| 1. |
- Flank, Peter, et al.
(författare)
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Dyslipidemia is common after spinal cord injury - independent of clinical measures
- 2015
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Ingår i: Jacobs Journal of Physical Rehabilitation Medicine. - 2469-3103. ; 1:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To survey the incidence of clinical risk markers and its correlation with established clinical measurements for cardiovascular disease (CVD) in a heterogeneous spinal cord injured (SCI) patient population.Design: Descriptive, cross-sectional study.Subjects: 78 patients with SCI, at different injury and functional level.Methods: Anthropometric data, blood pressure, a blood lipid panel, blood glucose and a questionnaire were analyzed.Results: Eighty-one percent of all patients had dyslipidemia (DL) and a majority of the patients with abdominal measures below the recommended cut-off levels had DL. Self-reported physical activity above the cut-off level was reported by 32.1%of the patients. There were no differences in clinical measures, serum lipid values and blood glucose between physically active and not active patients. No differences were seen between men/women, tetraplegia/paraplegia and wheelchair dependent/not wheelchair dependent patients.Conclusion: DL is common and seems to be not treated or undertreated in the studied SCI patient group with different neurological lesion and functional levels. General anthropometric clinical measures do not seem to be valid for evaluating risk for CVD in this patient group.
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| 2. |
- Flank, Peter, 1972-, et al.
(författare)
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Pain, anxiety and depression in spinal cord injured patients
- 2017
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Ingår i: Jacobs Journal of Physical Rehabilitation Medicine. - : Jacobs Publishers. - 2469-3103. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the prevalence of pain, anxiety and depression in a sample of chronic SCI patients in Northern Sweden.Design: Descriptive, cross-sectional study.Setting: Specialist Clinic at a University Hospital.Participants: 78 patients with chronic spinal cord injury, at different injury and functional level.Outcome measures: Patients registered presented pain above, at or below injury level on a Visual Analogue Scale (VAS). Patients currently on pain medication were also registered as having pain. Depression and anxiety were assessed by the Hospital Anxiety and Depression Rating Scale (HADS).Results: Out of 78 patients, 58 (74%) indicated current presence of pain or were on continuous pain medication. Pain above injury level was present in 32% of the patients, with a mean VAS of 15.9±20.1, range 0-60mm. Pain at injury level were present in 24% of the patients, mean VAS 11.0±17.0, range 0-50mm and 58% had pain below injury level with a mean VAS 31.4±22.3, range 0-80mm.Clinically significant psychological disorders were reported in 4 patients (5%) for both anxiety and depression.Conclusions: Pain is very common in persons with chronic SCI, but, at least in a drug-treated population, the pain is at a mild or moderate level. Anxiety and depression were found much less common than reported in other studies. Medication effects have been considered. Even in a presumably well-medicated and well-rehabilitated population, there is still a need for further optimization of pain management, including both pharmacological and non-pharmacological methods.Keywords: Tetraplegia; Paraplegia; Psychological Disorders; Visual Analogue Scale; Hospital Anxiety and Depression Scale
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| 3. |
- Flank, Peter, 1972-
(författare)
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Spinal cord injuries in Sweden : studies on clinical follow-ups
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A spinal cord injury is a serious medical condition, often caused by a physical trauma. An injury to the spinal cord affects the neurotransmission between the brain and spinal cord segments below the level of injury. The SCI causes a loss of motor function, sensory function and autonomic regulation of the body, temporary or permanent. Significantly improved acute care, primary comprehensive rehabilitation and life-long structured follow-up has led to persons with spinal cord injury (SCI) living longer than ever before. However, increased long-time survival has allowed secondary conditions to emerge, like diabetes mellitus and where cardiovascular disease (CVD) now is the most common cause of death among SCI patients. Other possible CVD-related comorbidities in this patient group have been reported to be pain and mood disturbances. There is still lack of, and need for more knowledge in the field of CVD-related screening and prevention after SCI.The overall aim of this thesis was to contribute to a scientific ground regarding the need for CVD-related screening and prevention after SCI.In Paper I and Paper II, patients with wheelchair-dependent post-traumatic SCI (paraplegia) were assessed. The results in paper I showed that 80% of the examined patients had at least one cardiovascular disease risk marker irrespective of body mass index (BMI). Dyslipidemia was common for both men and women at all BMI categories. The study also showed a high prevalence of hypertension, especially in men. Paper II showed a low frequency of self-reported physical activity, where only one out of 5 persons reported undertaking physical activity >30 min/day. The physically active had lower diastolic blood pressure but no significant difference in blood lipids.In paper III and IV, patients with SCI (tetraplegia and paraplegia) participated in the studies. Eighty-one percent of the patients had dyslipidemia, where also a majority of the patients with normal abdominal clinical measures had dyslipidemia. Self-reported physical activity >30min/day was reported by one third of the patients. No differences were found between physically active and not physically active patients when it came to blood glucose, serum lipid values and clinical measures (paper III). Pain was common in the patient group, however, most often on a mild to moderate level. Anxiety and depression was less common than reported in other studies (paper IV).
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| 4. |
- Granlund, Lena, et al.
(författare)
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Prevalence of vitamin D deficiency and its association with nutrition, travelling and clothing habits in an immigrant population in Northern Sweden
- 2016
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Ingår i: European Journal of Clinical Nutrition. - : Springer Science and Business Media LLC. - 0954-3007 .- 1476-5640. ; 70:3, s. 373-379
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study prevalence and determinants of vitamin D deficiency in immigrants from Africa and the Middle East living in Umeå, Sweden.DESIGN: Cross-sectional population based.SETTING: Umeå, Sweden (63° N).SUBJECTS/METHODS: Immigrants aged 25-65 years from nine countries in Africa or the Middle East (n=1306) were invited. A total of 111 men and 106 women (16.5%) completed the study. S-25-hydroxyvitamin D3 was measured with HPLC. Anthropometry, medical, socioeconomic and lifestyle data were registered.RESULTS: Vitamin D status was insufficient or deficient in 73% of the participants. Specifically, 12% had vitamin D deficiency (25(OH)D3<25 nmol/l), and only 3.7% had optimal vitamin D status (25(OH)D3 75-125 nmol/l). Mean 25(OH)D3 level was 41.0 nmol/l (±16.6) with no difference between sexes. Levels of 25(OH)D3 were lower (P=0.030) and vitamin D deficiency was twice as common in immigrants from Africa compared with those from the Middle East. In the multiple regression analysis, vitamin D deficiency was significantly associated with low fatty fish intake (OR 4.31, 95% CI 1.61-11.55), not travelling abroad (OR 3.76, 95% CI 1.18-11.96) and wearing long-sleeved clothes in summer (OR 3.15, 95% CI 1.09-9.12).CONCLUSIONS: The majority of immigrants from Africa and the Middle East who live in northern Sweden have vitamin D deficiency or insufficiency. Our results are consistent with sun exposure and a diet with high intake of fatty fish being most important in avoiding vitamin D deficiency.
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| 5. |
- Granlund, Lena, 1960-
(författare)
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Vitamin D deficiency in Northern Sweden : a cross-sectional study of an immigrant population at latitude 63° N, including an open partially randomized, controlled trial studying the effect of supplementation with different doses of cholecalciferol
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Vitamin D is a prohormone that plays a key role in the calcium and phosphate balance and has physiological functions throughout the entire body. Vitamin D is supplied by exposure to ultraviolet light or by food. The prevalence of vitamin D deficiency in immigrants in Northern Sweden was unknown. There was no consensus on how to define or treat vitamin D deficiency and no pure preparations of cholecalciferol available in Sweden.Aims: To study the prevalence and determinants of vitamin D deficiency in immigrants of African and Middle Eastern origin, to examine associations between vitamin D status and muscle strength, anxiety, depression and quality of life, and to determine the effect of supplementation with cholecalciferol on 25-hydroxyvitamin D3 [25(OH)D] and vitamin D status.Methods: 1. A cross-sectional, population-based study. Immigrants ages 25-65 from Africa and the Middle East (n=1306) living in Umeå, Sweden, were invited to participate. A total of 111 men and 106 women (16.5%) participated. 25(OH)D was measured by LC-MsMs. Anthropometry, medical, socioeconomic and lifestyle data was registered. Examinations: lower limb muscle strength, grip strength, HAD, health-related quality of life (QoL) 2. An open, partially randomized, controlled trial including immigrants from Africa or the Middle East, 192 subjects screened, 160 included and 147 completed the study. Intervention: cholecalciferol 12±2 weeks, 4 parallel groups; Group 1: 25(OH)D <25nmol/L: 10000 IU/d, Groups 2a and 2b: 25(OH)D 25-49 nmol/L: 2000 IU/d or 2000 IU/w, Group 3: 25(OH)D 50-74 nmol/L: 2000 IU/d.Results: Twelve percent of the immigrants showed a vitamin D deficiency (25(OH)D ˂25 nmol/L) and 73 % showed 25(OH)D ˂50 nmol/L. Vitamin D deficiency was twice as common in African immigrants as in the Middle Eastern group. Vitamin D deficiency was associated with intake of fatty fish less than once a week, absence of travel abroad and use of long-sleeved clothing in summer. Lower limb muscle strength was associated with 25(OH)D levels and weaker grip strength was associated with vitamin D deficiency. Vitamin D deficiency was not associated with anxiety, depression or QoL in the total immigrant population. In Middle Eastern women, in whom prevalence of anxiety was higher, anxiety was associated with 25(OH)D ≤49 nmol/L. Oral cholecalciferol was effective in increasing 25(OH)D. At study end, 100% in Group 1, 89% in Group 2a, 55% in Group 2b and 96% in Group 3 reached adequate vitamin D status (25(OH)D ˃50 nmol/L). In Group 1; 62 % reached 25(OH)D ≥125 nmol/L.Conclusions: Vitamin D deficiency and insufficiency was common in the immigrant group and no difference was shown between men and women. A diet including a high intake of fatty fish was most important in avoiding vitamin D deficiency. Vitamin D status was associated with muscle strength in all immigrants. Vitamin D deficiency was not associated with anxiety, depression or QoL in the immigrants. In female immigrants from the Middle East, anxiety was associated with 25(OH)D levels ≤49 nmol/L. Supplementation with cholecalciferol 2000 IU/day for three months was safe in healthy individuals with initial 25(OH)D 25-49 nmol/L, but monitoring is warranted since 11 % did not attain sufficient vitamin D status. The dose 10 000 IU/day in patients with initial 25(OH)D <25 nmol/L was unnecessarily high.
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| 6. |
- Granlund, Lena, 1960-, et al.
(författare)
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Vitamin D is associated with lower limb muscle strength and grip strength in Middle Eastern- and African-born immigrants in Sweden
- 2018
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Ingår i: Nutrition Research. - : Elsevier. - 0271-5317 .- 1879-0739. ; 59, s. 29-35
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Tidskriftsartikel (refereegranskat)abstract
- There is increasing evidence that vitamin D status is associated with muscle function. Vitamin D deficiency is common in immigrants. We hypothesized that there was a positive association between vitamin D status and muscle strength in immigrants. The aim of this study was to examine associations between vitamin D status and muscle strength in an immigrant population in Sweden. All immigrants aged 25-65 years, born in 9 African or Middle East countries, and living in a district in Umeå (n = 1306) were invited. A total of 111 men and 105 women (16.5%) completed the study. Lower limb muscle strength was examined using a standardized muscle function indices of muscle strength. Grip strength was examined using a JAMAR hand dynamometer. Serum 25-hydroxyvitamin D [25(OH)D] was measured using liquid chromatography–tandem mass spectrometry. The analyses were adjusted for sex, age, height, body mass index, years since immigration, 25(OH)D, vitamin D deficiency, physical activity, and medical and socioeconomic factors. Twelve percent of the immigrants had vitamin D deficiency [25(OH)D levels <25 nmol/L]. In multivariable analyses, reduced lower limb muscle strength remained linearly associated with lower 25(OH)D concentrations (P = .008) and weaker grip strength remained associated with vitamin D deficiency (P = .022) after adjustments. The association between vitamin D deficiency and reduced lower limb muscle strength did not reach statistical significance (P = .052). The results demonstrate that vitamin D deficiency and low 25(OH)D concentrations were associated with muscle weakness in immigrants.
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| 7. |
- Ramnemark, Anna, et al.
(författare)
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Adequate vitamin D levels in a Swedish population living above latitude 63°N : The 2009 Northern Sweden MONICA study
- 2015
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Ingår i: International Journal of Circumpolar Health. - : CoAction Publishing. - 1239-9736 .- 2242-3982. ; 74:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Even though vitamin D is mainly produced by exposure to sunlight, little is known regarding vitamin D levels in populations living in sub-Arctic areas with little or no daylight during winter.OBJECTIVE: We describe distributions of vitamin D3 and the prevalence of adequate levels in a population living above 63°N.DESIGN: We sampled 1,622 randomly selected subjects, aged 25-74 years, between January and May, 2009, as part of the Northern Sweden MONICA study (69.2% participation rate). By using HPLC, 25(OH) vitamin D3 was analysed. Levels used for definitions were deficient, D3<25 nmol/l (<10 ng/ml); insufficient, D3 25-49.9 nmol/l (10-20 ng/ml); and adequate, D3≥50 nmol/l (20 ng/ml).RESULTS: Mean (median) level of vitamin D3 was 65.2 (63.6) nmol/l in men and 71.0 (67.7) nmol/l in women. Adequate levels were found in 79.2%, more often in women (82.7%) than in men (75.6%). Only 0.7% of the population were vitamin D3-deficient but 23.1% of men and 17.1% of women had insufficient levels. Levels of vitamin D3 increased with age and insufficient status was most common among those aged 25-34 years, 41.0% in men and 22.3% in women. If subjects using vitamin D-supplementation are excluded, the population level of D3 is 1-2 nmol/l lower than in the general population across sex- and age groups. There were no differences between the northern or the southern parts, between urban or rural living or according to educational attainment. Those subjects born outside of Sweden or Finland had lower levels.CONCLUSION: The large majority living close to the Arctic Circle in Sweden have adequate D3 levels even during the second half of the dark winter. Subjects with D3 deficiency were uncommon but insufficient levels were often found among young men.
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| 8. |
- Ramnemark, Anna, et al.
(författare)
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D-vitaminbrist oväntat ovanlig i norr
- 2015
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Ingår i: Läkartidningen. - : Läkartidningen förlag. - 0023-7205 .- 1652-7518. ; 112:38
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Tidskriftsartikel (populärvet., debatt m.m.)
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