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- Berglund, Anita
(författare)
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On associations between different factors and whiplash injury
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to evaluate associations between different factors and whiplash injury (defined as a soft tissue injury to the neck without fracture or dislocation), focusing on risk of initial and future complaints. The objectives in Paper 1 and II was to determine whether exposure to a rear-end collision, with or without whiplash injury, is associated with future neck or shoulder pain (Paper 1) and other health complaints, besides neck pain (Paper II). The purpose of the third article was to evaluate whether occupant- and crash-related factors, such as age, gender, seating position and type of motor vehicle crash (MVC) are associated with the risk of whiplash injury, given that an MVC had occurred and at least one occupant in the car has been injured. In the fourth paper, the aim was to estimate the effect of potential prognostic factors on the presence of neck pain over a 2-year period among subjects with whiplash injury. The first and the second paper were based on the same study population. Claim reports were collected from the period November 1987 to April 1988. Drivers exposed to a rear-end collision were divided into two subgroups: those with reported whiplash injury (n=232) and those without reported whiplash injury (n=204). For comparison, 3688 subjects who were unexposed to MVCs were selected, with consideration taken to the age and gender distribution in the exposed subgroups. The prevalence of different health complaints among the study subjects was estimated according to a mailed questionnaire at follow-up in 1994, 7 years after the rear-end collision. The age- and gender-adjusted relative risk (RR) of health complaints at follow-up was calculated for subjects in each exposed subgroup as compared with unexposed subjects, using the Mantel-Haenszel technique. In the third article a study of occupants in cars covered by motor insurance at one of the largest insurance companies in Sweden, was undertaken during a one-year period. The study population comprised all occupants in cars exposed to an MVC in which at least one occupant was injured (n=7120). Adjusted estimates of the relative risk of whiplash injury, associated with the different occupant- and crashrelated factors, were calculated by means of binomial regression analysis. In the fourth paper, the association between potential prognostic factors and the presence of neck pain at follow-up was estimated in subjects with whiplash injury at one month, six months, one year and two years after the MVC (n=2280), by calculating odds ratios (OR) together with 95% confidence intervals (Cl). The outcome, i.e., neck pain, was defined as a score of 60 mm and over on a 100 mm visual analogue scale (VAS). The simultaneous effect of several potential prognostic factors was calculated by means of logistic regression. A separate analysis was carried out for each of the four different follow-ups, respectively. In Paper I, it was shown that the relative risk of neck or shoulder pain at follow-up was 1.3 (95% Cl 0.8-2.0) in the exposed subjects without whiplash injury compared with the unexposed. The corresponding relative risk in subjects with whiplash injury was 2.7 (95% Cl 2.1-3.5). For this group, increased relative risks were also seen for headache, thoracic and low back pain, as well as for fatigue, sleep disturbances and ill health (RR in the range of 1.6- 3.7) (Paper 11). No corresponding increased risks were found among the exposed subjects without reported whiplash injury. In Paper III it was found that, considering different MVCs, rear-end collisions were associated with the highest relative risk of whiplash injury when compared with side impacts (1.82; 95% Cl 1.68-1.96), while drivers showed the strongest association with respect to seating position when compared with passengers in the rear seat (1.78; 95% Cl 1.60-1.97). Females had a somewhat higher risk of whiplash injury compared with males (RR 1.20; 95% Cl 1.16-1.25). No interaction between the studied factors was observed on the additive scale. In Paper IV, it was demonstrated that the most pronounced prognostic factor was neck pain intensity at baseline, with an OR in the range of 15 to 39 at the different followups, respectively. Compared with subjects with a low degree of perceived helplessness, the odds ratio increased with higher degrees of helplessness and the strength of the association remained relatively constant over time. The OR was 5.6 (95% Cl 2.8-11.2) and 5.1 (95% Cl 2.5-10.3) at the one- and twoyear follow-ups, respectively, for subjects reporting a high degree of helplessness at baseline. Females had an approximately twofold increased odds of having neck pain compared with men. The studies included in this thesis have added important knowledge regarding risk factors for whiplash injury, as well as for factors of relevance for future consequences due to whiplash injury.
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| 2. |
- Berglund, Anita, et al.
(författare)
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The influence of prognostic factors on neck pain intensity, disability, anxiety and depression over a 2-year period in subjects with acute whiplash injury
- 2006
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Ingår i: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0304-3959 .- 1872-6623. ; 125:3, s. 244-256
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Tidskriftsartikel (refereegranskat)abstract
- The influence of potential prognostic factors (occupant- and crash-related factors, initial neck pain intensity and headache, whiplash injury severity, helplessness, locus of control, socioeconomic status) on neck pain intensity (VAS), disability (DRI), anxiety and depression (HADS) was estimated in a cohort of 3704 subjects with whiplash injury following a motor vehicle crash. Questionnaires were administered (baseline, 1-, 6-, 12-, 24-month follow-ups). VAS was trichotomized; "low" (0-30), "moderate" (31-54), "severe" (55-100). A cumulative logit model with a proportional odds assumption was applied. Results regarding depression differed somewhat from the other outcomes. Overall, initial neck pain intensity was an important prognostic factor, but acted also as an evident effect modifier. Females had slightly increased odds for all outcomes but depression, for which no gender differences were shown. Injury severity was associated with all outcomes, but was most pronounced regarding disability among those who perceived numbness/pain in arms/hands and also had severe initial neck pain (proportional odds ratio [OR] 6.5; 95% confidence interval [CI] 2.5-17.0). Initial headache influenced all outcomes. Income was not related to any of the outcomes, whereas a lower level of education was associated with all outcomes but depression. Locus of control was not a factor of importance. In contrast, helplessness was related to all outcomes, but was most pronounced regarding neck pain intensity and depression for subjects with severe initial neck pain (OR 4.8; 95% CI 2.9-7.8; OR 6.6; 95% CI 2.6-17.0). Associations seem to be established early, and then to be relatively constant over time.
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| 3. |
- Berglund, Birgitta, et al.
(författare)
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SBS descriptor profile groups of occupants and their association with psychological factors
- 1999
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Ingår i: Proceedings of Indoor Air '99, Edinburgh, Scotland, August 8-13, 1999. London: Construction Research Communications Ltd. ; 1, s. 870-872
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Konferensbidrag (refereegranskat)abstract
- The aim of this study is to identify groups of occupants with distinct descriptor profiles of sensory reactions in the eyes, upper airways and facial skin and to study the potential association between classes of such descriptor profiles and psychological factors. Occupants with similar descriptor profiles were grouped with the aid of cluster analysis. Five different distinct group profiles were found for each of the three target organs, however, a sensation of dryness characterized a major part of them (11 out of 15 descriptor group profiles). The psychological factors depression, anxiety, and somatization were found to be associated with the descriptor profile groups dominated by adverse descriptors in all target organs.
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| 4. |
- Berglund, Mia, 1964-, et al.
(författare)
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The best of both worlds – entering the nursing profession with support of a transition programme
- 2022
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 36:2, s. 446-455
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Tidskriftsartikel (refereegranskat)abstract
- Background: Transition into clinical practice for newly graduated nurses is a difficult time, with high stress levels defined by a demanding period of personal and professional acclimatisation. Transitions are complicated and multi-dimensional, and to understand this process, it is crucial to identify the factors that facilitate or stand in the way of a healthy transition.Aim: The phenomenological study aimed to describe newly graduated nurses’ expectations of transitioning into the nursing profession at the start of a clinical nursing introduction programme, including education, supervision, and critical reflection with peers.Method: The study was based on seven group interviews with newly graduated nurses. The interviews utilised open-ended and follow-up questions and were carried out as a dialogue to enable reflection on the phenomenon of interest. This was explored and illuminated using the reflective lifeworld research approach, based on phenomenological epistemology.Findings: “Expectations of transition into the nursing profession viathe Clinical Nursing Introduction Programme” is signified by an oscillating movement between uncertainty, security, challenge, and growth on the threshold of a new identity. The phenomenon is constituted by the courage to grow, responsibility and fear, belonging and vulnerability, and support and challenge.Conclusion: Transitioning into the nursing profession viathe Clinical Nursing Introduction Programme means having the best of both worlds. Newly graduated nurses have the opportunity to receive education and structured support at the same time as they work independently in clinical practice.
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| 8. |
- Carrasquilla, Germán D, et al.
(författare)
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Does menopausal hormone therapy reduce myocardial infarction risk if initiated early after menopause? : A population-based case-control study
- 2014
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Ingår i: Menopause. - 1072-3714 .- 1530-0374. ; 22:6, s. 598-606
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study aims to assess whether the timing of menopausal hormone therapy initiation in relation to onset of menopause and hormone therapy duration is associated with myocardial infarction risk.METHODS: This study was based on the Stockholm Heart Epidemiology Program, a population-based case-control study including 347 postmenopausal women who had experienced a nonfatal myocardial infarction and 499 female control individuals matched for age and residential area. Odds ratios (with 95% CIs) for myocardial infarction were calculated using logistic regression.RESULTS: Early initiation of hormone therapy (within 10 y of onset of menopause or before age 60 y), compared with never use, was associated with an odds ratio of 0.87 (95% CI, 0.58-1.30) after adjustments for lifestyle factors, body mass index, and socioeconomic status. For late initiation of hormone therapy, the corresponding odds ratio was 0.97 (95% CI, 0.53-1.76). For hormone therapy duration of 5 years or more, compared with never use, the adjusted odds ratio was 0.64 (95% CI, 0.35-1.18). For hormone therapy duration of less than 5 years, the odds ratio was 0.97 (95% CI, 0.63-1.48).CONCLUSIONS: Neither the timing of hormone therapy initiation nor the duration of therapy is significantly associated with myocardial infarction risk.
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| 9. |
- Carrasquilla, Germán D, et al.
(författare)
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Postmenopausal hormone therapy and risk of stroke : A pooled analysis of data from population-based cohort studies.
- 2017
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Ingår i: PLoS Medicine. - : Public Library of Science (PLoS). - 1549-1277 .- 1549-1676. ; 14:11
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Recent research indicates a favourable influence of postmenopausal hormone therapy (HT) if initiated early, but not late, on subclinical atherosclerosis. However, the clinical relevance of timing of HT initiation for hard end points such as stroke remains to be determined. Further, no previous research has considered the timing of initiation of HT in relation to haemorrhagic stroke risk. The importance of the route of administration, type, active ingredient, and duration of HT for stroke risk is also unclear. We aimed to assess the association between HT and risk of stroke, considering the timing of initiation, route of administration, type, active ingredient, and duration of HT.METHODS AND FINDINGS: Data on HT use reported by the participants in 5 population-based Swedish cohort studies, with baseline investigations performed during the period 1987-2002, were combined in this observational study. In total, 88,914 postmenopausal women who reported data on HT use and had no previous cardiovascular disease diagnosis were included. Incident events of stroke (ischaemic, haemorrhagic, or unspecified) and haemorrhagic stroke were identified from national population registers. Laplace regression was employed to assess crude and multivariable-adjusted associations between HT and stroke risk by estimating percentile differences (PDs) with 95% confidence intervals (CIs). The fifth and first PDs were calculated for stroke and haemorrhagic stroke, respectively. Crude models were adjusted for age at baseline only. The final adjusted models included age at baseline, level of education, smoking status, body mass index, level of physical activity, and age at menopause onset. Additional variables evaluated for potential confounding were type of menopause, parity, use of oral contraceptives, alcohol consumption, hypertension, dyslipidaemia, diabetes, family history of cardiovascular disease, and cohort. During a median follow-up of 14.3 years, 6,371 first-time stroke events were recorded; of these, 1,080 were haemorrhagic. Following multivariable adjustment, early initiation (<5 years since menopause onset) of HT was associated with a longer stroke-free period than never use (fifth PD, 1.00 years; 95% CI 0.42 to 1.57), but there was no significant extension to the time period free of haemorrhagic stroke (first PD, 1.52 years; 95% CI -0.32 to 3.37). When considering timing as a continuous variable, the stroke-free and the haemorrhagic stroke-free periods were maximal if HT was initiated approximately 0-5 years from the onset of menopause. If single conjugated equine oestrogen HT was used, late initiation of HT was associated with a shorter stroke-free (fifth PD, -4.41 years; 95% CI -7.14 to -1.68) and haemorrhagic stroke-free (first PD, -9.51 years; 95% CI -12.77 to -6.24) period than never use. Combined HT when initiated late was significantly associated with a shorter haemorrhagic stroke-free period (first PD, -1.97 years; 95% CI -3.81 to -0.13), but not with a shorter stroke-free period (fifth PD, -1.21 years; 95% CI -3.11 to 0.68) than never use. Given the observational nature of this study, the possibility of uncontrolled confounding cannot be excluded. Further, immortal time bias, also related to the observational design, cannot be ruled out.CONCLUSIONS: When initiated early in relation to menopause onset, HT was not associated with increased risk of incident stroke, regardless of the route of administration, type of HT, active ingredient, and duration. Generally, these findings held also for haemorrhagic stroke. Our results suggest that the initiation of HT 0-5 years after menopause onset, as compared to never use, is associated with a decreased risk of stroke and haemorrhagic stroke. Late initiation was associated with elevated risks of stroke and haemorrhagic stroke when conjugated equine oestrogen was used as single therapy. Late initiation of combined HT was associated with haemorrhagic stroke risk.
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