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  • 3801.
    Ågren, Sara
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykoterapi.
    Elfving, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Självmedkänsla och hälsa: Psykoterapeutstudenter och legitimerade psykoterapeuter2016Självständigt arbete på avancerad nivå (yrkesexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Självmedkänsla anses vara betydelsefull för vår fysiska och psykiska hälsa och ökar förutsättningarna för vår inre trygghet vid motgångar och svårigheter. Självmedkänsla motverkar nedstämdhet, stress och ökar förmågan till känslomässig självreglering och ger ökad kontakt med adaptiva aktiverande affekter med ökad förmåga till läkande och helande hos människan. Blivande psykoterapeuter och andra inom människovårdande yrken anses speciellt utsatta och självomsorg blir en viktig komponent. Självmedkänsla utvecklas i den trygga anknytningen och kan övas upp som vuxen, via meditation, mindfulness, affektfokuserade psykoterapier och i en trygg terapeutisk relation. Studiens syfte var att undersöka självskattad självmedkänsla och fysisk/psykisk hälsa bland psykoterapeutstudenter och göra en jämförelse med legitimerade psykoterapeuter. En enkät (Self-Compassion Scale, SF-36) som mäter självmedkänsla respektive fysisk/psykisk hälsa, distribuerades till studenterna i en klassrumssituation och till legitimerade psykoterapeuter via post. Totalt kom 33 psykoterapistudenter och 34 legitimerade psykoterapeuter att ingå i studien. Resultatet visar att psykoterapeutstudenterna, enligt självskattning, hade en signifikant bättre självmedkänsla men signifikant sämre fysisk och psykisk hälsa än de legitimerade psykoterapeuterna. Båda grupperna hade en medel nivå avseende självskattad självmedkänsla. Mindfulnessträning och meditation kan vara verktyg att stärka upp självmedkänslan och minska självkritiken.

  • 3802.
    Åhman, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Edvardsson, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia.
    Fagerli, Tove Anita
    Darj, Elisabeth
    Holmlund, Sophia
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Small, Rhonda
    Mogren, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia.
    A much valued tool that also brings ethical dilemmas: a qualitative study of Norwegian midwives' experiences and views on the role of obstetric ultrasound2019Ingår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, artikel-id 33Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Midwives are the main providers of routine antenatal care services including the routine ultrasound examination in Norway. The ultrasound examination can be perceived by expectant parents not only as a medical examination but also as a social event facilitating attachment to their fetus. This study explores Norwegian midwives' experiences and views on the role of ultrasound in clinical management of pregnancy.

    Methods: A qualitative study design was applied. Twenty-four midwives who all performed obstetric ultrasound examinations were recruited for focus group discussions and individual interviews. Data collection took place in 2015 in five hospitals in two different regions of Norway. Data were analyzed using qualitative content analysis.

    Results: Midwives described obstetric ultrasound examinations as very valuable although doing ultrasounds placed high demands on their operational and counselling skills. Increasing requests for ultrasound from pregnant women were mentioned. Advancements in ultrasound diagnosis were considered to have put the fetus in the position of a patient, and that pregnant women declining ultrasound could be viewed as irresponsible by some health professionals. Ethical concerns were raised regarding the possibility of pregnancy termination when fetal anomalies were detected. Fears were also expressed that prenatal diagnoses including those following ultrasound, might create a society where only perfect' children are valued. However, participants stressed that their intention in performing ultrasound was to optimize pregnancy outcome and thereby assist expectant couples and their unborn children.

    Conclusions: Midwives in Norwegian maternity care services describe obstetric ultrasound as very valuable, playing a central role in pregnancy management by optimizing pregnancy outcomes. Although high demands are placed on operators' technical skills and counseling, midwives described performing obstetric ultrasound as very satisfying work. However, midwives believed that expectant parents' approach to the ultrasound examination, both its medical value and the precious images obtained of the fetus, could put extra strain on the midwives performing ultrasounds. The potential of ultrasound to detect fetal anomalies and the possibility that this may lead to termination of pregnancy, seemed to create some ambivalent feelings in midwives towards its use.

  • 3803.
    Åhman, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Edvardsson, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Judith Lumley Centre, La Trobe University, Melbourne, Australia.
    Kidanto, Hussein Lesio
    Ngarina, Matilda
    Small, Rhonda
    Mogren, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    'Without ultrasound you can't reach the best decision': midwives' experiences and views of the role of ultrasound in maternity care in Dar Es Salaam, Tanzania2018Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 15, s. 28-34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To explore Tanzanian midwives' experiences and views of the role of obstetric ultrasound in relation to clinical management of pregnancy, and in situations where maternal and fetal health interests conflict. Method: In 2015, five focus group discussions were conducted with midwives (N = 31) at three public referral hospitals in the Dar es Salaam region as part of the CROss Country Ultrasound Study (CROCUS). Results: Ultrasound was described as decisive for proper management of pregnancy complications. Midwives noted an increasing interest in ultrasound among pregnant women. However, concerns were expressed about the lack of ultrasound equipment and staff capable of skilful operation. Further, counselling regarding medical management was perceived as difficult due to low levels of education among pregnant women. Conclusion: Ultrasound has an important role in management of pregnancy complications. However, lack of equipment and shortage of skilled healthcare professionals seem to hamper use of obstetric ultrasound in this particular low-resource setting. Increased availability of obstetric ultrasound seems warranted, but further investments need to be balanced with advanced clinical skills' training as barriers, including power outages and lack of functioning equipment, are likely to continue to limit the provision of pregnancy ultrasound in this setting.

  • 3804.
    Åhman, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Kidanto, Hussein Lesio
    Ngarina, Matilda
    Edvardsson, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.
    Small, Rhonda
    Mogren, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    'Essential but not always available when needed': an interview study of physicians' experiences and views regarding use of obstetric ultrasound in Tanzania2016Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, artikel-id 31062Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The value of obstetric ultrasound in high-income countries has been extensively explored but evidence is still lacking regarding the role of obstetric ultrasound in low-income countries.

    Objective: We aimed to explore experiences and views among physicians working in obstetric care in Tanzania, on the role of obstetric ultrasound in relation to clinical management.

    Design: A qualitative study design was applied. Data were collected in 2015, through 16 individual interviews with physicians practicing in obstetric care at hospitals in an urban setting in Tanzania. Data were analyzed using qualitative content analysis.

    Results: Use of obstetric ultrasound in the management of complicated pregnancy was much appreciated by participating physicians, although they expressed considerable concern about the lack of ultrasound equipment and staff able to conduct the examinations. These limitations were recognized as restricting physicians' ability to manage complications adequately during pregnancy and birth. Better availability of ultrasound was requested to improve obstetric management. Concerns were also raised regarding pregnant women's lack of knowledge and understanding of medical issues which could make counseling in relation to obstetric ultrasound difficult. Although the physicians perceived a positive attitude toward ultrasound among most pregnant women, occasionally they came across women who feared that ultrasound might harm the fetus.

    Conclusions: There seems to be a need to provide more physicians in antenatal care in Tanzania with ultrasound training to enable them to conduct obstetric ultrasound examinations and interpret the results themselves. Physicians also need to acquire adequate counseling skills as counseling can be especially challenging in this setting where many expectant parents have low levels of education. Providers of obstetric care and policy makers in Tanzania will need to take measures to ensure appropriate use of the scarce resources in the Tanzanian health care system and prevent the potential risk of overuse of ultrasound in pregnancy.

  • 3805.
    Åhman, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Persson, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Edvardsson, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Judith Lumley Centre, La Trobe University, Melbourne, Vic 3000, Australia.
    Lalos, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Graner, Sophie
    Small, Rhonda
    Mogren, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Two sides of the same coin - an interview study of Swedish obstetricians' experiences using ultrasound in pregnancy management2015Ingår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, artikel-id 304Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The extended use of ultrasound that is seen in maternity care in most Western countries has not only affected obstetric care but also impacted on the conception of the fetus in relation to the pregnant woman. This situation has also raised concerns regarding the pregnant woman’s reproductive freedom. The purpose of this study was to explore Swedish obstetricians’ experiences and views on the role of obstetric ultrasound particularly in relation to clinical management of complicated pregnancy, and in relation to situations where the interests of maternal and fetal health conflict.

    Methods: A qualitative study design was applied, and data were collected in 2013 through interviews with 11 obstetricians recruited from five different obstetric clinics in Sweden. Data were analysed using qualitative content analysis.

    Results: The theme that emerged in the analysis ‘Two sides of the same coin’ depicts the view of obstetric ultrasound as a very important tool in obstetric care while it also was experienced as having given rise to new and challenging issues in the management of pregnancy. This theme was built on three categories: I. Ultrasound is essential and also demanding; II. A woman’s health interest is prioritised in theory, but not always in practice; and III. Ultrasound is rewarding but may also cause unwarranted anxiety.

    Conclusions: The widespread use of ultrasound in obstetric care has entailed new challenges for clinicians due to enhanced possibilities to diagnose and treat fetal conditions, which in turn might conflict with the health interests of the pregnant woman. There is a need for further ethical discussions regarding the obstetrician’s position in management of situations where maternal and fetal health interests conflict. The continuing advances in the potential of ultrasound to impact on pregnancy management will also increase the need for adequate and appropriate information and counselling. Together with other health care professionals, obstetricians therefore need to develop improved ways of enabling pregnant women and their partners to make informed decisions regarding pregnancy management.

  • 3806.
    Åhman, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Förenklad ADHD diagnostik Ettårs- uppföljning av patienter samt utvärdering av diagnostisk metodik.2014Självständigt arbete på avancerad nivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 3807.
    Åkerman, Sune
    et al.
    Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier.
    Högberg, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Andersson, Tobias
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Survival of orphans in nineteenth-century Sweden1996Ingår i: Orphans and foster-children: a historical and cross-cultural perspective / [ed] Lars-Göran Tedebrand, Umeå: Umeå universitet , 1996, s. 83-105Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 3808. Åkeson, Pia Karlsland
    et al.
    Åkesson, Kristina E
    Lind, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Öhlund, Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Vitamin D Intervention and Bone: A Randomized Clinical Trial in Fair- and Dark-skinned Children at Northern Latitudes2018Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 67, nr 3, s. 388-394Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The aim of the study was to evaluate vitamin D status and effects of vitamin D intervention on bone mineral density (BMD) and content (BMC) in children with fair and dark skin in Sweden during winter.

    Methods: In a 2-center prospective double-blinded randomized intervention study 5- to 7-year-old children (n = 206) with fair and dark skin in Sweden (55 degrees N-63 degrees N) received daily vitamin D supplements of 25 mu g, 10 mu g, or placebo (2 mu g) during 3 winter months. We measured BMD and BMC for total body (TB), total body less head (TBLH), femoral neck (FN), and spine at baseline and 4 months later. Intake of vitamin D and calcium, serum 25-hydroxy vitamin D (S-25 [OH]D), and related parameters were analyzed.

    Results: Despite lower S-25(OH)D in dark than fair-skinned children, BMD of TB (P = 0.012) and TBLH (P = 0.002) and BMC of TBLH (P = 0.04) were higher at baseline and follow-up in those with dark skin. Delta (Delta) BMD and BMC of TB and TBLH did not differ between intervention and placebo groups, but FN-BMC increased more among dark-skinned children in the 25 mu g (P = 0.038) and 10 mu g (P = 0.027) groups compared to placebo. We found no associations between Delta S-25(OH)D, P-parathyroid hormone, P-alkaline phosphatase, and Delta BMD and BMC, respectively.

    Conclusions: BMD and BMC remained higher in dark- than fair-skinned children despite lower vitamin D status. Even though no difference in general was found in BMD or BMC after vitamin D intervention, the increase in FN-BMC in dark-skinned children may suggest an influence on bone in those with initially insufficient vitamin D status.

  • 3809. Åsman, Peter
    et al.
    Lindén, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Oftalmiatrik.
    Internet-based assessment of medical students' ophthalmoscopy skills2010Ingår i: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 88, nr 8, s. 854-857Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Ophthalmoscopy is an important skill in undergraduate medical education. The use and outcome of a novel Internet-based method for assessing motor skills-related aspects of ophthalmoscopy skills in medical students are described. Methods: A total of 139 students in Malmö and 255 students in Umeå were assessed during four consecutive semesters. An optic disc photograph was obtained in each student. At assessment each student was asked to examine the eye of a fellow student. Fifteen disc photographs were displayed on a computer screen. One of the photographs was from the fellow student. The remaining images had been randomly selected. The student was asked to identify the optic disc of the fellow student from the 15 photographs on the screen. In one semester, the time spent on this by each student was recorded. Results: All students completed the task. The average pass ratio was 96.4% (ranging from 94.0% to 98.0%). Median student times were 5.53 mins in Malmö and 6.36 mins in Umeå. Conclusions: This is the first automated, Internet-based assessment of an ophthalmic motor skill performed in co-operation between universities. The method used bears more similarities to real-life ophthalmoscopy than methods that use model eyes. Time investments and infrastructure demands were comparatively low. The method was designed for stand-alone assessment of ophthalmoscopy or as an objective structured clinical examination station, but it may also be used during the learning process. The collaboration between universities was easily transformed into routine practice and similar projects should be encouraged to increase the standardization of assessment

  • 3810.
    Åström, Elisabeth
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Rönnlund, Michael
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Carelli, Maria Grazia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Depressive symptoms and time perspective in older adults: associations beyond personality and negative life events2019Ingår i: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 23, nr 12, s. 1674-1683Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To examine the extent to which time perspective, an individual’s habitual way of relating to the past, the present, and the future time frames, accounts for variations in self-reported depressive symptoms among older adults.

    Method: Four hundred two participants (60–90 years) completed the Center for Epidemiological Studies Depression scale (CES-D) and the Swedish Zimbardo Time perspective Inventory (S-ZTPI). The influence of personality as reflected by the Temperament and Character Inventory (TCI) and self-reported negative life events (NLEs) were controlled for in hierarchic regression analyses.

    Results: The six S-ZTPI dimensions accounted for 24.5% of the variance in CES-D scores beyond age and gender. Half of the variance remained when the TCI factors and NLEs were controlled for. Past Negative, Future Negative, and Past Positive (inverse association) were the significant unique predictors. Significant age interactions were observed for two S-ZTPI dimensions, with a diminished association to depressive symptoms for Future Negative and a magnified association for Present Fatalistic with higher age.

    Conclusions: The results demonstrate a substantial relation between facets of time perspective and depressive symptoms in old age. They also indicate an age-related shift in the relative importance from concerns about of the future (Future Negative) to the present (Present Fatalistic) with increased age. In young old-age, when the future is more ‘open’, future worries (Future Negative) may be a more frequent source of distress. In late senescence, perceived threats to autonomy (e.g. physical health problems and cognitive deficits), as reflected by higher scores on Present Fatalistic, may instead have more bearing on mood state.

  • 3811.
    Åström, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Depression after stroke1993Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Both stroke and depression are major health problems in the elderly. In this study, the prevalence of major depression after stroke was investigated in a well-defined sample of acute stroke patients (n=80), followed up at 3 months, 1 year, 2 and 3 years after the stroke event. Links to biological and psychosocial factors were examined. Hypercortisolism was studied by the dexamethasone suppression test and compared with healthy elderly. Living conditions (including demographic caracteristics, economic resources, health, functional ability, activity/leisure, social network) and life satisfaction were described before and after stroke in relation to a general elderly population.

    Demographic caracteristics, economic resources, social network and psychiatric morbidity prestroke did not differ from the general elderly population. Already prior to the stroke, patients reported more health problems and lower functional ability in many aspects of daily life, more passive leisure time and a lower global life satisfaction. After stroke, contacts with children were maintained, whilst contacts outside the family declined and remained lower than in the general elderly population. Stroke involved a marked reduction in global life satisfaction. Poor life satisfaction at 1 year remained poor for the entire three years; these stroke victims had a higher frequency of major depression early after stroke.

    The prevalence of major depression was 25% at the acute stage, 31% at 3 months, decreased to 16% at 1 year, was 19% at 2 years and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in self-care ability and loss of social contacts outside the family were the most important predictors at 3 months. From 1 year onwards, loss of social contacts contributed most to depression and at 3 years also cerebral atrophy. Sixty percent of patients with early depression (0-3 months) had recovered at 1 year; those not recovered at 1 year had a high risk of chronicitation.

    Hypercortisolism as measured by the dexamethasone suppression test was associated with major depression late (3 years) but not early (0-3 months) after stroke. At 3 years, the dexamethasone suppression test had a sensitivity of 70%, a specificity of 97%, a positive predictive value of 88%, a negative predicitive value of 91%, and a diagnostic accuracy of 90%. Nonsuppression of dexamethasone at 3 months was a significant predictor of major depression at 3 years.

  • 3812.
    Åström, Monica
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Asplund, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Major depression in stroke patients: A 3-year longitudinal study1993Ingår i: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 24, nr 7, s. 976-982Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND PURPOSE: This prospective study was designed to examine the contributions of neurobiological, functional, and psychosocial factors to major depression after stroke. In addition, the prevalence and longitudinal course of major depression were studied. METHODS: Major depression, functional ability, and social network were assessed repeatedly for a period of 3 years in a population-based cohort of 80 patients with acute stroke (mean age, 73 years). Cerebral atrophy and brain lesion parameters were determined from computed tomographic scans performed acutely and after 3 years. RESULTS: The prevalence of major depression was 25% at the acute stage and approximately the same at 3 months (31%). It decreased to 16% at 12 months, was 19% at 2 years, and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in activities of daily living was the most important predictor at 3 months. From 12 months on, the patient's having few social contacts outside the immediate family contributed most to depression, and at 3 years cerebral atrophy also contributed. At 1 year, 60% of the patients with early depression (0 to 3 months) had recovered; those not recovered at this follow-up had a high risk of development of chronic depression. CONCLUSIONS: The study has provided evidence of a differentiation of factors likely to be implicated in the development of depression after stroke based or the period of time since the stroke event.

  • 3813.
    Åström, Monica
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Asplund, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Åström, T.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Life before and after Stroke: Living Conditions and Life Satisfaction in Relation to a General Elderly Population1992Ingår i: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 2, nr 1, s. 28-34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Living conditions and life satisfaction before and after stroke were assessed in 80 patients with acute stroke (mean age 73 years). The results were compared with a general elderly population. Already prior to their stroke the patients had more health problems, lower functional ability, more passive leisure time and lower global life satisfaction. Low life satisfaction was associated with dependence in the activities of daily living (ADL). Economic resources, social network and psychiatric morbidity before stroke did not differ from the general elderly population. At 3 months of follow-up, almost half of the patients reported low life satisfaction, compared to only 2% in the national sample. Major depression and ADL dependence were associated with low life satisfaction after stroke. We conclude that much of the disability and handicap seen in stroke patients is present already before the stroke. Stroke-related deterioration of ADL performance, major depression and social disintegration after stroke interact to further reduce life satisfaction for the stroke victims and their families.

  • 3814.
    Åström, Monica
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Asplund, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Åström, T.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Psychosocial function and life satisfaction after stroke1992Ingår i: Stroke, Vol. 23, nr 4, s. 527-531Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This prospective study was designed to describe different aspects of psychosocial function after stroke and the development of changes over time. A major aim has been to identify mental, functional, and social factors associated with low life satisfaction late after stroke.

    Social network, functional ability, leisure-time activities, experience of ill health, major depression, and life satisfaction were assessed repeatedly over 3 years in a population-based sample of 50 long-term survivors of stroke (mean age 71.4 years).

    Compared with a general elderly population, patients 3 years poststroke had more psychiatric symptoms, lower functional ability, and reduced life satisfaction. Contacts with children were maintained over the 3-year follow-up period, whereas contacts with friends and neighbors declined early after stroke and remained lower than in the general elderly population (p less than 0.05). When time dependency was analyzed, activities of daily living and somatic/neurological symptoms were found to change little after 3 months, while psychiatric symptoms showed changes later. Between 3 and 12 months poststroke, the prevalence of major depression decreased, leisure-time activities and social contacts were partly resumed, and life satisfaction improved (p less than 0.01). Once good life satisfaction was restored it was maintained, and poor life satisfaction at 1 year remained poor for the entire 3 years.

    It is concluded that major depression early after stroke, functional disability, and an impaired social network interact to reduce life satisfaction for the long-term survivors of stroke.

  • 3815.
    Åström, Monica
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Asplund, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Different linkage of depression to hypercortisolism early versus late after stroke: A 3-year longitudinal study1993Ingår i: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 24, nr 1, s. 52-57Artikel i tidskrift (Refereegranskat)
    Abstract [en]

     Using the dexamethasone suppression test, we studied the suppressibility of the cortisol axis and its clinical determinants at various time points after stroke. A major aim was to examine the dexamethasone test as a diagnostic tool for the diagnosis of major depression in stroke patients.The dexamethasone suppression test, major depression, functional ability, and disorientation were assessed in a cohort of 70 patients with acute stroke and after 3 months (n = 63) and 3 years (n = 43).Early after stroke, 24% of the patients were nonsuppressors, with about the same proportion at 3 months (22%) and 3 years (21%). None of the controls (17 healthy elderly volunteers) were nonsuppressors. High cortisol levels early after stroke were significantly associated with functional impairment (r = 0.35; p = 0.003) and disorientation (r = 0.27; p = 0.03). Three years after stroke, high postdexamethasone cortisol levels were significantly associated with major depression (r = 0.57; p < 0.001). The sensitivity of the dexamethasone test was 70% and the specificity 97%. In a longitudinal analysis of the long-term survivors (n = 42), postdexamethasone cortisol values at 3 months predicted major depression at 3 years.Hypercortisolism is associated with major depression late (3 years) but not early (0-3 months) after stroke. Patients with hypercortisolism 3 months after stroke are at risk of major depression later in the course and warrant careful follow-up from a psychiatric viewpoint.

  • 3816.
    Åström, Siv
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Oftalmiatrik.
    Long-term follow-up of pseudoexfoliation, intraocular pressure and glaucoma: epidemiological studies in northern Sweden2013Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Purpose An age-cohort was studied with long-term follow-up. The population was born in 1915, living in the municipality of Skellefteå in 1981. The purpose was to investigate the prevalence and incidence of pseudoexfoliation (PEX), its influence on intraocular pressure (IOP) and development of open-angle glaucoma (OAG). Another purpose was to estimate the value of screening for glaucoma by comparing the screened group within the cohort with the remaining unscreened group.

    Methods In 1981, 339 (40%) of the 856 individuals in the cohort underwent an eye examination. This screened group was re-examined at seven-year intervals until 2002. At each visit the presence of PEX was registered, IOP was measured and the presence of glaucoma was assessed. After the 21-year follow-up period, glaucoma cases were also searched for in the medical records of the remaining unscreened individuals in the cohort. Proportions of glaucoma were compared between the two groups.

    Results The prevalence of PEX was 23% (95% confidence interval (CI): 20-26%) at the age of 66 and increased to 61% (CI: 50-71%) at the age of 87. The annual incidence of PEX was 1.8% (CI: 1.3-2.4%). The prevalence of OAG increased from 2.1% (CI: 0.8-4.3%) at the age of 66 years to 25 % (CI: 16-35%) at 87 years. The overall annual incidence of OAG was 0.9% (CI: 0.6-1.3%) and for OAG with PEX 2.1% (CI: 1.2-3.3%). PEX increased the risk of developing glaucoma at least four-fold. The incidence of diagnosed OAG in women was higher in the screened group than in the unscreened group (incidence rate ratio (IRR)=1.94, p=0.035). A corresponding difference could not be verified for men (p=0.58). The mean, agedependent, increase in IOP during the 21-year observation period was 0.05 mmHg/year.

    Conclusion The prevalence of PEX in this study population was the highest reported, and it increased with age. The presence of PEX increased the risk of developing OAG four times. In this study a higher proportion of OAG was revealed by screening among women but not among men. The age-related IOP increase was clinically insignificant.

  • 3817.
    Åström, Siv
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Oftalmiatrik.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindén, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Oftalmiatrik.
    Diagnosed open-angle glaucoma in screened versus unscreened subjects: a long-term age cohort study2014Ingår i: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 92, nr 6, s. 501-506Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To investigate and compare the cumulative incidence of diagnosed open-angle glaucoma (OAG) in an age cohort of elderly people, of which one group was screened. METHODS: Cohort study comprising all 856 individuals born in 1915 and living in the municipality of Skellefteå in1981. A randomly selected subgroup of the cohort (40%) was repeatedly screened, and suspected OAG cases were followed until 2002 for the development of OAG. Medical records were collected and analysed for OAG. The numbers of OAG cases were compared between the screened group and the remaining part of the cohort (the unscreened group). RESULTS: The cohort consisted of 339 screened and 517 unscreened persons. Before 1981, there were six known cases of OAG in the screened group and nine cases in the unscreened group. During the follow-up from 1981 to 2002, there were 33 new cases in the screened group and 31 new cases of OAG in the unscreened group. The incidence of diagnosed OAG in women was higher in the screened group than in the unscreened group, incidence rate ratio = 1.94 (p = 0.035). In contrast, the cumulative incidence of diagnosed OAG in men was similar in the two groups (p = 0.58). For the whole population, there was no significant difference (p = 0.053) CONCLUSION: In this population with a high prevalence of PEX and increased risk for glaucoma, there was a non-significant difference between the screened and unscreened groups regarding the proportion of diagnosed OAG. The failure to reach significance may be due to the limited sample size. OAG was diagnosed twice as often among women in the screened group than in the unscreened group.

  • 3818.
    Åström, Siv
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Oftalmiatrik.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindén, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Oftalmiatrik.
    Incidence and prevalence of pseudoexfoliations and open-angle glaucoma in northern Sweden: II. Results after 21 years of follow-up.2007Ingår i: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 85, nr 8, s. 832-837Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To prospectively evaluate the prevalence and incidence of pseudoexfoliation (PEX) syndrome and open-angle glaucoma (OAG) with and without PEX and to evaluate PEX as a risk factor for glaucoma in a population born in 1915 and living in the municipality of Skellefteå in northern Sweden.

    METHODS: A randomized population study comprising 339 individuals. The cohort was followed for 21 years at 7 year intervals. The examination included tonometry, dilated slit-lamp biomicroscopy, optic disc evaluation and, if glaucoma was suspected, a visual field analysis.

    RESULTS: The prevalence of PEX increased from 23%[95% confidence interval (CI): 20-26] at 66 years of age to 61% (CI 50-71) at 87 years. The annual incidence of PEX was 1.8% (CI 1.3-2.4). In the group of subjects with unilateral PEX, 55% converted to bilateral PEX during follow-up. The prevalence of OAG was 2.1% (CI 0.8-4.3%) at 66 years of age and 25% (CI 16-35) at 87 years. Of the glaucoma cases, 59% had PEX. There was no difference in incidence between the sexes. The annual incidence of PEX and OAG did not increase with time. The overall annual incidence of OAG was 0.9% (CI 0.6-1.3%) [0.5% (CI 0.2-0.9) without PEX and 2.1% (CI 1.2-3.3) with PEX]. PEX increased the risk of glaucoma four fold in both sexes. There was no significant difference in mortality between individuals with or without PEX.

    CONCLUSION: PEX syndrome and OAG are common in the north of Sweden. Prevalences increase with age. PEX increases the risk of glaucoma four fold. The consequences of this situation demand guidelines for handling patients with PEX, with or without other risk factors. In order to issue guidelines, more information is needed on the impact of the disease on the general health in the ageing population.

  • 3819.
    Åström, Siv
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Oftalmiatrik.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindén, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Oftalmiatrik.
    Intraocular pressure changes over 21 years: a longitudinal age-cohort study in northern Sweden2014Ingår i: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 92, nr 5, s. 417-420Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose:  To follow intraocular pressure (IOP) and the influence of pseudoexfoliation (PEX) and cataract extraction in an age-cohort in northern Sweden; patients were followed prospectively for 21 years from age 66 to 87 years.

    Methods:  Three Hundred and thirty-nine individuals, randomly selected from an age-cohort born in 1915 underwent ophthalmological examination including measurement of IOP with Goldmann applanation tonometry, screening for PEX and glaucoma. Follow-up examinations were performed three times with 7-year intervals. Medical records were reviewed for dates of cataract surgery and glaucoma treatment. A linear mixed model was used to analyse the impact of sex, eye (right/left), PEX, cataract extraction and time on IOP.

    Results:  Without cataract surgery, the IOP from age of 66 to 87 years, increased by 0.05 mmHg/year (p < 0.001). If cataract surgery was included in the model, no significant change in IOP over time was found. The estimated contribution of PEX to IOP was +2.05 mmHg (p < 0.001), and the contribution of cataract surgery was −2.13 mmHg (p < 0.001). The mean IOP in women was 1.22 mmHg higher than in men (p = 0.001).

    Conclusion:  A small but statistically significant increase in IOP with age was detected when excluding eyes that had undergone cataract surgery. PEX was associated with a higher IOP and cataract extraction with a lower.

  • 3820.
    Åström, Siv
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Oftalmiatrik.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindén, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Oftalmiatrik.
    Open-angle glaucoma in screened versus unscreened subjects: a long-term age-cohort studyArtikel i tidskrift (Övrigt vetenskapligt)
  • 3821.
    Öberg, Emely
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Conformity between Magnetic Resonance Imaging and Surgery Outcome in Cholesteatomas2019Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 3822.
    Ödmark, Inga-Stina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Hormone replacement therapy: benefits and adverse effects2004Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Numerous studies have shown that estrogen replacement therapy (ERT) is an effective treatment for vasomotor symptoms, insomnia and vaginal dryness. Beneficial effects have also been shown on lipid patterns and on the incidence of osteoporotic fractures. As ERT increases the risk of endometrial adenocarcinoma, combinations with various progestogens have been developed in order to protect the endometrium. However, the addition of progestogens tends to reduce the beneficial effects of estrogens on mood, cognition and lipid metabolism. The added progestogen often causes side effects such as irritability and depression. There is evidence that the effect on wellbeing varies between women and with the type of progestogen used. Women who prefer to avoid withdrawal bleedings can be given continuous combined hormone replacement therapy (HRT). Unfortunately, irregular bleedings are common at the beginning of treatment and reduces compliance. Recently, several studies have reported an increased risk of breast cancer and venous thrombosis, and therefore long-term treatment with HRT for women without climacteric symptoms is no longer recommended. The ongoing debate has, for the time being, resulted in a recommendation that improving quality of life (QoL) by treatment of climacteric symptoms should be the only indication for prescribing HRT.

    Aims and methods: The aims of the study were to investigate bleeding patterns, changes in wellbeing at onset and during long-term treatment, and lipid and lipoprotein profiles with two different types of continuous combined HRT. In addition, women starting, and women switching from mainly sequential HRT were compared. The design was a randomised, double-blind, one year, prospective, multicentre study including 249 healthy postmenopausal women who were given continuous daily oral treatment with either combined 0.625mg conjugated estrogen (CE) and 5mg medroxyprogesterone acetate (MPA) or combined 2mg 17β - estradiol (E2) and 1mg norethisterone acetate (NETA). Bleedings, if any, were recorded daily throughout the study. The main outcome measures (changes in wellbeing and climacteric symptoms) consisted of daily ratings of 12 items on a validated symptom scale. Serum concentrations of lipids and lipoproteins were measured at baseline and after one year of treatment.

    Results and conclusions: The majority of drop-outs were confined to the first three months, and the main reasons were bleedings and/or decreased wellbeing. Drop-outs were three times more common in the E2/NETA group. During the first month, 67% of the women reported irregular bleedings. The number of bleeding days decreased on both treatments during the first four months. Treatment with CE/MPA resulted in less irregular bleedings and a shorter time to amenorrhoea compared to E2/NETA.

    As expected, "starters" experienced more sweats than "switchers" at the onset of treatment, but both groups improved significantly. Side effects such as breast tenderness, swelling, depression and irritability appeared during the first treatment week in both groups. The side effects of HRT appeared much more quickly than the benefits and were more frequent in women with a history of premenstrual syndrome (PMS). Breast tenderness was more common in the E2/NETA group throughout the whole study period. Apart from that, there were no differences between the two treatment regimens as regards effects on well-being at the end of the study.

    Lipoprotein(a) levels, an important risk factor for cardiovascular disease, decreased in both treatment groups. Triglyceride levels increased in women treated with CE/MPA, and levels of total cholesterol, high density lipoprotein and low density lipoprotein fell in the E2/NETA group.

    In conclusion, treatment with E2/NETA caused more bleeding problems than treatment with CE/MPA. CE/MPA was better tolerated than E2/NETA at the beginning of the study, but among the women remaining in the study there was no difference in QoL between the two treatment groups. HRT counselling should take into account that a history of PMS increases the likelihood of side effects and that these may precede any beneficial effects. Both treatments produced beneficial effects on lipid and lipoprotein levels, and neither of the regimens was superior in this respect.

  • 3823.
    Ödmark, Inga-Stina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bixo, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Englund, Doris
    Risberg, Björn
    Jonsson, Björn
    Olsson, Sven-Eric
    Endometrial safety and bleeding pattern during a five-year treatment with long-cycle hormone therapy2005Ingår i: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 12, nr 6, s. 699-707Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To determine compliance, the incidence of untoward effects, and endometrial safety in postmenopausal women treated with 3-month sequential hormone therapy for up to 5 years.

    Design: A prospective, uncontrolled multicenter study of 129 women treated with 0.625 mg conjugated estrogens daily plus 10 mg medroxyprogesterone acetate for 14 days every third month. Endometrial biopsy samples were taken before the initiation of the study and then yearly during the next 5 years. Bleeding patterns were recorded.

    Results: Upon completion of the first 12 months of treatment, 76 of 126 biopsied women (60%) had secretory endometrium. After 5 years, this finding was reversed in biopsy specimens completed by 59 women, among whom 32 (56%) had insufficient or atrophic endometrium.We did not find any hyperplasia when the biopsy specimen was taken according to the protocol. One endometrial cancer was found by biopsy after 12 months, but the subsequent hysterectomy showed no sign of cancer. Ultrasound determinations of mean endometrial thickness during therapy showed a thin endometrium (mean = 4 mm, range = 1-13 mm). Amenorrhea was reported by 6.2% of 129 women after 12 months of treatment. Among the 59 women who completed the study, 71.2% had regular bleeding patterns every third month, 25.4% reported amenorrhea, and 3.4% had irregular bleeding patterns.

    Conclusions: The addition of 10 mg of medroxyprogesterone acetate for 14 days every third month to treatment with 0.625 mg of conjugated estrogens daily was well tolerated, and was associated with high endometrial safety.

  • 3824.
    Ödmark, Inga-Stina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bäckström, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Haeger, Magnus
    Jonsson, Björn
    Bixo, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Effects of continuous combined conjugated estrogen/medroxyprogesterone acetate and 17beta-estadiol/norethisterone acetate on lipids and lipoproteins2004Ingår i: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 48, nr 2, s. 137-146Artikel i tidskrift (Refereegranskat)
  • 3825.
    Ödmark, Inga-Stina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bäckström, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Jonsson, B
    Bixo, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Long-term effects of two different continuous combined regimens of hormone replacement therapy on well-being2004Ingår i: Gynecological Endocrinology, ISSN 0951-3590, E-ISSN 1473-0766, Vol. 18, nr 6, s. 305-317Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Our aim was to compare the effect on well-being of two different continuous combined hormone replacement therapies (HRT) in women starting treatment (‘starters’) and women switching from mainly sequential HRT (‘switchers’). The design was a randomized, double-blind, 1-year, prospective study, including 249 postmenopausal women treated with 0.625 mg conjugated estrogen (CE)/ 5 mg medroxyprogesterone acetate (MPA) or 2 mg estradiol/1 mg norethisterone acetate (NETA) continuously. The main outcome measure was well-being, reported daily on a validated symptom scale during treatment cycles 1, 2, 6 and 13. Both treatment groups, starters and switchers, improved significantly in episodes of sweating during the first 6 months (p50.05). Women treated with estradiol/NETA experienced more breast tenderness compared to women using CE/MPA during the whole study period (p50.001), whereas there were no differences in negative mood symptoms between treatment groups. Starters experienced improved wellbeing during the whole study, whereas switchers experienced a transient improvement during the first 2 months. Overall, negative mood symptoms were more frequently reported by women with a history of premenstrual syndrome (PMS) (p50.05). Progestogen side-effects were more pronounced with estradiol/NETA than with CE/MPA combinations. Individual factors, such as previous PMS and previous HRT use, should be taken into consideration when prescribing HRT.

  • 3826.
    Ödmark, Inga-Stina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bäckström, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Jonsson, Björn
    Bixo, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Well-being at onset of hormone replacement therapy: comparison between two continuous combined regimens2004Ingår i: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 7, nr 1, s. 92-102Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives To compare the effect on well-being of two continuous combined hormone replacement therapies (HRTs) in women starting treatment (‘starters’) and women switching from mainly sequential HRT (‘switchers’).

    Methods This was a randomized, double-blind, 1-month trial, in which 249 postmenopausal women were treated with either conjugated estrogen plus medroxyprogesterone acetate (CE/MPA 0.625 mg/5 mg) or 17β-estradiol plus norethisterone acetate (E2/NETA 2 mg/1 mg) continuously. Twelve items for measuring climacteric symptoms and well-being were reported daily on a validated symptom scale.

    Results Women taking CE/MPA reported lower scores for breast tenderness (p = 0.005), depression (p = 0.019), irritability (p = 0.004) and tension (p = 0.048), compared with women taking E2/NETA. Compared with pretreatment, both groups developed side-effects during the first week: breast tenderness, swelling and depression (p < 0.05). Starters, but also switchers, improved in sweats (p < 0.001 and p = 0.030). Compared with pretreatment ratings, switchers reported higher scores for breast tenderness (p < 0.001), depression (p = 0.050) and negative effects on daily life (p < 0.001), whereas starters reported only physical side-effects (p < 0.05). A history of premenstrual syndrome (PMS) predicted high scores for swelling (p = 0.023), depression (p = 0.024), tension (p = 0.009), irritability (p = 0.027), headache (p < 0.001) and negative effects on daily life (p < 0.001).

    Conclusions CE/MPA 0.625 mg/5 mg is better tolerated than E2/NETA 2 mg/1 mg, and starters react differently from switchers. Side-effects occur more quickly than benefits with HRT, and are more frequent in women with previous PMS.

  • 3827.
    Ödmark, Inga-Stina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Carlström, Kjell
    Jonsson, Björn
    Jonasson, Aino Fianu
    Conjugated estrogen/progestagen versus tibolone hormone replacement therapy in postmenopausal women: effects on carbohydrate metabolism and serum sex hormone-binding globulin2006Ingår i: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 53, nr 1, s. 89-96Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To study the effects of different types of continuous hormone replacement therapy on carbohydrate metabolism.

    Method: Postmenopausal women were treated with conjugated estrogens, 0.625 mg/medroxyprogesterone acetate, 2.5 or 5mg (CEE/MPA) or tibolone 2.5 mg daily for 13 28-day cycles. Serum glucose and insulin were measured before and during a 75 g oral glucose tolerance test (OGTT) at baseline and after 3, 6 and 13 cycles and areas under the curve (AUC) were calculated. Sex hormone-binding globulin (SHBG) was measured as an additional marker of nutritional and insulin status.

    Results: Neither CEE/MPA2.5 mg nor tibolone had any effects on carbohydrate metabolism whileAUCinsulin, AUCglucose and also body mass index (BMI) increased after 13 cycles of treatment in the CEE/MPA 5 mg group. SHBG increased significantly during CEE/MPA treatment and decreased significantly during treatment with tibolone. The effects on SHBG were less pronounced in the CEE/MPA 5 mg group. Pretreatment SHBG showed significant negative correlations to BMI and to variables that may reflect a certain degree of insulin resistance, the most pronounced being fasting glucose. Changes in SHBG during treatment with tibolone were negatively correlated to pretreatment SHBG and positively to BMI, AUCinsulin and fasting insulin resistance index, while no such correlations were found in the CEE/MPA groups. There were no correlations between changes in AUCinsulin and AUCglucose on one hand and basal variables or treatment SHBG on the other in the CEE/MPA groups.

    Conclusion: The effects of tibolone and CEE/MPA on carbohydrate metabolism were considered to have clinical significance only for CEE/MPA 5 mg, indicating a less favourable role of the higher progestagen dose. The results further support the important role of metabolic and insulin status in the physiological regulation of SHBG and also indicate that the suppressive effect of tibolone on circulating SHBG is mainly depends on pretreatment SHBG levels. SHBG does not reflect changes in carbohydrate metabolism during CEE/MPA treatment.

  • 3828. Ödmark, Inga-Stina
    et al.
    Jonsson, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bäckström, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bleeding patterns in postmenopausal women using continuous combination hormone replacement therapy with conjugated estrogen and medroxyprogesterone acetate or with 17β-estradiol and norethindrone acetate2001Ingår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 184, nr 6, s. 1131-1138Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: We studied bleeding patterns in postmenopausal women who were using 2 types of continuous combination regimens.

    STUDY DESIGN: A prospective, double-blind, randomized study of 208 postmenopausal women treated with conjugated estrogen, 0.625 mg, and medroxyprogesterone acetate, 5 mg, or with 17beta-estradiol, 2 mg, and norethindrone acetate, 1 mg.

    RESULTS: The mean number of bleeding days decreased during the first 4 months of treatment (P <.002) but not thereafter. The number of bleeding days was fewer (P <.002) and the time until amenorrhea was shorter (P <.02) in patients receiving conjugated estrogen and medroxyprogesterone acetate than in patients receiving 17beta-estradiol and norethindrone acetate. The odds ratio for progression to amenorrhea with the use of conjugated estrogen and medroxyprogesterone acetate was 1.58, in comparison with the use of 17beta-estradiol and norethindrone acetate. A thick endometrium at the start of treatment resulted in more bleeding days than were found for a thin endometrium (P <.03). Body mass index, age, and blood pressure had no predictive value for bleeding problems.

    CONCLUSIONS: Treatment with continuous combined conjugated estrogen and medroxyprogesterone acetate resulted in fewer bleeding problems than did treatment with 17beta-estradiol and norethindrone acetate. Endometrial thickness may help to predict the chance of achieving amenorrhea during early hormone replacement therapy.

  • 3829.
    Öfverman, Charlotte
    Umeå universitet, Medicinsk fakultet, Klinisk vetenskap, Obstetrik och gynekologi.
    Progesterone metabolites: learning, tolerance, antagonism & metabolism2009Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Progesterone metabolites as allopregnanolone, isoallopregnanolone and tetrahydrodeoxy-corticosterone (THDOC) are increased in the luteal phase of the menstrual cycle, throughout pregnancy and during stress. Allopregnanolone and THDOC are neurosteroids with 3α-hydroxy, 5α-configurations and positive modulating effect on the GABAA receptor. They have similar properties and effect, and share the same binding sites on the GABAA receptor. Isoallopregnanolone has a 3β-hydroxy, 5α-configuration and a diverse effect as a proposed antagonist to both allopregnanolone and THDOC. Neurosteroids are thought to exert their effect predominantly at extrasynaptic GABAA receptors, containing for example α4- or α5-subunits. Such receptors are involved in the tonic response. Different subunits have diverse distribution pattern in the brain and are involved in different functions. The α5-subunit, mainly expressed in the hippocampus, is involved in learning, while α4 is more widespread and involved in e.g. anxiety and anaesthesia.

    The aim of the present thesis was to contribute to the knowledge about selected progesterone metabolites and their effects on learning and tolerance development, as well as their metabolism. Also basic characteristics between different α-subunits of the GABAA receptor were evaluated.

    The thesis shows that the effect of bicuculline and pentobarbital is not dependent on the α-subunit isoform of the GABAA receptor expressed in oocytes. Acute tolerance developed after allopregnanolone-induced anaesthesia with a decrease at both mRNA and protein levels of the GABAA receptor α4-subunit in the thalamus VPM nucleus. A negative correlation between the α4 mRNA and the increased dose of allopregnanolone needed to maintain the anaesthesia level was also shown. In addition, allopregnanolone induces a learning impairment in the Morris water maze test, when high concentrations of allopregnanolone are present in the brain. This impairment is not possible to reverse by isoallopregnanolone. In α5β3γ2L-transfected HEK-293 cells THDOC induces a baseline shift of its own and also potentiate the GABA-current. Neither of those THDOC effects can be inhibited by isoallopregnanolone. Instead isoallopregnanolone shows an agonistic effect on the THDOC-potentiation of the GABA-response. The main allopregnanolone metabolites identified, 5α-DHP and isoallopregnanolone, as well as allopregnanolone itself are mainly localized to the brain after an i.v. injection. After an isoallopregnanolone injection there is a more even distribution of the given steroid and the metabolites between plasma and brain. There is an epimerisation between isoallopregnanolone and allopregnanolone and vice versa.

    In conclusion, the present thesis shows that the α4-subunit in the thalamus VPM nucleus is likely to be involved in the acute tolerance development against allopregnanolone and that allopregnanolone-induced learning impairment is likely to be hippocampus dependent. The lack of antagonistic effect of isoallopregnanolone on the THDOC-induced α5β3γ2L-GABAA response, together with epimerisation of isoallopregnanolone to allopregnanolone, could explain why isoallopregnanolone does not work as an antagonist to the allopregnanolone-induced learning impairment in a hippocampus dependent learning task.

  • 3830.
    Öfverman, Charlotte
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Hill, Martin
    Institute of Endocrinology, Nároni trída 8, CZ 116 94 Prague, Czech Republic.
    Bäckström, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Johansson, Inga-Maj
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Neurosteroid metabolism: identification of allopregnanolone and isoallopregnanolone metabolites in rat brain and plasmaManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Metabolism of progesterone produces steroids that by themselves have other functional properties than the hormone. The most prominent metabolite, allopregnanolone (3α-OH-5α-pregnane-20-one), has a strong GABAA receptor agonistic activity. Isoallopregnanolone (3β-OH-5α-pregnane-20-one) is also formed from progesterone; this allopregnanolone epimer can in certain situations function as an antagonist to effects induced by allopregnanolone.

    This study was designed to further evaluate the metabolism of allopregnanolone and isoallopregnanolone in the rat. This was done by intravenous injections of either steroid and analyses of selected possible metabolites within the brain as well as in plasma, eight minutes after the injection. Analyses were performed with GC-MS.

    It was found that the main metabolites accumulated after the allopregnanolone treatment was the precursor 5α-dihydroprogesterone, followed by isoallopregnanolone. The injected allopregnanolone, as well as the two major metabolites formed, were mainly present in the brain. When isoallopregnanolone was injected, the main metabolites formed were allopregnanolone and 6α-hydroxylated isoallopregnanolone, followed by the precursor 5α-dihydroprogesterone. Interestingly, the metabolites formed after isoallopregnanolone injections were more evenly distributed between the analyzed brain areas and the plasma. After both treatments a high proportion of conjugation (typically around 50%), was in plasma found for both the injected and the produced steroids.

    With the high amounts of metabolites found in the brain, there might be a high converting capacity within the brain for these kinds of steroids. This suggests that interchange between the studied epimers is of physiological nature. One may then speculate that the brain uses the conversion between allopregnanolone and isoallopregnanolone to regulate the GABAergic inhibition. If this is the case, a dysregulation of this metabolism might cause symptoms and/or CNS disorders. 

  • 3831.
    Öfverman, Charlotte
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Strömberg, Jessica
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Birzniece, Vita
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Turkmen, Sahruh
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Hill, Martin
    Institute of Endocrinology, Nároní trída 8, CZ 116 94, Prague, Czech Republic.
    Lundgren, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bäckström, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Johansson, Inga-Maj
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    The progesterone metabolite isoallopregnanolone is a subunit-selective antagonist of the GABA-A receptorManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

     Allopregnanolone is a progesterone metabolite that can negatively affect learning and induce anaesthesia in rats. It also impairs episodic memory in women. Allopregnanolone levels are elevated during the luteal phase of the menstrual cycle, during pregnancy, and during stress. Allopregnanolone is a strong positive modulator of the GABAA receptor. The subunit composition of the GABAA receptor is of importance for effects of modulators, and GABAA receptors including the α5-subunit are of significance for learning, while receptors with other subunits are involved in e.g. anesthesia. Isoallopregnanolone, a natural 3β-epimer of allopregnanolone, has been shown to antagonize allopregnanolone-induced anesthesia in rats.

    We tried to block the allopregnanolone-induced impairment of learning in rats in the Morris water maze test, using isoallopregnanolone (4–32 mg/kg). We also determined steroid concentrations in blood and brain tissue, and with whole-cell patch clamp we studied the effects of isoallopregnanolone and tetrahydrodeoxycorticosterone (a neurosteroid similar to allopregnanolone) on HEK-293 cells expressing the human α5β2γ2L GABAA receptor.

    Isoallopregnanolone did not block the negative effects of allopregnanolone (2 mg/kg) in the Morris water maze test. Our presumed antagonist actually had an agonistic effect on the tetrahydrodeoxycorticosterone-mediated potentiation of the GABA effect on the α5β2γ2L GABAA receptor. The baseline shift induced by tetrahydrodeoxycorticosterone alone was not reversed by isoallopregnanolone. A bidirectional epimerisation between allopregnanolone and isoallopregnanolone was also identified in the rat.

    The lack of antagonistic effect at the α5β2γ2L GABAA receptor together with the epimerisation of isoallopregnanolone to allopregnanolone would probably explain the lack of effect of our proposed antagonist on the allopregnanolone-induced impairment of learning 

  • 3832.
    Ögren, Kenneth
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Operera psykisk sjukdom2014Ingår i: Västerbotten, ISSN 0346-4938, nr 3, s. 54-59Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 3833.
    Ögren, Kenneth
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Umeå universitet, Humanistiska fakulteten, Institutionen för kultur- och medievetenskaper.
    Psychosurgery in Sweden 1944 - 1958: the practice, the professional and media discourse2007Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background. The pioneering early experiments of prefrontal lobotomy were performed in 1944 by neurosurgeons in Stockholm in collaboration with psychiatrists. There was a rapid implementation of the new surgical approach. In 1946 and 1947 the two state mental hospitals, Umedalen and Sidsjön, introduced prefrontal lobotomy on a large scale. General surgeons now performed operations, a practice which was established all over Sweden. Prefrontal lobotomy was burdened, in certain city hospitals, by an initially high rate of postoperative mortality reaching more than 15 %. Pre-frontal lobotomy was phased out continuously already before 1950 and refined psychosurgical methods were introduced , but prefrontal lobotomy was still continued which lacked specialised neurosurgical units. The aims of the thesis were to contribute to and deepen the knowledge and understanding of the general and specific questions of early psychosurgery in its professional and social context.

    Specific aims: (Explore the practice of prefrontal lobotomy at the Umedalen State Mental hospital and plot the frequency of psychosurgery operations in Sweden.

    • Analyze the patients subjected to prefrontal lobotomy at the Umedalen State Mental Hospital 1947-1958, with respect to symptomatology and diagnosis, indications for the operation, gender distribution postoperative mortality, the practice of consent and other clinical factors.

    • Explore and analyze what was written on psychosurgery, when and how, and to identify differences, similarities and characteristics of the portrayal of psychosurgery in Swedish and American media 1936-1959.

    • Explore and analyze the confluence of the role of the State authority, The Swedish National Board of Health (Medicinalstyrelsen), the professional discourses on lobotomy and the media portrayal, in dealing with problems of implementation and mortality.

    Results. Paper I. At the Umedalen State Mental Hospital, 771 prefrontal lobotomies were performed 1947-1958 with an overall postoperative mortality of 7.4 %. Most of the patients operated on from Umedalen were women (61.2%) and most of the patients were diagnosed with schizophrenia. Of all the lobotomies performed in Sweden (approx. 4,500), 28% had been carried out at the Sidsjön and Umedalen State Mental Hospitals.

    Paper II. A sample of 105 patients, who were studied in detail from psychiatric records. It was found that 79% had been six years in primary school and only 3% had a higher education. In an analysis of the descriptions of behavioural problems stated in the medical records, it was found that the female candidate for prefrontal lobotomy was described as suffering from different problems more often than the male candidate. Disturbing behaviour, fluctuations of mood and violence against others were the most frequently described symptoms most often referred to with respect to the female lobotomy candidate.

    Paper III. In the comparative media study it was found that most of the articles on lobotomy in the Swedish and American media were positive or neutral towards psychosurgery, while very negative articles were least frequent. Neutral articles were more common in Swedish media (43%) while less common in the American media (19%). Articles being very negative towards lobotomy were considerably more often found in the American material (32%) than in the Swedish (14%).

    Paper IV. The implementation of lobotomy was rapid in Sweden and more than 4000 lobotomies were performed between 1944 and 1964. It was considered feasible for prefrontal lobotomies to be performed by general surgeons and, from 1951, it can be verified that most hospitals (12/20) had engaged general surgeons for the lobotomy operation while a minority (8/20) had engaged a neurosurgeon. The Swedish State, through the Swedish National Board of Health was responsible of the allocation and surveillance of mental care. With a system consisting of a Chief Inspector of Mental Care, State mental hospitals were inspected annually. Medical superintendents were given full autonomy to decide on the implementation and practice of lobotomy. No indications were found of any significant interference by the Swedish National Board of Health restricting lobotomy.

    Main conclusion. Medical superintendents were given full autonomy to decide on the clinical practice of lobotomy. Being left in the periphery of neurosurgical facilities, this led to their engaging general surgeons. Patients were operated on in surgical theatres lacking the sophisticated technical equipment of coping securely with haemorrhages, which were common in the early implementation of the operation. The practice of lobotomy in some mental hospitals was extensive and postoperative deaths were numerous but the Swedish National Board of Health took a defensive role and, even with the annual inspections, there was no important interference with the lobotomy question. Swedish media reported mostly positively on lobotomy, underlining the promising prospects of the new method submitted by the early proponents without critical questioning or independent investigations.

  • 3834.
    Ögren, Kenneth
    Umeå universitet, Humanistiska fakulteten, Kultur och medier. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    The surgical offensives against mental disorder: psychosurgery in Sweden 1944-19582005Licentiatavhandling, sammanläggning (Övrigt vetenskapligt)
  • 3835.
    Ögren, Kenneth
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Implementation of lobotomy in Sweden: the role of the state and the professionsManuskript (Övrigt vetenskapligt)
  • 3836.
    Ögren, Kenneth
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Umeå universitet, Humanistiska fakulteten, Kultur och medier.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Lobotomy at a state mental hospital: a survey of patients operated during the period 1947 to 19582007Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 61, nr 5, s. 355-362Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This retrospective survey aims at describing patients subjected to prefrontal lobotomies and the general treatment conditions at Umedalen State Mental Hospital during the period 1947–1958. Data collected from psychiatric and surgical medical records was analysed using quantitative and qualitative content analysis. A total of 771 patients subjected to lobotomy during the years 1947–1958 were identified. From these, a sample of 105 patients was selected for the purpose of obtaining detailed data on socio-economic status, diagnosis, symptomatology, other psychiatric treatments applied before the pre-frontal lobotomy operation, time spent in hospital before operation, praxis of consent and mortality. The diagnosis of schizophrenia was found in 84% of the 771 lobotomized patients. The post-operative mortality was 7.4% (57 deaths), with the highest rate in 1949 (17%). The mean age of the patient at the time of operation was 44.8 years for females and 39.5 years for male patients. The average length of pre-operative time in hospital for females was 10.7 years and for males 3.5 years. It remains unclear why this mental hospital conducted the lobotomy operation to such a comparatively great extent. Factors such as overcrowding of wards and its status as a modern mental hospital may have contributed.

  • 3837.
    Ögren, Kenneth
    et al.
    Umeå universitet, Humanistiska fakulteten, Kultur och medier. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Psychosurgery in Sweden 1944-19642005Ingår i: Journal of the History of the Neurosciences, ISSN 0964-704X, E-ISSN 1744-5213, Vol. 14, nr 4, s. 353-367Artikel i tidskrift (Refereegranskat)
  • 3838.
    Öhlund, Doris
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykoterapi.
    ”Det väcker så mycket tankar, när du ställer dina frågor”: Föräldraintervjuer om deras upplevelser av barnpsykiatrisk behandling för deras barn med diagnos ADHD. 2008Självständigt arbete på avancerad nivå (yrkesexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Mitt syfte har varit att ta del av föräldrars erfarenheter av den barnpsykiatriska behandlingen för deras barn med ADHD-diagnos. Jag ville också få en bild av hur samspelet fungerar mellan barn och föräldrar.

    Metoden jag använt har varit kvalitativa intervjuer med föräldrar till fyra barn.

    En utgångspunkt i mina frågeställningar har varit om vi inom barnpsykiatrin i bemötandet av dessa familjer har haft en helhetssyn och ett relationsperspektiv som sedan också präglat behandlingen.

    Sammanfattningsvis framkommer att föräldrarna fått behandling som dom är nöjda med men alla familjerna frågar samtidigt efter en helhetssyn i bemötandet och komplementära behandlingsalternativ.

    Djupintervjuerna belyser en stark efterfrågan på psykologisk behandling på både individual/familj och föräldranivå.

    Tre av fyra föräldrapar uttrycker behov av att utvecklingspsykologiskt kunna förstå sitt barn, vad är symtom och vad är normalt.

    Samspelet mellan barn och föräldrar är ett område som berör känslomässigt. Ett område som föräldrarna beskriver har inneburit osäkerhet i föräldraskapet och vanmakt inför att kunna få en fungerande relation till barnet.

     

     

     

     

  • 3839.
    Öhlund, Inger
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Health implications of dietary intake in infancy and early childhood2008Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: Swedish children are the healthiest in Europe. Through regular visits to well-baby clinics, infants and young children are checked and parents given information and advice on diet and other relevant matters for their child. For a long time, adequate nutrition during infancy and childhood has been focused on encouraging proper nutrition, preventing malnutrition and deficiency states, and obtaining optimal growth. Today, malnutrition and deficiency states in infants and children are rare. But other public health problems have arisen. Nutrition early in life is now thought to influence health and diseases even in adulthood. Thus promotion of a healthy diet in early life is important for preventing public health diseases such as iron deficiency, cardiovascular disease, obesity, and dental caries.

    Aims: This study investigates health implications of dietary intake in infancy and early childhood. More specific focus was on the associations between dietary fat intake and serum lipid levels in infants, early dietary intake, iron status, dental caries, and Body Mass Index (BMI) at 4 years of age. In addition, hereditary factors and changes over time were evaluated.

    Methods: Before 6 month of age, 300 healthy infants were recruited from well-baby clinics in Umeå. This thesis is based on secondary analysis of a prospective study in these infants run from 6-18 months and a follow-up of 127 of the children at 4 years. Between 6-18 months and at 4 years, dietary intakes were assessed, anthropometric measures performed, and venous blood samples taken. At 4 years, a dental examination was also performed and anthropometric data and blood samples were collected from parents and included in the study.

    Results: All but two infants were ever breastfed and at 6 months 73% were still breastfed. The quality of dietary fat was not within national recommendations. At 4 years, intake of vitamin D and selenium were below and intake of sugar and sweet products above the recommendations. In girls, but not boys, higher polyunsaturated fatty acid intake was associated with lower levels of total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B levels. Iron status of the children was generally good and no child had iron deficiency anaemia (IDA). Children’s haemoglobin (Hb) levels tracked from infancy to 4 years and correlated with their mother’s Hb. Fortified infant products and meat were important sources of iron at both 12 months and 4 years. Children with frequent intake of cheese had less caries in this population with low caries prevalence. We found higher protein intake over time to be associated with higher Body Mass Index (BMI) at 4 years and high BMI at 4 years was associated with high BMI at 6 mo. There was also an association between the BMI of the child and that of its parents.

    Conclusions: BMI of the child and parents (especially the father), and iron status at 6 months were predictors of these variables at 4 years of age. The quality rather than the quantity of dietary fat in infancy affected serum lipid values. Even in a healthy and well-nourished group of Swedish infants and young children, quality of food and intake of nutrients are important for current and later health of the child.

  • 3840.
    Öhlund, Inger
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Fett i barnets kost: kvalitet minst lika viktigt som kvantitet2011Ingår i: Nordisk Nutrition, ISSN 1654-8337, nr 1, s. 31-34Artikel i tidskrift (Övrigt vetenskapligt)
  • 3841.
    Öhlund, Inger
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Lind, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Serum lipid and apolipoprotein levels in 4-year-old children are associated with parental levels and track over time2011Ingår i: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 65, nr 4, s. 463-469Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background/Objectives: There are only a few studies linking dietary fat intake to serum lipid levels in young children. Our objective was to prospectively evaluate serum lipid levels from infancy to early childhood, and to explore their possible association with dietary, growth and parental factors.

    Subjects/Methods: Children (n=127) followed from early infancy were examined for serum lipid levels, anthropometry and dietary intake at 4 years of age. We also studied possible associations with parental anthropometric and blood biochemistry data collected from 122 mothers' and 118 fathers' when children were 4 years of age.

    Results: Serum concentrations of total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC) and the apolipoprotein B/apolipoprotein A-1 ratio (apo B/apo A-1) showed significant tracking from infancy to 4 years. Furthermore, children's TC levels correlated with paternal TC level from 6 months to 4 years, but with maternal only at 4 years. In girls, both LDLC and HDLC correlated with parental LDLC and HDLC. In all children, intake of saturated fatty acids (SAFAs) was higher than recommended, and in 90% of the children polyunsaturated fatty acid (PUFA) intake was lower than recommended.

    Conclusions: Serum lipid levels values tracked from infancy to 4 years and were associated with parental values. Higher serum lipid levels at 4 years compared with 6-18 months of age may result from changes in the quality of dietary fat. We therefore suggest that intake of dietary fat in 4-year-old children should be more focused on quality. Furthermore, as there were strong associations between the child and parental serum lipid levels this supports the view that family-based rather than individual intervention is preferable.

  • 3842.
    Öhlund, Inger
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lind, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    BMI at 4 years of age is associated with previous and current protein intake and with paternal BMI2010Ingår i: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 64, nr 2, s. 138-145Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Objectives:To evaluate possible associations between body mass index (BMI) at 4 years of age, current and previous dietary intakes and parental BMI.Methods:A follow-up of dietary intake and anthropometry in 127 4-year-old children corresponding to 54% of children who completed an initial intervention study at 18 months of age.Results:Fourteen percent of the girls and 13% of the boys were overweight (age-adjusted BMI>/=25) and 2% of the girls and 3% of the boys were obese (age-adjusted BMI>/=30). Thirty-four percent and 9% of the fathers and 19 and 7% of the mothers were overweight and obese, respectively. BMI at 6-18 months was a strong predictor of BMI at 4 years. Univariate regression analyses revealed that intake of protein in particular, and also of total energy and carbohydrates at 17/18 months and at 4 years, was positively associated with BMI at 4 years. Although BMI at 6-18 months was the strongest predictor of BMI at 4 years, in the final multivariate models of the child's BMI, protein intake at 17-18 months and at 4 years, energy intake at 4 years and the father's-but not the mother's-BMI were also independent contributing factors.Conclusions:Among these healthy children, BMI at 4 years of age tracked from 6 to 18 months of age and were associated with previous and current protein intake as well as parental BMI, particularly that of the father.

  • 3843.
    Öhlund, Inger
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    lind, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Dietary fat in infancy should be more focused on quality than on quantity2008Ingår i: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 62, nr 9, s. 1058-1064Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The primary aim was to assess, the association of the quantity and quality of dietary fat intake from 6 to 12 months of age and serum lipids at 12 months.

    Subjects/Methods: Three hundred healthy term Swedish infants were recruited in a longitudinal prospective study at the age of 6 months; 276 remained in the study at 12 months. Food records and anthropometric data were collected monthly from 6 to 12 months; serum lipids were analysed at 6 and 12 months.

    Results: Swedish infants had a total fat intake within the Nordic recommendations, but intake of polyunsaturated fatty acids (PUFA) was low (5.6 percent of total energy (E%)) and intake of saturated fatty acids (SAFA) was high (15.1 E%). Higher PUFA intake was associated with lower total serum cholesterol (TC, B=−0.13, P=0.003), lower low-density-lipoprotein cholesterol (LDL-C, B=−0.12, P=0.004) and apolipoprotein B (B=−0.03) (P=0.034) in girls but not in boys. When data from the present study were compared to data from similar studies in Finland and Iceland, it appears that the quality of the dietary fat has greater impact on serum lipid levels than the quantity of fat in the diet.

    Conclusions: Higher PUFA and lower SAFA intakes may reduce TC and LDL-C early in life, particularly in girls. Further, with respect to lowering serum lipid concentrations in early childhood it seems appropriate to set focus on fat quality rather than the quantity.

  • 3844.
    Öhlund, Inger
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Lind, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Iron status and its relations to diet, growth and heredity in 4-years old, well-nourished Swedish children2007Ingår i: European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), 2007Konferensbidrag (Övrigt vetenskapligt)
  • 3845.
    Öhlund, Inger
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Lif Holgerson, Pernilla
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Pedodonti.
    Lind, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Johansson, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Kariologi.
    Bäckman, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Pedodonti.
    Diet intake and caries prevalence in four-year-old children living in a low-prevalence country.2007Ingår i: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 41, nr 1, s. 26-33Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Preventive measures have dramatically decreased the prevalence of dental caries in children. However, risk factors for the disease in children living in low-prevalence areas remain elusive. In the present study we evaluated associations between dental caries, saliva levels of mutans streptococci and lactobacilli, and diet with special emphasis on the intake of fermentable carbohydrates and dairy products in 4-year-old children living in an area where the overall caries prevalence was low. Dietary intake was recorded in 234 infants as part of the Study of Infant Nutrition in Umea, Sweden (SINUS). Of these the parents of 124 children gave consent to participate in a follow-up at 4 years of age. Dietary intake, height and weight, dental caries, oral hygiene, including tooth brushing habits, presence of plaque and gingival inflammation, fluoride habits and numbers of mutans streptococci and lactobacilli in saliva were recorded. Using multivariate stepwise logistic regression, caries experience was negatively associated with intake frequency of cheese (OR = 0.67; 95% CI = 0.44-0.98) and positively associated with the salivary level of mutans streptococci (OR = 1.57; 95% CI = 1.21-2.03). Caries experience was not correlated with intake frequency or amounts of carbohydrate-containing foods, with any other particular food, or with daily intake of energy, carbohydrate or any other macro- or micronutrient. We conclude that cheese intake may have a caries-protective effect in childhood populations where the overall caries prevalence and caries experience are low and the children are regularly exposed to fluoride from toothpaste.

  • 3846.
    Öhlund, Inger
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lind, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Karlsland Åkeson, Pia
    Increased vitamin D intake differentiated according to skin color is needed to meet requirements in young Swedish children during winter: a double-blind randomized clinical trial2017Ingår i: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 106, nr 1, s. 105-112Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Dark skin and low exposure to sunlight increase the risk of vitamin D insufficiency in children. Objective: The aim of the study was to evaluate the amount of vitamin D needed to ascertain that most children >4 y of age attain sufficient serum25-hydroxyvitamin D [S-25(OH) D; i.e., >= 50 nmol/L] during winter regardless of latitude and skin color. Design: In a longitudinal, double-blind, randomized, food-based intervention study, 5- to 7-y-old children from northern (638 degrees N) and southern (558 degrees N) Sweden with fair (n = 108) and dark (n = 98) skin were included. Children, stratified by skin color by using Fitzpa-trick's definition, were randomly assigned to receive milk-based vitamin D-3 supplements that provided 2 (placebo), 10, or 25 mu g/d during 3 winter months. Results: Mean daily vitamin D intake increased from 6 to 17 mu g and 26 mu g in the intervention groups supplemented with 10 and 25 mu g, respectively. In the intention-to-treat analysis, 90.2% (95% CI: 81.1%, 99.3%) of fair-skinned children randomly assigned to supplementation of 10 mu g/d attained sufficient concentrations, whereas 25 mu g/d was needed in dark-skinned children to reach sufficiency in 95.1% (95% CI: 88.5%, 100%). In children adherent to the study product, 97% (95% CI: 91.3%, 100%) and 87.9% (95% CI: 76.8%, 99%) of fair-and dark-skinned children, respectively, achieved sufficient concentrations if supplemented with 10 mu g/d. By using 95% prediction intervals for 30 and 50 nmol S-25(OH) D/L, intakes of 6 and 20 mu g/d are required in fair-skinned children, whereas 14 and 28 mu g/d are required in children with dark skin. Conclusion: Children with fair and dark skin require vitamin D intakes of 20 and 28 mu g/d, respectively, to maintain S-25(OH) D >= 50 nmol/L, whereas intakes of 6 and 14 mu g/d, respectively, are required to maintain concentrations >= 30 nmol/L during winter.

  • 3847.
    Öhlund, Inger
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lind, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Predictors of iron status in well-nourished 4-y-old children.2008Ingår i: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 87, nr 4, s. 839-845Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Iron status in childhood is influenced by diet. Other factors affecting iron status at that age are unclear. OBJECTIVES: The objectives of the study were to evaluate iron status in 4-y-old children, to track that status from infancy to childhood, and to examine the associations of iron status with dietary factors, growth, and heredity. DESIGN: This study consisted of a longitudinal follow-up at age 4 y of children (n = 127) from the cohort of a study that began at age 6 mo. Blood samples and anthropometry were assessed in both children and their parents; food records were collected from children only. RESULTS: Dietary intake was not significantly correlated with hemoglobin concentrations, whereas the consumption of meat products had a positive effect on serum ferritin concentrations and mean corpuscular volume in boys (P = 0.015 and 0.04, respectively). The prevalences of anemia and iron deficiency were low, affecting 2 (1.8%) and 3 (2.8%) children, respectively; no child had iron deficiency anemia. There was significant within-subject tracking of hemoglobin and mean corpuscular volume from age 6 mo to 4 y. The mother's but not the father's hemoglobin correlated with the child's hemoglobin over time. CONCLUSIONS: Food choices had little effect on iron status. Hemoglobin concentrations and mean corpuscular volume were tracked from infancy to childhood. In healthy, well-nourished children with a low prevalence of iron deficiency, the mother's hemoglobin was significantly associated with that of her child, but the underlying mechanism is unclear.

  • 3848.
    Öhlund, Inger
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lind, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Serum 25-Hydroxyvitamin D Levels in Preschool-Age Children in Northern Sweden Are Inadequate After Summer and Diminish Further During Winter2013Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 56, nr 5, s. 551-555Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and Objective: Despite studies indicating that vitamin D intake among Swedish children does not meet the recommendation, little is known of their vitamin D status. The aim of the present study was to examine vitamin D status in preschool-age children in relation to vitamin D intake, season, body mass index, and skin color. Methods: Preschool-age children (n = 90; mean age 54 +/- 7.1 months), all living in northern Sweden (latitude 63 degrees north), half of them with fair skin, half with darker complexion, were recruited from well-baby clinics. The study group was examined first in August-September (late summer) and then the following January-February (winter). Skin type, vitamin D intake, anthropometrics, serum 25-hydroxyvitamin D (S-25[OH] D), and serum parathyroid hormone were assessed. Results: Mean +/- SD S-25(OH) Din summer and winter were 60 +/- 15 nmol/L and 55 +/- 16 nmol/L, respectively (P < 0.001). Fifteen percent and 10% had S-25(OH) D >= 75 nmol/L, and 25% and 40% had S-25(OH) D < 50 nmol/L, respectively. The mean vitamin D intake was higher in dark-skinned compared with fair-skinned children. In spite of this, S-25(OH) D in dark-skinned children was lower compared with fair-skinned children during both seasons. The dietary intake of vitamin D was positively associated with S-25(OH) D levels. Conclusions: Vitamin D status is inadequate in preschool-age children living in northern Sweden, especially in dark-skinned children and during the winter despite vitamin D intakes meeting the recommendations, prompting strategies to improve intake of vitamin D in this population.

  • 3849.
    Öhlund, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Öhlund, Inger
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Dietary shortcomings in children on a gluten-free diet2010Ingår i: Journal of human nutrition and dietetics (Print), ISSN 0952-3871, E-ISSN 1365-277X, Vol. 23, nr 3, s. 294-300Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Coeliac disease (CD), or permanent gluten intolerance, is one of the most common chronic food-related diseases among children in Europe and the USA. The treatment is lifelong gluten-free diet (GFD) (i.e. the exclusion of wheat, rye and barley from the diet, which are important sources particularly of iron, dietary fibre and vitamin B). The present study aimed to evaluate dietary intakes of energy and nutrients in children and adolescents on GFD and compare these with intake of comparable age groups on a normal diet as well as current recommendations.

    Methods: Thirty children, 4-17 years of age with confirmed CD and on GFD were agreed to participate in this study at the Department of Pediatrics, Umeå University Hospital. Weight and height were used to calculate individual energy requirement according to Nordic Nutrition Recommendations 2004 (NNR-04). Dietary intake was assessed using 5-day food records and household measures were used for quantities. Twenty-five children completed their dietary record.

    Results: Thirteen of the 25 children did not meet the recommended energy intake and the dietary intakes were inadequate regarding quality of macronutrients and quantity of minerals and vitamins. The mean intakes of sucrose and saturated fatty acids were above and the intakes of dietary fibre, vitamin D, magnesium and selenium below the NNR-04. High intakes of sucrose and saturated fat and a low intake of dietary fibre were also noted in a previous national survey on healthy children on a normal diet. The nutrient density of vitamin D, riboflavin, niacin, thiamine, magnesium and selenium were lower among CD children than healthy children but, for iron and calcium, it was higher in CD children.

    Conclusions: Children on GFD appear to follow the same trends as healthy children on a normal diet, with high intakes of saturated fat and sucrose and low intakes of dietary fibre, vitamin D and magnesium compared to recommendations.

  • 3850.
    Öhlund, Louise
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Antibiotic use before 1 year of age and development of allergic symptoms at 1, 4 and 13 years of age. A prospective Swedish birth cohort.2014Självständigt arbete på avancerad nivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
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