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  • 9001.
    Åstrom, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hales, Simon
    Beguin, Andreas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Louis, Valerie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Sauerborn, Rainer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Potential Distribution of Dengue Fever Under Scenarios of Climate Change and Economic Development2012Ingår i: EcoHealth, ISSN 1612-9202, E-ISSN 1612-9210, Vol. 9, nr 4, s. 448-454Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Dengue fever is the most important viral vector-borne disease with similar to 50 million cases per year globally. Previous estimates of the potential effect of global climate change on the distribution of vector-borne disease have not incorporated the effect of socioeconomic factors, which may have biased the results. We describe an empirical model of the current geographic distribution of dengue, based on the independent effects of climate and gross domestic product per capita (GDPpc, a proxy for socioeconomic development). We use the model, along with scenario-based projections of future climate, economic development, and population, to estimate populations at risk of dengue in the year 2050. We find that both climate and GDPpc influence the distribution of dengue. If the global climate changes as projected but GDPpc remained constant, the population at risk of dengue is estimated to increase by about 0.28 billion in 2050. However, if both climate and GDPpc change as projected, we estimate a decrease of 0.12 billion in the population at risk of dengue in 2050. Empirically, the geographic distribution of dengue is strongly dependent on both climatic and socioeconomic variables. Under a scenario of constant GDPpc, global climate change results in a modest but important increase in the global population at risk of dengue. Under scenarios of high GDPpc, this adverse effect of climate change is counteracted by the beneficial effect of socioeconomic development.

  • 9002.
    Åström, André
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Ischemic Stroke after AMI and CABG Surgery Risk of Ischemic Stroke After Acute Myocardial Infarction in Patients Undergoing Coronary Artery Bypass Graft Surgery2017Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 9003.
    Åström, Charlotte
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Lindkvist, Markus
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Burström, Lage
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Karlsson, J Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Changes in EMG activity in the upper trapezius muscle due to local vibration exposure.2009Ingår i: Journal of Electromyography & Kinesiology, ISSN 1050-6411, E-ISSN 1873-5711, Vol. 19, nr 3, s. 407-415Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Exposure to vibration is suggested as a risk factor for developing neck and shoulder disorders in working life. Mechanical vibration applied to a muscle belly or a tendon can elicit a reflex muscle contraction, also called tonic vibration reflex, but the mechanisms behind how vibration could cause musculoskeletal disorders has not yet been described. One suggestion has been that the vibration causes muscular fatigue. This study investigates whether vibration exposure changes the development of muscular fatigue in the trapezius muscle. Thirty-seven volunteers (men and women) performed a sub-maximal isometric shoulder elevation for 3min. This was repeated four times, two times with induced vibration and two times without. Muscle activity was measured before and after each 3-min period to look at changes in the electromyography parameters. The result showed a significantly smaller mean frequency decrease when performing the shoulder elevation with vibration (-2.51Hz) compared to without vibration (-4.04Hz). There was also a slightly higher increase in the root mean square when exposed to vibration (5.7% of maximal voluntary contraction) compared to without (3.8% of maximal voluntary contraction); however, this was not statistically significant. The results of the present study indicate that short-time exposure to vibration has no negative acute effects on the fatiguing of upper trapezius muscle.

  • 9004.
    Åström, Charlotte
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Rehn, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Lundström, Ronnie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Nilsson, Tohr
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Burström, Lage
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Hand-arm vibration syndrome (HAVS) and musculoskeletal symptoms in the neck and the upper limbs in professional drivers of terrain vehicles: a cross sectional study2006Ingår i: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 37, nr 6, s. 793-799Artikel i tidskrift (Refereegranskat)
  • 9005.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Health effects of heatwaves: short and long term predictions2017Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Climate change is defined by the Intergovernmental Panel on Climate Change as changes in the state of the climate associated with changes in the mean and/or the variability of its properties. Climate change will affect temperatures both as an increase in mean temperature as well as changes in the frequency of temperature extremes. Health effects associated with extreme heat, both mortality and morbidity, have been observed all over the globe. Groups that are often found to be more vulnerable are the elderly and people diagnosed with certain diseases and/or on taking some specific types of medication. The health effects from climate change in the future depend on a number of underlying sociodemographic and other factors. It is difficult to predict how the underlying societal factors that are likely to alter the health effects from high temperatures will change. The aim of this thesis is to investigate the influence of the underlying assumptions and factors that are key components when predicting and projecting heat-related illness, both in the short and long term. This work aims to identify and to some extent quantify different sources of uncertainty that will have effects on the outcome of health impact assessments.

    Methods: We wanted to evaluate if different statistical models would alter the ability to identify days with elevated heat-related risk. We used observations of temperatures and daily mortality for Greater Stockholm to model different exposure-response relationships (Paper I). Along the observed data, we collected temperature forecasts for the Stockholm area. We defined what constitutes a risk day and compared the model’s ability to identify these days using both observed and forecasted temperatures to evaluate the predictive performance of models based on the different statistical approaches. To estimate how climate change will alter the heat-related health impacts we used climate change projections from a range of climate change scenarios to be able to get stable estimates as well as a measure of the uncertainty in the climate projections (Paper II-III). We estimated the change in respiratory hospital admissions (Paper II) and the future need for adaptation to keep heat-related mortality at current levels (Paper III) in Europe. We also estimated the change in heat-related mortality due to changes in climate, demographics and health status of the population in Stockholm (Paper IV).

    Results: The models using a highly complex exposure-response relationship showed lower predictive performance, especially when looking at a longer time-scale. The more complex models did also estimate a lower mortality increase compared to the less complex ones. There was however high agreement of which days to be considered risk days. The estimated increase in heat-related illness from the three health impact assessment studies showed impacts on a similar order of magnitude when looking at changes in climate only. Respiratory hospital admissions were estimated to more than double in Europe and heat-related mortality in Stockholm was estimated to increase to around 257% of current levels. Therefore, adaptation needs to lower the vulnerability to heat by around 50% in the European countries. In study III and IV we take changes in demographics into account and find that the future health burden from heat will increase due to the growing elderly population.

    Conclusion: To be able to make predictions of future health burdens from heat, both in the long and short term, we need to consider the properties of the epidemiological models and how the choice of model might limit its use within a health impact assessment. Climate change seems to be the main driver of the future health burden from extreme temperatures, but our results suggests that changing demographics will add to the burden considerably unless relevant adaptation measures are implemented. Adding this on top of the challenges posed by climate change, we find that need for adaptation will increase substantially in the future.

  • 9006.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Bjelkmar, Pär
    Folkhälsomyndighe-ten, Stockholm.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Ovanligt många dödsfalli Sverige sommaren 2018: drygt 600 kan ha dött till följd av värmeböljan2019Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, artikel-id FLFHArtikel i tidskrift (Refereegranskat)
  • 9007.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ebi, Kristie L
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Langner, Joakim
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Developing a heatwave early warning system for Sweden: evaluating sensitivity of different epidemiological modelling approaches to forecast temperatures2015Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, nr 1, s. 254-267Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Over the last two decades a number of heatwaves have brought the need for heatwave early warning systems (HEWS) to the attention of many European governments. The HEWS in Europe are operating under the assumption that there is a high correlation between observed and forecasted temperatures. We investigated the sensitivity of different temperature mortality relationships when using forecast temperatures. We modelled mortality in Stockholm using observed temperatures and made predictions using forecast temperatures from the European Centre for Medium-range Weather Forecasts to assess the sensitivity. We found that the forecast will alter the expected future risk differently for different temperature mortality relationships. The more complex models seemed more sensitive to inaccurate forecasts. Despite the difference between models, there was a high agreement between models when identifying risk-days. We find that considerations of the accuracy in temperature forecasts should be part of the design of a HEWS. Currently operating HEWS do evaluate their predictive performance; this information should also be part of the evaluation of the epidemiological models that are the foundation in the HEWS. The most accurate description of the relationship between high temperature and mortality might not be the most suitable or practical when incorporated into a HEWS.

  • 9008.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Orru, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. orru@ut.ee.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Strandberg, Gustav
    Rossby Centre, SMHI, Norrköping, Sweden.
    Ebi, Kristie L
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Heat-related respiratory hospital admissions in Europe in a changing climate: a health impact assessment2013Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, nr 1, s. e001842-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives Respiratory diseases are ranked second in Europe in terms of mortality, prevalence and costs. Studies have shown that extreme heat has a large impact on mortality and morbidity, with a large relative increase for respiratory diseases. Expected increases in mean temperature and the number of extreme heat events over the coming decades due to climate change raise questions about the possible health impacts. We assess the number of heat-related respiratory hospital admissions in a future with a different climate.                                

    Design A Europe-wide health impact assessment.                                

    Setting An assessment for each of the EU27 countries.                                

    Methods Heat-related hospital admissions under a changing climate are projected using multicity epidemiological exposure–response relationships applied to gridded population data and country-specific baseline respiratory hospital admission rates. Times-series of temperatures are simulated with a regional climate model based on four global climate models, under two greenhouse gas emission scenarios.                                

    Results Between a reference period (1981–2010) and a future period (2021–2050), the total number of respiratory hospital admissions attributed to heat is projected to be larger in southern Europe, with three times more heat attributed respiratory hospital admissions in the future period. The smallest change was estimated in Eastern Europe with about a twofold increase. For all of Europe, the number of heat-related respiratory hospital admissions is projected to be 26 000 annually in the future period compared with 11 000 in the reference period.                                

    Conclusions The results suggest that the projected effects of climate change on temperature and the number of extreme heat events could substantially influence respiratory morbidity across Europe.                                

     

  • 9009.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oudin Åström, Daniel
    Lund Universitet.
    Andersson, Camilla
    SMHI.
    Ebi, Kristie L.
    University of Washington.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Future health impact of higher ambient temperatures in Stockholm, SwedenManuskript (preprint) (Övrigt vetenskapligt)
  • 9010.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oudin Åström, Daniel
    Lund Universitet.
    Andersson, Camilla
    SMHI.
    Ebi, Kristie L.
    University of Washington.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Vulnerability reduction needed to adapt to projected future heat exposure in Europe: Magnitude and determinantsManuskript (preprint) (Övrigt vetenskapligt)
  • 9011.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Åström, Daniel Oudin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
    Andersson, Camilla
    Ebi, Kristie L
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Vulnerability Reduction Needed to Maintain Current Burdens of Heat-Related Mortality in a Changing Climate-Magnitude and Determinants2017Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, nr 7, artikel-id 741Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The health burden from heatwaves is expected to increase with rising global mean temperatures and more extreme heat events over the coming decades. Health-related effects from extreme heat are more common in elderly populations. The population of Europe is rapidly aging, which will increase the health effects of future temperatures. In this study, we estimate the magnitude of adaptation needed to lower vulnerability to heat in order to prevent an increase in heat-related deaths in the 2050s; this is the Adaptive Risk Reduction (ARR) needed. Temperature projections under Representative Concentration Pathway (RCP) 4.5 and RCP 8.5 from 18 climate models were coupled with gridded population data and exposure-response relationships from a European multi-city study on heat-related mortality. In the 2050s, the ARR for the general population is 53.5%, based on temperature projections under RCP 4.5. For the population above 65 years in Southern Europe, the ARR is projected to be 45.9% in a future with an unchanged climate and 74.7% with climate change under RCP 4.5. The ARRs were higher under RCP 8.5. Whichever emission scenario is followed or population projection assumed, Europe will need to adapt to a great degree to maintain heat-related mortality at present levels, which are themselves unacceptably high, posing an even greater challenge.

  • 9012.
    Åström, Daniel Oudin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Centre for Primary Health Care Research, Department of Clinical Science, Malmö, Lund University, Lund.
    Edvinsson, Sören
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Hondula, Daniel
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Schumann, Barbara
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    On the association between weather variability and total and cause-specific mortality before and during industrialization in Sweden2016Ingår i: Demographic Research, ISSN 1435-9871, Vol. 35, s. 991-1009Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: While there is ample evidence for health risks associated with heat and other extreme weather events today, little is known about the impact of weather patterns on population health in preindustrial societies.

    OBJECTIVE: To investigate the impact of weather patterns on population health in Sweden before and during industrialization.

    METHODS: We obtained records of monthly mortality and of monthly mean temperatures and precipitation for Skelleftea parish, northern Sweden, for the period 1800-1950. The associations between monthly total mortality, as well as monthly mortality due to infectious and cardiovascular diseases, and monthly mean temperature and cumulative precipitation were modelled using a time series approach for three separate periods, 1800-1859, 1860-1909, and 1910-1950.

    RESULTS: We found higher temperatures and higher amounts of precipitation to be associated with lower mortality both in the medium term (same month and two-months lag) and in the long run (lag of six months up to a year). Similar patterns were found for mortality due to infectious and cardiovascular diseases. Furthermore, the effect of temperature and precipitation decreased over time.

    CONCLUSIONS: Higher temperature and precipitation amounts were associated with reduced death counts with a lag of up to 12 months. The decreased effect over time may be due to improvements in nutritional status, decreased infant deaths, and other changes in society that occurred in the course of the demographic and epidemiological transition.

    CONTRIBUTION: The study contributes to a better understanding of the complex relationship between weather and mortality and, in particular, historical weather-related mortality.

  • 9013.
    Åström, Evelina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Lung cancer incidence after cessation of asbestos exposure in Swedish construction workers.2012Självständigt arbete på avancerad nivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 9014.
    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.

  • 9015.
    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.

  • 9016.
    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.

  • 9017.
    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.

  • 9018.
    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.

  • 9019.
    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.

  • 9020.
    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)
  • 9021.
    Ögren, J.
    et al.
    Hosp Ostersund, Dept Internal Med, Sect Cerebrovasc Dis, Ostersund, Sweden.
    Irewall, Anna-Lotta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Bergström, L.
    Hosp Ostersund, Dept Internal Med, Neurol Sect, Ostersund, Sweden.
    Mooe, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Intracranial hemorrhage after ischemic stroke Incidence, time-trends and predictors in a Swedish nationwide cohort of 196765 patients2014Ingår i: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 9, s. 165-165Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    BACKGROUND:

    Epidemiological data on the risk of intracranial hemorrhage (ICrH) after ischemic stroke are sparse. The aims of this study were to describe incidence, trends over time, and predictors of ICrH within 1 year after ischemic stroke.

    METHODS AND RESULTS:

    All patients registered in the Swedish stroke register Riksstroke for 1998 to 2009 were included (n=196 765), and data were combined with the National Patient Register to identify ICrH occurrence. A matched reference population was obtained. Incidence rates and cumulative incidences were calculated. Multivariable regression analyses were used to identify predictors. Analyses were performed separately for the first 30 days and days 31 to 365 after ischemic stroke. The incidence rate was 1.97% per year at risk for the first year (0.13% in the reference population) and 0.85% excluding the first 30 days. Over time, the cumulative incidence increased the first 30 days but decreased over days 31 to 365. Thrombolysis, previous ICrH, atrial fibrillation, and male sex were associated with increased risk of ICrH during the first 30 days. Previous ICrH, increasing age, and male sex were associated with increased risk during days 31 to 365. Statins and antithrombotic treatment did not independently predict ICrH occurrence.

    CONCLUSIONS:

    The incidence of ICrH within 1 year after ischemic stroke was ≈2% per year at risk, about 15 times higher compared with the reference population. Over the study period, ICrH risk increased within the first 30 days but decreased thereafter. Previous ICrH, thrombolysis, and male sex affected the risk, whereas an increased use of antithrombotic treatments and statins did not.

  • 9022.
    Ögren, Joachim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Serious hemorrhage and secondary prevention after stroke and TIA2018Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: The number of stroke survivors is growing worldwide, and these patients have an increased risk of new vascular events and death. This risk decreases with secondary treatment medications recommended in guidelines. However, the characteristics of unselected stroke patients differ from patients included in randomized controlled trials (RCTs). Thus, the efficacy of these treatments based on RCT results may not be directly transferable to the patients treated in clinical practice. A treatment may be associated with a higher risk of serious side-effects or less benefit than expected:1) Antithrombotic treatment increases the risk of a serious hemorrhage, a risk that is not well studied in an unselected population with older age and more comorbidities; 2) Treatment of modifiable risk factors after a stroke can be improved. Many patients do not reach treatment targets, which indicates a need for strategies to improve secondary prevention and increase treatment benefit.It is therefore essential to evaluate recommended treatments through studies in a real-world setting.

    Aims: The aims of this thesis were to assessincidence, temporal trends, effect on mortality, and factors associated with an increased risk of a serious hemorrhage after ischemic stroke (IS) or transient ischemic attack (TIA); andif a nurse-led, telephone-based intervention including medical titration could improve modifiable risk factors in patients after stroke or TIA.

    Methods: In paper I, all patients registered with an IS in the national stroke register Riksstroke during 1998–2009 were studied. The register was combined with the In-Patient Register and a diagnosis of intracranial haemorrhage (ICrH) within 1 year after IS was identified. In paper II, any diagnosis of serious hemorrhage was identified during follow-up up to 2015 in all patients with an IS or TIA diagnosis, 2010–2013, at Östersund hospital. The incidences of ICrH (papers I and II) and all serious hemorrhages (paper II) were calculated. Kaplan–Meier analysis was used to assess any temporal trend in paper I and if a serious hemorrhage affected survival in study II. Cox regression analysis was used in both studies I and II to assess any factor associated with hemorrhage.

    In the randomized controlled NAILED stroke trial, all patients with acute stroke or TIA treated at Östersund hospital during 2010–2013 were screened for participation. Patients whose condition permitted a telephone-based follow-up were randomized to either a control group with follow-up according to usual care or to an intervention group with a nurse-led, telephone-based follow-up including titration of medication. Blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) were assessed at 1, 12, 24, and 36 months. We assessed the effect of the intervention on mean levels of BP and LDL-C and on the proportion of patients reaching treatment targets at 12 months (Study III) and at 36 months (Study IV). Study III also assessed for interactions between group allocation and measurement levels at baseline with BP and LDL-C at the 12-month follow-up. Study IV also explored temporal trends.

    Results: The risk of an ICrH was 1.97% per year at risk, within the first year after IS,  and 0.85% excluding the first 30 days. Between 1998 and 2009, the risk of an ICrH increased during the first 30 days after an IS but decreased during days 31–365. The risk of a serious hemorrhage was 2.48% per year at risk in paper II. It was more common in elderly. The incidence rate was higher in patients discharged with AP compared with RCTs. A hemorrhage increased the risk of death in patients with good functional status but did not affect the already high mortality in patients with impaired functional status. Male sex and previous ICrH were associated with an increased risk of ICrH during the first year after IS, thrombolytic treatment, atrial fibrillation and warfarin were associated with an increased risk in the acute phase. A previous diagnosis of hypertension was associated with an increased risk of all serious hemorrhages. 

    The NAILED trial intervention group had a significantly lower mean systolic BP (SBP), diastolic BP (DBP), and LDL-C at 12 and 36 months. The mean SBP at 36 months was 128.1 mmHg (95% confidence interval (CI): 125.8–130.5) in the intervention group, 6.1 mmHg (95% CI: 3.6–8.6; p<0.001) lower than the control group. The interaction analysis at 12 months showed that the effect of the intervention was confined to patients whose values were above the respective targets at baseline and therefore had their medication adjusted. At 36 months, a significantly higher proportion of patients in the intervention group reached treatment targets for SBP, DBP, and LDL-C. The mean differences and differences in proportions reaching treatment target for BP increased during the 36 months of follow-up.

    Conclusion: A serious hemorrhage after an IS or TIA is fairly common. It is more common in elderly and patients with impaired functional status. The incidence is higher in patients discharged with AP compared with RCTs. A serious hemorrhage could affect survival in patients with good functional status. The nurse-led, telephone-based intervention including medical titration used in the NAILED stroke trial improved risk factor levels after stroke and TIA, and more patients reached treatment targets. The effect increased over time. 

  • 9023.
    Ögren, Joachim
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Irewall, Anna-Lotta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Bergström, Lisa
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Mooe, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Intracranial Hemorrhage After Ischemic Stroke Incidence, Time Trends, and Predictors in a Swedish Nationwide Cohort of 196765 Patients2015Ingår i: Circulation. Cardiovascular Quality and Outcomes, ISSN 1941-7713, E-ISSN 1941-7705, Vol. 8, nr 4, s. 413-420Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Epidemiological data on the risk of intracranial hemorrhage (ICrH) after ischemic stroke are sparse. The aims of this study were to describe incidence, trends over time, and predictors of ICrH within 1 year after ischemic stroke. Methods and Results All patients registered in the Swedish stroke register Riksstroke for 1998 to 2009 were included (n=196 765), and data were combined with the National Patient Register to identify ICrH occurrence. A matched reference population was obtained. Incidence rates and cumulative incidences were calculated. Multivariable regression analyses were used to identify predictors. Analyses were performed separately for the first 30 days and days 31 to 365 after ischemic stroke. The incidence rate was 1.97% per year at risk for the first year (0.13% in the reference population) and 0.85% excluding the first 30 days. Over time, the cumulative incidence increased the first 30 days but decreased over days 31 to 365. Thrombolysis, previous ICrH, atrial fibrillation, and male sex were associated with increased risk of ICrH during the first 30 days. Previous ICrH, increasing age, and male sex were associated with increased risk during days 31 to 365. Statins and antithrombotic treatment did not independently predict ICrH occurrence. Conclusions The incidence of ICrH within 1 year after ischemic stroke was approximate to 2% per year at risk, about 15 times higher compared with the reference population. Over the study period, ICrH risk increased within the first 30 days but decreased thereafter. Previous ICrH, thrombolysis, and male sex affected the risk, whereas an increased use of antithrombotic treatments and statins did not.

  • 9024.
    Ögren, Joachim
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Irewall, Anna-Lotta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Söderström, Lars
    Mooe, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Long-term, telephone-based follow-up after stroke and TIA improves risk factors: 36-month results from the randomized controlled NAILED stroke risk factor trial2018Ingår i: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 18, artikel-id 153Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Strategies are needed to improve adherence to the blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) level recommendations after stroke and transient ischemic attack (TIA). We investigated whether nurse-led, telephone-based follow-up that included medication titration was more efficient than usual care in improving BP and LDL-C levels 36 months after discharge following stroke or TIA.

    Methods: All patients admitted for stroke or TIA at Ostersund hospital that could participate in the telephone-based follow-up were considered eligible. Participants were randomized to either nurse-led, telephone-based follow-up (intervention) or usual care (control). BP and LDL-C were measured one month after discharge and yearly thereafter. Intervention group patients who did not meet the target values received additional follow-up, including lifestyle counselling and medication titration, to reach their treatment goals (BP < 140/90 mmHg, LDL-C < 2.5 mmol/L). The primary outcome was the systolic BP level 36 months after discharge.

    Results: Out of 871 randomized patients, 660 completed the 36-month follow-up. The mean systolic and diastolic BP values in the intervention group were 128.1 mmHg (95% CI 125.8-1305) and 75.3 mmHg (95% CI 73.8-76.9), respectively. This was 6.1 mmHg (95% CI 3.6-8.6, p < 0.001) and 3.4 mmHg (95% CI 1.8-5.1, p < 0.001) lower than in the control group. The mean LDL-C level was 22 mmol/L in the intervention group, which was 03 mmol/L (95% CI 0.2-0.5, p < 0.001) lower than in controls. A larger proportion of the intervention group reached the treatment goal for BP (systolic: 79.4% vs. 55.3%, p < 0.001; diastolic 90.3% vs. 77.9%, p < 0.001) as well as for LDL-C (69.3% vs. 48.9%, p < 0.001).

    Conclusions: Compared with usual care, a nurse-led telephone-based intervention that included medication titration after stroke or TIA improved BP and LDL-C levels and increased the proportion of patients that reached the treatment target 36 months after discharge.

  • 9025.
    Ögren, Joachim
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Irewall, Anna-Lotta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Söderström, Lars
    Mooe, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Serious hemorrhages after ischemic stroke or TIA - Incidence, mortality, and predictors2018Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, nr 4, artikel-id e0195324Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Data are lacking on the risk and impact of a serious hemorrhage on the prognosis after ischemic stroke (IS) or transient ischemic attack (TIA). We aimed to estimate the incidence of serious hemorrhage, analyze the impact on mortality, and identify predictors of hemorrhage after discharge from IS or TIA.

    Methods and findings: All patients admitted to Östersund Hospital for an IS or TIA in 2010–2013 were included (n = 1528, mean age: 75.1 years). Serious hemorrhages were identified until 31st December 2015. Incidence rates were calculated. The impact on mortality (stratified by functional level) was determined with Kaplan-Meier analysis. Non-parametric estimation under the assumption of competing risk was performed to assess the cumulative incidence and predictors of serious hemorrhages. The incidence rates of serious (n = 113) and intracranial hemorrhages (n = 45) after discharge from IS and TIA were 2.48% and 0.96% per year at risk, respectively. Patients with modified Rankin Scale (mRS) scores of 3–5 exhibited 58.9% mortality during follow-up and those with mRS scores of 0–2 exhibited 18.4% mortality. A serious hemorrhage did not affect mortality in patients with impaired functional status, but it increased the risk of death in patients with mRS scores of 0–2. Hypertension was associated with increased risk of serious hemorrhage.

    Conclusions: We found that, after discharge from an IS or TIA, serious hemorrhages were fairly common. Impairments in function were associated with high mortality, but serious hemorrhages only increased the risk of mortality in patients with no or slight disability. Improved hypertension treatment may decrease the risk of serious hemorrhage, but in patients with low functional status, poor survival makes secondary prevention challenging.

  • 9026.
    Ögren, Kenneth
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin.
    Lindblad, I-B
    Lobotomy i Swedish and American media 1936-1959Manuskript (Övrigt vetenskapligt)
  • 9027.
    Öhberg, Fredrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik. Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Centrum för medicinsk teknik och fysik (CMTF).
    Lundström, Ronnie
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Centrum för medicinsk teknik och fysik (CMTF). Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Grip, Helena
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Centrum för medicinsk teknik och fysik (CMTF).
    Comparative analysis of different adaptive filters for tracking lower segments of a human body using inertial motion sensors2013Ingår i: Measurement science and technology, ISSN 0957-0233, E-ISSN 1361-6501, Vol. 24, nr 8, s. 085703-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    For all segments and tests, a modified Kalman filter and a quasi-static sensor fusion algorithm were equally accurate (precision and accuracy similar to 2-3 degrees) compared to normalized least mean squares filtering, recursive least-squares filtering and standard Kalman filtering. The aims were to: (1) compare adaptive filtering techniques used for sensor fusion and (2) evaluate the precision and accuracy for a chosen adaptive filter. Motion sensors (based on inertial measurement units) are limited by accumulative integration errors arising from sensor bias. This drift can partly be handled with adaptive filtering techniques. To advance the measurement technique in this area, a new modified Kalman filter is developed. Differences in accuracy were observed during different tests especially drift in the internal/external rotation angle. This drift can be minimized if the sensors include magnetometers.

  • 9028.
    Öhberg, Fredrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Blomberg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Claesson, Kenji
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Edström, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Holmner, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Home-based system for recording pulmonary function and disease-related symptoms in patients with chronic obstructive pulmonary disease, COPD: a pilot study2016Ingår i: SM Journal of Pulmonary Medicine, ISSN 2574-240X, Vol. 2, nr 1, artikel-id 1011Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Many patients with Chronic Obstructive Pulmonary Disease (COPD) suffer from acute exacerbations characterized by an increase in symptoms beyond normal day-to-day variation. The prognosis of patients with frequent exacerbations is poor and effort to curb these worsening episodes has great potential to improve the patient’s quality of life and to reduce associated costs. Telemonitoring has been proposed as a promising strategy in this respect. However, information on what physical signs or symptoms that should be recorded and how recorded data should be interpreted is largely missing in the literature.

    Methods: A new home-based system, based on a tablet computer, which can guide COPD patients to perform spirometry (inspiratory capacity, IC and forced expiratory volume in one and six seconds, FEV1 and FEV6) and record symptoms (COPD assessment test, CAT) was developed. The system was evaluated for 8-12 weeks in four patients with moderate to severe COPD with the aims to; i) assess the feasibility of the system to be used unsupervised by COPD patients and, ii) to evaluate the quality and ability of recorded parameters to reveal early signs of an exacerbation. Pearson bivariate correlation was performed between all outcome measures and descriptive information about inherent subject properties were presented.

    Results: The system was well accepted by all study subjects and the study generated a total of 253 measurements of which 94.5% were considered acceptable for analysis. One of the subjects developed an acute exacerbation towards the end of the study, whereas the other three subjects remained stable. Descriptive analysis of the data suggest that trends in the CAT score may indicate changes in health status and that IC tends to be more responsive to these changes compared to FEV1.

    Conclusion: The system developed in this study is well suited to be used unsupervised by COPD patients. Recorded data, in particular CAT, may be sensitive enough to detect early signs of an acute COPD exacerbation, although more data is needed to fully resolve the nature of such an association.

  • 9029.
    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.

  • 9030.
    Öhlund, Louise
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Ott, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Oja, Sofia
    Bergqvist, Malin
    Lundqvist, Robert
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Renberg, Ellinor Salander
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Sunderby Hospital – Psychiatry, 97180 Luleå, Sweden.
    Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study2018Ingår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, artikel-id 37Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Lithium remains first choice as maintenance treatment for bipolar affective disorder. Yet, about half of all individuals may stop their treatment at some point, despite lithium’s proven benefits concerning the prevention of severe affective episodes and suicide.

    Methods: Retrospective cohort study in the Swedish region of Norrbotten into the causes of lithium discontinuation. The study was set up to (1) test whether patients with bipolar affective disorder or schizoaffective disorder, treated with lithium maintenance therapy, were more likely to discontinue lithium because of adverse effects than lack of therapeutic effectiveness, (2) explore gender differences, (3) understand the role of diagnosis and (4) identify who, patient or doctor, took the initiative to stop lithium. Review of medical records for all episodes of lithium discontinuation that had occurred between 1997 and 2013 with the intent to stop lithium for good.

    Results: Of 873 patients treated with lithium, 54% discontinued lithium, corresponding to 561 episodes of lithium discontinuation. In 62% of episodes, lithium was discontinued due to adverse effects, in 44% due to psychiatric reasons, and in 12% due to physical reasons interfering with lithium treatment. The five single most common adverse effects leading to lithium discontinuation were diarrhoea (13%), tremor (11%), polyuria/polydipsia/diabetes insipidus (9%), creatinine increase (9%) and weight gain (7%). Women were as likely as men to take the initiative to stop lithium, but twice as likely to consult a doctor before taking action (p < 0.01). Patients with type 1 BPAD or SZD were more likely to discontinue lithium than patients with type 2 or unspecified BPAD (p < 0.01). Patients with type 1 BPAD or SZD were more likely to refuse medication (p < 0.01). Conversely, patients with type 2 or unspecified BPAD were three times as likely to discontinue lithium for lack or perceived lack of effectiveness (p < 0.001).

    Conclusions: Stopping lithium treatment is common and occurs mostly due to adverse effects. It is important to discuss potential adverse effects with patients before initiation and continuously during lithium treatment, to reduce the frequency of potentially unnecessary discontinuations.

  • 9031.
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Genus i vårdens organisationer2004Ingår i: Kropp och genus i medicinen / [ed] Birgitta Hovelius, Eva E. Johansson, Lund: Studentlitteratur, 2004, s. 137-145Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 9032.
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Genuskodade kroppsideal i hälso- och sjukvården2004Ingår i: Kropp och genus i medicinen / [ed] Birgitta Hovelius, Eva E. Johansson, Lund: Studentlitteratur, 2004, s. 177-184Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 9033.
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Genuskodade kroppsideal i hälso- och sjukvården2004Rapport (Övrigt vetenskapligt)
  • 9034.
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Genusperspektiv på vårdvetenskap2009Rapport (Övrig (populärvetenskap, debatt, mm))
  • 9035.
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Global public health and gender theory: the need for integration.2008Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 36, nr 5, s. 449-51Artikel i tidskrift (Refereegranskat)
  • 9036.
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Policing or disciplining emotions in research collaborations2013Ingår i: The emotional politics of research collaboration / [ed] Gabriele Griffin, Annelie Bränström-Öhman, Hildur Kalman, London: Routledge, 2013, s. 53-66Kapitel i bok, del av antologi (Refereegranskat)
  • 9037.
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Profession on the move: Changing conditions and gendered development in physiotherapy2001Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Physiotherapy in Sweden has developed from a practical, hands-on, assistant job predominantly taught at college level to a university-based academic discipline emphasising evidence-based practice and research. Women are in majority although an increasing number of men have entered the profession. Women and men physiotherapists tend to undertake different career paths. The overall aim of the present thesis was to use a gender perspective to describe and analyse attitudes to the professional role, health care work and the development of the profession among actors engaged in physiotherapy education.

    A questionnaire was distributed in 1997 to all Swedish physiotherapy students in the second semester of the education (n=273). The same cohort was investigated in 1999 at the completion of the education. The response rate was 93 percent at both occasions. For an international comparison, the same questionnaire was distributed in 1997 and in 1999 to a group of Canadian physiotherapy students in their first and last semesters (n=60). Qualitative research interviews were conducted with 8 novices in physiotherapy and with 14 women educators in academia. Five focus group discussions with clinical supervisors were conducted (10 women and 5 men). Methods used were Grounded theory, factor analysis, logistic regression and path analysis. Feminist theories and Bourdieu's theory of culture constituted a theoretical framework

    Four ideal types were identified among the novices representing attitudes to the professional role. The Treater and The Supervisor were attitudes found among the women, whereas The Coach and The Entrepreneur were attitudes among the men. Type of health care facility was important for their positioning in the organisational hierarchy. Swedish students favour future employment in private practice. Sports medicine clinics and fitness centres are health care facilities highly endorsed, as is health promotion. Neither care of elderly nor hospital work are preferable fields of practice. Research is not favoured. Men students are more likely to have chosen the profession because of their interest in physical activity and sports. They are also more likely to prefer owning a private clinic and working with alternative approaches such as fitness training in sports medicine clinics. Women students are more likely to prefer an employment in private practice. The Canadian men students favour private practice whereas the women prefer the public sector of health care. The academic educators experience a gap between theory and practice which causes conflicting messages to students. Competing professions, emergent societal change and a conservative clinical practice constitute threats to the profession. The uniqueness of professional competency, theoretical development and new arenas such as home rehabilitation, consulting and research constitute a vision for future development of the profession. Masculinity is highly valued for status and power whereas femininity symbolises empathy and caring. The clinical supervisors update their theoretical knowledge base through supervision of students, but claim that students lack hands-on skills. Stress at work, unequal power relations in the hierarchy and restructuring of health care are factors that influence work satisfaction negatively. To conclude, gendered habitus, different symbolic capital and different attitudes towards health care work and development of the profession were found in the sub-fields of physiotherapy.

  • 9038.
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Qualitative methodology for rehabilitation research.2005Ingår i: J Rehabil Med, ISSN 1650-1977, Vol. 37, nr 5, s. 273-80Artikel i tidskrift (Refereegranskat)
  • 9039.
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    When mobility becomes too high: on gender, power and work in elderly care2016Ingår i: Gränser, mobilitet och mobilisering: Boundaries, mobility and mobilisation : Nationell konferens för genusforskning = Swedish conference for gender research / [ed] Silje Lundgren, Maja Lundqvist, Björn Pernrud, Göteborg: Nationella sekretariatet för genusforskning , 2016, s. 165-Konferensbidrag (Övrigt vetenskapligt)
  • 9040.
    Öhman, Ann
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Emmelin, Maria
    Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Sweden.
    Development policies, intimate partner violence, Swedish gender equality and global health2014Ingår i: Women's Studies: International Forum, ISSN 0277-5395, E-ISSN 1879-243X, Vol. 46, s. 115-122Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper discusses current Swedish international development policies on gender and violence. It deals with the relationship between development policies, global health, promotion of gender equality, and violence against women in a global perspective. The focus is on intimate partner violence and the highly promoted gender mainstreaming policy. Theoretically, our point of departure lies within a feminist notion of gender relations, power structures, and male hierarchies that constrain and subordinate women and girls and which expose them to gendered violence. We claim that stronger links need to be created between local activist groups in low and middle income countries and the international development agencies. It is important to initiate and formalize a North South dialogue between such groups, as well as enhancing South South dialogue and cooperation.

  • 9041.
    Öhman, Ann
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Eriksson, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Gender and health: aspects of importance for understanding health and illness in the world2015Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, artikel-id 26908Artikel i tidskrift (Refereegranskat)
  • 9042.
    Öhman, Ann
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hägg, Kerstin
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för barn- och ungdomspedagogik, specialpedagogik och vägledning (BUSV).
    Dahlgren, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    A stimulating, practice-based job facing increased stress: Clinical supervisors’ perceptions of professional role, physiotherapy education and the status of the profession2005Ingår i: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 7, nr 3, s. 114-122Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim was to study perceptions of professional role, education and the status of the profession among clinical physiotherapy supervisors. Five focus group discussions were conducted with 15 supervisors attached to four universities in Sweden. Qualitative analyses were carried out using constant comparisons. Triangulation of researchers was used to increase trustworthiness. The supervisors experienced themselves as being in the centre of two competing and changing fields - the academic setting and the clinic in healthcare organization. The contact with students and their updated knowledge base were the most positive aspects of being clinical supervisors. To create a good learning environment for the students was considered important, but lack of time in all aspects of the work created stress and dissatisfaction. Students’ hands-on skills and treatment techniques were regarded to be rather poor and there is too much emphasis on theoretical knowledge and research methods in the curriculum. The physiotherapy profession has potentials to develop in innovative fields such as health promotion and disease prevention outside the hospitals, but healthcare with its hierarchical organization is a hindrance for this development. Collaborative efforts to bridge the gap between university and clinical setting are needed.

  • 9043.
    Öhman, Ann
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Hägg, Kerstin
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för barn- och ungdomspedagogik, specialpedagogik och vägledning (BUSV).
    Dahlgren, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Competent women and competing professions: Physiotherapy educators' perceptions of the field1999Ingår i: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 1, nr 2, s. 59-72Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Career choices are still strongly gendered in health care professions. In Sweden, physiotherapy is a middle-class women's profession that nowadays also attracts men. Career strategies and professional development in physiotherapy are sparsely studied from a gender perspective. The purpose of this qualitative study was to describe and analyse perceptions of individual professional development, physiotherapy education and the profession in general, among a group of women educators in physiotherapy, using a gender theoretical framework and some of Bourdieu's theoretical concepts in the analysis. Thematized in-depth interviews with fourteen educators in physiotherapy were performed. The analysis used the Grounded Theory method of constant comparison. To increase credibility, the study design used triangulation in interviewers and investigators, member checking and reference group checking. Three core categories were identified. The Competent Woman category involves the professional development of the educators, including aspects of competence, success, efficiency and flexibility. Perceptions of femininity and masculinity reflect the symbolic dimension of gender. Femininity is regarded as symbolic capital for empathy and care, while masculinity represents status and power. The core category Theory-Practice Gap describes the isolated position of physiotherapy education in relation to the field of health care. The fragmented and disintegrated professional knowledge base does not facilitate the development of the profession. The core category Profession under Change reflects ideas about physiotherapy in society. Other female health care professions, ongoing societal change and conservative physiotherapy practices constitute a threat to the future development of the field. Visions for future development of the field emphasized the importance of professional competence and engagement in innovative activities in new arenas and new professional roles. The results shed light on the symbolic dimension of gender in a professional field where femininity is connected with academic success, empathy and care, while masculinity is related to business mentality, status and power. Notions of competition include both internal and external factors affecting the field of physiotherapy.

  • 9044.
    Öhman, Ann
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS). Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Keisu, Britt-Inger
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Enberg, Birgit
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Team social cohesion, professionalism, and patient-centeredness: gendered care work, with special reference to elderly care – a mixed methods study2017Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, artikel-id 381Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Healthcare organisations are facing large demands in recruiting employees with adequate competency to care for the increasing numbers of elderly. High degrees of turnover and dissatisfaction with working conditions are common. The gendered notion of care work as 'women's work', in combination with low salaries and status, may contribute to negative work experiences. There is abundant information about the negative aspects of elderly care health services, but little is known about positive aspects of this work. The study aim was to investigate work satisfaction from a gender perspective among Swedish registered nurses, physiotherapists, and occupational therapists, focusing specifically on healthcare services for the elderly.

    Methods: A mixed methods approach was adopted in which we combined statistics and open-ended responses from a national survey with qualitative research interviews with healthcare professionals in elderly care organisations. The survey was administered to a random sample of 1578 registered nurses, physiotherapists, and occupational therapists. Qualitative interviews with 17 professionals were conducted in six elderly care facilities. Qualitative and quantitative content analyses, chi2 and constructivist grounded theory were used to analyse the data.

    Results: There was a statistically significant difference in overall work satisfaction between those who worked in elderly care and those who did not (64 and 74,4% respectively, p < 0.001). Nine themes were derived from open-ended responses in the questionnaire. The qualitative interviews revealed four prominent storylines: 'Team social cohesion', 'Career development and autonomy', 'Client-centeredness', and 'Invisible and ignored power structures'.

    Conclusions: The results show the complexity of elderly care work and describe several aspects that are important for work satisfaction among health professionals. The results reveal that work satisfaction is dependent on social interrelations and cohesion in the work team, in possibilities to use humour and to have fun together, and in the ability to work as professionals to provide client-centered elderly care. Power relations such as gendered hierarchies were less visible or even ignored aspects of work satisfaction. The storylines are clearly linked to the two central discourses of professionalism and gender equality.

  • 9045.
    Öhman, Ann
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Dahlgren, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Career choice, professional preferences and gender ?:  the case of Swedish physiotherapy students2001Ingår i: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 3, nr 3, s. 94-107Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim was to identify reasons for the career choice and professional preferences among students enrolled in the Swedish physiotherapy education. The study design was longitudinal and used a questionnaire administered to a cohort of 273 students in the beginning of the university programme in 1997 as well as at the completion of the programme in 1999, yielding a response rate of 93%. Data were analysed with factor analysis and univariate and multivariate logistic regression analysis. To test the relationship between the factors and outcomes that showed significant effect in the logistic regression analysis, a path analysis was performed. The two most preferred healthcare facilities after graduation were sports medicine clinics and fitness centres. Future work in private practice was highly endorsed by a majority of students. Health promotion was highly valued. Care of elderly and hospital work were not preferred. Significant differences between men and women appeared. Men were more likely to have chosen the programme because of their interest in sports and physical activity. Men were also more choice decided about future professional activities, whereas women were more open for several areas of practice. Men preferred to become the owner of a private clinic and to work with alternative approaches to healthcare, such as fitness training in sports medicine clinics.

  • 9046.
    Öhman, Ann
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Åström, Lena
    Malmgren-Olsson, Eva-Britt
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Feldenkrais(®) therapy as group treatment for chronic pain: a qualitative evaluation2011Ingår i: Journal of Bodywork & Movement Therapies, ISSN 1360-8592, E-ISSN 1532-9283, Vol. 15, nr 2, s. 153-161Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Positive experiences from the Feldenkrais group treatment were reported, especially concerning movement ability and body awareness. The exercises were however regarded as difficult to perform as self-training on a daily basis.

  • 9047.
    Öhman, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Forssén, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Sörlin, Anette
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Tano, Krister
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Patients' experiences of living with superior canal dehiscence syndrome2018Ingår i: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 57, nr 11, s. 825-830Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The study investigated how the symptoms of superior canal dehiscence syndrome (SCDS) affected patients in their daily life, and how patients coped with the disease.

    Design: This was a qualitative study; semi-structured interviews were performed and analysed according to the systematic text condensation method.

    Study sample: Twelve of 13 identified patients with SCDS in the county of Norrbotten, Sweden, were included in the study.

    Results: Five main categories were created based on the patients' experiences of living with SCDS: (1) Experiencing strange symptoms: One "new" symptom was identified - mental fatigue. (2) A restricted life socially, physically and at work: All patients experienced some extent of limitation in their daily life. (3) To accept and to protect oneself: All patients had developed strategies to protect their ears from noise. (4) Misunderstood in health care: The diagnosis was sometimes delayed several years due to lack of knowledge among healthcare workers. (5) Carefully considering treatment (surgery): Symptoms were weighed against the risk of side effects.

    Conclusions: SCDS was rendered an invisible disability. In the present study, we identified mental fatigue as a symptom not previously considered in the literature.

  • 9048.
    Öhman, Lena
    et al.
    Umeå universitet, Samhällsvetenskaplig fakultet, Psykologi.
    Nordin, Steven
    Umeå universitet, Samhällsvetenskaplig fakultet, Psykologi.
    Bergdahl, Jan
    Umeå universitet, Samhällsvetenskaplig fakultet, Psykologi.
    Slunga Birgander, Lisbeth
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Stigsdotter-Neely, Anna
    Umeå universitet, Samhällsvetenskaplig fakultet, Psykologi.
    Cognitive function in outpatients with perceived chronic stress2007Ingår i: Scand J Work Environ Health, ISSN 0355-3140, Vol. 33, nr 3, s. 223-232Artikel i tidskrift (Refereegranskat)
  • 9049.
    Öhman, Ludvig
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Johansson, Magdalena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Jansson, Jan-Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Lind, Marcus
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Johansson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Positive predictive value and misclassification of diagnosis of pulmonary embolism and deep vein thrombosis in Swedish patient registries2018Ingår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 10, s. 1215-1221Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To validate diagnoses of pulmonary embolism (PE) and deep vein thrombosis (DVT) in administrative registries. We also estimated the frequency of misclassified PE and DVT events.

    Patients and methods: A registry search for ICD codes representing PE and DVT was performed between 1985 and 2014 in a large population-based cohort in northern Sweden. An additional search using an extended set of ICD codes was performed to identify misclassified events. Diagnoses were validated manually by reviewing medical records and radiology reports.

    Results: Searching ICD codes in the National Patient Registry and Cause of Death Registry identified 2,450 participants with a first-time diagnosis of PE or DVT. The positive predictive value (PPV) for a diagnosis of PE or DVT was 80.7% and 59.2%, respectively. For the period of 2009 to 2014, the PPV was higher for PE (85.8%) but lower for DVT (54.1%). Misclassification occurred in 16.4% of DVT events and 1.1% of PE events.

    Conclusion: Registry-based data on PE, especially in recent years, are of acceptable quality and can be considered for use in registry-based studies. For DVT, we found that data were of low quality in regards to both PPV and misclassification and should not be used without validation.

  • 9050.
    Öhman, M.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi.
    Öhman, M-L
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi.
    Wållberg-Jonsson, Solveig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi.
    The apoB/apoA1 ratio predicts future cardiovascular events in patients with rheumatoid arthritis2014Ingår i: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 43, nr 4, s. 259-264Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Patients with rheumatoid arthritis (RA) have increased mortality and morbidity due to cardiovascular disease (CVD). A high apolipoprotein (apo)B/apoA1 ratio is known to predict cardiovascular events (CVEs) in the population. apoA1 has, besides anti-atherogenic effects, anti-inflammatory properties. The importance of apolipoproteins in the development of CVEs, in the context of lipids, haemostatic factors, and inflammation, was evaluated over 18 years in patients with RA. Method: Seventy-four patients with inflammatory active RA (61 females/13 males, mean age 63.6 years, disease duration 22.1 years) had been previously investigated in a study of haemostatic factors [tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI)-1, von Willebrand factor (vWF)], lipids (cholesterol and triglycerides), apolipoproteins (apoA1 and apoB), lipoprotein(a) [Lp(a)], and markers of inflammation [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and haptoglobin]. After 18 years, the first CVE during follow-up and the presence of traditional CV risk factors, extra-articular disease, and pharmacological treatment were registered. Cox proportional hazards regression was used to identify predictors of a new CVE. Results: A new CVE (n = 34) was predicted by the apoB/apoA1 ratio (p < 0.01), the triglyceride level (p < 0.01), PAI-1 (p < 0.01) and tPA (p < 0.01) activities, vWF (p < 0.001), ESR (< 0.001), CRP (< 0.05), and haptoglobin (p < 0.05). apoA1 (p = 0.056) and apoB (p < 0.05) correlated weakly and inversely with haptoglobin and CRP, respectively. In a multiple Cox regression model, adjusted for gender and previous CVD, the apoB/apoA1 ratio significantly predicted a new CVE, as did vWF, PAI-1, and ESR. Conclusions: The apoB/apoA1 ratio was a good predictor of CVE during 18 years of follow-up in patients with active RA. Apolipoproteins correlated negatively with inflammation.

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