| 1. |
- Christell, Helena, et al.
(författare)
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Willingness to pay for osteoporosis risk assessment in primary dental care
- 2019
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Ingår i: Health Economics Review. - : BioMed Central (BMC). - 2191-1991. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fragility fracture related to osteoporosis among postmenopausal women is a significant cause of morbidity. The care and aftercare of these fractures are associated with substantial costs to society. A main problem is that many individuals suffer from osteoporosis without knowing it before a fracture happens. Dentists may have an important role in early identification of individuals with osteoporosis by assessment of dental radiographs already included in the dental examination. The aim of this study was therefore to investigate postmenopausal women's preferences for an osteoporosis risk assessment in primary dental care. Results: Most respondents (129 of 144 (90%)) were willing to pay for an osteoporosis risk assessment in primary dental care. The overall mean willingness to pay (WTP) including respondents that denoted none or zero WTP was 44.60 Euro (CI 95% 38.46-50.74 Euro) (median 34.75 Euro). A majority (80.6%) of the respondents that denoted WTP also gave a motivation for their answer. The two most common reasons denoted for being willing to pay for osteoporosis risk assessment were the importance of early diagnosis and preventive care to avoid fractures (41.0%) and the importance of knowledge of a risk of osteoporosis (26.4%). A majority of respondents (67.8%) considered it valuable if dental clinics would offer osteoporosis risk assessment. Conclusions: Postmenopausal women seem to find it valuable to be offered osteoporosis risk assessment in primary dental care and are willing to pay for such a risk assessment. From a societal perspective early diagnosis of osteoporosis by risk assessment in primary dental care could prevent osteoporotic related fractures and benefit women's health and quality of life, as well as have a major impact on the health-care budget in terms of cost-savings.
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| 2. |
- DICKINSON, JOANNA, et al.
(författare)
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Hållbar transportplanering? : Jämförande studie av policy och planering i storstadsregionerna Stockholm, Vancouver och Hamburg
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport utgör en fallstudie med jämförelse av policy och planering för hållbara transporter i storstadsregionerna Vancouver, Hamburg och Stockholm. Dessa tre storstadsregioner är internationellt omtalade för sina respektive målsättningar för hållbara transporter och en hållbar stads- och regional utveckling.Studien är att betrakta som ett nedslag i respektive storstadsregions planeringskontext, och belyser viktiga aspekter i policy och planering för hållbara transporter. Slutsatser dras om vad och hur Stockholmsregionen kan lära av de båda övriga studerade storstadsregionernas planering för hållbara transporter.
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| 3. |
- Drake, Isabel, et al.
(författare)
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Scoring models of a diet quality index and the predictive capability of mortality in a population-based cohort of Swedish men and women.
- 2012
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Ingår i: Public Health Nutrition. - 1475-2727. ; :May 29, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To examine how different scoring models for a diet quality index influence associations with mortality outcomes. DESIGN: A study within the Malmö Diet and Cancer cohort. Food and nutrient intakes were estimated using a diet history method. The index included six components: SFA, PUFA, fish and shellfish, fibre, fruit and vegetables, and sucrose. Component scores were assigned using predefined (based on dietary recommendations) and population-based cut-offs (based on median or quintile intakes). Multivariate Cox regression was used to model associations between index scores (low, medium, high) and all-cause and cause-specific mortality by sex. SETTING: Malmö, the third largest city in Sweden. SUBJECTS: Men (n 6940) and women (n 10 186) aged 44-73 years. During a mean follow-up of 14·2 years, 2450 deaths occurred, 1221 from cancer and 709 from CVD. RESULTS: The predictive capability of the index for mortality outcomes varied with type of scoring model and by sex. Stronger associations were seen among men using predefined cut-offs. In contrast, the quintile-based scoring model showed greater predictability for mortality outcomes among women. The scoring model using median-based cut-offs showed low predictability for mortality among both men and women. CONCLUSIONS: The scoring model used for dietary indices may have a significant impact on observed associations with disease outcomes. The rationale for selection of scoring model should be included in studies investigating the association between dietary indices and disease. Adherence to the current dietary recommendations was in the present study associated with decreased risk of all-cause and cause-specific mortality, particularly among men.
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| 4. |
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| 5. |
- Gullberg, Joanna, et al.
(författare)
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Osteoporosis risk assessment in primary dental care-The attitudes of Swedish dentists, patients and medical specialists
- 2020
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Ingår i: Gerodontology. - : John Wiley & Sons. - 0734-0664 .- 1741-2358. ; 37:2, s. 208-216
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Tidskriftsartikel (refereegranskat)abstract
- Objective To explore and identify the attitudes of dentists, patients and medical specialists regarding implementation of osteoporosis risk assessment into Swedish primary dental care. Background Osteoporosis is a major health problem leading to fragility fractures. As shown in academic-based research, dental radiological examination can be used for osteoporosis risk assessment. A substantial number of patients undergo radiographic examinations in primary dental care each year, but little is known about implementation of osteoporosis risk assessment in this setting. Materials and methods A qualitative research approach using focus group discussions and manifest content analysis was applied. Five focus groups with dentists and representatives from patient support groups and a single individual interview with one medical specialist were included in the sample. Results From the manifest content analysis, three categories emerged: (a) barriers to change in practice, (b) benefits to change in practice, and (c) needs and requirements prior to change in practice. Most participants felt that there was insufficient knowledge of osteoporosis as well as a heavy existing workload. A concern was expressed about medical practitioners' willingness to take on responsibility for patients referred by dentists. Representatives from patient support groups highlighted a lack of knowledge about osteoporosis among both the general public and the medical professionals. Clear guidelines and improved communication channels between stakeholders would have to be established to ensure a smooth treatment path for patients. Conclusion Despite interest in osteoporosis risk assessment in primary dental care, there are political, workflow and educational barriers that must be overcome for successful implementation.
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| 6. |
- Gullberg, Joanna, et al.
(författare)
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The challenge of applying digital image processing software on intraoral radiographs for osteoporosis risk assessment
- 2022
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Ingår i: Dentomaxillofacial Radiology. - : British Institute of Radiology. - 0250-832X .- 1476-542X. ; 51:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The purpose of this study was to evaluate rater agreement and the accuracy of a semi-automated software and its fully automated tool for osteoporosis risk assessment in intraoral radiographs. Methods: A total of 567 intraoral radiographs was selected retrospectively from women aged 75-80 years participating in a large population based study (SUPERB) based in Gothenburg, Sweden. Five raters assessed participants' risk of osteoporosis in the intraoral radiographs using a semi-automated software. Assessments were repeated after 4 weeks on 121 radiographs (20%) randomly selected from the original 567. Radiographs were also assessed by the soft wares' fully automated tool for analysis. Results: Overall interrater agreement for the five raters was 0.37 (95% CI 0.32-0.41), and for the five raters with the fully automated tool included as 'sixth rater' the overall Kappa was 0.34 (0.30-0.38). Intrarater agreement varied from moderate to substantial according to the Landis and Koch interpretation scale. Diagnostic accuracy was calculated in relation to reference standard for osteoporosis diagnosis which is T score values for spine, total hip and femoral neck and presented in form of sensitivities, specificities, predictive values, likelihood ratios and odds ratios. All raters' mean sensitivity, including the fully automated tool, was 40,4% (range 14,3%-57,6%). Corresponding values for specificity was 69,5% (range 59,7%-90,4%). The diagnostic odds ratios ranged between 1 and 2.7. Conclusion: The low diagnostic odds ratio and agreement between raters in osteoporosis risk assessment using the software for analysis of the trabecular pattern in intraoral radiographs shows that more work needs to be done to optimise the automation of trabecular pattern analysis in intraoral radiographs.
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| 7. |
- Gullberg, Joanna, et al.
(författare)
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The outcome of an automated assessment of trabecular pattern in intraoral radiographs as a fracture risk predictor
- 2022
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Ingår i: Dentomaxillofacial Radiology. - : British Institute of Radiology. - 0250-832X .- 1476-542X. ; 51:5
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This study aims to investigate if automated analyses of the trabecular pattern in intraoral radiographs independently contribute to fracture risk assessment when other risk factors incorporated in the Fracture Risk Assessment Tool (FRAX) are taken into account. A secondary aim is to explore the correlation between the automated trabecular pattern assessment in intraoral radiographs and Trabecular Bone Score (TBS). Methods: A total of 567 intraoral radiographs from older females participating in a large population-based study (SUPERB) based in Gothenburg, Sweden, were selected to analyse trabecular pattern using semi-automated and fully automated software. Associations between trabecular pattern analysis and incident fractures were studied using Cox proportional hazard model, unadjusted and adjusted for FRAX risk factors (previous fracture, family history of hip fracture, smoking, corticosteroids, rheumatoid arthritis, without and with bone mineral density (BMD) of the femoral neck). In addition, the correlation between trabecular pattern analysis and TBS of the lumbar spine was investigated using Pearson correlation analysis. Results: Neither the unadjusted nor the adjusted trabecular pattern analysis in intraoral radiographs was significantly associated with any fracture or major osteoporotic fracture (MOF). A weak correlation was found between semi-automated trabecular pattern analysis and TBS. No correlation was found between the fully automated trabecular pattern analysis and TBS. Conclusions: The present study shows that semi-automated and fully automated digital analyses of the trabecular pattern in intraoral radiographs do not contribute to fracture risk prediction. Furthermore, the study shows a weak correlation between semi-automated trabecular pattern analysis and TBS.
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| 8. |
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| 9. |
- Hlebowicz, Joanna, et al.
(författare)
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Food patterns, inflammation markers and incidence of cardiovascular disease: the Malmö Diet and Cancer study.
- 2011
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Ingår i: Journal of Internal Medicine. - : Wiley. - 1365-2796 .- 0954-6820. ; 270, s. 365-376
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To examine the associations between food patterns constructed using cluster analysis and markers of systemic and vascular inflammation, and incident cardiovascular disease (CVD) after 13 years of follow-up. Design: Population-based, prospective cohort study. Setting and subjects: Cluster analysis identified six food patterns from 43 food group variables among 4999 subjects, aged 45-68 years, who participated in the Malmö Diet and Cancer cardiovascular programme between 1991 and 1994. Lipoprotein-associated phospholipase A(2) (Lp-PLA(2) ), C-reactive protein concentration and white blood cell (WBC) count were measured using blood samples at baseline. Incidence of CVD (coronary events and ischaemic stroke) was monitored over 13 years of follow-up. Results: The fibre-rich bread pattern was associated with favourable effects on WBC count in women, and the low-fat and high-fibre pattern with favourable effects on Lp-PLA(2) mass in women, and on Lp-PLA(2) activity in men. However, the milk fat and sweets and cakes patterns were both associated with adverse effects; the former on WBC count in women and on Lp-PLA(2) mass in men, and the latter on WBC count and Lp-PLA(2) mass in women. The milk fat and sweets and cakes patterns were associated with increased CVD risk in women. Conclusions: The results of this study support the present Nordic dietary recommendations indicating that diets rich in high-fibre, low-fat and low-sugar foods are favourably associated with markers of inflammation and, potentially, with CVD risk.
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| 10. |
- Sonestedt, Emily, et al.
(författare)
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Diet quality and change in blood lipids during 16 years of follow-up and their interaction with genetic risk for dyslipidemia
- 2016
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 8:5
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Tidskriftsartikel (refereegranskat)abstract
- A high diet quality according to the Swedish nutrition recommendations is associated with a reduced risk of cardiovascular disease in the population-based Malmö Diet and Cancer cohort. To further clarify this protective association, we examined the association between high diet quality and change in triglycerides, high density lipoprotein-cholesterol (HDL-C), and low density lipoprotein-cholesterol (LDL-C) after 16 years of follow-up in 3152 individuals (61% women; 46–68 years at baseline). In addition, we examined if genetic risk scores composed of 80 lipid-associated genetic variants modify these associations. A diet quality index based on intakes of saturated fat, polyunsaturated fat, sucrose, fiber, fruit and vegetables, and fish was constructed. A high diet quality was associated with lower risk of developing high triglycerides (p = 0.02) and high LDL-C (p = 0.03) during follow-up compared with a low diet quality. We found an association between diet quality and long-term change in HDL-C only among those with lower genetic risk for low HDL-C as opposed to those with higher genetic risk (p-interaction = 0.04). Among those with lower genetic risk for low HDL-C, low diet quality was associated with decreased HDL-C during follow-up (p = 0.05). In conclusion, individuals with high adherence to the Swedish nutrition recommendation had lower risk of developing high triglycerides and LDL-C during 16 years of follow-up.
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| 11. |
- Sonestedt, Emily, et al.
(författare)
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High disaccharide intake associates with atherogenic lipoprotein profile
- 2012
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Ingår i: British Journal of Nutrition. - : Cambridge University Press. - 0007-1145 .- 1475-2662. ; 107:7, s. 1062-1069
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Tidskriftsartikel (refereegranskat)abstract
- Increased plasma concentrations of small LDL particles denote an atherogenic lipoprotein phenotype (ALP) that is correlated with increased circulating TAG and reduced HDL-cholesterol. Principal component analyses of subfraction concentrations have previously been used in the Swedish population-based Malmö Diet and Cancer (MDC) cohort to identify three independent components, one pattern representing the ALP. The aim of the present study was to examine the associations between macronutrient intakes and the principal component representing the ALP. We examined 4301 healthy subjects (46–68 years old, 60 % women) at baseline in the MDC cohort. Dietary data were collected using a modified diet history method. Plasma lipoprotein subfractions were measured using a high-resolution ion mobility method. The principal component corresponding to the ALP was significantly associated with a higher intake of disaccharides, and inversely related to protein and alcohol consumption (P < 0·001 for all). The present findings indicate that the ALP may be improved by a low intake of disaccharides, and moderate intakes of protein and alcohol.
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| 12. |
- Wallström, Peter, et al.
(författare)
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Dietary fiber and saturated fat intake associations with cardiovascular disease differ by sex in the malmö diet and cancer cohort: a prospective study.
- 2012
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 7:2
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of the study was to examine associations between intake of macronutrients and dietary fiber and incident ischemic cardiovascular disease (iCVD) in men and women. METHODS: We used data from 8,139 male and 12,535 female participants (aged 44-73 y) of the Swedish population-based Malmö Diet and Cancer cohort. The participants were without history of CVD and diabetes mellitus, and had reported stable dietary habits in the study questionnaire. Diet was assessed by a validated modified diet history method, combining a 7-d registration of cooked meals and cold beverages, a 168-item food questionnaire (covering other foods and meal patterns), and a 1-hour diet interview. Sociodemographic and lifestyle data were collected by questionnaire. iCVD cases, which included coronary events (myocardial infarctions or deaths from chronic ischemic heart disease) and ischemic strokes, were ascertained via national and local registries. Nutrient-disease associations were examined by multivariate Cox regressions. RESULTS: During a mean follow-up of 13.5 years, we identified 1,089 male and 687 female iCVD cases. High fiber intakes were associated with lower incidence rates of iCVD in women and of ischemic stroke in men. In post-hoc analysis, we discovered statistically significant interactions between intake of fiber and saturated fat; these interactions also differed between men and women (p<0.001). CONCLUSIONS: In this well-defined population, a high fiber intake was associated with lower risk of iCVD, but there were no robust associations between other macronutrients and iCVD risk. Judging from this study, gender-specific nutrient analysis may be preferable in epidemiology.
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