| 31. |
- Björkelund, Cecilia, 1948, et al.
(författare)
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Psykiatrin och primärvården har ett gemensamt ansvar : Psychiatry and primary health care have common responsibility
- 2011
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Ingår i: Läkartidningen. - 1652-7518. ; 108:14
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Ångesttillstånd är vanliga och återkommande. Samsjukligheten är hög. Det finns effektiv farmakologisk och psykoterapeutisk behandling, men vården måste också vara tillgänglig och kunna erbjuda kontinuitet för att fungera. Primärvården kan erbjuda basen för tillgänglighet, kontinuitet och behandling, men psykiatrins spets behövs för att hantera en delad vård vid vissa tillstånd. Det finns lovande möjlighetern med Internetbaserade terapier, som kan bli ett komplement till dagens vård.
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| 32. |
- Björkelund, Cecilia, 1948, et al.
(författare)
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Rehabilitation cooperation and person-centred dialogue meeting for patients sick-listed for common mental disorders: 12 months follow-up of sick leave days, symptoms of depression, anxiety, stress and work ability - a pragmatic cluster randomised controlled trial from the CO-WORK-CARE project.
- 2023
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Ingår i: BMJ open. - 2044-6055. ; 13:6
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Tidskriftsartikel (refereegranskat)abstract
- To study whether early and enhanced cooperation within the primary care centres (PCC) combined with workplace cooperation via a person-centred employer dialogue meeting can reduce days on sick leave compared with usual care manager contact for patients on sick leave because of common mental disorders (CMD). Secondary aim: to study lapse of CMD symptoms, perceived Work Ability Index (WAI) and quality of life (QoL) during 12 months.Pragmatic cluster randomised controlled trial, randomisation at PCC level.28 PCCs in Region Västra Götaland, Sweden, with care manager organisation.30 PCCs were invited, 28 (93%) accepted invitation (14 intervention, 14 control) and recruited 341 patients newly sick-listed because of CMD (n=185 at intervention, n=156 at control PCCs).Complex intervention consisting of (1) early cooperation among general practitioner (GP), care manager and a rehabilitation coordinator, plus (2) a person-centred dialogue meeting between patient and employer within 3 months.regular contact with care manager.12 months net and gross number of sick leave days at group level.12 months depression, anxiety, stress symptoms, perceived WAI and QoL (EuroQoL-5 Dimensional, EQ-5D).No significant differences were found between intervention and control groups concerning days of sick leave (intervention net days of sick leave mean 102.48 (SE 13.76) vs control 96.29 (SE 12.38) p=0.73), return to work (HR 0.881, 95% CI 0.688 to 1.128), or CMD symptoms, WAI or EQ-5D after 12 months.It is not possible to speed up CMD patients' return to work or to reduce sick leave time by early and enhanced coordination among GP, care manager and a rehabilitation coordinator, combined with early workplace contact over and above what 'usual' care manager contact during 3 months provides.NCT03250026.
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| 33. |
- Björkelund, Cecilia, 1948, et al.
(författare)
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Reproductive history in relation to relative weight and fat distribution
- 1996
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Ingår i: International Journal of Obesity. ; 20, s. 213-219
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Tidskriftsartikel (refereegranskat)abstract
- Department of Primary Health Care, Sahlgrenska University Hospital, Göteborg University, Gothenburg, Sweden. OBJECTIVE: To investigate the relationship between reproductive history and body composition. DESIGN: Prospective population study in Sweden. SUBJECTS: 1462 randomly selected women representing five separate age cohorts (38, 46, 50, 54 and 60 at the 1968-1969 baseline examination) have been followed longitudinally. MEASUREMENTS: Relative weight, fat distribution, and fat cellularity were related to menarche, parity, lactation, menopause and oestrogen medication. RESULTS: Age of menarche did not show any association with subsequent fat distribution, nor did length of lactation time. On the other hand parity was positively associated to total as well as central obesity, and lactation time was positively associated to abdominal fat cell diameter. Premenopausal women showed higher mean body weight and hip circumference than postmenopausal women of the same age. Change from pre- to postmenopausal status was associated with increase of waist circumference as well as reduction of hip circumference, resulting in an increased waist-hip ratio (WHR). Oestrogen replacement suggested some postponement of this increase. CONCLUSION: Parity and menopause are the reproductive factors most associated with gradual changes in body fat distribution. Oestrogen medication seems to play an additional role in diminishing waist circumference increase and could thus contribute to decreased cardiovascular morbidity in women. PMID: 8653141 [PubMed - indexed for MEDLINE]
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| 34. |
- Björkelund, Cecilia, 1948, et al.
(författare)
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Secular trends in cardiovascular risk factors with a 36-year perspective: observations from 38- and 50-year-olds in the Population Study of women in Gothenburg
- 2008
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 1502-7724 .- 0281-3432. ; 26:3, s. 140-6
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Tidskriftsartikel (refereegranskat)abstract
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Sweden. cecilia.bjorkelund@allmed.gu.se OBJECTIVES: To study secular trends in cardiovascular risk factors in four different cohorts of women examined in 1968-1969, 1980-1981, 1992-1993 and 2004-2005. DESIGN: Comparison of four representative cohorts of 38- and 50-year-old women over a period of 36 years. SETTING: Gothenburg, Sweden with approximately 450,000 inhabitants. SUBJECTS: Four representative samples of 38- and 50-year-old women were invited to free health examinations (participation rate 59-90%, n =1901). MAIN OUTCOME MEASURES: Body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), leisure time exercise, use of antihypertensive medication, smoking, levels of haemoglobin, b-glucose, s-cholesterol, s-triglycerides and HDL-cholesterol. RESULTS: There was no significant difference in mean BMI from 1968-1969 versus 2004-2005. Mean leisure time exercise was significantly higher in later born cohorts; in 1968, around 15% were physically active compared with 40% in 2004. SBP and DBP, mean s-cholesterol and s-triglyceride levels were significantly lower in both 38- and 50-year-old cohorts in 2004-2005 versus 1968-1969. HDL-cholesterol (not measured until 1992-1993), showed a significantly higher mean level in 2004-2005. Reduction of risk factors was apparent in women with a high as well as low level of physical activity. Smoking declined most in women with high levels of physical activity. CONCLUSIONS: Several cardiovascular risk factors related to lifestyle have improved in middle-aged women from the 1960s until today. Most of the positive trends are observed in women with both low and high physical activity.
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| 35. |
- Björkelund, Cecilia, 1948, et al.
(författare)
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Sleep disturbances in midlife unrelated to 32-year diabetes incidence: the prospective population study of women in Gothenburg
- 2005
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Ingår i: Diabetes Care. ; 28, s. 2739-2744
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Tidskriftsartikel (refereegranskat)abstract
- Department of Primary Health Care, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden. cecilia.bjorkelund@allmed.gu.se OBJECTIVE: To study the relation between diabetes incidence and sleep problems in a population-based sample of women followed for 32 years. RESEARCH DESIGN AND METHODS: The researchers conducted a prospective population study initiated in 1968-1969, with follow-ups in 1974-1975, 1980-1981, 1992-1993, and 2000-2001 in Gothenburg, Sweden. A total of 1,462 women born in 1908, 1914, 1918, 1922, and 1930, representative of women of the same ages in the general population, initially participated (90% participation rate). Reported sleep duration, sleep problems, and use of sleeping medication were related to incident diabetes from 1968 to 2000. Associations between sleep problems and diabetes were corrected for waist-to-hip ratio (WHR), BMI, subscapular skinfold, fasting blood glucose and serum lipid concentrations, blood pressure, heart rate, smoking, physical activity, education, and socioeconomic status. Additionally, associations between BMI, WHR, and sleep problems were examined. RESULTS: Over 32 years, 126 women (8.7%) developed diabetes. Associations between diabetes and initial sleep problems were tested in a Cox regression analysis, taking into consideration factors associated (P < 0.1) with diabetes. Sleep problems in 1968 did not increase risk of developing diabetes during the following 32 years. Obesity, particularly centralized, was associated with sleep problems. CONCLUSIONS: No association between sleep problems and developing diabetes was seen in this 32-year follow-up of middle-aged women. Obesity, on the other hand, known to cause increased risk of diabetes, was associated with current sleep problems. PMID: 16249549 [PubMed - indexed for MEDLINE]
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| 36. |
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| 37. |
- Björkelund, Cecilia, 1948, et al.
(författare)
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Using patient-centred consultation when screening for depression in elderly patients: A comparative pilot study
- 2011
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 29:1, s. 51-56
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Using validated screening instruments to detect depressive symptoms in the elderly has been recommended. The aim of this study was to compare a patient-centred consultation model with the PRIME-MD screening questionnaire, using the MADRS-S as reference for detecting depressive symptoms in an elderly primary care population. Design. Comparative study. Setting. Primary care, Sweden. Subjects. During an 11-month period 302 consecutive patients aged 60 and over attending a primary care centre were screened with the PRIME- MD and the Montgomery-Asberg Depression Rating Scale-Self-rated version (MADRS-S) instrument. The results were unknown to the GPs who used a structured, patientcentred consultation model comprising seven open-ended “key questions”. Main outcome measures. Sensitivity, specifi city, positive predictive values (PPV), and negative predictive values (NPV) were calculated for the PRIME-MD screening questionnaire and the patient-centred consultation model using MADRS-S as reference for possible depression at two cut-off levels with 15% prevalence. Results. Sensitivity was lower for the consultation model than the PRIME-MD screening questionnaire: 78% and 98%, respectively. The GPs failed to identify every fi fth patient using the lower cut-off (MADRS-S 13) but the number of required diagnostic interviews decreased by almost 50%: 85 versus 162, respectively. PPV was 43% and 28%, respectively. Both instruments showed high sensitivity (93%) using the higher cut-off (MADRS-S 20) and had high NPV: 95% and 99%, respectively. Conclusions. The fi ndings suggest that the consultation screening procedure might be as useful in everyday practice as the PRIME-MD screening questionnaire. Both screening procedures may also be useful for ruling out depressive symptoms.
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