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1.	Agardh, Daniel, et al. (author) Coeliac disease-specific tissue transglutaminase autoantibodies are associated with osteoporosis and related fractures in middle-aged women 2009 In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 44:5, s. 571-578 Journal article (peer-reviewed)abstract Objective. To investigate whether the serological marker for coeliac disease, tissue transglutaminase autoantibody (tTGAb), is associated with decreased bone mass density (BMD) and increased frequency of fractures in middle-aged women screened for osteoporosis. Material and methods. The study comprised 6480 women (mean age 56 years, range 50-64) who answered a number of questionnaires and who underwent dual X-ray absorptiometry of the wrist bone. Serum samples were analysed for tTGAb using radioligand binding assays. A tTGAb level of 4 U/ml was used to determine a positive value and a level of 17 U/ml was used as an alternative discrimination of high levels. Results. A tTGAb level 4 U/ml was found among 90/6480 (1.4%) women and correlated with lower BMD (multiple linear regression coefficient -382.1; 95% CI = - 673.6-90.7, p=0.011) and with fracture frequency (r=0.18, p=0.023). The 59 women with tTGAb levels 17 U/ml had a lower BMD (0.410.08 g/cm2 versus 0.440.08 g/cm2, p=0.001) and a lower T-score (-1.401.28 versus -0.901.40, p=0.003) as well as a higher prevalence of osteoporosis (13.4% versus 6.5%, p=0.008) compared with the remaining 6421 women with tTGAb levels 17 U/ml. Furthermore, fracture frequency was more pronounced in women with tTGAb levels 17 U/ml, among whom 19/59 (32.2%) had fractures during the study period compared with 1204/6421 (18.8%) among women with tTGAb levels 17 U/ml (p=0.009). Conclusions. High levels of tTGAb indicating coeliac disease are associated with lower BMD and higher fracture frequency in women between 50 and 64 years of age. Osteometry is therefore warranted in middle-aged women detected with tTGAb.
2.	Akesson, A, et al. (author) Cadmium-induced effects on bone in a population-based study of women 2006 In: Environmental Health Perspectives. - : Environmental Health Perspectives. - 1552-9924 .- 0091-6765. ; 114:6, s. 830-834 Journal article (peer-reviewed)abstract High cadmium exposure is known to cause bone damage, but the association between low-level cadmium exposure and osteoporosis remains to be clarified. Using a population-based women's health survey in southern Sweden [Women's Health in the Lund Area (WHILA)] with no known historical cadmium contamination, we investigated cadmium-related effects on bone in 820 women (53-64 years of age). We measured cadmium in blood and urine and lead in blood, an array of markers of bone metabolism, and forearm bone mineral density (BMD). Associations were evaluated in multiple linear regression analysis including information on the possible confounders or effect modifiers: weight, menopausal status, use of hormone replacement therapy, age at menarche, alcohol consumption, smoking history, and physical activity. Median urinary cadmium was 0.52 mu g/L adjusted to density (0.67 mu g/g creatinine). After multivariate adjustment, BMD, parathyroid hormone, and urinary deoxypyridinoline (U-DPD) were adversely associated with concentrations of urinary cadmium (p < 0.05) in all subjects. These associations persisted in the group of never-smokers, which had the lowest cadmium exposure (mainly dietary). For U-DPD, there was a significant interaction between cadmium and menopause (p = 0.022). Our results suggest negative effects of low-level cadmium exposure on bone, possibly exerted via increased bone resorption, which seemed to be intensified after menopause. Based on the prevalence of osteoporosis and the low level of exposure, the observed effects, although slight, should be considered as early signals of potentially more adverse health effects.
3.	Akesson, AA, et al. (author) Tubular and glomerular kidney effects in Swedish women with low environmental cadmium exposure 2005 In: Environmental Health Perspectives. - : Environmental Health Perspectives. - 1552-9924 .- 0091-6765. ; 113:11, s. 1627-1631 Journal article (peer-reviewed)abstract Cadmium is a well-known nephrotoxic agent in food and tobacco, but the exposure level that is critical for kidney effects in the general population is not defined. Within a population-based women's health survey in southern Sweden (Women's Health in the Lund Area, WHILA), we investigated cadmium exposure in relation to tubular and glomerular function, from 1999 through early 2000 in 820 women (71% participation rate) 53-64 years of age. Multiple linear regression showed cadmium in blood (median, 0.38 mu g/L) and urine (0.52 mu g/L; density adjusted = 0.67 mu g/g creatinine) to be significantly associated with effects on renal tubules (as indicated by increased levels of human complex-forming protein and N-acetyl-beta-D-glucosaminidase in urine), after adjusting for age, body mass index, blood lead, diabetes, hypertension, and regular use of nephrotoxic drugs. The associations remained significant even at the low exposure in women who had never smoked. We also found associations with markers of glomerular effects: glomerular filtration rate and creatinine clearance. Significant effects were seen already at a mean urinary cadmium level of 0.6 mu g/L (0.8 mu g/g creatinine). Cadmium potentiated diabetes-induced effects on kidney. In conclusion, tubular renal effects occurred at lower cadmium levels than previously demonstrated, and more important, glomerular effects were also observed. Although the effects were small, they may represent early signs of adverse effects, affecting large segments of the population. Subjects with diabetes seem to be at increased risk.
4.	Ali, Imran, et al. (author) Associations between cadmium exposure and circulating levels of sex hormones in postmenopausal women. 2014 In: Environmental Research. - : Elsevier BV. - 1096-0953 .- 0013-9351. ; 134, s. 265-269 Journal article (peer-reviewed)abstract Recent epidemiological as well as in vivo and in vitro studies collectively suggest that the metalloestrogen cadmium (Cd) could be a potential risk factor for hormone-related cancers in particularly breast cancer. Assessment of the association between Cd exposure and levels of endogenous sex hormones is of pivotal importance, as increased levels of such have been associated with a higher risk of breast cancer in postmenopausal women. The present study investigated the perceived relationship (multivariable-adjusted linear regression analyses) between Cd exposure [blood Cd (B-Cd) and urinary Cd (U-Cd)], and serum levels of androstenedione, testosterone, estradiol, and sex-hormone binding globulin (SHBG), in 438 postmenopausal Swedish women without hormone replacement therapy (HRT). A significant positive association between B-Cd (median 3.4nmol/L) and serum testosterone levels, as well as a significant inverse association between B-Cd and serum estradiol levels and with the estradiol/testosterone ratio were encountered. However, U-Cd (median 0.69nmol/mmol creatinine) was inversely associated with serum estradiol levels only. Our data may suggest that Cd interferes with the levels of testosterone and estradiol in postmenopausal women, which might have implications for breast cancer risk.
5.	Andrada, Maria, et al. (author) Serum estradiol does not differentiate stress, mixed and urge incontinent women around menopause. A report from the Women's Health in the Lund Area (WHILA) study. 2011 In: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : Elsevier BV. - 0301-2115. ; 159:1, s. 209-212 Journal article (peer-reviewed)abstract OBJECTIVE: To outline serum estradiol levels in perimenopausal women with stress, mixed or urge incontinence. We believe the majority of urgency symptoms in perimenopausal women to be caused by a pelvic floor dysfunction and a hypermobility of the bladder neck. If this is the case, there would be no difference in estradiol levels between the groups. STUDY DESIGN: Setting: University hospital. In the observational Women's Health in the Lund Area study, a subset of 400/2221 women reporting urinary incontinence completed a detailed questionnaire regarding lower urinary tract symptoms and had their serum steroid hormone levels measured. Statistical analyses were made by Chi-square test, nonparametrical tests, ANOVA, multi- and univariate logistic regression analysis. RESULTS: Stress incontinence was reported by 196, mixed incontinence by 153 and urge incontinence by 43 women; in 369, serumestradiol values were available. Serum estradiol did not differ significantly between stress incontinent (median 49.5pmo/l, range 2.63-875.4), urge incontinent (median 31.6pmol/l, range 2.63-460.7) or mixed incontinent women (median 35.5pmol/l, range 2.63-787.9, p=0.62). Logistic regression analysis correcting for age, parity, hormonal status, smoking, hysterectomy and BMI also failed to show any difference in estradiol levels between the groups (p=0.41-0.58). CONCLUSION: No significant differences in serum estradiol levels between stress, mixed or urge incontinent perimenopausal women could be demonstrated.
6.	Ceausu, Iuliana, et al. (author) The hysterectomized woman Is she special? The women's health in the Lund area (WHILA) study. 2006 In: Maturitas. - : Elsevier BV. - 1873-4111 .- 0378-5122. ; 53:2, s. 201-209 Journal article (peer-reviewed)
7.	Cederfjäll, Jenny, et al. (author) Alcohol Consumption among Middle-Aged Women: A Population-Based Study of Swedish Women. The Women's Health in Lund Area (WHILA) Study. 2004 In: European Addiction Research. - : S. Karger AG. - 1421-9891 .- 1022-6877. ; 10:1, s. 15-21 Journal article (peer-reviewed)abstract From a total population of 10,766 Swedish 50- to 59-year-old women, 6,917 (64.2%) participated in the Women’s Health in Lund Area (WHILA) study, and among them 6,623 (95.7%) answered the questions on alcohol consumption. One out of 4 women (26.0%) consumed no alcohol in an ordinary week (non-drinkers), 57.4% consumed not more than 83 g alcohol, 12.5% consumed 84–167 g and 4.2% consumed 168 g or more. The weekly drinkers had a median consumption of 40.0 g alcohol (range 2.5–1,036.0) and the main sort of alcohol was wine. Comparing the four drinking groups, most differences occurred between the non-drinking and the weekly drinking women. The non-drinkers had lower socio-demographic status, poorer health and more symptoms, especially physical symptoms. In a multivariate logistic regression analysis, most associations between non-drinking and lower socio-demographic status remained.
8.	de Jong, Annelise, et al. (author) LCA Systemanalys av återanvändbara förpackningar för take-away mat och dryck 2023 Reports (other academic/artistic)abstract Den här studien har genomförts av IVL Svenska Miljöinstitutet på uppdrag av Naturvårdsverket och undersöker miljöpåverkan av återanvändbara förpackningar för take-away mat och dryck. Rapporten fungerar som underlag till ett Regeringsuppdrag som genomförs av Naturvårdsverket och Livsmedelsverket för att ta fram vägledning och riktlinjer för verksamheter gällande återanvändbara muggar och matlådor (M2021/02087). I den nya förordningen (2021:996) om engångsprodukter, lyfts ökade krav på återanvändning av förpackningar till januari 2024 och även att system ska registreras hos Naturvårdsverket. Där finns även krav på aktörer att informera deras kunder om miljöpåverkan av användning av engångsförpackningar samt om fördelar av minskad förbrukning av dessa. Naturvårdsverket har beställt denna studie för att ta framkunskapsunderlag inom miljöpåverkan av flergångsförpackningar för att visa upp fördelar gentemot engångsförpackningar, baserat på hela livscykeln från allt från tillverkning av flergångsförpackningar till flera användningscyklar, och sen avfallshantering. Materialval för muggar som analyserades är fossil plast, biobaserad plast, och stål, och för matlådor fossil plast, biobaserad plast, glas och stål.En systemanalys (LCA) tillämpades för att svara på följande frågor i studien:På vilket sätt (när och hur) medhavda återanvändbara muggar och matlådor bör användasVilka material i återanvändbara muggar och matlådor som bör användas för att uppnå störst miljönyttaResultatet visar att råvaruutvinningen dominerar för alla materialalternativ, utom för fossil plast där även förbränningen i avfallsskedet har en betydande klimatpåverkan. Om inte hänsyn tas till att glas eller stål kan användas fler gånger än plast blir glas och stål mycket sämre än plast på grund av större vikt och för att stål också har en större klimatpåverkan per kg material vid tillverkningen av materialet. Det studien ändå signalerar är att fossil-baserad plast (i denna studie PP) sannolikt är det sämsta materialet ur klimatsynpunkt, vilket till stor del beror på att när behållaren förr eller senare förbränns så bidrar detta till fossil klimatpåverkan.Det bio-baserade plast alternativet är bra ur klimatsynpunkt, främst eftersom förbränning av ett bio-baserat material inte bidrar till fossil klimatpåverkan, men också för att tillverkningen av materialet också är lägre även om det där finns en större osäkerhet då de data som använts i den här studien baseras på en LCA publicerad av en enda leverantör. För stålförpackningar har utmaningen i analysen varit dels att försöka göra detta material rättvisa då det kan användas fler gånger än plastmaterialen, men också det som nämnts ovan att det varit svårt att definiera en produktvikt som är representativ i jämförelsen med de andra materialen. Studien visar också att glas (som bara är relaterad till matlådor i denna studie) också är ett bra alternativ, Valet av material har alltså stor betydelse, och det/de material som kan användas flest gånger bör beaktas.Transporter har relativt liten påverkan totalt sett men transporten till ”användare” syns även om den har lägre påverkan än diskningen. Ju tyngre mugg/låda desto större är påverkan från transporter. Diskningen har betydelse, men är relativt liten jämfört med råmaterialet till muggen/lådan. Icke-centraliserad diskning har inte analyserats men borde ge en lägre påverkan (p.g.a. ingen transport), men eventuellt högre påverkan (p.g.a. lägre effektivitet), och detta skulle möjligen kunna ta ut varandra, men har som sagt inte analyserats. Att ta med egen matlåda eller mugg skulle troligen ha större påverkan från diskning på grund av ineffektiv diskning.
9.	Engstrom, Annette, et al. (author) Cadmium-induced bone effect is not mediated via low serum 1,25-dihydroxy vitamin D 2009 In: Environmental Research. - : Elsevier BV. - 1096-0953 .- 0013-9351. ; 109:2, s. 188-192 Journal article (peer-reviewed)abstract Cadmium is a widespread environmental pollutant, which is associated with increased risk of osteoporosis. It has been proposed that cadmium's toxic effect on bone is exerted via impaired activation of vitamin D, secondary to the kidney effects. To test this, we assessed the association of cadmium-induced bone and kidney effects with serum 1,25-dihydroxyvitamin D (1,25(OH)(2)D); measured by enzyme immunoassay. For the assessment, we selected 85 postmenopausal women, based on low (0.14-0.39 mu g/L) or high (0.66-2.1 mu g/L) urinary cadmium, within a cross-sectional population-based women's health survey in Southern Sweden. We also measured 25-hydroxy vitamin D. cadmium in blood, bone mineral density and several markers of bone remodeling and kidney effects. Although there were clear differences in both kidney and bone effect markers between women with low and high cadmium exposure, the 1,25(OH)(2)D concentrations were not significantly different (median, 111 pmol/L (5-95th percentile, 67-170 pmol/L) in low- and 125 pmol/L (66-200 pmol/L) in high-cadmium groups; p = 0.08). Also, there was no association between 1,25(OH)(2)D and markers of bone or kidney effects. It is concluded that the low levels of cadmium exposure present in the studied women, although high enough to be associated with lower bone mineral density and increased bone resorption, were not associated with lower serum concentrations of 1,25(OH)(2)D. Hence, decreased circulating levels of 1,25(OH)(2)D are unlikely to be the proposed link between cadmium-induced effects on kidney and bone. (C) 2008 Elsevier Inc. All rights reserved.
10.	Engstrom, Annette, et al. (author) Retinol May Counteract the Negative Effect of Cadmium on Bone 2011 In: Journal of Nutrition. - : Elsevier BV. - 1541-6100 .- 0022-3166. ; 141:12, s. 2198-2203 Journal article (peer-reviewed)abstract Cadmium and high vitamin A intake are both proposed risk factors for low bone mineral density (BMD), but potential interactions have not been studied. Within the Women's Health in the Lund Area, a population-based study in southern Sweden, we measured retinol in serum among 606 women aged 54-64 y. Data on BMD were measured by DXA at the distal forearm. Parathyroid hormone (PTH), bone alkaline phosphatase (bALP), and osteocalcin in serum and deoxypyridinoline (DPD) and cadmium in urine were available. Associations were evaluated using multivariable-adjusted linear regression analysis. Serum retinol concentrations (median, 1.9; range, 0.97-4.3 mu mol/L) were inversely associated with the bone formation markers bALP and osteocalcin (P <= 0.04) and with PTH (P = 0.07) and tended to be positively associated with BMD (P = 0.08) but not with the bone resorption marker DPD, indicating different effects on bone compared to urinary cadmium (median, 0.66; range, 0.12-3.6 nmol/mmol creatinine). Women with serum retinol less than the median and cadmium greater than the median had lower BMD than those with retinol greater than the median and cadmium less than the median (P = 0.016 among all women and P = 0.010 among never-smokers). Our findings suggest that adequate vitamin A status may counteract the adverse association between cadmium and BMD. J. Nutr. 141: 2198-2203, 2011.
11.	Enstrom, I, et al. (author) Does blood pressure differ between users and non-users of hormone replacement therapy? The Women's Health in the Lund Area (WHILA) Study 2002 In: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 11:4, s. 240-243 Journal article (peer-reviewed)abstract Objective: To examine whether blood pressure over 24 h differed between postmenopausal women receiving and not receiving hormone replacement therapy. Methods: One group of hormone replacement postmenopausal women (n = 32) and one group of non-hormone replacement (n = 32) postmenopausal women underwent non-invasive 24-h ambulatory blood pressure monitoring. They were randomly selected among the 2000 firstly screened women in an ongoing project in Lund, Sweden. The study was designed to detect a difference of 5 mmHg in diastolic blood pressure over 24 h with a power of 80% and 5% significance (two-tailed test). Results: The hormone replacement women had a mean (SD) office blood pressure of 128/76 (12/8) mmHg and the non-hormone replacement 126/78 (16/8) mmHg. Mean ambulatory blood pressure over 24 h, day and night, in the hormone replacement group was 121/72 (11/7), 126/76 (12/8), 111/64 (11/7) mmHg. The corresponding values in the non-hormone replacement group were 118/72 (12/7), 124/77 (12/7), and 107/64 (13/7) ( p > 0.40 for diastolic blood pressure and p > 0.20 for systolic blood pressure). Mean heart rate over 24 h was 71 (7) and 73 (8) beats/min in the hormone and non-hormone replacement groups, respectively. Conclusion: There was no difference in blood pressure or heart rate between the hormone replacement and non-hormone replacement postmenopausal women, either over 24 h or during the day or night. Hormone replacement in postmenopausal women seems not to have an influence on blood pressure, but of course we are aware that this is a cross-sectional study, which has its limitations.
12.	Gunnarsson, Marianne, et al. (author) Effects of pelvic floor exercises in middle aged women with a history of naïve urinary incontinence: a population based study. 2002 In: European Urology. - 1873-7560. ; 41:5, s. 556-561 Journal article (peer-reviewed)abstract OBJECTIVE: To follow the effect of a 4-month pelvic floor exercise (PFE) program in women with naïve urinary incontinence with vaginal electromyography (EMG), pressure and palpation and also to compare the initial findings with symptom-free women of the same age.METHODS: The pelvic floor function expressed with vaginal EMG, pressure and palpation was measured before, during and after 4 months of PFEs in 60 previously untreated incontinent women, 50 of whom completed the study. The patients' perception of the situation and the amount of leakage were estimated before and after PFE. The incontinent group was compared at baseline and after PFE with 28 healthy controls. All women in this study (age 53-63) were randomly recruited from a major population based study.RESULTS: At baseline, the incontinent women had significant reductions of both vaginal EMG activity and pelvic floor muscle condition as estimated by palpation compared to the healthy group. During training a successive, significant increase was seen in both EMG, pressure and palpation and the values eventually exceeded those of the healthy women. The measures reflecting improvement of pelvic floor function thus showed a consistent and progressive pattern. The degree of improvement was higher in those with initial high values in the muscle function tests than in the women with lower initial EMG values, pressures and findings on palpation. No differences were seen between patients with a history of stress incontinence and patients with an urge component, i.e. urge or mixed incontinence. Sixty-four percent of the women were satisfied and wanted no further treatment. The median leakage at pad-test decreased from 5 (range 0-328) to 1 (range 0-126) g/24h. The correlation between the vaginal and the pad-test measurements was weak.CONCLUSION: Women with urinary incontinence have a significant reduction of pelvic floor function as estimated with vaginal EMG and palpation as compared to symptom-free controls. A successive normalization of vaginal EMG, pressure and findings at palpation was seen during the 4-month training period. Incontinence of both stress type and with an urge component can be alleviated in most of the women with PFE. These methods might be useful for routine evaluation of the pelvic neuromuscular disorder present in incontinent women.
13.	Götmar, Anders, et al. (author) Symptoms in peri- and postmenopausal women in relation to testosterone concentrations. Data fromThe Women's Health in the Lund Area (WHILA) study 2008 In: Climacteric. - : Informa UK Limited. - 1369-7137 .- 1473-0804. ; 11:4, s. 304-314 Journal article (peer-reviewed)abstract Objectives: The aim of this study was to investigate possible associations between androgen concentrations in perimenopausal women and symptoms that may be associated with low androgen concentrations in the blood. Methods: All women born 1935 to 1945 living in a defined geographic area in Sweden (n=10766) were invited to a screening program that included physical and laboratory examinations and a questionnaire. Three groups were identified; premenopausal women, women on hormone replacement therapy (HRT) and postmenopausal women without HRT. Concentrations of testosterone (T), androstendione, Sex Hormone Binding Globulin and estradiol were measured. Waist Hip Ratio, Body Mass Index and Free Testosterone Index (FTI) were calculated. Results: 6908 women participated. The women on HRT had lower T and FTI and were less satisfied with mood and energy (p<0.05). Women with hot flushes had higher T and FTI and women reporting coldness had lower concentrations (p<0.05). Sexual well-being were not correlated to T or FTI (p>0.05). Conclusions: Lower T concentrations were associated with lower quality of life in perimenopausal women but not to sexual well-being. There must be other factors than decrements in sex hormones that contribute to the emergence of some perimenopausal symptoms.
14.	Håkansson, Carita, et al. (author) Self-rated health in middle-aged women : Associations with sense of coherence and socioeconomic and health-related factors 2003 In: Scandinavian Journal of Occupational Therapy. - London : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 10:3, s. 99-106 Journal article (peer-reviewed)abstract This study aimed to describe and analyse self-rated health in relation to sense of coherence and socioeconomic and health-related factors and to explore the associations between self-rated health and these factors in order to identify health resources and health limitations in a group of healthy middle-aged women. Healthy middle-aged women from a defined geographical area in Southern Sweden ( n =577) answered a postal survey with the sense of coherence scale and questions about socioeconomic and health-related conditions. The results showed that very good/rather good self-rated health was associated with high sense of coherence and good economic situation, and these factors can be seen as a health resource. Poor self-rated health was most strongly associated with perceived symptoms of tension, weak sense of coherence, treatment for depression, treatment for chronic disease, and difficult economic situation, and these factors can be seen as health limitations. In conclusion, only 29% of the women rated their health as very good and 41% of the women had symptoms of tension but they were not sick-listed. It is of major public health interest to improve the understanding of self-rated health and to develop health promotion for women and methods to prevent symptoms of tension and sick-listing.
15.	Håkansson, Carita, et al. (author) Well-being and occupational roles among middle-aged women 2005 In: Work. - Amsterdam : IOS Press. - 1051-9815 .- 1875-9270. ; 24:4, s. 341-351 Journal article (peer-reviewed)abstract One purpose of the present study is to explore the stability of the pattern of health/work and sickness absence among middle-aged women over a period of three years. Two hypotheses were tested: 1. that enduringly healthy working women would perceive more valued occupational roles and higher well-being than long-term sick-listed women, and 2. that high levels of well-being at baseline would predict enduring health and occupational role value at a 3-year follow-up. Middle-aged women (n = 208) answered a postal survey with the Role checklist, a well-being scale and questions about work and sickness situation. The results showed that there was a considerable variability in the pattern of health/work and sickness absence. The results showed that the enduringly healthy women experienced a more valued worker role and higher well-being than the long-term sick-listed women. Furthermore, high levels of well-being concerning health and work predicted enduring health in the studied sample.
16.	Jernström, Helena, et al. (author) A prospective study of different types of hormone replacement therapy use and the risk of subsequent breast cancer: the women's health in the Lund area (WHILA) study (Sweden) 2003 In: Cancer Causes and Control. - 1573-7225. ; 14:7, s. 673-680 Journal article (peer-reviewed)abstract Objectives: Reports suggest that combined estrogen plus progestin hormone replacement therapy (HRT) confers a higher breast cancer risk than estrogen alone. We aimed to establish whether breast cancer risk depends on the type of HRT formula. Methods: The cohort consisted of 6586 women, aged 50 - 64 years, from the Lund area, Sweden, with no reported breast cancer upon inclusion. We obtained information such as HRT use through a questionnaire between December 1995 and February 2000. New breast cancers were identified through the South Swedish tumor registry. Results: Between inclusion and December 2001, 101 women developed breast cancer. Only ever use of the continuous combined estrogen plus progestin ( CCEP) formula differed between cases and controls (45.2% versus 23.5%; p = 0.000001). Compared with never users, exclusive CCEP users had the highest age-adjusted hazard ratio HR 3.3 (95% CI: 1.9 - 5.6; p < 0.001), followed by users of CCEP in addition to other HRT formulas HR 2.8 (95% CI: 1.4 - 5.5; p = 0.003). No significant increase was seen in women who exclusively used other HRT formulas. Conclusion: Women who used CCEP had over three times the risk of developing breast cancer compared with never users and twice the risk compared with users of other types of HRT.
17.	Khatibi Esfanjani, Ali, et al. (author) Blood pressure in middle-aged women: are androgens involved? A population-based study of Swedish women: the Women's Health in the Lund Area study 2007 In: Journal of Hypertension. - 1473-5598. ; 25:10, s. 2044-2050 Journal article (peer-reviewed)abstract Objective To assess the prevalence of hypertension and use of antihypertensive drug therapy in relation to menopausal status and to delineate perceived associations between androgens and blood pressure in perimenopausal women. Methods A population- based sample of women aged 50 - 59 ( nU6893). Women were divided into three groups according to their hormonal status: premenopausal, postmenopausal without hormone therapy, and postmenopausal with hormone therapy. Result In the premenopausal, postmenopausal without hormone therapy, and postmenopausal with hormone therapy groups, the prevalence of high blood pressure (>= - 140mmHg systolic or >= 90mmHg diastolic) was 43.9, 49.9 and 45.8%, respectively. In women with normal blood pressure, adjusting for age, body mass index and smoking, there were negative associations between serum testosterone and systolic blood pressure in the total sample ( P< 0.01) and the postmenopausal without hormone therapy group ( P< 0.05). In women using antihypertensive drug therapy with a blood pressure of at least 140/ 90mmHg, positive associations were found between serum testosterone and systolic blood pressure in the total series ( P< 0.05) and in the postmenopausal without hormone therapy group ( P< 0.05). Conclusion Abnormal blood pressure is common in middle- aged women regardless of hormonal status. Our findings suggest that testosterone could have a dual influence on blood pressure in perimenopausal women.
18.	Khatibi Esfanjani, Ali, et al. (author) Could androgens protect middle-aged women from cardiovascular events? A population-based study of Swedish women: The Women's Health in the Lund Area (WHILA) Study 2007 In: Climacteric. - : Informa UK Limited. - 1369-7137 .- 1473-0804. ; 10:5, s. 386-392 Journal article (peer-reviewed)abstract Objective The aim of this analysis was to delineate perceived associations between androgens and cardiovascular events in perimenopausal women. Design A cross-sectional, population-based study of 6440 perimenopausal women aged 50-59 years, living in Southern Sweden. In all, 461 (7.1%) women were premenopausal (PM), 3328 (51.7%) postmenopausal without hormone therapy (HT) (PMO) and 2651 (41.2%) postmenopausal with HT (PMT). For further comparisons, 104 women (1.6%) who reported cardiovascular disease (CVD) were studied in detail; 49 had had a myocardial infarction, 49 a stroke and six women both events. For each woman with CVD, two matched controls were selected (n = 208). Results In the matched controlled series, androstenedione levels were lower (p < 0.005) in cases. Cases with hormone therapy had also lower testosterone levels than matched controls (p = 0.05). In the total cohort, by using multiple logistic regression analyses, testosterone was positively associated with low density lipoprotem cholesterol (p < 0.001) and high density lipoprotein cholesterol (HDL-C) (p < 0.001) in all women, but negatively associated with levels of triglycerides in both the PMO (p < 0.001) and PMT (p < 0.001) groups. Androstenedione levels were positively associated with HDL-C (p < 0.05) and negatively with triglycerides (p < 0.05) in the PM group. Conclusion Women with cardiovascular disease had lower serum androgen levels, particularly women using hormone replacement therapy, even when controlled for lipids and other potential risk factors.
19.	Khatibi Esfanjani, Ali, et al. (author) Does hormone therapy increase allergic reactions and upper gastrointestinal problems?; Results from a population-based study of Swedish woman. The women's health in the Lund area (WHILA) study. 2004 In: Maturitas. - : Elsevier BV. - 1873-4111 .- 0378-5122. ; 48:4, s. 438-445 Journal article (peer-reviewed)abstract Objectives: To delineate the use of various drugs particularly pertaining to allergy and upper gastrointestinal problems in relation to hormone status in middle aged women. Methods: An analysis from a population-based study on women born between 1935 and 1945 and lived in the Lund area southern Sweden. Of 10766 women, 6917 provided complete data sets; in turn 5673 were assessed for the use of medication in this study. Among the cohort, 9% of women were premenopausal (PM), 54% were postmenopausal without hormone replacement therapy (PM0) and 37% were current hormone replacement therapy users (PMT). Results: There were 7 (1.3%) women in PM, 11 (0.4%) in PMO and 21 (1.0%) in PMT group who used loratadine regularly. There was a significant difference between the PM and PMO groups and also between the PMO and PMT groups in the use of loratadine (P < 0.05). Among 21 loratadine users in PMT group 4 (19%) used transdermal patches and 17 (81%) used oral HRT. The result for omeprazole use was as follows: 4 (0.8%) of PM group, 39 (1.3%) of PMO group and 42 (2.0%) of PMT group. The use of omeprazole was significantly higher in the PMT group than in the PM (P = 0.05) and PMO group (P < 0.05). There was no relation between the use of omeprazole and smoking or alcohol consumption. Conclusions: Use of hormone replacement therapy seems to be related to a higher frequency of omeprazole and loratadine use, which implies that hormone replacement therapy, may be associated with more upper gastrointestinal symptoms as well as allergy. (C) 2003 Published by Elsevier Ireland Ltd.
20.	Khatibi Esfanjani, Ali, et al. (author) Nonhormonal drug use and its relation to androgens in perimenopausal women: a population-based study of Swedish women. The Women's Health in the Lund Area Study. 2009 In: Menopause. - : Ovid Technologies (Wolters Kluwer Health). - 1530-0374 .- 1072-3714. ; 16, s. 315-319 Journal article (peer-reviewed)abstract OBJECTIVE:: To outline the prevalence of nonhormonal drug use in middle-aged women and to assess plausible associations between serum androgen levels and variables associated to health such as drug use and planned visits to healthcare units. METHODS:: This was a population-based study of women aged 50 to 59 years (n = 6,893). Women were divided into three groups according to their menopause status: premenopausal (PM), postmenopausal without hormone therapy (PM0), and postmenopausal with hormone therapy (PMT). Data regarding current drug use and healthcare visits were collected from a questionnaire. RESULTS:: The overall prevalence of nonhormonal drug use was 36.4% in all women. In the PM, PM0, and PMT groups, these percentages were 28.3%, 35.3%, and 39.3%, respectively, and the differences between them were statistically significant (P < 0.01). In all women, the most common medication used was for cardiovascular conditions (12.0%), followed by those for asthma (4.0%) and pain (3.7%). The number of drugs used by all women and women in the PM0 and the PMT groups were negatively associated with the serum levels of androstenedione (P < 0.05). In the postmenopausal groups, the number of visits to healthcare units was negatively associated to the levels of serum testosterone and androstenedione (P < 0.05). CONCLUSIONS:: Hormone therapy in postmenopausal women seems to be associated with increased use of nonhormonal pharmacotherapy, rendering higher prevalence of such drugs in middle-aged women. Postmenopausal women with lower serum testosterone and a higher number of office visits used medications for cardiovascular problems and depression more than other medications. Whether this is an effect related to the hormone therapy itself or to experiencing more perimenopausal symptoms in this group of women is still unclear.
21.	Li, Cairu, et al. (author) Background factors influencing somatic and psychological symptoms in middle-age women with different hormonal status A population-based study of Swedish women. 2005 In: Maturitas. - : Elsevier BV. - 1873-4111 .- 0378-5122. ; 52:3-4, s. 306-318 Journal article (peer-reviewed)abstract Objective: To analyse the influence of socio-demographic characteristics and environmental factors on self-reported somatic and psychological symptoms among middle-aged Swedish women. Methods: A total of 6917 women living in the Lund area of southern Sweden were participates of this study. They completed a generic questionnaire pertaining to socio-demographic characteristics, lifestyle factors and current health related problems. According to hormonal status, the participants were subdivided into three groups, i.e. premenopause, postmenopause and perior postmenopausal women with hormone replacement therapy (HRT). Results: By using multiple logistic regression models, a high risk for somatic symptoms was independently associated with unemployment, no exercise, unmarried, high body weight and diseases affecting the cardiovascular system as well as a history of cancer. Psychological symptoms were independently associated with higher educational level, unemployment, no exercise, unmarried, heavy smoking habits (>= 15 cig/day), weight gain and a history of cancer. In addition, the background factors seemed to have less impact on symptoms among women who used HRT. Conclusion: Socio-demographic characteristics, lifestyle factors and concurrent health problems appear to have influences on the frequency and the number of somatic and psychological symptoms in middle-age women. Hormone replacement therapy seems to be able to counteract negative impacts caused by un-healthy lifestyle and other health problems.
22.	Li, Cairu, et al. (author) Health profile of middle-aged women: The Women's Health in the Lund Area (WHILA) study. 2002 In: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 17:5, s. 1379-1385 Journal article (peer-reviewed)abstract BACKGROUND: Middle-aged women experience various health-related problems. The aim of this study was to evaluate the impacts of menopause status and hormone intervention on women's health. METHODS: In an ongoing, population-based study, 4943 women, born 1935 to 1945 and living in the Lund area of Southern Sweden, were included in this analysis. They completed a generic questionnaire pertaining to socio-demographic background and current health-related symptoms. Among the cohort, 9% of women were pre-menopausal (PM), 52% were post-menopausal without hormone replacement therapy (PMO) and 39% were current hormone replacement therapy users (PMT). RESULTS: Hot flushes and vaginal dryness were strongly related to menopausal status. The prevalence of somatic symptoms worsened progressively from the groups of PM to PMO to PMT. The most abundant complaints were headache and muscle-skeletal-joint problems. A total of 85% of women experienced psychological problems. Contrary to our expectation, a poorer profile of psychological health was found in the PMT group when compared with the PMO group. CONCLUSIONS: The high prevalence of symptoms in middle-aged women could be attributed to age, hormonal influence as well as personality.
23.	Li, Cairu, et al. (author) Menopause-related symptoms: what are the background factors? A prospective population-based cohort study of Swedish women (The Women's Health in Lund Area study). 2003 In: American Journal of Obstetrics and Gynecology. - 1097-6868. ; 189:6, s. 1646-1653 Journal article (peer-reviewed)
24.	Lidfeldt, Jonas, et al. (author) A screening procedure detecting high-yield candidates for OGTT. The Women's Health in the Lund Area (WHILA) study: a population based study of middle-aged Swedish women 2001 In: European Journal of Epidemiology. - 1573-7284. ; 17:10, s. 943-951 Journal article (peer-reviewed)abstract The objective was to evaluate a screening procedure for detecting high-yield candidates for an OGTT, in a population of middle-aged Swedish women. A two-step screening procedure was performed in 6917 subjects. Women with a positive screening outcome, i.e. increased non-fasting capillary blood glucose, serum triglycerides, BMI, WHR, blood pressure or a family history of diabetes, pharmacological treatment of hypertension or hyperlipidaemia at the primary screening underwent a 75-g OGTT. A control group of women with negative screening outcome (n = 221) also underwent an OGTT. In 2923 women with positive screening outcome, 517 (17.7%) had NFG/IGT (normal fasting venous blood glucose <5.6 mmol/l and 2h-glucose 6.7-9.9 mmol/l), 109 (3.7%) IFG/IGT (fasting 5.6-6.0 and 2h 6.7-9.9 mmol/l) and 223 (7.6%) diabetes (fasting > or = 6.1 or 2h > or = 10.0 mmol/l). These figures were three, five and four times higher, respectively, than in the control group with negative screening outcome (p < 0.001 for all); no differences were found for IFG/NGT (fasting 5.6-6.0 and normal 2h < 6.7 mmol/l) (4.6% vs. 7.2%). For predicting impaired glucose metabolism (IFG/NGT, NFG/IGT, IFG/IGT, diabetes), the screening instrument showed an estimated sensitivity of 70%, specificity of 55%, positive predictive value of 34% and negative predictive value of 85%, based on findings in the control sample. The odds ratio for NFG/IGT increased with the numbers of risk factors from 2.8 to 7.7, for IFG/ IGT from 5.7 to 55.0 and for diabetes from 2.5 to 18.1. High B-glucose, WHR and BMI were the three most important factors associated with an increased risk for NFG/IGT, IFG/IGT and diabetes. In subjects with IFG/NGT, none of the screening variables was associated with an increased risk. In summary, the results show a population screening method focused on features of the metabolic syndrome that discloses high-yield candidates for OGTT. A high prevalence of unknown impaired glucose metabolism was found in middle-aged women with a positive screening profile.
25.	Lidfeldt, Jonas, et al. (author) Basic lifestyle advice 2004 In: Diabetes Research. - 0265-5985. ; , s. 9-9 Journal article (peer-reviewed)
26.	Lidfeldt, Jonas, et al. (author) Biological factors are more important than socio-demographic and psychosocial conditions in relation to hypertension in middle-aged women. The Women's Health in the Lund Area (WHILA) study. 2002 In: Blood Pressure. - 0803-7051. ; 11:5, s. 270-278 Journal article (peer-reviewed)
27.	Lidfeldt, Jonas (author) Health in middle-aged women, with emphasis on features of the metabolic syndrome and related markers for diabetes. Women´s Health in the Lund Area Study. 2003 Doctoral thesis (other academic/artistic)abstract The aims were to study the biological, socio-demographic and psychosocial health profile in a geographically defined population of middle-aged women, with focus on features of the metabolic syndrome and diabetes, and to study the efficiency of a screening method for high-risk individuals and the outcome of baseline lifestyle advices on the diabetes incidence. All women aged 50-59 years (n=10766) were invited to a screening procedure including questionnaires and laboratory assessments. Subjects were discriminated as positive or negative on one to eight variables linked to the metabolic syndrome. Those with positive screening and impaired glucose tolerance (IGT) at oral glucose tolerance test, were followed for 2.5 years after a one-hour session of lifestyle advices. A sub-sample of women with negative screening and normal glucose tolerance (NGT) were also studied at follow-up. Altogether, 6917 women attended the study and 93% were postmenopausal. Nearly half had hormone replacement therapy (HRT). A positive screening profile was found in 51%, and 14% had IGT and 6,4% diabetes, out of whom 4.8% were previously unknown. High blood glucose, waist hip ratio and body mass index were the most important factors associated with glucose intolerance. The screening instrument showed a sensitivity of 80% and a specificity of 55%. A total of 27% had hypertension. The prevalence of osteoporosis was 6.6%. In the longitudinal study, 11.9% of women with IGT developed diabetes, while 38% turned normal. In the group with NGT no one developed diabetes. Biological factors interrelated with socio-demographic and psychosocial disparities, like low level of education, living single and low subjective physical well-being. Low or moderate alcohol consumption seemed beneficial on the metabolic profile. The results on smoking and HRT were contradictory concerning the effect on features of the metabolic syndrome, while more crucial for the bone density. A high prevalence of risk variables was found, and many cases of IGT and diabetes. Screening of women at high risk for diabetes should be performed, and the biological risk profile considered jointly with socio-demographic and psychosocial factors. A one-hour baseline occasion of lifestyle advices reduces significantly the risk for new cases of diabetes.
28.	Lidfeldt, Jonas, et al. (author) Socio-demographic and psychosocial factors are associated with features of the metabolic syndrome. The Women's Health in the Lund Area (WHILA) study. 2003 In: Diabetes, Obesity and Metabolism. - : Wiley. - 1462-8902. ; 5:2, s. 106-112 Journal article (peer-reviewed)abstract Aim:The aim was to analyse any associations between socio-demographic and psychosocial factors and different features of the metabolic syndrome in a geographically well-defined population of middle-aged women. Methods:A population of 10 766 Caucasian women aged 50-59 years was investigated regarding biological and socio-demographic conditions, physical activity, dietary habits, aspects of quality of life, and subjective physical and mental symptoms. The screening instrument was used to discriminate subjects as positive or negative on one or more of a total of eight variables considered to be linked to the metabolic syndrome. The cut-off values for positive screening were non-fasting capillary blood glucose >= 8.0 mmol/l and serum triglycerides >= 2.3 mmo/l, BMI >= 30 kg/m2, WHR >= 0.90, blood pressure >= 160 and/or 95 mmHg, a family history of diabetes, and pharmacological treatment for hypertension or hyperlipidaemia. Results:Altogether 6805 women (63.2%) participated: 3535 with positive and 3270 with negative screening. Multiple logistic regression analyses showed that comprehensive (OR 1.62, 95% CI 1.41-1.87) and upper secondary (1.40, 1.24-1.57) school, low physical quality of life (1.41, 1.23-1.61) and high sum of subjective physical symptoms (1.06, 1.04-1.08) were positively associated with one or more features of the metabolic syndrome, while high leisure-time exercise and healthy diet (0.84, 0.71-0.99), and low (<= 83 g/week) (0.71, 0.63-0.81) and moderate (84-167 g/week) (0.78, 0.65-0.93) alcohol consumption were negatively associated. Conclusions:To identify middle-aged women with cardiovascular risk factors and high risk for diabetes, it is important to consider not only biological, but also socio-demographic and psychosocial conditions.
29.	Lidfeldt, Jonas, et al. (author) The influence of hormonal status and features of the metabolic syndrome on bone density: A population-based study of Swedish women aged 50 to 59 years. The women's health in the Lund area study 2002 In: Metabolism, Clinical and Experimental. - : Elsevier BV. - 1532-8600. ; 51:2, s. 267-270 Journal article (peer-reviewed)abstract This study investigated whether there is an association between bone density and features of the metabolic syndrome in relation to hormonal status. All women aged 50 to 59 years living in a defined geographic area in Sweden were offered a health assessment program including blood glucose, lipid profile, blood pressure, and bone densitometry. Women were divided into 3 groups according to their hormonal status: premenopausal (PM), postmenopausal with hormone replacement therapy (PMT), and postmenopausal without hormone replacement therapy (PMO). Of the 6,886 women investigated, 7% were PM, 41% PMT, and 52% PMO. The overall prevalence of osteopenia and osteoporosis, according to the World Health Organization (WHO) definition, was 42.6% and 6.6%, respectively. T-score in the PM group was higher than in the PMT (P <.05) and PMO groups (P <.001) and higher in the PMT group compared with the PMO group (P <.001). Also, in the total cohort, the bone density was positively associated with body weight, body mass index (BMI), waist-to-hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum triglycerides, and blood glucose (P <.001 for all) and negatively associated with serum levels of cholesterol (P <.05) and high-density lipoprotein (HDL) (P <.001). This was most evident among the PMO women, suggesting that the influence of metabolic factors on bone density increases when the levels of hormones decrease. This indicates that hormone replacement therapy maintains treated women in a premenopausal status concerning the metabolic factors.
30.	Lidfeldt, Jonas, et al. (author) Women living alone have an increased risk to develop diabetes, which is explained mainly by lifestyle factors. 2005 In: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 28:10, s. 2531-2536 Journal article (peer-reviewed)abstract OBJECTIVE— The purpose of this study was to assess the role of household conditions for the progression to diabetes in women with impaired glucose tolerance (IGT). RESEARCH DESIGN AND METHODS— A total of 461 women, aged 50–64 years, with IGT defined by an oral glucose tolerance test, had baseline advice on physical exercise, diet, smoking, and alcohol habits. Physical examination, blood tests, and questionnaires were completed at baseline and after 2.5 years. Household status was categorized into living alone or with a partner, other adults, or children. RESULTS— Women living alone had a 2.68-fold increased risk (95% CI 1.02–7.05) of developing diabetes after adjustments for biological risk factors. Further stepwise adjustments for education, occupation, subjective mental health, exercise, diet, and alcohol showed remaining significant odds ratios (ORs), decreasing from 3.26 (1.19–8.96) to 3.03 (1.02–8.99). However, when smoking status was added, the OR became nonsignificant, 2.07 (0.62–6.88). More women who lived alone smoked and did not reduce their daily cigarette consumption compared with women in other household conditions. At follow-up, women living alone had reduced their alcohol consumption and were more often abstainers and fewer had healthy dietary habits or had improved their diet. Physical exercise did not differ among the groups. Separate analyses of any other household status did not show any excess risk for development of diabetes. CONCLUSIONS— Women living alone had a higher risk to progress from IGT to diabetes, mostly explained by smoking, alcohol, and dietary habits. Household conditions should be accounted for when assessing future risk for diabetes.
31.	Moghaddas, Fatemeh, et al. (author) Prevalence of urinary incontinence in relation to self-reported depression, intake of serotonergic antidepressants, and hormone therapy in middle-aged women: a report from the Women's Health in the Lund Area study. 2005 In: Menopause. - 1530-0374. ; 12:3, s. 318-324 Journal article (peer-reviewed)
32.	Nazeri, Kavoos, et al. (author) Colorectal cancer in middle-aged women in relation to hormonal status: A report from the Women's Health in the Lund Area (WHILA) study. 2006 In: Gynecological Endocrinology. - : Informa UK Limited. - 0951-3590 .- 1473-0766. ; 22:8, s. 416-422 Journal article (peer-reviewed)abstract Objective. To delineate a perceived association of estradiol versus estradiol plus norethisterone hormone therapy on the prevalence of colorectal cancer in postmenopausal women. Methods. The Women's Health in the Lund Area (WHILA) project covers 10 766 women aged 50-60 years, living in the Lund area, Sweden. Out of this population, 6908 (64%) women completed questionnaires, underwent physical and laboratory assessments and had self-reported information regarding colorectal cancer. Four hundred and twenty-two (6%) were premenopausal (PM), 3600 (52%) were postmenopausal without hormone therapy (PM0), 2452 (36%) were postmenopausal with combined hormone therapy (PMT-HT) and 364 (5%) were postmenopausal with estrogen monotherapy (PMT-E). Results. There were 21 cases of colorectal cancer (0.3%), one in the PM group, 16 in the PM0 group, two in the PMT-HT group and another two in the PMT-E group. Colorectal cancer prevalence was lower in the PMT-HT than in the PM0 group (odds ratio (OR) = 0.18, 95% confidence interval (CI) = 0.04-0.80). However, for the PMT-E group, the OR (95% CI) was 1.02 (0.86-1.20). There was a positive association between low physical activity (p = 0.04), low parity (p = 0.02) and risk of colorectal cancer. Conclusion. Combined hormone therapy seemed to be associated with a lower risk of colorectal cancer in postmenopausal women in contrast to estrogen monotherapy. Hence the progestin might have a protective role.
33.	Nerbrand, Christina, et al. (author) Serum lipids and lipoproteins in relation to endogenous and exogenous female sex steroids and age; The Women's Health in the Lund Area (WHILA) study. 2004 In: Maturitas. - : Elsevier BV. - 1873-4111 .- 0378-5122. ; 48:2, s. 161-169 Journal article (peer-reviewed)
34.	Rignell-Hydbom, Anna, et al. (author) Exposure to p,p'-DDE: a risk factor for type 2 diabetes. 2009 In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 4:10 Journal article (peer-reviewed)abstract BACKGROUND: Persistent organic pollutants (POPs), such as PCBs, DDT and dioxins have in several cross-sectional studies shown strong associations with type 2 diabetes mellitus. Reversed causality can however not be excluded. The aim of this case-control study was to evaluate whether POPs concentration is a risk factor for type 2 diabetes. METHODOLOGY/PRINCIPAL FINDINGS: A case-control study was performed within a well-defined cohort of women, age 50-59 years, from the Southern part of Sweden. Biomarkers for POP exposure, 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) and 1,1-dichloro-2,2-bis (p-chlorophenyl)-ethylene (p,p'-DDE) were analyzed in stored serum samples, which were collected at the baseline examination when the cohort was established. For 107 out of the 371 cases, serum samples were stored at least three years before their type 2 diabetes was diagnosed. In this data set, CB-153 and p,p'-DDE were not associated with an increased risk to develop type 2 diabetes. However, when only the cases (n = 39) that were diagnosed more than six years after the baseline examination and their controls were studied, the women in the highest exposed quartile showed an increased risk to develop type 2 diabetes (OR of 1.6 [95% 0.61, 4.0] for CB-153 and 5.5 [95% CI 1.2, 25] for p,p'-DDE). CONCLUSIONS/SIGNIFICANCE: The results from the present case-control study, including a follow-up design, confirms that p,p'-DDE exposure can be a risk factor for type 2 diabetes.
35.	Roos, Camilla, et al. (author) Insulin resistance and self-rated symptoms of depression in Swedish women with risk factors for diabetes: the Women's Health in the Lund Area study. 2007 In: Metabolism, Clinical and Experimental. - : Elsevier BV. - 1532-8600. ; 56:6, s. 825-829 Journal article (peer-reviewed)abstract Previous studies have suggested that depression increases the risk for diabetes and that this may be mediated through insulin resistance. The study aimed to analyze if self-rated symptoms of depression are related to insulin resistance among middle-aged and older Swedish women with features of the metabolic syndrome and being at risk for type 2 diabetes mellitus. We analyzed data from 1047 Swedish women aged 50 to 64 years without a history of diabetes and living in the southern part of Sweden. A variable self-rated symptoms of depression (SRSD) was defined by using the Gothenburg Quality of Life instrument. We estimated odds ratios (ORs) to determine whether or not SRSD was associated with the homeostasis model assessment of insulin resistance. The variable SRSD was not associated with insulin resistance. However, it was positively associated with waist-hip ratio (OR, 1.95; 95% confidence interval, 1.28-3.00) and negatively associated with physical exercise (OR, 1.29; 95% confidence interval, 0.99-1.68) after multivariate adjustment. In conclusion, lifestyle factors such as physical inactivity and abdominal obesity, but not insulin resistance, seem to be related to self-rated symptoms of depression in women with risk factors for diabetes mellitus. The relationship between insulin resistance and major depression needs to be further examined.
36.	Rundberg, Jenny, et al. (author) Abstinence, occasional drinking and binge drinking in middle-aged women. The women's health in Lund area (WHILA) study 2008 In: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 62:3, s. 186-191 Journal article (peer-reviewed)abstract Although drinking patterns in women have received increased attention, few studies have focused on middle-aged women. Drinking patterns were investigated in a population sample of 513 Swedish women aged 50-59, and analysed in relation to social situation, and mental and physical health. The chi-square test was used to analyse differences in proportions. Variables showing significant differences were entered into a multivariate or multinomial logistic regression model. Abstainers and occasional drinkers had lower levels of education and more often regular medical control compared with weekly drinkers. Furthermore, abstainers more often had disability pension. Among women drinking alcohol, 56.6% affirmed binge drinking within the last year and 39.4% within the last month. Binge drinkers did not differ in terms of social situation, mental or physical health, compared with other drinkers. Drinking to relieve tension was affirmed by 7.2%. These women had more mental symptoms and less contact with friends compared with other drinkers; furthermore, they were more often binge drinkers. Binge drinking was common and health and social consequences of this drinking pattern in middle-aged women need to be further explored. Women drinking to relieve tension may need intervention for both drinking habits and mental health.
37.	Rundberg, Jenny, et al. (author) Few middle-aged women with severe mental symptoms use psychotropic drugs: The women's health in Lund area ( WHILA) study 2005 In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 33:5, s. 384-391 Journal article (peer-reviewed)abstract Aims: In a population of middle-aged women a survey was carried out to ascertain the prevalence of mental symptoms and psychotropic drug use, and further to investigate whether severe mental symptoms are associated with social situation, alcohol consumption, smoking, and physical health. Methods: All women (n510,766) aged 50-59 years and living in the Lund area were invited to the WHILA study, a health survey including laboratory examinations and a self-administered questionnaire; 6,917 (64.2%) participated. This study is based on the questionnaire only. Results: During the past three months 25.4% (n=1,709) had been troubled by none or 1 mental symptom ( labelled "absent/slight''), 52.8% (n=3,555) by 2-6 mental symptoms ("moderate'') and 21.8% (n=1,471) by 7-10 mental symptoms ("severe"). Among women with severe mental symptoms 15.4% regularly used psychotropic drugs, mainly antidepressants. A multiple logistic regression analysis showed that women with severe mental symptoms had higher odds for living alone (OR 1.7; CI 1.3-2.2) or as single parents (OR 2.1; CI 1.2-3.6), being university-educated (OR 1.5; CI 1.1-2.0), being on long-term sick-leave (OR 8.8; CI 3.0-25.5), using hormone replacement therapy (OR 1.3; CI 1.1-1.6), and having severe physical symptoms (136.8; CI 89.2-209.7) compared with women with absent/slight mental symptoms. Conclusion: Mental symptoms were common among the participating women. The presence of severe mental symptoms was strongly associated with severe physical symptoms. Few women with severe mental symptoms used psychotropic drugs. Middle-aged women with severe mental symptoms need to be identified and provided with appropriate psychopharmacological, hormonal, and/or psychosocial treatment.
38.	Rundberg, Jenny, et al. (author) Mental symptoms, psychotropic drug use and alcohol consumption in immigrated middle-aged women. The Women's Health in Lund Area (WHILA) Study. 2006 In: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 60:6, s. 480-485 Journal article (peer-reviewed)abstract This study aims to analyse mental symptoms, psychotropic drug use and alcohol consumption, in immigrant women born in Finland, the other Nordic countries, Eastern Europe, Western Europe and countries outside Europe, compared with Swedish-born women, and furthermore, to study if age at immigration may have an influence. All women (n = 10,766) aged 50 - 59 years and living in the Lund area of southern Sweden received a postal invitation to a health survey named the Women's Health in Lund Area; 64.2% (n = 6917) participated. The participants answered a questionnaire including prevalence of mental symptoms during the past 3 months, regular use of psychotropic drugs, alcohol consumption during an average week, country of birth and age at immigration. Severe mental symptoms were more common among most immigrant groups compared with native Swedes, but the association to country of birth was not significant after adjustment for possible confounders. Regular use of hypnotics was more common among Nordic immigrants only (odds ration, OR = 4.4). East European and non-European immigrants less often were alcohol consumers (OR = 1.6 and OR = 3.8). Heavy drinking was more common among non-Nordic immigrants who immigrated at a younger age than at an older age. Furthermore, it was found that although East European and non-European immigrants had a higher educational level, they were less often gainfully employed compared with native Swedes. In middle-aged women, country of birth as well as age at immigration are important factors to consider in relation to alcohol consumption, but these factors may be of less importance considering mental health.
39.	Samsioe, Göran, et al. (author) The Women's Health in the Lund Area (WHILA) study-An overview. 2010 In: Maturitas. - : Elsevier BV. - 1873-4111 .- 0378-5122. ; 65, s. 37-45 Journal article (peer-reviewed)abstract The Women's Health in the Lund Area (WHILA) study invited all women (n=10,766) living in the Lund area of Southern Sweden by 1995, who were born between 1935 and 1945. The health screening program included a postal validated questionnaire concerning medical history, drug treatment, family history of diabetes and hypertension, menopausal status, smoking and alcohol habits, education, household, and working status, physical activity, quality of life as well as subjective physical and mental symptoms. The screening consisted of a routine physical examination with standardized blood pressure measurements, bone densitometry and an extended laboratory examination. A link with the mammography registry was established. Based on menopausal status, the population was divided in three subgroups; premenopausal (PM), postmenopausal with hormone replacement therapy (PMT), and postmenopausal without hormone replacement therapy (PM0). Menopause was defined as a bleed-free interval of at least 12 months. Of 10,766 women, 6917 (64.2%) had complete data sets. A number of observational analyses were carried out based on the screening data at baseline, to be followed by long-term follow-up analyses based on national register linkages that are currently being started.
40.	Samsioe, Göran, et al. (author) Urogenital symptoms in women aged 50-59 years. Women's Health in Lund Area (WHILSA) Study Group 1999 In: Gynecological Endocrinology. - 0951-3590. ; 13:2, s. 113-117 Journal article (peer-reviewed)abstract Problems related to the urogenital tract are common in elderly women. Control of micturition is often impeded and questionnaire-based studies have reported a prevalence of poor control of micturition in about 30% of postmenopausal women. In an ongoing cohort comprising women born between 1935 and 1945, an interim analysis was performed in 1800 women based on an interview and questionnaire. The prevalence of urinary incontinence was found to be 33%, which is in accordance with previous reports. The main difference between the interview and the questionnaire was that the interview could take into account intensity as well as intermittence of symptoms. There were no differences between premenopausal women and postmenopausal women using or not using hormone replacement therapy. In agreement with earlier studies, we found poorer control of micturition in parous women. A higher percentage of incontinence was also found in women who had lost more than 5 kg in body weight during the preceding 5 years. In addition, women with a family history of diabetes were more prone to complaints of incontinence. Of the 155 women who had a family history of diabetes, 66 were incontinent (p < 0.01). It was also found that women who were incontinent were more often on regular surveillance for various diseases, using more medications regularly and had been hospitalized during the last 5 years more often than women who were continent. There were no differences in smoking habits. The present results imply that urinary incontinence in women is of a complicated origin and that the hormonal situation plays a minor role for this socially handicapping symptom.
41.	Shakir, Yasameen, et al. (author) Cardiovascular risk factors in middle-aged women and the association with use of hormone therapy: results from a population-based study of Swedish women. The Women's Health in the Lund Area (WHILA) Study. 2004 In: Climacteric. - : Informa UK Limited. - 1369-7137 .- 1473-0804. ; 7:3, s. 274-283 Journal article (peer-reviewed)
42.	Shakir, Yasameen, et al. (author) Combined hormone therapy in postmenopausal women with features of metabolic syndrome. Results from a population-based study of Swedish women: Women’s Health in the Lund Area study. 2004 In: Menopause. - 1530-0374. ; 11:5, s. 549-555 Journal article (peer-reviewed)
43.	Shakir, Yasameen, et al. (author) Do sex hormones influence features of the metabolic syndrome in middle-aged women? A population-based study of Swedish women: The Women's Health in the Lund Area (WHILA) Study. 2007 In: Fertility and Sterility. - : Elsevier BV. - 1556-5653 .- 0015-0282. ; 88:1, s. 163-171 Journal article (peer-reviewed)abstract Objective: To outline perceived associations between various sex hormones and risk markers for cardiovascular disease in middle-aged women, with an emphasis on features of the metabolic syndrome (MS). Design: Cross-sectional analysis. Setting: Women's Health in the Lund Area Study. Patient(s): Population-based cohort. Intervention(s): A generic questionnaire, physical examinations, and laboratory assessments were completed by 6,917 women aged 50-59 years living in the Lund area of southern Sweden. Women at or above defined cutoff limits for the MS were considered positively screened. After exclusion of women using hormone therapy (HT), 2,038 women with (MS+) and 2,054 women without features of the MS (MS-) were included. The ELISA techniques were used for the determination of serum androstendione (A), E-2, T, sex hormone-binding globulin (SHBG), cortisol, insulin, and leptin levels. Serum lipids and lipoproteins were determined by conventional methods. Multiple linear regression analyses were performed, controlling for age, body mass index (BMI), and smoking habits. Main Outcome Measure(s): Features of the MS, sex steroids, cardiovascular risk markers. Result(s): In the MS+ group, a positive association was seen between A and systolic blood pressure. Estradiol was negatively associated with total cholesterol and diastolic blood pressure. The SHBG was negatively associated with triglycerides, blood glucose, and diastolic blood pressure and positively with high-density lipoprotein (HDL). In the MS- group, there were positive associations between A, blood glucose, and systolic blood pressure. Testosterone was positively associated with HDL. Estradiol was negatively associated with total cholesterol and positively with systolic blood pressure. The SHBG was positively associated with HDL and negatively with triglycerides and diastolic blood pressure. There were positive associations between cortisol, low-density lipoprotein (LDL) cholesterol, blood glucose, and systolic blood pressure and a negative association with triglycerides in both MS+ and MS- groups. Conclusion(s): Androstendione, E-2, and T levels were associated with cardiovascular risk factors in middle-aged women. Effects by sex steroids on cardiovascular risk markers seem to be different in women with or without features of the MS.
44.	Shakir, Yasameen, et al. (author) Does the hormonal situation modify lipid effects by lifestyle factors in middle-aged women? Results from a population-based study of Swedish women: the Women's Health in the Lund Area study. 2006 In: Metabolism, Clinical and Experimental. - : Elsevier BV. - 1532-8600. ; 55:8, s. 1060-1066 Journal article (peer-reviewed)abstract The aim of the study was to outline whether the influence by lifestyle factors on serum lipids was modified by the hormonal situation in middle-aged women. Six thousand nine hundred eight women, aged 50 to 59 years, participated in a health assessment program, including a serum lipid profile evaluation. The women were grouped according to their hormonal status into premenopausal (PM) (n = 492), postmenopausal without hormone therapy (HT) (PM0) (n = 3600), and postmenopausal with HT (PMT) (n = 2816). From the PMT group, we analyzed oral (n = 901) and transdermal HT (n = 351) regimens, containing norethisterone acetate and 17β-estradiol. Serum lipids and lipoproteins were determined by conventional methods. Lifestyle factors included smoking and physical activity at leisure time and at work. Multivariate linear regression analysis controlling for age, education, and dietary habits showed that current smoking was positively associated with triglycerides in the PM, PM0, PMT, and oral HT groups. In the PM0, PMT, and oral HT groups, current smoking was positively associated with total cholesterol and low-density lipoprotein and negatively associated with high-density lipoprotein (HDL). Low physical activity at leisure time was positively associated with triglycerides in the PM and PMT groups and negatively associated with HDL in the PM0 and PMT groups. High physical activity at work was positively associated with triglycerides in the PMT group and with total cholesterol in the PM0 group, but negatively associated with HDL in the PMT and transdermal groups. Body mass index was positively associated with triglycerides and negatively with HDL in all the groups regardless of the hormonal situation. The serum lipid profile as influenced by lifestyle factors was modified by the hormonal situation. Compared with the postmenopausal women without HT use, the use of HT contributes to fewer “negative” effects by lifestyle factors on serum lipids.
45.	Shakir, Yasameen, et al. (author) Health Hazards in Middle-Aged Women with Cardiovascular Disease: A Case-Control Study of Swedish Women. The Women's Health in the Lund Area (WHILA) Study. 2007 In: Journal of Women's Health. - : Mary Ann Liebert Inc. - 1931-843X .- 1540-9996. ; 16:3, s. 406-414 Journal article (peer-reviewed)abstract Objective: To delineate the health profile in middle-aged women with cardiovascular disease (CVD). Methods: The Women's Health in the Lund Area (WHILA) project covered all women born 1935 - 1945 ( n = 10,766) living in the Lund area; 6917 (64.2%) women completed a generic questionnaire and underwent physical and laboratory assessments. Of the 6917 women, 6416 were postmenopausal women, of whom 104 had CVD. For each woman with CVD, two controls were selected and matched for age, smoking habits, body mass index (BMI), waist/hip ratio (WHR), low-density lipoprotein cholesterol (LDL-C), high-density liproprotein cholesterol (HDL-C), diastolic blood pressure and hormonal status. Results: One hundred four women (1.6%) reported CVD. Forty-nine had a myocardial infarction (MI), 49 had a stroke, and 6 women had both events; 71.4% were postmenopausal, with never use of hormone therapy ( HT) ( PM0), and 28.6% were postmenopausal with ever use of HT (PMT). Compared with the control group, serum androstendione was lower ( p = 0.004) in the case group, and menopausal estradiol (E-2) values were less frequent ( p = 0.037) in cases from the PM0 group. Among psychological and somatic symptoms, nervousness ( p < 0.05), difficulty relaxing, crying easily, visual disturbance ( p <= 0.01 for all), dizziness, difficulties in voiding urine, shortness of breath, breast tenderness, "and constipation ( p <= 0.001 for all) were more common among women with CVD. Women with CVD expressed less satisfaction with feeling healthy, body image, memory loss, irritability, and sexuality ( p <= 0.05 for all). The case group had more problems with daily activities, more days spent in hospital during the previous 5 years, and more regular medical appointments with healthcare centers, more often had diabetes mellitus (DM) ( p < 0.001 for all), and had experienced more falls in the previous year ( p < 0.05). Urinary incontinence and decreased body weight were more common among cases ( p <= 0.01 for both). Conclusion: Several health hazards as well as somatic and psychological symptoms were more common in subjects with CVD, rendering them more susceptible to future disease.
46.	Spetz, Anna-Clara, et al. (author) Prevalence of symptoms in relation to androgen concentrations in women using estrogen plus progestogen and women using estrogen alone 2009 In: MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY. - : Ovid Technologies (Wolters Kluwer Health). - 1072-3714 .- 1530-0374. ; 16:1, s. 149-155 Journal article (peer-reviewed)abstract Objective: Women using estrogen plus progestogen therapy sometimes report difficult to describe symptoms, eg, changes in libido, mood, and memory, that may be related to decreased androgens. To evaluate the prevalence or such symptoms and relate these symptoms to androgen levels ill women using estrogen plus progestogen therapy, data from the Womens Health in the Lund Area Study were analyzed.Design: A total of 2,816 women using estrogen plus progestogen therapy were asked to complete a questionnaire consisting of questions concerning sexual well-being and different aspects of quality of life. Serum concentrations of testosterone, androstendione, sex lion-none-binding globulin, and estradiol were measured.Results: A total of 2,048 questionnaires were eligible for evaluation. Almost 40% of the women reported decreased libido. Approximately 70% were satisfied with their current sex life. Eight percent reported that intercourse was unpleasant because of vaginal dryness. No evident associations were found between libido and serum hormone concentrations. The most positive effects of estrogen plus progestogen therapy concerning memory and urinary tract and vaginal complaints were found in women with the highest and/or moderate testosterone levels (P < 0.05).Conclusions: We found no strong association between symptoms related to sexual well-being or quality of life and androgen concentrations in this study. Estrogen plus progestogen therapy did not seem to affect
47.	Suwazono, Yasushi, et al. (author) Benchmark dose for cadmium-induced osteoporosis in women 2010 In: Toxicology Letters. - : Elsevier BV. - 1879-3169 .- 0378-4274. ; 197:2, s. 123-127 Journal article (peer-reviewed)abstract We applied a hybrid approach to estimate the benchmark dose (BMD) and the lower 95% confidence limit (BMDL) for cadmium-induced bone effects in a population with low environmental exposure. Morning urine samples were collected by 794 Swedish women, aged 53-64 years, participating in a population-based study We measured urinary cadmium (U-Cd), a marker of long-term exposure, and bone mineral density, expressed as its T-score (reference 20-year old women) of the non-dominant wrist. BMD and BMDL, adjusted for relevant covariates. corresponding to an additional risk (BMR) of 5% or 10% were calculated, with the background risk at zero exposure set at 1% or 5%. With a BMR of 5% and a background risk of having low bone mineral density (at U-Cd=0) of 1% or 5% (corresponding to T-score cut-offs -2.75 and -2 09, respectively), the BMD of U-Cd ranged 1 8-3.7 mu g/g creatinine, and the BMDL ranged 1.0-2 1 mu g/g creatinine For a 5% BMR of osteoporosis (T-score < -2 5), the BMD was 29 mu g/g creatinine and the BMDL 1 6 mu g/g creatinine. The lowest obtained BMD of U-Cd for wrist bone mineral density was only slightly higher than the lowest reference concentration previously reported for cadmium-related kidney effects Our results provide additional scientific support for the low tolerably weekly intake (TWI) of cadmium set by the European Food Safety Authority in 2009. (C) 2010 Elsevier Ireland Ltd. All rights reserved
48.	Suwazono, Yasushi, et al. (author) Benchmark dose for cadmium-induced renal effects in humans 2006 In: Environmental Health Perspectives. - : Environmental Health Perspectives. - 1552-9924 .- 0091-6765. ; 114:7, s. 1072-1076 Journal article (peer-reviewed)abstract OBJECTIVES: Our goal in this study was to explore the use of a hybrid approach to calculate benchmark doses (BMDs) and their 95% lower confidence bounds (BMDLs) for renal effects of cadmium in a population with low environmental exposure. METHODS: Morning urine and blood samples were collected from 820 Swedish women 53-64 years of age. We measured urinary cadmium (U-Cd) and tubular effect markers [N-acetyl-beta-D-glucosaminidase (NAG) and human complex-forming protein (protein HQ in 790 women and estimated glomerular filtration rate (GFR; based on serum cystatin Q in 700 women. Age, body mass index, use of nonsteroidal anti-inflammatory drugs, and blood lead levels were used as covariates for estimated GFR. BMDs/BMDLs corresponding to an additional risk (benchmark response) of 5 or 10% were calculated (the background risk at zero exposure was set to 5%). The results were compared with the estimated critical concentrations obtained by applying logistic models used in previous studies on the present data. RESULTS: For both NAG and protein HC, the BMDs (BMDLs) of U-Cd were 0.5-1.1 (0.4-0.8) mu g/L (adjusted for specific gravity of 1.015 g/mL) and 0.6-1.1 (0.5-0.8) mu g/g creatinine. For estimated GFR, the BMDs (BMDLs) were 0.8-1.3 (0.5-0.9) mu g/L adjusted for specific gravity and 1.1-1.8 (0.7-1.2) mu g/g creatinine. CONCLUSION: The obtained benchmark doses of U-Cd were lower than the critical concentrations previously reported. The critical dose level for glomerular effects was only slightly higher than that for tubular effects. We suggest that the hybrid approach is more appropriate for estimation of the critical U-Cd concentration, because the choice of cutoff values in logistic models largely influenced the obtained critical U-Cd.
49.	Svartvik, Lena, et al. (author) Dyslipidaemia and impaired well-being in middle-aged women reporting low Sense of Coherence. The Women's Health in the Lund Area (WHLA) Study 2000 In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 18:3, s. 177-182 Journal article (peer-reviewed)abstract OBJECTIVE: A low Sense of Coherence (SOC) is a concept related to a feeling of ill health. Not much is known about possible relationships between SOC and biological factors. SETTING: Population-based study of middle-aged women. SUBJECTS AND METHODS: Four-hundred-and-fifty women participated as a subgroup of a larger study of cardiovascular risk factor screening. A self-administered questionnaire with 29 questions related to SOC was completed in addition to questions on social background factors and medical history. RESULTS: The mean score of SOC was 150.9 (SD 23.4). HDL cholesterol was lower (p < 0.05) and triglyceride levels higher (p < 0.05) in women with low SOC (1.5 and 2.1 mmol/L) compared to women with medium (1.8 and 1.4 mmol/L) or high SOC (1.7 and 1.5 mmol/L). In multiple regression analysis, a low HDL cholesterol level was still significantly associated with low SOC (p < 0.05) after adjustment for possible confounders. Women reporting low SOC were further characterised by a higher proportion of subjects with regular clinical visits for health care (49% vs 35% and 29%). CONCLUSIONS: Middle-aged women reporting low SOC showed lower HDL cholesterol and higher triglyceride levels, and reported more clinical visits and medical symptoms than women with higher SOC.
50.	Svartvik, Lena, et al. (author) Hög känsla av sammanhang kan ha hälsofrämjande effekter 2002 In: Läkartidningen. - 0023-7205. ; 99:11, s. 1195-1200 Journal article (peer-reviewed)abstract Sense of coherence (SOC), e.g. meaningfulness of life, is according to the sociologist A. Antonovsky a health-promoting construct, which has been used in a number of descriptive studies in various populations. The aim of this population-based cross-sectional study was to investigate if middle-aged women with a self-reported low level of SOC also differed in biological variables, e.g. related to glucose and lipid metabolism, from women with a high level of SOC. These variables could potentially represent links in the pathophysiological chain of events causing somatic disease. We found significant differences according to dyslipidaemia (low HDL cholesterol and increased triglyceride levels) between groups of women with differing SOC scores, most negative findings were found in the group with lowest SOC. Women with medium-high or high SOC also reported less symptoms and need of regular medical controls. The results support a potential association between cognitive processes (SOC) and biological mechanisms causing adverse health effects.

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Author/Editor: Lidfeldt, Jonas (53); Samsioe, Göran (49); Nerbrand, Christina (39); Agardh, Carl-David (20); Nyberg, Per (10); Scherstén, Bengt (9); show more...; Skerfving, Staffan (7); Teleman, Pia (6); Öjehagen, Agneta (5); Mattiasson, Anders (5); Lundh, Thomas (5); Vahter, Marie (5); Akesson, Agneta (5); Nilsson, Peter (3); Nilsson, Peter M (2); Vahter, M (2); Bjellerup, P (2); Jernström, Helena (2); Håkansson, Carita (2); Borgfeldt, Christer (2); Spetz, Anna-Clara (2); Sand, Salomon (2); Romelsjo, A (2); Bendahl, Pär Ola (1); Fredrikson, Mats (1); Agardh, Daniel (1); Ali, Imran (1); Björck, Sara (1); Strömberg, Ulf (1); Akesson, A. (1); Akesson, AA (1); Eklund, Mona (1); Rylander, Lars (1); Halldin, Krister (1); Hakansson, Helen (1); Engström, Annette (1); Burgaz, Ann (1); Hammar, Mats (1); Westrin, Åsa (1); Källén, Karin (1); Andrada, Maria (1); Nyberg, P. (1); Lindholm, L (1); Rignell-Hydbom, Anna (1); de Jong, Annelise (1); Rantakokko, Panu (1); Kiviranta, Hannu (1); Holmdahl, Lydia (1); Lidfeldt, Matilda (1); Ceausu, Iuliana (1); show less...

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