcomes until December 31, 2013. MAIN OUTCOMES AND MEASURES The combined primary end point of death or MI and the secondary end point of incident diabetes were evaluated in heavier compared with leaner twins in a co-twin control analysis using multivariable conditional logistic regression. RESULTS Mean (SD) baseline age for both cohorts was 57.6 (9.5) years (range, 41.9-91.8 years). During a mean follow-up period of 12.4 (2.5) years, 203 MIs (5.0%) and 550 deaths (13.6%) occurred among heavier twins (mean [SD] BMI, 25.9 [3.6] [calculated as weight in kilograms divided by height in meters squared]) compared with 209 MIs (5.2%) and 633 deaths (15.6%) among leaner twins (mean [SD] BMI, 23.9 [3.1]; combined multivariable adjusted odds ratio [OR], 0.75; 95% CI, 0.63-0.91). Even in twin pairs with BMI discordance of 7.0 or more (mean [SE], 9.3 [0.7]), where the heavier twin had a BMI of 30.0 or more (n = 65 pairs), the risk of MI or death was not greater in heavier twins (OR, 0.42; 95% CI, 0.15-1.18). In contrast, in the total cohort of twins, the risk of incident diabetes was greater in heavier twins (OR, 2.14; 95% CI, 1.61-2.84). Finally, increases in BMI since 30 years before baseline were not associated with the later risk of MI or death (OR, 0.97; 95% CI, 0.89-1.05) but were associated with the risk of incident diabetes (OR, 1.13; 95% CI, 1.01-1.26). CONCLUSIONS AND RELEVANCE In MZ twin pairs, higher BMI was not associated with an increased risk of MI or death but was associated with the onset of diabetes. These results may suggest that lifestyle interventions to reduce obesity are more effective in decreasing the risk of diabetes than the risk of cardiovascular disease or death.

  • 322.
    Nordström, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Religa, Dorota
    Wimo, Anders
    Winblad, Bengt
    Eriksdotter, Maria
    The use of cholinesterase inhibitors and the risk of myocardial infarction and death: a nationwide cohort study in subjects with Alzheimer's disease2013Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, nr 33, s. 2585-2591Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: Cholinesterase inhibitors (ChEIs) are used for symptomatic treatment of Alzheimer's disease. These drugs have vagotonic and anti-inflammatory properties that could be of interest also with respect to cardiovascular disease. This study evaluated the use of ChEIs and the later risk of myocardial infarction and death. METHODS AND RESULTS: The cohort consisted of 7073 subjects (mean age 79 years) from the Swedish Dementia Registry with the diagnoses of Alzheimer's dementia or Alzheimer's mixed dementia since 2007. Cholinesterase inhibitor use was linked to diagnosed myocardial infarctions (MIs) and death using national registers. During a mean follow-up period of 503 (range 0-2009) days, 831 subjects in the cohort suffered MI or died. After adjustment for confounders, subjects who used ChEIs had a 34% lower risk for this composite endpoint during the follow-up than those who did not [hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.56-0.78]. Cholinesterase inhibitor use was also associated with a lower risk of death (HR: 0.64, 95% CI: 0.54-0.76) and MI (HR: 0.62, 95% CI: 0.40-0.95) when analysed separately. Subjects taking the highest recommended ChEI doses (donepezil 10 mg, rivastigmine >6 mg, galantamine 24 mg) had the lowest risk of MI (HR: 0.35, 95% CI: 0.19-0.64), or death (HR: 0.54, 95% CI: 0.43-0.67) compared with those who had never used ChEIs. CONCLUSION: Cholinesterase inhibitor use was associated with a reduced risk of MI and death in a nationwide cohort of subjects diagnosed with Alzheimer's dementia. These associations were stronger with increasing ChEI dose.

  • 323.
    Nordström, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Sievänen, Harri
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Pedersen, Nancy L
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    High physical fitness in young adulthood reduces the risk of fractures later in life in men: a nationwide cohort study2013Inngår i: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 28, nr 5, s. 1061-1067Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A few studies indicate that self reported physical activity is associated with the risk of fractures in middle-aged and elderly men. We investigated whether objectively measured physical fitness in young adulthood was associated with the risk of low-energy fractures later in life in men. Aerobic capacity and isometric muscle strength were measured in 435445 Swedish men that conscripted for military service from 1969-1978. Incident fractures were searched in national registers. During a median follow-up period of 35 years (range, 11-41 years), 8 030 subjects sustained at least one fracture, increasing the risk of death 1.8 times (95% CI = 1.6-2.0) during follow up. When comparing men in the lowest and highest decile of physical fitness, the risk of a fracture was 1.8 times higher (95% CI = 1.6-2.1) and that of hip fracture was 2.7 times higher (95% CI = 1.6-4.7). The risk of fracture was also 1.4-1.5 times higher when comparing the extreme deciles of muscle strength (p < 0.001 for all). In a subcohort of 1009 twin pairs, up to 22% of the variation in physical fitness and 27-39% of the variation in muscle strength was attributable to environmental factors unique to one twin, e.g. physical activity. In conclusion, low aerobic capacity and muscle strength in young adulthood are associated with an increased risk of low-energy fractures later in life, while a low-energy fracture is associated with an increased risk of death already in middle-aged men.

  • 324.
    Nordström, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Thorngren, Karl-Gunnar
    Hommel, Ami
    Ziden, Lena
    Anttila, Sten
    Effects of Geriatric Team Rehabilitation After Hip Fracture: Meta-Analysis of Randomized Controlled Trials2018Inngår i: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 19, nr 10, s. 840-845Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Objective: Systematic rehabilitation by geriatric interdisciplinary teams has been associated with favorable outcomes in frail older patients. The aim of the present meta-analysis was to evaluate the effects of interdisciplinary geriatric team rehabilitation in older patients with hip fracture. Design, setting, and participants: Randomized controlled trials involving participants sustaining hip fractures at the age of 65 years or older were included. Included trials evaluated effects of interdisciplinary geriatric team rehabilitation compared with usual postoperative care and reported on at least one of the following outcomes: activities of daily living (ADLs), physical function, mobility, depression, cognitive function, discharge to home, quality of life, influence on relatives, complications, and survival. Seven studies of at least moderate quality with a total of 1763 participants were included. Measures: Data were combined using a random-effects model. The GRADE system (1-4, where 4 is highest level of evidence) was used to rate the quality of the estimates. Results: Outcomes were grouped into 4 categories, each of which was reported on in at least 4 studies: ADL/physical function, mobility, living in one's own home, and survival. Interdisciplinary geriatric team rehabilitation increased ADL/physical function (standardized mean difference [SMD], 0.32; 95% confidence interval [CI], 0.17-0.47) and mobility (SMD, 0.32; 95% CI, 0.12-0.52) compared with conventional care. In contrast, interdisciplinary geriatric team rehabilitation did not increase the chance of living in one's own home after discharge (risk ratio [RR], 1.07; 95% CI, 0.99-1.16) or survival (RR, 1.02; 95% CI, 0.99-1.06) compared with conventional care. All results were rated as GRADE 3. Conclusion: Systematic rehabilitation by geriatric interdisciplinary teams increases physical function and mobility significantly compared with conventional care in patients with hip fracture. In contrast, the chance of being discharged to one's own home and survival are not influenced.

  • 325.
    Nordström, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Toots, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Thorngren, Karl-Göran
    Hommel, Ami
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bisphosphonate Use After Hip Fracture in Older Adults: A Nationwide Retrospective Cohort Study2017Inngår i: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 18, nr 6, s. 515-521Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: The aim of this study was to investigate the association between bisphosphonate use and the risk of new fracture in a nationwide cohort of individuals with previous hip fractures, with emphasis on individuals above 80 years of age.

    DESIGN, SETTING, AND PARTICIPANTS: From a nationwide cohort with hip fracture (2006-2012) (n = 93, 601), each individual prescribed bisphosphonates after hip fracture (n = 5845) was matched with up to three individuals not prescribed bisphosphonates, resulting in a cohort of 21,363 individuals.

    MAIN OUTCOME MEASURE: A new hip fracture.

    RESULTS: During a mean follow-up period of 2.98 (range, 0.02-8) years, 4581 fractures occurred in the cohort. Before the initiation of bisphosphonate therapy, individuals later prescribed bisphosphonates had an increased risk of hip fracture (multivariable adjusted odds ratio [OR], 2.63; 95% confidence interval [CI], 2.23-3.24) compared with controls. In the period after bisphosphonate therapy initiation, individuals prescribed bisphosphonates had a lower risk of hip fracture (multivariable adjusted hazard ratio [HR], 0.76; 95% CI, 0.65-0.90) compared with controls. Similar effects were seen after the initiation of bisphosphonates in individuals aged more than 80 years (HR, 0.79; 95% CI, 0.62-0.99). In contrast, the initiation of bisphosphonate therapy did not influence the risk of injurious falls not resulting in fracture (HR, 0.95; 95% CI, 0.86-1.05).

    CONCLUSION: Bisphosphonate use was associated with a decreased risk of hip fracture in this nationwide cohort of older men and women, with similar risk reductions in individuals older than 80 years.

  • 326. Normann, Hans Ketil
    et al.
    Asplund, Kenneth
    Karlsson, Stig
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Geriatrik.
    Sandman, Per-Olof
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    People with severe dementia exhibit episodes of lucidity. A population-based study.2006Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, Vol. 15, nr 11, s. 1413-7Artikkel i tidsskrift (Fagfellevurdert)
  • 327. Nyberg, Lars
    et al.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Sjukgymnastik.
    Sondell, Björn
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Geriatrik.
    Backman, Anders
    Holmlund, Kenneth
    Eriksson, Staffan
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Sjukgymnastik.
    Stenvall, Michael
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Geriatrik.
    Rosendahl, Erik
    Maxhall, Marcus
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Geriatrik.
    Bucht, Gustaf
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Geriatrik.
    Using a virtual reality system to study balance and walking in a virtual outdoor environment: a pilot study.2006Inngår i: Cyberpsychology & behavior, ISSN 1094-9313, Vol. 9, nr 4, s. 388-95Artikkel i tidsskrift (Fagfellevurdert)
  • 328.
    Nyberg, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Sondell, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Backman, Anders
    Holmlund, Kenneth
    Eriksson, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Stenvall, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Rosendahl, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Maxhall, Marcus
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Bucht, Gösta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Development of a virtual reality system to study tendency of falling among older people2004Inngår i: Proc 5th International Conference Series on Disability Virtual Reality and Associated Technologies, s. 315-320Artikkel i tidsskrift (Annet vitenskapelig)
  • 329.
    Nygren, Björn
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Aléx, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jonsén, Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Resilience, sense of coherence, purpose in life and self-transcendence in relation to perceived physical and mental health among the oldest old.2005Inngår i: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 9, nr 4, s. 354-362Artikkel i tidsskrift (Fagfellevurdert)
  • 330. Nyqvist, Fredrica
    et al.
    Cattan, Mima
    Andersson, Lars
    Forsman, Anna K.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Social Capital and Loneliness Among the Very Old Living at Home and in Institutional Settings: A Comparative Study2013Inngår i: Journal of Aging and Health, ISSN 0898-2643, E-ISSN 1552-6887, Vol. 25, nr 6, s. 1013-1035Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this study was to investigate the association between aspects of social capital and loneliness among the very old living at home and in institutional settings. Method: Half of those aged 85 years, and all 90- and 95-year-olds and older in urban and rural municipalities in northern Sweden and western Finland were invited to participate in a cross-sectional population-based study in 2005-2007. A sample of 483 participants who completed the study was included in the analyses. Results: Loneliness was experienced by 55% percent of those living in institutional settings often or sometimes and 45% of those living in their own homes. Loneliness was closely related to living alone, to depression, and to region (northern Sweden). Discussion: Social capital and loneliness are context dependent (i.e., geographical or living environment). Among the very old, the link between social capital resources and loneliness is also highly influenced by health status.

  • 331. Nyqvist, Fredrica
    et al.
    Cattan, Mima
    Conradsson, Mia
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nasman, Marina
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Prevalence of loneliness over ten years among the oldest old2017Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, nr 4, s. 411-418Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: This study examined the prevalence of loneliness among the oldest old within a 10-year period and studied the influence of various sociodemographic, social and health characteristics on loneliness.

    Methods: The study used population-based data from the Umea85+/GErontological Regional DAtabase-study (GERDA) for the years 2000-2002, 2005-2007 and 2010-2012 including 85-year-old, 90-year-old and 95-year-old participants. A final sample of 304 participants in 2000-2002, 329 participants in 2005-2007 and 401 participants in 2010-2012 was included in the analyses.

    Results: Although the level of loneliness was already high in 2000-2002 (49.3% reported frequent loneliness), the results showed limited changes in loneliness during the 10-year study period. Loneliness was closely related to living alone, depressive symptoms and living in institutional settings.

    Conclusions: Although societal changes such as solitary living and growing urbanization suggest a changing trend in loneliness, we found that the prevalence of loneliness was relatively stable in this study. Nevertheless, loneliness is common among the oldest old and a focus on social issues related to living arrangements and on depressive symptoms is important in understanding loneliness.

  • 332.
    Nyström, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Parkinson’s disease: the prodromal phase and consequences with respect to working life2016Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background: Parkinson’s disease (PD) is a common, progressive neurodegenerative disorder, recognized by the motor symptoms of bradykinesia, tremor, rigidity, and postural impairment. At clinical onset, extensive amounts of dopaminergic neurons have already been lost. The duration of this prodromal phase is uncertain, and it is thought to include predominantly non-motor symptoms. The progressive nature and the symptoms of PD are disabling and reduces the quality of life. Among patients affected in working age, early cessation of employment is common, and such socioeconomic consequences of PD may contribute to an impaired quality of life. The aims of this thesis were to investigate the life situation for people affected by PD in working age, with attention to factors of importance for quality of life and working situation, and to evaluate long-term associations between potential prodromal signs and the later development of PD.Methods: We used a postal survey to investigate the self-perceived life situation among working-aged individuals with PD compared to matched controls, with a specific attention to socioeconomic consequences of disease (paper I). To investigate risk markers preceding the diagnosis of PD (paper II-IV), we used data from nationwide registers. Study II was performed as a cohort study, based on the Swedish Military Service Conscription Register, and study III-IV were performed as nested case-control studies based on a cohort comprising all Swedish citizens aged ≥50 years in 2005.Results: In the survey study (paper I), 38% of the PD participants and 9% of the controls were dissatisfied with life as a whole, and the working situation was an independent risk factor for dissatisfaction with life. In total, 59% of the PD participants had reduced working hours or stopped working due to PD, and many PD participants struggled to cope with their work demands. Support from employer was associated with a higher likelihood to remain employed.We found that low muscle strength in young adulthood, (paper II) and depression (paper III) were associated with an increased risk of PD over follow-up times of more than 2 decades, and that patients with PD were at increased risk of fall-related injuries, hip fractures in particular, a decade or more before the PD diagnosis (paper IV). For depression and fall-related injuries, the association with PD was clearly time-dependent, strongest in the last years before the diagnosis of PD.Conclusions: The results suggest that the prodromal phase of PD may last for more than 2 decades and include also motor symptoms. The consequences of PD include a reduced quality of life associated with the working situation. Employer’s support appear to be particularly important for a successful vocational rehabilitation.

  • 333.
    Nyström, Helena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Risk of Injurious Fall and Hip Fracture up to 26 y before the Diagnosis of Parkinson Disease: Nested Case-Control Studies in a Nationwide Cohort2016Inngår i: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 13, nr 2, artikkel-id e1001954Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Low muscle strength has been found in late adolescence in individuals diagnosed with Parkinson disease (PD) 30 y later. This study investigated whether this lower muscle strength also may translate into increased risks of falling and fracture before the diagnosis of PD.

    METHODS AND FINDINGS: Among all Swedish citizens aged ≥50 y in 2005, two nested case-control cohorts were compiled. In cohort I, individuals diagnosed with PD during 1988-2012 (n = 24,412) were matched with up to ten controls (n = 243,363), and the risk of fall-related injuries before diagnosis of PD was evaluated. In cohort II, individuals with an injurious fall in need of emergency care during 1988-2012 (n = 622,333) were matched with one control (n = 622,333), and the risk of PD after the injurious fall was evaluated. In cohort I, 18.0% of cases and 11.5% of controls had at least one injurious fall (p < 0.001) prior to PD diagnosis in the case. Assessed by conditional logistic regression analysis adjusted for comorbid diagnoses and education level, PD was associated with increased risks of injurious fall up to 10 y before diagnosis (odds ratio [OR] 1.19, 95% CI 1.08-1.31; 7 to <10 y before diagnosis) and hip fracture ≥15 y before diagnosis (OR 1.36, 95% CI 1.10-1.69; 15-26 y before diagnosis). In cohort II, 0.7% of individuals with an injurious fall and 0.5% of controls were diagnosed with PD during follow-up (p < 0.001). The risk of PD was increased for up to 10 y after an injurious fall (OR 1.18, 95% CI 1.02-1.37; 7 to <10 y after diagnosis). An important limitation is that the diagnoses were obtained from registers and could not be clinically confirmed for the study.

    CONCLUSIONS: The increased risks of falling and hip fracture prior to the diagnosis of PD may suggest the presence of clinically relevant neurodegenerative impairment many years before the diagnosis of this disease.

  • 334.
    Näsman, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    The limbic-hypothalamic-pituitary-adrenal axis in Alzheimer's disease1994Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Dysfunction of the limbic-hypothalamic-pituitary-adrenal (LHPA) axis is a common finding in advanced dementia. In this study, the function of the LHPA axis at different levels was investigated in patients with dementia and in healthy elderly.

    A subtle disturbance in the feedback regulation of the LHPA axis was found in patients with early (i.e., mild to moderate) Alzheimer’s disease (AD). After 0.5 mg dexamethasone, serum cortisol levels were less suppressed in AD patients and plasma adrenocorticotropin (ACTH) levels were lower as compared with healthy elderly. After stimulation with human corticotropin-releasing hormone a blunted ACTH response was found in AD patients while relative serum cortisol, dehydroepiandrosterone, and androstenedione responses were increased. Significant correlations were found between low plasma ACTH levels and temporal lobe atrophy and between low peak plasma ACTH levels and hippocampal atrophy measured with computer tomography. Patients with advanced AD and multi-infarct dementia had lower basal levels of dehydroepiandrosterone sulphate in combination with no difference in cortisol levels, resulting in a high cortisol/DHAS ratio. The difference persisted after adjustments for age and sex in a multivariate analysis. In patients with early AD, basal serum levels of dehydroepiandrosterone and androstenedione were increased, and this increase was accentuated after stimulation with ACTH. Peripheral glucocorticoid sensitivity was examined by skin vasoconstrictor blanching tests. Patients with AD and patients treated with glucocorticoids showed skin blanching at higher clobetasol concentrations than healthy elderly.

    These findings justify further investigations on the role of LHPA axis dysfunction in Alzheimer’s disease and its possible importance for the pathophysiology of the disease.

  • 335.
    Näsman, Marina
    et al.
    Åbo Akademi University.
    Niklasson, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nygård, Mikael
    Åbo Akademi University.
    Olofsson, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nyqvist, Fredrika
    Åbo Akademi University.
    Risk factors for a decrease in high morale in very old peopleover a 5‑year period: data from two Nordic countries2019Inngår i: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    High morale could be considered to be an essential part of aging well and increased knowledge of how to prevent a decreasein high morale in very old age could have important implications for policy, and social and health care development. Theobjective was to identify social and health-related risk factors for a decrease in morale over 5 years in very old peopleamong those with high morale at baseline. The study is based on data derived from the Umeå85+/GERDA study conductedin Northern Sweden and Western Finland. The final sample consisted of 174 individuals who were 85 years and older atbaseline and who had completed the follow-up 5 years later. Morale was measured with The Philadelphia Geriatric CenterMorale Scale (PGCMS). A set of social and health-related variables were used to test which factors were associated with adecrease in morale over 5 years. Linear regression was used for the multivariable analyses. The sample had a mean changeof − 1.3 (SD = 2.5) in PGCMS scores from T1 to T2. The results from the regression analyses showed that development ofdepressive disorders, increased feelings of loneliness and the death of a child during the follow-up period were associatedwith a decrease in morale. The results from our study indicate that preventing the development of depressive disorders andincreasing loneliness are key factors in preventing a decrease in high morale. Additionally, very old people who have recentlylost an adult child should receive adequate psychosocial support

  • 336. Näsman, Marina
    et al.
    Niklasson, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Saarela, Jan
    Nygård, Mikael
    Olofsson, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Conradsson, Mia
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nyqvist, Fredrica
    Five-year change in morale is associated with negative life events in very old age2019Inngår i: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, s. 84-91Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: The objectives were to study changes in morale in individuals 85 years and older, and to assess the effect of negative life events on morale over a five-year follow-up period.

    METHOD: The present study is based on longitudinal data from the Umeå85+/GERDA-study, including individuals 85 years and older at baseline (n = 204). Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS). Negative life events were assessed using an index including 13 negative life events occurring during the follow-up period. Linear regression was used for the multivariate analyses.

    RESULTS: The majority of the sample (69.1%) had no significant changes in morale during the five-year follow-up. However, the accumulation of negative life events was significantly associated with a greater decrease in PGCMS. A higher baseline PGCMS score did not attenuate the adverse effect negative life events had on morale.

    CONCLUSION: Morale seemed to be mainly stable in a five-year follow-up of very old people. It seems, nonetheless, that individuals are affected by negative life events, regardless of level of morale. Preventing negative life events and supporting individuals who experience multiple negative life events could have important implications for the care of very old people.

  • 337.
    Olofsson, Birgitta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Geriatrik.
    Lundström, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Geriatrik.
    Borssén, Bengt
    Nyberg, Lars
    Department of Health Sciences, Luleå University of Technology, Boden, Sweden.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Geriatrik.
    Delirium is associated with poor rehabilitation outcome in elderly patients treated for femoral neck fractures.2005Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, nr 2, s. 119-127Artikkel i tidsskrift (Fagfellevurdert)
  • 338.
    Olofsson, Birgitta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Persson, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Bellelli, G.
    Morandi, A.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Stenvall, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Development of dementia in patients with femoral neck fracture who experience postoperative delirium: A three-year follow-up study2018Inngår i: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 33, nr 4, s. 623-632Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives It remains unclear to what extent postoperative delirium (POD) affects the incidence of dementia in hip fracture patients, and the methods used to detect delirium and dementia require validation. The aim of this study was to investigate the development of dementia within 3 years of femoral neck fracture repair surgery, with a focus on POD as a potential predictive factor.

    Methods Patients were assessed for cognition, delirium, depression, psychological well-being, and nutritional status during their hospitalization as well as 4, 12, and 36 months after the operation. Logistic regression models were used to analyse factors associated with POD and factors associated with the development of dementia.

    Results The study sample consisted of 135 patients without a history of dementia, of whom 20 (14.8%) were delirious preoperatively and 75 (55.5%) postoperatively. Three years after their operations, 43/135 patients (31.8%) were diagnosed with dementia. A greater portion of patients diagnosed with dementia (39/43, 90.6%) than patients with no dementia (36/92, 39.1%) were included among the 75 patients who had experienced POD (P<0.001). In a logistic regression model, after adjustment for covariates (age, sex, diabetes, delirium pre- and postoperatively, hyperactive delirium, days with delirium, urinary tract infection, and Mini Nutritional Assessment score), POD emerged an independent predictor for the development of new dementia (odds ratio, 15.6; 95% confidence interval, 2.6-91.6) within 3 years after the operation.

    Conclusion Geriatric hip fracture patients who exhibit POD should be monitored closely for the development of dementia.

  • 339.
    Olofsson, Birgitta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Stenvall, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Lundström, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Carlsson, Maine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Englund, Undis
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Berglund, Monica
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Vårdprogram för patienter med höftfrakturer, andra upplagan: ortoped-geriatriskt preoperativt vårdprogram för alla patienter med höftfraktur och postoperativt vårdprogram för patienter över 80 år med cervikala och basocervikala höftfrakturer som behandlas vid Norrlands universitets sjukhus i Umeå2008Rapport (Annet vitenskapelig)
  • 340.
    Olofsson, Birgitta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Stenvall, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Lundström, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Mental status and surgical methods in patients with femoral neck fracture2009Inngår i: Orthopedic Nursing, ISSN 0744-6020, E-ISSN 1542-538X, Vol. 28, nr 6, s. 305-313Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: About one third of hip-fractured patients have dementia and thus may have difficulties adhering to postoperative instructions. Hip replacement is the most common treatment when a femoral neck fracture is displaced in healthy older people, whereas for those with dementia and other severe comorbidities, internal fixation (IF) is generally recommended.

    PURPOSE: To evaluate complications, functional outcome, and mortality for both surgical methods, IF and hemiarthroplasty (HAP), in older patients suffering from femoral neck fracture with or without dementia. SAMPLE: One hundred eighty patients, aged 70 years or older, who were operated on using IF (n = 69) in undisplaced femoral neck fracture and HAP (n = 111) if the fractures were displaced.

    DATA COLLECTION: Mental state was assessed using the Mini-Mental State Examination and Organic Brain Syndrome scale, and dementia and delirium were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Outcomes of mortality, complications, functional ability, and quality of life were measured.

    FINDINGS: There was no difference in complications or mortality at 4 months and 1 year for the IF or HAP groups. Patients with and without dementia, operated on with HAP, had a better functional outcome after 1 year than those operated on with IF. The result of this study indicates that dementia per se is not a reason for disqualifying those patients from the most appropriate surgical method.

  • 341.
    Olofsson, Birgitta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Stenvall, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Lundström, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Malnutrition in hip fracture patients: an intervention study.2007Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, nr 11, s. 2027-2038Artikkel i tidsskrift (Fagfellevurdert)
  • 342.
    Olofsson, Hanna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Ulander, Eva Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Hörnsten, Carl
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Association between socioeconomic and health factors and edentulism in people aged 65 and older: a population-based survey2018Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, nr 7, s. 690-698Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: To study edentulism and use of dental services in a population-based sample of people aged 65 years and older from northern Sweden and western Finland.

    Methods: In 2010, people aged 65, 70, 75 and 80 years who were living in one of 32 municipalities in northern Sweden and western Finland were invited to answer a questionnaire as part of the Gerontological Regional Database (GERDA) study (n = 6099). The questionnaire contained items related to socioeconomic status, general health and edentulism.

    Results: The prevalence of edentulism was 34.9% in Finland, compared with 20.6% in Sweden (p < 0.001), 31.9% in rural areas, compared with 20.9% in urban areas (p < 0.001), and 25% overall. The prevalence of edentulism rose from 17.8% in 65-year-olds, 23.8% in 70-year-olds, 33.5% in 75-year-olds and 37.3% in 80-year-olds (p < 0.001), and was 23.8% in women, compared with 27% in men (p < 0.001). In multivariate models, edentulism was associated with lower educational level (odds ratio (OR) 2.87, 95% confidence interval (CI) 2.31-3.58), low income level (OR 1.7, CI 1.09-1.47), residence in a rural area (OR 1.43, CI 1.23-1.66), male sex (OR 1.30, CI 1.12-1.52), dependence in instrumental activities of daily living (OR 1.48, CI 1.25-1.74), social isolation (OR 1.52, CI 1.17-1.98) and poor self-experienced health (OR 1.38, CI 1.17-1.62).

    Conclusions: One-quarter of the total sample was edentulous, with a higher prevalence of edentulism in Finland than in Sweden and in rural than in urban areas. Edentulism was associated with socioeconomic, psychological and health-related factors. These findings could be used to inform preventive measures and identify people aged 65 years and older who are in need of oral care.

  • 343.
    Olsson, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Löfgren, Britta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Arbetsterapi.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nyberg, Lars
    Validation of a fall risk index in stroke rehabilitation2005Inngår i: Journal of stroke and cerebrovascular diseases, ISSN 1052-3057, Vol. 14, nr 1, s. 23-28Artikkel i tidsskrift (Fagfellevurdert)
  • 344.
    Olsson, Jan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Johansson, Jörgen
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi. Laboratory Medicine, Clinical Microbiology, Umeå University Hospital, Umeå, Sweden.
    Honkala, Emma
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Blomqvist, Bert
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi. Laboratory Medicine, Clinical Microbiology, Umeå University Hospital, Umeå, Sweden.
    Kok, Eloise
    Weidung, Bodil
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Elgh, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Urea dilution of serum for reproducible anti-HSV1 IgG avidity index2019Inngår i: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 19, artikkel-id 164Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Herpes simplex virus type 1 (HSV1), establishes life-long latency and can cause symptoms during both first-time infection and later reactivation. The aim of the present study was to describe a protocol to generate a reliable and discriminative avidity index (AI) for anti-HSV1 IgG content in human sera. Human serum from two distinct cohorts; one a biobank collection (Betula) (n = 28), and one from a clinical diagnostics laboratory at Northern Sweden University Hospital (NUS) (n = 18), were assessed for presence of IgG antibodies against HSV1 by a commercially available ELISA-kit. Addition of urea at the incubation step reduces effective binding, and the ratio between urea treated sample and non-treated sample was used to express an avidity index (AI) for individual samples. AI score ranged between 43.2 and 73.4% among anti-HSV1 positive biobank sera. Clinical samples ranged between 36.3 and 74.9%. Reproducibility expressed as an intraclass correlation coefficient (ICC) was estimated at 0.948 (95% CI: 0.900-0.979) and 0.989 (95% CI 0.969-0.996) in the biobank and clinical samples, respectively. The method allows for AI scoring of anti-HSV1 IgG from individual human sera with a single measurement. The least significant change between two measurements at the p < 0.05 level was estimated at 5.4 and 3.2 points, respectively, for the two assessed cohorts.

  • 345.
    Olsson, Jan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Kok, Eloise
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Elgh, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Herpes virus seroepidemiology in the adult Swedish population2017Inngår i: Immunity & Ageing, ISSN 1742-4933, E-ISSN 1742-4933, Vol. 14, artikkel-id 10Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Herpes viruses establish a life-long latency and can cause symptoms during both first-time infection and later reactivation. The aim of the present study was to describe the seroepidemiology of Herpes simplex type 1 (HSV1), Herpes simplex type 2 (HSV2), Cytomegalovirus (CMV), Varicella Zoster virus (VZV) and Human herpes virus type 6 (HHV6) in an adult Swedish population (35-95 years of age). Methods: Presence of antibodies against the respective viruses in serum from individuals in the Betula study was determined with an enzyme-linked immunosorbent assay (ELISA). Singular samples from 535 persons (53.9% women, mean age at inclusion 62.7 +/- 14.4 years) collected 2003-2005 were analyzed for the five HHVs mentioned above. In addition, samples including follow-up samples collected 1988-2010 from 3,444 persons were analyzed for HSV. Results: Prevalence of HSV1 was 79.4%, HSV2 12.9%, CMV 83.2%, VZV 97.9%, and HHV6 97.5%. Herpes virus infections were more common among women (p = 0.010) and a lower age-adjusted HSV seroprevalence was found in later birth cohorts (p < 0.001). The yearly incidence of HSV infection was estimated at 14.0/1000. Conclusion: Women are more often seropositive for HHV, especially HSV2. Age-adjusted seroprevalence for HSV was lower in later birth cohorts indicating a decreasing childhood and adolescent risk of infection.

  • 346.
    Olsson, Jan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Honkala, Emma
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Karhunen, Pekka J.
    Elgh, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Kok, Eloise H.
    HSV presence in brains of individuals without dementia: the TASTY brain series2016Inngår i: Disease Models and Mechanisms, ISSN 1754-8403, E-ISSN 1754-8411, Vol. 9, nr 11, s. 1349-1355Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Herpes simplex virus (HSV) type 1 affects a majority of the population and recent evidence suggests involvement in Alzheimer's disease aetiology. We investigated the prevalence of HSV type 1 and 2 in the Tampere Autopsy Study (TASTY) brain samples using PCR and sero-positivity in plasma, and associations with Alzheimer's disease neuropathology. HSV was shown to be present in human brain tissue in 11/584 (1.9%) of samples in the TASTY cohort, of which six had Alzheimer's disease neuropathological amyloid beta (A beta) aggregations. Additionally, serological data revealed 86% of serum samples tested were IgG-positive for HSV. In conclusion, we report epidemiological evidence of the presence of HSV in brain tissue free from encephalitis symptoms in a cohort most closely representing the general population (a minimum prevalence of 1.9%). Whereas 6/11 samples with HSV DNA in the brain tissue had A beta aggregations, most of those with A beta aggregations did not have HSV present in the brain tissue.

  • 347.
    Olsson, Tommy
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Åström, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Eriksson, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Forssell, Åke
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Hypercortisolism revealed by the dexamethasone suppression test in patients with acute ischemic stroke1989Inngår i: Stroke, Vol. 20, nr 12, s. 1685-1690Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Using the dexamethasone suppression test, we studied the activity of the hypothalamicpituitary-adrenal axis within the first week after onset in 62 patients with acute ischemic stroke. Compared with two control groups (one comprising 25 elderly patients with various acute medical disorders and the other comprising 33 80-year-old volunteers), stroke patients had higher postdexamethasone cortisol levels (p=0.08 and /?=0.001, respectively). By multiple regression analysis, high postdexamethasone cortisol levels in the stroke patients were significantly associated with proximity of the lesion to the frontal pole of the brain (p=0.008) and with disorientation (p=0.03), whereas no association with major depression was seen. Many stroke patients are exposed to hypercortisolism, which may have negative consequences upon organ functions. The extent to which dexamethasone administration suppresses cortisol levels seems to be determined mainly by the site of brain lesion and cannot be used as an indicator of major depression early after stroke.

  • 348. Ovchinnikova, Olga
    et al.
    Gylfe, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk bakteriologi.
    Bailey, Leslie
    Umeå universitet, Medicinska fakulteten, Institutionen för molekylärbiologi (Medicinska fakulteten).
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Rudling, Mats
    Jung, Christian
    Bergström, Sven
    Umeå universitet, Medicinska fakulteten, Institutionen för molekylärbiologi (Medicinska fakulteten).
    Waldenström, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Hansson, Göran K
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Osteoprotegerin promotes fibrous cap formation in atherosclerotic lesions of ApoE-deficient mice--brief report.2009Inngår i: Arteriosclerosis, Thrombosis and Vascular Biology, ISSN 1079-5642, E-ISSN 1524-4636, Vol. 29, nr 10, s. 1478-1480Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Osteoprotegerin (OPG) is a tumor necrosis factor receptor-related cytokine, initially found to inhibit osteoclastogenesis. In the present study we investigated the effect of OPG treatment on atherosclerosis. METHODS AND RESULTS: Hypercholesterolemic apoe(-/-) mice were treated with recombinant 15 mg/kg OPG or vehicle injections twice a week for 10 consecutive weeks. Mice treated with OPG showed increased amounts of smooth muscle cells and collagen within the atherosclerotic lesions. OPG treatment did not affect atherosclerotic lesion size (8.2% versus 7.6%) or total vessel area but led to a 250% increase in lesion collagen, formation of mature collagen fibers in subendothelial fibrous caps, and upregulated mRNA for lysyl oxidase that promotes collagen crosslinking. In cell culture studies, OPG promoted cell proliferation in rat aortic smooth muscle cells. In contrast, OPG treatment did not affect markers of vascular or systemic inflammation. CONCLUSIONS: OPG treatment promotes smooth muscle accumulation, collagen fiber formation, and development of fibrous caps but does not affect inflammatory properties of atherosclerotic lesions. Its effects may contribute to plaque stabilization.

  • 349.
    Pellfolk, Tony
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Geriatrik.
    Physical restraint use and falls in institutional care of old people: effects of a restraint minimization program2010Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Physical restraint use and falls are common in institutional care of old people and various attempts have been made to reduce their occurrence. Falls and concomitant injuries are a major problem due to their negative effect on morbidity and mortality. Prevention of falls and injuries is the most common reason for physically restraining old people in institutional care. Its use has, however, been questioned both from an ethical perspective, since restraints can be perceived as coercive and also because of the lack of sound evidence of their effectiveness in preventing falls, as well as the adverse effects associated with their use.

    The main purposes of this thesis were to investigate differences in the us of physical restraints over time, to identifify risk factors for falls among people with dementia, to evaluate the effects of a restraint minimization program on staff knowledge, attitudes, and work environment and use of physical restraints and the quality of care.

    The present thesis is based on three main data collections, two census surveys conducted within institutional care for old people in the county of Västerbotten in 2000 (n=3,804) and 2007 (n=2,970) and one cluster-Randomized Controlled Trial (RCT) including 40 group dwellings for people suffering from dementia where the intervention consisted of staff education.

    The use of physical restraints increased slightly between 2000 and 2007 (16.2% to 18.4%, p=0.016). Analyses suggest that the increase might be independent of any change in resident characteristics. Restrained residents were also subjected to restraints for longer times in 2007.

    During a six-month follow-up 64/160 (40.0%) residents in group dwellings for those with dementia sustained at least one fall. Independent risk factors for falls were ‘requiring help with hygiene’, ‘displaying verbally disruptive/attention-seeking behavior’, ‘able to rise from a chair’, ‘walking with assistive devices’, and ‘participating in outdoor walks’, which explained 36.1% of the falls. The majority of the 191 falls were un-witnessed, 35% occurred during the night and anxiety and confusion were the most common symptoms preceding the falls.

    A six-month restraint minimization program showed a positive impact on staff knowledge, attitudes and work environment as well as on the use of physical restraints and subjectively estimated quality of care. Residents in the intervention group present throughout the entire study period had lower odds, relative to the residents in the control group of being physically restrained at follow-up (OR= 0.21, CI 95%=0.08-0.57) after controlling for potential confounders and the cluster effect. Adjusted analyses including all residents present at either baseline or follow-up also showed that the use of physical restraints was less in the intervention group relative to the control group at follow-up. There was no change in the occurrence of falls or use of psychoactive drugs. The intervention also reduced stress of conscience, job demands and strain in the staff, and improved their job control and the caring climate. Subgroup analysis indicated a greater effect in units where the use of physical restraints had been reduced or remained constant.

    In conclusion, physical restraint use and falls remains common in institutional care of old people. The practice of physical restraint seems to have changed. In the RCT it was found that it is possible to change restraint practice and also to improve staff work environment. Falls among residents with dementia require a certain mobility function and anxiety and confusion are common symptoms preceding falls.

  • 350.
    Pellfolk, Tony
    et al.
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Geriatrik.
    Glasberg, Ann-Louise
    Yrkeshögskolan Novia, Vasa, Finland.
    Eriksson, Sture
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Geriatrik.
    Karlsson, Stig
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Effects of a restraint minimization programme on staff’s work environment and the quality of care: a cluster randomized trialManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Aims and objectives. The aim of the study was to evaluate the effects of a restraint minimization education programme on staff’s work environment and the quality of care in group dwellings for persons with dementia.

    Background. Nursing staff in dementia care frequently face ethically difficult situations and have a challenging work environment. The use of physical restraints is one factor found to be associated with an impaired work environment and to evoke negative feelings such as guilt and sadness among the staff.

    Design. Cluster randomized controlled trial.

    Methods. The intervention and control groups each consisted of 20 group dwellings for persons with dementia. Staff and resident data were gathered by means of questionnaires one month before and after the 6-month education programme. Staff’s work environment was measured using the Stress of Conscience Questionnaire, the Demand–Control–Social Support model, and an assessment of caring climate, while the quality of care was subjectively rated for each resident by the staff.

    Results. Analyses showed that nursing staff’s work environment improved in the intervention group, as well as did the quality of care, while there was no significant change in the control group. Subgroup analysis within the intervention group indicated that the largest effect on staff’s work environment occurred in those group dwellings where the use of physical restraints was reduced or stayed constant.

    Conclusions. Staff’s work environment and the quality of care can be improved by the implementation of staff education. The findings also indicate that there was a synergistic effect between the education programme and the change in physical restraints use.

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