| 1. |
- Garvin, Peter, 1976-, et al.
(författare)
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Association between ambulatory saliva cortisol levels and plasma levels of matrix metalloproteinase-9 in a normal population
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Psychosocial strain has been demonstrated to be a risk factor for coronary artery disease (CAD) and also to be associated with a dysfunctional HPA-axis. Based on a proposal on cortisol resistance in maladaptive monocytes as a potential mechanism linking psychosocial strain with CAD, this study aimed at testing the association between levels of salivary cortisol and matrix metalloproteinase-9 (MMP-9) in a normal population. Methods: 359 participants (50 % women) aged 45-69 were enrolled to this study, randomly drawn from a normal population in Sweden. Saliva samples were collected thrice per day (at awakening, 30 minutes after awakening, and just before going to bed) during three consecutive days. Cortisol levels at awakening and 30 minutes after awakening were used to estimate the diurnal peak. Cortisol was analyzed using a radioimmunoassay method. MMP-9 was measured in plasma using an ELISA-method. Results: After adjustment for age and sex, significant trends regarding MMP-9 were found both for cortisol peak quintiles (beta +1.9 ng/mL per quintile, p=0.029) and cortisol evening values (beta +2.1 ng/ml per quintile, p=0.017). These findings were consistent in regressions either excluding participants with known diagnoses of myocardial infarction, angina pectoris, rheumatoid arthritis, diabetes, cancer with ongoing treatment, chronic obstructive lung disease, osteoporosis and hypothyroidism, or adjusting for these diseases, also after adjustment for cardiovascular risk factors. Conclusions: The associations found between cortisol levels and MMP-9 in a normal population hint at a potential pathway linking prolonged psychosocial strain with cardiovascular events.
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| 2. |
- Garvin, Peter, 1976-, et al.
(författare)
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Circulating Matrix Metalloproteinase-9 Is Associated with Cardiovascular Risk Factors in a Middle-Aged Normal Population
- 2008
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 3:3, s. e1774-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Elevated levels of circulating matrix metalloproteinase-9 (MMP-9) have been demonstrated in patients with established coronary artery disease (CAD). The aim of this study was to analyse levels of MMP-9 in a population free from symptomatic CAD and investigate their associations with cardiovascular (CV) risk factors, including C-reactive protein (CRP). Methods: A cross-sectional study was performed in a population based random sample aged 45–69 (n = 345, 50% women). MMP-9 levels were measured in EDTA-plasma using an ELISA-method. CV risk factors were measured using questionnaires and standard laboratory methods.Results: Plasma MMP-9 was detectable in all participants, mean 38.9 ng/mL (SD 22.1 ng/mL). Among individuals without reported symptomatic CAD a positive association (p<0.001) was seen, for both men and women, of MMP-9 levels regarding total risk load of eight CV risk factors i.e. blood pressure, dyslipidemia, diabetes, obesity, smoking, alcohol intake, physical activity and fruit and vegetable intake. The association was significant also after adjustment for CRP, and was not driven by a single risk factor alone. In regression models adjusted for age, sex, smoking, alcohol intake and CRP, elevated MMP-9 levels were independently positively associated with systolic blood pressure (p = 0.037), smoking (p<0.001), alcohol intake (p = 0.003) and CRP (p<0.001). The correlation coefficient between MMP-9 and CRP was r = 0.24 (p<0.001). Conclusions: In a population without reported symptomatic CAD, MMP-9 levels were associated with total CV risk load as well as with single risk factors. This was found also after adjustment for CRP
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| 3. |
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| 4. |
- Garvin, Peter, 1976-
(författare)
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Plasma levels of matrix metalloproteinase‐9 in a normal population : a psychoneuroendocrinological approach
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Several large‐scale epidemiological studies have demonstrated the prognostic significance of psychosocial factors and stress for coronary artery disease (CAD). Observations of sudden changes in CAD incidence have led to the proposal of mechanisms regarding atherosclerotic plaque vulnerability. The collagen‐degrading enzyme matrix metalloproteinase-9 (MMP-9) is increased in rupture‐prone plaques with high inflammatory activity, and circulating levels of MMP-9 are raised in patients with acute coronary syndrome. However, the distribution of MMP‐9 levels and its relations to psychosocial factors and the stress hormone cortisol have not been previously explored in a normal population.The aim of this dissertation was to examine in a normal population the association of circulating levels of MMP-9 with traditional cardiovascular risk factors including levels of C-reactive protein (CRP), with psychosocial factors, and with saliva levels of cortisol. In addition, the reliability of a new method of ambulatory saliva sampling for assessment of cortisol levels was evaluated. A sub‐sample of the Life conditions, Stress, and Health (LSH)-study, a population based study exploring psychoneuroendocrinological pathways mediating the differences in CAD incidence over socioeconomic status, was used. Plasma levels of MMP-9 were examined in a sample randomly drawn from the LSH‐study (n=400), aged 45 to 69 years at enrollment.The main findings were: 1) there was a positive association between plasma MMP-9 levels and total risk load of cardiovascular risk factors. The findings were persistent after adjusting for CRP and could not be attributed to a single risk factor. 2) After adjusting for traditional cardiovascular risk factors and CRP, MMP-9 levels were positively associated with psychosocial risk factors and negatively associated with psychosocial resources. 3) Pooling saliva samples prior to laboratory analysis were as reliable as arithmetic means for assessment of diurnal cortisol variation in a field research setting. 4) There was a positive association between circulating levels of MMP‐9 and saliva levels of cortisol, both diurnal peak level and evening level of cortisol. The observed associations between MMP‐9 and traditional cardiovascular risk factors, psychosocial factors, and saliva cortisol levels suggest a psychoneuroendocrinological pathway linking stress to plaque vulnerability and provide increased understanding of the association between psychosocial factors and CAD.
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| 5. |
- Garvin, Peter, 1976-, et al.
(författare)
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Pooling ambulatory saliva cortisol samples over consecutive days – as reliable as arithmetic means
- 2008
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Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - : Informa UK Limited. - 0036-5513 .- 1502-7686. ; 68:6, s. 508-512
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Tidskriftsartikel (refereegranskat)abstract
- Objective: When cortisol measurements are to be studied in large populations, cost-effective analyses are needed. This study aimed at testing whether one pooled cortisol value over three consecutive days is as reliable as using the arithmetic mean of the samples from the same measure points. Material and methods: Thirty participants aged between 45 and 69 collected saliva in salivettes immediately after awakening (t1), 30 min after awakening (t2) and in the evening (t3) during 3 consecutive days. A fixed volume from each of the samples (t1, t2 and t3) was pooled prior to laboratory analysis. Mean levels over 3 days for t1, t2 and t3 were compared to corresponding levels of pooled vials. Cortisol levels were analysed using a radio immunoassay.Results: All measures tested had high correlations between mean values and pooled samples, exemplified with diurnal deviation rdif t2–t350.974 (CI 0.946;0.987), and awakening response rdif t2–t150.982 (CI 0.963;0.991). There were no statistical differences between the pooled values and the arithmetic means.Conclusion: Pooling samples gave as reliable results as arithmetic means did. Pooling samples prior to laboratory analysis is a cost-effective method for measuring general diurnal cortisol variation in field research projects.
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| 6. |
- Garvin, Peter, 1976-, et al.
(författare)
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Psychosocial factors in atherosclerosis
- 2006
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Ingår i: XIV International Symposium on Atherosclerosis,2006.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 7. |
- Granström, Fredrik, et al.
(författare)
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Distinguishing independent and shared effects of material/structural conditions and psychosocial resources on educational inequalities in self-rated health : results from structural equation modelling
- 2021
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Ingår i: Public Health. - : Elsevier. - 0033-3506 .- 1476-5616. ; 196, s. 10-17
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to distinguish independent and shared effects of material/structural factors and psychosocial resources in explaining educational inequalities in self-rated health (SRH) by using structural equation modelling. Study design: Cross-sectional survey. Methods: Data were derived from a questionnaire sent to a random sample of the population in five counties in Sweden in 2008. The study population (aged 25–75 years) included 15,099 men and 17,883 women. Exploratory structural equation modelling was used to analyse the pathways from educational level to SRH. Results: The pathway including both material/structural factors (e.g. financial buffer and unemployment) and psychosocial resources (e.g. sense of coherence and social participation) explained about 40% of educational differences in SRH for both men and women. The pathways including only the independent effects of psychosocial resources (14% in men and 20% in women) or material/structural factors (9% and 18%, respectively) explained substantial but smaller proportions of the differences. Conclusions: The major pathway explaining educational inequalities in SRH included both material/structural factors and psychosocial resources. Therefore, to reduce educational inequalities in SRH, interventions need to address both material/structural conditions and psychosocial resources across educational groups.
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| 8. |
- Granström, Fredrik
(författare)
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Inequalities in Health : the Importance of Material/Structural Factors and Psychosocial Resources
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Socioeconomic inequalities in health are well-documented in most countries. Health differences have been shown to follow a gradient, where health status in average is somewhat poorer for every lower level in the social hierarchy. Notably, the welfare state Sweden is no exception. Considerable socioeconomic inequalities in health are found, and the magnitude of e.g. educational inequalities in health has even increased over recent decades. Important contributors, or “health determinants” of observed health inequalities, include material/structural factors, behavioral factors and psychosocial factors. The inequalities arise from uneven distributions of these health determinants accumulated over the life course. Whereas earlier research has focused on independent effects of different determinants, recent research has showed that health determinants interact in complex ways when contributing to health inequalities. However, the relative importance of the independent contributions of specific types of health determinants and of the shared contributions have not been assessed. The overall aim of this thesis was to examine possible explanations of inequalities in self-reported health among groups with different educational levels in a Swedish population, in particular how material/structural factors and psychosocial resources contribute to these inequalities. This thesis is based on four population-based studies. Studies I and IV used data from the Life & health study, based on crosssectional survey questionnaires, conducted in 2000, 2004 and 2008 in five counties in the central part of Sweden. Around 35,000 respondents were included each year with response rates varying from 60% to 67%. Studies II and III used data from a sub-sample of the Swedish national public health survey (HLV) from 2012, another cross-sectional survey questionnaire. The sub-sample was carried out in four counties in the central part of Sweden. The total number of respondents in the sub-sample was 26,706, with a response rate of 53%. Outcome variables were, in studies I, II and IV, self-rated health (SRH) and, in study III, psychological distress. The magnitudes of health inequalities were examined using rate ratios and rate differences. The associations between health determinants and health out-comes were examined using logistic regression, and the analysis of independent versus shared contributions of health determinants to health inequalities was conducted using structural equation modeling (SEM). Study I showed that relative educational inequalities in SRH were two-fold among men, unchanged from 2000 to 2008, while the inequalities initially were smaller among women but increased over time, from 1.7 to 2.1. This increase was mainly due to growing inequalities in the age group 25–34 years. The distributions of all observed health determinants were more unfavorable in low education groups; most prominent for lack of a financial buffer, smoking and low optimism. These educational differences were, for most health determinants, unchanged over time. Study II examined the association of adult SRH with adverse material conditions (eco-nomic stress in the family) in childhood as well as adverse psychosocial conditions (condescending treatment) in childhood. Both economic stress and condescending treatment in childhood were strongly associated with poorer adult SRH. These associations were attenuated, but still statistically significant after adjustment for economic stress and condescending treatment in adulthood and other risk factors. Study III showed, after adjustment for age, economic difficulties, employment status and social support, a moderate association between educational level and psychological dis-tress, where low and medium educational levels were related to a lower risk of psychological distress. However, current economic difficulties showed a strong, and positive, association with psychological distress. Study IV showed that the shared pathways, including both material/structural fac-tors (e.g. financial buffer and unemployment) and psychosocial resources (e.g. optimism and social participation), explained about 40% of educational inequalities in SRH for both men and women aged 25–74 years. The pathways including only the independent effects of psychosocial resources (14% in men and 20% in women) or material/structural factors (9% and 18%, respectively) explained substantial but smaller proportions of the inequalities. In conclusion, in an adult population in the central part of Sweden, prevalence of poor SRH was, among men, twice as high in the low education group compared to the high education group during the first decade of the new millennium. Among women, educational inequalities were initially smaller, but increased over time to the same level as among men. However, when using self-reported psychological distress as health outcome, no corresponding educational inequalities were found. Instead, economic difficulties were an important determinant of psychological distress. SRH in adulthood was significantly associated with economic stress and condescending treatment during childhood, also when the same conditions in adulthood were taken into account. Material/structural factors and psychosocial resources explained more than half of the educational inequalities in SRH, and the majority of this contribution was in the form of a shared effect of material/structural factors and psychosocial resources. A shared effect means that a material/structural factor and a psychosocial resource are strongly associated, and that the combination of the two has an effect on the educational inequalities in SRH. Therefore, to reduce educational inequalities in SRH, interventions need to address both material/structural conditions and psychosocial resources. This needs to be done across educational groups, using a life course perspective, but with more intensive interventions in lower education groups.
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| 9. |
- Lundgren, Oskar, 1979-, et al.
(författare)
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A journey through chaos and calmness : experiences of mindfulness training in patients with depressive symptoms after a recent coronary event - a qualitative diary content analysis.
- 2018
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Ingår i: BMC Psychology. - : BioMed Central. - 2050-7283. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Psychological distress with symptoms of depression and anxiety is common and unrecognized in patients with coronary artery disease (CAD). Efforts have been made to treat psychological distress in CAD with both conventional methods, such as antidepressant drugs and psychotherapy, and non-conventional methods, such as stress management courses. However, studies focusing on the experiences of mindfulness training in this population are still scarce. Therefore, the aim of this study was to explore immediate experiences of mindfulness practice among CAD patients with depressive symptoms.METHODS: A qualitative content analysis of diary entries, written immediately after practice sessions and continuously during an 8-week long Mindfulness Based Stress Reduction course (MBSR), was applied.RESULTS: Twelve respondents participated in the study. The main category: a journey through chaos and calmness captured the participants' concurrent experiences of challenges and rewards over time. This journey appears to reflect a progressive development culminating in the harvesting of the fruits of practice at the end of the mindfulness training. Descriptions of various challenging facets of mindfulness practice - both physical and psychological - commonly occurred during the whole course, although distressing experiences were more predominant during the first half. Furthermore, the diary entries showed a wide variety of ways of dealing with these struggles, including both constructive and less constructive strategies of facing difficult experiences. As the weeks passed, participants more frequently described an enhanced ability to concentrate, relax and deal with distractions. They also developed their capacity to observe the content of their mind and described how the practice began to yield rewards in the form of well-being and a sense of mastery.CONCLUSIONS: Introducing MBSR in the aftermath of a cardiac event, when depressive symptoms are present, is a complex and delicate challenge in clinical practice. More nuanced information about what to expect as well as the addition of motivational support and skillful guidance during the course should be given in accordance with the participants' experiences and needs.TRIAL REGISTRATION: The trial was retrospectively registered in clinicaltrials.gov (registration number: NCT03340948 ).
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| 10. |
- Lundgren, Oskar, 1979-, et al.
(författare)
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Inverted items and validity : A psychobiological evaluation of two measures of psychological resources and one depression scale
- 2018
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Ingår i: Health psychology open. - : Sage Publications. - 2055-1029. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Psychological resources and risk factors influence risk of coronary heart disease. We evaluated whether inverted items in the Self-esteem, Mastery, and Center for Epidemiological Studies Depression scales compromise validity in the context of coronary heart disease. In a population-based sample, validity was investigated by calculating correlations with other scales (n = 1004) and interleukin-6 (n = 374), and by analyzing the relationship with 8-year coronary heart disease risk (n = 1000). Negative items did not affect the validity of the resource scales. In contrast, positive items from Center for Epidemiological Studies Depression showed no significant relationships with biological variables. However, they had no major impact on the validity of the original scale.
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