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| 2. |
- Lind, Marcus, et al.
(author)
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Cystatin C and creatinine as markers of bleeding complications, cardiovascular events and mortality during oral anticoagulant treatment
- 2013
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In: Thrombosis Research. - : Pergamon-Elsevier. - 0049-3848 .- 1879-2472. ; 132:2, s. E77-E82
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Journal article (peer-reviewed)abstract
- Introduction: Impaired kidney function has been linked to both ischemic events as well as bleeding complications in several clinical conditions. Our aim was to investigate if cystatin C, creatinine and calculated glomerular filtration rate (eGFR) were related to future risk of bleeding complications, cardiovascular events or all-cause mortality during oral anticoagulant treatment.Materials and methods: In a cohort study, 719 patients on long-term vitamin K antagonist (VKA) treatment were followed for a mean of 4.2 years. Blood sampling was taken at inclusion and patients were followed prospectively. Cystatin C and creatinine were analysed and eGFR was calculated. All medical records were reviewed. Major bleeding events, myocardial infarctions, strokes, arterial emboli, and deaths were recorded and classified.Results: After adjustment for age, no association between cystatin C, creatinine or eGFR and major bleeding was found. Cystatin C was independently associated with cardiovascular events (hazard ratio 1.50 (95% CI: 1.27-1.77)) and all-cause mortality (hazard ratio 1.62 (95% CI: 1.38-1.90)). Creatinine was only associated with all-cause mortality, while eGFR was not associated with any of the outcomes.Conclusions: Our findings underscore the superiority of cystatin C as a marker of cardiovascular risk compared to creatinine or eGFR. VKA-treated patients with increased cystatin C levels should be considered to be at an increased risk of cardiovascular events, and not bleeding complications.
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| 3. |
- Lind, Marcus, et al.
(author)
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D-dimer predicts major bleeding, cardiovascular events and all-cause mortality during warfarin treatment
- 2014
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In: Clinical Biochemistry. - : Elsevier BV. - 0009-9120 .- 1873-2933. ; 47:7-8, s. 570-573
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Journal article (peer-reviewed)abstract
- Objectives: Previous studies have shown that biomarkers in blood plasma can predict bleeding complications during anticoagulant treatment as well as thromboembolic events and may improve existing risk stratification schemes in patients on or considered for oral anticoagulant treatment. The aim of this study was to investigate if levels of D-dimer, tissue plasminogen activator (tPA) and its complex with plasminogen inhibitor type 1 (tPA/PAI-1 complex) can predict major bleedings, cardiovascular events and all-cause mortality in patients with warfarin treatment.Design and methods: In a longitudinal cohort study, 719 patients on oral anticoagulant treatment were followed for a total of 3001 treatment years. Major bleeding, stroke, arterial emboli, myocardial infarction and death were recorded and classified. Blood samples collected at baseline were analyzed for D-dimer, tPA, and tPA/PAI-1 complex.Results: In multivariate Cox regression analysis, high levels of D-dimer were associated with major bleeding (HR 1.27 per SD; 95% CI: 1.01-1.60), cardiovascular events (HR 1.23 per SD; 95% CI: 1.05-1.45) and all-cause mortality (HR 1.25 per SD; 95% CI: 1.06-1.47). Neither tPA nor the tPA/PAI-1 complex was associated with major bleeding, cardiovascular events or all-cause mortality.Conclusion: We conclude that high levels of D-dimer predict major bleeding, cardiovascular events and all-cause mortality during warfarin treatment. (C) 2014 The Canadian Society of Clinical Chemists.
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| 4. |
- Lind, Marcus, et al.
(author)
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Von Willebrand factor predicts major bleeding and mortality during oral anticoagulant treatment
- 2012
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In: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 271:3, s. 239-246
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Journal article (peer-reviewed)abstract
- Aims. Oral anticoagulation (OAC), predominantly with warfarin, is an effective treatment to prevent thromboembolic events. Serious bleeding is a frequent and feared treatment complication. In this longitudinal cohort study of OAC-treated patients, we aimed to evaluate the relationship between von Willebrand factor (VWF) levels and risk of bleeding complications, cardiovascular mortality and all-cause mortality.Methods and results. A total of 719 patients receiving warfarin treatment were observed for a mean duration of 4.2 years. All bleeding complications causing hospitalization were registered and classified into clinically relevant bleeding (CRB) and major bleeding. Ischaemic stroke, peripheral arterial embolism, myocardial infarction, and death were also recorded. We identified 113 cases of CRB and 73 of major bleeding. In total, 161 deaths occurred during follow-up with cardiovascular disease identified as the cause of death in 110 patients. Patients in the highest tertile of VWF had a significantly increased risk of bleeding complications: hazard ratio (HR) 2.53 (95% CI 1.41-4.56) for major bleeding and HR 2.19 (95% CI 1.38-3.48) for CRB. VWF, expressed either in tertiles or as a continuous variable, showed a significant association with cardiovascular mortality (HR 1.68, 95% CI 1.40-2.01) and all-cause mortality (HR 1.77, 95% CI 1.52-2.05). In multivariate Cox regression analysis, the findings remained significant after adjusting for age, high-sensitivity C-reactive protein and creatinine.Conclusions. Patients with high levels of VWF had an increased risk of bleeding complications, cardiovascular mortality and all-cause mortality during OAC treatment. Our findings imply that the use of VWF as a risk marker for thromboembolic events is complicated by the association of VWF with bleeding complications.
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| 5. |
- Norlund, Sofia
(author)
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Psychosocial work factors and burnout : a study of a working general population and patients at a stress rehabilitation clinic
- 2011
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Doctoral thesis (other academic/artistic)abstract
- Background The psychosocial work environment affects our health (e.g., sick leave and mortality rates). Research on psychosocial work factors and burnout has focused on specific workplaces or occupations and rarely evaluated in the general population or used longitudinal designs. In Sweden, the diagnosis of exhaustion disorder (closely related to burnout) is a common cause for sick leave. The effects of psychosocial work environments on the process of returning to work has not been studied in this specific patient group. The overall aims of this thesis were to (1) assess the level of burnout in a working general population and investigate the importance of psychosocial work factors and sex on burnout, and (2) study reduction of sick leave and experiences of returning to work in burnout patients, with special attention towards psychosocial work factors.Methods An occupationally active subset (n=1000) of the 2004 Northern Sweden MONICA survey was used in a cross-sectional study. A five-year follow-up of this population was also performed (n=626). Level of burnout was measured using the Shirom Melamed Burnout Questionnaire (SMBQ). Burnout patients were studied for the second thesis aim. A cohort of 117 patients from the REST project was investigated using a baseline questionnaire and sick leave data at two-year follow-up. Grounded Theory was used for an in-depth interview and analysis of 12 employed patients.Results Cross-sectional results from the working general population showed that women have higher levels of burnout than men. In both sexes, work demands, work control, and job insecurity were associated with burnout levels. Among women, education, socioeconomic position, work object, and working hours were also important. Work factors in combination with situational life factors explained about half the difference in burnout level between women and men. Longitudinal results show that burnout levels decrease with age in both sexes, although the changes occur at an earlier age for men. A constant job strain, increased job insecurity, and a worsened economic situation are related to an increase in burnout level. When studying risk factor accumulation, each additional risk factor exposure increases the burnout level.In burnout patients, low work control and use of covert coping towards supervisors and workmates predicts unchanged sick leave levels after a twoyear period. Borderline significance was found between work overcommitment and reduced sick leave. Both personal resources and external support are described as important factors when regaining the ability to work. Perceived validation, insights into the situation and adaptive coping skills increase the chance of regaining the ability to work. External support, particularly from the workplace, is also important.Conclusion There are links between psychosocial work factors and burnout levels in a working general population and sick leave levels in burnout patients. Socioeconomic position and working conditions are important for the level of burnout among working women. In the working population, age differences occur between the sexes; women reduce their burnout levels later in life than men. In the burnout patient population, coping patterns and control at work predict sick leave levels after two years. Both internal resources and external support are important when burnout patients describe the process of regaining the ability to work. The workplace and the work environment are important in preventing working people from becoming burned out and in easeing return to work after sick leave. A person’s coping pattern is also important in reduction of sick leave.
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| 6. |
- Sonntag-Öström, Elisabet, et al.
(author)
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Can the boreal forest be used for rehabilitation and recovery from stress-related exhaustion? A pilot study.
- 2011
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In: Scandinavian Journal of Forest Research. - : Taylor & Francis. - 0282-7581 .- 1651-1891. ; 26:3, s. 245-256
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Journal article (peer-reviewed)abstract
- It has been suggested that humans suffering from mental exhaustion recover better in environments that do not demand directed attention. Hence, we hypothesized that forests have restorative effects and examined whether the boreal forest in northern Sweden can be used for rehabilitation from stress-related exhaustion in a pilot study. Six participants suffering from stress-related exhaustion were offered visits twice a week, for 11 weeks, in six different forest settings: pine forest, mixed forest, spruce forest, forest by the lake, the forest with a small stream and rock outcrops. The participants chose one forest setting prior to each visit, and the mental state of each participant was evaluated before and after each visit. Interviews focusing on the experience of the forest were conducted after the 22 visits. Solitude and forest settings with light were identified as positive factors for recovery. Despite the limited amount of data, the results showed that the forest visits had significant positive effects on the participants' mental state. The interviews also indicated that the concept is suitable for use in larger randomized studies and that it is important to provide various forest settings to meet individual preferences of the participants and to offer the possibility of solitude.
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| 7. |
- Sonntag-Öström, Elisabet, 1958-
(author)
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Forest for rest : recovery from exhaustion disorder
- 2014
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Doctoral thesis (other academic/artistic)abstract
- Background Exhaustion disorder (ED) is a common mental and behavioural disorder which often leads to severe negative consequences for the individual and the society. Natural environments have positive effects on mental, physiological and attentional recovery in stressed persons, which encouraged us to test if forest visits could improve recovery from ED. The main objective of the thesis was to study if visits to different kinds of forest environments have positive health effects on patients suffering from ED, and if forest visits can be utilized for rehabilitation.Methods Participants in the MiniRest study (n=20) and the Pilot study (n=6) (Papers I and II) were recruited from the Stress Rehabilitation Clinic (SRC) at the University Hospital in Umeå. Participants in the randomised controlled study, ForRest (n=99) and the Interview study (n=19) (Papers III and IV) were recruited from both the SRC and the Swedish Social Insurance Agency in Umeå. The MiniRest study involved only female ED patients and focused on immediate mental, physiological and attention capacity effects in one urban and three forest environments. The Pilot study investigated the practical arrangements for the forthcoming ForRest study. Participants in the ForRest study were randomised into either a three-month forest rehabilitation group; A (forest visits twice a week/4 hours per day) or to a control condition; B. Both groups received Cognitive Behavioural Rehabilitation (CBR) at 24 occasions/once a week after the three-month study period. Preferences for forest environments, mental state and attention capacity were studied for group A only. Psychological health measurements and sick leave data were compared between the groups after (i) the forest rehabilitation and (ii) the CBR. The Interview study was conducted according to grounded theory methodology and consisted of 19 participants from group A to explore personal experiences from the forest rehabilitation. Data collection was implemented through questionnaires, medical records, physiological measurements, and interviews.Results Exposure to forest environments was associated with higher preference, more favourable mental state and physiological responses, and increased attention capacity compared to an urban environment (Paper I). Open and accessible forest environments were preferred (Papers I, II and III). Recovery from ED was found in both groups in the ForRest study, but there were no differences between the groups over time. In group A, positive effects on mental state and attention capacity were found during the forest visits. An interaction effect was found with more positive effects on mental state during spring compared to autumn (Paper III). Solitude, feelings of freedom and no demands were important for finding peace of mind during the forest visits. Moreover, easier access to peace of mind, reflective thinking and positive feelings were reported as the forest rehabilitation progressed (Papers II and IV).Conclusions Forest visits have restorative effects for ED patients through enhanced mental well-being, easier access to peace of mind, beneficial physiological reactions and increased attention capacity which support the use of forest environments in rehabilitation. However, forest rehabilitation tested in a randomised controlled trial did not improve recovery from ED. Potentially rehabilitation with CBR and forest visits integrated could be more effective and should be further investigated in nature-assisted rehabilitation for ED patients.
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| 8. |
- Sonntag-Öström, Elisabet, et al.
(author)
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Restorative effects of visits to urban and forest environments in patients with exhaustion disorder
- 2014
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In: Urban Forestry & Urban Greening. - : Elsevier BV. - 1618-8667 .- 1610-8167. ; 13:2, s. 344-354
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Journal article (peer-reviewed)abstract
- This experimental study investigated differences in perceived restorativeness, mood, attention capacity and physiological reactions when visiting city and forest environments. Twenty female patients diagnosed with exhaustion disorder visited three different forest environments and one city environment in randomized order. They performed a standardized 90-min test procedure in each of these environments. Evaluation of the environments and psychological effects in mood were studied with self-administered questionnaires. Attention capacity was studied with Necker Cube Pattern Control task. Physiological responses were measured with regularly scheduled controls of heart rate and blood pressure, and a single test of heart rate recovery. Visits to the forest environments were perceived as significantly more restorative, enhancing mood and attention capacity compared to the city. This also applies to the results of heart rate and to some extent to the results of the diastolic blood pressure. The results from this experimental study support our hypothesis that short visits to forest environments enhance both psychological and physiological recovery and that visits to forest environments are likely to be beneficial when suffering from exhaustion disorder.
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| 9. |
- Stenlund, Therese, 1970-, et al.
(author)
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Effects of rehabilitation programmes for patients on long-term sick leave for burnout : a 3-year follow-up of the REST study
- 2012
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In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 44:8, s. 684-690
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Journal article (peer-reviewed)abstract
- Objective: To evaluate the long-term effects of two different rehabilitation programmes for patients on long-term sick leave for burnout. Design: Three-year follow-up of a randomized controlled trial with two 1-year group programmes: (A) cognitively oriented behavioural rehabilitation in combination with Qigong; and (B) Qigong alone. Patients: A total of 107 patients with burnout (78 women and 29 men), who all completed the 1-year rehabilitation programme per-protocol, were asked to participate in the follow-up. Methods: At the 3-year follow-up, data on psychological measures, sick leave and use of medication were compared between the programmes. Results: Patients in programme A reported being significantly more recovered from their burnout (p = 0.02), reported lower levels of burnout (p = 0.035), used more cognitive tools learned from the programme (p < 0.001), and had reduced their use of medication for depression (p = 0.002). No significant differences were found between the groups in terms of sick leave rates; both groups had improved. Conclusion: A multimodal rehabilitation including cognitively oriented behavioural rehabilitation and Qigong showed positive effects 3 years after the end of intervention. The results indicate that, for many burnout patients on sick-leave, it takes time to implement cognitive tools and to establish new behaviours.
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