| 1. |
- Bergström, Gunnar, et al.
(författare)
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A comprehensive workplace intervention and its outcome with regard to lifestyle, health and sick leave : the AHA study
- 2008
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Ingår i: Work. - 1051-9815 .- 1875-9270. ; 31:2, s. 167-180
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Tidskriftsartikel (refereegranskat)abstract
- This study is a prospective multicentre cohort study entitled Work and Health in the Processing and Engineering Industries, the AHA Study (AHA is the Swedish abbreviation for the study). Four large workplaces in Sweden participated during the years from 2000 to 2003. The present report has two objectives: (1) to present a comprehensive occupational health intervention programme and (2) to evaluate this programme with a focus on lifestyle (smoking and exercise), health related quality of life (HRQoL) and sick leave. Interventions were provided on an individual and group level, including evidence-based methods for four health/focus areas (individual level) and a group intervention based on a survey-feedback methodology. The analyses in this report were exclusively employed at an organizational level. The proportion of smokers decreased at three companies and the course of the HRQoL was advantageous at two of the companies as compared to a gainfully employed reference group. A significant decrease in sick leave was revealed at one company, whereas a break in an ascending sick-leave trend appeared at a second company as compared to their respective corporate groups. This comprehensive workplace intervention programme appears to have had positive effects on smoking habits, HRQoL and sick leave.
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| 2. |
- Blom, Victoria, 1975-, et al.
(författare)
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Genetic susceptibility to burnout in a Swedish twin cohort
- 2012
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Ingår i: European Journal of Epidemiology. - : Springer. - 0393-2990 .- 1573-7284. ; 27:3, s. 225-231
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Tidskriftsartikel (refereegranskat)abstract
- Most previous studies of burnout have focused on work environmental stressors, while familial factors so far mainly have been overlooked. The aim of the study was to estimate the relative importance of genetic influences on burnout (measured with Pines Burnout Measure) in a sample of monozygotic (MZ) and dizygotic (DZ) Swedish twins. The study sample consisted of 20,286 individuals, born 1959–1986 from the Swedish twin registry who participated in the cross-sectional study of twin adults: genes and environment. Probandwise concordance rates (the risk for one twin to be affected given that his/her twin partner is affected by burnout) and within pair correlations were calculated for MZ and DZ same—and opposite sexed twin pairs. Heritability coefficients i.e. the proportion of the total variance attributable to genetic factors were calculated using standard biometrical model fitting procedures. The results showed that genetic factors explained 33% of the individual differences in burnout symptoms in women and men. Environmental factors explained a substantial part of the variation as well and are thus important to address in rehabilitation and prevention efforts to combat burnout.
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| 3. |
- Blom, Victoria, et al.
(författare)
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The Importance of Genetic and Shared Environmental Factors for the Associations between Job Demands, Control, Support and Burnout.
- 2013
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Ingår i: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 8:9, s. e75387-
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Tidskriftsartikel (refereegranskat)abstract
- Within occupational health research, one of the most influential models is the Job Demands-Control-Support model. Numerous studies have applied the model to different domains, with both physical and psychological health outcomes, such as burnout. The twin design provides a unique and powerful research methodology for examining the effects of environmental risk factors on burnout while taking familial factors (genetic and shared environment) into account. The aim of the present study was to investigate the impact of familial factors on the associations of burnout with job demands, control and support. A total of 14 516 individuals from the Swedish Twin Registry, who were born between 1959 and 1986, and who participated in the Study of Twin Adults: Genes and Environment (STAGE) by responding to a web-based questionnaire in 2005, were included in the analyses. Of these, there were 5108 individuals in complete same-sex twin pairs. Co-twin control analyses were performed using linear mixed modeling, comparing between-pairs effects and within-pair effects, stratified also by zygosity and sex. The results indicate that familial factors are of importance in the association between support and burnout in both women and men, but not between job demands and burnout. There are also tendencies towards familial factors being involved in the association between control and burnout in men. These results offer increased understanding of the mechanisms involved in the associations between work stress and burnout.
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| 4. |
- Bodin Danielsson, Christina, et al.
(författare)
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Difference in satisfaction with office environment among employees in different office types
- 2009
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Ingår i: Journal of Architectural and Planning Research. - 0738-0895. ; 26:3, s. 241-257
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Tidskriftsartikel (refereegranskat)abstract
- Differences between office types may have an influence on the employees' satisfaction and psychological responses with respect to different aspects of the office environment. For this study, 469 employees rated their perceptions of and satisfaction with the office environments of seven different office types, which were classified as cell-office, shared-room office, small open-plan office, medium open-plan office, large open-plan office, flex-office, and combi-office. Three domains of environmental factors were analyzed: (1) ambient factors, (2) noise and privacy, and (3) design-related factors. Employee responses were evaluated using multivariate logistic and Poisson regression., Adjustments were made for potential confounders such as age, gender job rank, and line of business. Substantial differences between employees in different office types were found The analysis of frequencies in complaints within the three domains shows that noise and privacy is the domain that causes the most dissatisfaction among office employees. Cell-office employees are most satisfied with the physical environment overall, followed by those in flex-office. However the results for cell-office are not uniformly best, since they score low with regard to the social aspects of design-related factors and, in particular on support of affinity. The most dissatisfaction is reported in medium and large open-plan offices, where the complaints about noise and lack of privacy are especially negative. Architectural and functional features of the offices are discussed as the main explanatory factors for these results.
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| 5. |
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| 6. |
- Bodin Danielsson, Christina, et al.
(författare)
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Office-type in Relation to Health, Well-being and Job Satisfaction Among Employees
- 2008
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Ingår i: Environment and Behavior. - : SAGE Publications. - 0013-9165 .- 1552-390X. ; 40, s. 636-668
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Tidskriftsartikel (refereegranskat)abstract
- This article investigates the hypothesis that office type has an influence on workers’ health status and job satisfaction and 469 employees in seven different types, defined by their unique setup of architectural and functional features, have rated their health status and job satisfaction. Multivariate regression models were used for analysis of these outcomes, with adjustment for age, gender, job rank, and line of business. Both health status and job satisfaction differed between the seven office types. Lowest health status was found in medium-sized and small open plan offices. Best health was among employees in cell offices and flex offices. Workers in these types of offices and in shared room offices also rated the highest job satisfaction. Lowest job satisfaction was in combi offices, followed by medium-sized open plan offices. The differences between employees could possibly be ascribed to variations in architectural and functional features of the office types.
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| 7. |
- Bodin Danielsson, Christina, et al.
(författare)
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Office type in relation to health, well-being, and job satisfaction among employees : Erratum
- 2010
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Ingår i: Environment and Behavior. - : Sage Publications. - 0013-9165 .- 1552-390X. ; 42:6, s. 887-887
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Tidskriftsartikel (refereegranskat)abstract
- Reports an error in "Office type in relation to health, well-being, and job satisfaction among employees" by Christina Bodin Danielsson and Lennart Bodin (Environment and Behavior, 2008[Sep], Vol 40[5], 636-668). In the original article, a symbol was missing from Table 7 on p. 654. In that table, an open circle ("o") should have been present to show that the odds ratio indicated low risk for having poor quality of sleep among those who worked in the flex office. The corrected table is present in the erratum. (The following abstract of the original article appeared in record 2008-12036-003). This article investigates the hypothesis that office type has an influence on workers' health status and job satisfaction and 469 employees in seven different types, defined by their unique setup of architectural and functional features, have rated their health status and job satisfaction. Multivariate regression models were used for analysis of these outcomes, with adjustment for age, gender, job rank, and line of business. Both health status and job satisfaction differed between the seven office types. Lowest health status was found in medium-sized and small open plan offices. Best health was among employees in cell offices and flex offices. Workers in these types of offices and in shared room offices also rated the highest job satisfaction. Lowest job satisfaction was in combi offices, followed by medium-sized open plan offices. The differences between employees could possibly be ascribed to variations in architectural and functional features of the office types. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
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| 8. |
- Bodin Danielsson, Christina, 1969-
(författare)
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The Office - An Explorative Study : Architectural Design's Impact on Health, Job Satisfaction & Well-being
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This doctoral thesis examines the office environment’s influence on employees’ perception oftheir workplaces, their organizations and their job satisfaction, as well as their health and wellbeing.It is based on an empirical study of 491 office employees from twenty-six companies anddivisions in large companies. Seven office types, defined by their architectural and functionalfeatures, are represented in the study group: cell-office, shared-room office, small open planoffice, medium-sized open plan office, large open plan office, flex-office and combi-office. Theresearch has its basis in architecture, although an interdisciplinary approach using organizationaland management theory, environmental psychology, and social and stress medicine has beenemployed. Qualitative (Articles I & V) and quantitative methods(Articles II & IV) were used.The thesis also contains an explorative, review article. Thus it comprises all in all five articles.Article I is an analysis of the importance of architectural quality for employees´ perceptionand experience of the office using Lynch’s method (1960) developed to measure inhabitants’perception of architectural quality in cities. The study shows that in the office the experienceto a high degree is independent of both the scale of the office and office type; instead it isdetermined by the quality of the plan layout combined with the quality of other design features.It also shows Lynch’s method to be useful in foreseeing where the elements that reinforce‘imageability’ will most likely appear in an office environment.Article II investigates employees’ environmental satisfaction focusing on:1) ambient factors; 2) noise and privacy; and 3) design-related factors. The results, based onregression models with age, gender, job rank and line of business as additional covariates,show office type as a factor with a statistically significant impact on satisfaction with the officeenvironment. Employees in cell-offices are prominently most satisfied, followed by those inflex-offices, cell-offices rate low only on social aspects of design-related factors. A major findingis the internal differences between office types where employees share workspace and facilitieswith lowest satisfaction in medium-sized and large open plan offices.Article III is a review article that analyzes the employees’ office experiences in two ways:1) by framing the physical work environment’s influence on employees into the model oforganizational theorist Davis (1994); and 2) by categorizing the office experience into twogroups based on the nature of the experience and problems related to them. The results of theemperical study presented in Article II are the basis for the discussion in this article.Article IV examines employees’ health, well-being and job satisfaction. A multivariateanalysis applied to the study sample and equivalent to that of Article II shows significantly higherrisks for ill health and poor well-being in medium-sized and small open plan offices, comparedespecially with cell-office. In medium-sized open plan and combi-offices the employees evincethe lowest job satisfaction. The best chance for good health status and job satisfaction is in cellofficesand flex-offices.Article V examines the office architecture´s importance for employees’ perception of theirown workplaces and organizations based on the two key components of architecture—theaesthetical and functional dimensions. The results show that overall the employees had positiveexperiences of their office environments. These mainly concerned the aesthetical dimension,whereas the negative comments dealt with the functional dimension. The aesthetical dimensionappears not only to set the agenda for employees’ perception of the workplace and organizationas a whole, but also for the perception of the functional dimensions. The functional dimensionswere only in focus when the workstation and its proximate area were discussed.
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| 9. |
- Bodin Danielsson, Christina, et al.
(författare)
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The relation between office type and workplace conflict : A gender and noise perspective
- 2015
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Ingår i: Journal of Environmental Psychology. - : Elsevier BV. - 0272-4944 .- 1522-9610. ; 42, s. 161-171
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Tidskriftsartikel (refereegranskat)abstract
- This exploratory study aimed to investigate the impact of the office design on workplace conflicts, with a special attention to noise in the office. A gender perspective was applied. The sample consisted of 5229 employees from the Swedish Longitudinal Occupational Survey of Health 2010 (SLOSH), working in different office types. In the multivariate analysis office type was used as the explanatory variable with adjustments for age, supervisory position and labour market sector. Analysis stratified for gender was used. Among women a significant impact of office type per se on workplace conflicts was found, but not among men. For women several office types differed significantly from the cell-office with regard to prevalence of conflicts during the past two years, but for men only the combi-office differed from the cell-office. Noise had an impact on workplace conflicts, but is not the only explanatory factor since the effect of office type remained also after adjustment for noise in multivariate analyses. Other environmental factors inherent in the office type might thus explain the occurrence of conflicts.
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| 10. |
- Franzén, Lennart E., et al.
(författare)
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Characterization of colon carcinoma growth pattern by computerized morphometry : definition of a complexity index
- 2008
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Ingår i: International Journal of Molecular Medicine. - : Spandidos Publications. - 1107-3756 .- 1791-244X. ; 22:4, s. 465-472
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Tidskriftsartikel (refereegranskat)abstract
- The invasive front of carcinomas may vary in complexity from smooth to highly complex when the front splits up into small cell clusters or even single cancer cells. The degree of complexity is usually estimated visually and semiquantitatively by a pathologist, although more objective methods based on computer-assisted image analysis are available. In this study, we compared the visual estimation of the irregularity of the tumour invasion front of colon carcinomas to different quantitative image analytical techniques and defined a complexity index for the invasive margin. Sections from 29 archived colon carcinomas were stained immunohistochemically for cytokeratin 8. Images of the tumour invasion front were read into a computer and thresholded so that the tumour tissue became black and the background white or so that the tumour front was outlined by a single pixel line. The invasive front was visually classified into four degrees of irregularity by a pathologist. The complexity of the front was then assessed using four different image analysis techniques, i.e. the estimation of fractal dimension, tumour front length, number of tumour cell clusters and lacunarity. Fractal dimension and tumour cell clusters together gave the best correlation to visual grading using a discriminant analysis. A cluster analysis and a tree diagram analysis were then performed and were found to be superior to visual estimation. The clusters represent different degrees of complexity and the result of the tree diagram analysis can be used to assign complexity indices to colon tumours. The fractal dimension separated tumours up to a certain level (1.5-1.6) of complexity. When the tumour front split up into small cell clusters, the counting of tumour cell clusters separated the cells over and above the fractal dimension. This new technique can be used to objectively and quantitatively describe the complexity of the invasive front of tumours.
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| 11. |
- Franzén, Lennart E, et al.
(författare)
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Semiquantitative evaluation overestimates the degree of steatosis in liver biopsies : a comparison to stereological point counting.
- 2005
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Ingår i: Modern Pathology. - : Elsevier BV. - 0893-3952 .- 1530-0285. ; 18:7, s. 912-916
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Tidskriftsartikel (refereegranskat)abstract
- The degree of steatosis in liver biopsies is usually assessed by a morphological semiquantitative approach in which the histopathologist uses a four-graded scale: 0-3 or none, slight, moderate and severe. Scores 1-3 are considered to correspond to fat deposition in <33, 33-66 and >66% of the hepatocytes. There is a considerable inter- and intra-individual variation in such scoring methods and a more standardized and quantitative approach is preferable. In the present study, we compare the semiquantitative technique with the stereological point counting method in the assessment of hepatic steatosis. A total of 75 archived liver needle biopsies were used. They were selected according to the original routine diagnosis of slight, moderate or severe steatosis. In all, 10 randomly selected images from each biopsy were digitized into a computer, a point grid lattice was superimposed and the number of hits on fat globules was counted. A pathologist scored the specimens in a four-graded scale as described above. The mean liver biopsy area (volume) with fat in hepatocytes was 2.2% for grade 1, 9.2% for grade 2 and 23.1% for grade 3. The kappa value for the semiquantitative estimates was 0.71 for the unweigthed kappa and 0.87 for weighted kappa. The intraclass correlation coefficient (ICC) was 0.99 for images counted twice and 0.95 when two sets of images were captured from the same biopsy. These ICCs indicate excellent agreement and above that of the semiquantitative estimates. In conclusion, the area/volume of fat content of the hepatocytes is greatly overemphasized in semiquantitative estimation. Furthermore, the point counting technique has a better reproducibility than visual evaluation and should be preferred in estimates of liver steatosis in scientific studies and in clinical contexts when the amount of steatosis is important for treatment and prognosis, such as liver transplantation.
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| 12. |
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| 13. |
- Hahn-Strömberg, Victoria, et al.
(författare)
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Disturbed expression of E-cadherin, beta-catenin and tight junction proteins in colon carcinoma is unrelated to growth pattern and genetic polymorphisms
- 2008
-
Ingår i: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS). - : Wiley. - 0903-4641 .- 1600-0463. ; 116:4, s. 253-262
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Tidskriftsartikel (refereegranskat)abstract
- Adhesion proteins are responsible for the structural integrity of epithelial tissue and in tumors this integrity is often lost, resulting in a disorganization of the tissue. In the present study the complexity of the invasive front of colon carcinomas was correlated with cell adhesion protein expression and with polymorphisms in their genes. A complexity index was constructed from 32 colon carcinomas using computer-assisted morphometry estimating fractal dimension and tumor cell clusters followed by tree analysis. Immunohistochemical staining of beta-catenin, E-cadherin, occludin and claudin 2 was used for assessment of protein expression. Genetic screening of tissue from the tumor invasion front with laser microdissection was performed using SSCP and DNA sequencing. Adhesion protein distribution was significantly disturbed in most carcinomas. A single mutation in the gene of beta-catenin was found but there was no correlation between protein expression and genetic polymorphism. Nor was there any correlation between the complexity of the invasive border and protein distribution or genetic alterations. The results indicate that the complexity of colon carcinoma invasion is not dependent on genetic derangements in the genes of adhesion proteins or the protein distribution. Rather, aberrations in the function of other proteins related to the adhesive proteins could be responsible.
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| 14. |
- Hahn-Strömberg, Victoria, et al.
(författare)
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Tumor volume of colon carcinoma is related to the invasive pattern but not to the expression of cell adhesion proteins
- 2009
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Ingår i: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS). - : Wiley-Blackwell Publishing Inc.. - 0903-4641 .- 1600-0463. ; 117:3, s. 205-211
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Tidskriftsartikel (refereegranskat)abstract
- Tumor volume increases during growth and due to tumor progression various mutations appear that may cause phenotypic changes. The invasive pattern may thus be affected resulting in a more disorganized growth. This phenomenon might be due to mutations in the genome of the adhesion proteins, which are responsible for the structural integrity of epithelial tissue. Tumor volume was assessed in whole mount sections of 33 colon carcinomas using Cavalieri's principle. Images from the entire invasive border were captured and used for calculating the irregularity of the border (Complexity Index). The expression of the adhesion proteins E-cadherin, beta-catenin, Claudin 2 and Occludin was assessed after immunohistochemical staining of two randomly selected areas of the invasive front of the tumor. Statistical significance for differences in volume was obtained for tumor Complexity Index, tumor stage (pT) and lymph node status (pN). Expression of adhesion proteins was significantly perturbed in the tumors compared with normal mucosa but only infrequently correlated to tumor differentiation or invasive pattern. The results show that when tumor volume increases the invasive pattern becomes more irregular which is compatible with tumor progression. A direct contribution of adhesion protein derangement to this process appears to be insignificant.
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| 15. |
- Linton, Steven J., 1952-, et al.
(författare)
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Psychological factors related to health, back pain, and dysfunction
- 1994
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Ingår i: Journal of occupational rehabilitation. - : Springer. - 1053-0487 .- 1573-3688. ; 4:1, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Psychosocial variables may be important determinants of experienced back pain as well as dysfunction. This paper reports on differences on a battery of psychosocial variables between women, from the same work place, off work because of back pain, having only back pain (not off work), and those without back pain. The groups suffering pain had similar levels of pain intensity and frequency and the covariates of age and work load were used in MANCOVA analyses. The results showed significant overall differences on the Coping Strategies Questionnaire, Handicap Index, Duke Health Profile, as well as items concerning family support and the relation of pain to work. Several variables differed between the Healthy group on the one hand and the two groups suffering pain on the other hand. However, coping strategies and perceived health produced significant differences between all three groups in univariate analyses. Unlike other studies the Work APGAR produced no significant results. These data suggest that work status is not directly related to pain intensity, but rather to an interaction between psychosocial factors and the pain experience. Future research should delineate which variables may be used in screening.
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| 16. |
- Magnusson, Magnus, et al.
(författare)
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Predicting grey-sided vole occurrence in northern Sweden at multiple spatial scales
- 2013
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Ingår i: Ecology and Evolution. - Hoboken, USA : Wiley-Blackwell Publishing Inc.. - 2045-7758. ; 3:13, s. 4365-4376
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Tidskriftsartikel (refereegranskat)abstract
- Forestry is continually changing the habitats for many forest-dwelling species around the world. The grey-sided vole (Myodes rufocanus) has declined since the 1970s in forests of northern Sweden. Previous studies suggested that this might partly be caused by reduced focal forest patch size due to clear-cutting. Proximity and access to old pine forest and that microhabitats often contains stones have also been suggested previously but never been evaluated at multiple spatial scales. In a field study in 2010–2011 in northern Sweden, we investigated whether occurrence of grey-sided voles would be higher in (1) large focal patches of >60 years old forest, (2) in patches with high connectivity to sur- rounding patches, and (3) in patches in proximity to stone fields. We trapped animals in forest patches in two study areas (V€asterbotten and Norrbotten). At each trap station, we surveyed structural microhabitat characteristics. Land- scape-scale features were investigated using satellite-based forest data combined with geological maps. Unexpectedly, the vole was almost completely absent in Norrbotten. The trap sites in Norrbotten had a considerably lower amount of stone holes compared with sites with voles in V€asterbotten. We suggest this might help to explain the absence in Norrbotten. In V€asterbotten, the distance from forest patches with voles to stone fields was significantly shorter than from patches without voles. In addition, connectivity to surrounding patches and size of the focal forest patches was indeed related to the occurrence of grey-sided voles, with connectivity being the overall best predictor. Our results support previous findings on the importance of large forest patches, but also highlight the importance of connectivity for occurrence of grey-sided voles. The results further suggest that proximity to stone fields increase habitat quality of the forests for the vole and that the presence of stone fields enhances the voles’ ability to move between nearby forest patches through the matrix
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| 17. |
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| 18. |
- Svedberg, Pia, et al.
(författare)
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Genetic and environmental influences on the association between performance-based self-esteem and exhaustion : A study of the self-worth notion of burnout
- 2016
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Ingår i: Scandinavian Journal of Psychology. - : John Wiley & Sons. - 0036-5564 .- 1467-9450. ; 57:5, s. 419-426
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Tidskriftsartikel (refereegranskat)abstract
- In the self-worth model, burnout is considered to be a syndrome of performance-based self-esteem (PBSE) and experiences of exhaustion. Studies have shown that PBSE and burnout indices such as Pines' Burnout Measure (BM) are associated. Whether these variables have overlapping etiologies has however not been studied before. Genetic and environmental components of covariation between PBSE and exhaustion measured with Pines' BM were examined in a bivariate Cholesky model using data from 14,875 monozygotic and dizygotic Swedish twins. Fifty-two per cent of the phenotypic correlation (r = 0.41) between PBSE and Pines' BM was explained by genetics and 48% by environmental factors. The findings of the present study strengthen the assumption that PBSE should be considered in the burnout process as proposed by the self-worth conception of burnout. The present results extend our understanding of the link between this contingent self-esteem construct and exhaustion and provide additional information about the underlying mechanisms in terms of genetics and environment. This finding corroborates the assumed syndrome view on burnout, while it also suggests an altered view of how the syndrome emerges and how it can be alleviated.
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| 19. |
- Ahlsson, Anders J., et al.
(författare)
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Postoperative atrial fibrillation is not correlated to C-reactive protein
- 2007
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 0003-4975 .- 1552-6259. ; 83:4, s. 1332-1337
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The peak incidence of postoperative atrial fibrillation (AF) occurs around the second postoperative day, a time at which serum inflammatory markers are elevated. The aim of this study was to investigate differences between patients with and without postoperative AF with special regard to C-reactive protein (CRP) serum levels. METHODS: The study cohort included all heart surgery patients who had sinus rhythm preoperatively, survived postoperative day 3, and were operated on between July 1, 2004, and June 30, 2005 (n = 524). Any episode of AF during the first 7 postoperative days defined the patient as belonging to the postoperative AF group. Creatine kinase-myocardial band (CK-MB) was measured at postoperative day 1, and CRP was measured preoperatively and at postoperative day 3. Risk factors for postoperative AF were determined using bivariate and multivariate regression analysis. RESULTS: Of 524 patients, 182 had at least one episode of AF (34.7%). Preoperative and postoperative CRP concentrations did not differ between the groups (postoperative CRP 175.4 +/- 64.4 versus 175.3 +/- 60.1 mg/L respectively, p = 0.99). Atrial fibrillation patients were significantly older (p < 0.001) and had higher CK-MB levels (33.6 +/- 53.1 microg/L versus 22.5 +/- 26.7 microg/L, respectively, p = 0.009). The odds ratio for postoperative AF with postoperative CK-MB greater than 70 microg/L was 3.5 (confidence interval: 1.4 to 8.6). CONCLUSIONS: Postoperative AF has no correlation to the inflammatory marker CRP in heart surgery patients. Ischemic myocardial injury might predispose for postoperative AF.
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| 20. |
- Ahlsson, Anders, 1962-, et al.
(författare)
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Patients with postoperative atrial fibrillation have a doubled cardiovascular mortality
- 2009
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Ingår i: Scandinavian cardiovascular journal : SCJ. - : Informa UK Limited. - 1651-2006 .- 1401-7431. ; 43:5, s. 330-336
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To investigate the impact of postoperative AF on late mortality and cause of death in CABG patients.DESIGN: All CABG patients without preoperative AF surgically treated between January 1, 1997 and June 30, 2000 were included (N = 1419). Altogether, 419 patients (29.5%) developed postoperative AF. After a median follow-up of 8.0 years, survival data were obtained, causes of death were compared and Cox proportional hazard analysis was used to determine predictors of late mortality.RESULTS: The total mortality was 140 deaths/419 patients (33.4%) in postoperative AF patients and 191 deaths/1 000 patients (19.1%) in patients without AF. Death due to cerebral ischemia (2.6% vs. 0.5%), myocardial infarction (7.4% vs. 3.0%), sudden death (2.6% vs. 0.9%), and heart failure (6.7% vs. 2.7%) was more common among postoperative AF patients. Postoperative AF was an age-independent risk indicator for late mortality with a hazard ratio (HR) of 1.56 (95% confidence interval 1.23-1.98).CONCLUSIONS: Postoperative AF is an age-independent risk factor for late mortality in CABG patients, explained by an increased risk of cardiovascular death.
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| 21. |
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| 22. |
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| 23. |
- Ahlsson, Anders, 1962-, et al.
(författare)
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Postoperative atrial fibrillation in patients undergoing aortocoronary bypass surgery carries an eightfold risk of future atrial fibrillation and a doubled cardiovascular mortality
- 2010
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940 .- 1873-734X. ; 37:6, s. 1353-1359
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This article presents a study of postoperative atrial fibrillation (AF) and its long-term effects on mortality and heart rhythm.METHODS: The study cohort consisted of 571 patients with no history of AF who underwent primary aortocoronary bypass surgery from 1999 to 2000. Postoperative AF occurred in 165/571 patients (28.9%). After a median follow-up of 6 years, questionnaires were obtained from 91.6% of surviving patients and an electrocardiogram (ECG) from 88.6% of all patients. Data from hospitalisations due to arrhythmia or stroke during follow-up were analysed. The causes of death were obtained for deceased patients.RESULTS: In postoperative AF patients, 25.4% had atrial fibrillation at follow-up compared with 3.6% of patients with no AF at surgery (p<0.001). An episode of postoperative AF was the strongest independent risk factor for development of late AF, with an adjusted risk ratio of 8.31 (95% confidence interval (CI) 4.20-16.43). Mortality was 29.7% (49 deaths/165 patients) in the AF group and 14.8% (60 deaths/406 patients) in the non-AF group (p<0.001). Death due to cerebral ischaemia was more common in the postoperative AF group (4.2% vs 0.2%, p<0.001), as was death due to myocardial infarction (6.7% vs 3.0%, p=0.041). Postoperative AF was an age-independent risk factor for late mortality, with an adjusted hazard ratio of 1.57 (95% CI 1.05-2.34).CONCLUSIONS: Postoperative AF patients have an eightfold increased risk of developing AF in the future, and a doubled long-term cardiovascular mortality.
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| 24. |
- Alipour, Akbar, et al.
(författare)
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The transitional pattern of pain and disability, from perceived pain to sick leave : Experience from a longitudinal study
- 2013
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Ingår i: Journal of Back and Musculoskeletal Rehabilitation. - : IOS Press. - 1053-8127 .- 1878-6324. ; 26:4, s. 411-419
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate the prospective value of the transitional and dynamic patterns of pain disability over time on sick leave in chronic recurrent back/neck pain cases.Methods: The material used was based on a longitudinal study with three repeated measurements. The graded Chronic Pain Scale was used to assess levels of pain disability. The relationship between the transitional patterns of the pain disability score ( ten defined states of decrease, increase or no change, between two time points) and sick leave was analyzed for 909 chronic/recurrent cases in three different models using logistic regression. Results: Those with high level of pain disability have a more transitional pattern and their pain level changed during the time period studied. When adjusting for age, gender, education and previous sick leave, the final model indicated that the current level of pain disability was a risk factor in taking sick leave. The likelihood of sick leave was highest in the transition of pain into the highest levels of disability, independent of past disability level of pain. Earlier sick leave remained as an important predictor of sick leave.Conclusions: From a clinical and prognostic perspective the probability of sick leave will be different and can be predicted based on previous sick leave but not from former history of pain disability level or its transitional pattern.
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| 25. |
- Almroth, Henrik, et al.
(författare)
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Safety of flecainide for atrial fibrillation : the Swedish atrial fibrillation cohort study
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background Little is known about the safety of flecainide in atrial fibrillation (AF). Whether current flecainide treatment practice in Sweden is associated with increased mortality compared to treatment with beta-blockers alone was investigated in patients with atrial fibrillation (AF).Methods and Results A total of 182,678 patients diagnosed with AF between 1 July 2005 and 31 December 2008 were identified through the Swedish National Hospital Discharge Register. These data were matched to data from the Prescribed Drug Register and information about death from the Total Population Register. The primary outcome was all cause mortality at the end of the study period, 1 Feb 2010. Flecainide was prescribed to 5381 patients (2.9%), and 64,918 patients (45.7%) received beta-blockers only. During follow-up, 2.8% and 30.8% of these patients died, respectively. After coarsened and exact matching, 2,178 patients (1.2% of total) on flecainide and beta-blockers had more similar baseline characteristics to 27,313 patients (15.3% of total) on beta-blockers only. In the main analysis, flecainide exposure was not associated with increased mortality (OR 0.27, 95% CI 0.21-0.36,P<0.001). In the matched flecainide population, 205 (9.4%) patients had underlying structural heart disease. Sixteen (28.6%) of the flecainide-exposed patients who died had structural heart disease. The patients who only received flecainide (n=264) had higher mortality rate than the patients who received flecainide and beta-blockers (6.8 versus 2.6%,P<0.001).Conclusions Flecainide is not associated with increased mortality in patients with AF compared to beta-blockers alone. Patients who die after receiving flecainide often have structural heart disease.
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| 26. |
- Amcoff, Karin, 1975-, et al.
(författare)
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Concordance in Anti-OmpC and Anti-I2 Indicate the Influence of Genetic Predisposition : Results of a European Study of Twins with Crohn's Disease
- 2016
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Ingår i: Journal of Crohn's & Colitis. - Oxford, United Kingdom : Oxford University Press. - 1873-9946 .- 1876-4479. ; 10:6, s. 695-702
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aims: An adaptive immunological response to microbial antigens has been observed in Crohn's disease (CD). Intriguingly, this serological response precedes the diagnosis in some patients and has also been observed in healthy relatives. We aimed to determine whether genetic factors are implicated in this response in a CD twin cohort.Methods: In total, 82 twin pairs (Leuven n = 13, Maastricht n = 8, Örebro n = 61) took part: 81 pairs with CD (concordant monozygotic n = 16, discordant monozygotic n = 22, concordant dizygotic n = 3, discordant dizygotic n = 40) and 1 monozygotic pair with both CD and ulcerative colitis. Serology for Pseudomonas fluorescens-related protein (anti-I2), Escherichia coli outer membrane porin C (anti-OmpC), CBir1flagellin (anti-CBir1) and antibodies to oligomannan (anti-Saccharomyces cerevisiae antibody [ASCA]) was determined by standardized enzyme-linked immunoassay.Results: All markers were more often present in CD twins than in their healthy twin siblings. Using the intraclass correlation coefficient (ICC), agreements in concentrations of anti-OmpC and anti-I2 were observed in discordant monozygotic but not in discordant dizygotic twin pairs with CD (anti-OmpC, ICC 0.80 and -0.02, respectively) and (anti-I2, ICC 0.56 and 0.05, respectively). In contrast, no agreements were found in anti-CBir, immunoglobulin (Ig) G ASCA and ASCA IgA.Conclusions: We show that anti-I2 and anti-CBir1 statuses have specificity for CD and confirm previous reported specificities for anti-OmpC and ASCA. Based on quantitative analyses and observed ICCs, genetics seems to predispose to the anti-OmpC and anti-I2 response but less to ASCA and anti-CBir1 responses.
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| 27. |
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| 28. |
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| 29. |
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| 30. |
- Arbeus, Mikael, et al.
(författare)
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Five-year patency for the no-touch saphenous vein and the left internal thoracic artery in on- and off-pump coronary artery bypass grafting
- 2021
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Ingår i: Journal of cardiac surgery. - : Wiley-Blackwell Publishing Inc.. - 0886-0440 .- 1540-8191. ; 36:10, s. 3702-3708
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Randomized trials show high long-term patency for no-touch saphenous vein grafts in coronary artery bypass grafting. The patency rate in off-pump coronary bypass surgery for these grafts has not been investigated. Our center participated in the CORONARY randomized trial, NCT00463294. This is a study aimed to assess the patency of no-touch saphenous veins in on- versus off-pump coronary bypass surgery at five-year follow-up.METHODS: Fifty-six patients were included. Forty of 49 patients, alive at 5 years, participated in this follow-up. There were 21 and 19 patients in the on- and off-pump groups respectively. No-touch saphenous veins were used to bypass all targets and in some cases the left anterior descending artery. Graft patency according to distal anastomosis was evaluated with computed tomography angiography.RESULTS: The five-year patency rate was 123/139 (88.5%). The patency for the no-touch vein grafts was 57/64 (89.1%) in the on-pump versus 37/45 (82.2%) in the off-pump group. All left internal thoracic arteries except for one, 29/30 (96.6%), were patent. All vein grafts used to bypass the left anterior descending and the diagonal arteries were patent 32/32. The lowest patency rate for the saphenous veins was to the right coronary territory, particularly in off-pump surgery (80.0% vs. 62.5% for the on- respective off-pump groups).CONCLUSIONS: Comparable 5-year patency for the no-touch saphenous veins and the left internal thoracic arteries to the left anterior descending territory in both on- and off-pump coronary artery bypass grafting. Graft patency in off-pump CABG is lower to the right coronary artery.
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| 31. |
- Arbeus, Mikael, et al.
(författare)
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Milrinone Increases Flow in Coronary Artery Bypass Grafts After Cardiopulmonary Bypass : A Prospective, Randomized, Double-Blind, Placebo-Controlled Study
- 2009
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : Elsevier BV. - 1053-0770 .- 1532-8422. ; 23:1, s. 48-53
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare the effects of a bolus of milrinone, 50 mu g/kg, versus placebo on flow in coronary artery bypass grafts after cardiopulmonary bypass (CPB). Design: A prospective, randomized, double-blind study. Setting: A university hospital. Participants: Forty-four patients with stable angina and left ventricular ejection fraction > 30% scheduled for elective coronary artery bypass graft (CABG) surgery were included. Intervention: Patients were randomized to receive 50 mu g/kg of milrinone (n = 22) or placebo (n = 22) after aortic declamping. Measurements and Main Results: The flow in coronary artery bypass grafts was measured with a transit time flow meter at 10 minutes and 30 minutes after termination of CPB. The hemodynamic evaluation included transesophageal echocardiography, mean arterial pressure (MAP), heart rate, and intracavitary measurement of left ventricular end-diastolic pressure (LVEDP). The flow in the saphenous vein grafts was significantly higher in the milrinone group when compared with the placebo group both at 10 and 30 minutes after termination of CPB (p < 0.001). At 10 minutes, the flow was 64.5 +/- 37.4 mL/min (mean +/- standard deviation) and 43.6 +/- 25.7 mL/min in nonsequential vein grafts for milrinone and placebo, respectively. Corresponding values at 30 minutes were 54.8 +/- 29.9 mL/min and 35.3 +/- 22.4 mL/min. The left internal thoracic artery (LITA) flow was higher in the milrinone group but did not reach statistical significance. The fractional area change was higher, and the MAP and calculated pressure gradient (MAP-LVEDP) were lower at 10 minutes in the milrinone group. Conclusion: Milrinone significantly increases the flow in anastomosed saphenous vein grafts after CPB, and has beneficial effects on left ventricular function.
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| 32. |
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| 33. |
- Arvidsson, Bo, 1962-, et al.
(författare)
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Reference data for bone mineral density in Swedish women using digital X-ray radiometry
- 2013
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Ingår i: Journal of clinical densitometry. - New York, USA : Elsevier. - 1094-6950 .- 1559-0747. ; 16:2, s. 183-188
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Tidskriftsartikel (refereegranskat)abstract
- During the last decade, digital X-ray radiometry (DXR) has been used to measure bone mineral density (BMD) in the metacarpal bones. The aim of this study was to establish Swedish reference material for bone mass in women, measured in the metacarpal bones with DXR, and compare these data with the data from the manufacturer. A sample of 1440 women aged 20-79yr living in Örebro County was randomly assigned from the population register. Microdose mammography was used (Sectra MDM L30; Sectra Imtec AB, Linköping, Sweden) to measure BMD. Cole's LMS method was used to calculate DXR. Six hundred sixty-nine (48.3%) women participated. Peak bone mass occurred at the age of 43.4yr with a BMD of 0.597g/cm(2) (standard deviation: 0.050). Our Swedish data correlated well with the manufacturer's material. Only among women aged 50-59yr did BMD differ, where the Swedish sample had lower values. The LMS method can be used to describe the DXR data and provide a more detailed picture of bone density distribution. DXR-BMD in Swedish women aged 20-79yr is equivalent to findings from other studies, showing the same distribution of BMD in most age groups except for ages 50-59yr.
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| 34. |
- Axén, Iben, et al.
(författare)
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Analyzing repeated data collected by mobile phones and frequent text messages : An example of Low back pain measured weekly for 18 weeks
- 2012
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Ingår i: BMC Medical Research Methodology. - : BioMed Central. - 1471-2288. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Repeated data collection is desirable when monitoring fluctuating conditions. Mobile phones can be used to gather such data from large groups of respondents by sending and receiving frequently repeated short questions and answers as text messages.The analysis of repeated data involves some challenges. Vital issues to consider are the within-subject correlation, the between measurement occasion correlation and the presence of missing values.The overall aim of this commentary is to describe different methods of analyzing repeated data. It is meant to give an overview for the clinical researcher in order for complex outcome measures to be interpreted in a clinically meaningful way.Methods: A model data set was formed using data from two clinical studies, where patients with low back pain were followed with weekly text messages for 18 weeks. Different research questions and analytic approaches were illustrated and discussed, as well as the handling of missing data. In the applications the weekly outcome “number of days with pain” was analyzed in relation to the patients’ “previous duration of pain” (categorized as more or less than 30 days in the previous year).Research questions with appropriate analytical methods1: How many days with pain do patients experience? This question was answered with data summaries.2: What is the proportion of participants “recovered” at a specific time point? This question was answered using logistic regression analysis.3: What is the time to recovery? This question was answered using survival analysis, illustrated in Kaplan-Meier curves, Proportional Hazard regression analyses and spline regression analyses.4: How is the repeatedly measured data associated with baseline (predictor) variables? This question was answered using generalized Estimating Equations, Poisson regression and Mixed linear models analyses.5: Are there subgroups of patients with similar courses of pain within the studied population?A visual approach and hierarchical cluster analyses revealed different subgroups using subsets of the model data.Conclusions: We have illustrated several ways of analysing repeated measures with both traditional analytic approaches using standard statistical packages, as well as recently developed statistical methods that will utilize all the vital features inherent in the data.
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| 35. |
- Axén, Iben, et al.
(författare)
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Clustering patients on the basis of their individual course of low back pain over a six month period
- 2011
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Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Several researchers have searched for subgroups in the heterogeneous population of patients with non-specific low back pain (LBP). To date, subgroups have been identified based on psychological profiles and the variation of pain.Methods: This multicentre prospective observational study explored the 6- month clinical course with measurements of bothersomeness that were collected from weekly text messages that were sent by 176 patients with LBP. A hierarchical cluster analysis, Ward's method, was used to cluster patients according to the development of their pain.Results: Four clusters with distinctly different clinical courses were described and further validated against clinical baseline variables and outcomes. Cluster 1, a "stable" cluster, where the course was relatively unchanged over time, contained young patients with good self- rated health. Cluster 2, a group of "fast improvers" who were very bothered initially but rapidly improved, consisted of patients who rated their health as relatively poor but experienced the fewest number of days with bothersome pain of all the clusters. Cluster 3 was the "typical patient" group, with medium bothersomeness at baseline and an average improvement over the first 4-5 weeks. Finally, cluster 4 contained the "slow improvers", a group of patients who improved over 12 weeks. This group contained older individuals who had more LBP the previous year and who also experienced most days with bothersome pain of all the clusters.Conclusions: It is possible to define clinically meaningful clusters of patients based on their individual course of LBP over time. Future research should aim to reproduce these clusters in different populations, add further clinical variables to distinguish the clusters and test different treatment strategies for them.
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| 36. |
- Axén, Iben, et al.
(författare)
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Searching for the optimal measuring frequency in longitudinal studies : an example utilizing short message service (SMS) to collect repeated measures among patients with low back pain
- 2016
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Ingår i: BMC Medical Research Methodology. - : BioMed Central. - 1471-2288. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Mobile technology has opened opportunities within health care and research to allow for frequent monitoring of patients. This has given rise to detailed longitudinal information and new insights concerning behaviour and development of conditions over time.Responding to frequent questionnaires delivered through mobile technology has also shown good compliance, far exceeding that of traditional paper questionnaires. However, to optimize compliance, the burden on the subjects should be kept at a minimum.In this study, the effect of using fewer data points compared to the full data set was examined, assuming that fewer measurements would lead to better compliance.Method: Weekly text-message responses for 6 months from subjects recovering from an episode of low back pain (LBP) were available for this secondary analysis. Most subjects showed a trajectory with an initial improvement and a steady state thereafter.The data were originally used to subgroup (cluster) patients according to their pain trajectory. The resulting 4-cluster solution was compared with clusters obtained from five datasets with fewer data-points using Kappa agreement as well as inspection of estimated pain trajectories. Further, the relative risk of experiencing a day with bothersome pain was compared week by week to show the effects of discarding some weekly data.Results: One hundred twenty-nine subjects were included in this analysis. Using data from every other weekly measure had the highest agreement with the clusters from the full dataset, weighted Kappa = 0.823. However, the visual description of pain trajectories favoured using the first 18 weekly measurements to fully capture the phases of improvement and steady-state. The weekly relative risks were influenced by the pain trajectories and 18 weeks or every other weekly measure were the optimal designs, next to the full data set.Conclusions: A population recovering from an episode of LBP could be described using every other weekly measurement, an option which requires fewer weekly measures than measuring weekly for 18 weeks. However a higher measuring frequency might be needed in the beginning of a clinical course to fully map the pain trajectories.
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| 37. |
- Axén, Iben, et al.
(författare)
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The Nordic maintenance care program : the clinical use of identified indications for preventive care
- 2013
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Ingår i: Chiropractic and Manual Therapies. - : BioMed Central (BMC). - 2045-709X. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Low back pain (LBP) is a prevalent condition and has been found to be recurrent and persistent in a majority of cases. Chiropractors have a preventive strategy, maintenance care (MC), aimed towards minimizing recurrence and progression of such conditions. The indications for recommending MC have been identified in the Nordic countries from hypothetical cases. This study aims to investigate whether these indications are indeed used in the clinical encounter.Methods: Data were collected in a multi-center observational study in which patients consulted a chiropractor for their non-specific LBP. Patient baseline information was a) previous duration of the LBP, b) the presence of previous episodes of LBP and c) early improvement with treatment. The chiropractors were asked if they deemed each individual patient an MC candidate. Logistic regression analyses (uni– and multi-level) were used to investigate the association of the patient variables with the chiropractor’s decision.Results: The results showed that “previous episodes” with LBP was the strongest predictor for recommending MC, and that the presence of all predictors strengthens the frequency of this recommendation. However, there was considerable heterogeneity among the participating chiropractors concerning the recommendation of MC.Conclusions: The study largely confirms the clinical use of the previously identified indications for recommending MC for recurrent and persistent LBP. Previous episodes of LBP was the strongest indicator.
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| 38. |
- Axén, Iben, et al.
(författare)
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The use of weekly text messaging over 6 months was a feasible method for monitoring the clinical course of low back pain in patients seeking chiropractic care
- 2012
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Ingår i: Journal of Clinical Epidemiology. - : Elsevier. - 0895-4356 .- 1878-5921. ; 65:4, s. 454-461
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study critically evaluates a new method of collecting frequent data using mobile phones and text messages. Fluctuating conditions such as low back pain (LBP) need frequent monitoring to describe the clinical course in detail and to account for individual and subgroup variations.Study Design and Setting: In this multicentre prospective observational study, 262 subjects with nonspecific LBP were followed with weekly text messages for 6 months, with the question “How many days this previous week has your low back pain been bothersome?” The text replies were instantly recorded in a data file to be merged with baseline and follow up data (age, gender, pain intensity, duration, and self- rated health) collected through ordinary questionnaires. The response rate, user-friendliness, and compliance of this method were evaluated.Results: The mean response rate for the text messages throughout the study was 82.5% and was unaffected by season. The method was found to be user friendly. Dropout was not affected by age and gender, but compliance was possibly somewhat affected by outcome.Conclusion: Weekly text messages are a useful method of data collection to examine the clinical course of LBP in the primary care sector.
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| 39. |
- Axén, Iben, et al.
(författare)
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Using few and scattered time points for analysis of a variable course of pain can be misleading : an example using weekly text message data
- 2014
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Ingår i: The spine journal. - : Elsevier. - 1529-9430 .- 1878-1632. ; 14:8, s. 1454-1459
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Tidskriftsartikel (refereegranskat)abstract
- Background context: Because low back pain (LBP) is a fluctuating condition, the diversity in the prediction literature may be due to when the outcome is measured.Purpose: The objective of this study was to investigate the prediction of LBP using an outcome measured at several time points.Study design/setting: A multicenter clinical observational study in Sweden.Patient sample: Data were collected on 244 subjects with nonspecific LBP. The mean age of the subjects was 44 years, the mean pain score at inclusion was 4.4/10, and 51% of the sample had experienced LBP for more than 30 days the previous year.Outcome measures: The outcome used in this study was the “number of days with bothersome pain” collected with weekly text messages for 6 months.Methods: In subjects with nonspecific LBP, weekly data were available for secondary analyses. A few baseline variables were chosen to investigate prediction at different time points: pain intensity, the presence of leg pain, duration of LBP the previous year, and self-rated health at baseline. Age and gender acted as additional covariates.Results: In the multilevel models, the predictive variables interacted with time. Thus, the risk of experiencing a day with bothersome LBP varied over time. In the logistic regression analyses, the predictive variable's previous duration showed a consistent predictive ability for all the time points. However, the variables pain intensity, leg pain, and self-rated health showed inconsistent predictive patterns.Conclusions: An outcome based on frequently measured data described the variability in the prediction of future LBP over time. Prediction depended on when the outcome was measured. These results may explain the diversity of the results of the predictor studies in the literature.
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| 40. |
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| 41. |
- 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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| 42. |
- Bergström, Cecilia, et al.
(författare)
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Using a psychosocial subgroup assignment to predict sickness absence in a working population with neck and back pain
- 2011
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Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: The overall objective was to evaluate the predictive validity of a subgroup classification based on the Swedish version of the MPI, the MPI-S, among gainfully employed workers with neck pain (NP) and/or low back pain (LBP) during a follow-up period of 18 and 36 months.Methods: This is a prospective cohort study that is part of a larger longitudinal multi-centre study entitled Work and Health in the Process and Engineering Industries (AHA). The attempt was to classify individuals at risk for developing chronic disabling NP and LBP. This is the first study using the MPI-questionnaire in a working population with NP and LBP.Results: Dysfunctional individuals (DYS) demonstrated more statistically significant sickness absence compared to adaptive copers (AC) after 36 months. DYS also had a threefold increase in the risk ratio of long-term sickness absence at 18 months. Interpersonally distressed (ID) subgroup showed overall more sickness absence compared to the AC subgroup at the 36-month follow-up and had a twofold increase in the risk ratio of long-term sickness absence at 18 months. There was a significant difference in bodily pain, mental and physical health for ID and DYS subgroups compared to the AC group at both follow-ups.Conclusions: The present study shows that this multidimensional approach to the classification of individuals based on psychological and psychosocial characteristics can distinguish different groups in gainfully employed working population with NP/LBP. The results in this study confirm the predictive validity of the MPI-S subgroup classification system.
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| 43. |
- Bergström, Gunnar, et al.
(författare)
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A 7-year follow-up of multidisciplinary rehabilitation among chronic neck and back pain patients : Is sick leave outcome dependent on psychologically derived patient groups?
- 2010
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Ingår i: European Journal of Pain. - : Elsevier. - 1090-3801 .- 1532-2149. ; 14:4, s. 426-433
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Tidskriftsartikel (refereegranskat)abstract
- A valid method for classifying chronic pain patients into more homogenous groups could be useful for treatment planning, that is, which treatment is effective for which patient, and as a marker when evaluating treatment outcome. One instrument that has been used to derive subgroups of patients is the Multidimensional Pain Inventory (MPI). The primary aim of this study was to evaluate a classification method based on the Swedish version of the MPI, the MPI-S, to predict sick leave among chronic neck and back pain patients for a period of 7 years after vocational rehabilitation. As hypothesized, dysfunctional patients (DYS), according to the MPI-S, showed a higher amount of sickness absence and disability pension expressed in days than adaptive copers (AC) during the 7-years follow-up period, even when adjusting for sickness absence prior to rehabilitation (355.8days, 95% confidence interval, 71.7; 639.9). Forty percent of DYS patients and 26.7% of AC patients received disability pension during the follow-up period. However, this difference was not statistically significant. Further analyses showed that the difference between patient groups was most pronounced among patients with more than 60days of sickness absence prior to rehabilitation. Cost-effectiveness calculations indicated that the DYS patients showed an increase in production loss compared to AC patients. The present study yields support for the prognostic value of this subgroup classification method concerning long-term outcome on sick leave following this type of vocational rehabilitation.
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| 44. |
- Bergström, Gunnar, et al.
(författare)
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Does sickness presenteeism have an impact on future general health?
- 2009
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Ingår i: International Archives of Occupational and Environmental Health. - Berlin : Springer. - 0340-0131 .- 1432-1246. ; 82:10, s. 1179-1190
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The primary aim of this prospective study was to investigate whether working despite illness, so called "sickness presenteeism", has an impact on the future general health of two different working populations during a follow-up period of 3 years.METHODS: The study was based on two bodies of data collected at a number of Swedish workplaces from 1999 to 2003. The first material comprised 6,901 employees from the public sector and the second 2,862 subjects from the private sector. A comprehensive survey was issued three times: at baseline, after 18 months and after 3 years. Apart from the explanatory variable sickness presenteeism, several potential confounders were considered. The outcome variable was good/excellent versus fair/poor self-reported health.RESULTS: Sickness presenteeism at baseline was consistently found to heighten the risk of fair/poor health at both the 18-month and 3-year follow ups even after adjusting for the detected confounders.CONCLUSIONS: To the best of the authors' knowledge, this study is the first to show that sickness presenteeism appears to be an independent risk factor for future fair/poor general health.
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| 45. |
- Bergström, Gunnar, Professor, et al.
(författare)
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Long-term, non-specific spinal pain: reliable and valid subgroups of patients
- 2001
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Ingår i: Behaviour Research and Therapy. - : Elsevier. - 0005-7967 .- 1873-622X. ; 39:1, s. 75-87
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to identify reliable and valid subgroups of spinal pain patients, using data from the Swedish version of the Multidimensional Pain Inventory (MPI-S). A second aim was to test the generalisability of the three patient profiles described in earlier studies on the MPI (”adaptive coper”, ”dysfunctional” and ”interpersonally distressed” patients). The study base consisted of two samples of individuals suffering from long-term, non-specific spinal pain and the results were validated across these samples. Cluster analysis was used to detect distinct groups of patients and the validity of these subgroups was evaluated on variables not used to generate the cluster solution. One subgroup was characterised by lower pain severity, lower interference with everyday activities, lower affective distress and higher life control than the other two subgroups. This patient profile was similar to the MPI adaptive coper patients. A second subgroup resembled the dysfunctional patient profile, thus displaying a worse adjustment to chronic pain than the AC patients. The third patient group reported significantly lower levels of social support from “significant others” than the other subgroups. This patient profile was similar to that of the interpersonally distressed patient group. Taken together, the results support the reliability, validity and generalisability of three subgroups of chronic pain patients derived from the MPI-S.
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| 46. |
- Bergström, Gunnar, et al.
(författare)
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Preventing sickness absenteeism among employees with common mental disorders or stress-related symptoms at work : Design of a cluster randomized controlled trial of a problem-solving based intervention versus care-as-usual conducted at the Occupational Health Services
- 2017
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Common mental disorders (CMDs) are among the leading causes of sick leave in Sweden and other OECD countries. They result in suffering for the individual and considerable financial costs for the employer and for society at large. The occupational health service (OHS) can offer interventions in which both the individual and the work situation are taken into account. The aim of this paper is to describe the design of a study evaluating the effectiveness of an intervention given at the OHS to employees with CMDs or stress-related symptoms at work. In addition, intervention fidelity and its relation to the outcome will be assessed in a process analysis.Methods: The study is designed as a cluster randomized trial in which the participating OHS consultants are randomized into either delivering the intervention or performing care as usual. Employees with CMDs or stress-related symptoms at work are recruited consecutively by the OHS consultants. The intervention aims to improve the match between the employee and the job situation. Interviews are held individually with the employee and the nearest supervisor, after which a joint meeting with both the employee and the supervisor takes place. A participatory approach is applied by which the supervisor and the employee are guided by the OHS consultant and encouraged to actively take part in problem solving concerning the work situation. Outcomes will be assessed at baseline and at six and 12 months. A long-term follow-up at 3 years will also be performed. The primary outcome is registered sickness absence during a 1-year period after study inclusion. Secondary outcomes are mental health and work ability. The intervention's cost effectiveness, compared to treatment as usual, both for society and for the employer will be evaluated. A process evaluation by both the OHS consultants and the employee will be carried out.Discussion: The study includes analyses of the effectiveness of the intervention (clinical and economic) as well as an analysis of its implementation at the participating OHSs. Possible methodological challenges such as selection bias and risk of contamination between OHS consultants delivering the experimental condition and consultants giving usual care are discussed.
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| 47. |
- Bergström, Gunnar, Professor, et al.
(författare)
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The impact of psychologically different patient groups on outcome after a vocational rehabilitation program for long-term spinal pain patients
- 2001
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Ingår i: Pain. - : LWW. - 0304-3959 .- 1872-6623. ; 93:3, s. 229-237
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Tidskriftsartikel (refereegranskat)abstract
- A better knowledge of differential treatment outcomes for subgroups of chronic spinal pain patients may, for instance, help clinicians in treatment planning or pain researchers in treatment outcome research. The purpose of this prospective study was to evaluate the predictive validity of a subgroup classification based on the Swedish version of the (West Haven Yale) Multidimensional Pain Inventory, the MPI-S. Patients referred to a vocational rehabilitation program were classified into one of three groups, labeled ‘adaptive copers’, ‘dysfunctional’ patients, and ‘interpersonally distressed’ patients, and followed over an 18-month follow-up period. The outcome variables were absence from work (defined as sick listing plus early retirement), general health status, and utilization of health care resources. To our knowledge, the predictive validity of the MPI subgroups has not been evaluated regarding sick listing and early retirement after rehabilitation. As hypothesized, the results showed that the ‘dysfunctional’ patient group had significantly more registered absences from work and reported higher utilization of health care, over the follow-up period compared to the ‘adaptive copers’. Furthermore, as hypothesized, the ‘interpersonally distressed’ and ‘dysfunctional’ patient groups report a poorer general health status than the ‘adaptive copers’ over the whole follow-up period. However, contrary to our hypothesis, the proportion of improved patients did not differ significantly between the subgroups. Altogether, the predictive validity of the MPI-S subgroup classification was mainly confirmed. The clinical implications of this study suggest that the matching of treatment to patient needs may enhance treatment outcome, reduce pain and suffering among chronic spinal pain patients and facilitate a better health economic allocation of treatment resources.
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| 48. |
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| 49. |
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| 50. |
- Björkqvist, Maria, et al.
(författare)
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Defective neutrophil oxidative burst in preterm newborns on exposure to coagulase-negative staphylococci
- 2004
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Ingår i: Pediatric Research. - : Springer Science and Business Media LLC. - 0031-3998 .- 1530-0447. ; 55:6, s. 966-971
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Tidskriftsartikel (refereegranskat)abstract
- The neutrophil oxidative burst is a product of the regulated assembly of the multicomponent oxidase enzyme. Our aim was to compare the oxidative burst in term (n = 10) and preterm newborns <31 wk gestational age (n = 10) after stimulation with coagulase-negative staphylococci in vitro. Strains of Streptococcus epidermidis with different invasive and slime-producing properties, one strain of S. haemolyticus, and one strain of group B-streptococcus were investigated. A whole-blood flow cytometric assay using the oxidation of hydroethidine to ethidium bromide was used. The oxidative activity in unstimulated neutrophil granulocytes [polymorphonuclear leukocytes (PMNLs)] was similar in term and preterm newborns, but the preterm newborns showed a significantly lower capacity to up-regulate the oxidative burst intensity after bacterial stimulation (p = 0.004). In the term but not in the preterm group, the oxidative burst intensity after bacterial stimulation correlated with the baseline oxidative burst intensity. After bacterial stimulation, there was a trend toward a greater percentage of activated neutrophils in the term group than in the preterm group, but the difference was less pronounced than that in oxidative burst intensity. Significant differences in oxidative burst response to different bacterial strains were observed (p < 0.001), but the differences could not be correlated exclusively to invasive capacity or slime-producing properties. It is concluded that the baseline oxidative activity is similar in term and preterm PMNLs but that preterm PMNLs have a decreased capacity to increase the oxidative burst in response to bacterial stimulation.
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