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| 2. |
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| 3. |
- Alexanderson, Kristina, et al.
(författare)
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Rehabkoordinatorer inom psykiatrin:erfarenheter från läkare : Resultat från Region Stockholm
- 2021
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I denna rapport presenteras resultat från två enkäter som skickades till läkare verksamma inom psykiatrin i Stockholms län år 2018 respektive år 2020. Enkäterna innehöll frågor om läkares arbete med sjukskrivningar. Syftet var att få kunskap om läkares erfarenheter av arbete med sjukskrivning av patienter inom psykiatrin och om detta förändrades när den nya funktionen rehabiliteringskoordination(1-3) infördes vid psykiatriska enheter. Enkäterna baserades på enkäter använda i tidigare studier(4, 5).
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| 4. |
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| 5. |
- Bender, Brendan C, et al.
(författare)
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Population pharmacokinetic pharmacodynamic modelling in oncology : a tool for predicting clinical response
- 2015
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Ingår i: British Journal of Clinical Pharmacology. - : Wiley. - 0306-5251 .- 1365-2125. ; 79:1, s. 56-71
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Forskningsöversikt (refereegranskat)abstract
- In oncology trials, overall survival (OS) is considered the most reliable and preferred endpoint to evaluate the benefit of drug treatment. Other relevant variables are also collected from patients for a given drug and its indication, and it is important to characterize the dynamic effects and links between these variables in order to improve the speed and efficiency of clinical oncology drug development. However, the drug-induced effects and causal relationships are often difficult to interpret because of temporal differences. To address this, population pharmacokinetic-pharmacodynamic (PKPD) modelling and parametric time-to-event (TTE) models are becoming more frequently applied. Population PKPD and TTE models allow for exploration towards describing the data, understanding the disease and drug action over time, investigating relevance of biomarkers, quantifying patient variability and in designing successful trials. In addition, development of models characterizing both desired and adverse effects in a modelling framework support exploration of risk-benefit of different dosing schedules. In this review, we have summarized population PKPD modelling analyses describing tumour, tumour marker and biomarker responses, as well as adverse effects, from anticancer drug treatment data. Various model-based metrics used to drive PD response and predict OS for oncology drugs and their indications are also discussed.
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| 6. |
- Berglund, Erik, et al.
(författare)
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Coordination and Perceived Support for Return to Work : A Cross-Sectional Study among Patients in Swedish Healthcare
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:7
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Tidskriftsartikel (refereegranskat)abstract
- Background: Receiving support from a return-to-work (RTW) coordinator (RTWC) may be beneficial for people on long-term sick leave. The aim of this study was to investigate whether the number of contacts with an RTWC and their involvement in designing rehabilitation plans for the patients were associated with perceiving support for RTW, emotional response to the RTWC, and healthcare utilization. Methods: In this cross-sectional study, 274 patients who had recently been in contact with an RTWC in Swedish primary or psychiatric care answered questions regarding their interaction with an RTWC, perceived support for RTW, and emotional response to the RTWC. Results: Having more contact with an RTWC was associated with perceiving more support in the RTW process (adjusted OR 4.14, 95% CI 1.49-11.47). RTWC involvement in designing a rehabilitation plan for the patient was associated with perceiving more support in the RTW process from an RTWC and having a more positive emotional response to the RTWC. Conclusions: From the patient's perspective, this study indicates that the involvement of an RTWC and receiving a rehabilitation plan that an RTWC has helped to design might be perceived as important in the RTW process.
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| 7. |
- Berglund, Erik, et al.
(författare)
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Physicians' experience of and collaboration with return-to-work coordinators in healthcare : a cross-sectional study in Sweden
- 2023
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Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165.
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Tidskriftsartikel (refereegranskat)abstract
- PurposeReturn-to-work coordinators (RTWCs) give people on sick leave individualized support and coordinate between different stakeholders, including physicians. The aim of this study was to explore physicians’ experience of RTWCs and investigate factors that influence how much physicians collaborate with RTWCs, or refer patients to them, in primary, orthopaedic, and psychiatric care clinics.Materials and methodsOf the 1229 physicians responding to a questionnaire, 629 physicians who had access to a RTWC in their clinic answered to questions about collaborating with RTWCs.ResultsAmong physicians who had access to a RTWC, 29.0% collaborated with a RTWC at least once a week. Physicians with a more favourable experience of RTWCs reported more frequent collaboration (adjusted OR 2.92, 95% CI 2.06–4.15). Physicians also collaborated more often with RTWCs if they reported to often deal with problematic sick-leave cases, patients with multiple diagnoses affecting work ability, and conflicts with patients over sickness certification.ConclusionsPhysicians who had more problematic sick-leave cases to handle and a favourable experience of RTWCs, also reported collaborating more often with RTWCs. The results indicate that RTWCs’ facilitation of contacts with RTW stakeholders and improvements in the sickness certification process may be of importance for physicians.Implications for RehabilitationThis study of physicians’ experience of collaborating with return-to-work coordinators (RTWCs) observes that physicians reported more collaboration with or referrals to coordinators if they had a favourable experience of coordinators.The results indicate that physicians report more collaboration with or referrals to RTWCs if they had more problematic sick-leave cases to handle in the clinic.These findings imply that it might be possible to increase the collaboration between physicians and RTWCs in clinical settings by managing factors of importance.
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| 8. |
- Bergsten, Eva L., 1969-, et al.
(författare)
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Fall and collision related injuries among pedestrians, sickness absence and associations with accident type and occupation
- 2023
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Ingår i: Journal of Safety Research. - : Elsevier. - 0022-4375 .- 1879-1247. ; 86, s. 357-363
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This study explores pedestrian fall accidents and collisions with other road users in the Swedish road transport system, and sickness absence (SA) in relation to accident type, injury, and occupation. Further, it studies the associations between accident type, occupation, and duration of SA. Methods: Data from several national registers were used that included 15,359 working age pedestrians (20–64 years) receiving healthcare after a fall or collision throughout 2014–2016. Individual characteristics, accident type, injury, and occupation were presented and related to SA. Logistic regression was used to estimate odds ratios (OR), with 95% confidence intervals, for associations between accident type, occupation, and SA duration. Results: About 11,000 pedestrians (72%) were involved in fall accidents in the road traffic environment and well over 4,000 in collisions with another road user; 22% of all injured pedestrians had a new SA. The population had a higher proportion of women and individuals in older age groups (≥45). Of the falls, 31% were due to snow or ice, and these were associated with a higher OR for both short SA (<90 days) 1.76 (95% CI 1.56–1.98) and long SA (≥90 days) 1.81 (95% CI 1.51–2.18), compared to the group slipping, tripping, and stumbling. The working sectors health & social care, and construction had the highest ORs for SA. A higher OR was found for health & social care, short SA 1.58 (95% CI 1.38–1.81), long SA 1.79 (95% CI 1.45–2.20) and for construction, short SA 1.56 (95% CI 1.24–1.96), long SA 1.75 (95% CI 1.26–2.44), compared to the sector finance, communication, & cultural service. Conclusions: The OR for having short and long SA was higher in falls due to snow or ice and differed between occupational sectors. Practical implications: This information contributes to the knowledge base for planning a safe road transport system for pedestrians.
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| 9. |
- Bergsten, Eva L., 1969-, et al.
(författare)
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Fall and collision related injuries among pedestrians, sickness absence and associations with accident type and occupation
- 2023
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Ingår i: Journal of Safety Research. - : Elsevier. - 0022-4375 .- 1879-1247. ; 86, s. 357-363
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This study explores pedestrian fall accidents and collisions with other road users in the Swedish road transport system, and sickness absence (SA) in relation to accident type, injury, and occupation. Further, it studies the associations between accident type, occupation, and duration of SA.METHODS: Data from several national registers were used that included 15,359 working age pedestrians (20-64 years) receiving healthcare after a fall or collision throughout 2014-2016. Individual characteristics, accident type, injury, and occupation were presented and related to SA. Logistic regression was used to estimate odds ratios (OR), with 95% confidence intervals, for associations between accident type, occupation, and SA duration.RESULTS: About 11,000 pedestrians (72%) were involved in fall accidents in the road traffic environment and well over 4,000 in collisions with another road user; 22% of all injured pedestrians had a new SA. The population had a higher proportion of women and individuals in older age groups (≥45). Of the falls, 31% were due to snow or ice, and these were associated with a higher OR for both short SA (<90 days) 1.76 (95% CI 1.56-1.98) and long SA (≥90 days) 1.81 (95% CI 1.51-2.18), compared to the group slipping, tripping, and stumbling. The working sectors health & social care, and construction had the highest ORs for SA. A higher OR was found for health & social care, short SA 1.58 (95% CI 1.38-1.81), long SA 1.79 (95% CI 1.45-2.20) and for construction, short SA 1.56 (95% CI 1.24-1.96), long SA 1.75 (95% CI 1.26-2.44), compared to the sector finance, communication, & cultural service.CONCLUSIONS: The OR for having short and long SA was higher in falls due to snow or ice and differed between occupational sectors.PRACTICAL IMPLICATIONS: This information contributes to the knowledge base for planning a safe road transport system for pedestrians.
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| 10. |
- Dervish, Jessica, et al.
(författare)
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Disclosing or concealing multiple sclerosis in the workplace : two sides of the same coin-insights from a Swedish population-based survey
- 2024
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Ingår i: Frontiers in Public Health. - : Frontiers Media S.A.. - 2296-2565. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: People with multiple sclerosis (PwMS) face health and social challenges of living with a chronic and potentially disabling condition. To disclose or conceal MS at work may critically affect individuals' work situation, career opportunities, and health. PwMS may experience a dilemma when assessing if the possible benefits of disclosing the diagnosis outweigh the possible risks. However, concealing in the long-term may have health implications and prevent opportunities for support and work adjustments. Few studies have examined what drives PwMS to disclose or conceal MS at work and the consequences of these ways of managing MS.Objectives: To explore the reasons PwMS report for disclosing and/or concealing their MS diagnosis in the workplace, as well as the consequences they have experienced.Methods: A web-based survey of PwMS was conducted in 2021. All individuals aged 20-50 listed in the Swedish MS registry were invited to participate. The response rate was 52% and among these participants, 3,810 (86%) completed questions regarding workplace disclosure and/or concealment of MS. Free-text responses on these topics were analyzed using inductive content analysis.Results: It was common to disclose MS in the workplace (85%). Identified drivers for disclosure and concealment related to four categories: Work-related, Social, Personal and Circumstantial. Work-related drivers focused on employment or protecting one's career, and changing one's work situation versus maintaining it. Social drivers included the need for support, addressing or preventing stigma, and being considerate of others. Personal drivers were linked to moral values/personal beliefs and processing of the diagnosis. Circumstantial drivers related to involuntary or unforeseen events, timing factors, one's medical condition and external opinion/advice. Identified consequences for disclosure and concealment related to three categories: Work-life, Social, and Personal. Work-life consequences included work arrangements, and career opportunities. Social consequences were linked to MS awareness, stigma, interactions and social support, as well as dynamics of work relationships. Personal consequences involved levels of disease acceptance, and attitudes toward managing MS.Conclusion: PwMS often described the question of disclosure as challenging and navigated it with caution, as both disclosure and concealment can yield favorable and unfavorable outcomes.
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| 11. |
- Elrud, Rasmus, et al.
(författare)
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Sickness absence among passenger car occupants following a Crash
- 2017
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Ingår i: Conference proceedings International Research Council on the Biomechanics of Injury, IRCOBI. - 2235-3151. ; 2017-September, s. 79-90
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Konferensbidrag (refereegranskat)abstract
- Sickness absence is a common consequence of road traffic crashes, with high costs for the individual and society. Yet, scarcely studied, therefore, the aim was to describe sickness absence among injured car occupants. A population-based study using register data was conducted, including all car occupants of working age living in Sweden, who in 2010 had specialised in-or outpatient healthcare due to a car crash (n=9427). Individuals were categorised based on age, sex, and injury type. Odds ratios with 95% confidence intervals for a new sickness absence spell >14 days were estimated. After excluding the 9% already on sickness absence or disability pension, 10% had a new sickness absence spell >14 days. Sex and crash type were not associated with new sickness absence, while old age and being born outside Europe were associated with higher odds ratios. Odds ratios varied with the type of injury and injured body region. The odds ratio for sickness absence was highest for injuries to the spine and spinal cord odds ratio: 8.64 (95% confidence interval 6.45-11.57). Traumatic brain injuries except concussion had an odds ratio of 6.99 (4.04-12.08) while concussions had an odds ratio of 2.66 (1.80-3.93).
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| 12. |
- Ernstsson, Olivia, et al.
(författare)
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Cost of Illness of Multiple Sclerosis : A Systematic Review
- 2016
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cost-of-illness (COI) studies of Multiple Sclerosis (MS) are vital components for describing the economic burden of MS, and are frequently used in model studies of interventions of MS. We conducted a systematic review of studies estimating the COI of MS, to compare costs between studies and examine cost drivers, emphasizing generalizability and methodological choices.MATERIAL AND METHOD: A literature search on studies published in English on COI of MS was performed in PubMed for the period January 1969 to January 2014, resulting in 1,326 publications. A mapping of studies using a bottom-up approach or top-down approach, respectively, was conducted for the 48 studies assessed as relevant. In a second analysis, the cost estimates were compared between the 29 studies that used a societal perspective on costs, human capital approach for indirect costs, presenting number of patients included, time-period studied, and year of price level used.RESULTS: The mapping showed that bottom-up studies and prevalence approaches were most common. The cost ratios between different severity levels within studies were relatively stable, to the ratio of 1 to 2 to 3 for disability level categories. Drugs were the main cost drivers for MS-patients with low disease severity, representing 29% to 82% of all costs in this patient group, while the main cost components for groups with more advanced MS symptoms were production losses due to MS and informal care, together representing 17% to 67% of costs in those groups.CONCLUSION: The bottom-up method and prevalence approach dominated in studies of COI of MS. Our findings show that there are difficulties in comparing absolute costs across studies, nevertheless, the relative costs expressed as cost ratios, comparing different severity levels, showed higher resemblance. Costs of drugs were main cost drivers for less severe MS and informal care and production losses for the most severe MS.
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| 13. |
- Ervasti, Jenni, et al.
(författare)
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Permanent work disability before and after ischaemic heart disease or stroke event : a nationwide population-based cohort study in Sweden.
- 2017
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 7:9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We examined the risk of disability pension before and after ischaemic heart disease (IHD) or stroke event, the burden of stroke compared with IHD and which factors predicted disability pension after either event.DESIGN: A population-based cohort study with follow-up 5 years before and after the event. Register data were analysed with general linear modelling with binary and Poisson distributions including interaction tests for event type (IHD/stroke).SETTING AND PARTICIPANTS: All people living in Sweden, aged 25‒60 years at the first event year, who had been living in Sweden for 5 years before the event and had no indication of IHD or stroke prior to the index event in 2006‒2008 were included, except for cases in which death occurred within 30 days of the event. People with both IHD and stroke were excluded, resulting in 18 480 cases of IHD (65%) and 9750 stroke cases (35%).PRIMARY OUTCOME MEASURES: Disability pension.RESULTS: Of those going to suffer IHD or stroke event, 25% were already on disability pension a year before the event. The adjusted OR for disability pension at first postevent year was 2.64-fold (95% CI 2.25 to 3.11) for people with stroke compared with IHD. Economic inactivity predicted disability pension regardless of event type (OR=3.40; 95% CI 2.85 to 4.04). Comorbid mental disorder was associated with the greatest risk (OR=3.60; 95% CI 2.69 to 4.83) after an IHD event. Regarding stroke, medical procedure, a proxy for event severity, was the largest contributor (OR=2.27, 95% CI 1.43 to 3.60).CONCLUSIONS: While IHD event was more common, stroke involved more permanent work disability. Demographic, socioeconomic and comorbidity-related factors were associated with disability pension both before and after the event. The results help occupational and other healthcare professionals to identify vulnerable groups at risk for permanent labour market exclusion after such an event.
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| 14. |
- Ervasti, Jenni, et al.
(författare)
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Trends in diagnosis-specific work disability before and after ischaemic heart disease : a nationwide population-based cohort study in Sweden
- 2018
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 8:4
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We examined trends of diagnosis-specific work disability before and after ischaemic heart disease (IHD).DESIGN: Participants were followed 4 years before and 4 years after an IHD event for diagnosis-specific work disability (sickness absence and disability pension).SETTING AND PARTICIPANTS: A Swedish population-based cohort study using register data on all individuals aged 25-60 years, living in Sweden, and who suffered their first IHD event in 2006-2008 (n=23 971) was conducted.RESULTS: Before the event, the most common diagnoses of work disability were musculoskeletal disorders (21 annual days for men and 44 for women) and mental disorders (19 men and 31 for women). After multivariable adjustments, we observed a fivefold increase (from 12 to 60 days) in work disability due to diseases of the circulatory system in the first postevent year compared with the last pre-event year among men. Among women, the corresponding increase was fourfold (from 14 to 62 days). By the second postevent year, the number of work disability days decreased significantly compared with the first postevent year among both sexes (to 19 days among men and 23 days among women). Among women, mean days of work disability due to diseases of the circulatory system remained at a higher level than among men during the postevent years. Work disability risk after versus before an IHD event was slightly higher among men (rate ratio (RR) 2.49; 95% CI 2.36 to 2.62) than among women (RR 2.29, 95% CI 2.12 to 2.49). When pre-event long-term work disability was excluded, diseases of the circulatory system were the most prevalent diagnosis for work disability after an IHD event among both men and women.CONCLUSIONS: An IHD event was strongly associated with an increase in work disability due to diseases of the circulatory system, especially among men and particularly in the first postevent year.
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| 15. |
- Farrants, Kristin, et al.
(författare)
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Trajectories of future sickness absence and disability pension days among individuals with a new sickness absence spell due to osteoarthritis diagnosis ≥21 days : a prospective cohort study with 13-month follow-up
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:8
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Osteoarthritis is one of the most common types of musculoskeletal diagnoses also among working-age populations, and often leads to long-term sickness absence (SA) spells or even disability pension (DP).THE AIM: was to identify future trajectories of days of SA and/or DP among people with a new SA spell due to osteoarthritis that became ≥21 long, and to investigate sociodemographic and morbidity characteristics of individuals in identified trajectories.METHODS: tests and multinomial logistic regression.RESULTS: We identified five trajectories of SA/DP days: 'fast decrease' (36% of the cohort), 'medium fast decrease' (29%), 'slow decrease' (15%), 'fluctuating' (12%) and 'late decrease' (8%). Individuals in the two trajectories who still had SA/DP days at end of follow-up (late decrease and fluctuating) were more likely to be older, born outside the EU and have indicators of more severe morbidity than those in the other trajectories.CONCLUSION: Five trajectories of future SA/DP days were identified; 80% of the cohort belonged to trajectories with no SA/DP by the end of follow-up. Identifying trajectories of future SA/DP provides new insights regarding the developments of SA/DP over time among people on SA due to osteoarthritis; not only days in the initial SA spell but also in new spells during follow-up need to be included for a better understanding.
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| 16. |
- Friberg, Emilie, et al.
(författare)
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Coffee drinking and risk of endometrial cancer-A population-based cohort study
- 2009
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Ingår i: International Journal of Cancer. - : WILEY. - 0020-7136 .- 1097-0215. ; 125:10, s. 2413-2417
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Tidskriftsartikel (refereegranskat)abstract
- Coffee drinking has been reported to have beneficial effects on insulin resistance, which has been directly associated with endometrial cancer. Although I relationship between coffee consumption and endometrial cancer risk is biologically plausible, this hypothesis has been previously explored in only 2 prospective studies, with a small number of cases. We used data from the Swedish Mammography Cohort, a population-based prospective cohort study of 60,634 women. During 17.6 years of follow-up 677 participants were diagnosed with incident endometrial cancer (adenocarcinoma). We examined the association between self-reported coffee consumption (at baseline 1987-90 and in 1997) and endometrial cancer risk using Cox proportional hazards models. Each additional cut) (200 g) of coffee per day was associated with 11 rate ratio (RR) of 0.90 [95% confidence interval (CI), 0.83-0.97]. In women drinking 4 or more cups of coffee a day, file RR For the risk reduction of endometrial cancer was 0.75 (95% CL 0.58-0.97) when compared with those who drank I cup or less. The association seemed largely confined to overweight and obese women, who showed a respective risk reduction of 12% (95% Cl, 0-23%) and 20% (95% CI, 7-31%) for every cup or coffee. but was not observed among normal-weight women. There,vas I statistically significant interaction between coffee consumption and body mass index (p(interaction) < 0.001). These data indicate that coffee consumption may be associated with decreased risk of endometrial cancer. especially among women with excessive body weight. If confirmed by other prospective studies. these results are of major public health significance. (C) 2009 UICC
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| 17. |
- Friberg, Emilie, et al.
(författare)
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Diabetes and risk of endometrial cancer : A population-based prospective cohort study
- 2007
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Ingår i: Cancer Epidemiology, Biomarkers and Prevention. - Karolinska Inst, Div Nutr Epidemiol, Natl Inst Environm Med, SE-17177 Stockholm, Sweden. Harvard Univ, Beth Israel Deaconess Med Ctr, Sch Med, Div Endocrinol Diabet & Metab,Dept Med, Boston, MA 02215 USA. : AMER ASSOC CANCER RESEARCH. - 1055-9965 .- 1538-7755. ; 16:2, s. 276-280
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Tidskriftsartikel (refereegranskat)abstract
- Although there is accumulating evidence that hyperinsulinemia in the context of insulin resistance is associated with carcinogenesis, only one prospective study of endometrial cancer incidence, in relation to diabetes, addressed this issue and showed no significant positive association. No previous study has investigated whether physical activity can modify the association between diabetes and endometrial cancer. We examined the association between diabetes and incidence of endometrial cancer and the potential effect modification by obesity and physical activity in the Swedish Mammography Cohort, a prospective cohort of 36,773 women, including 225 incident endometrial adenocarcinoma cases. After adjustments, the relative risk (RR) for endometrial cancer among women with diabetes comparing with nondiabetic women was 1.94 [95% confidence interval (95% CI), 1.23-3.08]. Among obese diabetics, the RR was 6.39 (95% CI, 3.28-12.06) compared with nonobese nondiabetic women. Among diabetics with low physical activity, the RR for endometrial cancer was 2.80 (95% CI, 1.62-4.85) compared with physically active nondiabetic women. Obese diabetics with low physical activity had a RR of 9.61 (95% CI, 4.66-19.83) compared with normal weight nondiabetic women with high physical activity. Diabetes was associated with a 2-fold increased risk, and combination of diabetes with obesity and low physical activity was associated with a further increased risk for endometrial cancer. Interventions to reduce body weight and increase physical activity may have important implications in terms of prevention of endometrial cancer and future management of diabetic subjects.
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| 18. |
- Friberg, Emilie
(författare)
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Diabetes, physical activity and endometrial cancer
- 2006
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Accumulating evidence suggests that hyperinsulinemia, in the context of insulin resistance, is associated with carcinogenesis. Physical activity is involved in the regulation of metabolic and hormonal pathways and is an important factor affecting hyperinsulinemia, insulin resistance and body weight. The major modifiable determinants of insulin resistance, hyperinsulinemia, and diabetes such as obesity, and physical activity, have also been shown to be risk factors for endometrial cancer. No previous studies have investigated whether physical inactivity is a modifier of the association between diabetes and risk of endometrial cancer. No previous study has evaluated a combined effect of diabetes, obesity and physical inactivity as a predictor of endometrial cancer risk. No previous meta-analysis of diabetes and endometrial cancer risk has been performed. Moreover no previous study has investigated the effect of leisure time physical inactivity directly on endometrial cancer risk. We examined the association between diabetes and incidence of endometrial cancer in the Swedish Mammography Cohort. Given that the effect of diabetes may vary by risk factors for endometrial cancer we also examined the potential effect modification by obesity and physical activity. In this population-based prospective cohort of 36 773 women, 225 incident endometrial adenocarcinoma cases were diagnosed between 1997 and 2005. The relative risk (RR) for endometrial cancer among women with diabetes compared to non diabetic women was 1.94, 95% CI =1.23 to 3.08. Obese diabetics with low physical activity had a RR = 9.61, 95% CI=4.66 to 19.83, compared to non-obese, non-diabetic women with high physical activity. We performed a meta-analysis on diabetes and endometrial cancer, we identified 16 studies (3 cohort and 13 case-control studies), and found that diabetes was statistically significantly associated with an increased risk of endometrial cancer incidence, (summary RR = 2.10 95% CI= 1.75-2.53). Analysis of 2 studies of mortality found a summary RR= 1.58 95% CI 0.94-2.66 for diabetes and endometrial cancer mortality. We investigated the association of total physical activity and different types of physical activity with risk of endometrial cancer in the Swedish Mammography Cohort. After exclusions due to some missing physical activity estimates 33 723 women and 199 endometrial cancer cases were included in the analysis. Relative risks (RR) for endometrial cancer comparing the second to fourth quartiles of total physical activity to the lowest one were 0.80 (95% CI 0.541.18); 0.87 (95% CI 0.59-1.28); 0.79 (95% CI 0.53-1.17) respectively. High leisure time inactivity (watching TV/sitting 5 hours or more a day) compared to low was associated with increased risk of endometrial cancer RR=1.66 (95% CI 1.05-2.61). We observed a statistically significant association between diabetes and endometrial cancer in our cohort. Results from the meta-analysis support a relationship between diabetes and increased risk of endometrial cancer incidence. The similar point estimates from the cohort analysis and metaanalysis suggest that diabetes may be associated with a two-fold increased risk of endometrial cancer. Total physical activity was only weakly associated with a decreased risk of endometrial cancer, although leisure time inactivity was statistically significantly associated with increased risk for endometrial cancer. These findings support general health recommendations to reduce obesity and increase physical activity.
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| 19. |
- Friberg, Emilie
(författare)
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Diet and endometrial cancer : insulin related factors
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is accumulating evidence that insulin resistance and hyperinsulinemia are involved in the etiology of endometrial cancer. Dietary intake can influence insulin levels especially among individuals who are already insulin resistant. Coffee drinking has been reported to have beneficial effects on insulin sensitivity. Glycemic index and load are concepts developed to quantify the glycemic response and insulin demand to carbohydrates in different foods. A moderate alcohol intake has been shown to improve insulin sensitivity whereas a higher intake has been shown to increase estrogen levels which unbalanced by progesterone may increase the risk of endometrial cancer. In the analyses we used data from the Swedish Mammography Cohort, a populationbased prospective cohort study including over 60 000 women, born 1914-48, among whom 689 endometrioid adenocarcinoma cases were diagnosed through 2007 (17.6 years of followup). We examined the association between coffee consumption, carbohydrate intake, glycemic index, glycemic load and alcohol consumption at baseline 1987-90 and in 1997 and endometrial cancer risk using Cox proportional hazards models. To quantitatively summarize the association between alcohol, diabetes and the risk of endometrial cancer, we conducted meta-analyses of published studies. In the meta-analyses we identified studies by literature searches of the databases PubMed and Embase and by searching the reference lists of relevant articles. We summarized the relative risks (RRs) with 95% confidence intervals (CIs) using random-effects models and in the meta-analysis of alcohol also with a dose-response random-effect meta-regression model. Drinking four cups or more of coffee per day was overall associated with a 25% decreased risk of endometrial cancer as compared to one cup of coffee or less per day. The association seemed to be largely confined to overweight and obese women. We observed no overall association between carbohydrate intake, glycemic index, or glycemic load and the incidence of endometrial cancer. Among overweight and obese women with low physical activity, who completed the questionnaire in 1997, carbohydrate intake and glycemic load were positively related to endometrial cancer risk. In this subgroup, the RRs comparing extreme quartiles were 1.90 (95% CI 0.84-4.31) for carbohydrate intake and 2.99 (95% CI 1.17-7.67) for glycemic load. We observed no association between alcohol and endometrial cancer risk in the Swedish elderly study population with a generally low consumption. However, in the meta-analysis of alcohol and endometrial cancer incidence based on 7 cohort studies, we observed a statistically significant inverse association with low consumption as compared to nondrinkers and a higher risk associated with 2 drinks or more per day. In the meta-analysis of diabetes and endometrial cancer, based on 16 studies, we found that diabetes was significantly associated with an increased risk of endometrial cancer (summary RR 2.10 95% CI 1.75-2.53). The meta-analysis of type 1 diabetes and endometrial cancer was based on three studies and also found a significant positive association. In conclusion, our results indicate that dietary factors related to insulin resistance and hyperinsulinemia as well as diabetes may play an important role in the development of endometrial cancer. Hyperinsulinemia may stimulate proliferation of endometrial cells both through insulin-like growth factors and by increased levels of unbound estrogens.
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| 20. |
- Friberg, Emilie, et al.
(författare)
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Long-term Alcohol Consumption and Risk of Endometrial Cancer Incidence : A Prospective Cohort Study
- 2009
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Ingår i: Cancer Epidemiology, Biomarkers and Prevention. - : AMER ASSOC CANCER RESEARCH. - 1055-9965 .- 1538-7755. ; 18:1, s. 355-358
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Tidskriftsartikel (refereegranskat)abstract
- Alcohol consumption has been hypothesized to increase the risk of endometrial cancer. We used data from the prospective population-based Swedish Mammography Cohort including 61,226 women to examine the association between alcohol and endometrial cancer incidence. Alcohol consumption was assessed with validated food frequency questionnaires at baseline 1.987 to 1.990 and at follow-up in 1997. During a mean follow-up of 17.6 years, 687 endometrial cancer cases were identified in the Swedish cancer registries. We found no association between alcohol consumption and endometrial cancer risk after adjustment for age, body mass index, and smoking, The multivariable rate ratios (95% confidence intervals) for the three upper categories of long-term alcohol consumption as compared with no consumption were 1.01 (0.84-1.22) for <3.4 g/d, 1.01 (0.80-1.27) for 3.4 to 9.9 g/d, and 1.09 (0.71-1.67) for >= 1.0 g/d, respectively. The association did not differ by age, body mass index, folic acid intake, or postmenopausal hormone use in stratified analysis. In conclusion, our results suggest that low alcohol consumption (up to one drink per day) is unlikely to substantially influence risk of endometrial cancer. (Cancer Epidemiol Biomarkers Prev 2009;18(1):355-8)
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| 21. |
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| 22. |
- Friberg, Emilie, et al.
(författare)
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Physical activity and risk of endometrial cancer : A population-based prospective cohort study
- 2006
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Ingår i: Cancer Epidemiology, Biomarkers and Prevention. - Karolinska Inst, Div Nutr Epidemiol, Natl Inst Environm Med, SE-17177 Stockholm, Sweden. Harvard Univ, Sch Med, Div Endocrinol Diabet & Metab, Dept Med,Beth Israel Deaconess Med Ctr, Boston, MA 02115 USA. : AMER ASSOC CANCER RESEARCH. - 1055-9965 .- 1538-7755. ; 15:11, s. 2136-2140
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Tidskriftsartikel (refereegranskat)abstract
- Physical activity is involved in the regulation of metabolic and hormonal pathways and is one of the factors important for the maintenance of body weight; obesity is a risk factor for endometrial cancer. A connection between physical activity and endometrial cancer risk through hormonal mechanisms, possibly mediated by body weight, is biologically plausible. Only one study has investigated total physical activity, and no previous study has examined leisure time inactivity directly. We investigated the association of total physical activity and different types of physical activity with risk of endometrial cancer in the Swedish Mammography Cohort, a population-based prospective cohort, including 33,723 women and 199 endometrial cancer cases. After adjustments for potential confounders (age, body mass index, parity, history of diabetes, total fruit and vegetable intake, and education), the relative risks for endometrial cancer for the second to fourth quartile of total physical activity compared with the lowest one were 0.80 [95% confidence interval (95% CI), 0.54-1.18], 0.87 (95% CI, 0.59-1.28), and 0.79 (95% CI, 0.53-1.17). High leisure time inactivity (watching TV/sitting >= 5 hours daily) compared with low was associated with increased risk of endometrial cancer (relative risk, 1.66; 95% CI, 1.05-2.61). The associations were not modified by body mass index. Findings from this study suggest that total physical activity is weakly inversely associated with endometrial cancer risk and that leisure time inactivity is statistically significantly associated with increased risk for endometrial cancer.
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| 23. |
- Friberg, Emilie, et al.
(författare)
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Sucrose, High-Sugar Foods, and Risk of Endometrial Cancer-a Population-Based Cohort Study
- 2011
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Ingår i: Cancer Epidemiology, Biomarkers and Prevention. - : AMER ASSOC CANCER RESEARCH. - 1055-9965 .- 1538-7755. ; 20:9, s. 1831-1837
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Tidskriftsartikel (refereegranskat)abstract
- Background: Consumption of high-sugar foods stimulates insulin production, which has been associated with endometrial cancer. Although a relationship between sucrose, high-sugar food consumption, and endometrial cancer risk is biologically plausible, this hypothesis has previously been explored in very few studies. Methods: We used data from the Swedish Mammography Cohort, including 61,226 women aged 40 to 74 years. We examined the association between consumption of total sucrose, high-sugar foods (at baseline 1987-1990 and 1997) and endometrial cancer risk by using Cox proportional hazards models to estimate incidence rate ratios (RR) with 95% CI. Results: During 18.4 years of follow-up, 729 participants were diagnosed with incident endometrial cancer. Total sucrose intake and consumption of sweet buns and cookies was associated with increased risk of endometrial cancer. RRs (with 95% CIs) for consuming more than 35 grams of sucrose per day and consuming sweet buns and cookies more than 3 times per week were 1.36 (1.04-1.77) and 1.42 (1.15-1.75) as compared with less than 15 grams of sucrose per day and consuming sweet buns and cookies less than 0.5 times per week, respectively. RRs for consuming more than 15 grams of sucrose per day as compared with 15 grams or less were 1.97 (1.27-3.04) among obese women and 1.56 (1.20-2.04) among women with low fat intake. Conclusions: These data indicate that sucrose intake and consumption of sweet buns and cookies may be associated with increased risk of endometrial cancer. Impact: Given the high intake of sweetened foods, these results have public health implications in terms of prevention of endometrial cancer. Cancer Epidemiol Biomarkers Prev; 20(9); 1831-7. (C)2011 AACR.
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| 24. |
- Genkinger, Jeanine M., et al.
(författare)
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Long-term dietary heme iron and red meat intake in relation to endometrial cancer risk
- 2012
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Ingår i: American Journal of Clinical Nutrition. - : OXFORD UNIV PRESS. - 0002-9165 .- 1938-3207. ; 96:4, s. 848-854
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Tidskriftsartikel (refereegranskat)abstract
- Background: Heme and total iron, present in meat, have been hypothesized to promote carcinogenesis. Few prospective studies have examined the associations between intakes of heme and total iron, types of meat, and endometrial cancer risk. Objective: We evaluated the associations between intakes of heme and total iron, types of meat, and risk of endometrial cancer in a large cohort of women. Design: Among 60,895 women in the Swedish Mammography Cohort, 720 endometrial cancer cases were confirmed during 21 y of follow-up. RRs and 95% CIs were calculated by Cox proportional hazards models. Results: A comparison of the highest with the lowest quartile showed a 20-30% higher risk of endometrial cancer for higher intakes of heme iron (RR: 1.24; 95% CI: 1.01, 1.53 for >= 1.63 compared with <0.69 mg/d), total iron (RR: 1.31; 95% CI: 1.07, 1.61 for >= 15.09 compared with <12.27 mg/d), and liver (RR: 1.29; 95% CI: 1.06, 1.56 for >= 100 compared with <100 g/wk). No statistically significant associations were observed between intakes of red and processed meats and endometrial cancer risk. RRs did not greatly differ when we stratified by BMI, parity, and intakes of alcohol, vitamin C, or zinc or when we excluded patients with diabetes. Conclusions: Our study suggests a modest positive association between heme iron, total iron, and liver intakes and endometrial cancer risk; no statistically significant associations were observed for intakes of other red and processed meats and endometrial cancer risk. The Swedish Mammography Cohort was registered at clinicaltrials.gov as NCT01127698. Am J Clin Nutr 2012;96:848-54.
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| 25. |
- Gyllensten, Hanna, 1979, et al.
(författare)
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Comparing costs of illness of multiple sclerosis in three different years: A population-based study.
- 2018
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Ingår i: Multiple sclerosis. - : SAGE Publications. - 1477-0970 .- 1352-4585. ; 24:4, s. 520-528
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Tidskriftsartikel (refereegranskat)abstract
- Little is known about changes in the costs of illness (COI) among multiple sclerosis (MS) patients during recent years.To compare the COI among MS patients and matched controls in 2006, 2009, and 2012, respectively, indicating the costs attributable to the MS disease.Three cross-sectional datasets were analyzed, including all MS patients in Sweden aged 20-60years and five matched controls for each of them. The analyses were based on 10,531 MS patients and 52,655 matched controls for 2006, 11,722 and 58,610 individuals for 2009, and 12,789 and 63,945 for 2012. Nationwide registers, including prescription drug use, specialized healthcare, sick leave, and disability pension, were linked to estimate the prevalence-based COI.Adjusted for inflation, the average difference in COI between MS patients and matched controls were Swedish Krona (SEK) 243,751 (95% confidence interval: SEK 239,171-248,331) in 2006, SEK 238,971 (SEK 234,516-243,426) in 2009, and SEK 225,923 (SEK 221,630-230,218) in 2012. The difference in indirect costs were SEK 170,502 (SEK 166,478-174,525) in 2006, SEK 158,839 (SEK 154,953-162,726) in 2009, and SEK 141,280 (SEK 137,601-144,960) in 2012.The inflation-adjusted COI of MS patients was lower in 2012 than in 2006, in particular regarding indirect costs.
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