| 1. |
- Bergström, Ulrica, 1970-, et al.
(författare)
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Fracture mechanisms and fracture pattern in men and women aged 50 years and older : a study of a 12-year population-based injury register, Umeå, Sweden
- 2008
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Ingår i: Osteoporosis International. - London : Springer International. - 0937-941X .- 1433-2965. ; 19:9, s. 1267-1273
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Tidskriftsartikel (refereegranskat)abstract
- Summary: In a study of a 12-year population-based injury register, Umeå, Sweden, we analyzed the fracture mechanisms and fracture pattern in men and women 50 years and older. Low-energy trauma was responsible for the major and costliest part of the fracture panorama, but the pattern differs between age groups. Introduction: Osteoporosis-related fracture is a major health problem: the number of hip fractures is expected to double to 2030. While osteoporosis is one of many risk factors, trauma is almost always involved. Therefore, we analyzed injury mechanisms in patients aged over 50. Methods: We registered injury mechanism, cause, diagnosis in all trauma patients at Umeå University hospital, Sweden. This population-based register (1993–2004) comprises a total of 113,668 injuries (29,189 fractures). Patients ≥50 years contributed to 13,279 fractures. Results: Low-energy trauma (fall <1 m) caused 53% of all fractures ≥50 years and older. In those over 75 low-energy trauma caused >80%. The seasonal variation of fractures was maximally 25%. With increasing age, proximal fractures became more common, in both upper and lower extremities. Proximal locations predominate in older age groups. Conclusions: Low-energy trauma was responsible for the largest and costliest part of the fracture panorama. In fact, almost all fractures in middle-aged and old people were caused by low-energy mechanisms; thus, most fractures in these patients have a fragility component, and the contribution of osteoporosis-related fractures is more important than previously thought. A better understanding of injury mechanisms also in low-energy trauma is a prerequisite for preventive interventions.
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| 2. |
- Bergström, Ulrica, 1970-
(författare)
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Fragility fractures in fragile people : epidemiology of the age quake
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Osteoporosis-related fracture is already today a major public health problem and the number of hip fractures is expected to double to 2030. Sweden has one of the highest hip fracture incidences worldwide. This may be explained by several factors: e.g. age, genetic, climatologic, geographic and a relative vitamin D deficiency, secondary to the limited sunlight exposure especially during winter months. Intrinsic and extrinsic factors contribute to a fracture, although a prior low energy fracture is one of the strongest predictors for a subsequent one and this should be a target for secondary fracture prevention in an orthopaedic setting. Since 1993 all injured patients admitted to the emergency floor and all in-hospital fractures at Umeå University Hospital, Sweden, were registered according to the Injury Data Base, former EHLASS. There were 31,173 fracture events (one or more fractures at the same time), of which 13,931 were in patients’ ≥ 50 years old. The fracture database was co analyzed with the Northern Sweden Health and Disease Study cohort in a nested case-control study for investigations of associations between osteoporotic fracture and serum markers, lifestyle data, nutrition etc. We found that there were differences in fracture pattern depending on age and sex. Both injury mechanism and fracture site were strongly dependent of age. The most severe fragility fracture, hip fracture, had a decreasing incidence. However, the incidence curve was right-shifting leading to an increase, both in numbers and in incidence of hip fractures among the oldest female. To identify people at high risk for fractures, re-fracture patients are useful. No less than 21% of the fracture patients had suffered more than one fracture event, accounting for 38% of all fracture events. The total risk ratio for a subsequent fracture was 2.2 (2.1-2.3 95% CI). In males the highest risk for re fracture was in the age cohort 70-79 years (RR 2.7, 2.3-3.2 95% CI), in females > 90 years (RR 3.9, 3.2-4.8 95% CI). Another possible risk factor in this subarctic population is the lack of sunlight, leading to a vitamin D deficit. The overall adjusted risk of sustaining a hip fracture in this population was 2.7 (95%CI:1.3-5.4) in subjects with a serum 25 hydroxyvitamin D below 50 nmol/l. The association was, however, different according to age at baseline. Thus in subjects aged 60 years and above at baseline, the adjusted odds ratio of sustaining a hip fracture was 6.2 (1.2-32.5 95%CI) for the group of individuals with a serum 25OHD below 50 nmol/l, whereas no significant association was found in the youngest age group. In the next 30 years the ongoing demographic changes will accelerate. The World War II baby boomers will cause an age quake. We can already see signs heralding a new fracture pattern: an increasing cohort of mobile but fragile elderly, with considerable co-morbidity is now at risk for fragility fractures. In fracture patients, clinical information is sufficient to pinpoint patients with a high risk for re-fractures. It is therefore clinically important to use the information provided by the fracture event. We suggest that trauma units and primary care units should screen for risk factors and inform patients about the treatment options, and to organize fracture liaison services. This seems to be especially cost-efficient for our oldest and frailest patients. Secondary prophylaxis and follow-up treatment after cardiovascular disorders are now a matter of course worldwide, but the screening for risk factors, in order to prevent a second fracture, is often neglected. This is one of the most important issues of fracture care in the future in order to improve general health.
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| 3. |
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| 4. |
- Bergström, Ulrica, 1970-, et al.
(författare)
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The hip fracture incidence curve is shifting to the right : a forecast of the age-quake
- 2009
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 80:5, s. 520-524
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Tidskriftsartikel (refereegranskat)abstract
- Background The number of hip fractures has doubled in the last 30–40 years in many countries. Age-adjusted incidence has been reported to be decreasing in Europe and North America, but is there a decreasing trend in all age groups? Patients and methods This population-based study included all hip-fracture patients over 50 years of age (a total of 2,919 individuals, 31% of whom were men) admitted to Umeå University Hospital, Sweden, from 1993 through 2005. Results The incidence of hip fracture declined between the periods 1993–1996 and 2001–2005: from 706 to 625 hip fractures per 105 women and from 390 to 317 hip fractures per 105 men. However, there was a 114% increase in the number of fractures in women aged 90 or older (12 and 25 hip fractures/year, respectively, in the two time periods). For the period 2001–05, women ≥ 90 years of age accounted for almost the same numbers of hip fractures as women aged 75–79 (27 fractures/year). The rate increased during this period, from 2,700 per 105 women to 3,900 per 105 women > 90 years. In men there were declining trends for both relative and absolute numbers. Interpretation Although age-adjusted incidence declined in the population > 50 years of age, absolute fracture rate and incidence increased in the very old. Women over 90 now have the same absolute number of hip fractures every year as women aged 75–79 years. There was a right-shift in hip fracture distribution towards the oldest old, probably due to an increased number of octo/nonagenarians, a new population of particularly frail old people that hardly existed earlier. Better health among septuagenarians may also have delayed the age at which fractures occurred. This changing pattern will strain orthopedic and geriatric resources even more.
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| 5. |
- Jonsson, Ulrica, et al.
(författare)
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Cerebral palsy prevalence, subtypes, and associated impairments: a population-based comparison study of adults and children.
- 2019
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Ingår i: Developmental Medicine & Child Neurology. - : Wiley. - 0012-1622 .- 1469-8749. ; 61:10, s. 1162-1167
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Tidskriftsartikel (refereegranskat)abstract
- To describe the prevalence of cerebral palsy (CP), subtype distribution, motor and intellectual impairment, and epilepsy in adults with CP compared with children with CP.CP subtype and impairment data from the population-based CP register of western Sweden and population data from Statistics Sweden were used to compare surviving adults (n=581; 244 females, 337 males) born between 1959 and 1978, with the same cohort as children (n=723; 307 females, 416 males), andwiththe most recent cohort, born from 2007 to 2010 (n=205; 84 females, 121 males).Prevalence of CP in adults born between 1959 and 1978 was 1.14 per 1000. The occurrence of impairments differed between CP subtypes. Motor and intellectual impairment were closely related, regardless of subtype. Subtype distribution among survivors differed significantly from the original cohorts (p=0.002), and the most recent cohort (p<0.01), tetraplegia and dyskinetic CP being less common in survivors. Severe motor impairment, intellectual disability, and epilepsy were less common among survivors than in the original cohorts (p=0.004, p=0.002, p=0.037) and the most recent cohort (p=0.004, p=0.008, p<0.01).Data on prevalence, subtype distribution, and impairments in children with CP are not applicable to adults with CP. Population-based studies of adults with CP are needed.Cerebral palsy (CP) subtypes are differently distributed in adults compared to children. The prevalence of impairments in adults with CP is related to CP subtype. Spastic tetraplegia and dyskinetic CP are less common in adults than children. Severe motor impairment, intellectual disability, and epilepsy are less common in adults.
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| 6. |
- Jonsson, Ulrica, et al.
(författare)
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Changes in walking ability, intellectual disability, and epilepsy in adults with cerebral palsy over 50 years: a population-based follow-up study.
- 2021
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Ingår i: Developmental Medicine & Child Neurology. - : Wiley. - 0012-1622 .- 1469-8749. ; 63:7, s. 839-845
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Tidskriftsartikel (refereegranskat)abstract
- To determine if walking ability and presence of intellectual disability and epilepsy change from childhood to 50years of age in individuals with cerebral palsy (CP), and if such changes are related to age, sex, or CP subtype.This was a population-based follow-up study of 142 adults born from 1959 to 1978 (82 males, 60 females; mean age 48y 4mo, range 37-58y; 44% unilateral, 35% bilateral, 17% dyskinetic, and 4% ataxic CP) listed in the CP register of western Sweden. We compared childhood data with a follow-up assessment in 2016.At follow-up, walking ability had changed significantly (p<0.001). The proportion of participants walking without aids had decreased from 71% to 62%, and wheelchair ambulation increased from 18% to 25%. Walking ability was related to subtype (p=0.001), but not to age, sex, pain, fatigue, or body mass index. The proportion classified as having intellectual disability had increased from 16% to 22% (p=0.039) and the proportion with epilepsy from 9% to 18% (p=0.015). Of those with childhood epilepsy, 46% were seizure-free without medication.Walking ability and the presence of intellectual disability and epilepsy had changed significantly since childhood. Life-long access to specialized health care is warranted for re-evaluation of impairments, treatment, and assistance.
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| 7. |
- Jonsson, Ulrica, et al.
(författare)
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Health Conditions in Adults With Cerebral Palsy: The Association With CP Subtype and Severity of Impairments
- 2021
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Ingår i: Frontiers in Neurology. - : Frontiers Media SA. - 1664-2295. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To determine the prevalence of common health conditions in adults with cerebral palsy (CP) and to identify associations with the CP subtype or the severity of impairments. Methods: A population-based, cross-sectional study of 153 adults with CP born from 1959 to 1978 (87 males, 66 females; median age 48 years 3 months, range 37–58 years; 41% with unilateral spastic, 36% bilateral spastic, 19% dyskinetic, and 4% with ataxic CP). Data was gathered through interviews, physical assessments, and medical record reviews. Results: The most common health conditions in adults with CP were pain 65%, upper gastrointestinal disorders 33%, dysphagia 29%, epilepsy 29%, and depression 27%. Cerebral palsy subtype was significantly associated with the presence of pain (p = 0.029), gastrointestinal (p < 0.001), and respiratory disorders (p = 0.006). A more severe physical impairment was associated with a higher prevalence of gastrointestinal disorders (p < 0.001), respiratory disorders (p < 0.001), and pressure ulcers (p < 0.001). Intellectual disability was associated with a higher prevalence of gastrointestinal disorders (p < 0.001), pneumonia (p = 0.001) epilepsy (p = 0.001), and pressure ulcers (p < 0.001), but with a lower prevalence of pain (p < 0.004) and hypertension (p = 0.043). Conclusion: The prevalence of several common health conditions is related to the CP subtype and severity of impairments, indicating that CP plays a role in the development of these health conditions. Follow-up of adults with CP needs to include not only impairments, but general health as well. Increased attention directed toward signs of gastrointestinal and respiratory disorders in individuals with either dyskinetic CP, gross motor function classification system (GMFCS) levels IV–V, or intellectual disability, is recommended.
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| 8. |
- Jonsson, Ulrica, et al.
(författare)
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Hur personer med cerebral pares eller ryggmärgsbråck upplever att deras symptom och hjälpbehov förändras över tid och om hjälpbehoven blir tillgodosedda eller inte
- 2010
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Ingår i: läkarstämman 1/12-2010.
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Konferensbidrag (refereegranskat)abstract
- Hur personer med cerebral pares eller ryggmärgsbråck upplever att deras symptom och hjälpbehov förändras över tid och om hjälpbehoven blir tillgodosedda eller inte Ulrica Jonsson specialistläkare rehabiliteringsmedicin, sektionen för klinisk neurovetenskap och rehabilitering, Sahlgrenska Universitetssjukhuset och handikappförvaltningen i Göteborg Katharina S.Sunnerhagen professor rehabiliteringsmedicin, sektionen för klinisk neurovetenskap och rehabilitering, Sahlgrenska Universitetssjukhuset och Sunnaas Rehabiliteringssjukhus, Medicinska fakulteten, Oslo Universitet Marie Törnbom lektor, med.dr. rehabiliteringsmedicin, sektionen för klinisk neurovetenskap och rehabilitering, Sahlgrenska Universitetssjukhuset och Institutionen för socialt arbete, Göteborgs universitet Bakgrund Få studier har undersökt hur symptom och hjälpbehov förändras över tid bland personer med cerebral pares eller ryggmärgsbråck. Vi hade dessa frågor i fokus och undersökte också vilka aktuella kontakter med sjukvårdspersonal och andra instanser personerna hade och identifierade behov som personerna upplevde inte blev tillgodosedda. Metod En longitudinell uppföljning där två grupper personer med cerebral pares eller ryggmärgsbråck utan intellektuellt funktionshinderintervjuades per telefon med ett halvstrukturerat frågeformulär, med kroppsliga besvär och tillgodosedda och inte tillgodosedda hjälpbehov i fokus. Grupp A studerades 1983 (antal 55), 1997 (antal 42) och 2009 (antal 28). En annan grupp (B) studerades 1998 (antal 30) och 2009 (antal 25). Resultat Symptomen förvärrades signifikant i grupp A mellan 1997 och 2009 jämfört med grupp B. Antalet personer som behöver praktisk hjälp ökade signifikant i båda grupperna mellan 1997-1998 och 2009. Praktisk hjälp verkställdes framför allt av de närmaste, personliga assistenter och av färdtjänst och majoriteten var nöjda med den hjälp de fick. De flesta i båda grupperna hade kontakter med sjukvårdspersonal och en majoritet av grupp A och en tredjedel av grupp B ville ha mer hjälp, speciellt ville man ha tillgång till ett specialiserat sjukvårdsteam. Några ville ha mindre byråkrati och ett bättre bemötande från socialtjänst, försäkringskassa, arbetsförmedling och färdtjänst. Sammanfattning Som en konsekvens av förvärrade symptom ökar behovet av praktisk hjälp över tid. Behovet av tillgång till specialiserad vård kvarstår hela livet.
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| 9. |
- Nyström, Markus B. T., et al.
(författare)
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Shame and interpersonal sensitivity : Gender differences and the association between internalized shame coping strategies and interpersonal sensitivity
- 2018
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Ingår i: Bulletin of the Menninger Clinic. - : Guilford Publications. - 0025-9284 .- 1943-2828. ; 82:2, s. 137-155
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Tidskriftsartikel (refereegranskat)abstract
- The present study investigated gender differences in interpersonal sensitivity and internalized shame coping strategies in 252 undergraduate students. To measure interpersonal sensitivity and shame coping strategies, the self-assessment forms Interpersonal Sensitivity Measure and Compass of Shame Scale were used. The analyses revealed that compared to men, women display interpersonal sensitivity to a higher degree, and they use internalized shame coping strategies to a greater extent. The results also showed that interpersonal sensitivity is highly correlated with shame coping strategies. However, in contrast to earlier research, no gender difference was found, and gender did not significantly mediate the association between interpersonal sensitivity and internalized shame coping. These results could aid clinicians and researchers in promoting, designing, delivering, and evaluating treatments for patients with, for example, depression, anxiety, and interpersonal and/or relational problems.
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| 10. |
- Törnbom, Marie, 1950, et al.
(författare)
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Increasing symptoms, met and unmet needs in adults with cerebral palsy or meningomyelocele a longitudinal follow-up.
- 2013
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Ingår i: Scandinavian Journal of Disability Research. - 1501-7419 .- 1745-3011. ; 15:3, s. 249-263
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate how symptoms and personal assistance needs change over time among people with cerebral palsy (CP) or meningomye- locele (MMC), and to identify unmet needs. The study design was a longitudinal follow up, both cohorts starting as young adults while treated at the adult habilitation clinic. The participants were interviewed by telephone. Group (A) was studied in 1983 (n 55), in 1997 (n 42) and in 2009 (n 28). Group (B) was studied in 1998 (n 30) and in 2009 (n 25). Perceived symptoms were aggravated in both groups in 2009 compared with 1997 (8), and significantly more aggravated in group A (older than group B). The number of participants needing practical assistance increased significantly in both groups between 1997 1998 and 2009. Most people in both groups had contact with health care professionals and many wanted more assistance, especially access to a specialized team. As a consequence of aggravating symptoms, the need for specialized health care continues into adulthood.
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