Department of Public Health and Caring Sciences

Department of Public
Health and Caring
Sciences
Annual Report 2010
Fastställd av Institutionsstyrelsen 2011-03-25
Introduction
During 2010 there were twelve research groups at the Department of Public Health and Caring
Sciences: Caring Sciences, Clinical Nutrition and metabolism, Disability and Habilitation,
Family Medicine and Clinical Epidemiology, Geriatric Research, Health Service Research,
Oxidative Stress and Inflammation, Preventive Medicine, Psychosocial Oncology and
Supportive Care. Research Ethics and Bioethics, Social Medicine and Sociomedical
Epidemiology.
Caring Sciences
Caring Sciences includes theory, methods and techniques for the study of problems and
interventions for individuals and groups within the health care system. The research emanates
from a multi scientific and multi professional perspective which includes preventive, supportive,
caring and rehabilitative actions. Research concerning health care organizing and education also
falls within the scope of Caring Sciences.
Clinical Nutrition and Metabolism
The research at Clinical Nutrition and Metabolism (CNM) deals with dietary intake and
metabolism during health and disease, and covers aspects of preventive public health nutrition,
clinical disease- and age-related nutrition, child and adult obesity, circadian metabolism, dietary
interventions, dietary assessments, energy metabolism, body composition, measurement and
implementation techniques.
Disability and Habilitation
Research in disability is interdisciplinary and multi-professional with a fundamental perspective
focussing the interface between the individual and his or her environment. A joint conceptual
tool is found in World Health Organisation’s classification ICF (International Classification of
Functioning, Disability and Health). Contextual Factors in particular serve as a framework for
research programme activities in elucidating environmental aspects of disability.
Family Medicine and Clinical Epidemiology
Family Medicine is the dominating academic branch in Primary Health Care and reflecting the
fact that primary health care is in the health care front line. Family Medicine research focuses
on the most common diseases and illnesses in the population, for instance cardiovascular
disease, diabetes, asthma, chronic obstructive lung disease, social insurance medicine (sicklisting and disability retirement), and musculo-skeletal disorders.
Geriatric Research
In geriatric research the main areas of research are: Molecular studies of dementia, clinical and
epidemiological research and clinical and epidemiological research affecting the elderly
population. The researchers are using cellular- and transgenic mice models of Alzheimer’s
disease. The research group is also involved in genetic analysis of dementia in human samples.
The major aim for the dementia research group in the future is to establish immunotherapeutic
strategies to treat dementia.
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Health Services Research
Health Services Research adopts three perspectives on health care research: provision,
organization, and system of care. The focus is on governance and implementation, intraorganisational control, inter-organisational relations and patient relations. Study objectives
include development of exploratory models for differences in public and private care,
identification of barriers for implementation of patient choice reforms and identification of
facilitators for patient centered care, especially within telecare. The group is multidisciplinary
and the researchers have backgrounds in medicine, nursing and political science.
Oxidative Stress and Inflammation
The key research areas are inflammation in physiology and disease state specifically with
bioactive eicosanoids. Additionally, oxidative stress which reflects increased levels of free
radicals in the body that implicated both in ageing and several inflammatory diseases is another
key research area. The research group has many national and international collaborative projects
within the research vicinity.
Preventive Medicine
The research within preventive medicine addresses mechanisms of social inequalities in health,
theories of the life course approach in current epidemiology and pertinent empirical topics like
the combined effect of early life and later life risk factors on health and morbidity and risk
factors triggering the onset of health problems.
Psychosocial Oncology and Supportive Care
The research within the Psychosocial Oncology and Supportive Care group study cancer during
adolescence, psychosocial and health economic consequences and posttraumatic stress disorder
among parents of children with cancer. The research group has collaboration with many
Swedish centres for pediatric oncology, health IT specialist, and health-economists. The
research is cross-disciplinary and is now integrated with the U-CARE program.
Research Ethics and Bioethics
The researchers conduct research on research ethics, bioethics and medical law. Research ethics
involves the application of ethical principles and values to a variety of research topics.
Bioethics, on the other hand, includes philosophical, theological, legal and social scientific
aspects of medicine and biology. Medical law spans a wide range of traditional branches of law
and there is collaboration with the Department of Law at Uppsala University.
Social Medicine
The research within social medicine focuses on three major and inter-related research areas. A
common factor for the research is to enhance the scientific understanding of risk- and resiliency
factors, as well as bio-psycho-social mechanisms, of relevance for sustained and equitable
occupational and social health and well-being. The research also concerns determinants of and
effective use of limited financial and human resources, and its implications for major health care
stakeholders, including patients, staff, and third-party payers.
3
Sociomedical Epidemiology
The research integrates social epidemiology, prevention research and health services research.
The aim of the research programme is to develop methods for identifying and analysing the
mechanisms behind preventable disease patterns in the population, and to evaluate the impact of
the health care system, and analyse psychosocial, behavioural and biological risk factors for ill
health and how these factors may be influenced in order to improve preventive strategies.
The researchers, at the Department of Public Helath and Caring Sciences published more than
200 articles in scientific journals during 2010 and the external funding was about 40 million
Swedish crowns. Sixteen of the doctoral students successfully defended their dissertations.
In all, 170 persons had positions at the department and another 150 were associated as doctoral
students or researchers. There were 19 professors (chairs, emeriti, promoted and adj), of which
five were women, 10 associated professors, 39 researchers, 18 research assistants, 14 senior
lecturers, 25 lecturers, 24 administrators and technicians. Seventy seven doctoral students were
studying at the department and 24 of those had appointments.
At the undergraduate level, about 500 full time students were studying at the department. The
students belonged to different programs and courses, 310 were educated within the Nursing
programs, 70 within the Physician program, 22 within the MSc-program in Public Health and
about 100 in other short courses.
Prices and awards
Maria Gottvall received the first price (500 Euro) for best oral presentation among young
scientists at the European Congress of Contraception and Reproductive health in Haag.
Margareta Sanner were appointed honourable member at the European Donationsday 2010-1023 in the Association “Life as a gift”.
The year 2010 has been a good year for the Department of Public Health and Caring Sciences
and a lot of achievements have been accomplished by the staff and the students. Three of the
research groups are situated at Dag Hammarskjölds väg 14B and the other nine at BMC but the
good cooperation between the groups will remain. We are now facing 2011 with of new KoF
evaluation, a new University organization, and economical, educational as well as scientific
challenges.
Uppsala 2011-03-25
Marianne Carlsson
Head of Department
4
List of Contents
Introduction
2
Organization
6
Address List
8
Associated Researchers
12
Doctoral Students
14
Centres
16
Scientific Reports
Caring Sciences
17
Clinical Nutrition and Metabolism
31
Disability and Habilitation
55
Family Medicine and Clinical Epidemiology
61
Geriatrics
100
Health Services Research
116
Oxidative Stress and Inflammation
130
Preventive Medicine
139
Psychosocial Oncology and Supportive Care
150
Research Ethics and Bioethics
158
Social Medicine
181
Sociomedical Epidemiology
192
5
Organization
Head of Department
Marianne Carlsson
Deputy Head of Department
Mats G Hansson
Department Board
Carina Ahlstedt, Teacher and Researcher Representative
Gunnar Bergström, Student Representative
Monica Blom Johansson, Graduate Student Representative
Tommy Cederholm, Teacher and Researcher Representative
Birgitta Edlund, Teacher and Researcher Representative
Margaretha Eriksson, Teacher and Researcher Representative
Annica Ernesäter, Graduate Student Representative Deputy
Ulf Holmbäck, Teacher and Researcher Representative Deputy
Inger Holmström, Teacher and Researcher Representative Deputy
Jonas Lindberg, Student Representative
Annie Lundberg, Technical and Administrative Representative, Deputy
Rose-Marie Marcusson, Technical and Administrative Representative
Karin Nordin, Teacher and Researcher Representative Deputy
Catarina Olsson, Protocol
Anja Saletti, Teacher and Researcher Representative Deputy
Charlotte Traneus, Economist
Ulrika Winblad Spångberg, Teacher and Researcher Representative
Professor Emeriti
Urban Rosenqvist
Björn Smedby
Kurt Svärdsudd
Claes-Göran Westrin
Bengt Vessby adj Professor Emeritus
Directors of Graduate Studies
Mats G Hansson, Head
Margaretha Eriksson
Inger Holmström
Karin Nordin, MSc in Public Health
Directors of Undergraduate Studies
Karin Björkegren, Head
Birgitta Edlund, Head
Carin Ahlstedt
Lena Kilander
Sören Kjellberg
Ragnar Westerling
Annika Åhs
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Director of Clinical Issues
Lars Lannfelt
Professors and Research Groups Leaders
Bengt Arnetz
Samar Basu
Karin Björkegren
Marianne Carlsson
Tommy Cederholm
Louise von Essen
Johan Hallqvist
Mats G Hansson
Inger Holmström
Lars Lannfelt
Karin Nordin
Karin Sonnander
Tanja Tydén
Ragnar Westerling
Ulrika Winblad Spångberg
Adj Professors, Guest Professors and adj Senior Lecturers
Annika Bardel
Hans Basun
Wulf Becker
Mats Gulliksson
Håkan Hall
Marie Johannesson
Gunnar Johansson
Mari-Ann Wallander
Thorne Wallman
Anna Christina Åberg
7
Address List
Department of Public Health and Caring Sciences, IFV (Institutionen för folkhälso- och
vårdvetenskap)
Address: The Department is situated at three different locations:
BMC, Dag Hammarskjölds väg 14B, and Rudbeck Laboratory, Dag Hammarskjölds väg 20.
e-mail address: firstnamn.lastname@pubcare.uu.se
Aarts Clara
Adolfsson Päivi
Agnedal Maria
Ahlstedt Carina
Alaie Iman
Alfonsson Sven
Ander Malin
Andersson Anita
Andersson Caroline
Anderzén Ingrid
Anshelm Cecilia
Arnetz Bengt
Arnetz Judith
Arving Cecilia
Ashir Assalie
Ax Erika
Bardel Annika
Basu Samar
Basun Hans
Becker Wulf
Bergknut Eva
Berglund Marie
Bergström Joakim
Bjerg-Bäckström Rie
Bjermo Helena
Björkegren Karin
Blom Johansson Monica
Brantnell Anders
Bratteby-Tollerz Linda
Burell Gunilla
Bäcklund Linus
Carlsson Maria
Carlsson Marianne
Cederholm Tommy
Cernvall Martin
Daryani Achraf
Demmelmeier Ingrid
Denison Eva
Edlund Birgitta
Ekholm-Pettersson Frida
Engvall Gun
Eriksson Birgitta
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Eriksson Carola
Eriksson Helène
Eriksson Margaretha
Eriksson Ove
Eriksson Stefan
Eriksson-Öhman Solveig
Ernesäter Annica
Etzell Camilla
Evers Katinka
Fagerqvist Therese
Fernow Josepine
Forsberg Joanna
Forslund Marina
Fredriksson Mio
Giedraitis Vilmantas
Glaser Anna
Godskesen Tove
Gottvall Maria
Granberg Gun-Britt
Gulliksson Mats
Gumucio Gatica Astrid
Gunningberg Lena
Gustavsson Gunilla
Hakimnia Roya
Halford Christina
Hall Håkan
Hallqvist Johan
Hansson Mats Gunnar
Hashemi Robab Nooshin
Hedlund Lena
Hedström Mariann
Holm Marta
Holmbäck Ulf
Holmström Inger
Honkanen Kirsti
Hovstadius Eva
Hovèn Emma
Hurtigh Liljestam Anna
Höglund Anna
Ingelsson Martin
Ingvoldstad Charlotta
Isaksson David
Isaksson Stina
Jalmsell Li
Jansson Håkan
Johannesson Marie
Johansson Gunnar
Johnsson Linus
Jonasson Sören
Jöreskog Karin
Kallings Lena
Kaminsky Elenor
Kihlbom Ulrik
Kilander Lena
Kirsebom Marie
stefan.eriksson@crb.uu.se
katinka.evers@crb.uu.se
josepine.fernow@crb.uu.se
joanna.forsberg@crb.uu.se
tove.godskesen@crb.uu.se
mats.hansson@crb.uu.se
anna.hoglund@crb.uu.se
li.jamsell@crb.uu.se
ulrik.kihlbom@crb.uu.se
9
Kjellberg Sören
Kuhlau Frida
frida.kuhlau@crb.uu.se
Källström Lillemor
Lampic Claudia
Lannfelt Lars
Lindahl Norberg Annika
Lindgren Björn
Lindstedt Helena
Ljungberg Anne-Marie
Lochan Ruth
Lundberg Annie
Lundberg Pranee
Lundin Birgit
Lundquist Annika
Lytsy Per
Magnusson Kristina
Magnusson Maria
Marcusson Rose-Marie
Marnell Harriet
Martinsson Carl Magnus
Masterton Malin
malin.masterton@crb.uu.se
Mattsson Elisabet
Modin Karin
Muntlin Athlin Åsa
Nilsson Gunilla
Nilsson Lars
Nordin Karin
Norinder Camilla
Normark Lena
Näsström Thomas
Ohlsson Anna
Olsson Catarina
Olsson Erik
Olsson Mona
Olsson Roger
O’callaghan Paul
Paulsson Ulrica
Peippo Maria
Pettersson Elisabet
Pettersson Mona
Philipson Ola
Pöder Ulrika
Rahman Mohammad Hafijur
Renberg Tobias
tobias.renberg@crb.uu.se
Riserus Ulf
Rissanen Ritva
Rosén-Hansson Inger
Roshanai Afsaneh
Rosvall Paula
Röing Marta
Saletti Anja
Schmidt Meta
Simu Barbro
Sjögren Per
Skärlund Mikael
10
Sonnander Karin
Stern Jenny
Stolt Ragnar
Sundelin Majbritt
Svanberg Ann-Carin
Svedberg Marie
Swenne Leo Christine
Tengblad Siv
Terner Annika
Thoudal Berit
Tirkkonen Leena
Torbratt Karin
Traneus Charlotte
Tydén Tanja
Törmä Johanna
Umb-Carlsson Öie
von Essen Louise
Wadensten Barbro
Wallander Mari-Ann
Wallenquist Monica
Wallman Thorne
Westerberg-Jacobson Josefin
Westerling Ragnar
Westin Marcus
Wiholm Clairy
Winblad Spångberg Ulrika
Zethelius Björn
Zethraeus Niklas
Zhang Xiao
Åberg Anna Cristina
Åhs Annika
Ärnlöf Johan
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Associated Researchers
e-mail address: firstnamn.lastname@pubcare.uu.se
Anderberg Ulla-Maria
Berglund Gunilla
Bernsten Cecilia
Björklund Bodegård Kristina
Björkman Ingeborg
Blomkvist Vanja
Bojner Horwitz Eva
Boll Madeleine
Boström Eva
Brattberg Gunilla
Brorsson Bengt
Bröms Kristina
Ekstrand Maria
Engström Maria
Falkeborn Margareta
Ferdous Tamanna
Gustafsson Carina
Hagerman Heidi
Hanning Marianne
Hansson Ann-Sophie
Hedov Gerth
Helmersson Johanna
Hjelmblink Finn
Hofsten Anna
Häggström Elisabeth
Ingelsson Erik
Jansson Pia von Voultée
Johansson Lars Age
Karlström Brita
Kjeldman Dorte
Kristofferzon Marja-Leena
Kullberg Kerstin
Kunkel Stefan
Kälvemark Sofia
Larsson Jan
Larsson Kjerstin
Lennernäs Maria
Lindahl Norberg Annika
Kindau Maria
Lindberg Magnus
Lindqvist Ragny
Lindström Veronica
Lisspers Karin
Ljunggren Birgitta
Lord Anna
Lunner Katarina
Lyskov Eugene
Muntlin Åsa
Mårtensson Gunilla
Nerelius Charlotte
Nlsson Annika
12
Olsson Gunilla Maria
Oscarsson Marie
Pless Mia
Rodhe Nils
Röing Marta
Skytt Bernice
Sanner Margareta
Skoglund Lena
Smedman Annika
Smide Bibi
Sobestiansky Sigvard
Ström Möller Kristina
Ståhlhammar Jan
Ställberg Björn
Svalastoga Anna Lydia
Swartling Malin
Söderback Ingrid
Wallman Thorne
Wasteson Elisabet
Veg Anniko
Welander Hedvig
Westerberg Jacobson Josefin
Wettergren Lena
Winterling Jeanette
Åhs Annika
13
Doctoral Students
Adamsson Viola
Atry Ashkan
Berg Peter
Bjermo Helena
Björn Catrine
Blom Johansson Monica
Boll Madeleine
Boman Jill
Bröms Kristina
Cedervall Ylva
Cernvall Martin
Degerman Gunnarsson Malin
Engström Sevek
Ernesäter Annica
Fagerqvist Therese
Fredriksson Mio
Glad Johan
Godskesen Tove
Gottvall Maria
Grunnesjö Marie
Gumucio-Gatica Astrid
Gustavsson Catharina
Gustavsson Hanna
Hagerman Heidi
Hakimina Roya
Halford Christina
Hallman David
Hayat Roshanay Afsane
Hedman Nils Olof
Höyer Marie
Iggman David
Isaksson Stina
Jalmsell Li
Jansson Stefan
Januss Grunnesjö Marie
Jobs Elisabeth
Johansson Hans-Erik
Johnsson Linus
Jönsson Birgitta
Kaminsky Elenor
Karlsson Bo
Kirsebom Marie
Kuhlau Frida
Lindberg Magnus
Lindberg Maria
Lytsy Per
Martinell Mats
Masterton Malin
Nerpin Elisabeth
Nordin Jenny
Nordlöf Hasse
Norrmén Gunilla
Näsström Tomas
14
O’callaghan Paul
Olai Lena
Olsson Erika
Paulsson Ulrica
Peterson Magnus
Pettersson Mona
Philipsson Ola
Rissanen Ritva
Rönnemaa Elina
Sehlin Dag
Sobestiansky Sigvard
Star Kristina
Stjernschantz Forsberg Joanna
Stolt Ragnar
Sundelöf Johan
Sving Eva
Söllvander Sofia
Terner Annika
Törmä Johanna
Vaegter Keld
Westerberg Jacobsson Josefine
Wiberg Bernice
Von Celsing Anna-Sophia
Östlund Ann-Sofi
15
Centres
During 2010, the Department of Public Health and Caring Sciences was the host of three
Centres, Centre for Disability Research, Centre Research Ethics and Bioethics (CRB), and
Uppsala University Psychosocial Care programme (U-Care).
Centre for Disability Research
(www.cff.uu.se).
Director: Karin Jöreskog
The Centre for Disability Research was established in 1988 to coordinate in disability issues in
various subject areas at the faculties at Uppsala University and to interact with society in issues
related to disability research. The aim is to disseminate information about research and to
stimulate long term acquisition of knowledge about issues involving disability by enhancing the
flow of information among teachers, researchers, and doctoral students as well as interested
parties outside the University. There is close collaboration with the research group Disability
and Habilitation (p 56).
Centre for Research Ethics & Bioethics (CRB)
(www.crb.uu.se)
Director: Mats G Hansson
The Centre for Research Ethics & Bioethics is an interfaculty centre. The centre is integrated
with the research group Research Ethics and Bioethics. The research profile includes research
ethics, bioethics, and medical law. More specifically, research on animal and environmental
ethics, autonomy, the ethics of biobanking, dual-use issues related to biosafety and
biosecurity,codes and guidelines for research, clinical ethics, enhancement of human
performance, genetic information and testing, medical law, neuroethics and the philosophy of
mind, ethics at the beginning of life, priorities in health care and quality of life issues (p 159).
Uppsala University Psychosocial Care Programme (U-Care)
Director: Louise von Essen
The U-Care Programme is one of the strategic research fundings from the Swedish Government
and was established in 2010. The Programme is integrated with the research group Psychosocial
oncology and Supportive care. The research activities are performed within the areas of
paediatric oncology, adult oncology, and cardiology in close collaboration with clinicians at
Uppsala Akademiska Hospital and other Swedish hospitals. U-Care is a forum for
interdisciplinary encounters and networking across the borders between social and medical
sciences (p 151).
16
Scientific Reports
Caring Sciences
Reseach Group Leader ProfessorTanja Tydén
Caring Sciences include theory, methods and techniques for the study of problems and
intervention for individuals and groups within the health care system and in broader contexts of
care. Outcome and relations between different, clinically relevant factors for care are evaluated,
as well as the processes involved - all from a multi-professional perspective.
Research in Caring Sciences emanates from a multiscientific and multiprofessional perspective
which includes preventive, supportive, caring, nursing and rehabilitative actions. One area of the
Caring Sciences emphasizes social and behavioural science, including such theories and
methods. An important field of study is the interaction between personnel, patients and their
family/ significant others. The individual's resources for keeping and regaining optimal health,
as well as his/hers ability to adjust to change in health status is another important focus for
research. Resources within the health care system for support to the individuals and their
families are also of great interest, particularly when such resources are lacking and in palliative
care. Finally, research concerning quality of care, cultural aspects, health care organising and
education is within the scope of the Caring Sciences.
Researchers
Our group consists of several researchers of which many are very experienced and have
interesting ongoing projects of high quality. The group is multi professional, but the majority is
RNs. We have four research themes;
Health and Care among Children, Adolescents and Young Adults
Psychosocial Genetics and Cancer Care
Quality of Care and Patient Safety
Health and Care among Elderly
All teachers including the professors are to a high degree engaged in education on
undergraduate level, master and doctoral level. The education mainly concerns courses in caring
sciences within the Nursing and Specialist Nursing Programs, single subject course and courses
within the Master Program in Public Health. Some teachers are also engaged in teaching within
other departments.
The following researchers and senior lecturers 2010:
Aarts Clara, RN, PhD, senior lecturer
Arving Cecilia, RN, PhD, researcher, guest lecture
Carlsson Maria, RN, associate professor, senior lecturer
Carlsson Marianne, PhD in psychology, professor
Edlund Birgitta, RN, associate professor, senior lecturer
Gunningberg Lena, RN, associate professor, senior lecturer
Hedström Mariann, RN, PhD, senior lecturer
Ingvoldstad Charlotte, PhD
Lampic Claudia, licensed psychologist, associate professor, senior lecturer
Leo Swenne Christine, RN, PhD, senior lecturer
Lundberg Pranee, RN and midwife, associate professor, senior lecturer
Nordin Karin, licensed psychologist, professor 50%, at Uppsala University and 50% at
the Univeristy of Bergen, Norway
Pöder Ulrika, RN, PhD, senior lecturer
17
Tydén Tanja, RN, midwife, professor
Wadensten Barbro, RN, associate professor, senior lecturer
Winblad Spångberg Ulrika, political scientist, associate professor, senior research assistant
Lecturers fulltime or part time
Ahlstedt Carina
Bergknut Eva
Eriksson‐Öhman Solveig
Hedlund Lena
Holm Marta
Hovstadius Eva
Kjellberg Sören
Lundin Birgit
Norinder Camilla
Normark Lena
Pettersson Mona
Rosvall Paula
Schmidt Meta
Staaf Anita
Svanberg Ann‐Carin
Thoudal Berit
Associated researchers
Ekstrand Maria, RN and midwife, PhD
Engström Maria, RN, associate professor
Häggström Elisabeth, RN and midwife, associate professor
Kristofferzon Marja-Leena, RN, PhD
Kullberg Kerstin, occupational therapist
Lindberg Magnus, RN, PhD
Lindqvist Ragny, RN, PhD
Ljunggren Birgitta, RN, PhD
Lunner Katarina, PhD
Muntlin Åsa, RN, PhD
Nilsson Annika, RN, PhD
Oscarsson Marie, RN and midwife, PhD
Skytt Bernice, RN, PhD
Smide Bibbi, RN, PhD
Söderback Ingrid, occupational therapist, PhD
Wasteson Elisabet, licensed psychologist, PhD
Westerberg Jacobson Josefin, MSc, PhD
Winterling Jeanette, RN, PhD
Fundings over 100.000 SEK 2010
Community of Uppsala 500 000
Medical Faculty Uppsala University 1 076 000
The Swedish Cancer Society 1 822 000
The Swedish Institute of Infectious Disease 250 000
The Swedish Research Council 796 000
Uppsala/Örebro Regional Research Council 525 000
18
Licentiate dissertation 2008-2010
Kullberg Kerstin, “Food in older men with somatic diseases. Eating habits and approaches to foodrelated activities”, 2009
Dissertations 2008-2010
Eva Landström, “To choose or not to choose functional foods? – Attitudes to and use of
functional foods among Swedish consumers and health care professionals”, 2008
Kjerstin B Larsson, “Quality of Life and Coping with Ulcerative colitis and Crohn’s Desease”,
2008
Annika Nilsson, ”Health Care Staff: Riskfactors for Pain, Disability and Sick Leave”, 2008
Mathilde Hedlund, “Coping, psychiatric morbidity and perceived care in patients with
aneurismal subarachnoid haemorrhage”, 2009
Gunilla Mårtensson, “The insider and outsider perspective. Clinical importance of agreement
between patients and RNs in cancer care concerning patients’ emotional distress, coping
resources and quality of life”, 2009
Rastad Cecilia “Winter Fatigue and Winter Depression – Prevalence and Treatment with bright
light”, 2009
Åsa Muntlin, “Identifying and improving quality of care at an emergency department – Patient
and Healthcare Professional perspectives”, 2009
Ingrid Demmelmaier, “Behaviours, Beliefs and Back Pain – Prognostic Factors for Disability in
the General Population and Implementation of Screening in Primary Care Physiotherapy”, 2010
Afsaneh Hayat Roshanai, “Psychological and Behavioral Aspects of Receiving Genetic
Counseling for Hereditary Cancer”, 2010
Birgitta Jönsson, “Behavioural Medicine Perspectives for Change and Prediction of Oral
Hygiene Behaviour - Development and Evaluation of an Individually Tailored Oral Health
Educational Program”, 2010
Magnus Lindberg, “Excessive Fluid Overload Among Haemodialysis Patients: Prevalence,
Individual Characteristics and Self-regulation of Fluid Intake”, 2010
Josefin Westerberg Jacobson, “Wish to be thinner – Development and Prediction of Disturbed
Eating A Longitudinal Study of Swedish Girls and Young Women”, 2010
Ongoing PhD students at caring sciences in 2010
Björn Catrine
Gottvall Maria
Gustavsson Catharina
Hagerman Heidi
Höyer Marie
Isaksson Stina
Kirsebom Marie
Lindberg Maria
19
Nordin Jenny
Rissanen Ritva
Star Kristina
Sving Eva
Östlund Ann-Sofi
Health and Care among Children, Adolescents and Young Adults
2008
1. Ekstrand M, Larsson M, Darj E & Tydén T (2008). Advance provision of emergency
contraceptive pills reduces treatment delay: a randomised controlled trial among
Swedish teenage girls. Acta Obstet Gynecol Scand, 87:354-9.
2. Galvin K, Emami A, Dahlberg K., Ekeberg M, Rosser E, Powell J, Bach S, Edlund B,
Terese Bondas T & Uhrenfeldt L (2008). Challenges for future caring science research:
a response to providing evidence for health- care practice. International Journal of
Nursing Studies, 45:971-4.
3. Gustafsson S.A, Edlund B, Kjellin L & Norring C (2008). Personal standards, selfevaluation and perceived benefits of thinness in girls and young women with disturbed
eating attitudes. European Eating Disorders Review, 16:463-471.
4. Lundberg PC & Gerezgiher A (2008). Experiences from pregnancy and childbirth
related to female genital mutilation among Eritrean immigrant women in Sweden.
Midwifery, 24:214-225.
5. Pöder U, Ljungman G & von Essen L (2008). Posttraumatic stress disorder among
parents of children on cancer treatment: a longitudinal study. Psychooncology, 17:430437.
6. Westerberg J, Edlund B & Ghaderi A (2008). A 2-Year longitudinal study of eating
attitudes, BMI, perfectionism, asceticism and family climate in adolescent girls and
their parents. Eating and Weight Disorders, 13:64-72.
2009
7. Ekstrand M, Tydén T, Darj E & Larsson M (2009). An illusion of power: qualitative
perspectives on abortion decision-making among teenage women in Sweden. Perspect
Sex Reprod Health, 41:173-80.
8. Gottvall M, Larsson M. Höglund A & Tydén T (2009). High HPV vaccine acceptance
despite low awareness among Swedish upper secondary school students. Eur J
Contracept Reprod Health Care,14:399-405.
9. Gustafsson A, Edlund B, Kjellin L & Norring C (2009). Risk and Protective Factors for
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Quality of Care and Patient Safety
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52. Arakelian E, Gunningberg L & Larsson J (2008). Job satisfaction or production? How
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23
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58. Gunningberg L & Stotts NA (2008).Tracking quality over time: what do pressure ulcer
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59. Gunningberg L, Dahm MF & Ehrenberg A (2008). Accuracy in the recording of
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62. Lindberg M & Lindberg P (2008). Overcoming obstacles for adherence to phosphate
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63. Lindholm C, Sterner E, Romanelli M, Pina E, Torra y Bou J, Hietanen H, Iivanainen A,
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64. Muntlin AM, Gunningberg LA, Carlsson MA (2008). Different patient groups
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2009
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24
68. Gunningberg L, Fogelberg-Dahm M & Ehrenberg A (2009). Improved quality and
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70. Jönsson B, Öhrn K, Oscarson P & Lindberg P (2009). An individually tailored
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72. Lindberg M, Carlsson M, Högman M & Skytt B (2009). Suffering from meticillinresistant Staphylococcus aureus: experiences and understanding of colonisation.
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73. Lindberg M, Prütz K-G, Lindberg P & Wikström B (2009). Interdialytic weight gain
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registry of clinical practice. Hemodialysis International, 13(2):181-8. DOI:
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2010
74. Arakelian E, Gunningberg L, Larsson J (2010). How operating room efficiency is
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75. Arnetz JE, Winblad U, Höglund AT, Lindahl B, Spångberg K, Wallentin L, Wang Y,
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76. Demmelmaier IE. Denison, et al. (2010). "Physiotherapists' telephone consultations
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77. Ernesäter A, Engström M, Holmström I & Winblad-Spångberg U (2010). Incident
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78. Gunningberg L, Brudin L & Idvall (2010). Nurse Managers' prerequisite for nursing
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79. Hedlund M, Ronne-Engström E, Carlson M & Ekselius L (2010). Coping strategies,
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80. Höglund A.T, Winblad U, Arnetz B & Arnetz JE (2010). Patient participation during
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81. Jangland E, Larsson J & Gunningberg L (2010). Surgical nurses' different
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Scandinavian Journal of Caring Sciences, Dec 16.
25
82. Johansson B, Fogelberg Dahm M & Wadensten B (2010). Evidence-based practice the importance of education and leadership. Journal of Nursing Management, 18:70-77.
83. Jönsson B, Öhrn K, Lindberg P & Oscarson N (2010). Evaluation of an individually
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84. Kjörnsberg A, Karlsson L, Babra A & Wadensten B (2010). Registered nurses’
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85. Lindberg M & Fernandes MAM (2010). Self-efficacy in relation to limited fluid intake
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87. Lundberg PC. & Kerdonfag P (2010). Spiritual care by Thai nurses in Intensive Care
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88. Lundberg PC (2010). Patienten har ordet. Invandrare & Minoriteter, 2:13-15.
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90.
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91. Muntlin A, Carlsson M & Gunningberg L (2010). Barriers to change hindering
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92. Or Z, Cases C, Lisac M, Vrangbæk K, Winblad U & Bevan G (2010). Are health
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93. Saunamäki N, Andersson M & Engström M (2010). Discussing sexuality with patients:
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94. Winblad U, Vrangbæk K & Östergren K (2010). Do the waiting-time guarantees in the
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Health and Care among Elderly
2008
95. Kullberg K, Åberg AC, Björklund A, Ekblad J & Sidenvall B (2008). Daily eating
events among co-living and single-living diseased older men. The Journal of Nutrition,
Health and Aging, 12(3):176-182.
26
2009
96. Engström M, Scandurra I, Ljunggren B, Lindqvist R, Koch S & Carlsson M (2009).
Evaluation of OLD@HOME Virtual Health Record; Staff opinions of the system and
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97. Engström M, Lindqvist R, Ljunggren B & Carlsson M (2009). Staff members’
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98. Hedström M, Lidström B & Hulter Åsberg K (2009). PHASE-20: ett nytt instrument
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99. Hägglund D, Wadensten B, Andersson C & Aflarenko M (2009). Effekten av
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100.
Häggström E, Kihlgren M & Wadensten B (2009). Caregivers working with
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101.
Häggström E, Engström M & Wadensten B (2009). A 9-month intervention
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102.
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103.
Wadensten B, Engström M & Häggström E (2009). Public nursing home staff’s
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104.
Wadensten B, Engholm R, Fahlström G & Hägglund D (2009). Nursing staff’s
description of a good encounter in nursing homes. International Journal of Older People
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105.
Wadensten B (2009). Older People's Experiences of Dream Coaching. Journal
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106.
Abdelrazek F, Skytt B, Aly M, Abd El-Sabour M, Ibrahim N & Engström M
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107.
Engström M, Wadensten B & Häggström E (2010). Caregivers’ job
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108.
Kullberg K, Björklund A, Sidenvall B & Åberg AC (2010). ‘I start my day by
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110.
Wadensten B (2010). Changes in nursing home residents during an innovation
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Other articles
2008
111.
Bill-Axelsson A, Christensson A, Carlsson M, Norlén BJ & Holmberg L (2008).
Experiences of randomisation: interviews with patients and clinicians randomising for trial.
Scandinavian Journal of Urology and Nephrology, 42: 358-363.
112.
Demmelmaier I, Lindberg P, Åsenlöf P & Denison E (2008). "The associations
between pain intensity, psychosocial variables, and pain duration/recurrence in a large sample of
persons with nonspecific spinal pain." Clinical Journal of Pain, 24(7):611-619.
113.
Fredriksson M & Winblad U (2008). Consequences of a decentralised healthcare
governance model: Measuring regional authority support for patient choice in Sweden. Social
Science & Medicine, 67:271-279.
114.
Hedlund M, Ronne Engström E, Ekselius E & Carlsson M (2008). From
monitoring physiological functions to using psychological strategies. Nurses’ view of caring for
the aneurismal subarachnoid haemorrhage patient. Journal of Clinical Nursing, 17(3):403-411.
115.
Häggström E, Mabusa E & Wadensten B (2008). Nurses perspectives of
workplace distress and ethical dilemmas in Tanzanian healthcare. Nursing Ethics, 15(4):478-91.
116.
Kristofferzon ML, Löfmark R. & Carlsson M (2008). Managing consequences
and finding hope - experiences of Swedish women and men 4-6 months after myocardial
infarction. Scandinavian Journal of Caring Sciences, 22:367-375.
117.
Rastad C, Ulfberg J & Lindberg P (2008). Light room therapy effective in mild
forms of SAD. - A randomised controlled study. Journal of Affective Disorders, 108:291-296.
118.
Sandborgh M, Lindberg P & Denison E (2008). The Pain Belief Screening
Instrument (PBSI) – Predictive validity for disability status in persistent musculoskeletal pain.
Disability and Rehabilitation, 30(15):1123 – 1130.
119.
Silén M, Ping Fen Tang, Wadensten B & Ahlström G (2008). Workplace
distress and ethical dilemmas in neuroscience nursing; A qualitative study of Swedish nurses'
experiences. Journal of Neuroscience Nursing, 40(4):222-231.
120.
Skoog Svanberg A, Sydsjö G, Ekholm Selling K & Lampic C (2008). Attitudes
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121.
Skytt B, Ljunggren B, Sjödén P-O & Carlsson M (2008). The roles of the
first-line nurse manager: perceptions from four perspectives. Journal of Nursing Management,
16 (8):1012-1020 .
122.
Skytt B, Ljunggren B, Carlsson M & Engström M (2008). Psychometric
testing of the Leadership and Management Inventory: a tool to measure the skills and abilities of
first-line nurse managers. Journal of Nursing Management, 16 (7):784-94.
123.
Soderback I (2008). Hospital discharge among frail elderly people: A pilot
study in Sweden. Occup. Ther. Int, 15(1):18-31.
124.
Unell M, Nordin K, Jernberg C, Stenström J & Jansson JK (2008). Degradation
of mixtures of phenolic compounds by Arthrobacter chlorophenolicus A6. Biodegradation,
19(4):495-505.
28
125.
Wadensten B, Wenneberg S, Silén M, Ping Fen Tang & Ahlström G (2008). A
Cross-cultural comparison of nurses’ ethical concerns. Nursing Ethics,15(6):745- 760.
126.
Winblad U (2008). Do Physicians care about patient choice? Social Science &
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2009
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Critchley K, Richardson E, Aarts C, Campbell B, Hemingway A, Koskinen L,
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128.
Demmelmaier IP. Åsenlöf et al. (2009). "Biopsychosocial predictors of pain,
disability, health care consumption, and sick leave in first-episode and long-term back pain: a
longitudinal study in the general population." International Journal of Behavioral Medicine,
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129.
Häggström E, Hofsten A & Wadensten B (2009). Nurses’ opinions about a webbased distance course in a specialist education programme for the care of older people: a
questionnaire study. International Journal of Older People Nursing, 4:177-184.
130.
Häggström E. & Nilsson A (2009). The meaning of living with rheumatoid
arthritis – a single case study based on one woman’s eight-year diary. Sygeplejeforskning, 3:915.
131.
Koskinen L, Campbell B, Aarts C, Chassé F, Hemmingway A, Juhansoo T,
Mitchell M, Marquis F, Critcley K (2009). Enhancing cultural competence: trans-atlantic
experiences of European and Canadian nursing students. International Journal of Nursing
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30
Scientific Reports
Clinical Nutrition and Metabolism (CNM)
Research Group Leader Professor Tommy Cederholm
Metabolic and dietary interaction during health and disease is the research focus at CNM.
Within this overall focus there are two major research pathways, i.e. 1) clinical disease- and
age-related nutrition, which includes understanding of catabolic processes, consequences and
treatment related to undernutrition, cachexia and sarcopenia in hospital, elderly care and
community settings, and 2) preventive nutrition and metabolism, including nutritional
epidemiology, obesity and metabolic intervention trials for elucidating effects on insulin
sensitivity and cardio-vascular risk factors.
Fatty acid (FA) and carbohydrate metabolism, inflammation, dietary interventions, dietary
assessment, energy metabolism, body composition measurements and implementation
techniques are examples of methodology expertise. CNM has laboratories that analyze FA
profiles in various tissues by gas-chromatography and measure body composition by airdisplacement and bioelectrical impedance, and energy expenditure.
Epidemiological studies consider nutritional, metabolic and dietary factors in relation to longterm clinical outcomes, e.g. diabetes type 2, metabolic syndrome, cardiovascular disease as well
as functional limitations, cognitive dysfunction, morbidity and mortality in young old and old
old populations. Clinical trials concern understanding of sarcopenic mechanisms during disease
and senescence, as well as potential effects of designed amino acid solutions and vitamin D to
sarcopenic old adults. Techniques of implementation to improve nutritional routines in elderly
care are investigated. Intervention trials in order to understand metabolic effects of healthy
Nordic diet and by providing various fat qualities i.e. saturated vs. mono- and polyunsaturated
fatty acids are performed in single-center as well as in larger multi-center controlled studies in
order to assess effects on insulin resistance, inflammation, liver fat and other cardio-vascular
risk factors.
Obesity, especially child obesity, is explored by metabolic characterization of insulin resistance,
energy metabolism, and body composition. Sleep pattern effects and disturbed circadian rhythm
effects on glucose metabolism are studied.
Members of the group during 2010
Academic title
Professional title
Tommy Cederholm
Professor
MD
Wulf Becker
Adjunct professor
Chief nutritionist
Brita Karlström
Professor
Dietitian
Bengt Vessby
Professor emeritus
MD
Ulf Riserus
Associate professor
Researcher
Ulf Holmbäck
Post-doc
Researcher
Anja Saletti
Post-doc
Dietitian
Per Sjögren
Post-doc
Researcher
Viola Adamsson
PhD student
Nutrition manager
David Iggman
PhD student
MD
31
Roger Olsson
PhD student
University teacher
Helena Petersson
PhD student
Elisabet Rytter
PhD student
Johanna Törmä
PhD student
Dietitian
Sigvard Sobestiansky
PhD student
MD
Erika Olsson
Licentiat student
Dietitian
Erika Ax
PhD student under reg.
Fredrik Rosqvist
PhD student under reg.
Siv Tengblad
Laboratory technician
Barbro Simu
Laboratory technician
Eva Lena Andersson
Tutor
Linda Bratteby-Tollerz
Physiotherapist
Marie Berglund
Research assistant
Partly affiliated or associated to CNM
Stefan Branth
Postdoc
Achraf Daryani
Postdoc
Tamanna Ferdous
Postdoc
Anders Forslund
Postdoc
Maria Lennernäs
Professor
Anders Sjödin
Ass professor
Annika Smedman
Postdoc
Eva Warensjö
Postdoc
Torbjörn Åkerfeldt
PhD student
MD
MD
MD
MD
Publications 2008-2010
Original articles
1. Adamsson V, Reumark A, Fredriksson IB, Hammarström E, Vessby B, Johansson G,
Risérus U. Effects of a healthy Nordic diet on cardiovascular risk factors in
hypercholesterolaemic subjects: a randomized controlled trial (NORDIET). J Intern
Med [E-pub 2010].
2. Al-Ani A, Flodin L, Söderqvist A, Ackerman P, Samnegård E, Dalén N, Sääf M,
Cederholm T, Hedström M. Does rehabilitation matter in patients with femoral neck
fracture and cognitive impairment? A prospective study of 246 patients. Arch Phys Med
Rehab 2010;91:5157.
3. Aro A, Becker W. Improving nutrition in Finland. Public Health Nutr
2010;13(6A):899-900.
32
4. Delgado-Lista J, Perez-Martinez P, García-Rios A, Phillips CM, Williams CM, Gulseth
HL, Helal O, Blaak EE, Kiec-Wilk B, Basu S, Drevon CA, Defoort C, Saris WH,
Wybranska I, Riserus U, Lovegrove JA, Roche HM, Lopez-Miranda J. Pleiotropic
effects of TCF7L2 gene variants and its modulation in the metabolic syndrome: from
the LIPGENE study. Atherosclerosis [E-pub 2010].
5. Emerging Risk Factors Collaboration, Kaptoge S, Di Angelantonio E, Lowe G, Pepys
MB, Thompson SG, Collins R, Danesh J. C-reactive protein concentration and risk of
coronary heart disease, stroke, and mortality: an individual participant meta-analysis.
Lancet 2010;375(9709):132-40.
6. Emerging Risk Factors Collaboration, Sarwar N, Gao P, Seshasai SR, Gobin R,
Kaptoge S, Di Angelantonio E, Ingelsson E, Lawlor DA, Selvin E, Stampfer M,
Stehouwer CD, Lewington S, Pennells L, Thompson A, Sattar N, White IR, Ray KK,
Danesh J. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular
disease: a collaborative meta-analysis of 102 prospective studies. Lancet
2010;375(9733):2215-22.
7. Faxén Irving G, Cederholm T. Energy dense oleic acid rich formula to newly admitted
geriatric patients - feasibility and effects on energy intake. Clin Nutr [E-pub 2010].
8. Ferdous T, Cederholm T, Nahar Kabir Z, Hamadani JD, Wahlin A. Nutritional status
and cognitive function in community living rural Bangladeshi older adults: Data from
the Poverty and Health in Ageing project. J Amer Ger Soc 2010;58:919-24.
9. Ferguson JF, Phillips CM, McMonagle J, Pérez-Martínez P, Shaw DI, Lovegrove JA,
Helal O, Defoort C, Gjelstad IM, Drevon CA, Blaak EE, Saris WH, LeszczyńskaGołabek I, Kiec-Wilk B, Risérus U, Karlström B, Lopez-Miranda J, Roche HM.
NOS3 gene polymorphisms are associated with risk markers of cardiovascular disease,
and interact with omega-3 polyunsaturated fatty acids. Atherosclerosis 2010
Aug;211(2):539-44.
10. Ferguson JF, Phillips CM, Tierney AC, Pérez-Martínez P, Defoort C, Helal O, Lairon
D, Planells R, Shaw DI, Lovegrove JA, Gjelstad IM, Drevon CA, Blaak EE, Saris WH,
Leszczynska-Golabek I, Kiec-Wilk B, Risérus U, Karlström B, Miranda JL, Roche
HM. Gene-nutrient interactions in the metabolic syndrome: single nucleotide
polymorphisms in ADIPOQ and ADIPOR1 interact with plasma saturated fatty acids to
modulate insulin resistance. Am J Clin Nutr 2010;91(3):794-801.
11. Fjellström C, Starkenberg Å, Wesslén A, Tysén Bäckström A-C, Faxén Irving G and
the OmegAD Study group. To be a good food provider: An exploratory study among
spouses of persons with Alzheimers disease. Am J Alzheiemer’s Diseases Other Dement
2010;25:521-6.
12. Gulliksson M, Burell G, Vessby B, Lundin L, Toss H, Svärdsudd K. Randomized
controlled trial of cognitive behavioral therapy vs standard treatment to prevent
recurrent cardiovascular events in patients with coronary heart disease: Secondary
Prevention in Uppsala Primary Health Care project (SUPRIM). Arch Intern Med [E-Pub
2010].
13. Gulseth HL, Gjelstad IM, Tierney AC, Lovegrove JA, Defoort C, Blaak EE, LopezMiranda J, Kiec-Wilk B, Risérus U, Roche HM, Drevon CA, Birkeland KI. Serum
vitamin D concentration does not predict insulin action or secretion in European
subjects with the metabolic syndrome. Diabetes Care 2010;33(4):923-5.
33
14. Gulseth HL, Gjelstad IM, Tierney AC, Shaw DI, Helal O, Hees AM, Delgado-Lista J,
Leszczynska-Golabek I, Karlström B, Lovegrove J, Defoort C, Blaak EE, LopezMiranda J, Dembinska-Kiec A, Risérus U, Roche HM, Birkeland KI, Drevon CA.
Dietary fat modifications and blood pressure in subjects with the metabolic syndrome in
the LIPGENE dietary intervention study. Br J Nutr 2010;104(2):160-3.
15. Helal O, Defoort C, Robert S, Marin C, Lesavre N, Lopez-Miranda J, Risérus U, Basu
S, Lovegrove J, McMonagle J, Roche HM, Dignat-George F, Lairon D. Increased levels
of microparticles originating from endothelial cells, platelets and erythrocytes in
subjects with metabolic syndrome: Relationship with oxidative stress. Nutr Metab
Cardiovasc Dis [E-pub 2010].
16. Iggman D, Arnlöv J, Vessby B, Cederholm T, Sjögren P, Risérus U. Adipose tissue
fatty acids and insulin sensitivity in elderly men. Diabetologia 2010;53(5):850-7.
17. Jansson E, Landberg R, Kamal-Eldin A, Wolk A, Vessby B, Aman P. Presence of
alkylresorcinols, potential whole grain biomarkers, in human adipose tissue. Br J Nutr
2010;104(5):633-6.
18. Jobs E, Risérus U, Ingelsson E, Helmersson J, Nerpin E, Jobs M, Sundström J, Lind L,
Larsson A, Basu S, Arnlöv J. Serum cathepsin S is associated with serum C-reactive
protein and interleukin-6 independently of obesity in elderly men. J Clin Endocrinol
Metab 2010;95(9):4460-4.
19. Kaiser MJ, Bauer JM, Rämsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR,
Anthony P, Charlton KE, Maggio M, Tsai AC, Vellas B, Sieber CC for the MNA
International Group. Frequency of malnutrition in the elderly: A multinational
perspective using the Mini Nutritional Assessment (MNA®). J Am Ger Soc
2010;58:1734-8.
20. Lowden A, Moreno C, Holmbäck U, Lennernäs M, Tucker P. Eating and shift work effects on habits, metabolism and performance. Scand J Work Environ Health
2010;36(2):150-62.
21. Nettleton JA, McKeown NM, Kanoni S, Lemaitre RN, Hivert MF, Ngwa J, van Rooij
FJ, Sonestedt E, Wojczynski MK, Ye Z, Tanaka T; CHARGE Whole Grain Foods
Study Group. Interactions of dietray whole-grain intake with fasting glucose- and
insulin-related genetic loci in individuals of Europeans descent: a meta-analysis of 14
cohort studies. Diabetes Care 2010;33(12):2684-91.
22. Petersson H, Risérus U, McMonagle J, Gulseth HL, Tierney AC, Morange S, Helal O,
Shaw DI, Ruano JA, López-Miranda J, Kieć-Wilk B, Gołąbek I, Blaak EE, Saris WH,
Drevon CA, Lovegrove JA, Roche HM, Basu S. Effects of dietary fat modification on
oxidative stress and inflammatory markers in the LIPGENE study. Br J Nutr
2010;104(9):1357-62.
23. Petersson H, Arnlöv J, Zethelius B, Risérus U. Serum fatty acid composition and
insulin resistance are independently associated with liver fat markers in elderly men.
Diabetes Res Clin Pract 2010;87(3):379-84.
24. Phillips CM, Goumidi L, Bertrais S, Field MR, Ordovas JM, Cupples LA, Defoort C,
Lovegrove JA, Drevon CA, Blaak EE, Gibney MJ, Kiec-Wilk B, Karlstrom B, LopezMiranda J, McManus R, Hercberg S, Lairon D, Planells R, Roche HM. Leptin Receptor
Polymorphisms Interact with Polyunsaturated Fatty Acids to Augment Risk of Insulin
Resistance and Metabolic Syndrome in Adults. J Nutr 2010;140(2):238-44.
34
25. Phillips CM, Goumidi L, Bertrais S, Field MR, Cupples LA, Ordovas JM, Defoort C,
Lovegrove JA, Drevon CA, Gibney MJ, Blaak EE, Kiec-Wilk B, Karlstrom B, LopezMiranda J, McManus R, Hercberg S, Lairon D, Planells R, Roche HM. Gene-nutrient
interactions with dietary fat modulate the association between genetic variation of the
ACSL1 gene and metabolic syndrome. J Lipid Res 2010;51(7):1793-800.
26. Phillips CM, Goumidi L, Bertrais S, Field MR, Cupples LA, Ordovas JM, McMonagle
J, Defoort C, Lovegrove JA, Drevon CA, Blaak EE, Kiec-Wilk B, Riserus U, LopezMiranda J, McManus R, Hercberg S, Lairon D, Planells R, Roche HM. ACC2 gene
polymorphisms, metabolic syndrome, and gene-nutrient interactions with dietary fat. J
Lipid Res 2010;51(12):3500-7.
27. Rehman JU, Brismar K, Holmbäck U, Akerstedt T, Axelsson J. Sleeping during the
day: effects on the 24-h patterns of IGF-binding protein 1, insulin, glucose, cortisol, and
growth hormone. Eur J Endocrinol 2010;163(3):383-90.
28. Risérus U, de Faire U, Berglund L, Hellénius ML. Sagittal abdominal diameter as a
screening tool in clinical research: cutoffs for cardiometabolic risk. J Obes 2010;2010.
pii: 757939 [E-pub 2010].
29. Rytter E, Johansson C, Vessby B, Sjödin A, Möller L, Akesson B, Basu S. Biomarkers
of oxidative stress in overweight men are not influenced by a combination of
antioxidants. Free Radic Res 2010;44(5):522-8.
30. Rytter E, Vessby B, Asgård R, Ersson C, Moussavian S, Sjödin A, AbramssonZetterberg L, Möller L, Basu S. Supplementation with a combination of antioxidants
does not affect glycaemic control, oxidative stress or inflammation in type 2 diabetes
subjects. Free Radic Res 2010;44(12):1445-53.
31. Sjögren P, Becker W, Warensjö E, Olsson E, Byberg L, Gustafsson IG, Karlströn B,
Cederholm T, Mediterranean and carbohydrate-restricted diets and mortality among
elderly men: a cohort study in Sweden. Am J Clin Nutr 2010;92(4):967-74.
32. Sjögren P, Cederholm T, Heimburger M, Stenvinkel P, Vedin I, Palmblad J, Hellenius
ML. Simple advice on lifestyle habits and long-term changes in biomarkers of
inflammation and vascular adhesion in healthy middle-aged men. Eur J Clin Nutr [Epub
2010].
33. Smedman A, Lindmark-Månsson H, Drewnowski A, Edman AK. Nutrient density of
beverages in relation to climate impact. Food Nutr Res 2010;54 doi:
10.3402/fnr.v54i0.5170.
34. Smedman A, Månsson HL, Drewnowski A, Edman AK. Response-letter to the editor
regarding nutrient density of beverages in relation to climate impact. Food Nutr Res
2010;54 doi: 10.3402/fnr.v54i0.5732.
35. Tierney AC, McMonagle J, Shaw DI, Gulseth HL, Helal O, Saris WH, Paniagua JA,
Gołąbek-Leszczyñska I, Defoort C, Williams CM, Karsltröm B, Vessby B,
Dembinska-Kiec A, López-Miranda J, Blaak EE, Drevon CA, Gibney MJ, Lovegrove
JA, Roche HM. Effects of dietary fat modification on insulin sensitivity and on other
risk factors of the metabolic syndrome-LIPGENE: a European randomized dietary
intervention study. Int J Obes (Lond) [ E-pub 2010].
35
36. Vedin T, Cederholm T, Freund-Levi Y, Basun H, Hjorth E, Faxén Irving G,
Eriksdotter Jönhagen M, Schultzberg M, Wahlund L, Palmblad J. Reduced
prostaglandin F2α release from blood mononuclear leukocytes after oral
supplementation of n3 fatty acids: the OmegAD study. J Lipid Res 2010;51:1179-85.
37. Vessby B, Ahrén B, Warensjö E, Lindgärde F. Plasma lipid fatty acid composition,
desaturase activities and insulin sensitivity in Amerindian women. Nutr Metab
Cardiovasc Dis [E-pub 2010].
38. Warensjö E, Jansson JH, Cederholm T, Boman K, Eliasson M, Hallmans G, Johansson
I, Sjögren P. Biomarkers of milk fat and the risk of myocardial infarction in men and
women: a prospective, matched case-control study. Am J Clin Nutr 2010;92(1):194-202.
39. Wennberg M, Bergdahl IA, Hallmans G, Norberg M, Lundh T, Skerfving S, Strömberg
U, Vessby B, Jansson JH. Fish consumption and myocardial infarction: a second
prospective biomarker study from northern Sweden. Am J Clin Nutr E-pub 2010].
40. Elkan AC, Engvall IL, Cederholm T, Hafström I. Rheumatoid cachexia, central obesity
and malnutrition in patients with low-active rheumatoid arthritis: feasibility of
anthropometry, Mini Nutritional Assessment and body composition techniques. Eur J
Nutr 2009;48(5):315-22.
41. Elkan AC, Håkansson N, Frostegård J, Cederholm T, Hafström I. Rheumatoid
cachexia is associated with dyslipidemia and low levels of atheroprotective natural
antibodies against phosphorylcholine but not with dietary fat in patients with
rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther 2009;11(2):R37.
42. Ewers B, Riserus U, Marckmann P. Effects of unsaturated fat dietary supplements on
blood lipids, and on markers of malnutrition and inflammation in hemodialysis patients.
J Ren Nutr 2009;19(5):401-11.
43. Ferdous T, Cederholm T, Razzaque A, Wahlin A, Nahar Kabir Z. Nutritional status
and self-reported and performance-based evaluation of physical function of elderly
persons in rural Bangladesh. Scand J Public Health 2009;37(5):518-24.
44. Ferdous T, Kabir ZN, Wahlin A, Streatfield K, Cederholm T. The multidimensional
background of malnutrition among rural older individuals in Bangladesh--a challenge
for the Millennium Development Goal. Public Health Nutr 2009;12(12):2270-8.
45. Freund-Levi Y, Hjorth E, Lindberg C, Cederholm T, Faxen-Irving G, Vedin I,
Palmblad J, Wahlund LO, Schultzberg M, Basun H, Eriksdotter Jönhagen M. Effects of
omega-3 fatty acids on inflammatory markers in cerebrospinal fluid and plasma in
Alzheimer's disease: the OmegAD study. Dement Geriatr Cogn Disord 2009;27(5):48190.
46. Hammar N, Hakala P, Jörgensen L, Becker W, Hedlund E, Rönnemaa T, Koskenvuo
M, Kaprio J. Migration and dietary habits – An epidemiological study of Finnish twins
in Sweden. Eur J Clin Nutr 2009;63:312-22.
47. Helmersson J, Arnlöv J, Axelsson T, Basu S. A polymorphism in the cyclooxygenase
1 gene is associated with decreased inflammatory prostaglandin F(2)(alpha) formation
and lower risk of cardiovascular disease. Prostaglandins Leukot Essent Fatty Acids
2009;80(1):51-6.
36
48. Ingelsson E, Sundström J, Melhus H, Michaëlsson K, Berne C, Vasan RS, Risérus U,
Blomhoff R, Lind L, Arnlöv J. Circulating retinol-binding protein 4, cardiovascular risk
factors and prevalent cardiovascular disease in elderly. Atherosclerosis
2009;206(1):239-44.
49. Ingelsson E, Arnlöv J, Sundström J, Risérus U, Michaëlsson K, Byberg L. Relative
importance and conjoint effects of obesity and physical inactivity for the development
of insulin resistance. Eur J Cardiovasc Prev Rehabil 2009;16(1):28-33.
50. Irving GF, Freund-Levi Y, Eriksdotter-Jönhagen M, Basun H, Brismar K, Hjorth E,
Palmblad J, Vessby B, Vedin I, Wahlund LO, Cederholm T. Omega-3 fatty acid
supplementation effects on weight and appetite in patients with Alzheimer's disease: the
omega-3 Alzheimer's disease study. J Am Geriatr Soc 2009;57(1):11-7.
51. Jacobsson JA, Risérus U, Axelsson T, Lannfelt L, Schiöth HB, Fredriksson R. The
common FTO variant rs9939609 is not associated with BMI in a longitudinal study on a
cohort of Swedish men born 1920-1924. BMC Med Genet 2009;9;10:131.
52. Katan MB, Boekschoten MV, Connor WE, Mensink RP, Seidell J, Vessby B, Willett
W. Which are the greatest recent discoveries and the greatest future challenges in
nutrition? Eur J Clin Nutr 2009;63(1):2-10.
53. Landberg R, Aman P, Friberg LE, Vessby B, Adlercreutz H, Kamal-Eldin A. Dose
response of whole-grain biomarkers: alkylresorcinols in human plasma and their
metabolites in urine in relation to intake. Am J Clin Nutr 2009;89(1):290-6.
54. Nydahl M, Gustafsson IB, Mohsen R, Becker W. Comparison between optical readable
and open-ended weighed food records. Food Nutr Res 2009;53. doi:
10.3402/fnr.v53i0.1889.
55. Orrevall Y, Tishelman C, Permert J, Cederholm T. Nutritional support and risk status
among cancer patients in palliative home care services. Support Care Cancer
2009;17(2):153-61.
56. Petersson H, Lind L, Hulthe J, Elmgren A, Cederholm T, Risérus U. Relationships
between serum fatty acid composition and multiple markers of inflammation and
endothelial function in an elderly population. Atherosclerosis 2009;203(1):298-303.
57. Petkeviciene J, Similä M, Becker W, Kriaucioniene V, Valsta LM. Validity and
reproducibility of the NORBAGREEN food frequency questionnaire. Eur J Clin Nutr
2009;63:141-9.
58. Rytter E, Vessby B, Asgård R, Johansson C, Sjödin A, Abramsson-Zetterberg L, Möller
L, Basu S. Glycaemic status in relation to oxidative stress and inflammation in wellcontrolled type 2 diabetes subjects. Br J Nutr 2009;101(10):1423-6.
59. Samuelsson B, Hedström MI, Ponzer S, Söderqvist A, Samnegård E, Thorngren KG,
Cederholm T, Sääf M, Dalen N. Gender differences and cognitive aspects on
functional outcome after hip fracture--a 2 years' follow-up of 2,134 patients. Age
Ageing 2009;38(6):686-92.
60. Shaw DI, Tierney AC, McCarthy S, Upritchard J, Vermunt S, Gulseth HL, Drevon CA,
Blaak EE, Saris WH, Karlström B, Helal O, Defoort C, Gallego R, López-Miranda J,
Siedlecka D, Malczewska-Malec M, Roche HM, Lovegrove JA. LIPGENE food-
37
exchange model for alteration of dietary fat quantity and quality in free-living
participants from eight European countries. Br J Nutr 2009;101(5):750-9.
61. Söderqvist A, Ekström W, Ponzer S, Pettersson H, Cederholm T, Dalén N, Hedström
M, Tidermark J; Stockholm Hip Fracture Group. Prediction of mortality in elderly
patients with hip fractures: a two-year prospective study of 1,944 patients. Gerontology
2009;55(5):496-504.
62. Warensjö E, Rosell M, Hellenius ML, Vessby B, De Faire U, Risérus U. Associations
between estimated fatty acid desaturase activities in serum lipids and adipose tissue in
humans: links to obesity and insulin resistance. Lipids Health Dis 2009;8:37:1-6.
63. Warensjö E, Smedman A, Stegmayr B, Hallmans G, Weinehall L, Vessby B,
Johansson I. Stroke and plasma markers of milk fat intake--a prospective nested casecontrol study. Nutr J 2009;21;8:21.
64. Wennersberg MH, Smedman A, Turpeinen AM, Retterstøl K, Tengblad S, Lipre E,
Aro A, Mutanen P, Seljeflot I, Basu S, Pedersen JI, Mutanen M, Vessby B. Dairy
products and metabolic effects in overweight men and women: results from a 6-mo
intervention study. Am J Clin Nutr 2009;90(4):960-8.
65. Wennberg M, Vessby B, Johansson I. Evaluation of relative intake of fatty acids
according to the Northern Sweden FFQ with fatty acid levels in erythrocyte membranes
as biomarkers. Public Health Nutr 2009;12(9):1477-84.
66. Ärnlöv J, Zethelius B, Risérus U, Basu S, Berne C, Vessby B, Alfthan G, Helmersson
J; Uppsala Longitudinal Study of Adult Men Study. Serum and dietary beta-carotene
and alpha-tocopherol and incidence of type 2 diabetes mellitus in a community-based
study of Swedish men: report from the Uppsala Longitudinal Study of Adult Men
(ULSAM) study. Diabetologia 2009;52(1):97-105.
67. Al-Ani A, Samuelsson B, Tidermark J, Norling A, Ekstrom W, Cederholm T,
Hedstrom M. Early operation on patients with a hip fracture improved the ability to
return to independent living: a prospective study of 850 patients. J Bone Joint Surg
2008;90:1436-42.
68. Andersson K, Karlström B, Fredén S, Petersson H, Ohrvall M, Zethelius B. A twoyear clinical lifestyle intervention program for weight loss in obesity. Food Nutr Res
2008;52. doi: 10.3402/fnr.v52i0.1656.
69. Bergkvist, C. Öberg M, Appelgren M, Becker W, Aune M, Ankarberg EH, Berglund
M, Håkansson H. Exposure to dioxin-like pollutants via different food commodities in
Swedish children and young adults. Food Chem. Toxicol 2008;46:3360-7.
70. Bräuner EV, Forchhammer L, Møller P, Barregard L, Gunnarsen L, Afshari A, Wåhlin
P, Glasius M, Dragsted LO, Basu S, Raaschou-Nielsen O, Loft S. Indoor particles
affect vascular function in the aged: an air filtration-based intervention study. Am J
Respir Crit Care Med 2008;177(4):419-25.
71. Cho K, Cederholm T, Lökk J. Calcium intake in elderly patients with hip fracture.
Food & Nutrition Research 2008;52. doi: 10.3402/fnr.v52i0.1654.
72. De Jong A, Plat J, Bast A, Godschalk RW, Basu S, Mensink RP. Effects of plant sterol
and stanol ester consumption on lipid metabolism, antioxidant status and markers of
38
oxidative stress, endothelial function and low-grade inflammation in patients on current
statin treatment. Eur J Clin Nutr 2008;62(2):263-73.
73. Elkan AC, Engvall IL, Tengstrand B, Cederholm T, Hafström I. Malnutrition in
women with rheumatoid arthritis is not revealed by clinical anthropometrical
measurements or nutritional evaluation tools. Eur J Clin Nutr 2008;62(10):1239-47.
74. Engvall IL, Elkan AC, Tengstrand B, Cederholm T, Brismar K, Hafstrom I. Cachexia
in rheumatoid arthritis is associated with inflammatory activity, physical disability, and
low bioavailable insulin-like growth factor. Scand J Rheumatol 2008;37(5):321-8.
75. Freund-Levi Y, Basun H, Cederholm T, Faxén-Irving G, Garlind A, Grut M, Vedin I,
Palmblad J, Wahlund LO, Eriksdotter-Jönhagen M. Omega-3 supplementation in mild
to moderate Alzheimer's disease: effects on neuropsychiatric symptoms. Int J Geriatr
Psychiatry 2008;23(2):161-9.
76. Ingelsson E, Risérus U. Effects of trans10cis12CLA-induced insulin resistance on
retinol-binding protein 4 concentrations in abdominally obese men. Diabetes Res Clin
Pract 2008;82:23-4.
77. Johansson C, Rytter E, Nygren J, Vessby B, Basu S, Möller L. Down-regulation of
oxidative DNA lesions in human mononuclear cells after antioxidant supplementation
correlates to increase of gamma-tocopherol. Int J Vit Nutr Res 2008;78:183-94.
78. Jong AD, Plat J, Bast A, Godschalk RWL, Basu S, Mensink RP. Effects of plant sterol
and stanol ester consumption on lipid peroxidation, antioxidant status and markers of
oxidative stress, endothelial function and low-grade inflammation in patients on current
statin treatment. Eur J Clin Nutr 2008:62;263-74.
79. Koochek A, Mirmiran P, Azizi T, Padyab M, Johansson SE, Karlström B, Azizi F,
Sundquist J. Is migration to Sweden associated with increased prevalence of risk factors
for cardiovascular disease? Eur J Cardiovasc Prev Rehabil 2008;15(1):78-82.
80. Krachler B, Norberg M, Eriksson JW, Hallmans G, Johansson I, Vessby B, Weinehall
L, Lindahl B. Fatty acid profile of the erythrocyte membrane preceding development of
Type 2 diabetes mellitus. Nutr Metab Cardiovasc Dis 2008;18(7):503-10.
81. Landberg R, Kamal-Eldin A, Andersson A, Vessby B, Aman P. Alkylresorcinols as
biomarkers of whole-grain wheat and rye intake: plasma concentration and intake
estimated from dietary records. Am J Clin Nutr 2008;87(4):832-8.
82. Larsson A, Helmersson J, Hansson LO, Basu S. Serum cystatin is associated with
other cardiovascular risk markers and cardiovascular disease in elderly men. Int J
Cardiol 2008;125(2):263-4.
83. Larsson A, Palm M, Hansson LO, Basu S, Axelsson O. Reference values for alpha (1)acid glycoprotein, alpha (1)-antitripsin, albumin, haptoglobin, C-reactive protein, IgA,
IgG and IgM during pregnancy. Acta Obstet Gynecol Scand 2008;87:1084-8.
84. Lindi V, Schwab U, Louheranta A, Vessby B, Hermansen K, Tapsell L, Riccardi G,
Rivellese AA, Laakso M, Uusitupa MI; KANWU Study Group. The G-250A
polymorphism in the hepatic lipase gene promoter is associated with changes in hepatic
lipase activity and LDL cholesterol: The KANWU Study. Nutr Metab Cardiovasc Dis
2008;18(2):88-95.
39
85. Lipcsey M, Söderberg E, Basu S, Larsson A, Sjölin J, Eriksson MB. F2-Isoprostane
associated changes in inflammation, cardiac function and oxygenation in endotoxaemic
pig. Prost Leuk Ess Fatty Acids 2008;78:209-17.
86. Melhus H, Risérus U, Warensjö E, Wernroth L, Jensevik K, Berglund L, Vessby B,
Michaëlsson K. A high activity index of stearoyl-CoA desaturase is associated with
increased risk of fracture in men. Osteoporosis Int 2008;19:929-34.
87. Nerpin E, Risérus U, Ingelsson E, Sundström J, Jobs M, Larsson A, Basu S, Arnlöv J.
Insulin sensitivity measured with euglycemic clamp is independently associated with
glomerular filtration rate in a community-based cohort. Diabetes Care 2008;31:1550-5.
88. Petersson H, Basu S, Cederholm T, Risérus U. Serum fatty acid composition and
indices of stearoyl-CoA desaturase activity are associated with systemic inflammation:
longitudinal analyses in middle-aged men. Br J Nutr 2008;99(6):1186-9.
89. Raff M, Tholstrup T, Basu S, Nonboe P, Straarup EM. A diet rich with conjugated
linoleic acid and butter increases lipid peroxidation but does not affect atherosclerotic,
inflammatory, or diabetic risk markers in healthy young men. J Nutr 2008;138:509-14.
90. Risérus U, Sprecher D, Johnson T, Olson E, Hirschberg S, Liu A, Fang Z, Hegde P,
Richards D, Sarov-Blat L, Strum JC, Basu S, Cheeseman J, Fielding BA, Humphreys
SM, Danoff T, Moore NR, Murgatroyd P, O'Rahilly S, Sutton P, Willson T, Hassall D,
Frayn KN, Karpe F. Activation of PPAR-δ promotes reversal of multiple metabolic
abnormalities, reduces oxidative stress and increases fatty acid oxidation in moderately
obese men. Diabetes 2008;57:332-9.
91. Schläwicke Engström K, Strömberg U, Lundh T, Johansson I, Vessby B, Hallmans G,
Skerfving S, Broberg K. Genetic variation in glutathione-related genes and body burden
of methylmercury. Environ Health Perspect 2008;116(6):734-9.
92. Sjögren P, Sierra-Johnson J, Gertow K, Rosell M, Vessby B, de Faire U, Hamsten A,
Hellenius ML, Fisher RM. Fatty acid desaturases in human adipose tissue: relationships
between gene expression, desaturation indexes and insulin resistance. Diabetologia
2008;51(2):328-35.
93. Steffen LM, Vessby B, Jacobs DR Jr, Steinberger J, Moran A, Hong CP, Sinaiko AR.
Serum phospholipid and cholesteryl ester fatty acids and estimated desaturase activities
are related to overweight and cardiovascular risk factors in adolescents. Int J Obes
(Lond) 2008;32(8):1297-304.
94. Sundelöf J, Arnlöv J, Ingelsson E, Sundström J, Basu S, Zethelius B, Larsson A,
Irizarry MC, Giedraitis V, Rönnemaa E, Degerman-Gunnarsson M, Hyman BT, Basun
H, Kilander L, Lannfelt L. Serum cystatin C and the risk of Alzheimer disease in elderly
men. Neurology 2008;71(14):1072-9.
95. Tholstrup T, Raff M, Staarup EM, Lund P, Basu S, Bruun JN. An oil mixture with
trans-10, cis-12 conjugated linoleic acid increases markers of inflammation and in vivo
oxidation compared to cis-7, trans-11 conjugated linoleic acid in post menopausal
women. J Nutr 2008;138:1445-51.
96. Turpeinen AM, Ylönen N, von Willebrand E, Basu S, Aro A. Immunological and
metabolic effects of cis-9, trans-11 CLA in subjects with birch pollen allergy. Br J Nutr
2007;1122:231-44.
40
97. Vedin I, Cederholm T, Freund Levi Y, Basun H, Garlind A, Faxen Irving G,
Eriksdotter Jonhagen M, Vessby B, Wahlund L, Palmblad J. Effects of
docosahexaenoic acid-rich n-3 fatty acid supplementation on cytokine release from
blood mononuclear leukocytes. The OmegAD Study. Am J Clin Nutr 2008;87:1616-22.
98. Warensjö E, Risérus U, Gustafsson IB, Mohsen R, Cederholm T, Vessby B. Effects
of saturated and unsaturated fatty acids on estimated desaturase activities during a
controlled dietary intervention. Nutr Metab Cardiovasc Dis 2008;18(10):683-90.
99. Warensjö E, Sundström J, Vessby B, Cederholm T, Risérus U. Markers of dietary fat
quality and fatty acid desaturation as predictors of total and cardiovascular mortality: a
population-based prospective study. Am J Clin Nutr 2008;88(1):203-9.
100.
Zethelius B, Berglund L, Sundström J, Ingelsson E, Basu S, Larsson A, Venge P,
Arnlöv J. Use of multiple biomarkers to improve the prediction of death from
cardiovascular causes. N Engl J Med 2008;358(20):2107-16.
101.
Ödlund Olin A, Koochek A, Cederholm T, Ljungqvist O. Minimal effect on
energy intake by additional evening meal for frail elderly service flat residents--a pilot
study. J Nutr Health Aging 2008;12:295-301.
Reviews 2008-2010
1. Bjermo H, Risérus U. Role of hepatic desaturases in obesity-related metabolic
disorders. Curr Opin Clin Nutr Metab Care 2010;13(6):703-8.
2. Cederholm T, Palmblad J. Are omega-3 fatty acids options for prevention and
treatment of cognitive decline and dementia? Curr Opin Clin Nutr Metabol 2010;
13:150-5.
3. Cruz-Jentoft A, Baeyens JP, Bauer J, Boirie Y, Cederholm T, Landi F, Martin F,
Michel JP, Rolland Y, Schneider S, Topinkova E, Vandewoude M, Zamboni M.
Sarcopenia: European Consensus on Definition and Diagnosis. Age Ageing
2010;39:412-23.
4. Holmbäck U. Insulin Resistance in Pediatric Obesity - Physiological Effects and
Possible Diet Treatment. Book chapter in Global Perspectives on Childhood Obesity
Current Status, Consequences and Prevention. Editor Bagchi D. Elsevier 2010.
5. Maggio M, Artoni A, Lauretani F, Ruggiero C, Cederholm T, Cherubini A, Ceda G.
The effect of polyunsaturated fatty acids on bone health. Reviews Clinical Gerontology
2010, accepted.
6. Muscaritoli M, Anker SD, Argiles J, Aversa Z, bauer J, Biolo G, Boirie Y, Bosaeus I,
Cederholm T, Costelli P, Fearon K, Laviano A, Maggio M, Rossi Fanelli F, Schneider
SM, Schols A, Sieber C, Consensus definition of sarcopenia, cachexia and precachexia: Joint document elaborated by Special Interest Groups (SIG) “cachexiaanorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr
2010;29;154-59.
7. Sobotka L, Schneider SM, Berner YN, Cederholm T, Krznaric Z, Shenkin A, Stanga
Z, Toigo G, Vandewoude M, Volkert D. ESPEN Guidelines on Parenteral Nutrition:
Geriatrics. Clin Nutr 2009;28:461-6.
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8. Risérus U, Willett WC, Hu FB. Dietary fats and prevention of type 2 diabetes. Prog
Lipid Res 2009;48(1):44-51.
9. Cederholm T. Nutrition and bone health in the elderly. In Food for the ageing
population. Woodhead Publishing Limited, Cambridge 2009
10. G Abellan Van Kan, G Gambassie, L de Groot, S Andrieu, T Cederholm, E Andre, J-P
Caubere, J-P Bonjour, P Ritz, A Salva, A Sinclair, B Vellas. Nutrition and aging. The
Carla Workshop. J Nutr Health Aging 2008;12:355-364.
11. Bauer JM, Wirth R, Volkert D, Werner H, Sieber CC; Teilnehmer des BANSSSymposium 2006. Malnutrition, sarcopenia and cachexia in the elderly: from
pathophysiology to treatment. Conclusions of an international meeting of experts,
sponsored by the BANSS Foundation. Dtsch Med Wochenschr 2008;133:305-10.
12. Basu S. F2-isoprostanes in human health and diseases: from molecular mechanisms to
clinical implications. Antioxid Redox Signal 2008;10(8):1405-34.
13. Erkkilä A, de Mello V, Risérus U, Laaksonen D. Dietary fatty acids and cardiovascular
disease. Prog Lip Res 2008;47:172-87.
Other articles 2008-2010
1. Bjermo H. Fettets kvalitet viktigare än mängden. Nordisk Nutrition 2010;3:9-13.
2. Korkeila M, Carrero JJ, Cederholm T, Stenvinkel P. Ghrelin – ny lovande behandling
vid anorexi och katabola tillstånd/Ghrelin-new promising treatment in anorexia and
catabolic conditions. Läkartidningen 2010;107:1627-28.
3. Risérus U. [Right diet can prevent cardiometabolic diseases]. Lakartidningen
2010;107(36):2077-82.
4. Sjögren P, Hellenius ML. Lågkolhydratkost bör baseras på vegetabilier.
Läkartidningen 2010;46:2877
5. Sjögren P. Ökad dödlighet hos män som äter lågkolhydratkost.
Läkartidningen 2010;45:2784
6. Sjögren P. Kostmönster och dödlighet hos äldre svenska män. Livsmedel i fokus
2010;8:48
7. Cederholm T, Saletti A. Måltidens plats i vardagen. Äldre i Centrum 2009;3:16-17.
8. Cederholm T, Ödlund-Olin A. Evidensbaserad nutritionsbehandling. Swespens
Nutritionsdag 2009. Nordisk Nutrition 2009 nr 3:33
9. Ödlund-Olin A, Orrevall Y, Faxen-Irving G, Cederholm T, Ljungqvist O, De Man F.
Maten en del av patientsäkerheten. Debattartikel Brännpunkt, Svenska Dagbladet 9/6
2009.
10. Cederholm T. Muskler, mat och träning under åldrandet. Nordisk Nutrition 2009;2:2123
11. Risérus U. Mat och hälsa: är det en fettfråga? Incitament 2009;1:507-510
42
12. Törmä J, Saletti A. Implementera nutritionsrutiner inom äldreomsorgen – räcker
utbildning och riktlinjer? Nordisk Nutrition 2009;2:24-26.
13. Cederholm T. Lågt proteinintag ger minskad muskelmassa hos äldre. Nordisk Nutrition
2008;3:13-4.
14. Cederholm T et al. Forskaren, samhället och jäv. Läkartidningen 2008;105:1206-7.
15. Cederholm T. Sarkopeni – ett ”nytt” begrepp med klinisk betydelse för den äldre.
Nordisk Geriatrik 2008;11(1):30-32.
Dissertations 2008-2010
Tamanna Ferdous. Determinants and Functional Impact of Nutritional Status Among Older
Persons in Rural Bangladesh. Uppsala Universitet 2009.
Associate professors 2008-2010
Ulf Risérus 2010
Agencies that support the work/Funding 2010 >100 000 SEK
Vetenskapsrådet
900 000
Hjärt-Lungfonden
300 000
Diabetesfonden
130 000
FAS
490 000
Centrum för klinisk forskning Dalarna
136 000
Uppsala County Council - ALF
1 080 000
Stockholm County Council – ALF (The OmegAD Trial)
400 000
Uppsala Municipality (”Stimulansmedel”)
1 700 000
Danone/Nutricia Research
170 000
Future promising research at CNM:
- Understanding sarcopenia from clinical, epidemiological and molecular perspectives, and its
treatment.
- Implementation techniques of nutritional routines and development of assessment tools for
meals in elderly care
- Dietary pattern effects on development of cognitive impairment and prostate cancer
- Omega-3 fatty acid effects on epigenetic markers, mononuclear blood cell gene expression
and effects on inflammation resolution
- Fatty acid effects on gene expression, insulin sensitivity, inflammation, endothelial cell
function and body fat distribution (ectopic fat accumulation)
- Nutritional impact on metabolomics
- Cardiometabolic, transcriptomic and epigenetic effects of a healthy Nordic diet
- Evaluation of sagittal abdominal diameter as a valuable anthropometric risk marker
- Individualized treatment of child obesity
43
Descriptions of on-going projects
1) Nutrition, ageing and disease
Participants: Tommy Cederholm, Brita Karlström, Anja Saletti, Johanna Törmä, Erika Ohlsson,
Per Sjögren, Sigvard Sobestiansky
Sarcopenia in geriatric care – the importance of skeletal muscle in elderly patients (The
SIGVARD Study)
Collaborators: Sigvard Sobestiansky, Anna Christina Åberg, Thomas Gustafsson, Andreas
Fugman, Tommy Cederholm
Sarcopenia denotes the loss of muscle mass linked to physiological changes during ageing
which is enhanced by age-related conditions like chronic disorders, chronic inflammation,
insufficient dietary intake an low physical activity, including periods of bed-rest due to
illnesses. Sarcopenia is the cause of disability and inability to recover from disease in the old
subject. Increased attention has been paid to this condition during the last 10-20 years. In a joint
effort with expertise on physiotherapy and muscle metabolism the prevalence of sarcopenia and
methods to define and diagnose the condition will be studied in a group of 100 consecutively
admitted geriatric patients. Body composition, physical strength, physical function and clinical
outcome will be addressed. Progress: During 2010 the major part of collecting the patient
material has been achieved
Muscle cell gene expression patterns predictive of sarcopenia in old men and women
Collaborators: Sigvard Sobestiansky,Thomas Gustafsson, Brun Ulfhake, Lars-Erik Thörnell,
Karl Michaelsson, Lars Lind, Lena Kilander, Ulf Riserus, Jamie Timmons, Tommy
Cederhol50m
The objective of this project is if there is a specific gene expression pattern that predicts later
development of sarcopenia. In the ULSAM study >1000 of the male participants at age 70
agreed to leave a muscle biopsy. From 100 subjects who also did DXA for body composition
measurement at 88 years of age muscle biopsies at 70 will be utilized for microarray analysis in
order to identify possible predictors through bioinformatic tools in combination with knowledge
of body composition data obtained from the DXA scans. To quantify total number and number
of activated satellite cells conventional immunohistochemistry will be used and to locate
specific mRNA expression in situ hybridization will be used. In order to assess if gene
expression patterns found in old men are also valid for older women, 100 female participants in
the PIVUS cohort will be asked to leave a muscle biosy at the age of 80. These specimens are
planned to be analysed similar to those of the ULSAM cohort.
Changes in muscle morphology and muscle regenerative capacity in Swedish men from 70
to 90 years of age.
Collaborators: Sigvard Sobestiansky,Thomas Gustafsson, Brun Ulfhake, Lars-Erik Thörnell,
Karl Michaelsson, Tommy Cederholm
The objective is to identify mechanisms involved in age-related muscle wasting by comparing
molecular and cellular findings in biopsies taken at ages 70 and 88 years in 40 Swedish males.
ULSAM cohort members who performed the 88 year follow-up, including DXA scan and had a
muscle biopsy taken at the age of 70 will be asked if they are willing to leave a new biopsy at
age 90. The material will be analysed according to the content of embryonic myosin (i.e.
regeneration), expression of acetyl choline receptor subunits (i.e. denervation) and numbers and
activity of satellite cells, which is the stem cell of muscle regeneration. Moreover, fiber type
distribution, muscle fiber area and muscle capillary density will be compared between the
biopsies from 70 to 90 years of age. Single nucleotide polymorfisms (SNPs) will be related to
muscle phenotypic data.
44
Selective Androgen Receptor Modifiers (SARMs) for the treatment of muscle
wasting/sarcopenia in free-living older adults
Collaborators: Ulf Holmbäck, Maria Berglund, Torbjörn Åkerfeldt, Roger Olsson, Karl
Michaelsson, Tommy Cederholm.
CNM was one of many international centers in a Phase II/III study performed by MSD to
evaluate feasibility, safety and effects on muscle strength and functionality in communitydwelling older adults with limited functional impairments by a new Selective Androgen
Receptor Modifier (SARM). CNM did a thorough screening of close to 50 subjects and finally
was able to include 4 in a 6-month protocol. CNM was the most successful of all participating
centers. Progress: The data collection was finished during 2009. Data analyses were
performed.in 2010. SARM gave a significant increase in muscle mass but only a trend-wise
improved muscle strength.
Protein and vitamin enforced supplementation to sarcopenic older adults - The
PROVIDE Study
Collaborators: Ulf Holmbäck, Marie Berglund, Sigvard Sobestiansky, Tommy Cederholm
This project aims to evaluate the muscle strengthening effects of a liquid supplementation rich
in essential amino acids, vitamin D and vitamin Bs, to subjects >65 years of age, altogether
~300, with reduced muscle mass and muscle strength. It is a RCT design and the intervention
period will be 6 months. It is a multi-center study involving 5 international centers and the study
is financed by by Danone/Nutriticia, the Netherlands and is performed in collaboration with
Good Food Practice, Uppsala, who provides logistic support. Progress: During late 2010 patient
recruitment started and CNM has been able to enroll about one third of its allocated required
participants.
Combined exercise training and dietary intervention by whey protein and vitamin D to
sarcopenic old adults – The VIVE2 Study
Collaborators: Tommy Cederholm, Afsaneh Kochek, Anna Cristina Åberg, Margaretha Nydahl,
Mai-Lis Hellenius, Roger Fielding
The aim is to test if provision of high-quality protein and vitamin D combined with an exercise
program give a stronger anabolic effect than exercise training alone. The study has been planned
during 2010 and will be performed as a joint venture between Uppsala University, Karolinska
Institutet, Tufts University in Boston, USA and Nestle Nutrition Research, Schweiz. Inclusion
criteria is reduced 400 meter walking speed and reduced score in Short Physical Performance
Battery (SPPB). All subjects will participate in physiotherapist supervised exercise sessions
three times per week for 6 months. The participants will be randomized to receive a newly
developed whey protein and vitamin D enriched liquid formula or placebo.
Implementing nutritional routines into institutionalized elderly care (The MUMS Project)
Collaborators: Anja Saletti, Johanna Törmä, Brita Karlström, Marianne Sellgren, Ulrika
Spångberg Winblad, Marianne Carlsson, Tommy Cederholm.
In year 2006 the Uppsala municipality adopted nutritional guidelines for the elderly. In order to
perform and evaluate the implementation process scientifically, the municipality searched
cooperation with the University of Uppsala. The project consists of three substudies:
Nutritional, cognitive, functional and vitamin D interactions and relationships with 1 –year
mortality in elderly care residents
Undernutrition and vitamin D deficiency is common in residents of municipal elderly care and
related to reduced physical and cognitive function and mortal outcome. In 172 elderly care
residents in Uppsala, the nutritional status by Mini Nutritional Assessment, MNA 0-30 p (20),
ADL by Barthel Index (0-20 p) and cognitive function by Short Portable Mental State
Questionnaire (SPMSQ 0-10 p), were determined. From 110 residents blood samples were
drawn for analyses of nutrition-related biomarkers, including plasma 25-hydroxy(OH) vitamin
D, inflammatory/catabolic indicators and insulin-like growth factor-I (indicating anabolism).
Population registers will be used for determining mortality rate within one year after base-line
45
examination. Progress: Preliminary results indicate prevailing undernutrition in elderly care
residents with functional correlations for nutritional status and prevalent reductions of plasma
25-OH vitamin D concentrations.
Implementing nutritional routines into elderly care
Despite an improved nutritional awareness and several years of educational efforts, malnutrition
and insufficient food intake is still common among elderly in community care. The hypothesis
of this project is that an action research based implementation program will create an effective
model for implementation of nutritional guidelines. Two interventions will be compared during
the implementation project, i.e. one model is based on the four principles of action research;
plan, act, observe and reflect. Action research involves both researchers and practitioners
(managers, nurses and care staff from four nursing homes), and the other is a three-hour
educational session. The effects of implementation on staff level are measured by a survey using
process (actual care delivered in accordance with the nutritional guidelines) and outcome
indicators (nutritional status, mobility, cognitive ability, blood samples and health-related
quality of life (EQ-5D). Process indicators will evaluate to what extent the staff screen for
malnutrition and carry out nutritional care plans by document analysis. In addition, whether the
length of the night fast and the number of meals is in accordance with the guidelines will be
measured by dietary assessment. Finally, observations of the mealtimes will be carried out to
evaluate the ambience during mealtimes. Progress: The questionnaire survey from baseline is
collected and the 221 personal responses from the eight units are analyzed.
Development of a tool for evaluating mealtime’s ambience in elderly care
Improvement of mealtimes in elderly care is one way to increase quality of life and nutritional
status. During the MUMS implementation project it became clear that there is a need for a tool
to measure ambience at mealtimes. As a template for such tool the Five Aspects Meal Model
(FAMM) is used. It is based on restaurant visits and emphasizes “the room”, “the meeting”, “the
food and beverages served”, together creating “the ambience” or the atmosphere surrounding
the meal. These four aspects are in turn affected by “the management control system”. The tool
will be created based on this model. A panel of experts consisting of researchers and
practitioners will be asked to give their aspects of the norm of the mealtimes. The tool will be
tested in a pilot study. The validity of the items in each aspect will be determinate through
factor analyses. Progress: A literature search on mealtime effects has been performed. Out of 69
articles, 60 were reports from special housing, nursing homes and assisted living, and a few in
the hospital setting. About half were performed in cognitive intact populations, and it was
mainly older people's perspective that was highlighted.
CNM as collaborating partner 2010:
Omega-3 fatty acid epigenetic effects, effects on gene-expression and on inflammation
resolution - The OmegAD Study
Collaborators: Tommy Cederholm, Samar Basu, Hans Basun, Yvonne Freund-Levi, Gerd Faxén
Irving, Inger Vedin, Maria Jönhagen Eriksdottir, Lars-Olof Wahlund, Marianne Schultzberg,
Jan Palmblad.
The OmegAD Trial, a collaborative study of 200 patients with Alzheimers disease (AD) given
omega-3 fatty acids, mainly docosahexaenoic acid, in a randomized protocol for 6 and in an
open protocol for another 6 months, has partly been able to confirm epidemiological evidence
indicating that high intake of fish oils rich in omega-3 fatty acids may slow decline rate of
cognitive impairment in patients with Alzheimer’s disease. Effects on cognition, behavior,
nutrition, oxidation, inflammation and gene expression are studied. Tommy Cederholm is PI for
this study. Progress: During 2010 data on fatty acid concentrations in cerebrospinal fluid during
the treatment period was analyzed. Micro-array analyses of gene expression effects in blood
mononuclear cells were performed. Studies on epigenetic effects of n-3 FA treatment were
46
prepared, and IRB approval was given for the analyses of DHA-metabolites with inflammation
resolution properties, e.g. resolvins, protectins and maresins.
Functionality and quality of life in stroke patients one year after the event
Collaborators: Birgit Wahlberg Tommy Cederholm, Lena Zetterberg, Karin Hellström,
The aim of this study is to describe the functional capacity and psycho-social well-being in 200
stroke patients 65-85 years of age one year after the event. Nutritional status (MNA), body
composition (BIA), function (ADL, gait speed, Physical Activity Scale) self-efficacy and
coping will be tested. This project is performed in collaboration with the Department of
Neuroscience at UU. Progress: Data collection was finalized 2010.
Protein supplementation and bisphosphonates in elderly lean patients with hip fracture.
Collaborators: Tommy Cederholm, Amer Al Ani, Nils Dalen, Paul Ackerman, Lena
Flodin,Margareta Hedström.
In the frame work of the Stockholm Hip Fracture Group, a research joint action between the
University hospitals in Stockholm, the effects on muscle and skeleton by the combined
treatment with protein supplementation and bisphonates are studied. Lean elderly patients with
hip fracture are randomized to active treatment or placebo for 6 months. Function, muscle mass
and bone mineral density are the main outcome variables. The study is performed in
collaboration with Fresenius Kabi. Progress: Initial power calculations indicated the need of 120
patients in the study. Currently 70 patients have been recruited.
2) Preventive nutrition and metabolism
Fat and carbohydrates in the diet and the body
Participants: Ulf Risérus, Brita Karlström, Siv Tengblad, Per Sjögren, Bengt Vessby.
Effects of a healthy Nordic diet on cardiovascular risk and the metabolic syndrome
Collaborators: Ulf Risérus, Viola Adamsson, Bengt Vessby, Gunnar Johansson, Tommy
Cederholm, Fredrik Rosqvist, David Iggman
In a series of randomized controlled studies, we are currently investigating the role of a “healthy
Nordic diet”, i.e. a diet containing foods traditionally used in the Nordic countries, and foods
that have documented health effects on metabolic and cardiovascular risk factors,
- CNM, Uppsala is one of 11 academic centres in the consortium “Nordic Centre of Food,
Nutrition and Health”, financed by NordForsk. The aim is to conduct a large dietary multicentre intervention study using systems biology to investigate the genetic and metabolic effects
of a Nordic diet in overweight subjects with the metabolic syndrome (SYSDIET project).
- We are also investigating the clinical effects of a Nordic diet in subjects with
hypercholesterolemia (NORDIET project), as well as
- investigating the metabolic impact of a Nordic healthy breakfast (NORDBREAK project)
Effects on liver- and abdominal fat accumulation when substituting saturated fat with
polyunsaturated fat in the diet – The HEPFAT Study
Collaborators: Ulf Risérus, Håkan Ahlström, Peter Arner, Mats Rudling,Tommy Cederholm,
Helena Bjermo, David Iggman
Liver fat accumulation has been suggested to be causal for the development of type 2 diabetes.
In a randomized controlled trial, HEPFAT, we aim to investigate if accumulation of hepatic and
visceral fat can be reduced in abdominally obese subjects by substituting saturated fat with
vegetable oils (n-6 polyunsaturated fat) in an isocaloric diet. Secondary aim is to investigate the
effects on adipose tissue gene expression. Other clinical variables such as insulin resistance,
blood lipids, oxidative stress and inflammation will also be investigated. Progress: The trial is
conducted, the results are being analyzed and manuscript(s) are under preparation. We
collaborate closely with the Radiology dept at Uppsala Academic hospital, with Karolinska
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institutet on gene expression and assessment of mechanisms behind cholesterol lowering effects
of unsaturated fatty acids. This study is currently followed up by another controlled study
(LIPOGAIN study), where a similar protocol will be used but under hypercaloric conditions
aiming at increasing the knowledge behind metabolic consequences of weight gain and the
influence of dietary fats.
Clinical measures of abdominal obesity and the link to insulin resistance, metabolic
disorders and cardiovascular risk
Collaborators: Ulf Risérus, Helena Bjermo, Johan Ärnlöv
It is known that abdominal, rather than generalized obesity is particularly health hazardous. For
example, in many cases, waist girth is a better risk marker than the body mass index (BMI).
Abdominal (visceral) fat distribution is closely associated with the metabolic syndrome and is a
strong risk factor for type 2 diabetes, stroke and cardiovascular disease. In various populations
we have compared different anthropometric measures that could be easily used in the clinic or
in diabetes and cardiovascular research. In particular, we have reported in several studies that
the "sagittal abdominal diameter", i.e. the "abdominal height" measured with the patient in lying
position on a bench, seem an even better risk marker than waist girth and waist-to-hip ratio.
Especially, the abdominal height predicts metabolic disorders related to insulin resistance. In
collaboration with prof Mai-Lis Hellénius and prof Ulf de Faire at Karolinska Institute, we are
now performing a large study comparing different anthropometric measures with regard to
metabolic and cardiovascular risk. The aim is to identify the best anthropometric measure with
regard to identifying those individuals at highest risk, and therefore require lifestyle and drug
treatment.
LIPGENE; diet, genomics and the metabolic syndrome: an integrated nutrition, agrofood, social and economic analysis.
Collaborators: Ulf Risérus, Brita Karlström, Helena Bjermo, Bengt Vessby and researchers
from 25 other universities and colleges across Europe.
Lipgene is a EU-project within the 6th frame work and the aim is to elucidate in the role of
dietary fat in development of the metabolic syndrome. Genetic variability, production
technology and consumer acceptance are taken into account. Uppsala University is taking part
in a dietary intervention study that includes 8 other European universities and their participants.
Progress: The intervention is conducted and several manuscripts are recently published or under
preparation.
Fatty acid composition in serum lipid esters and desaturases in health and disease dietary and genetic aspects.
Collaborators: Ulf Risérus, Tommy Cederholm, Fredrik Rosqvist, Eva Warensjö, Tommy
Olsson, Julia Goedecke, Marja Mutanen, Björn Sundström, Juan Jesus Carrero, Bengt Vessby.
It is well known that the fatty acid composition in serum lipids and estimated desaturase
activities, as a marker of fat quality, is linked to obesity, insulin resistance, cardiovascular
disease and diabetes. Associations between fatty acid composition, estimated desaturase
activities and clinical variables, metabolic disease and dietary intakes are studied in several
substudies using various cohorts.The aim of our studies is to learn more about the FAcomposition and estimated desaturase activities in relation to the metabolic syndrome, to cardiovascular risk factors such as endothelial markers, as well as a potential role in the development
of malignancy..We will also study how the FA composition and estimated desaturase ratios
change after a diet rich in either saturated fat or unsaturated fat. In addition, genetic differences
(SNPs) in the SCD-gene will be studied in relation to obesity, insulin sensitivity and FA-ratios.
The importance of delta-5-desaturase (FADS) will be addressed. Several of these studies will be
carried out in the ULSAM- and PIVUS cohorts. We also have several international
collaborations with this regard, e.g. in collaboration with University of Capetown and Umeå
University we perform detailed phenotype characterization of white and black South African
women in order to detect dietary, anthropometric and metabolic differences among these subpopulations, including fatty acid metabolism. Apart from our main focus on obesity-related
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diseases and cardiometabolic disorders we have also several other projects going concerning
other major diseases as well as rare diseases. We believe that fatty acid intakes play a role as
well as an altered fatty acid metabolism in multiple diseases. For example, the relation between
dietary fat, FA profiles in plasma and desaturase activity in young women from Mozambique
will be studied. In collaboration with Umeå University FA-profiles in patients with rheumatic
diseases, and in collaboration with researchers at Dept of Nephrology, Karolinska Institutet,
similar questions will be addressed in patients with chronic kidney failure. These studies might
influence future dietary recommendations since FA composition and desaturase activities are
modifiable by diet.
Effects on appetite and cognitive performance of meals with different glycaemic load
Collaborators: Agneta Andersson, Anders Sjödin, Bengt Vessby, Louise Dye and John Blundell.
In within-subjects repeated-measures design the effect on appetite, cognitive performance and
subjective state during the post-lunch period of composite meals with different carbohydrates
sources is investigated. A computerised cognitive test battery is used to evaluate the cognitive
performance before and after lunch. Simultaneous appetite and subjective mood is rated and
analyses of blood glucose and insulin is performed. An ad libitum meal is finally used to assess
effect on food intake later during the day. In these way possible relationships between glucose
and insulin levels in blood, cognitive performance and appetite are evaluated. The project is
performed in collaboration with the Biopsychology Group, Leeds University, UK and financial
supported by VINNOVA. Progress: Data are collected. Manuscript will be written.
Dietary patterns and health effects
Participants: Wulf Becker, Brita Karlström, Bengt Vessby, Annika Smedman, Per Sjögren
Dietary patterns and long-term health. Longitudinal studies in 70 year old men in the
ULSAM Cohort
Collaborators: Per Sjögren, Erika Olsson, Erika Ax, Brita Karlström, Tommy Cederholm, Lena
Kilander, Karl Michaelsson, Anna Bill Axelsson, Hans Garmo, Lars Holmberg, Marcello
Maggio, Wulf Becker
Dietary data collected in the ULSAM Study at 70 years of age, around 1100 males, is compiled
into dietary patterns; i.e. Mediterranean-like Diet, WHO-recommended Diet and Carbohydrate
Restricted (Atkins-like). Detailed dietary habits were available from 7-day dietary records and
misreporters of dietary energy intake were identified. We investigate relationships between the
adherence to the various dietary patterns and long-term health outcome, e.g. mortality,
cardiovascular disease, cognitive function, oateoporosis and cancer. Corresponding studies are
planned for the PIVUS cohort.
Dietary pattern and mortality
Aim: To study the impact of the habitual dietary habits on all-cause and cardiovascular
mortality over a 12-year follow-up period.
Methods: The study was based on the third follow up of the ULSAM study. Degree of
adherence to the various dietary patterns (described above) was related to all-cause and
cardiovascular mortality (derived from national registries). Risk relations were calculated with
and without dietary misreporters included, and adjusted for potential confounders. Progress: A
first paper from this project was published during 2010 in the American Journal of Clinical
Nutrition. We found strong protective effects on both cardiovascular and all-cause mortality
from increased adherence to a Mediterranean-like diet. Conversely, adherence to a
Carbohydrate restricted diet was associated with increased mortality, especially cardiovascular
mortality in these men.
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Dietary pattern and prostate cancer
Aim: To study the impact of the habitual dietary habits on the risk of prostate cancer over a 16year follow-up period.
Methods: The study is based on the third follow-up of the ULSAM study. Degree of adherence
to the various dietary patterns (described above) will be related to the incidence of prostate
cancer, derived from the National Cancer Registry. Risk relations will be calculated with and
without dietary misreporters included, and adjusted for potential confounders. The risk of
competing events will be taken into consideration. Exploratory analyses will be performed to
investigate the impact of individual nutrients. Progress: Preliminary data are presented.
Corresponding studies have been initiated in other population based cohorts, one Swedish (H70,
Gothenburg) and one Italian (InChianti, Parma).
Dietary pattern and risk of cognitive disorders (The DICO Study)
Aim: To study the impact of dietary intake and the risk of incident Alzheimer's disease, all-type
dementia and mild cognitive impairment, respectively, in late life.
Methods: The study will be based on the third and fifth follow up of the ULSAM study. Data
from the dietary survey at age 70 will be used and related to the incidence of Alzheimer's
disease, all-type dementia and mild cognitive impairment, respectively. All participants in the
first investigation of the ULSAM study were invited to a third follow up for a new investigation
at the age of 70 years old. Risk relations will be calculated with and without dietary misreporters included, and adjusted for potential confounders such as ApoE-genotype. Progress:
Dietary data and risk relations were computed in the beginning of 2010. Due to maternal leave
the project will be completed 2011.
Dietary patterns in relation to nutritional status, body composition, psychological status,
health and disease in 82 year old men (ULSAM cohort).
Collaborators: Per Sjögren, Erika Olsson, Brita Karlström, Karl Michaëlsson, Tommy
Cederholm
The aim of the study is to evaluate dietary intake and dietary habits in the ULSAM population at
the age of 82, i.e. energy and nutrient intake, meal pattern, and frequency of meals/food items.
Moreover, to relate dietary intake/dietary habits to nutritional status and body composition
(DEXA), risk of malnutrition (MNA), vitamin B12, folate, ADL, psychosocial situation,
medical-, psychological and sociological factors, physical activity level, and parameters for
health/diseases (coronary heart disease and diabetes). Dietary intake was measured at the fifth
follow-up of ULSAM - Uppsala Longitudinal Study of Adult Men, when the participants were
82 years old, using a pre-coded 7-d record book and with a food frequency questionnaire
(FFQ).
An investigation of food intake in relation to environmental toxins in 70-year old men and
women in the PIVUS cohort
Collaborators: Per Sjögren, Erika Ax, Tommy Cederholm, Monica Lind, Lars Lind
Cross-sectional relations between food intake and environmental toxins in the body will be
investigated. The study will be based on baseline data from the PIVUS cohort, a longitudinal
study of 1000 men and women (all 70 years of age) initiated in 2001 and with ongoing
reinvestigations and follow-ups. Detailed dietary habits are available from 7-day dietary
records, including food groups and nutrients. Mis-reporters of reported energy intake will be
identified. Quantitative measures of a wide spectrum of environmental toxins, such as PCB,
dioxins and phthalates, are available from fasting blood samples of all participants. Associations
between dietary patterns, food groups and nutrients and the different toxins will be investigated.
Progress: Computation of dietary data was initiated in 2010 and associations to environmental
toxins will be carried out in 2011.
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Gene-diet-interactions and cardio-metabolic risk (The ULSAM, PIVUS and LIPGENE
cohorts)
Collaborators: Per Sjögren, Ulf Riserus, Erik Ingelsson, Lars Lind, Jennifer A Nettleton
Our genetic background interacts with dietary modifications in determining health outcome. In
this project we focus on the intake of certain nutrients, how they interact with selected gene
variants and the effect on this interaction on intermediate risk factors for type-2-diabetes and
cardiovascular disease. These studies are part of a large multinational collaboration (i.e. the
CHARGE consortium) including several prospective cohort studies, and coordinated by JA
Nettleton (Texas, USA). Progress: The first paper was published 2010, investigating the impact
from the interaction of whole grain intake and selected gene variants on fasting plasma glucose
and insulin levels. Similar studies on selected gene variants and their interaction with dietary
patterns, coffee, zinc and magnesium, respectively, are in progress.
Effects of increased intake of fruit and vegetables on dietary composition, body weight and
metabolic control
Collaborators: Anette Järvi, Brita Karlström, Wulf Becker, Bengt Vessby.
Project description: Sixty-four overweight adult men and women were randomised to either an
intervention group that during 4 months received 500 g/d fruit and vegetables or a control group
that received general dietary advice. The effects on dietary habits, anthropometry, blood lipids,
blood glucose, antioxidant status, etc., were investigated. Progress: Data are collected. A
manuscript will be written.
Obesity and overweight in children and adults
Participants: Ulf Holmbäck, Tommy Cederholm, Roger Olsson, Linda Bratteby Tollerz, Marie
Berglund, Torbjörn Åkerfeldt, Arvo Hänni, Anders Forslund
Weight reducing operations and effects on body composition and endocrine function.
Collaborators: Ulf Holmbäck, Tommy Cederholm, Anders Karlsson, Arvo Hänni, Magnus
Sundbom
Morbid obesity is treated with various operative techniques, depending on degree of obesity.
Few studies have examined the impact of various operation techniques at weight stabilization.
Using a cross-sectional approach, we are studying obese subjects after gastric bypass or
duodenal switch and comparing them to weight matched non-operated controls. We are
assessing body composition, energy expenditure, psychometric variables, expression of
lipogenic genes, appetite regulation, inflammation and markers for fat, protein and muscle
turnover. Progress: About half of the subjects have been examined.
Individualized treatment of pediatric obese patients
Collaborators: Ulf Holmbäck, Anders Forslund, Jan Gustafsson, Roger Olsson, Arvo Hänni
In spring 2008 the children’s obesity clinic opened in Uppsala. We have a multi-disciplinary
approach with the aim of individualizing the treatment, both in terms of cognitive treatment but
also dietary approaches, and by that keep patient satisfaction high and attrition low. Progress: A
pilot study has started.
Assessment of nutrition status in pediatric patients
Collaborators: Roger Olsson,Marie Berglund, Linda Bratteby-Tollertz, Anders Forslund, Ulf
Holmbäck
In various diseases, such as obesity, cystic fibrosis or neurological conditions such as cerebral
pareses, correct assessment of nutrition status is important. Often caloric needs are estimated
from equations, and these equations might underestimate energy needs in these patient
populations. By using various techniques such as activity monitors, heart rate monitors and
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activity diaries, together with indirect calorimetry and body composition assessment, we strive
to get a more complete picture of these patients nutrition status. These, hopefully, more correct
nutrition status figures will aid in the treatment and increase health in these patient populations.
Progress: Data from more than 200 children have been collected. Preliminary data have been
presented.
The effects of nutrition and physical activity on muscle metabolism and biochemical
variables.
Collaborators: Torbjörn Åkerfeldt, Mats Stridsberg, Ulf Holmbäck.
In various clinical settings, such as after surgical procedures, patients have to recover from loss
of muscle mass and muscle function. Our projects aim to learn more about how to optimize
nutrition support for muscle gain, and also to elucidate what changes occur within the muscle as
well as on the whole body level. Progress: Data collection and analysis have ended; manuscript
under preparation.
Circadian Metabolism - Metabolic, endocrine and mental performance effects of sleep
restriction with and without sleep misalignment
Contact person and collaborators: Ulf Holmbäck, Rachel Leproult (University of Chicago), Eve
Van Cauter (University of Chicago)
Subjects are tested before and after sleeping 5 h per night, with or without sleep restriction.
Among others, the following variables are studied: glucose metabolism, energy intake, mental
performance, hormones and cardiovascular function. Progress: Data collection and analysis
have ended. One article published and several manuscripts are under final preparation.
Will short sleep in adolescents affect energy expenditure, glucose metabolism and
appetite? – The SLOPUS Study
Participants: Ulf Holmbäck, Anders Sjödin & Lars Klingenberg (University of Copenhagen) &
Jean-Philippe Chaput (University of Ottawa).
Adolescents will take part in a randomized interventions trial looking at the effects of short
sleep on energy expenditure, glucose metabolism and subjective and objective appetite.
Progress: All subjects have been run and initial data analysis have begun, Preliminary data have
been presented at conferences.
Undergraduate Teaching 2010
Biomedical Laboratory Science Program - Biomedicinsk analytiker (BMA)-programmet.
Energy balance, body composition and nutrition status in the course “Biochemistry”; lectures
and seminars, together with the Department of Medical Biochemistry and Microbiology.
Dietitian Program – Dietistutbildningen
Fifth semester – Pediatrics, geriatrics and nutritional status (course). Nutritional status in theory,
methodological tools and practical applications. Body composition in practice, together with the
Department of Food, Nutrition and Dietetics.
Medical Program - Läkarprogrammet
First semester – Energy balance and nutrition status; lectures and seminars, together with the
Department of Medical Cell Biology
Sixth and seventh semester – Clinical nutrition and public health nutrition: lectures, seminars,
case reports and discussion.
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”Livsmedelsagronom”-programmet
Energy balance, body composition, substrate metabolism and nutrition status in the course
“Human nutrition”; lectures and seminars together with the Department of Food Science, the
Swedish University of Agricultural Sciences
Master in Public Health - Master i Folkhälsa
Responsible for the 15 HTPS course ”Diet, nutrition and health; lectures, seminars, projects and
examination.
Nursing Program - Sjuksköterskeprogrammet
First semester – Energy balance and nutrition status; lectures and seminars, together with the
Department of Medical Cell Biology
Third semester: ”Nursing for obese patients”; lectures, seminars, and memo
Sixth semester: “Nutrition for elderly”; lectures
Physiotherapy Program – Sjukgymnastprogrammet, together with the Department of
Neuroscience, Unit of Physiotherapy.
Second semester – Rehabilitation towards increased physical activity (basic course). Caloric
turn-over in theory, methodological tools and practical applications.
Fourth semester - Rehabilitation towards increased physical activity (advanced course). Caloric
turn-over and nutritional status in theory, methodological tools and practical applications.
Centers and Facilities
International collaborations: CNM researchers have on-going collaborations with scientists
from Tufts University, from Harvard School of Medicine and from Harvard School of Public
Health, Boston, USA regarding research in exercise/nutrition physiology, nutritional
epidemiology and n-3 fatty acid biochemistry. We work with University of Alberta, Nursing
Science, Canada on issues of importance for elderly care and implementation research, and
takes part of nutria-genetic collaborations within The CHARGE Consortium, University of
Texas. Together with Cambridge/Oxford Integrative Physiology Consortium for Metabolic
Diseases and Centre for Diabetes and Royal Society of Medicine, London we collaborate on
the interaction between food and insulin resistance. Fatty acid metabolic collaborations are in
progress with University of Cape Town, South Africa and University of Helsinki, Finland.
CNM is part of the LIPGENE Study funded in the EU 7th Frame Work Program. In the
Systems biology in dietary intervention studies (SYSDIET), Nordic Centre of Excellence in
Food, Nutrition and Health (NoCE), a vast Nordic collaboration is performed with University
of Eastern Finland, Kuopio, and University of Copenhagen. OPUS is another Nordic
collaboration between various Danish and international universities to orchestrate the world’s
largest intervention study on the effect of diet and lifestyle on children and adolescents. The
Provide Study is a multi-center study with centres in Brussels, Newcastle, Nuernberg and
Cologne, performed in collaboration with Danone/Nutricia Research and where CNM is PI
centre. In collaboration with University of Parma, Italy, joint efforts are performed with the
InChianti Study to evaluate interactions of food and health in elder populations of different
origins. Circadian metabolic disturbances and metabolism of sleep disorders are joint objectives
with University of Chicago, and University of Ottawa.
International networks/memberships: Gerontonet - European Centre of Excellence in
Geriatric Science. European Society for Clinical Nutrition and Metabolism (ESPEN): Council
membership for chairmen of the national societies (Swespen). ESPEN Special Interest Group Geriatric nutrition/The SIG GN works on a European level to coordinate research efforts and
53
recommendations for nutrition in the elderly. EFSA – Scientific cooperation & Assistance
Directorate within European Food Safety Authority. Diabetes Nutrition Study Group – DNSG is
a part of the European Association for the Study of Diabetes (EASD) and comprise of
researchers mainly involved in the development of nutritional guidelines for the treatment of
diabetes. Other international networks are EuroFIR – European Food Information Resource,
which is an EU 6th Framework Network of Exellence in the area of food composition databases
with 47 partners across Europe. Euronut – 15 European institutions with high quality nutrition
research collaborating around Diet and ageing, in accordance with EU:s 7th Frame Program.
Nordic Nutrition Academy – Nordic Nutrition School for young researchers in nutrition; six
three day-seminars over two years. European Working Group on Sarcopenia.
National collaborations: CNM have numerous collaborations with researchers at Karolinska
Institutet, at the departments of Geriatrics, Endocrinology & Metabolism, Physiology &
Pharmacology, Clinical Neuroscience, Nephrology, Molecular Medicine, and Medical
Epidemiology and Cardio-Vascular Research to name some. We also collaborate with the
Kungsholmen Project, Aging Research Center, KI, the Stockholm Hip Fracture Group
which includes Departments of Surgery at Karolinska University Hospital Solna and Huddinge,
Stockholm Söder Hospital and Danderyds Hospital). Moreover we work together with
University of Agricultural Sciences (SLU), Uppsala, Integrative Biological Medicine, Umeå
University (sarcopenia and the KNOTA Project), Health 70 with University of Gothenburg,
and Uppsala Community and Uppsala County Council (elderly care), Stress Research
Institute, Stockholm University. Lunds University in the SYSDIET project, and Dept of
Health and Social Sciences, Högskolan, Dalarna. At Uppsala University CNM collaborates
with researchers in the Uppsala Longitudinal Study on Adult Men (ULSAM), Prospective
Investigation of Vasculature in Uppsala Seniors (PIVUS), and has co-workers at Dept of Food
Science, Dept of Medical Science, Dept of Radiology, Oncology and Radiation Science, Dept of
Neuroscience, Department of Food Science, Faculty of Social Sciences, Dept of Surgical
Science, Dept of Women and Children’s Health etc. Logistic services and collaboration in many
studies, mainly intervention trials, is performed with Good Food Practice (GFP), a private
enterprise for clinical nutrition trials.
National networks and memberships: DiabetesForum – an Uppsala network of researchers
working with diabetes. Dietitians in Geriatrics – DIG facilitate national clinical and research
collaboration between dietitians working in geriatric medicine. Network Epidemiology &
Nutrition (NEON) – network of nutritional epidemiologists, to support and improve
competence in nutritional epidemiology. Nutritionistföreningen in Sweden. Swespen – the
Swedish branch of the European Society of Clinical Nutrition and Metabolism, and Swedish
Society of Clinical Nutrition (SFKN) within The Swedish Society of Medicine (SLS). Swedish
Nutrition Foundation – an organisation to facilitate collaboration between academy and
industry..Expert Council for Food and Health and expert group for the revision of Nordic
Nutrition Rcommendations 5 at Swedish Food Administration (SLV). National Board of Social
Welfare and Health (SOS) – expert group for revision of nutritional guidelines for hospital and
elderly care.
54
Scientific Reports
Disability and Habilitation
Research Group Leader Professor Karin Sonnander
People with disabilities often experience extensive difficulties in everyday life.
Research in Disability and Habilitation is interdisciplinary and multi-professional
with a fundamental focus on the interface between the individual and his/her
environment. A joint conceptual perspective is found in the WHO Classification
ICF. Contextual Factors in particular serve as a framework for research activities in
elucidating environmental aspects of disability at present including adults with
intellectual disability, mental health disorder or aphasia, children with significant
developmental delay, as well as children at risk of neglect. More specifically,
current study objectives include development of methods, environmental and
personal factors as potential facilitators and/or barriers and the outcome of the
person-environment interaction from the perspective of people with disabilities,
their networks as well as of professionals.
Members of the group during 2010
Monica Blom Johansson, BA, PhD student
Johan Glad, BA, PhD student
Carina Gustafsson, PhD Faculty of Medicine, associated researcher
Gerth Hedov, PhD Faculty of Medicine, associated researcher
Kjerstin Larsson, PhD Faculty of Medicine, associated researcher
Helena Lindstedt, PhD Faculty of Medicine, senior researcher
Gunilla M. Olsson, PhD, associated researcher
Mia Pless, PhD Faculty of Medicine, associated researcher
Karin Sonnander, PhD, professor
Annika Terner, BA, PhD student
Õie Umb-Carlsson, PhD Faculty of Medicine, senior researcher
External partners
Amanthi Bandusena, PhD student, Department of Community Medicine, University of Sri
Jayewardenepura, Colombo, Sri Lanka
Mats Brommels, PhD Faculty of Medicine, professor, Medical Management Centre, LIME,
Karolinsla Institute, Stockholm
Marianne Carlsson, PhD, professor, Department of Public Health and Caring Sciences, Uppsala
University
Helge Folkestad, PhD, senior lecturer, Department of Social Education and Social Work,
Bergen University College, Norway
Berit Höglund, PhD student, Department of Women’s and Children’s Health, Uppsala
University
Ann-Britt Ivarsson, PhD Faculty of Medicine, associate professor, School of Health and
Medical Sciences, Örebro University
Gunnel Janeslätt, PhD Faculty of Medicine, Centre for Clinical Research Falun, Uppsala
University
Lennart Jansson, PhD Faculty of Medicine, Department of Neuroscience, psychiatry, Uppsala
University
Ulla Jergeby, PhD, National Board of Health and Welfare
55
Margareta Larsson, PhD Faculty of Medicine, senior lecturer, Department of Women’s and
Children’s Health, Uppsala University
Gunilla Lindmark, PhD Faculty of Medicine, professor em. ,Department of Women’s and
Children’s Health, Uppsala University
Erik Lundström, PhD Faculty of Medicine, Department of Neuroscience, Uppsala University
Liselotte Norling Hermansson, PhD Faculty of Medicine, Clinical Research Centre, Örebro
University Hospital, Örebro
Mariann Olsson, PhD, associate professor, Department of Neurobiology, Care sciences and
Society, Division of Social Work, Karolinska Institute, Stockholm
Ingvor Pettersson, PhD Faculty of Medicine, senior lecturer, School of Health and Medical
Siences, Örebro University
Birgitta Rosberg, occupational therapist, Uppsala University Hospital
Anna Cristina Åberg, PhD Faculty of Medicine, adj. clinical lecturer, Department of Public
Health and Caring Sciences
Publications 2008-2010
1. Ericsson, K., Gebre-Medhin, M. & Sonnander, K. (2008). Sweden-China partnership:
areas of ongoing development. Journal of Policy and Practice in Intellectual Disability,
5, 2: 112-117
2. Larsson K. (2008). Psykosociala perspektiv på ulcerös kolit och Crohns sjukdom –
Hälsorelaterad livskvalitet, stress och coping. Socionomen (forskningssupplement)6;4657 (In Swedish)
3. Larsson K, Lööf L, Rönnblom A, Nordin K. (2008). Quality of life for patients with
exacerbation in inflammatory bowel disease and how they cope with disease activity. J
Psychosom Res 64(2):139-148
4. Li, M., Zhang, Z. & Sonnander, K. (2008). Developmental screening in selected
counties in China. In China Disabled Persons’ Federation and Uppsala University:
Prevention and rehabilitation of iodine-related mental retardation. A decade of SinoSwedish co-operation, Department of Women’s and Children’s Health, Uppsala
University
5. Lindstedt, H. (2008). Utvärdering av delprojektet KogniTek i Uppsala (No.08368-pdf).
Vällingby: Hjälpmedelsinstitutet (in Swedish)
6. Lindstedt, H. (2008). Daily occupations in mentally disordered offenders in Sweden
(Abstract/Poster),8. Europäischer und 53. Deutscher Ergotherapie-Kongress, COTEC
2008, Hamburg, BRD.
7. Lindstedt, H., & Ivarsson, A. (2008). Goal Attainment Scaling GAS,
Måluppfyllelseskala - Manual (Vol. 3). Örebro: Örebro universitet
8. Pless, M & Adolfsson, M. (2008). Forskning pågår: Hälsoklassifikationen ICF – Varför,
när och hur? Fysioterapi 1, 38-46 (in Swedish)
9. Springer, L. & Gustafsson, C. (2008). Systematisk bedömning av föräldraförmåga.
Pilotstudie om tillämpbarheten i ett svenskt sammanhang av Parent Assessment
Manual (PAM). Rapport 50, Habilitering och Hjälpmedel, landstinget i Uppsala län
(in Swedish)
10. Umb-Carlsson, Õ. (2008). Public special services provided to people with intellectual
disabilities in Sweden – A life-span perspective. Journal of Policy and Practice in
Intellectual Disabilities. 5, 4: 237-244
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11. Umb-Carlsson, Õ. (2008). Understanding quality of life from the perspective of women
and men with intellectual disability (Conference abstract), International Association on
the Scientific Study of Intellectual Disability (IASSID), Cape Town, South Africa
12. Blom Johansson, M., Carlsson, M. & Sonnander, Karin. (2009). How do we work with
persons with aphasia and their relatives? Preliminary results from a survey of Swedish
speech and language pathologists. (Conference Abstract), Nordic Aphasia Conference,
Copenhagen, Denmark.
13. Gustafsson, C., Öjehagen, A., Hansson, L., Sandlund, M., Nyström, M., Glad, J., Cruce,
G., Jonsson, A-K. & Fredriksson, M. (2009). Effects of psychosocial interventions for
persons with intellectual disabilities and mental health problems: a survey of systematic
reviews, Research on Social Work Practice, 19:281-290
14. Pless, M. Ibragimova, N. Adolfsson, M. Björck-Åkesson, E. Granlund, M (2009).
Evaluation of in-service training in using the ICF and ICF version for children and
youth. Journal of Rehabilitation Medicine 41(6): 451-458
15. Umb-Carlsson, Õ. (2009). Understanding the quality of life from the perspective of
people with intellectual disability”. (Conference Abstract), Nordic Network on
Disability Research. Nyborg, Denmark
16. Umb-Carlsson, Õ. & Jansson, L. (2009). Support in housing: a comparison between
people with psychiatric disabilities and people with intellectual disabilities. Community
Mental Health Journal, 45, 6: 420-426
17. Adolfsson, M. Granlund, M., Björck-Åkesson, E., Ibragimova, N. & Pless, M.
(2010). Exploring changes over time in habilitation: professionals’ perceptions
and applications of the International Classification of Functioning, Disability and
Health, version for Children and Youth (ICF-CY). Journal of Rehabilitation
Medicine, 42, 7: 670-678
18. Adolfsson, M., Malmqvist, J., Pless, M. & Granlund, M. (2010) Identifying child
functioning from an ICF-CY perspective: everyday life situations explored in
measures of participation. Disability and Rehabilitation, oct 19
19. Björck-Åkesson, E., Wilder, J., Granlund, M., Pless, M., Simeonsson, R.,
Adolfsson, M., Almqvist, L., Klang, N. & Lillkvist, A. (2010). The International
Classification of Functioning, Disability and Health and the version for children
and youth as a tool in child habilitation/early childhood intervention: feasibility
and usefulness as a common language and fram of reference for practice.
Disability and Rehabilitation, 32, 1: 125-138
20. Blom Johansson, M., Carlsson, M., & Sonnander, K. (2010). Working with
families of persons with aphasia: a survey of Swedish speech and language
pathologists. Disability & Rehabilitation, Early on line, 1-12
21. Lindstedt, H., Grann, M. & Söderlund, A. (2010) Mentally disordered offenders’
daily occupations after one year of forensic care. Scandinavian Journal of
Occupational Therapy, Early Online, 1-10
22. Olsson, G. M.& Hultling, A. (2010). Intellectual profile and associations with IQ
among a clinical group of obese children and adolescents. Eating & Weight
Disorders,15, 1-2: 68-73
57
23. Stenhammar, Ch., Olsson, G.M., Edlund, B., Baymanyar, S., Hulting, A-L.,
Wettergren, B. & Montgomery, S.M. (2010). Family stress and BMI in young
children. Acta Paediatrica, 99, 8: 1205-1212
24. Terner, A., Lindstedt, H. & Sonnander. K. (2010). Health professionals´choice of
keywords in an EHR system. Proceedings of the 13th World congress on medical
informatics, eds. Safran, C. Reti, S. & Marin, H.F. Studies in Health Technology
and Informatics, 160: 1521
25. Umb-Carlsson, Õ. & Lindstedt, H. (2010). The prerequisites for QoL of people
with intellectual disabilities. Scandinavian Journal of Disability Research, iFirst
article 1-13
Reviews 2008-2010
1. Umb-Carlsson, Õ. (2008.) Studier om hälsa för personer med utvecklingsstörning.
Statens folkhälsoinstitut, Stockholm (in Swedish)
2. Coren, E., Hutchfield, J., Thomae, M. & Gustafsson, C. (2010). Parent training
support for intellectually disabled parents. Cochrane Database of Systematic
Reviews 2010, Issue 6. Art.No.: DOI: 10.1002/14651858.CD007987.pub2
Dissertations 2008- 2010
Halftime review: Monica Blom Johansson
External agencies that support the work/External Funding 2008-2010
Regional Research Council in Uppsala-Örebro Region: 350 000
Swedish International Development Cooperation Agency (SIDA): 200 000
The Sävstaholm Foundation: 430 000
Project 1: Living with aphasia: communication and communication strategies from the
perspectives of significant others, speech and language pathologists, and persons with
aphasia – a description of experiences, and a trial of intervention
Monica Blom Johansson, Marianne Carlsson, Karin Sonnander
The aim of this thesis is to obtain more knowledge about how the person with aphasia, the
significant other and the speech and language therapist perceive the communicative situation
between the significant other and the person with aphasia.
A second aim is to develop a model of intervention and carry out a trial of intervention for
improving the couple’s communication skills.
Project 2: The HOME Inventory, Home Observation for Measurement of the
Environment - A Swedish Adaptation
Johan Glad, Carina Gustafsson, Ulla Jergeby, Karin Sonnander
The aim of this thesis is to assess the relevance of an international published instrument
(HOME) for assessing parental ability to satisfy children’s needs and to develop a reliable and
valid Swedish version. Psychometric properties and issues pertinent to administration and
implementation in a Swedish context will be established based on a national sample (n=150).
58
Project 3: A pilot study of a Swedish version of the Parent Assessment Manual (PAM) in a
field setting
Carina Gustafsson, Lydia Springer, Karin Sonnander
PAM (Parent Assessment Manual) is a comprehensive tool for identifying family strengths and
weaknesses. Although it can be used with all parents, it is geared towards parents with
intellectual disabilities. The aim of this pilot study is to evaluate the clinical utility of PAM in
the Swedish social services context and to evaluate the face validity and the preliminary
interrater-reliability of the PAM scoring criteria (n=5).
Project 4: Support and information to parents of children with Down syndrome
Gerth Hedov
Down syndrome (DS) is the largest group of children born with a chronic condition. Today the
incidence of DS in Sweden is 1/800 new-borns. In contrast to an international outlook there are
few Swedish studies focussing this group of parents. The purpose of the project is to formulate
evidence-based guidelines (based on empirical studies as well as experienced practice) on how
to give initial support and information to parents of children with DS followed by a quasiexperimental intervention study. The project also includes a 10-year follow-up study of 165
Swedish parents (in 86 families) concerning workload, employment and sick-leave rate and
parental stress.
Project 5: People with mental health disorder, implementing individual treatment goals
and long-term follow-up in psychiatric rehabilitation.
Helena Lindstedt, Marianne Carlsson, Ann-Britt Ivarsson
The aim is to implement and evaluate a treatment concept with individualized measurable
methodology of treatment and structured long-term follow-up (Goal Attainment Scaling, GAS)
for people with mental health disorders. Patients (n=80) report subjective occupational
performance, daily occupation satisfaction and quality of life. Occupational therapists (n=20)
report work satisfaction.
Project 6: Early identification by parental assessment of children with developmental
delay in Colombo, Sri Lanka
Amanthi Bandusena, Karin Sonnander
The general objective of this study is to estimate the prevalence of children aged eighteen
months in the Colombo district with developmental delay, to describe their parents’ perceptions
on selected aspects of care giving and facilities currently available for them.
Project 7: The concept of successful aging from the perspective of elderly men.
Birgitta Rosberg, Õie Umb-Carlsson, Anna Cristina Åberg
The aim is to describe, define and gain insight into the concept of successful aging from the
perspective of elderly men. Elderly men born between 1920 and 1924 are interviewed
concerning the concept of successful aging, contributory factors of successful aging and their
lived experiences of successful aging.
Project 8: Pregnancy, childbirth and newborn health of women with intellectual
disabilities and their infants.
Berit Höglund, Õie Umb-Carlsson, Margareta Larsson
The objective is to describe pregnancy, childbirth and health care from the perspective of
women with intellectual disabilities. Women with intellectual disabilities in Sweden who gave
birth 1973-2006 are interviewed regarding pregnancy and childbirth, including experiences of
support provided by the health care system during pregnancy and childbirth.
59
Project 9: People with intellectual disabilities as participants in the research process.
Õie Umb-Carlsson
The aim of the project is to gain experience and further knowledge in involving people with
intellectual disabilities in the research process. People with intellectual disabilities are involved
in validation of a quality of life model, in identifying issues of importance in a quality of life
scale and in production of the research report.
Project 10: Men and women with intellectual disabilities and quality of life
Õie Umb-Carlsson, Helena Lindstedt
The aim is to uncover the essence of the phenomenon quality of life from the perspective of
women and men with intellectual disabilities. Women and men with mild and moderate
intellectual disability are interviewed concerning their lived experiences of quality of life
(n=21).
Project 11: Support in housing- a comparison between people with psychiatric disability
and people with intellectual disability
Õie Umb-Carlsson, Lennart Jansson
The aim is to compare need and provision of support in housing among people with psychiatric
disability (n=397) and people with intellectual disability (n=110) based on questionnaire
reports.
Project 12: Parents' use of ICF and ICF-CY when reporting on focus in habilitation
services for their children with developmental disabilities
Mia Pless, Nina Ibragimova, Margareta Adolfsson, Eva Björck-Åkesson, Mats Granlund
The aim is to report on parents' use (n=87) of the International Classification of Functioning,
Disability and Health, ICF/ ICF-CY (Children and Youth version) when reporting on what
focus habilitation services have concerning their children with developmental disabilities. The
design is descriptive with a questionnaire using the structure and language in ICF model and
with questions concerning identification, goal setting and intervention of function and health.
Project 13: Patient safety and electronic health record (EHR)
Annika Terner, Helena Lindstedt, Karin Sonnander
The aim is to investigate the relationship between patient safety and documentation by studying
a shared EHR system in a Swedish county council. Research questions concern characteristics
of applied terms in the EHR system, to what extent they are applied across eight different health
professions as well as shared by these professional groups and how health professional users
value the shared EHR system. Finally, reported aberrancy incidents before and after the
implementation of a shared EHR system will be studied. Reported incidents related to
documentation in patient records will be identified and analyzed.
Project 14: Evaluation and implementation of lean thinking in the development of new
procedures for stroke patients
Kjerstin Larsson, Mats Brommels, Karin Sonnander, Mariann Olsson, Erik Lundström
The aim is to evaluate and implement an ongoing development work of new procedures using
lean thinking, for stroke patients and their relatives. A second aim is to analyse qualitative text,
i.e. patients’ comments, in follow up questionnaires from the National Qualitative Register
(RiksStroke) and to develop and evaluate psychosocial support to the patients’ relatives.
60
Scientific Report
Family Medicine and Clinical Epidemiology
Research Group Leaders Senior Lecturer Karin Björkegren & Professor Emeritus
Kurt Svärdsudd
Family medicine is the dominant academic field in primary health care. Moreover, it is the
parent specialization of all other non-surgical physician specializations. The content of family
medicine reflects the fact that primary health care is in the front line of all health care, i.e. it is
the health care facility patients are expected to begin by consulting. For this reason family
medicine research focuses on the most common diseases and illnesses in the population, for
instance cardiovascular disease, diabetes, asthma, allergy, chronic obstructive pulmonary
disease (COPD), musculo-skeletal disorders, low back pain, tennis elbow, fibromyalgia,
pharmacoepidemiology, and the most common infectious diseases as well as social insurance
medicine (sick-listing and disability retirement). In the research programme the focus is on
patient-centred research, using clinical as well as epidemiological techniques.
The researchers at our section also teach the undergraduate curriculum in the medical and
nursing programmes. In addition, the researchers lecture regularly each term at Uppsala
University in the physical therapy program and the Master’s program in public health, as well as
at other universities and university colleges at undergraduate level for students in the programs
in physical therapy, health education, sports education, and for students in non-matriculated
courses in sports psychology and continuing education courses for health care personnel at the
Karolinska Institute and elsewhere.
Members of the group during 2010:
Research supervisors:
Dan Andersson
Annika Bardel
Karin Björkegren
Stefan Blomberg
Johan Bogefeldt
Kristina Bröms
Gunilla Burell
Jan Cederholm
Dag Elmfeldt
Lars Englund
Margaretha Eriksson
Mats Gulliksson
Christina Halford
Mikael Hasselgren
Anna Hofsten
Sara Holmberg
Marie Johannesson
Gunnar Johansson
Lena Kallings
Per Kristiansson
Karin Lisspers
Gunilla Norrmén
Lena Olai
Nils Rodhe
Åke Schwan
Jan Stålhammar
Associate researcher, postdoc
Associate researcher, postdoc
Lecturer
Postdoc
Postdoc
Associate researcher, postdoc
Senior researcher
Associate professor
Adjunct professor, emeritus
Postdoc
Researcher, postdoc
Postdoc
Postdoc
Postdoc
Associate researcher, lecture
Postdoc
Professor
Professor
Visiting teacher, postdoc
Associate professor
Associate researcher, postdoc
Postdoc
Postdoc
Associate researcher, postdoc
Postdoc
Associate researcher, postdoc
61
MD, PhD
MD, PhD
MD, PhD
MD, PhD
MD, PhD
MD, PhD
Psychologist, PhD
MD, PhD
MD, PhD
MD, PhD
PhD, Faculty of Medicine
MD, PhD
MD, PhD
MD, PhD
MD, licentiate
MD, PhD
MD, PhD
MD, PhD
Doctor of Medical Science
MD, PhD
MD, PhD
MD, PhD
PhD, Faculty of Medicine,
MD, PhD
MD, PhD
MD, PhD
Björn Ställberg
Kurt Svärdsudd
Malin Swartling
Rolf Wahlström
Mari-Ann Wallander
Associate researcher, postdoc
Professor emeritus
Postdoc
Associate researcher
Associate professor
Thorne Wallman
Ture Ålander
Associate lecturer, postdoc
Postdoc
MD, PhD
MD, PhD
MD, PhD
MD, PhD
Epidemiologist,
PhD, Faculty of Medicine
MD, PhD
MD, PhD
Doctorial students:
Anders Carlberg
Lars Carlsson
Anna-Sophia von Celsing
Sevek Engström
Marie Grunnesjö
Stefan Jansson
Bo Karlsson
Linda Lännerström
Sveinn Magnusson
Mats Martinell
Lars Nilsson
Magnus Peterson
Keld Vaegter
PhD student
PhD student
PhD student
PhD student
PhD student
PhD student
PhD student
PhD student
PhD student
PhD student
PhD student
PhD student
PhD student
Psychotherapist
MD
MD
Dentist
Doctor of Naprapathy
MD
MD
RN
MD
MD
MD
MD
MD
Medical Programme - Professional Development
Annika Bardel, responsible for training of student tutors
Karin Björkegren, responsible for terms 1 and 2
Mats Gulliksson, responsible for terms 3 and 4
Bo Karlsson, responsible for term 11
Publications 2008-2010:
Publications 2010
1.
Afghahi H, Cederholm J, Eliasson B, Zethelius B, Gudbjornsdottir S, Hadimeri H,
Svensson MK: Risk factors for the development of albuminuria and renal impairment in
type 2 diabetes—the Swedish National Diabetes Register (NDR). Nephrol Dial
Transplant 2010, Epub ahead of print, Sept 2010.
2.
Afghahi H, Hadimeri H, Cederholm J, Eliasson B, Zethelius B, Gudbjornsdottir S,
Svensson MK: The majority of type 2 diabetic patients with renal impairment have nonalbuminuric renal disease - the Swedish National Diabetes register (NDR).
Diabetologia 2010, 53(Suppl 1):110.
3.
Arne M, Lisspers K, Ställberg B, Boman G, Hedenström H, Janson C, Emtner M: How
often is diagnosis of COPD confirmed with spirometry? Respir Med 2010, 104(4):550556.
4.
Burell GK, Svärdsudd K, Gulliksson M: Stress management prolongs life for CHD
patients: a randomized clinical trial assessing the effects of group intervention on all
62
cause mortality, recurrent cardiovascular disease, and quality of life. Int J Behav Med
2010, 17:96-96.
5.
Cederholm J, Gudbjornsdottir S, Eliasson B, Zethelius B, Eeg-Olofsson K, Nilsson PM,
Ndr: Systolic blood pressure and risk of cardiovascular diseases in type 2 diabetes: an
observational study from the Swedish national diabetes register. J Hypertens 2010,
28(10):2026-2035.
6.
Chavannes N, Ställberg B, Lisspers K, Roman M, Moran A, Langhammer A, Crockett
A, Cave A, Williams S, Jones R et al: UNLOCK: uncovering and noting long-term
outcomes in COPD to enhance knowledge. Prim Care Respir J 2010, 19(4):408.
7.
Eeg-Olofsson K, Cederholm J, Nilsson PM, Zethelius B, Svensson AM,
Gudbjornsdottir S, Eliasson B: New aspects of HbA1c as a risk factor for cardiovascular
diseases in type 2 diabetes: an observational study from the Swedish National Diabetes
Register (NDR). J Intern Med 2010, 268(5):471-482.
8.
Eeg-Olofsson K, Zethelius B, Svensson AM, Gudbjornsdottir S, Eliasson B, Cederholm
J: A new risk model for cardiovascular disease in type 1 diabetes. Diabetologia 2010,
53(Suppl 1):150.
9.
Eeg-Olofsson K, Cederholm J, Nilsson PM, Zethelius B, Svensson AM,
Gudbjornsdottir S, Eliasson B: Glycemic control and cardiovascular disease in 7,454
patients with Type 1 diabetes: an observational study from the Swedish National
Diabetes Register (NDR). Diabetes Care 2010, 33(7):1640-1646.
10.
Eliasson B, Gudbjornsdottir S, Eeg-Olofsson K, Svensson AM, Zethelius B, Cederholm
J: LDL-cholesterol is not the best blood lipid predictor of CHD risk in type 2 diabetes.
Diabetologia 2010, 53(Suppl 1):1235.
11.
Fharm E, Cederholm J, Eliasson B, Gudbjornsdottir S, Rolandsson O: Time trends in
absolute and modifiable CHD risk in Type 2 diabetes patients in the Swedish National
Diabetes Register (NOR) 2003-2008. Diabetes 2010, 59:A219-A219.
12.
Gulliksson M, Burell G, Vessby B, Lundin L, Toss H, Svärdsudd K: A randomised
controlled trial of cognitive behavioral therapy versus standard treatment on recurrent
cardiovascular events in coronary heart disease patients. Arch Int Med Accepted.
13.
Halford C, Ekselius L, Anderzen I, Arnetz B, Svardsudd K: Self-rated health, life-style,
and psychoendocrine measures of stress in healthy adult women. Upsala Journal of
Medical Sciences 2010, 115(4):266-274.
14.
He J, Ma XQ, Zhao YF, Wang R, Yan XY, Yan H, Yin P, Kang XP, Fang JQ, Hao YT
et al: A population-based survey of the epidemiology of symptom-defined
gastroesophageal reflux disease: the Systematic Investigation of Gastrointestinal
Diseases in China. BMC Gastroenterol 2010, 10.
15.
Holmberg SAC, Thelin AG: Predictors of sick leave owing to neck or low back pain: a
12-year longitudinal cohort study in a rural male population. Ann Agric Environ Med
2010, 17:251-257.
16.
Jansson C, Wallander MA, Johansson S, Johnsen R, Hveem K: Stressful psychosocial
factors and symptoms of gastroesophageal reflux disease: a population-based study in
Norway. Scand J Gastroenterol 2010, 45(1):21-29.
17.
Jansson SPO, Andersson DKG, Svärdsudd K: Mortality trends in subjects with and
without diabetes during 33 years of follow-up. Diabetes Care 2010, 33(3):551-556.
18.
Johansson S, Wallander MA, de Abajo FJ, Garcia Rodriguez LA: Prospective drug
safety monitoring using the UK primary-care General Practice Research Database:
theoretical framework, feasibility analysis and extrapolation to future scenarios. Drug
Saf 2010, 33(3):223-232.
63
19.
Kallings LV, Hellénius M-L: Mindre stillasittande och mer fysisk aktivitet bra för
hälsan. Läkartidningen 2010, 107(36):2090-2095.
20.
Kallings LV: Fysisk aktivitet på recept (FaR) en fungerande metod! . Svensk
Idrottsmedicin 2010, 1:29-31.
21.
Kallings LV: Fysisk aktivitet på recept i Norden: erfarenheter och rekommendationer
Nordisk nettverk for fysisk aktivitet, mat og sunnhet In press.
22.
Kallings LV: Fysisk aktivitet på recept i Norden – erfarenheter och rekommendationer
[Physical activity on prescription in the Nordic countries – experiences and
recommendations]. In NHV rapport 2010:12 R. Edited by Nordisk nettverk for fysisk
aktivitet mos. Göteborg: Nordiska högskolan för folkhälsovetenskap; 2010:77.
23.
Kjeldsen SE, Stålhammar J, Hasvold P, Bodegard J, Olsson U, Russell D: Effects of
losartan vs candesartan in reducing cardiovascular events in the primary treatment of
hypertension. J Hum Hypertens 2010, 24(4):263-273.
24.
Leijon M, Kallings LV, Faskunger J, Lärum G, Börjesson M, Ståhle A: Promoting
physical activity. In FYSS Physical activity in disease prevention and disease treatment.
Volume 14. Edited by Ståhle A: Yrkesföreningar för fysisk aktivitet (YFA): Statens
folkhälsoinstitut Report R; 2010.
25.
Lisspers K, Ställberg B, Hasselgren M, Johansson G, Svärdsudd K: Primary health care
centres with asthma clinics: effects on patients knowledge and asthma control. Prim
Care Respir J 2010, 19(1):37-44.
26.
Martin-Merino E, Ruigomez A, Garcia Rodriguez LA, Wallander MA, Johansson S:
Depression and treatment with antidepressants are associated with the development of
gastroesophageal reflux disease. Aliment Pharmacol Ther 2010.
27.
Martin-Merino E, Ruigomez A, Wallander MA, Johansson S, Garcia-Rodriguez LA:
Prevalence, incidence, morbidity and treatment patterns in a cohort of patients
diagnosed with anxiety in UK primary care. Fam Pract 2010, 27(1):9-16.
28.
Martín-Merino E, Ruigómez A, Johansson S, Wallander MA, García-Rodriguez LA:
Study of a cohort of patients newly diagnosed with depression in general practice:
prevalence, incidence, comorbidity, and treatment patterns. Prim Care Companion J
Clin Psychiatry 2010, 12(1):PCC.08m00764.
29.
McAfee AT, Rodríguez LA, Goettsch WG, González-Pérez A, Johansson S, Ming EE,
Wallander MA, Herings RM: Characteristics and drug utilization patterns of new users
of rosuvastatin and other statins in four countries. Minerva Cardioangiol 2010,
58(6):611-622.
30.
Nilsson HE, Dragomir A, Lazorova L, Johannesson M, Roomans GM: CFTR and tight
junctions in cultured bronchial epithelial cells. Exp Mol Pathol 2010, 88(1):118-127.
31.
Norrmén G, Svärdsudd K, Andersson DK: The association of patient's family, leisure
time, and work situation with sickness certification in primary care in Sweden.
Scandinavian Journal of Primary Health Care 2010, 28(2):76-81.
32.
Pettersson B, Lindgren P, Ringborg A, Martinell M, Stålhammar J: Resource
comsumption and costs of care the year before and after initiation of insulin theraphy in
Swedish patients with type 2 diabetes. Value Health 2010, 13(3):A58-A58.
33.
Pettersson B, Amgegaonkar B, Sazonov V, Martinell M, Stålhammar J, Wändell P:
Prevalence of lipid abnormalities before and after introduction of lipid modifying
therapy among Swedish patients with dyslipidemia (PRIMULA). BMC Public Health
2010, 10:737.
64
34.
Pinnock H, Thomas M, Tsiligianni I, Lisspers K, Østrem A, Ställberg B, Yusuf O, Ryan
D, Buffels J, Cals JW et al: The International Primary Care Respiratory Group (IPCRG)
Research Needs Statement 2010. Prim Care Respir J 2010, 19(Suppl 1):S1-20.
35.
Ringborg A, Lindgren P, Yin DD, Martinell M, Stålhammar J: Time to insulin
treatment and factors associated with insulin prescription in Swedish patients with type
2 diabetes. Diabetes Metab 2010, 36(3):198-203.
36.
Rodriguez LAG, Wallander MA, Martin-Merino E, Johansson S: Heart failure,
myocardial infarction, lung cancer and death in COPD patients: A UK primary care
study. Respiratory Medicine 2010, 104(11):1691-1699.
37.
Ruigomez A, Lundborg P, Johansson S, Wallander MA, Rodriguez LAG: Follow-up of
a cohort of children and adolescents with gastro-esophageal reflux disease who were
free of reflux esophagitis at initial diagnosis. Scand J Gastroenterol 2010, 45(7-8):814821.
38.
Ruigomez A, Wallander MA, Lundborg P, Johansson S, Rodriguez LA:
Gastroesophageal reflux disease in children and adolescents in primary care. Scand J
Gastroenterol 2010, 45(2):139-146.
39.
Russell D, Stålhammar J, Bodegard J, Hasvold P, Thuresson M, Kjeldsen SE:
Cardiovascular events in subgroups of patients during primary treatment of
hypertension with candesartan or losartan. J Clin Hypertens 2010.
40.
Svensson AM, Gudbjornsdottir S, Eliasson B, Eeg-Olofsson K, Zethelius B, Cederholm
J: Risk factor control in patients with type 2 diabetes and coronary heart disease.
Diabetologia 2010, 53(Suppl 1):190.
41.
Svensson MK, Cederholm J, Eliasson B, Zethelius B, Afghahi H, Hadimeri H,
Gudbjornsdottir S: Cardiovascular risk factors differ between type 2 diabetic patients
with and without renal impairment. Diabetologia 2010, 53(Suppl 1):1196.
42.
Thorell E, Svärdsudd K, Andersson K, Kristiansson P: Moderate impact of full-term
pregnancy on estimated peak oxygen uptake, physical activity and perceived health.
Acta Obstetricia Et Gynecologica Scandinavica 2010, 89(9):1140-1148.
43.
Vaegter K, Wahlström R, Wedel H, Svärdsudd K: Effect of mailed feedback on drug
prescribing profiles in general practice: a seven-year longitudinal study in Storstrom
County, Denmark. Upsala Journal of Medical Sciences 2010, 115(4):238-244.
44.
Wallman T, Svärdsudd K: Do disability pensioners have a higher mortality rate than
non-pensioners? Adjusting for potential confounding: A commentary on Hult, Stattin,
Janlert and Jarvholm. Social Science & Medicine 2010, 70(10):1487-1488.
45.
Varelogianni G, Oliynyk I, Roomans GM, Johannesson M: The effect of Nacetylcysteine on chloride efflux from airway epithelial cells. Cell Biol Int 2010,
34(3):245-252.
46.
Zethelius B, Gudbjornsdottir S, Eliasson B, Eeg-Olofsson K, Svensson AM, Cederholm
J: Risk prediction of cardiovascular disease in type 2 diabetes - a new risk equation
from the Swedish NDR. Diabetologia 2010, 53(Suppl 1):149.
Publications 2009
47.
Afghahi H, Cederholm J, Eliasson B, Nilsson PM, Eeg-Olofsson K, Gudbjornsdottir S,
Svensson MK: Different sets of risk factors for the development of albuminuria and
renal impairment in type 2 diabetes - the Swedish National Diabetes register (NDR).
Diabetologia 2009, 52(Suppl 1):45.
65
48.
Ambegaonkar B, Pettersson B, Sazonov V, Martinell M, Stålhammar J: Prevalence of
lipid abnormalities before and after introduction of lipid modifying therapy among
Swedish patients with type 2 diabetes and/or coronary heart disease (PRIMULA
Sweden). Diabetologia 2009, 52:1284.
49.
Bardel A, Wallander MA, Wedel H, Svärdsudd K: Age-specific symptom prevalence in
women 35-64 years old: a population-based study. BMC Public Health 2009, 9:37.
50.
Berglund L, Berne C, Svardsudd K, Garmo H, Zethelius B: Early insulin response and
insulin sensitivity are equally important as predictors of glucose tolerance after
correction for measurement errors. Diabetes Research and Clinical Practice 2009,
86(3):219-224.
51.
Björkegren K, Wallander MA, Johansson S, Svärdsudd K: General symptom reporting
in female fibromyalgia patients and referents: a population-based case-referent study.
BMC Public Health 2009, 9:402.
52.
Björklund L, Wallander MA, Johansson S, Lesen E: Aspirin in cardiology--benefits and
risks. Int J Clin Pract 2009, 63(3):468-477.
53.
Bröms K, Norbäck D, Eriksson M, Sundelin C, Svärdsudd K: Effect of degree of
urbanisation on age and sex-specific asthma prevalence in Swedish preschool children.
BMC Public Health 2009, 9.
54.
Byström P, Björkegren K, Larsson A, Johansson L, Berglund Å: Serum vitamin B12
and folate status among patients with chemotherapy treatment for advanced colorectal
cancer Ups J Med Sci 2009, 114(3):160-164.
55.
Cai GH, Broms K, Malarstig B, Zhao ZH, Kim JL, Svardsudd K, Janson C, Norback D:
Quantitative PCR analysis of fungal DNA in Swedish day care centers and comparison
with building characteristics and allergen levels. Indoor Air 2009, 19(5):392-400.
56.
Cederholm J, Nilsson PM, Eliasson B, Eeg-Olofsson K, Zethelius B, Gudbjornsdottir S:
[Connections between risk factors and complications in diabetes. A report after 13 years
with the National Diabetes Registry (NDR)]. Läkartidningen 2009, 106(42):2684-2689.
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Cederholm J, Zethelius B, Nilsson PM, Eeg-Olofsson K, Eliasson B, Gudbjornsdottir S,
Swedish Natl Diabet R: Effect of tight control of HbA1c and blood pressure on
cardiovascular diseases in type 2 diabetes: An observational study from the Swedish
National Diabetes Register (NDR). Diabetes Research and Clinical Practice 2009,
86(1):74-81.
58.
Eeg-Olofsson K, Cederholm J, Nilsson PM, Zethelius B, Nunez L, Gudbjornsdottir S,
Eliasson B: Risk of cardiovascular disease and mortality in overweight and obese
patients with type 2 diabetes: an observational study in 13,087 patients. Diabetologia
2009, 52(1):65-73.
59.
Garcia Rodriguez LA, Wallander MA, Tolosa LB, Johansson S: Chronic obstructive
pulmonary disease in UK primary care: incidence and risk factors. COPD 2009,
6(5):369-379.
60.
Gonzalez EL, Johansson S, Wallander MA, Rodriguez LA: Trends in the prevalence
and incidence of diabetes in the UK: 1996-2005. J Epidemiol Community Health 2009,
63(4):332-336.
61.
Gudbjornsdottir S, Eeg-Olofsson K, Cederholm J, Zethelius B, Eliasson B, Nilsson PM:
Risk factor control in patients with Type 2 diabetes and coronary heart disease: findings
from the Swedish National Diabetes Register (NDR). Diabet Med 2009, 26(1):53-60.
62.
Gulliksson M, Wedel H, Köster M, Svärdsudd K: Hazard function and secular trends in
the risk of recurrent acute myocardial infarction 30 Years of follow-up of more than 775
000 incidents. Circulation-Cardiovascular Quality and Outcomes 2009, 2(3):178-185.
66
63.
Hage C, Malmberg K, Ryden L, Wallander M: The impact of infarct type on the
reliability of early oral glucose tolerance testing in patients with myocardial infarction.
Int J Cardiol 2009.
64.
Holmberg S, Thelin A, Stiernström E-L: Food choices and coronary heart disease: a
population based cohort study of rural Swedish men with 12 years of follow-up. Int J
Environ Res Public Health 2009, 6:2626-2638.
65.
Högman M, Lafih J, Merilainen P, Bröms K, Malinovschi A, Janson C: Extended NO
analysis in a healthy subgroup of a random sample from a Swedish population. Clin
Physiol Funct Imaging 2009, 29(1):18-23.
66.
Jansson C, Nordenstedt H, Wallander MA, Johansson S, Johnsen R, Hveem K,
Lagergren J: A population-based study showing an association between
gastroesophageal reflux disease and sleep problems. Clin Gastroenterol Hepatol 2009,
7(9):960-965.
67.
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among patients with cystic fibrosis and their first-degree relatives. Int J Cancer 2009,
125(12):2953-2956.
68.
Johansson S, Farahmand B, Joelson S, Estborn L, Wallander MA: Risk of upper
gastrintestinal adverse events and the effect of acid-suppressive therapy in patients
receiving acetylsalicylic acid for cardiovascular risk management. Value Health 2009,
12(3):A58-A58.
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Kallings LV, Leijon ME, Kowalski J, Hellénius ML, Ståhle A: Self-reported adherence
- a method for evaluating prescribed physical activity in primary health care patients. J
Phys Act Health 2009, 6:483-492.
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body composition and cardiometabolic risk factors - results from a RCT. Eur J
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Nilsson PM, Cederholm J, Eeg-Olofsson K, Eliasson B, Zethelius B, Fagard R,
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77.
Nilsson PM, Cederholm J, Eeg-Olofsson K, Eliasson B, Zethelius B, Gudbjornsdottir S:
Pulse pressure strongly predicts cardiovascular disease risk in patients with type 2
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35(6):439-446.
67
78.
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new hvent, and Healthcare utilization among stroke patients > 65 years. Stroke 2009,
40(11):3585-3590.
79.
Oliynyk I, Varelogianni G, Schalling M, Asplund MS, Roomans GM, Johannesson M:
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Lung Res 2009, 35(3):210-221.
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83.
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84.
Rodriguez LAG, Ruigomez A, Wallander MA, Johansson S: Acid-suppressive drugs
and community-acquired pneumonia. Epidemiology 2009, 20(6):800-806.
85.
Rodriguez LAG, Wallander MA, Martin-Merino E, Johansson S: Heart failure,
myocardial infarction and lung cancer in patients with chronic obstructive pulmonary
disease. Pharmacoepidemiology and Drug Safety 2009, 18:S49-S50.
86.
Rodriguez LAG, Wallander MA, Tolosa LB, Johansson S: Chronic obstructive
pulmonary disease in UK primary care: incidence and risk factors. COPD - J Chron
Obstr Pulm Dis 2009, 6(5):369-379.
87.
Rosengren A, Eriksson H, Hansson PO, Svärdsudd K, Wilhelmsen L, Johansson S,
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Swedish men aged 50. J Intern Med 2009, 266(3):268-276.
88.
Ruigomez A, Johansson S, Wallander MA, Edvardsson N, Garcia Rodriguez LA: Risk
of cardiovascular and cerebrovascular events after atrial fibrillation diagnosis. Int J
Cardiol 2009, 136(2):186-192.
89.
Ruigomez A, Masso-Gonzalez EL, Johansson S, Wallander MA, Garcia-Rodriguez LA:
Chest pain without established ischaemic heart disease in primary care patients:
associated comorbidities and mortality. Br J Gen Pract 2009, 59(560):e78-86.
90.
Ruigomez A, Wallander MA, Johansson S, Rodriguez LA: Irritable bowel syndrome
and gastroesophageal reflux disease in primary care: is there a link? Dig Dis Sci 2009,
54(5):1079-1086.
91.
Ställberg B, Lisspers K, Hasselgren M, Janson C, Johansson G, Svärdsudd K: Asthma
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Respir J 2009, 18(4):279-286.
92.
Ställberg B, Nokela M, Ehrs PO, Hjemdal P, Jonsson EW: Validation of the clinical
COPD Questionnaire (CCQ) in primary care. Health Qual Life Outcomes 2009, 7:26.
93.
Ställberg B, Selroos O, Vogelmeier C, Andersson E, Ekström T, Larsson K:
Budesonide/formoterol as effective as prednisolone plus formoterol in acute
exacerbations of COPD. A double-blind, randomised, non-inferiority, parallel-group,
multicentre study. Respir Res 2009, 10:11.
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94.
Thelin N, Holmberg S, Nettelbladt P, Thelin A: Mortality and morbidity among
farmers, non-farming rural men and urban referents: a prospective population-based
study. Int J Occup Environ Health 2009, 15:21-28.
95.
Wallman T, Wedel H, Palmer E, Rosengren A, Johansson S, Eriksson H, Svärdsudd K:
Sick-leave track record and other potential predictors of a disability pension. A
population based study of 8,218 men and women followed for 16 years. BMC Public
Health 2009, 9.
96.
Wallman T: Effekter och biverkningar av sjukskrivning: vad åstadkommer vi med
långtidssjukskrivning? In Sjukskrivning på gott och ont. Edited by Svenska
läkaresällskapet; 2009:39-45.
97.
Wang R, Yan X, Ma XQ, Cao Y, Wallander MA, Johansson S, He J: Burden of
gastroesophageal reflux disease in Shanghai, China. Dig Liver Dis 2009, 41(2):110-115.
98.
Wennergren G, Ställberg B, Löfdahl C, Skoogh B, Olsson P, Neij F, Ekström T:
Budesonide/formoterol maintenance and reliever therapy - lower corticosteroid load in
the treatment of asthma in adolescents. Allergy 2009, 64:156.
Publications 2008
99.
Agreus L, Talley NJ, Sheen A, Johansson SE, Jones MP, Svardsudd K: Predictors and
non-predictors of symptom relief in dyspepsia consultations in primary care. Dig Dis
2008, 26(3):248-255.
100.
André M, Vernby A, Odenholt I, Lundborg CS, Axelsson I, Eriksson M, Runehagen A,
Schwan Å, Mölstad S: General practitioners prescribed less antibiotics but used the
CRP test more: diagnosis-prescription studies in 2000-2005. Läkartidningen 2008,
105(41):2851-2854.
101.
André M, Vernby A, Odenholt I, Lundborg CS, Axelsson I, Eriksson M, Runehagen A,
Schwan Å, Mölstad S: Diagnosis-prescribing surveys in 2000, 2002 and 2005 in
Swedish general practice: consultations, diagnosis, diagnostics and treatment choices.
Scand J Infect Dis 2008, 40(8):648-654.
102.
Anselmino M, Mellbin L, Wallander M, Ryden L: Early detection and integrated
management of dysglycemia in cardiovascular disease: a key factor for decreasing the
likelihood of future events. Rev Cardiovasc Med 2008, 9(1):29-38.
103.
Anselmino M, Wallander M, Norhammar A, Mellbin L, Ryden L: Implications of
abnormal glucose metabolism in patients with coronary artery disease. Diab Vasc Dis
Res 2008, 5(4):285-290.
104.
Berglund L, Garmo H, Lindbäck J, Svärdsudd K, Zethelius B: Maximum likelihood
estimation of correction for dilution bias in simple linear regression using replicates
from subjects with extreme first measurements. Statist Med 2008, 27:4397-4407.
105.
Berglund LGT, Berne C, Svärdsudd K, Garmo H, Zethelius B: Relative importance of
early insulin response and insulin sensitivity corrected for measurement errors, on type
2 diabetes and HbA(1c). Cross-sectional and 12 year follow-up studies. Diabetologia
2008, 51:314.
106.
Bogefeldt J, Grunnesjö MI, Svärdsudd K, Blomberg S: Sick leave reductions from a
comprehensive manual therapy programme for low back pain: the Gotland Low Back
Pain Study. Clin Rehabil 2008, 22(6):529-541.
107.
Cai G, Zhao Z, Bröms K, Svärdsudd K, Norbäck D, Kim J: Cat, dog and horse allergens
in allergen avoidance and conventional Swedish daycare centers-associations with
building characteristics. Allergy 2008, 63:232.
69
108.
Cao Y, Yan X, Ma XQ, Wang R, Johansson S, Wallander MA, He J: Validation of a
survey methodology for gastroesophageal reflux disease in China. BMC Gastroenterol
2008, 8:37.
109.
Cederholm J, Eeg-Olofsson K, Eliasson B, Zethelius B, Nilsson PM, Gudbjornsdottir S,
Swedish Natl Diabet R: Risk prediction of cardiovascular disease in Type 2 diabetes.
Diabetes Care 2008, 31(10):2038-2043.
110.
Eeg-Olofsson K, Cederholm J, Nilsson PM, Zethelius B, Gudbjornsdottir S, Eliasson B:
Glycaemic control and cardiovascular complications and death in type 1 diabetes: an
observational study in 17,691 patients. Diabetologia 2008, 51:191.
111.
Eliasson B, Gudbjörnsdottír S, Cederholm J, Liang Y, Vercruysse F, Smith U: Weight
loss and metabolic effects of topiramate in overweight and obese type 2 diabetic
patients: a randomized double-bind placebo-controlled trial. Int J Obes 2008,
31(7):1140-1147.
112.
Eriksson HG, von Celsing AS, Wahlström R, Janson L, Zander V, Wallman T: Sickness
absence and self-reported health a population-based study of 43,600 individuals in
central Sweden. BMC Public Health 2008, 8(Dec 30):426 [on line publication].
113.
Esmaily HM, Savage C, Vahidi R, Amini A, Zarrintan MH, Wahlström R: Identifying
outcome-based indicators and developing a curriculum for a continuing medical
education programme on rational prescribing using a modified Delphi process. BMC
Med Educ 2008, 8:33.
114.
Farahmand B, Brobert G, Yawn B, Wallander MA: Abdominal pain is commonly
associated with other pains in the general population: Olmsted county health study.
Pharmacoepidemiol Drug Saf 2008, 17:189.
115.
Faresjö A, Grodzinsky E, Johansson S, Wallander MA, Faresjö T, Timpka T: Selfreported use of pharmaceuticals among patients with irritable bowel syndrome in
primary care. J Manag Care Pharm 2008, 14(9):870-877.
116.
Garcia Rodriguez LA, Ruigomez A, Martin-Merino E, Johansson S, Wallander MA:
Relationship between gastroesophageal reflux disease and COPD in UK primary care.
Chest 2008, 134(6):1223-1230.
117.
García Rodríguez LA, Tolosa LB, Ruigómez A, Johansson S, Wallander MA:
Rheumatoid arthritis in UK primary care: incidence and prior morbidity. Scand J
Rheumatol 2008(Dec 31):1-5.
118.
Garcia-Rodriguez LA, Gonzalez-Perez A, Stang MR, Wallander MA, Johansson S: The
safety of rosuvastatin in comparison with other statins in over 25,000 statin users in the
Saskatchewan Health Databases. Pharmacoepidemiol Drug Saf 2008, 17(10):953-961.
119.
Garcia-Rodriguez LA, Masso-Gonzalez EL, Wallander MA, Johansson S: The safety of
rosuvastatin in comparison with other statins in over 100,000 statin users in UK primary
care. Pharmacoepidemiol Drug Saf 2008, 17(10):943-952.
120.
Gonzalez ELM, Johansson S, Wallander MA, Garcia-Rodriguez LA: Diabetes in the
UK: trends in the prevalence, incidence and treatment 1996-2005. Diabetologia 2008,
51:433.
121.
Huerta C, Johansson S, Wallander MA, Rodriguez LA: Risk of myocardial infarction
and overall mortality in survivors of venous thromboembolism. Thromb J 2008, 6:10.
122.
Jansson C, Nordenstedt H, Wallander MA, Johansson S, Johnsen R, Hveem K,
Lagergren J: Severe symptoms of gastro-oesophageal reflux disease are associated with
cardiovascular disease and other gastrointestinal symptoms, but not diabetes: a
population-based study. Aliment Pharmacol Ther 2008, 27(1):58-65.
70
123.
Kallings LV, Leijon M, Hellénius ML, Ståhle A: Physical activity on prescription in
primary health care: a follow-up of physical activity level and quality of life. Scand J
Med Sci Sports 2008, 18:154-161.
124.
Kull I, Johansson GS, Lisspers K, Jagorstrand B, Romberg K, Tilling B, Stallberg B:
[Efficient care in asthma/COPD primary health care clinics]. Läkartidningen 2008,
105(42):2937-2940.
125.
Nilsson PM, Cederholm J, Eliasson B, Eeg-Olofsson K, Zethelius B, Gudbjornsdottir S,
Swedish Natl Diabet R: Successful long-term blood pressure control and lower
incidence of cardiovascular disease: A report from the Swedish National Diabetes
Register (NDR). J Hypertens 2008, 26:S202-S202.
126.
Norrmén G, Svärdsudd K, Andersson DK: How primary health care physicians make
sick listing decisions: the impact of medical factors and functioning. BMC Fam Pract
2008, 9:3.
127.
Ringborg A, Lindgren P, Martinell M, Yin DD, Schön S, Stålhammar J: Prevalence and
incidence of type 2 diabetes and its complications 1996-2003: estimates from a Swedish
population-based study. Diabet Med 2008, 25(10):1178-1186.
128.
Ringborg A, Martinell M, Stålhammar J, Yin DD, Lindgren P: Resource use and costs
of type 2 diabetes in Sweden: estimates from population-based register data. Int J Clin
Pract 2008, 62(5):708-716.
129.
Rodhe N, Englund L, Mölstad S, Samuelsson E: Bacteriuria is associated with urge
urinary incontinence in older women. Scand J Prim Health Care 2008, 26(1):35-39.
130.
Rodhe N, Löfgren S, Matussek A, André M, Englund L, Kuhn I, Mölstad S:
Asymptomatic bacteriuria in elderly: high prevalence and high turnover of strains.
Scand J Infect Dis 2008, 40(10):804-810.
131.
Ruigomez A, Rodriguez LA, Wallander MA, Johansson S, Dent J: Endoscopic findings
in a cohort of newly diagnosed gastroesophageal reflux disease patients registered in a
UK primary care database. Dis Esophagus 2008, 21(3):251-256.
132.
Ruigómez A, Wallander MA, Johansson S, Rodríguez LA: Irritable bowel syndrome
and gastroesophageal reflux disease in primary care: is there a link. Dig Dis Sci
2008(Aug 22).
133.
Ruigomez A, Wallander MA, Lundborg P, Johansson S, Garcia-Rodriguez L:
Gastroesophageal reflux disease in children and adolescents in primary care: Incidence,
prevalence and treatment patterns. Gastroenterology 2008, 134(4):A593-A593.
134.
Ställberg B, Ekström T, Neij F, Olsson P, Skoogh BE, Wennergren G, Löfdahl CG: A
real-life cost-effectiveness evaluation of budesonide/formoterol maintenance and
reliever therapy in asthma. Respir Med 2008, 102(10):1360-1370.
135.
Ställberg B, Löfdahl C, Skoogh B, Wennergren G, Olsson P, Neij F, Joensson B,
Ekström T: Symbicort SMART - Effective treatment at a lower cost. J Allergy Clin
Immunol 2008, 121(2):S154-S154.
136.
Swartling M, Wahlström R: Isolated specialist or system integrated physician - different
views on sickness certification among orthopaedic surgeons: an interview study. BMC
Health Serv Res 2008, 8(1):273.
137.
Swartling MS, Alexanderson KA, Wahlström RA: Barriers to good sickness
certification: an interview study with Swedish general practitioners. Scand J Public
Health 2008, 36(4):408-414.
138.
Svedberg P, Johansson S, Wallander MA, Pedersen NL: No evidence of sex differences
in heritability of irritable bowel syndrome in Swedish twins. Twin Res Hum Genet
2008, 11(2):197-203.
71
139.
Thelin A, Holmberg S, Thelin N: Functioning in neck and low back pain from a 12-year
perspective: a prospective population-based study. J Rehabil Med 2008, 40:555-561.
140.
Thom J, Samuelsson E, Wändell P, Håkansson A, Svärdsudd K, Borgquist L,
Björkelund C: [The situation for Swedish general practice research. An inventory of
bigger research projects and financing of these]. Läkartidningen 2008, 105(40):27782780.
141.
Tilling B, Jagorstrand B, Johansson G, Kull I, Lisspers K, Romberg B, Ställberg B:
Astma/KOL-mottagning i primärvåd - nya kriterier. AllmänMedicin 2008, 5:9-13.
142.
Wahlqvist P, Brook RA, Campbell SM, Wallander MA, Alexander AM, Smeeding JE,
Kleinman NL: Objective measurement of work absence and on-the-job productivity: a
case-control study of US employees with and without gastroesophageal reflux disease. J
Occup Environ Med 2008, 50(1):25-31.
143.
Wahlqvist P, Karlsson M, Johnson D, Carlsson J, Bolge SC, Wallander MA:
Relationship between symptom load of gastro-oesophageal reflux disease and healthrelated quality of life, work productivity, resource utilization and concomitant diseases:
survey of a US cohort. Aliment Pharmacol Ther 2008, 27(10):960-970.
144.
Welin L, Adlerberth A, Caidahl K, Eriksson H, Hansson PO, Johansson S, Rosengren
A, Svärdsudd K, Welin K, Wilhelmsen L: Prevalence of cardiovascular risk factors and
the metabolic syndrome in middle-aged men and women in Gothenburg, Sweden. BMC
Public Health 2008, 8:403.
145.
Wilhelmsen L, Welin L, Svärdsudd K, Wedel H, Eriksson H, Hansson PO, Rosengren
A: Secular changes in cardiovascular risk factors and attack rate of myocardial
infarction among men aged 50 in Gothenburg, Sweden. Accurate prediction using risk
models. J Intern Med 2008(Feb 20).
146.
Zagari RM, Fuccio L, Wallander MA, Johansson S, Fiocca R, Casanova S, Farahmand
BY, Winchester CC, Roda E, Bazzoli F: Gastro-oesophageal reflux symptoms,
oesophagitis and Barrett's oesophagus in the general population: the LoianoMonghidoro study. Gut 2008, 57(10):1354-1359.
147.
Zethelius B, Cederholm J, Eliasson B, Eeg-Olofsson K, Nilsson PM, Gudbjornsdottir S:
Cardiovascular disease risk in type 2 diabetes patients, non-obese that meet and obese
who do not meet goals for glucose and blood pressure control. A Swedish National
Diabetes Registry report. Diabetologia 2008, 51:412.
148.
Ålander T, Heimer G, Svärdsudd K, Agréus L: Abuse in women and men with and
without functional gastrointestinal disorders. Dig Dis Sci 2008, 53(7):1856-1864
149.
Ålander T, Svärdsudd K, Agréus L: Functional gastrointestinal disorder is associated
with increased non-gastrointestinal healthcare consumption in the general population.
Int J Clin Pract 2008, 62:234-240.
Dissertations 2008-2010:
Bröms K. A nationwide study of asthma and allergy in Swedish preschool children: with special
reference to environment, daycare, prevalence, co-ocurrence and incidence. Medical sciences.
Uppsala University, 2010.
Halford C. Self-rated health with special reference to prevalence, determinants and
consequences. Medical sciences. Uppsala University, 2010.
72
Norrmén G. To be or not to be sick-certified: with special reference to physicians and patient
related factors. Medical sciences. Uppsala University, 2010.
Olai L. Life after a stroke event: with special reference to aspects on prognosis, health and
municipality care utilization, and life satisfaction among patients and their informal caregivers.
Medical sciences. Uppsala University, 2010.
Bogefeldt J. Low back pain: with special reference to prevalence, diagnosis, treatment and
prognosis. Medical sciences. Uppsala University, 2009.
Gulliksson M. Studies of secondary prevention after coronary heart disease with special
reference to determinants of recurrent event rate. Medical sciences. Uppsala University, 2009.
Lisspers K. Organisation of asthma in primary care, quality of life and sex-related aspects in
asthma outcomes. Medical sciences. Uppsala University, 2008.
Rodhe N. Asymptomatic bacteriuria in elderly. Medical sciences. Uppsala University, 2008.
Ställberg B. Asthma in primary care: severity, treatment and level of control. Medical sciences.
Uppsala University, 2008.
Swartling M. Physician sickness certification practice: focusing on views and barriers among
general practitioners and orthopaedic surgeons. Medical sciences. Uppsala University, 2008.
Wallman T. Disability pension with special reference to sick leave track record, health effects,
health care utilisation and survival: a population-based study. Medical sciences. Uppsala
University, 2008.
Ålander T. Functional gastrointestinal disorders: co-morbidity and non-somatic aspects.
Medical sciences. Karolinska Institute and Uppsala University, 2008.
Agencies that support our work / Funding 2010 (SEK):
Swedish Asthma and Allergy Association
The Vårdal Foundation –
for Health Care Sciences and Allergy Research
Hjerpstedts stiftelse
Dalarna County Council
Gävleborg County Council
Stockholm County Council
Södermanland County Council
Uppsala University and Uppsala County Council
Västernorrland County Council
Örebro County Council
73
196.000
150.000
40.000
1.300.000
400.000
800.000
1.500.000
2.160.000
200.000
1.000.000
Social Insurance Medicine
Lars Englund, Gunilla Norrmén, Kurt Svärdsudd, Malin Swartling, Rolf Wahlström and Thorne
Wallman
Regional social insurance research group in the Uppsala-Örebro region (I:1)
RUFS is the Swedish acronym for the regional social insurance research group in the Uppsala
Örebro Region in Sweden. This research group consists of senior researchers and PhD students
from the primary health care county councils of Dalarna, Sörmland, Västmanland, Örebro and
Uppsala. It was established in May 2010 and has already had two full-day meetings at which
regional social insurance research was presented and discussed. This year the groups work was
financed by the Uppsala-Örebro regional research council. The group was invited to arrange a
seminar for the family medicine section at The Swedish Society of Medicine meeting in
Gothenburg in December 2010.
Life and Health Sörmland (I:2)
FmG Sörmland is a local research group in the county of Sörmland, working with the regional
study Liv & Hälsa (Life and Health), which contains data on 43,600 women and men 18-84
years of age. One article has been published [1] and another has been submitted for publication
[2].
The natural history of disability pension – risk factors, track record and health consequences
(I:3)
A consortium including the research group for cardiovascular epidemiology at the Sahlgrenska
Academy, Gothenburg, the Swedish Social Insurance Agency and our unit of Family Medicine
and Clinical Epidemiology was created to perform a project aiming at analysing the course of
events leading to disability pension (track record), to find factors which, in addition to the
underlying disease, affect the course of events, and to determine the consequences in terms of
health situation, quality of life, continued health care utilisation and survival as compared with
the corresponding general population.
The study population was created using data from five ongoing population studies with
approximately 7,000 men and women who have been followed since 1980-1993 and onwards.
Thorne Wallman, who completed his PhD in 2008 [3], is working with the study, which is
financially supported by the Swedish Social Insurance Agency, the Medical Research Council,
Sörmland county council, Västra Götaland county council and Uppsala University.
The first report shows that health care utilisation continued to be 3-4 times higher among
disability pensioners than among the corresponding general population even 13 years after
retirement. The health care diagnoses had no relation to the retirement diagnoses [4]. Retirement
thus had no obvious curative effect, as has been claimed previously.
In the second report, survival after disability retirement was presented as compared to the
corresponding general population. Male pensioners had a more than threefold and female
pensioners an approximately 2.5-fold increased mortality rate, even when the influences of age,
education, smoking habits, family structure, reason for retirement and health care diagnoses
after retirement (underlying disease) were taken into account. The increased mortality rate is
thus non-specific, i.e., not related to the underlying disease and could be attributable to factors
relating to the retirement process per se [5].
In a third report, the track record measured as duration of sick-listing periods before retirement
was analysed and compared with that of the corresponding general population. The sick leave
track record was the most important predictor of the probability of being granted a disability
pension in this study, even when the influences of other variables affecting the outcome were
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taken into account [6].
In the fourth report, the quality of life before and after retirement was analysed. Quality of life
has been measured on several occasions and in various points in time in relation to retirement.
Time-dependent analysis was used in order to disclose a possible relationship to retirement [7].
To be or not to be sick-listed (I:4)
This project is based on approximately 600 appointments in Örebro primary health care, where
sickness certification was a possible option. The physician and the patient each gave their view
of what factors were of importance for the outcome, i.e., to be or not to be sick-listed. In the first
report, physician-related factors were analysed. A long professional career, part-time work and
training in social insurance medicine all increased the probability of the patient being sick-listed
[8]. In the second report, patient-related medical factors and functioning were analysed [9]. The
strongest predictors for sick-listing were the patient’s and GP’s assessment of the patient’s
reduced work capacity, with a striking concordance between physician and patient on this
assessment. Patient complaints judged by the physician to be non-somatic increased the
probability of the patient being sick-listed. In the third report, the patient’s family, leisure time,
and work situation were analysed [10]. Work-related factors, indicating support in work and
influence over the work situation reduced the probability of sick-listing, while worrying about
becoming ill or injured at work almost doubled the probability of sick-listing. Family and
leisure time variables had little impact on the probability of being sick-listed. The fourth report,
analysed attitudes towards statements concerning health and social insurance matters among
physicians and patients in relation to the probability of the patient being sick-listed. GPs and
their patients had fairly similar views on the statements. Attitudes expressed by the GPs seem to
have a greater impact than patients’ attitudes on the GP’s decision of whether or not to sick-list
a patient [11]. The project has generated one PhD thesis (Gunilla Normén 2010) [12].
Early prediction of patients at risk for long-term sickness absence (I:5)
This work is based on a project carried out during eight months in 2004 at a primary health care
centre in Eskilstuna, Sweden. The overall purpose was early rehabilitation of sick-listed
individuals, considered to beat risk of long-term sickness absence, in cooperation with the
Swedish Social Insurance Agency, jobseekers agency and the county council for social support,
in order to regain work ability. The early prediction of patients at risk of long term sickness
absence is essential for identification of individuals in need of rehabilitation measures. A team
of experienced rehabilitation professionals, one physiotherapist, one physician and one
administrator from the local social insurance agency categorised all sick-listed individuals into
two groups considering risk factors for long-term sickness absence. The rehabilitation team used
a few variables from the sickness certificate form when categorising all sick-listed individuals
into two groups, group 1 (n=447) at risk for long-term sickness absence and group 2 (n=496)
without risk factors. Variables at baseline were age, sex, sick leave diagnosis, extent of sick
leave percentage, employment status, and periods of sick leave one year before baseline. In this
three-year prospective cohort study, data was obtained from the Swedish Social Insurance
Agency on all compensated days of sick leave and disability pension from 1 January 2003 until
31 December 2007. The aim of the study is to reveal whether risk of long-term sickness absence
can be predicted on the basis of just a few variables from the sickness certificate [13].
We will also evaluate possible effects of the rehabilitation intervention in cooperation with
primary health care and the Swedish Social Insurance Agency, jobseekers agency and the
county council for social support. Do sick listed individuals regain work ability after an
intervention to a greater extent than those who did not receive any intervention at all? The
project is generating one PhD thesis (Anna-Sophia von Celsing).
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Nurses’ experience of managing sick-listing issues in telephone advisory services (I:6)
The aim of this project is to produce of a report performed in collaboration between our research
group and the School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna.
The result of a previous Master’s degree thesis has been further analyzed, focusing on sicklisting management. Nurses working with telephone advisory services were interviewed in
groups. The aim was to explore how sick-listing issues are present in their phone calls, how the
nurses manage these issues and at factors obstruct and facilitate this work. This project is part of
a future doctoral thesis aimed at describing experiences of long-term sickness absence and
identifying preventive and predictive factors of return to work after sick-listing. One PhD
student, Linda Lännerström, is involved.
Factors among doctors, patients and patients’ families affecting the risk of long-term sick
leave periods and effects of early multidisciplinary assessment in primary health care (I:7)
“RUMPVALS” – is an acronym for “Randomized study of early multidisciplinary assessment
in a primary care centre to prevent long-term sick leave” in Swedish. Patients who saw doctors
for psychiatric or musculoskeletal problems and were sick-listed were invited to participate in
the study. After randomization half of the participants were assessed by a physiotherapist,
psychotherapist and occupational therapist. The other half received “reguar care”, which does
not include such early assessments. Our hypothesis was that such assessments would result in
faster and more adequate rehabilitation leading to faster recover and less need of sick leave. A
manuscript is in progress. In upcoming studies, factors among doctors and patients’ families
affecting sick leave will be studied. The project is generating one PhD thesis (Lars Carlsson).
Physicians’ views of the sick-listing commission (I:8)
This project is being carried out in collaboration between our research group, the rehabilitation
section of the Department of Neuroscience, Uppsala University, and the social insurance centre
at the Department of Clinical Neuroscience, Karolinska Institute. It is focused on obtaining
information concerning physicians’ views of patients’ wishes to be sick-listed and the
physician’s duty to the social insurance system, as a gatekeeper in society. Deep interviews and
postal questionnaires were used. Two groups of physicians, general practitioners and
orthopaedic surgeons, were approached [14-17]. The project was led by Rolf Wahlström, has
generated one PhD thesis (Malin Swartling 2008 [18]) and has received financial supported
from the Swedish Social Insurance Agency and Uppsala University.
Musculo-skeletal disorders
Karin Björkegren, Stefan Blomberg, Johan Bogefeldt, Kurt Svärdsudd and Mari-Ann Wallander
The Säter and Gotland studies (II:1)
These projects are based on two randomised controlled clinical trials of manual therapy
(orthopaedic medicine therapy) versus traditional treatment (traditional physiotherapy and the
patient’s own physical activities) with the aim of assessing whether manual therapy affects the
pain level, use of analgesic drugs and return to work more than traditional physiotherapy. The
two trials had somewhat different designs. In the Säter study the manual therapy was performed
by one therapist and primary health care personnel performed the control treatment. In the
Gotland study general practitioners trained in manual therapy performed the manual therapy and
orthopaedic surgeons the control treatment. In both studies, patients who received manual
therapy had a faster return to work and less sick-listing, and used less analgesics [19, 20].
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In the Gotland study pain drawings were tested for their clinical value as predictors of pain
course [21] and the nomenclature used by different categories of physicians for the same pain
condition were described [22, 23]. The project has generated two PhD theses (Stefan Blomberg
1993 [19] and Johan Bogefeldt 2009 [24]) and another one is in progress (Marie Grunnesjö).
The projects are receiving financial support from Stockholm stay-active clinic, the province of
Gotland, and Uppsala University.
Prevalence and consequences of low back pain (II:2)
This project is based on data from a large number of ongoing population studies in Gothenburg,
Eskilstuna, and Uppsala with a total of 14,000 observations and an age range of 25-99 years in
both sexes and data collected during the time period 1980-1993. Some of the instruments used
in the population studies were identical and will be used in the project. The aims are to analyse
the prevalence of low back pain by sex and age, adjusted for a large number of possible other
outcome-affecting variables, to analyse possible secular trends (cohort effects) related to
increasing or decreasing back pain reporting over time, and to analyse the consequences of low
back pain in terms of well-being, sick leave, health care utilisation, disability pension, and
survival [25, 26]. The project has generated one PhD thesis (Johan Bogefeldt 2009 [24]) and is
being carried out in cooperation with the research group for cardiovascular epidemiology at the
Sahlgrenska Academy, Gothenburg, the Swedish Social Insurance Agency, and the National
Board of Health and Welfare.
Epicondylosis (II:3)
Tennis elbow (epicondylitis) is a common pain condition that heals spontaneously within three
months in 90% of cases. In the remaining 10% the condition becomes “chronic” or persistent
and the diagnosis changed to epicondylosis. This project has three main purposes to map
treatment methods currently used in primary health care, to test a new treatment method, and to
shed some light on the pathophysiology of the condition.
The first purpose was fulfilled in a postal questionnaire study involving general practitioners
and physiotherapists, which showed that a large number of methods were used, some of which
were not tested for efficacy, and even some that had been shown to be ineffective [27]. The
second purpose was fulfilled in a double randomised controlled clinical trial in which the effect
of exercise versus wait-and-see was first tested, and then the effect of two treatment methods
(eccentric and concentric exercise) were compared. The study involved more than 200 patients
in a multicentre setting in Uppsala and Linköping. A publication on exercise versus wait-andsee has been submitted [28]. A manuscript on eccentric versus concentric exercise is in progress
[29].
The third part of the project is a study of the pathophysiology of eoicondylosis by analysis of
tissue biopsies from healthy and affected elbows in cooperation with Kings College, London.
The pathophysiology is also being studied with positron emission tomography (PET) of the
healthy and the affected elbows in cooperation with Uppsala Imanet. The PET scan data are
almost completely analysed and a report is in progress. The project is generating one PhD thesis
(Magnus Peterson) and is receiving financial support from the Medical Research Council, the
Amershan Fund, the General Medicine Fund and Uppsala University.
Cognitive behavioural therapy in fibromyalgia (II:4)
This project, which is being performed in collaboration with the sections of social medicine and
caring sciences at our department and the section for biological research on drug dependence at
Uppsala University, is a randomised controlled trial of cognitive behavioural therapy (CBT) in
fibromyalgia, the purpose of which is to assess the effects of CBT on this condition. Fifty
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women with a fibromyalgia diagnosis in Northern Uppland were randomised to one of two
groups. One group received CBT for one year with the other group as control. After one year
the control group also received CBT. A large number of variables have been collected through
questionnaires and blood samples. The data are now being analysed. The project is generating
one PhD thesis (Bo Karlsson) and is receiving financial support from Uppsala University.
Subcutaneous injections of sterile water or saline solution in fibromyalgia tenderpoints (II:5)
A number of therapies have previously been tried with doubtful or only short-term effects in
fibromyalgia. However, subcutaneous injections of small amounts of sterile water have been
shown to decrease pain in other pain conditions with variable effect duration. There are two
prevalent hypotheses of the origin of the fibromyalgia pain syndrome, and both predict
influence on the nociceptor (causing the tenderpoint) of, for instance, substances with osmotic
effects or mechanical irritation. In two pilot studies we showed that injections of sterile water
were more effective than those of saline solution. In collaboration with the clinical chemistry
and immunology laboratories at Uppsala University Hospital and the section for biological
research on drug dependence at Uppsala University we are now performimg a full-scale
randomised controlled clinical trial of subcutaneous injections of sterile water versus saline
solution in 60 women, half randomised to water and the other half to saline solution. Blood
samples have also been taken for neuropeptide measurements. The project is receiving
financially support from the Medical Research Council and Uppsala University.
The VIP study (II:6)
VIP is the Swedish acronym for well-being in the population – a population-based study. This
project is a postal questionnaire-based case referent study of 150 women in Uppsala County
diagnosed with fibromyalgia (cases) and 750 matched reference individuals from the general
population. The purpose of the study is to compare cases and referents regarding psycho-socioeconomic status, symptom reporting, and prevalence of functional gastrointestinal problems.
This is one the first controlled studies in the world of symptom reporting among fibromyalgia
patients that has shown that a considerable proportion of the fibromyalgia patients report not
only traditional fibromyalgia symptoms but also high frequencies of other symptoms. A first
report has been published [30].
Asthma, allergy and COPD
Kristina Bröms, Gunnar Johansson, Karin Lisspers, Björn Ställberg and Kurt Svärdsudd
A national study of the health of children at allergy avoidance and conventional day care
centres in Sweden (III:1)
This project is a national study of the health of preschool children regarding asthma and various
allergies, and of their home and school environments. The main purpose is to assess whether
special allergy avoidance day care centres improves the situation for allergic children. All such
existing day care centres in the country were identified and for each such centre two ordinary
day care centres in the vicinity were chosen as controls, giving a total of 593 day care centre
sections. All these sections received a postal questionnaire regarding the physical environment
of the school, cleaning routines, rules regarding personnel and parents smoking and pets at
home. A first report showed considerably less allergogenic environments at the allergy
avoidance centres than in the control centres [31]. Later a postal questionnaire about the
children’s health situation and home environment was sent to the parents of the 8,700 children
at the allergy avoidance and control centres. All children who had signs of asthma in the
returned questionnaires received a symptom diary to be filled out for two weeks in order to get a
better measure of asthma severity than was possible from the questionnaire. In early 2007 a
follow-up questionnaire similar to the first one was sent out to the parents.
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The first results from the questionnaire are focused on providing reliable age and sex-specific
prevalence. There are several earlier studies but they are either regional, local or small. We have
computed one-year age class prevalence for boys and girls using five diagnostic criteria. Using
physician-based criteria there are large regional prevalence differences, whereas physicianneutral criteria show no regional differences. Moreover, in an analysis of geographical asthma
prevalence gradients, the strongest geographic/demographic variable was population density, as
a proxy for degree of urbanisation [32]. In a third report the “atopic march” hypothesis was
tested, i.e., that allergic children develop one atopic manifestation after another. A manuscript
has been submitted [33]. A fourth publication is underway in which the asthma incidence is
estimated [34]. The project has generated one PhD thesis (Kristina Bröms 2010 [35]) and is
receiving financial support from Vårdalstiftelsen, the Asthma and Allergy Patient Foundation,
Uppsala University, and a number of smaller funds.
The AIM study (III:2)
AIM is the Swedish acronym for “Asthma in Mid-Sweden”. In this project asthma management
and treatment in adults at primary health care centres in the Uppsala-Örebro health care region
was investigated. The purpose was both to assess asthma control and quality of life in patients
with asthma and to assess the proportion of centres with special asthma clinics [36].
A random sample of approximately 1,100 patients from the 42 randomly selected centres was
drawn and patients were sent a questionnaire regarding their socio-economic background,
asthma symptoms, treatment and quality of life. The first report from the AIM study described
the organisation of asthma care in primary care [36].
Another report demonstrated that Swedish adolescents with asthma were managed and treated
somewhat differently in paediatric and primary care but with equal and, for the most part,
satisfactory results [37]. A third report has been published showing a strong association between
perceived quality of life and the asthma disease control [38].
A fourth report demonstrated that female sex, age, pollen and pet allergy, not having the asthma
prescription filled owing to cost, and daily smoking were all independently associated with
asthma severity [39].
A fifth report from the AIM study has demonstrated that having an asthma clinic at a primary
health care centre improves asthma patients’ knowledge of the disease, and better asthma
control is achieved if the nurse is allocated more time [40].
The project was led by Gunnar Johansson, has generated three PhD theses (Mikael Hasselgren
2006 [41], Karin Lisspers and Björn Ställberg in 2008 [42, 43]) and has received financial
support from the county councils of the Uppsala-Örebro Region, and Uppsala University.
The ALMA study (III:3)
The ALMA project ("Att Leva Med Astma" living with asthma) is a national study of the
limitations of living with asthma. The project was performed by a national project group as a
telephone interview study in a random sample of 10,350 men and women nationwide, of whom
240 were later the subjects of an in-depth interview. A postal questionnaire was also sent to a
random sample of general practitioners. It was found that asthma patients generally had more
symptoms than their general practitioners were aware of [44]. Björn Ställberg was leader of the
project which has now been concluded.
Asthma during childhood and adolescence (III:4)
This project is based on a series of measurements in 150 school children in a small municipality.
The purpose was to evaluate the course of asthma with onset in childhood. The six year followup study demonstrated that many adolescents with current asthma do not achieve asthma
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control. One reason might be undertreatment with inhaled corticosteroids. This study was part
of Björn Ställberg’s dissertation; he is the project leader [45]. The project was supported by
Sörmland’s county council.
The Praxis-study asthma/COPD (III:5)
The aim of the Praxis-study is to compare asthma and COPD guidelines with the actual care. A
postal survey in 2005 was answered by 1,210 randomly selected patients with asthma and 1,113
with COPD from 56 randomly selected primary health care centres and outpatient clinics at 14
hospitals in the Uppsala-Örebro health care region. The records of these patients have also been
examined. Two reports have been published, the first about asthma control, which concluded
that in spite of treatment guidelines many patients in Swedish primary care still have
insufficient asthma control [46]. The second evaluated how often a diagnosis of COPD was
confirmed with spirometry [47]. A third report about sex-related differences in asthma was part
of Karin Lisspers’ dissertation [42]. A fourth report regarding co-morbidity in COPD-patients
has been submitted [48].
A follow-up investigation is planned for 2011. The project is being led by Karin Lisspers, Björn
Ställberg and Christer Jansson (Professor at the Department of Medical Sciences: Respiratory
Medicine & Allergology, Uppsala University). The project is generating one PhD thesis (Josefin
Sund, Department of Respiratory Medicine, Örebro University Hospital), and is receiving
financial support from the county councils of the Uppsala-Örebro Region, the Swedish Heart
and Lung Association, the Swedish Asthma and Allergy Association, the Bror Hjerpstedt
Foundation, Uppsala, and Uppsala University.
International research collaboration in asthma and COPD in primary care (III:6)
Karin Lisspers and Björn Ställberg are involved in international collaboration aimed at
highlighting unanswered questions on the management of respiratory diseases of importance in
primary care. This has resulted in a published Research Needs Statement from the International
Primary Care Respiratory Group (IPCRG) [49].
They are also involved in an international research project comparing the management of COPD
in primary care in different countries, the UNLOCK study [50].
The physicians’ actions in the management of COPD (III:7)
Björn Ställberg is involved in research collaboration with the Center for Family and Community
Medicine (CEFAM), at the Karolinska Institute. The aim of this project
is to study how quality of care for patients in primary care with COPD can be improved by
better understanding of the prevalence, indicators, and physicians’ actions. The project is
generating one PhD thesis (Hanna Sandelowsky, Karolinska Institutet, Stockholm).
Validation study (III:8)
Björn Ställberg, in collaboration with researchers at the Karolinska Institute, has published a
validation study of the Clinical COPD Questionnaire (CCQ) in primary care [51].
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Clinical trials (III:9)
Björn Ställberg has been involved as coordinator in two clinical trials in asthma and COPD
respectively [52, 53].
Björn Ställberg is a member in the steering committee for a study about treatment of rhinosinuites, the SOSAR-study.
Karin Lisspers is a member of the steering committee for a study regarding screening for
COPD, the DETECT-study [54].
The NO-KOL study (III:10)
This study was performed at one single centre, Nyby health care centre. 40 patients with chronic
obstructive pulmonary disease (COPD) were randomized to double-blind crossover treatment
with a inhaled steroid (mometasone). The purpose of the study was to evaluate the effects of the
treatment on exhaled nitric oxide (NO). The level of exhaled NO has been demonstrated to be a
good predictor of response to inhaled corticosteroids in asthma. The role of exhaled NO in
COPD has been less studied.
The treatment with inhaled mometasone significantly reduced the NO as compared with
placebo. The expiratory flows measured with spirometry (FEF75, FEF50 and FEF25) were
significantly improved by the steroid treatment as compared with placebo. The baseline value
for NO did not predict a positive response in terms of improvements in expiratory flows.
Instead, the major reduction in NO after active treatment was related to significant
improvements in expiratory flows. A study has been submitted for publication [55]. The project
is being led by Gunnar Johansson and Kjell Alving and is receiving financial support from
Schering-Plough.
Treatment of asthma in primary health care using exhaled nitric oxide analysis (III:11)
A total of 187 patients with asthma at 17 primary health care centres have been included in a
study. The aim is to examine whether use of exhaled nitric oxide (NO) to guide antiinflammatory treatment can improve asthma-related quality of life in adult patients with allergic
asthma. The data have been collected and are being processed. The same study is examining
whether there is an association between different circulating cytokines (systemic inflammation),
exhaled NO and quality of life. The project is being led by Kjell Alving, Jörgen Syk and Gunnar
Johansson and is receiving financial support from Karolinska Institutet.
A retrospective epidemiological study to map outpatients with chronic obstructive pulmonary
disease (COPD) and describe COPD health care in real-life primary care during the first ten
years of the 21st century – PATHOS (III:12)
This is a retrospective epidemiological study to map outpatients with COPD and describe
COPD health care in real-life primary care during the first ten years of the 21st century. Data
will be extracted anonymously from electronic patient records in primary care. By extraction of
data from 80 primary health care centres it is estimated that we willobtain data on
approximately 20,000 to 25,000 patients. In addition, data regarding morbidity and mortality
will be collected from the Hospital Discharge Register (Slutenvårdsregistret) and the Cause of
Death Register and information on prescribed drugs will be collected from the Prescription
Register. Data on social-economic status will also be collected from Statistics Sweden (SCB).
The merging of data will be performed by the National Board of Health and Welfare. The
software program Pygargus Customized eXtraction Program (CXP) will be used to extract
patient data from the electronic patient records of the participating primary care centres for all
patients with a diagnosis of COPD (ICD 10: J44) and/or prescription of drugs in the ATC class
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R03 (pharmaceuticals for obstructive lung diseases). The social security number of identified
patients will immediately be replaced with a study ID-number for further anonymous processing
of data. No identification of patients will be possible once the database is finalized. Collected
data are being processed. The project is being led by Gunnar Johansson and is receiving
financial support from AstraZeneca. The data management will be performed by Pygargus and
Uppsala clinical research centre.
Investigations on arteriosclerosis status in patients with chronic obstructive pulmonary
disease (COPD) (III:13)
Patients with COPD often have cardiovascular diseases with a progression associated with
advanced lung disease. At one primary care centre patients with COPD will be investigated with
different methods regarding cardiovascular diseases and the results will be correlated to their
lung function. Principal investigators are Sousan Elliin, Mansour Alemi and Gunnar Johansson
and the study has been financially supported by the primary care.
Utilisations of pharmaceuticals
Annika Bardel, Kurt Svärdsudd and Mari-Ann Wallander
Women’s utilisation of pharmaceuticals (IV:1)
This project is based on a postal questionnaire sent to a random sample of 4,200 women in the
Uppsala-Örebro region, 35-64 years old. The purpose of the project is to study utilisation of
pharmaceuticals among women. In a first report the pharmaceutical panorama and the diseases
for which the drugs were prescribed was presented [56]. In a second report the use of hormone
replacement therapy at menopaus and symptoms reported by users and non-users was presented
[57]. In a third report adherence to the prescribed drug and its determinants were presented [58].
Adherence increased with age, if a new appointment was scheduled and if the disease was
serious or the drug necessary, while adherence decreased if the respondent had negative feelings
about the safety of the drug. A fourth report shows the symptom prevalence across age and use
of pharmaceuticals [59]. Symptom reporting is now being tested in the consort dataset (see
above under natural history of disability pension) including more than 17,000 observations in
men and women 25-99 years old. Later we intend to examine the relationship between symptom
reporting among men and women and their sick-listing, disability pension, survival and use of
hospital health care. The project is being led by Mari-Ann Wallander and Annika Bardel, has
generated one PhD thesis (Annika Bardel 2007 [60]), and is receiving financial support by
Vårdalstiftelsen, Sörmland county R&D and Uppsala University.
Rational drug prescribing (IV:2)
This project is based on the registration of prescribed pharmaceuticals in the county of
Storstrøm in southern Denmark. Ninety-four practices for general practitioners were involved.
The aim was to study factors leading to rational drug prescribing. In the first report, prescription
data from the 94 practices (DDD/1,000 listed patients for 13 drug groups) were extracted from
the database. Every six months for seven years a letter was then sent to each practice, asking
about the level of prescriptions, and how they thought it compared with all the other practices.
One report has been published [61].
In the second part of the project, a trained general practitioner made two visits, one year apart,
to each practice. The GPs in the practice were asked to indicate their level of prescriptions, and
to estimate how they thought that level compared with the levels of all the other practices. The
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results of the first visit were somewhat better than chance, while on the second occasion they
had improved significantly. A report has been submitted for publication [62].
In the third part of the project the 94 practices were randomized to two groups: an intervention
group and a control group, to investigate the prescription of antibiotics (ATC group J). The
groups were then switched for the next intervention, to investigate the prescription of non
steroid anti inflammatory drugs (NSAID) (ATC group M01). The same general practitioner as
above visited the 94 practices once a year and discussed the use of antibiotics in half of the
practices and the use of NSAIDs in the other half. The effects of these visits in terms of
prescriptions were followed by examining register data. A third manuscript will be forthcoming.
The project is generating one PhD thesis (Keld Vaegter), and is receiving financial support from
Storstrøms amt, Sörmland county R&D and Uppsala University.
Pharmacoepidemiology (IV:3)
The area of pharmacoepidemiology is a fairly new branch of epidemiology and is
methodologically still in its development phase. Research in this area requires access to high
quality health care databases and collaboration with various academic groups in Europe and the
US.
We have longstanding research collaboration with Dr Luis A García Rodríguez and colleagues
at Centro Español de Investigación Farmacoepidemiológica-CEIFE (Spanish Centre for
Pharmacoepidemiologic Research) which has resulted in numerous publications on the natural
history of diseases including respiratory diseases such as COPD and pneumonia [63-65],
diabetes [66], gastroesophageal reflux disease and irritable bowel disorder [67] [68], reumatoid
arthritis [69] cardiovascular diseases like atrial fibrillation [70], MI [71], chest pain [72] and
also studies investigating the safety and utilization of a new statin, rosuvastatin [73, 74].
In the study of the natural history of gastroesophageal reflux disease, research has also been
done in collaboration with a research group in Bologna, Italy [75] and researchers from several
Chinese Universities [76-79].
In recent years, we have also had research collaboration with Professor John Dent, Adelaide
[68, 79], Professor Roger Jones, London, Professor Christos Lionis, Kreta, Professor Ken
Rothman, Boston, Professor Hershel Jick, Boston, Professor Susan Jick, Boston, Professor
Alexander Walker, Boston and Professor David Price, Aberdeen.
Cardiovascular disease and diabetes
Dan Andersson, Jan Cederholm, Margaretha Eriksson, Mats Gulliksson, Gunnar Johansson,
Lena Kallings, Marianne Omne-Pontén, Jan Stålhammar and Kurt Svärdsudd
The impact of birth weight (V:1)
This project is a recently completed study of the impact of birth weight on the prevalence of
cardiovascular risk factors, and the incidence of cardiovascular disease, diabetes and prostate
cancer. The study population consisted of 1,800 men born in Gothenburg in 1913, of whom one
fraction participated in the Study of Men Born in 1913. Birth weights and other obstetric data
were retrieved from various archives. The men were followed regarding survival until age 85.
For one fraction (the Study of Men Born in 1913), screening data were available from several
occasions. In a first publication a quality control of the collected data was performed indicating
sufficient quality for scientific use [80]. In a second report an inverse relationship was found
between birth weight on the one hand and adult blood pressure and serum cholesterol on the
other [81]. However, no relationship was found to adult myocardial infarction incidence, death
from cardiovascular disease or death of all causes [82]. Moreover, there was a curvilinear
83
relationship between birth weight and adult diabetes incidence, with high incidence levels
among those with a low and those with a high birth weight. Finally, a direct relationship was
found between birth weight and adult prostate cancer incidence [83]. Barker’s hypothesis of
intrauterine priming could thus be verified in certain respects but not in others. The project has
generated one PhD thesis (Margaretha Eriksson 2005 [84]) and has received financial support
from the Medical Research Council, Heart-Lung Foundation and Uppsala University.
Morbidity and mortality among diabetes patients (V:2)
This project is based on the 1,500 diabetes patients in the Tierp health care database during the
years 1976-1994 and a matched control group of 4,500 individuals from the population register.
The Tierp heath care database is a longitudinal registration of all appointments at the Tierp
health care centre, the only one in the area. The purpose of the project was to test the hypothesis
that the aggressive diabetes treatment with better metabolic control used during recent years
might have improved the survival outlook for diabetes patients. Preliminary data indicate that
the diabetes patients have had less decline in mortality rate than the general population. Jan
Stålhammar has completed his PhD within the project [85], which was supported by the
Medical Research Council and Uppsala University.
Determinants for the survival of diabetes patients (V:3)
This project is based on the 800 diabetes patients followed and treated at Laxå primary health
care centre since 1972 and approximately 4,000 referents from the general population matched
to the cases by age, sex, and year of onset for the diabetes patients. The purpose is, firstly, to
determine whether the diabetes patients have had the same decline in mortality rate as the
general population, and secondly, to evaluate determinants for survival among the diabetes
patients (blood glucose, blood pressure, blood lipids and others). A first report dealing with
diabetes incidence and prevalence during 30 years of follow up has been published [86] as well
as a study of mortality trends in subjects with and without diabetes during 33 years of follow up
[87]. A third report will be forthcoming. The project is being led by Dan Andersson and Stefan
Jansson, is generating one PhD thesis (Stefan Jansson) and is receiving financial support from
Örebro University and Uppsala University.
The Swedish National Diabetes Register (V:4)
The Swedish National Diabetes Register (NDR), now including more than 70% of all patients
with diabetes in Sweden, forms the basis for several research projects. With the register center
located in Gothenburg, one of our senior researchers, Jan Cederholm, is responsible for the
statistical and epidemiological analyses, in cooperation with Björn Zethelius (Geriatrics),
forming the Uppsala branch of the working group of the NDR. More than 20 articles have been
published in 2002-2010, as presented at www.ndr.nu [88-109]. A summary of the development
of risk factor control in type 1 and type 2 diabetes, and in patients with previous coronary heart
disease (CHD) in recent years was published in Läkartidningen 2009 [105], including a report
on the importance of risk factors for risk of CHD and cardiovascular disease (CVD). In
summary, almost half (40-43%) of all cases of CHD and CVD could be prevented, if HbA1c
(DCCT) >7.5%, blood pressure >140/90 mmHg, obesity and smoking could all be eliminated at
the same time.
It has been shown that HbA1c (DCCT) <7% strongly reduced risk of CVD, with no increased
risk at low HbA1c values, even in patients with longer diabetes duration in type 1 [106] and
type 2 diabetes [110], and in patients with a history of CVD in type 2 diabetes. It has also been
shown that systolic blood pressure (SBP) <140 mmHg strongly reduced risk of CVD, indicating
a SBP treatment target well below 140 mmHg, although no significant differences in CVD risk
was seen between SBP 130-139 mmHg and 110-129 mmHg [108]. Normal weight reduced risks
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of CHD and CVD by 15% and 22%, as compared with overweight or obesity [101], and nonsmoking at middle age reduced risks of CHD and CVD by 57% and 38% [102]. A multifactorial
approach to risk factor control decreased CVD risk, and combined long-term control of HbA1c
<7.5% (median 6.5%) and BP <140/90 mmHg (median 130/80) was shown to reduce risks of
CHD and CVD by 31% and 33%, with additive effects of HbA1c and BP on outcomes risks
[103]. High pulse pressure >75 mmHg (indirect measure of increased arterial stiffness) has been
shown as an independent risk factor for CHD and CVD [104].
Long-term tight control of HbA1c [98] and BP were related to low BMI, HbA1c also to nonsmoking, and BP also to absence of albuminuria [94]. Long-term development of renal
complications (albuminuria and renal impairment) were predicted by elevated HbA1c and
systolic BP, and also by elevated BMI and triglycerides [92, 109].
A simplified risk model for estimation of 5-year CVD risk has been introduced for clinical use
[99]. More elaborated risk models for estimation of 5-year CVD risk in both type 1 and type 2
diabetes, as well as risk factor control in patients with type 2 diabetes and previous CHD, and
lipid control associated with CHD risk, has been presented at the EASD Congress in Stockholm,
September 2010.
All data in the NDR from a participating unit are reported back to the unit and also compared
with corresponding national NDR-data in order to improve diabetes care. Patients can follow
their own data together with a treating doctor or nurse at www.ndr.nu. The patient organization
Swedish Diabetes Association strongly supports the NDR.
Real-life Effectiveness and Care Patterns of Diabetes Management – Recap-DM (V:5)
Recap-DM includes primary care data of 11,856 patients with type 2 diabetes (T2DM) residing
in the county of Uppsala, Sweden, from January 1993 to October 2004. The register was created
from electronic medical records by automated data-mining at 26 publically financed primary
health care centres. Four additional data sources were used. The Akademiska Hospital provided
data on the number of appointments study patients had at individual hospital outpatient clinics.
The National Inpatient Register provided data on all hospitalisations in Sweden between 1987
and 2004, with information on diagnoses, surgical procedures and dates of admission and
discharge. The Causes of Death Register provided comprehensive data on mortality and
underlying cause of death until 2003. Finally, the Swedish Registry for Active Treatment of
Uremia (SRAU) provided data on treatment for renal failure between 1988 and 2005, including
the date of treatment start and the initial form of treatment. The aim of Recap-DM is to study
fiscal cost, managemental praxis, treatment patterns, morbidity and mortality of T2DM in a
real-life setting. So far, four publications have evolved from the project [111-114]. The first
study described the incidence and prevalence of T2DM [111]. The second and third studies
provided an in depth analysis of the resource use and costs of T2DM [112, 113]. In the fourth
study the time to insulin treatment and factors associated with insulin prescription are described
[114]. The project is being led by Jan Stålhammar, is generating one PhD thesis (Mats
Martinell) and is being supported by primary health care in Uppsala and Uppsala University.
Recap-DM is a joint venture between us (Family Medicine and Clinical Epidemiology), the
Karolinska Institute (A. Ringborg, PhD student) and i3 Innovus Sweden (P. Lindgren, PhD,
MD). The data extraction and initial data management was financed by Merck Sharpe & Dohme
(MSD), Sweden AB.
Prevalence of lipid abnormalities before and after introduction of lipid modifying therapy
among Swedish patients with dyslipidemia – PRIMULA (V:6)
The objective of this study is to estimate the prevalence of dyslipidemia and attainment of
goal/normal lipid levels in patients treated with lipid modifying therapy. It is a longitudinal
retrospective observational study which covers time periods before and after treatment. Data
85
were collected from 1994-2007 electronic patient records in public primary health care centers
in Uppsala county Sweden. Patients were included if they had been treated with lipid modifying
therapy and had at least one lipid abnormality indicating dyslipdemia and if complete lipid
profile data were available. Threshold levels for lipids were defined as per Swedish guidelines.
5,424 patients were included. Focusing therapy on low-density lipoprotein reduction allows
40% of patients to achieve goal levels and helps reducing triglyceride level during follow-up
[115]. Almost 60% of patients experience persistent high-density lipoprotein and/or triglyceride
abnormality independent of low-density lipoprotein levels. The data extraction and initial data
management was financed by Merck Sharpe & Dohme (MSD), Sweden AB. PRIMULA is a
joint venture between us (Family Medicine and Clinical Epidemiology) and the Karolinska
Institute.
A retrospective epidemiological study to investigate outcome and mortality with glucose
lowering drug treatment in primary care - ROSE (V:7)
This is a retrospective epidemiological study of patients with diabetes mellitus and an
investigation of the outcome and mortality associated with glucose lowering treatment in reallife primary care during the first ten years of the 21st century. Data will be extracted
anonymously from electronic patient records in primary care. By extraction of data from 80
primary health care centres it is estimated that we will obtain on approximately 60,000 to
80,000 patients. In addition, data regarding morbidity and mortality will be collected from the
Hospital Discharge Register (Slutenvårdsregistret) and the Cause of Death Register and
information on prescribed drugs will be collected from the Prescription Register. Data on socialeconomic status will also be collected from Statistics Sweden (SCB). The merging of data will
be performed by the National Board of Health and Welfare. The software program Pygargus
Customized eXtraction Program (CXP) will be used to extract the patient data from the
electronic patient records of the participating primary care centres for all patients with a
diagnosis of diabetes mellitus (ICD-10: I10). The social security numbers of identified patients
will immediately be replaced with a study ID-number for further processing of data. It will not
be possible to identify patients once the database is finalized. Data are now being collected. The
project is being led by Gunnar Johansson and is receiving financial support from AstraZeneca.
The data management will be performed by Pygargus and the Family Medicine and Clinical
Epidemiology section.
Cardiovascular events during primary treatment of hypertension – REAL-LIFE (V:8)
This study compared the effects of antihypertensive treatment with candesartan or losartan on
cardiovascular disease (CVD) using Swedish registers (merged data from existing electronic
patient records, and electronic hospital discharge and cause of death registers). Patients without
previous CVD who were prescribed candesartan (n=7,329) or losartan (n=6,771) for
hypertension during 1999-2007 at 72 Swedish primary care centers were followed up for 9
years. Adjusted risk reduction in all CVD was 14% with candesartan compared with losartan
treatment [116] irrespective of sex, age, previous antihypertensive treatment, baseline blood
pressure, and presence diabetes [117]. The project is being led by Jan Stålhammar and is
receiving financial support from AstraZeneca. The data management is performed by Pygargus
and the Family Medicine and Clinical Epidemiology section.
Effects of angiotensin converting enzyme inhibitors vs candesartan in reducing
cardiovascular events in primary treatment of hypertension – ARB-ACE study (V:9)
The planned study will be a retrospective study on the effect of ACEis vs candesartan on
cardiovascular events and on health economic effects in a “real life” setting in Sweden. The
study procedure is the same as above described in the ROSE project (V:7). The estimated
number of patients is 50,000. The project is being led by Jan Stålhammar and is receiving
86
financial support from AstraZeneca. The data management will be performed by Pygargus and
the Family Medicine and Clinical Epidemiology section.
SUPRIM (V:10)
This project deals with secondary prevention after a coronary heart event and is a randomised
controlled clinical trial of two prevention concepts: optimised risk factor control and
behavioural modification. The study population consists of 362 patients discharged from
Uppsala University Hospital to their general practitioners who were cross-randomised according
to a factorial design. First, their general practitioners were randomised into two groups, one
receiving education in optimal risk factor control, the other left to handle the market
information. The patients in each of these two groups were then cross-randomised into
behavioural modification or no modification. The factorial design allows for evaluation of the
two concepts separately.
After a baseline examination immediately after discharge, the patients were followed up with
new examinations every six months for 30 months, where the risk factor levels were measured.
A nutritional examination was also done twice, as has a video interview to measure the effects
of the behavioural modification programme, and a large number of psycho-socio-economic
variables have been measured by questionnaire. The trial has now been concluded. The first
publication described the patients’ psycho-socio-economic status during the first year after a
CHD event. It compared almost 1,000 matched referents, matched to cases by age, sex, and
place of residence. In this first controlled study, disease and gender status both appeared to be
determinants of psychological well-being, with gender status apparently the strongest [118]. In a
second report the main results of the randomised trial were presented. During a mean 94 months
of follow up, the intervention group had 41% fewer fatal and non-fatal first recurrent CVD (HR
0.59, 95%CI 0.42-0.83, p=0.003), 45% fewer recurrent AMI (HR 0.55, 95%CI 0.36-0.85,
p=0.007), and a non-significant 28% lower all cause mortality (HR 0.72, 95%CI 0.40-1.30,
p=0.28) than the reference group after adjustment for other outcome affecting variables. In the
cognitive behavioural therapy (CBT) group there was a strong dose-response relationship
between intervention group attendance and outcome. During the first 2 years of follow up there
were no significant group differences in traditional risk factors [119]. The project has generated
one PhD thesis (Mats Gulliksson 2009 [120]). This study has received financial support from
Swedish Medical Research Council, Vårdal Foundation, the Swedish Council for Working Life
and Social Research, the National Board of Health and Welfare, the National Heart and Lung
Patient Association, Uppsala county council, Uppsala branch office of the Swedish Social
Insurance Agency, and Uppsala University.
Secular trends in recurrent myocardial infarction (V:11)
This project is being performed in collaboration with Centre for Epidemiology (EpC) at the
National Board of Health and Welfare and the Cardiovascular Epidemiology Group at
Sahlgrenska Academy, Gothenburg. It is based on the National Swedish Myocardial Infarction
Register at EpC, which contains all incidents of myocardial infarction (AMI) since the early
1970s, in total 1.2 million incidents. The purpose is to study the risk of recurrent AMI during
the years following a first AMI, and how this risk has changed over the years. During the study
period, the risk of a new event among survivors of a previous AMI decreased sharply during the
first 2 years after the previous event, reached its lowest point after 5 years, and then increased
slowly again. The risk of a recurrent AMI during the first year after a previous event was fairly
stable over time until the late 1970s and then decreased by 36% in women and 40% in men until
the late 1990s, irrespective of age and AMI number, mirroring the incidence decrease over the
years for primary events [121]. In a second report the effects of degree of urbanisation on the
risk of recurrent acute myocardial infarction were described. There was considerable
geographical variation in recurrent AMI risk, the same for men and women, best explained by
residential area population density [122]. The project has generated one PhD thesis (Mats
87
Gulliksson 2009 [120]), and has received financial support from the Swedish Medical Research
Council, the Vårdal foundation, the Swedish Council for Working Life and Social Research, the
Swedish National Board of Health and Welfare, the Swedish Heart and Lung Association,
Uppsala primary health care administration, and Uppsala University.
Damaged brain and susceptible life (V:12)
The project is a one-year follow up of all 390 stroke patients discharged from Falun Hospital
during a specified period of time and who, before admission, were living in their own homes. At
discharge, the staff was asked to indicate their view of the patient’s prognosis. The patients were
followed with an interview at home immediately after discharge, and again after 3 and 12
months. On the same occasions a close relative responded to a matching questionnaire.
Furthermore, all health care utilization at hospital, primary health care, municipal social service
support and the caring efforts of close relatives have been recorded.
In the first publication the prognostic ability of the staff was analysed. Prognoses were given
regarding health development, need of help and living condition. The prognoses were correct
(67%) or much better than chance (33%), and were mainly influenced by the patient’s pre- and
post-morbid state [123]. The risk of dying or having a new stroke decreased rapidly during the
early post-stroke phase. Health care utilization, in hospitals as well as in primary health care,
and municipal social service support were all considerably higher after the stroke than before,
but the utilization of these services was lower than previously reported [124]. Health problem
prevalence according to interview and record scrutiny was modest, peaked early after discharge
and then declined [125]. Support from informal caregivers increased significantly after
discharge and remained high during the first post-stoke year. The informal caregivers reported
considerable strain and burden, with significantly higher levels of anxiety and depression than
the stroke patients [126]. The project has generated one PhD thesis (Lena Olai 2010 [127]), and
has received financial support from Vårdal foundation, Dalarna county council and Uppsala
University.
Screening for diabetes and hypertension in the Dental Care Service (V:13)
The dental service is the only clinical area where patients on a large scale come for check-ups
without having symptoms. This project deals with the possibility of using the dental health
service as a screening function for high blood pressure and diabetes. The purpose is to evaluate
to what extent new diabetes or hypertension cases, not known previously to health care
personnel, can be detected. Three dental services in Gävleborg County, in places with only one
primary health care centre, measured blood pressure and blood sugar in all patients attending the
dental service, approximately 1,500 patients. All patients who had blood pressure or blood sugar
above preset levels were referred to the primary health care centre for evaluation. Data from
these units regarding the referred persons covering the three years preceding and following the
screening occasion, in total more than 30,000 appointments, were obtained to find out whether
the referred person was already known or, if not, if he or she came for evaluation and, if so, if he
or she received a hypertension or diabetes diagnosis. A first publication based on a pilot study
showed a strong relationship between high blood pressure and the prevalence of deep gingival
pockets [128]. In a second report the efficacy of blood pressure screening in dental care and
primary care work up of those who screened positive was analysed. The report has been
submitted [129]. Currently the efficacy of diabetes screening is being analysed. The project is
generating one PhD thesis (Sevek Engström), and is receiving financial support from Gävleborg
county council, dental sevice Gävleborg and Uppsala University.
88
Physical activity in prevention and treatment of disease (V:14)
Physical activity is one of the most important public health determinants, and the health care
sector is highlighted as a central setting in the promotion of physical activity in the population
as well as at individual level. The project consists of several studies of methods for promotion
of physical activity in patients with cardiometabolic risk factors. The main method is physical
activity on prescription (PAP). Previous studies have shown that this method is effective in
clinical settings and increases physical activity level and self-reported quality of life, and has
good adherence [130-132]. Data collection from long-term follow ups of an RCT have been
collected and will be analyzed, several papers are planned. One paper has been published from
the 6-month follow up and, shows that PAP increases physical activity level at moderate
intensity, and reduces sedentary time as well as reducing several cardiometabolic risk factors in
elderly women and men with low physical activity level, overweight and abdominal obesity
[133]. This study is being conducted in collaboration with several researchers at the Karolinska
Institute, Uppsala University and Umeå University. The project leader is Lena Kallings. One
RCT with patients with osteoarthritis in primary health care started spring 2010 and one PhD
student is involved in the project which is financially supported by Gävleborg county council
and Uppsala-Örebro regional research council. One clinical study with physical activity in
treatment of depression will start in 2011 and one RCT with PAP to patient with depression is
planned for 2012. One PhD student is involved in the studies with depression which is
financially supported by Uppsala county council and Uppsala-Örebro regional research council.
Adaption and testing PAP as a method to promote physical activity in children and adolescents
is conducted as a method development, financially supported by Uppsala county council. Lena
Kallings is responsible and a RCT is planned to start in 2012. On behalf of a “The Nordic
network for physical activity, nutrition and health” an overview of existing approaches in
physical activity prescriptions in the Nordic countries has been carried out during 2010 [134],
financially supported by the Nordic Council of Ministers. This work has been reported on both
Nordic level and international level (HEPA meeting in Czech Republic). As a result a similar
work for the whole Europe will be planned in Slovakia Mars 2011.
Varia
Lars Englund, Christina Halford, Gunnar Johansson, Nils Rodhe and Kurt Svärdsudd
Infections in the elderly (VI:1)
The purpose of the project is to determine whether or not asymptomatic bacteriuria in elderly
should be treated. The project is based on all individuals 80 years old or older in a health care
district of Falun. The study population was followed for a few years with repeated assessments,
bacterial cultivations and other lab tests. Four reports have been published, showing the
prevalence of asymptomatic bacteriuria as measured by means of urine cultures, determinants of
asymptomatic bacteriuria, change of bacterial strains indicating that the infections come and go,
and the possibility of differ between simple lab tests innocent asymptomatic bacteriurias and
those in need of treatment with [135-138]. The project was led by Lars Englund, has generated
one PhD thesis (Nils Rodhe 2008 [139]), and the project has received financial support from
Dalarna county.
Self-rated health (VI:2)
Simple global self-ratings of health (SRH) hold predictive validity in relation to functional
ability, morbidity, health care utilisation, and mortality, and are therefore extensively used in
public health monitoring and research. In this project, associations between stress-theory based
psychobiological variables and SRH were investigated in 212 adult healthy women and men.
Psychological resource and psychological strain variables were strongly associated with SRH in
89
women and men. Associations between endocrine variables and SRH were observed in men, but
not in women. Furthermore, associations between age, year of investigation and SRH, and
effects of SRH on risk of sick leave, disability-pension, hospital admission and mortality, were
investigated in a population-based sample of 11,880 adult and elderly women and men. Age,
year of investigation, and SRH were inversely associated, linearly in women, and non-linearly
in men. Furthermore, in women and in men, SRH was inversely associated with number of days
on sick leave, disability pension, and with mortality, during the follow-up period. Finally, SRH
was inversely associated with first hospital admission rate in men, but not in women. Two
articles have been published [140, 141], one manuscript has been submitted [142] and one
manuscript is forthcoming (Halford, Preprint #1654}. The project has generated one PhD thesis
(Halford 2010, [143]). The project leader is Kurt Svärdsudd and the project is being financially
supported by the Uppsala University.
Vitamin D status among immigrated women from countries in the Middle East as compared
with Swedish women (VI:3)
Vitamin D in blood has been demonstrated in studies to be low in women from countries
located in the southern part of Middle East and some countries in Africa. Immigrant women
from countries in the Middle East will be investigated by a physician and a dietician in terms of
different aspects of their vitamin D status and possible associated diseases. They will be
compared with age-matched Swedish women. Preliminary results show a large difference in
vitamin D levels with low values in many immigrant women in comparison with the Swedish
women. Treatment with vitamin D and calcium is ongoing. The principal investigators are Anne
Björk, Åsa Andersson and Gunnar Johansson. The project is receiving financial support by the
Uppsala primary health care.
Vitamin D status and the correlation to muscle function in patients with chronic obstructive
pulmonary disease (COPD) (VI:4)
Many patients with advanced COPD are affected by their decreased lung function and often
have reduced muscular function as well. They consequents often do not go out, and their diet
also tends to be low in products containing vitamin D. This study will investigate the vitamin D
status and the correlation to muscle function in these patients with COPD. The study is planned
to be performed at a primary health care centre by a physician and a dietician. If the patients are
shown to have low values, treatment with vitamin D and calcium will be initiated. The principal
investigators are Anne Björk, Åsa Andersson and Gunnar Johansson. The project is receiving
financial support from the Uppsala primary care.
Breaking borders and barriers for health (VI:5)
The European population is ageing rapidly and it is necessary to develop new methods for
improving quality of life for the elderly. In Sweden, Latvia and Finland population ageing
implies a double burden on the public social security service sector with an increased flow of
clients because of rising unemployment at the same time as municipal resources are being cut
back. A network including primary health care in Uppsala county, Östhammar municipality, and
Folkhälsans förbund (the public health association), Finland has been set up to work with the
problem, shared by all, that the different systems dealing with health in a
society/organization/country have difficulties co-operating communicating ideas. The network
focuses its work on crossing system borders for health promotion. Gunilla Burell, senior
researcher, and Bo Karlsson, PhD student, are involved in the project.
90
Psychiatric secondary prevention – Case management (VI:6)
This project is focused on psychiatric secondary prevention. The purpose is to determine
whether case management in psychiatry reduces the risk of readmission to hospital. Case
management using managers from outside the health care system has been tried earlier with
moderate success. In this project we evaluated the effects of professional managers, i.e.,
psychiatric ward staff. All patients discharged from a psychiatric ward unit after at least three
days in hospital and who agreed to participate (50 patients) were randomly allocated to one of
two groups. One group was offered a case manager from among the staff in the ward, while the
other group was referred to a psychiatric outpatient clinic. The case manager contacted or met
with the patient regularly. Every third month questionnaires were filled out by the patient and
the case manager. The control group was also sporadically in touch with the managers. After
one year the control group was offered case managers and the first intervention group was able
to go on with their contact at their own initiative. After one year the first case manager group
had significantly fewer re-admissions to hospital than the control group. A manuscript will be
forthcoming. The project leader was Lars Nilsson and the project has received financial support
from the Social Insurance Agency, Karolinska Institute and Uppsala University.
References to the six research areas:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Eriksson HG, von Celsing AS, Wahlström R, Janson L, Zander V, Wallman T: Sickness
absence and self-reported health a population-based study of 43,600 individuals in
central Sweden. BMC Public Health 2008, 8(Dec 30):426 [on line publication].
Wallman A, von Celsing A-S, Eriksson H-G, Wahlström R, Wallman T: Sickness
absence and health care and drug utilisation: a population-based study 43,000 + 40,700
individuals in central Sweden. Submitted.
Wallman T: Disability pension with special reference to sick leave track record, health
effects, health care utilisation and survival: a population-based study. Medical sciences.
Uppsala University; 2008.
Wallman T, Burell G, Kullman S, Svärdsudd K: Health care utilisation before and after
retirement due to illness: a 13-year population-based follow-up study of prematurely
retired men and referents from the general population. Scand J Prim Health Care 2004,
22:95-100.
Wallman T, Wedel H, Johansson S, Rosengren A, Eriksson H, Welin L, Svärdsudd K:
The prognosis for individuals on disability retirement. An 18-year mortality follow-up
study of 6887 men and women sampled from the general population. BMC Public
Health 2006, 6:103.
Wallman T, Wedel H, Palmer E, Rosengren A, Johansson S, Eriksson H, Svärdsudd K:
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population based study of 8,218 men and women followed for 16 years. BMC Public
Health 2009, 9.
Wallman T, Wedel H, Palmer E, Johansson S, Rosengren A, Eriksson H, Welin L,
Svärdsudd K: Quality of life measures among disability pensioners and referents in a
longitudinal population-based study. Submitted.
Norrmén G, Svärdsudd K, Andersson D: Impact of physician-related factors on sickness
certification in primary health care. Scand J Prim Health Care 2006, 24:104-109.
Norrmén G, Svärdsudd K, Andersson DK: How primary health care physicians make
sick listing decisions: the impact of medical factors and functioning. BMC Fam Pract
2008, 9:3.
Norrmén G, Svärdsudd K, Andersson DK: The association of patient's family, leisure
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Norrmén G, Svärdsudd K, Andersson DK: Influence on sickness certification of
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Norrmén G: To be or not to be sick certified with special reference to physician and
patient related factors. Medical science. Uppsala University; 2010.
von Celsing A-S, Eriksson H-G, Björkegren K, Eriksson M, Svärdsudd K, Wallman T:
Early prediction of patients at risk for long term sickness absence: a three-year
prospective cohort study. Submitted.
Swartling M, Peterson S, Wahlström R: Views on sick-listing practice among Swedish
general practitioners: a phenomenographic study. BMC Fam Pract 2007, 8:44.
Swartling M, Wahlström R: Isolated specialist or system integrated physician - different
views on sickness certification among orthopaedic surgeons: an interview study. BMC
Health Serv Res 2008, 8(1):273.
Swartling MS, Alexanderson KA, Wahlström RA: Barriers to good sickness
certification: an interview study with Swedish general practitioners. Scand J Public
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Swartling M: Physicians’ sickness certification: views on practice and barriers. Medical
sciences. Uppsala University; 2008.
Blomberg S: A pragmatic approach to low-back pain including manual therapy and
steroid injections: a multicenter study in primary health care. Medical Sciences. Uppsala
University; 1993.
Grunnesjö M, Bogefeldt J, Svärdsudd K, Blomberg S: A randomized controlled clinical
trial of stay-active care versus manual therapy in addition to stay-active care: functional
variables and pain. . J Manipulative Physiol Ther 2004, 27(7):431-441.
Grunnesjö M, Bogefeldt JP, Blomberg SI, Delany HR, Svärdsudd KS: The course of
pain drawings during a 10-week treatment period in patients with acute and sub-acute
low back pain. BMC Musculoskelet Disord 2006, 7(1):65.
Bogefeldt J, Grunnesjö M, Svärdsudd K, Blomberg S: Diagnostic differences between
general practitioners and orthopaedic surgeons in low back pain patients. Upsala
Journal of Medical Sciences 2007, 112(2):199-212.
Bogefeldt J, Grunnesjö MI, Svärdsudd K, Blomberg S: Sick leave reductions from a
comprehensive manual therapy programme for low back pain: the Gotland Low Back
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Bogefeldt J: Low Back Pain: With Special Reference to Prevalence, Diagnosis,
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Bogefeldt J, Wallman T, Eriksson M, Welin L, Eriksson H, Johansson S, Grunnesjö M,
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sampled from the general population. Preprint.
Bogefeldt J, Wallman T, Palmer E, Eriksson M, Johansson S, Eriksson H, Welin L,
Grunnesjö M, Svärdsudd K: Medical and social consequences of back pain: a
longitudinal study of 7,074 men and women sampled from the general population.
Preprint.
Peterson M, Elmfeldt D, Svärdsudd K: Treatment practice in chronic epicondylitis: A
survey among general practitioners and physiotherapists in Uppsala County, Sweden.
Scand J Prim Health Care 2005, 23:239-241.
Peterson M, Eriksson M, Svärdsudd K: A randomised controlled trial of exercise versus
wait-and-see in chronic tennis elbow (lateral epicondylosis). Submitted.
Peterson M, Butler S, Eriksson M, Svärdsudd K: A randomised controlled trial of
eccentric versus concentric exercise in chronic tennis elbow (lateral epicondylosis).
Preprint.
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Björkegren K, Wallander MA, Johansson S, Svärdsudd K: General symptom reporting
in female fibromyalgia patients and referents: a population-based case-referent study.
BMC Public Health 2009, 9:402.
Bröms K, Svärdsudd K, Sundelin C, Norbäck D: A nationwide study of indoor and
outdoor environments in allergen avoidance and conventional daycare centers in
Sweden. Indoor Air 2006, 16(3):227-235.
Bröms K, Norbäck D, Eriksson M, Sundelin C, Svärdsudd K: Effect of degree of
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BMC Public Health 2009, 9.
Bröms K, Norbäck D, Eriksson M, Sundelin C, Svärdsudd K: Prevalence and cooccurrence of asthma and allergic manifestations in pre-school children. Submitted.
Bröms K, Eriksson M, Norbäck D, Sundelin C, Svärdsudd K: A nationwide study of
asthma incidence and its determinants in pre-school children during five years of follow
up. Preprint.
Bröms K: A nationwide study of asthma and allergy in Swedish preschool children:
with special reference to environment, daycare, prevalence, co-ocurrence and incidence.
Medical science. Uppsala University; 2010.
Lisspers K, Ställberg B, Hasselgren M, Johansson G, Svärdsudd K: Organisation of
asthma care in primary health care in Mid-Sweden. Prim Care Respir J 2005,
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Hasselgren M, Gustafsson D, Ställberg B, Lisspers K, Johansson G: Management,
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Lisspers K, Ställberg B, Hasselgren M, Johansson G, Svärdsudd K: Quality of life and
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Ställberg B, Nyström Kronander U, Olsson P, Gottberg L, Rönmark E, Lundbäck B:
Living with asthma in Sweden: the ALMA study. Respir Med 2003, 97(7):835-843.
Ställberg B, Hedström H, Johansson G, Svärdsudd K: A follow up of adolescents and
young adults with asthma: airway hyperresponsiveness and asthma control. Submitted.
Ställberg B, Lisspers K, Hasselgren M, Janson C, Johansson G, Svärdsudd K: Asthma
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comorbidity and body mass index with quality of life in COPD. Submitted.
Pinnock H, Thomas M, Tsiligianni I, Lisspers K, Østrem A, Ställberg B, Yusuf O, Ryan
D, Buffels J, Cals JW et al: The International Primary Care Respiratory Group (IPCRG)
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36((Suppl) 54).
Johansson G, Alving K, Venge P, Hedenström H: Relationship between exhaled NO
measurements and mometasone-induced changes in respiratory variables in patients
with moderate chronic obstructive pulmonary disease (COPD) in a primary health care
setting. Submitted.
Bardel A, Wallander MA, Svärdsudd K: Reported current use of prescription drugs and
some of its determinants among 35 to 65-year-old women in mid-Sweden: A
population-based study. J Clin Epidemiol 2000, 53(6):637-643.
Bardel A, Wallander MA, Svärdsudd K: Hormone replacement therapy and symptom
reporting in menopausal women: a population-based study of 35-65-year-old women in
mid-Sweden. Maturitas 2002, 41(1):7-15.
Bardel A, Wallander MA, Svärdsudd K: Factors associated with adherence to drug
therapy: a population-based study. Eur J Clin Pharmacol 2007, 63(3):307-314.
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women 35-64 years old: a population-based study. BMC Public Health 2009, 9:37.
Bardel A: Women's health and drug consumption: a population based study. Medical
sciences. Uppsala University; 2007.
Vaegter K, Wahlström R, Wedel H, Svärdsudd K: Effect of mailed feedback on drug
prescribing profiles in general practice: a seven-year longitudinal study in Storstrom
County, Denmark. Upsala Journal of Medical Sciences 2010, 115(4):238-244.
Vaegter K, Wahlström R, Svärdsudd K: General practitioners' awareness of their own
prescribing profiles after postal feedback and outreach visits in Storstrøm County,
Denmark. Submitted.
Garcia Rodriguez LA, Wallander MA, Tolosa LB, Johansson S: Chronic obstructive
pulmonary disease in UK primary care: incidence and risk factors. COPD 2009,
6(5):369-379.
Rodriguez LAG, Ruigomez A, Wallander MA, Johansson S: Acid-suppressive drugs
and community-acquired pneumonia. Epidemiology 2009, 20(6):800-806.
Garcia Rodriguez LA, Ruigomez A, Martin-Merino E, Johansson S, Wallander MA:
Relationship between gastroesophageal reflux disease and COPD in UK primary care.
Chest 2008, 134(6):1223-1230.
Gonzalez EL, Johansson S, Wallander MA, Rodriguez LA: Trends in the prevalence
and incidence of diabetes in the UK: 1996-2005. J Epidemiol Community Health 2009,
63(4):332-336.
Ruigomez A, Wallander MA, Johansson S, Rodriguez LA: Irritable bowel syndrome
and gastroesophageal reflux disease in primary care: is there a link? Dig Dis Sci 2009,
54(5):1079-1086.
Ruigomez A, Rodriguez LA, Wallander MA, Johansson S, Dent J: Endoscopic findings
in a cohort of newly diagnosed gastroesophageal reflux disease patients registered in a
UK primary care database. Dis Esophagus 2008, 21(3):251-256.
Rodriguez LA, Tolosa LB, Ruigomez A, Johansson S, Wallander MA: Rheumatoid
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38(3):173-177.
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Huerta C, Johansson S, Wallander MA, Rodriguez LA: Risk of myocardial infarction
and overall mortality in survivors of venous thromboembolism. Thromb J 2008, 6:10.
Ruigomez A, Masso-Gonzalez EL, Johansson S, Wallander MA, Garcia-Rodriguez LA:
Chest pain without established ischaemic heart disease in primary care patients:
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Garcia-Rodriguez LA, Gonzalez-Perez A, Stang MR, Wallander MA, Johansson S: The
safety of rosuvastatin in comparison with other statins in over 25,000 statin users in the
Saskatchewan Health Databases. Pharmacoepidemiol Drug Saf 2008, 17(10):953-961.
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care. Pharmacoepidemiol Drug Saf 2008, 17(10):943-952.
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Eriksson M, Wallander MA, Krakau I, Wedel H, Svärdsudd K: Birth weight and
cardiovascular risk factors in a cohort followed until 80 years of age: the study of men
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Eriksson M, Wallander MA, Krakau I, Wedel H, Svärdsudd K: The impact of birth
weight on coronary heart disease morbidity and mortality in a birth cohort followed up
for 85 years: a population-based study of men born in 1913. J Intern Med 2004,
256(6):472-481.
Eriksson M, Wedel H, Wallander MA, Krakau I, Hugosson J, Carlsson S, Svärdsudd K:
The impact of birth weight on prostate cancer incidence and mortality in a populationbased study of men born in 1913 and followed up from 50 to 85 years of age. Prostate
2007, 67(11):1247-1254.
Eriksson M: The impact of birth weight on cardiovascular risk factors, coronary heart
disease and prostate cancer: population-based studies of men born in 1913 and followed
up until old age. Medical Sciences. Uppsala University; 2005.
Stålhammar J: Drug treatment practice in diabetes mellitus during 1975-1994:
population-based pharmacoepidemiologiacal studies. Medical Sciences. Uppsala
University; 2000.
Jansson SPO, Andersson DKG, Svärdsudd K: Prevalence and incidence rate of diabetes
mellitus in a Swedish community during 30 years of follow-up. Diabetologia 2007,
50(4):703-710.
Jansson SPO, Andersson DKG, Svärdsudd K: Mortality trends in subjects with and
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Gudbjornsdottir S, Cederholm J, Nilsson PM, Eliasson B, Steering Committee of the
Swedish National Diabetes Register: The National Diabetes Register in Sweden: an
implementation of the St. Vincent Declaration for Quality Improvement in Diabetes
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Gudbjornsdottir S, Cederholm J, Nilsson PM, Eliasson B, Berne C, Adamson U: [The
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care]. Läkartidningen 2004, 101(47):3790, 3793-3797.
Nilsson PM, Gudbjornsdottir S, Eliasson B, Cederholm J, Steering Committee of the
Swedish National Diabetes Register: Smoking is associated with increased HbA1c
values and microalbuminuria in patients with diabetes--data from the National Diabetes
Register in Sweden. Diabetes Metab 2004, 30(3):261-268.
Cederholm J, Eliasson B, Nilsson PM, Weiss L, Gudbjornsdottir S, Steering Committee
of the Swedish National Diabetes Register: Microalbuminuria and risk factors in type 1
and type 2 diabetic patients. Diabetes Res Clin Pract 2005, 67(3):258-266.
Eliasson B, Cederholm J, Nilsson PM, Gudbjornsdottir S, Steering Committee of the
Swedish National Diabetes Register (NDR): The gap between guidelines and reality:
Type 2 diabetes in a National Diabetes Register 1996-2003. Diabet Med 2005,
22(10):1420-1426.
Nilsson PM, Cederholm J, Gudbjornsdottir S, Eliasson B, Steering Committee of the
Swedish National Diabetes Register of Sweden: Predictors of successful long-term
blood pressure control in type 2 diabetic patients: data from the Swedish National
Diabetes Register (NDR). J Hypertens 2005, 23(12):2305-11.
Cederholm J, Eliasson B, Nilsson PM, Weiss L, Gudbjornsdottir S: [Steering
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Ridderstråle M, Gudbjornsdottir S, Eliasson B, Nilsson PM, Cederholm J, Steering
Committee of the Swedish National Diabetes Register (NDR): Obesity and
cardiovascular risk factors in type 2 diabetes: results from the Swedish National
Diabetes Register. J Intern Med 2006, 259(3):314-22.
Eeg-Olofsson K, Cederholm J, Nilsson PM, Gudbjornsdottir S, Eliasson B, Steering
Comm S: Glycemic and risk factor control in type 1 diabetes - Results from 13,612
patients in a national diabetes register. Diabetes Care 2007, 30(3):496-502.
Eliasson B, Eeg-Olofsson K, Cederholm J, Nilsson PM, Gudbjornsdottir S:
Antihyperglycaemic treatment of type 2 diabetes: results from a national diabetes
register. Diabetes Metab 2007, 33(4):269-276.
Cederholm J, Eeg-Olofsson K, Eliasson B, Zethelius B, Nilsson PM, Gudbjornsdottir S,
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Diabetes Care 2008, 31(10):2038-2043.
Gudbjornsdottir S, Eeg-Olofsson K, Cederholm J, Zethelius B, Eliasson B, Nilsson PM:
Risk factor control in patients with Type 2 diabetes and coronary heart disease: findings
from the Swedish National Diabetes Register (NDR). Diabet Med 2009, 26(1):53-60.
Eeg-Olofsson K, Cederholm J, Nilsson PM, Zethelius B, Nunez L, Gudbjornsdottir S,
Eliasson B: Risk of cardiovascular disease and mortality in overweight and obese
patients with type 2 diabetes: an observational study in 13,087 patients. Diabetologia
2009, 52(1):65-73.
Nilsson PM, Cederholm J, Eeg-Olofsson K, Eliasson B, Zethelius B, Fagard R,
Gudbjornsdottir S: Smoking as an independent risk factor for myocardial infarction or
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cardiovascular diseases in type 2 diabetes: An observational study from the Swedish
National Diabetes Register (NDR). Diabetes Research and Clinical Practice 2009,
86(1):74-81.
Nilsson PM, Cederholm J, Eeg-Olofsson K, Eliasson B, Zethelius B, Gudbjornsdottir S:
Pulse pressure strongly predicts cardiovascular disease risk in patients with type 2
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35(6):439-446.
Cederholm J, Nilsson PM, Eliasson B, Eeg-Olofsson K, Zethelius B, Gudbjornsdottir S:
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Eeg-Olofsson K, Cederholm J, Nilsson PM, Zethelius B, Svensson AM,
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Eeg-Olofsson K, Cederholm J, Nilsson PM, Zethelius B, Svensson AM,
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diseases in type 2 diabetes: an observational study from the Swedish National Diabetes
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Cederholm J, Gudbjornsdottir S, Eliasson B, Zethelius B, Eeg-Olofsson K, Nilsson PM,
Ndr: Systolic blood pressure and risk of cardiovascular diseases in type 2 diabetes: an
observational study from the Swedish national diabetes register. J Hypertens 2010,
28(10):2026-2035.
Afghahi H, Cederholm J, Eliasson B, Zethelius B, Gudbjornsdottir S, Hadimeri H,
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type 2 diabetes—the Swedish National Diabetes Register (NDR). Nephrol Dial
Transplant 2010, Epub ahead of print, Sept 2010.
Eeg-Olofsson K, Zethelius B, Svensson AM, Gudbjornsdottir S, Eliasson B, Cederholm
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53(Suppl 1):150.
Ringborg A, Lindgren P, Martinell M, Yin DD, Schön S, Stålhammar J: Prevalence and
incidence of type 2 diabetes and its complications 1996-2003: estimates from a Swedish
population-based study. Diabet Med 2008, 25(10):1178-1186.
Ringborg A, Martinell M, Stålhammar J, Yin DD, Lindgren P: Resource use and costs
of type 2 diabetes in Sweden: estimates from population-based register data. Int J Clin
Pract 2008, 62(5):708-716.
Ringborg A, Yin DD, Martinell M, J. S, Lindgren P: The impact of acute myocardial
infarction and stroke on health care costs in patients with type 2 diabetes in Sweden.
Eur J Cardiovasc Prev Rehabil 2009 Oct;16(5):576-82 2009, 16(5):576-582.
Ringborg A, Lindgren P, Yin DD, Martinell M, Stålhammar J: Time to insulin
treatment and factors associated with insulin prescription in Swedish patients with type
2 diabetes. Diabetes Metab 2010, 36(3):198-203.
Pettersson B, Amgegaonkar B, Sazonov V, Martinell M, Stålhammar J, Wändell P:
Prevalence of lipid abnormalities before and after introduction of lipid modifying
therapy among Swedish patients with dyslipidemia (PRIMULA). BMC Public Health
2010, 10:737.
Kjeldsen SE, Stålhammar J, Hasvold P, Bodegard J, Olsson U, Russell D: Effects of
losartan vs candesartan in reducing cardiovascular events in the primary treatment of
hypertension. J Hum Hypertens 2010, 24(4):263-273.
Russell D, Stålhammar J, Bodegard J, Hasvold P, Thuresson M, Kjeldsen SE:
Cardiovascular events in subgroups of patients during primary treatment of
hypertension with candesartan or losartan. J Clin Hypertens 2010.
Gulliksson M, Burell G, Lundin L, Toss H, Svärdsudd K: Psychosocial factors during
the first year after a coronary heart disease event in cases and referents: Secondary
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Prevention in Uppsala Primary Health Care Project (SUPRIM). BMC Cardiovasc
Disord 2007, 7:36.
Gulliksson M, Burell G, Vessby B, Lundin L, Toss H, Svärdsudd K: A randomised
controlled trial of cognitive behavioral therapy versus standard treatment on recurrent
cardiovascular events in coronary heart disease patients. Arch Int Med Accepted.
Gulliksson M: Studies of secondary prevention after coronary heart disease with special
reference to determinants of recurrent event rate. Medical science. Uppsala University;
2009.
Gulliksson M, Wedel H, Köster M, Svärdsudd K: Hazard function and secular trends in
the risk of recurrent acute myocardial infarction 30 Years of follow-up of more than 775
000 incidents. Circulation-Cardiovascular Quality and Outcomes 2009, 2(3):178-185.
Gulliksson M, Wedel H, Köster M, Svärdsudd K: Effects of degree of urbanisation on
risk of recurrent acute myocardial infarction: more than 775,000 incidents followed for
30 years. Submitted.
Olai L, Omne-Ponten M, Borgquist L, Svärdsudd K: Prognosis assessment in stroke
patients at discharge from hospital. Age and Ageing 2007, 36(2):184-189.
Olai L, Omne-Ponten M, Borgquist L, Svärdsudd K: Survival, hazard function for a
new hvent, and Healthcare utilization among stroke patients > 65 years. Stroke 2009,
40(11):3585-3590.
Olai L, Omne-Ponten M, Borgquist L, Svärdsudd K: Health problems in elderly patients
during the first post-stroke year. Submitted.
Olai L, Omne-Ponten M, Borgquist L, Svärdsudd K: Life situation among informal
caregivers to stroke patients. Preprint.
Olai L: Life after a stroke event: with special reference to aspects on prognosis, health
and municipality care utilization, and life satisfaction among patients and their informal
caregivers. Medical science. Uppsala University; 2010.
Engström S, Gahnberg L, Högberg H, Svärdsudd K: Association between high blood
pressure and deep periodontal pockets - A nested case-referent study. Upsala Journal of
Medical Sciences 2007, 112(1):95-103.
Engström S, Gahnberg L, Högberg H, Svärdsudd K: Efficacy of blood pressure
screening in dental health care. Submitted.
Kallings LV, Leijon M, Hellénius ML, Ståhle A: Physical activity on prescription in
primary health care: a follow-up of physical activity level and quality of life. Scand J
Med Sci Sports 2008, 18:154-161.
Kallings LV, Leijon ME, Kowalski J, Hellénius ML, Ståhle A: Self-reported adherence
- a method for evaluating prescribed physical activity in primary health care patients. J
Phys Act Health 2009, 6:483-492.
Kallings LV: Physical Activity on Prescription -Studies on physical activity level,
adherence and cardiovascular risk factors. Karolinska Institutet; 2008.
Kallings LV, Sierra Johnson J, Fisher RM, de Faire U, Ståhle A, Hemmingsson E,
Hellénius ML: Beneficial effects of individualized physical activity on prescription on
body composition and cardiometabolic risk factors - results from a RCT. Eur J
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Kallings LV: Fysisk aktivitet på recept i Norden – erfarenheter och rekommendationer
[Physical activity on prescription in the Nordic countries – experiences and
recommendations]. In NHV rapport 2010:12 R. Edited by Nordisk nettverk for fysisk
aktivitet mos. Göteborg: Nordiska högskolan för folkhälsovetenskap; 2010:77.
Rodhe N, Englund L, Mölstad S, Svärdsudd K: Asymptomatic bacteriuria in a
population of elderly residents in the community: prevalence, characteristics and
associated factors. Fam Pract 2006, 23(3):303-307.
Rodhe N, Englund L, Mölstad S, Samuelsson E: Bacteriuria is associated with urge
urinary incontinence in older women. Scand J Prim Health Care 2008, 26(1):35-39.
Rodhe N, Löfgren S, Matussek A, André M, Englund L, Kuhn I, Mölstad S:
Asymptomatic bacteriuria in elderly: high prevalence and high turnover of strains.
Scand J Infect Dis 2008, 40(10):804-810.
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Rodhe N, Löfgren S, Strindhall J, Matussek A, Mölstad S: Cytokines in urine in elderly
subjects with acute cystitis and asymptomatic bacteriuria. Scand J Prim Health Care
2009, 27(2):74-79.
Rodhe N: Asymptomatic Bacteriuria in the Elderly. Medical science. Uppsala
University; 2008.
Halford C, Anderzen I, Arnetz B: Endocrine measures of stress and self-rated health - A
longitudinal study. Journal of Psychosomatic Research 2003, 55(4):317-320.
Halford C, Ekselius L, Anderzen I, Arnetz B, Svardsudd K: Self-rated health, life-style,
and psychoendocrine measures of stress in healthy adult women. Upsala Journal of
Medical Sciences 2010, 115(4):266-274.
Halford C, Welin L, Bogefeldt J, Wallman T, Rosengren A, Bardel A, Johannson S,
Eriksson H, Svärdsudd K: Effects of age and secular trends on self-rated health: a
population-based study of nearly 15,000observations among Swedish women and men
during 1973-2003. Submitted.
Halford C: Self-rated health with special reference to prevalence, determinants and
consequences. Medical science. Uppsala University; 2010.
Undergraduate Teaching
Medical programme
– responsibility for “Professional Development” on terms 1-4, with complementary
teaching in "Leadership training" on terms 4-5, 7-8, and 10-11
– responsibility for the course in Family Medicine on term 11 including general practice
and insurance medicine
Registered Nurse Programme
- teaching on various levels
- teaching on various levels
Centres and Facilities
Epidemiology Centre (EpC) at the National Board of Health, Stockholm
The Cardiovascular Epidemiology Group at Sahlgren’s Academy, Gothenburg
National Social Insurance Board
Centre for Clinical Research, Örebro County Council/Uppsala University
Centre for Clinical Research, Dalarna County Council/Uppsala University
Centre for Clinical Research, Gävleborg County Council/Uppsala University
Centre for Clinical Research, Södermanland County Council/Uppsala University
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Scientific Report
Geriatrics
Research Group Leader Professor Lars Lannfelt
Ongoing Research
General description
The main areas of research are molecular studies of dementia as well as clinical and
epidemiological research in these and other age related diseases, such as cardiovascular and
renal disorders. Cellular and transgenic models of Alzheimer’s disease, Parkinson’s disease and
Lewy body dementia are used to understand mechanisms of abnormal protein aggregation in the
brain and to develop new biomarkers and disease-modifying therapies. We are using a broad
repertoire of experimental techniques, e.g. molecular biology, biochemistry, histology and
behavioural analyses in our dementia research.
Aβ protofibrils in Alzheimer’s disease (Assoc. Prof. Frida Ekholm Pettersson)
We are testing our hypothesis that large soluble Aβ oligomers, i.e. protofibrils, are neurotoxic
in Alzheimer’s disease (AD). We have developed mAb158 and other Aβ protofibril selective
monoclonal antibodies (mAbs). With ELISA based on these mAbs, we have found that
increased Aβ protofibril levels correlate with impaired spatial learning in transgenic mice. At
present, we assess brain, CSF, plasma and fibroblasts from AD patients for Aβ protofibril
content. The ultimate goal of these studies is to develop a novel biomarker for early diagnosis of
AD and for evaluation of amyloid-directed therapies.
Moreover, we aim to establish immunotherapeutic strategies for dementia. Immunotherapy is
at present a promising strategy for treating AD and has received great attention worldwide. As a
direct result of our research, a humanized version of mAb158, BAN2401, has now been brought
to clinical trial. A single ascending dose study, launched in the US in August 2010, is carried
out by Eisai Pharmaceuticals of Japan after licensing the rights from BioArctic Neuroscience,
founded by Prof. Lannfelt. Apart from having brought BAN2401 to clinical trial, BioArctic
Neuroscience is seeking to commercialise a number of novel therapeutic and diagnostic tools
generated by the academic group at Uppsala University.
Pathology and amyloid imaging in transgenic Alzheimer’s disease mice (Assoc. Prof.
Lars Nilsson)
For pre-clinical evaluation, we are treating transgenic Alzheimer APP mice with mAb158
and other Aβ protofibril selective mAbs. In addition, another transgenic mouse model for
dementia, expressing human tau, is currently being generated and may be used for future
treatment studies. For development of novel biomarkers, we have developed a new 125Ilabelled antibody-based ligand that detects soluble Aβ protofibrils. The APP transgenic mice are
now examined with micro-PET using this ligand and the general amyloid-ligand 11C-PIB. The
ultimate aim is to bring our new biological ligand to the clinic, as a novel PET marker for early
diagnosis and for monitoring functional decline in patients.
Parkinson’s disease (Assoc. Prof. Martin Ingelsson)
As aggregated proteins in brain is a general feature for neurodegeneration, immunotherapy
could have potential also for other disorders. In Parkinson’s disease, alpha-synuclein deposits as
Lewy bodies and Lewy neurites. As with Aβ in AD, large soluble oligomeric or protofibrillar
forms of alpha-synuclein are believed to be particularly neurotoxic in Parkinson’s disease. We
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are analyzing the formation of such intermediately sized species of α-synuclein, with the aim to
develop new diagnostic and therapeutic principles. We generate recombinant forms of αsynuclein oligomers / protofibrils and analyze these with techniques such as high-performance
liquid chromatography (HPLC), atomic force microscopy, circular dichroism and mass
spectrometry. We are developing mAbs against α-synuclein oligomers / protofibrils and are
currently evaluating them in cell-based and animal models.
Genetics (Dr. Vilmantas Giedraitis)
We are screening for mutations and copy number changes of established dementia-causing
genes and searching for new disease genes with genetic mapping. We have access to a large and
well characterised collection of familial dementia patients, diagnosed with various dementia
disorders. Association studies searching for susceptibility factors are carried out, mainly in
collaboration with other research groups.
Clinical research (Assoc. Profs. Lena Kilander, Björn Zethelius, Johan Ärnlöv and Anna
Cristina Åberg)
The close contact between the laboratory and the Geriatric Clinic at Uppsala University
Hospital facilitates access to appropriate clinical samples. The clinical research unit is currently
categorizing dementia patients clinically and neuropathologically. This research is based on our
own tissue bank with DNA, CSF, plasma, serum, fibroblasts and brain tissues. Longitudinal
studies of dementia patients are carried out in collaboration with the Uppsala PET-center, using
the amyloid-binding PIB ligand together with PET FDG and AD CSF-biomarkers.
Population based investigations have been performed on samples from the Uppsala
Longitudinal Study of Adult Men (ULSAM), a cohort of initially 2322 50-year old men
followed on six occasions since 1970. We have measured plasma levels of Aβ as well as other
proteins and evaluated their respective predictive values for development of AD. Further, the
role of cerebrovascular risk factors and dietary intake of fat as predictors of AD are examined.
Impaired insulin secretion at age 50 has been shown to predict the development of AD at high
age. Another population based cohort of AD patients and healthy controls have been collected,
in which we perform replication studies of genes that have shown association to AD within
ULSAM.
New powerful predictors for disease outcome are explored. An important article on
cardiovascular disease was published in the New England Journal of Medicine in 2008. Data
from Dr Björn Zethelius has shown that in men with or without prevalent cardiovascular
disease, the simultaneous addition of several biomarkers substantially improved the risk
stratification. In yet another epidemiological project, different pathways that may explain the
interplay between kidney damage and the development of cardiovascular disease are explored.
Dr Johan Ärnlöv is involved in international collaborations such as the CKD-prognosis
Consortium and CKDgen. The project has received funding from Vetenskapsrådet and the
Swedish Heart-Lung Foundation and has so far led to several publications in leading journals.
One line of research aims to investigate motor function and physical activity in relation to
health among elderly people. Dr Anna Christina Åberg is studying new methods for clinical
motor function assessment, as well as a potential association between motor function and
subjective health aspects, such as life satisfaction and fear of falling. The research is mainly
directed towards elderly with a need for rehabilitation due to multiple diseases/functional
limitations, and those with specific neurological or neurodegenerative diagnoses, such as stroke
or AD.
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Ongoing, particularly successful, research
Our translational research efforts have been very successful and we have maintained an
international visibility and high quality of publications. Among the expanded and new efforts,
we have a particular focus on developing better principles of imaging and diagnostics for
Alzheimer’s disease and explore possibilities for novel future therapeutics against αsynucleinopathies (Parkinson’s disease and Lewy body dementia). We are one of several groups
focusing on protein aggregation and age-related amyloid diseases in Uppsala (Torleif Härd,
Gunilla and Per Westermark and Jan Johansson are leading the other groups). The scientific
environment in Uppsala provides a unique opportunity for collaborative efforts to increase
knowledge on mechanisms underlying amyloid disorders, especially within the Berzelii Centre
for Neurodiagnostics and in Sci Life Lab. We also believe it would be justified to increase
support of our research considering the great unmet medical needs.
Compared to other dementia research teams in Sweden our focus on molecular mechanisms
in the pathogenesis of Alzheimer’s disease has been very successful. We have a clear scientific
strategy and a good research structure. Each larger project is headed by an associate professor.
The preclinical and clinical activities have been successfully integrated in Uppsala, which
enables a more efficient translational research process. A very fruitful collaboration has been
created since Björn Zethelius joined the scientific data group of the Swedish National Diabetes
Register in 2007.
The most promising research lines in a 5-10 year perspective
In 2009, we started to collaborate with GE Healthcare and Imanet on the development of
imaging, targeting soluble Aβ with engineered antibody-fragments. Antibody-based ligands are
new in PET imaging. The project was funded by a three-year grant from VINNOVA and two
postdoctoral fellows were hired. Within only one year, we have rapidly generated promising in
vitro and ex vivo data with a 125I-labelled antibody.
Prizes and awards
Prof. Lannfelt was awarded the “2010 Alzheimer Research Forum Outstanding Contributor
Award”.
External recrutiments
Hedvig Welander (Karolinska Institutet), Charlotte Nerelius (SLU), Marie Svedberg
(Karolinska Institutet)
Kristina Magnusson, Veronica Lindström
New projects with external funding
VINNOVA (2009-2012; 7500 KSEK), New amyloid-β (Aβ) PET markers for Alzheimer’s
disease. Swedish Brain Foundation, The Parkinson Foundation in Sweden (800 KSEK
annually), Alfa-synuclein oligomers/protofibrils in disorders with alpha-synuclein pathology.
International collaborations
Guest visits in foreign laboratories
Thomas Näsström (with Dr. Tiago Outiero, Lisbon, Portugal; Febr-May 2010)
Foreign collaborative partners
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Harvard Medical School, NIH, University of Goettingen, University of Kuopio, University of
Ulm, INSERM, Max Planck/Berlin- 7 publications, Swedish National Diabetes Register- 11
publications, DECODE, A European diabetes research collaboration– 9 publications, Århus
University, Denmark, profesor A Flyvbjerg– 4 publications, Odense University, Denmark,
professor J Juul Holst – 2 publications, University of Tuebingen, University of Lisbon,
Institut Pasteur de Lille, University of California San Diego, University of California San
Francisco, Mental Health Research Institute, Parkville Australia – manuscripts in progress
Adjunct professors
Hans Basun, BioArctic Neuroscience, 2005; Håkan Hall, Uppsala Applied Science
Laboratory, GE Healthcare, 2010
Patents
a) US7709695, transgenic mouse expressing arctic mutation E693G (LL, LN)- 2010
b) NZ567888, improved protofibril-selective antibodies and use thereof (LL, FE)- 2010
c) US2007248606, treatment for Alzheimer´s disease (LL) - 2007
d) FP1450us00, Tau transgenic mouse, US provisional application (LN) - 2009
e) 61/048,865, Antibodies and vaccines for use in therapeutic and diagnostic methods for
Parkinson’s disease, dementia with Lewy bodies and other neurodegenerative disorders
(LL, MI) -2008
f) Antibodies and vaccines for use in therapeutic and diagnostic methods for IAPP-related
disorders, US Provisional Application 61/333489 (LL, MI) - 2010
Engagement in the external society
Swedish association of local authorities and regions, Stockholm. Prevent falls and fall injuries
in health care (national campaign for patient safety). Stockholm, 2008. (ACÅ), Membership of
The Regional Ethics Review Board (REPN) in Uppsala (LK, BZ, ACÅ). Membership of the
Quality assurance group (Q) at the Medical Products Agency since February 2010 (BZ).
Personnel
1. Professors – Lars Lannfelt (chair), Hans Basun (adjunct), Håkan Hall (adjunct) 2.
University lecturer – Lena Kilander 3. Researchers – Lars Nilsson, Martin Ingelsson, Xiao
Zhang, Vilmantas Giedraitis, Frida Ekholm-Pettersson, Joakim Bergström Johan Ärnlöv, Björn
Zethelius, Anna Cristina Åberg 4. Postdocs and research assistants – Charlotte Nerelius, Hedvig
Welander, Kristina Magnusson, Ola Philipson, Veronica Lindström, Marie Svedberg, Dag
Sehlin, Bernice Wiberg, Johan Sundelöf, Hans-Erik Johansson 5. PhD students – Astrid
Gumucio, Paul O’Callaghan, Sofia Söllvander, Therese Fagerqvist, Thomas Näsström, Malin
Degerman-Gunnarsson, Elina Rönnemaa, Ylva Cedervall 6. Other personnel – AnneMarie
Ljungberg (BMA), Sofie Ingvast (BMA), RoseMarie Brundin, Gunilla Gertz (research nurses).
New associated professors
Martin Ingelsson 2009, Johan Ärnlöf 2009, Anna Cristina Åberg 2010, Lena Kilander 2010,
Frida Ekholm Pettersson 2011
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PhD theses
Elin Blom (2008) Genetic Studies of Alzheimer's Disease.
Lena Skoglund (2009) Molecular Mechanisms of Frontotemporal Lobar Degeneration.
Anna Lord (2009) Targeting Early Stages of Alzheimer's Disease in a Transgenic Model.
Hillevi Englund (2009) Soluble amyloid-β aggregates in Alzheimer's disease.
Lars Berglund (2009) Measurement Variability Related to Insulin Secretion and Sensitivity:
Assessment and Implications in Epidemiological Studies.
Ola Philipson (2010) Modeling Amyloid-ß Pathology in Alzheimer's Disease Using the
Arctic Mutation.
Dag Sehlin (2010) Aβ Conformation Dependent Antibodies and Alzheimer’s Disease
Hans-Erik Johansson (2010) The impact of bariatric surgery on obesity related metabolic
traits with specific emphasis on glucose, insulin and proinsulin dynamics.
Bernice Wiberg (2010) Risk Factors for Stroke, in Adult Men. A Population-based Study.
Johan Sundelöf (2011) Amyloid Beta-Protein, Cystatin C and Cathepsin B as Biomarkers of
Alzheimer’s Disease.
Licentiate theses
Kerstin Kullberg (2009) Food in older men with somatic diseases. Eating habits and
approaches to food-related activities.
Original articles
1.
Andersson K, Karlström B, Fredén S, Petersson H, Öhrvall M, Zethelius B. A two-year
clinical lifestyle intervention program for weight loss in obesity. Food Nutr Res 2008; 52.
2.
Auro K, Kristiansson K, Zethelius B, Berne C, Lannfelt L, Taskinen MR, Jauhiainen M,
Perola M, Peltonen L, Syvänen AC. USF1 gene variants contribute to metabolic traits in
men in longitudinal 32-year follow-up study. Diabetologia 2008; 51: 464-472.
3. Basun H, Bogdanovic N, Ingelsson M, Almkvist O, Näslund J, Axelman K, Bird TD,
Nochlin D, Schellenberg GD, Wahlund LO, Lannfelt L. Clinical and neuropathological
features of the arctic APP gene mutation causing early-onset Alzheimer disease. Arch
Neurol 2008; 65: 499-505.
4.
Berglund L, Garmo H, Lindback J, Svärdsudd K, Zethelius B. Maximum likelihood
estimation of correction for dilution bias in simple linear regression using replicates from
subjects with extreme first measurements. Stat Med 2008; 27: 4397-4407.
5.
Bertram L, Schjeide BM, Hooli B, Mullin K, Hiltunen M, Soininen H, Ingelsson M,
Lannfelt L, Blacker D, Tanzi RE. No association between CALHM1 and Alzheimer's
disease risk. Cell 2008; 135: 993-994; author reply 994-996.
6.
Blom ES, Holmans P, Arepalli S, Adighibe O, Hamshere ML, Gatz M, Pedersen NL,
Bergem AL, Owen MJ, Hollingworth P, Goate A, Williams J, Lannfelt L, Hardy J,
Wavrant-De Vrièze F, et al. Does APOE explain the linkage of Alzheimer's disease to
chromosome 19q13? Am J Med Genet B Neuropsychiatr Genet 2008; 147B: 778-783.
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7.
Blom ES, Viswanathan J, Kilander L, Helisalmi S, Soininen H, Lannfelt L, Ingelsson M,
Glaser A, Hiltunen M. Low prevalence of APP duplications in Swedish and Finnish
patients with early-onset Alzheimer's disease. Eur J Hum Genet 2008; 16: 171-175.
8.
Cederholm J, Eeg-Olofsson K, Eliasson B, Zethelius B, Nilsson PM, Gudbjörnsdóttir S,
Swedish National Diabetes R. Risk prediction of cardiovascular disease in type 2 diabetes:
a risk equation from the Swedish National Diabetes Register. Diabetes Care 2008; 31:
2038-2043.
9.
Engler H, Santillo AF, Wang SX, Lindau M, Savitcheva I, Nordberg A, Lannfelt L,
Långström B, Kilander L. In vivo amyloid imaging with PET in frontotemporal dementia.
Eur J Nucl Med Mol Imaging 2008; 35: 100-106.
10. Freund-Levi Y, Basun H, Cederholm T, Faxen-Irving G, Garlind A, Grut M, Vedin I,
Palmblad J, Wahlund LO, Eriksdotter-Jonhagen M. Omega-3 supplementation in mild to
moderate Alzheimer's disease: effects on neuropsychiatric symptoms. Int J Geriatr
Psychiatry 2008; 23: 161-169.
11. Gao W, Group DS. Does the constellation of risk factors with and without abdominal
adiposity associate with different cardiovascular mortality risk? Int J Obes (Lond) 2008; 32:
757-762.
12. Holdstock C, Zethelius B, Sundbom M, Karlsson FA, Edén Engström B. Postprandial
changes in gut regulatory peptides in gastric bypass patients. Int J Obes (Lond) 2008; 32:
1640-1646.
13. Ingelsson E, Hulthe J, Lind L. Inflammatory markers in relation to insulin resistance and the
metabolic syndrome. Eur J Clin Invest 2008; 38: 502-509.
14. Ingelsson E, Risérus U. Effects of trans10cis12CLA-induced insulin resistance on retinolbinding protein 4 concentrations in abdominally obese men. Diabetes Res Clin Pract 2008;
82: e23-24.
15. Ingelsson E, Syvänen AC, Lind L. Endothelium-dependent vasodilation in conduit and
resistance vessels in relation to the endothelial nitric oxide synthase gene. J Hum Hypertens
2008; 22: 569-578.
16. Ingelsson E, Syvänen AC, Lind L. Polymorphisms in the estrogen receptor alpha gene and
endothelial function in resistance and conduit arteries in the elderly. Atherosclerosis 2008;
199: 162-171.
17. Kullberg K, Åberg AC, Björklund A, Ekblad J, Sidenvall B. Daily eating events among coliving and single-living, diseased older men. J Nutr Health Aging 2008; 12: 176-182.
18. Lannfelt L, Blennow K, Zetterberg H, Batsman S, Ames D, Harrison J, Masters CL, Targum
S, Bush AI, Murdoch R, Wilson J, Ritchie CW. Safety, efficacy, and biomarker findings of
PBT2 in targeting Abeta as a modifying therapy for Alzheimer's disease: a phase IIa,
double-blind, randomised, placebo-controlled trial. Lancet Neurol 2008; 7: 779-786.
19. Michaëlsson K, Lind L, Frystyk J, Flyvbjerg A, Gedeborg R, Berne C, Zethelius B, Mallmin
H, Söderberg S, Melhus H. Serum adiponectin in elderly men does not correlate with
fracture risk. J Clin Endocrinol Metab 2008; 93: 4041-4047.
20. Nerpin E, Risérus U, Ingelsson E, Sundström J, Jobs M, Larsson A, Basu S, Ärnlöv J.
Insulin sensitivity measured with euglycemic clamp is independently associated with
glomerular filtration rate in a community-based cohort. Diabetes Care 2008; 31: 15501555.
21. O'Callaghan P, Sandwall E, Li JP, Yu H, Ravid R, Guan ZZ, van Kuppevelt TH, Nilsson
LN, Ingelsson M, Hyman BT, Kalimo H, Lindahl U, Lannfelt L, Zhang X. Heparan sulfate
accumulation with Abeta deposits in Alzheimer's disease and Tg2576 mice is contributed
by glial cells. Brain Pathol 2008; 18: 548-561.
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22. Rönnemaa E, Zethelius B, Sundelöf J, Sundström J, Degerman-Gunnarsson M, Berne C,
Lannfelt L, Kilander L. Impaired insulin secretion increases the risk of Alzheimer disease.
Neurology 2008; 71: 1065-1071.
23. Skoglund L, Viitanen M, Kalimo H, Lannfelt L, Jonhagen ME, Ingelsson M, Glaser A,
Herva R. The tau S305S mutation causes frontotemporal dementia with parkinsonism. Eur
J Neurol 2008; 15: 156-161.
24. Sundelöf J, Giedraitis V, Irizarry MC, Sundström J, Ingelsson E, Rönnemaa E, Ärnlöv J,
Gunnarsson MD, Hyman BT, Basun H, Ingelsson M, Lannfelt L, Kilander L. Plasma beta
amyloid and the risk of Alzheimer disease and dementia in elderly men: a prospective,
population-based cohort study. Arch Neurol 2008; 65: 256-263.
25. Sundelöf J, Ärnlöv J, Ingelsson E, Sundström J, Basu S, Zethelius B, Larsson A, Irizarry
MC, Giedraitis V, Rönnemaa E, Degerman-Gunnarsson M, Hyman BT, Basun H, Kilander
L, Lannfelt L. Serum cystatin C and the risk of Alzheimer disease in elderly men.
Neurology 2008; 71: 1072-1079.
26. Sundsten T, Zethelius B, Berne C, Bergsten P. Plasma proteome changes in subjects with
Type 2 diabetes mellitus with a low or high early insulin response. Clin Sci (Lond) 2008;
114: 499-507.
27. Sundström J, Ärnlöv J, Stolare K, Lind L. Blood pressure-independent relations of left
ventricular geometry to the metabolic syndrome and insulin resistance: a population-based
study. Heart 2008; 94: 874-878.
28. Vedin I, Cederholm T, Freund Levi Y, Basun H, Garlind A, Faxen Irving G, Jonhagen ME,
Vessby B, Wahlund LO, Palmblad J. Effects of docosahexaenoic acid-rich n-3 fatty acid
supplementation on cytokine release from blood mononuclear leukocytes: the OmegAD
study. Am J Clin Nutr 2008; 87: 1616-1622.
29. Wei JF, Wei L, Zhou X, Lu ZY, Francis K, Hu XY, Liu Y, Xiong WC, Zhang X, Banik NL,
Zheng SS, Yu SP. Formation of Kv2.1-FAK complex as a mechanism of FAK activation,
cell polarization and enhanced motility. J Cell Physiol 2008; 217: 544-557.
30. Vellas B, Andrieu S, Sampaio C, Coley N, Wilcock G, European Task Force group.
Endpoints for trials in Alzheimer's disease: a European task force consensus. Lancet Neurol
2008; 7: 436-450.
31. Zethelius B, Berglund L, Hänni A, Berne C. The interaction between impaired acute insulin
response and insulin resistance predict type 2 diabetes and impairment of fasting glucose:
report from a 20-year follow-up in the Uppsala Longitudinal Study of Adult Men ULSAM. Ups J Med Sci 2008; 113: 117-130.
32. Zethelius B, Berglund L, Sundström J, Ingelsson E, Basu S, Larsson A, Venge P, Ärnlöv J.
Use of multiple biomarkers to improve the prediction of death from cardiovascular causes.
N Engl J Med 2008; 358: 2107-2116.
33. Åberg AC. Care recipients' perceptions of activity-related life space and life satisfaction
during and after geriatric rehabilitation. Qual Life Res 2008; 17: 509-520.
34. Ärnlöv J, Zethelius B. Ny kombination av markörer kan förbättra riskbedömningen vid
hjärt-kärlsjukdom. Lakartidningen 2008; 105: 2088.
35. Berglund L, Berne C, Svärdsudd K, Garmo H, Zethelius B. Early insulin response and
insulin sensitivity are equally important as predictors of glucose tolerance after correction
for measurement errors. Diabetes Res Clin Pract 2009; 86: 219-224.
36. Blom ES, Giedraitis V, Arepalli S, Hamshere ML, Adighibe O, Goate A, Williams J,
Lannfelt L, Hardy J, Vrièze FW, Glaser A. Further analysis of previously implicated
linkage regions for Alzheimer's disease in affected relative pairs. BMC Med Genet 2009;
10: 122.
106
37. Blom ES, Giedraitis V, Zetterberg H, Fukumoto H, Blennow K, Hyman BT, Irizarry MC,
Wahlund LO, Lannfelt L, Ingelsson M. Rapid progression from mild cognitive impairment
to Alzheimer's disease in subjects with elevated levels of tau in cerebrospinal fluid and the
APOE epsilon4/epsilon4 genotype. Dement Geriatr Cogn Disord 2009; 27: 458-464.
38. Byberg L, Melhus H, Gedeborg R, Sundström J, Ahlbom A, Zethelius B, Berglund LG,
Wolk A, Michaëlsson K. Total mortality after changes in leisure time physical activity in
50 year old men: 35 year follow-up of population based cohort. Br J Sports Med 2009; 43:
482.
39. Cederholm J, Nilsson PM, Eliasson B, Eeg-Olofsson K, Zethelius B, Gudbjörnsdóttir S,
utdatagrupp ND. Connections between risk factors and complications in diabetes. A report
after 13 years with the National Diabetes Registry (NDR). Lakartidningen 2009; 106:
2684-2689.
40. Cederholm J, Zethelius B, Nilsson PM, Eeg-Olofsson K, Eliasson B, Gudbjörnsdóttir S,
Swedish National Diabetes R. Effect of tight control of HbA1c and blood pressure on
cardiovascular diseases in type 2 diabetes: an observational study from the Swedish
National Diabetes Register (NDR). Diabetes Res Clin Pract 2009; 86: 74-81.
41. Eeg-Olofsson K, Cederholm J, Nilsson PM, Zethelius B, Nunez L, Gudbjörnsdóttir S,
Eliasson B. Risk of cardiovascular disease and mortality in overweight and obese patients
with type 2 diabetes: an observational study in 13,087 patients. Diabetologia 2009; 52: 6573.
42. Emerging Risk Factors Collaboration, Di Angelantonio E, Sarwar N, Perry P, Kaptoge S,
Ray KK, Thompson A, Wood AM, Lewington S, Sattar N, Packard CJ, Collins R,
Thompson SG, Danesh J. Major lipids, apolipoproteins, and risk of vascular disease. JAMA
2009; 302: 1993-2000.
43. Englund H, Degerman Gunnarsson M, Brundin RM, Hedlund M, Kilander L, Lannfelt L,
Pettersson FE. Oligomerization partially explains the lowering of Abeta42 in Alzheimer's
disease cerebrospinal fluid. Neurodegener Dis 2009; 6: 139-147.
44. Freund-Levi Y, Hjorth E, Lindberg C, Cederholm T, Faxen-Irving G, Vedin I, Palmblad J,
Wahlund LO, Schultzberg M, Basun H, Eriksdotter Jonhagen M. Effects of omega-3 fatty
acids on inflammatory markers in cerebrospinal fluid and plasma in Alzheimer's disease:
the OmegAD study. Dement Geriatr Cogn Disord 2009; 27: 481-490.
45. Frykberg GE, Åberg AC, Halvorsen K, Borg J, Hirschfeld H. Temporal coordination of the
sit-to-walk task in subjects with stroke and in controls. Arch Phys Med Rehabil 2009; 90:
1009-1017.
46. Giedraitis V, Kilander L, Degerman-Gunnarsson M, Sundelöf J, Axelsson T, Syvänen AC,
Lannfelt L, Glaser A. Genetic analysis of Alzheimer's disease in the Uppsala Longitudinal
Study of Adult Men. Dement Geriatr Cogn Disord 2009; 27: 59-68.
47. Gudbjörnsdóttir S, Eeg-Olofsson K, Cederholm J, Zethelius B, Eliasson B, Nilsson PM,
Swedish National Diabetes R. Risk factor control in patients with Type 2 diabetes and
coronary heart disease: findings from the Swedish National Diabetes Register (NDR).
Diabet Med 2009; 26: 53-60.
48. Hagström E, Hellman P, Larsson TE, Ingelsson E, Berglund L, Sundström J, Melhus H,
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141. Wesnes K, Edgar C, Andreasen N, Annas P, Basun H, Lannfelt L, Zetterberg H, Blennow
K, Minthon L. Computerized cognition assessment during acetylcholinesterase inhibitor
treatment in Alzheimer's disease. Acta Neurol Scand 2010; 122: 270-277.
142. Wiberg B, Lind L, Kilander L, Zethelius B, Sundelöf JE, Sundström J. Cognitive function
and risk of stroke in elderly men. Neurology 2010; 74: 379-385.
143. Wiberg H, Ek P, Pettersson FE, Lannfelt L, Emmer A, Roeraade J. Separation and
characterization of aggregated species of amyloid-beta peptides. Anal Bioanal Chem 2010;
397: 2357-2366.
144. Wiig EH, Annas P, Basun H, Andreasen N, Lannfelt L, Zetterberg H, Blennow K, Minthon
L. The stability of AQT processing speed, ADAS-Cog and MMSE during
acetylcholinesterase inhibitor treatment in Alzheimer's disease. Acta Neurol Scand 2010;
121: 186-193.
145. Wirths O, Bethge T, Marcello A, Harmeier A, Jawhar S, Lucassen PJ, Multhaup G, Brody
DL, Esparza T, Ingelsson M, Kalimo H, Lannfelt L, Bayer TA. Pyroglutamate Abeta
pathology in APP/PS1KI mice, sporadic and familial Alzheimer's disease cases. J Neural
Transm 2010; 117: 85-96.
146. Wirths O, Erck C, Martens H, Harmeier A, Geumann C, Jawhar S, Kumar S, Multhaup G,
Walter J, Ingelsson M, Degerman-Gunnarsson M, Kalimo H, Huitinga I, Lannfelt L, Bayer
TA. Identification of low molecular weight pyroglutamate abeta oligomers in Alzheimer
disease: a novel tool for therapy and diagnosis. J Biol Chem 2010.
147. Zhou XH, Qiao Q, Zethelius B, Pyorala K, Soderberg S, Pajak A, Stehouwer CD, Heine
RJ, Jousilahti P, Ruotolo G, Nilsson PM, Calori G, Tuomilehto J, Group DS. Diabetes,
prediabetes and cancer mortality. Diabetologia 2010; 53: 1867-1876.
114
148. Åberg AC, Frykberg GE, Halvorsen K. Medio-lateral stability of sit-to-walk performance
in older individuals with and without fear of falling. Gait Posture 2010; 31: 438-443.
149. Ärnlöv J, Ingelsson E, Sundström J, Lind L. Impact of body mass index and the metabolic
syndrome on the risk of cardiovascular disease and death in middle-aged men. Circulation
2010; 121: 230-236.
150. Ärnlöv J, Sundström J, Ingelsson E, Lind L. The Impact of Body Mass Index and the
Metabolic Syndrome on the Risk of Diabetes in Middle-Aged Men. Diabetes Care 2010.
151. Hansson J, Vasan RS, Ärnlöv J, Ingelsson E, Lind L, Larsson A, Michaëlsson K,
Sundström J. Biomarkers of extracellular matrix metabolism (MMP-9 and TIMP-1) and
risk of stroke, myocardial infarction, and cause-specific mortality: cohort study. PLoS One
2011; 6: e16185.
152. Jacobsson JA, Rask-Andersen M, Risérus U, Moschonis G, Koumpitski A, Chrousos GP,
Lannfelt L, Marcus C, Gyllensten U, Schiöth HB, Fredriksson R. Genetic variants near the
MGAT1 gene are associated with body weight, BMI and fatty acid metabolism among
adults and children. Int J Obes (Lond) 2011.
153. Nerpin E, Ingelsson E, Risérus U, Sundström J, Larsson A, Jobs E, Jobs M, Hallan S,
Zethelius B, Berglund L, Basu S, Ärnlöv J. The combined contribution of albuminuria and
glomerular filtration rate to the prediction of cardiovascular mortality in elderly men.
Nephrol Dial Transplant 2011.
154. Näsström T, Fagerqvist T, Barbu M, Karlsson M, Nikolajeff F, Kasrayan A, Ekberg M,
Lannfelt L, Ingelsson M, Bergström J. The lipid peroxidation products 4-oxo-2-nonenal and
4-hydroxy-2-nonenal promote the formation of alpha-synuclein oligomers with distinct
biochemical, morphological, and functional properties. Free Radic Biol Med 2011; 50: 428437.
Books
1. Nyström F, ed. Hypertoni och metabola syndromet. Studentlitteratur, 2008. B. Zethelius is an
author of one chapter.
2. Agardh C-J, Berne C, eds. Diabetes. 4 ed. Liber, 2009. B. Zethelius is an author of one
chapter.
3. Halvarsson K, Zethelius B, eds. Fetma medicinsk behandling och kognitiv beteendeterapi.
Studentlitteratur, 2009. B. Zethelius is an author of three chapters.
4. Kilander L, Landahl P, Ingelsson M. O, min man- om den förbryllande sjukdomen
frontallobsdemens. Gothia, 2009.
5. Zhang X, Li J-P. Heparan Sulfate Proteoglycans in Amyloidosis. Progress in Molecular
Biology and Translational Science, Vol. 93; 2010. p 309-34.
6. Lingren S, Engström-laurent A, Karason K, Jansson ET, eds. Internmedicin. Studentlitteratur,
2011, in press. B. Zethelius is an author of one chapter.
7. Läkemedelsboken 2011-2012. Läkemedelsverket, 2011, in press. B. Zethelius is an author of
one chapter.
115
Scientific Reports
Health Services Research
Research Group Leaders Associate Professor Inger Holmström and Associate
Professor Ulrika Winblad
The aim of Helath Services Research (HSR) in Europe is to evaluate and improve the
contribution of health services research for evidence- informed health care policy. HSR adopts
three contrasting but interconnected perspectives; at care provision - organisational - and system
level. The Uppsala group is engaged in research at all three levels with focus on governance and
implementation, intra-organisational control, inter-organisational relations and patient relations.
More specifically, current study objectives include development of exploratory models for
differences in public and private care, identification of barriers for implementation of patient
choice reforms as well as identification of facilitators for patient centred care, especially within
telecare. The group is multidisciplinary and the researchers have different professional
backgrounds such as medicine, psychology, nursing and political science.
Members of the research group during 2010
Inger Holmström, RN, PhD, associate professor, research group leader
Ulrika Winblad, PhD, associate professor, vice group leader
Caroline Andersson, MSc, research assistant
Pia Bastholm Rahmner, PhD
Cecilia Bernsten, Registered pharmacist, PhD, associate professor
Ingeborg Björkman, Registered pharmacist, PhD
Madeleine Boll, Physiotherapist, Licentiate, PhD student
Eva Boström, RN, PhD
Gunilla Brattberg, MD, PhD, associate professor
Helène Eriksson, administrator
Annica Ernesäter, RN, MSc, PhD student
Mio Fredriksson, MSc, PhD student
Roya Hakimnia, MSc (Medicine), PhD student
Finn Hjelmblink, MD, PhD
Johan Hopfgarten, Medical student, research assistant
David Isaksson, BSc, research assistant
Elenor Kaminsky, RN, BSc, PhD student
Dorte Kjeldmand, MD, PhD
Jan Larsson, MD, PhD
Åsa Muntlin Athlin, RN, PhD
Martin Rejler, MD, PhD student
Urban Rosenqvist, MD, Professor emeritus
Marta Röing, DDS, PhD
Margareta Sanner, Registered psychologist, PhD, associate professor
Ragnar Stolt, Licentiate, PhD student
Anikó Vég, PhD
116
Publications 2008-2010
1. Arakelian, E., Gunningberg, L., Larsson, J. How operating room efficiency is
understood in a surgical team: a qualitative study. International Journal for Quality in
Health Care. In press 2010.
2. Arving, C., Holmström, I. Creating a new profession in cancer nursing? - Experiences
of working as a psychosocial nurse in cancer care. Journal of Clinical Nursing. In press
2010.
3. Boll, M., Rosenqvist, U. Variations in how physiotherapists understand their work on
organizational and societal levels. Physiotherapy Research International. In press 2010
Tully, MP., Beckman-Gyllenstrand, A., Bernsten, C. Factors predicting poor
counselling about prescription medicines in Swedish community pharmacies. Patient
Education and Counseling. In press 2010.
4. Flodén, A., Sanner, MA. Attitudes to organ donation among Swedish ICU nurses.
Journal of Clinical Nursing, Accepted 2010.
5. Winblad, U., Andersson, C. 2010. Kåren och köerna. En ESO-rapport om den
medicinska professionens roll i styrningen av svensk hälso- och sjukvård. En rapport till
Expertgruppen för studier i offentlig ekonomi (ESO), 2010:9.
6. Björkman, I., Berg, J., Röing, M., Erntell, M., Lundborg, CS. Perceptions among
Swedish hospital physicians on prescribing of antibiotics and antibiotic resistance.
Quality & Safety in Health Care, 2010 Dec;19(6):e.
7. Kaminsky, E., Carlsson, M., Höglund, A., Holmström, I. Paediatric health calls to
Swedish telenurses: a descriptive study of content and outcome. Journal of
Telemedicine and Telecare, 2010 Dec:16(8) 454-57.
8. Jangland, E., Larsson, J., Gunningberg. L. Surgical nurses' different understandings of
their interactions with patients: a phenomenographic study. Scandinavian Journal of
Caring Sciences, article first published online: 16 Dec 2010
9. Kjeldmand, D., Holmström, I. Difficulties in Balint Groups: a qualitative study of
leaders’ experiences. British Journal of General Practice, 2010 Nov;60(580):808-14.
10. Arnetz,, J. E., Winblad, U., Höglund, A. T., Lindahl, B., Spångberg, K., Wallentin, L.,
Wang, Y., Ager, J., Arnetz, B. Is patient involvement during hospitalization for acute
myocardial infarctial infarction associated with post-discharge treatment outcome? An
exploratory study. Health Expectations, 2010 Sep;13(3):298-311.
11. Höglund, A.T., Winblad, U., Arnetz, B., Arnetz, J. E. Patient participation during
hospitalization for myocardial infarction: Perceptions among patients and personnel.
Scandinavian Journal of Caring Sciences, 2010 Sep;24(3):482-89.
12. Muntlin, Å., Carlsson, M., Gunningberg, L. Barriers to change hindering quality
improvement - the reality of emergency care. Interviews with healthcare professionals.
Journal of Emergency Nursing, 2010 Jul;36(4):317-23.
117
13. Sanner, MA., Lagging, E., Tibell, A. The kidney recipients' path to transplantation: a
comparison between living and deceased kidney donor recipients in Stockholm,
Sweden. Nephrology, Dialysis, Transplantation, 2010 Jul:28.
14. Larsson, J., Sanner, M. Doing a good job and getting something good out of it: on
stress and well-being in anaesthesia. British Journal of Anaesthesia, 2010
Jul;105(1):34-7.
15. Ernesäter, A., Engström, M., Holmström, I., Winblad, U. Incident reporting within
nurse-led national telephone triage in Sweden: reported errors reveal a pattern that
needs to be broken. Journal of Telemedicine and Telecare, 2010 Jul;16(5):243-7.
16. Larsson, J., Gordh, TE. Testing whether the epidural works: too time consuming? Acta
Anaesthesiologica Scandinavica, 2010 Jul;54(6):761-3.
17. Or Z, Cases C, Lisac M, Vrangbæk K, Winblad U, Bevan G. Are health problems
systemic? Politics of access and choice under Beveridge and Bismarck systems. Health
Economics, Policy and Law, 2010 Jul;5(03):269-93.
18. Boll, M., Boström Lindberg, E. Physiotherapists’ understanding and approach to
health promotion work in compulsory school: perceiving and supporting coherence.
Physiotherapy Theory and Practice, 2010 Jul;26(5):318-26.
19. Holmström, I. Diabetes telehealth and computerized decision support systems: a sound
system with a human touch is needed. Journal of Diabetes Science and Technology,
2010 Jul;4(4):1012-5.
20. Hjelmblink, F., Holmström, I., Kjeldmand, D. Stroke patients’ delay of emergency
treatment. Scandinavian Journal of Caring Sciences, 2010 Jun;24(2):307-11.
21. Holmström, I., Röing, M. The relation between patient-centeredness and patient
empowerment: A discussion on concepts. Patient Education and Counseling, 2010
May;79(2):167-172.
22. Bernsten, C., Andersson, K., Gariepy, Y., Simoens, S. A comparative analysis of
remuneration models for pharmaceutical professional services. Health Policy, 2010
Apr;92(1):1-9.
23. Bastholm Rahmner, P., Gustafsson, LL., Holmström, I., Rosenqvist, U., Tomson, G.
Whose job is it anyway?: Swedish general practitioners’ perception of their
responsibility for the patient's drug list. Annals of Family Medicine, 2010
Jan/Feb;8(1):40-6.
24. Muntlin, Å. Hur kan vi som sjuksköterskor förbättra vården på akutmottagningar för
patienter som söker för buksmärta? (How could nurses improve the pain management in
the emergency department for patients with abdominal pain?). Smärta, 2010;3:16-9. In
Swedish.
25. Winblad, U., Vrangbaeck, K., Östergren, K. Do the waiting-time guarantees in the
Scandinavian countries empower patients? International Journal of Public Sector
Management, 2010;23(4):353-63.
26. Fahlén, M., Rosenqvist, U. Snomed CT kan ge vårdens journalsystem gemensam röst:
Internationell referensterminologi nu redo för praktiska test. Läkartidningen,
2010;107(11):760-3.
118
27. Hughes, CM., Hawwa, AF., Scullin, C., Anderson, C., Bernsten, CB., et al. Provision
of pharmaceutical care by community pharmacists: a comparison across Europe.
Pharmacy World & Science, 2010;32(4):472-87.
28. Eiermann, B., Bastholm Rahmner, P., Korkmaz, S., Lilja, B., Vég A., Wettermark, B.,
et al. Knowledge databases for clinical decision support in drug prescribingdevelopment, quality assurance, management, integration, implementation and
evaluation of clinical value. Chapter in Clinical Decision Support, Vienna 2010.
29. Olsson, J., Bergman, Å., Carlsten, A., Thimothy, O., Bernsten, C., Schmidt, IK.,
Fastbom, J. Quality of drug prescribing in elderly people in nursing homes and special
care units for dementia: a cross-sectional computerized pharmacy register analysis.
Clinical Drug Investigation, 2010;30(5):289-300.
30. Or, Z., Cases, C., Lisac, M., Vrangbaeck, K., Winblad, U., Bevan, G. “Are Health
Problems Systemic? Politics of Access and Choice under Beveridge and Bismarck
Systems.” Report no 27, IRDES, Paris, September 2009.
31. Winblad, U., Ringard, Å., “Meeting rising public expectations: the changing roles of
patients and citizens”. I: Magnusson, J., Vrangbaeck, K., Saltman, B, R. (eds.) (2009),
Nordic Health Care Systems: Recent Reforms and Current Policy Challenges.
Maidenhead: Open University Press.
32. Röing, M., Hirsch, JM., Holmström, I., Schuster, M., Making new meanings of being
in the world after treatment for oral cancer. Qualitative Health Research, 2009
Aug;19(8):1076-86.
33. Winblad, U., Andersson, C., Isaksson, D., “Kundval i hemtjänsten – Erfarenheter av
information och uppföljning”, Sveriges Kommuner och Landsting, 2009.
34. Hjelmblink, F., Holmström, I., Sanner, M., The meaning of rehabilitation for older
people who have survived stroke. Journal of Nursing and Healthcare of Chronic
Illness, 2009 Jun;1(2):186-95.
35. Ernesäter, A., Holmström, I., Engström, M. Telenurses' experiences of working with
computerized decision support: supporting, inhibiting and quality improving. Journal of
Advanced Nursing, 2009 May;65(5):1074-83.
36. Bastholm Rahmner, P., Gustafsson, LL., Larsson, J., Rosenqvist, U., Tomson, G.,
Holmström, I., Variations in understanding the drug prescribing process: A qualitative
study among Swedish general practitioners. Family Practice, 2009 Apr;26(2):121-7.
37. Larsson, J., Studying Tacit Knowledge in Anesthesiology: a Role for Qualitative
Research. Anesthesiology, 2009 Mar;110(3):443-4.
38. Stolt, R., Winblad, U., Mechanisms behind privatization: A case study of private
growth in Swedish elderly care. Social Science & Medicine, 2009 Mar;68(5):903-11.
39. Kaminsky, E., Rosenqvist, U., Holmström, I., Telenurses understanding of work:
detective or educator? Journal of Advanced Nursing, 2009 Feb; 65(2):382-90.
40. Kunkel, S., Rosenqvist, U., Westerling, R. Implementation strategies influence the
structure, process and outcome of quality systems: an empirical study of hospital
departments in Sweden. Quality & Safety in Health Care, 2009 Feb;18(1):49-54.
119
41. Fredriksson, M., Winblad, U., Den privata vården. En ideologisk skiljelinje i svensk
politik. I: Lindberg, K., Blomgren, M., (red.) Mellan offentligt och privat. Om styrning,
praktik och intressen i hälso- och sjukvården, 2009.
42. Wettermark, B., Pehrsson, Å., Juhasz-Haverinen, M., Vég, A., Edlert, M., TörnwallBergendahl, G., Almkvist, H., Godman, B., Bergman, U. Improving the quality and
efficiency of drug prescribing in primary care by means of financial incentives.
Pharmacoepidemiology and Drug Safety, 2009;18(S1):S261.
43. Wettermark, B., Pehrsson, Å., Vég, A., Edlert, M., Törnwall-Bergendahl, G., Godman,
B., Granath, F., Bergman, U. Financial incentives linked to self-assessment of
prescribing patterns: a new approach for quality improvement of drug prescribing in
primary care. Quality in Primary Care, 2009;17(3):179-89.
44. Höglund, A., Holmström, I., Ethical issues in telenursing. International Hospital
Equipment & Solutions, 2008 Dec – 2009 Jan;34(7):18-9.
45. Jingxiong, J., Rosenqvist, U., Huishan, W., Koletzko, B., Guangli, L., Jing, H., Greiner,
T. Relationship of parental characteristics and feeding practices to overweight in infants
and young children in Beijing China. Public Health Nutrition, 2009;12:(7):973-8,
Published online by Cambridge University Press, 2008 Aug 15.
46. Björkman, I., Bernsten, C., Sanner, M., Care ideologies reflected in 4 conceptions of
pharmaceutical care. Research in Social and Administrative Pharmacy, 2008
Dec;4(4):332-42.
47. Björkman, I., Sanner, M., Bernsten, C., Comparing 4 classification systems for drugrelated problems: processes and functions. Research in Social and Administrative
Pharmacy, 2008 Dec;4(4):320-31.
48. Björkman, I., Viberg, N., Rydberg, L., Stålsby Lundborg, C., Health promotion at
Swedish pharmacies – views of the staff. Pharmacy Practice (Internet), 2008 OctDec;6(4):211-18.
49. Arakelian, E., Gunningberg, L., Larsson, J., Job satisfaction or production? Variation
in how staff and leadership understand operating room efficiency: a qualitative study.
Acta Anaesthesiologica Scandinavica, 2008 Nov; 52(10): 1423-8.
50. Winblad, U., Do Physicians care about patient choice? Social Science & Medicine,
2008 Nov;67(10):1502-11.
51. Höglund, A., Holmström, I., "It’s easier to talk to a woman" – Aspects of gender in
Swedish telenursing. Journal of Clinical Nursing, 2008 Nov;17(22):2979-86.
52. Arnetz, J.E., Höglund, A.T., Arnetz, B., Winblad, U., Development and evaluation of a
questionnaire for measuring patient views of involvement in myocardial infarction care.
European Journal of Cardiovascular Nursing, 2008 Sep;7(3):229-38.
53. Fredriksson, M., Winblad, U., Consequences of a decentralized healthcare governance
model: measuring regional authority support for patient choice in Sweden. Social
Science & Medicine, 2008 Jul;67(2):271-9.
120
54. Arnetz, J.E., Höglund, A.T., Arnetz, B., Winblad, U., Physicians' and nurses'
perceptions of patient involvement in myocardial infarction care. European Journal of
Cardiovascular Nursing, 2008 Jun;7(2):113-20.
55. Wihlman, U., Lundborg CS., Axelsson, R., Holmström, I., Barriers of interorganisational integration in vocational rehabilitation. International Journal of
Integrated Care, 2008 Jun;19;8:e52.
56. Anderzén, I., Demmelmaier, I., Hansson, A-S., Johansson, P., Lindahl, E., Winblad,
U., Samverkan i Resursteam: Effekter på organisation, hälsa och Sjukskrivning .
Rapport, Institutionen för Folkhälso- och vårdvetenskap & Nationalekonomiska
Institutionen, april 2008.
57. Arnetz, JE., Höglund, AT., Arnetz, BB., Winblad, U., Staff views and behaviour
regarding patient involvement in myocardial infarction care: development and
evaluation of a questionnaire. European Journal of Cardiovascular Nursing, 2008
Mar;7(1):27-35.
58. Kjeldmand, D., Holmström, I., Balint groups as a means to increase job satisfaction
and prevent burnout among general practioners. Annals of Family Medicine, 2008
Mar;6(2):138- 45.
59. Röing, M., Hirsch, JM., Holmström, I., Living in a state of suspension - a
phenomenological approach to the spouse´s experience of oral cancer. Scandinavian
Journal of Caring Sciences, 2008 Mar;22(1):40-7.
60. Bastholm Rahmner, P., Tomson, G., Rosenqvist, U., Gustafsson, LL., Holmström, I.
"Limit work to here and now": A focus group study on how emergency physicians view
their work in relation to patients' drug treatment. International Journal of Qualitative
Studies on Health and Well-being, 2008;3(3):155-64.
61. Holmström, I., Höglund, AT. Det ansiktslösa mötets etik: Sjuksköterskors erfarenheter
av etiska dilemman vid telefonrådgivning. Kapitel i bok: Telefonrådgivning i hälso- och
sjukvård. Holmström, I. (red). Studentlitteratur, Lund 2008.
62. Sanner, M. Recruiting a living kidney donor: Experiences of living donors and
recipients of living and necro kidneys. I: Weimar, W., Bos, MA., Busschbach, JJ. (eds.)
(2008), Organ transplantation: Ethical, legal and psychosocial aspects. Towards a
common European policy. Pabst Science Publishers, Lengerich.
63. Sanner, M., Dew, MA., Busschbach, JJ. Altruism, councelling and psychosocial
aspects of living donation. I: Weimar, W., Bos, MA., Busschbach, JJ. (eds.) (2008),
Organ transplantation: Ethical, legal and psychosocial aspects : towards a common
European policy. Pabst Science Publishers, Lengerich.
Dissertations 2008-2010
Wihlman, Ulla. Development of interorganisational integration: a vocational rehabilitation
project. Göteborg, 2009 - 75 p. Dissertation: Nordiska högskolan för folkhälsovetenskap, in
collaboration with Uppsala University.
Bastholm, Pia. Doctors and drugs: how Swedish emergency and family physicians understand
drug prescribing. Stockholm, 2009 - 50 p. Dissertation: Karolinska institutet, in collaboration
with Uppsala University.
121
Hjelmblink, Finn. Understanding life after stroke. Uppsala, 2008 - 80 p. Digital Comprehensive
Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206; 376.
Licentiate dissertation
Madeleine, B., Competence of Physiotherapists Working in New Contexts. Uppsala, 2009 -68p.
Conference
During 2010 we hosted the international conference: The 6th Nordic Interdisciplinary
Conference on Qualitative Methods in the Service of Health (QMSH10). The conference
attracted 110 participants from 11 countries.
Agencies that support the work/Funding (2008-10)
The Swedish Research Council (Vetenskapsrådet)
The Faculty of Medicine, Uppsala University
Swedish Healthcare Direct 1177
SEK
4 380 000
2 300 000
2 200 000 (collaboration with
the Political Science
Department, UU)
1 430 000
200 000
Swedish Associations of Local Authorities and Regions
The Government and the Government Offices of Sweden
Uppsala Regional Council
Uppsala County Council
Total
265 000
760 000
90 000
100 000
11 725 000
Research projects on macro (system) level:
Privatization of elderly care and its consequences on care quality
Participants: Ragnar Stolt, Ulrika Winblad & Johan Hallqvist
One of the major policy trends in recent decades has been the privatization of social services.
Particularly in the elderly care sector with an increase of private providers from 1% in 1990 to
16 % in 2010. The on-going privatization of elderly care in Sweden and many other countries
has raised important questions regarding the consequences of this policy transformation.
The focus of this national research project is to explain the mechanisms behind privatization as
well as the resulting effects on care quality. Almost all nursing homes in Sweden are included in
the study. Preliminary results imply that privately managed elderly care has established itself
mainly in metropolitan areas dominated by right-wing regimes. Furthermore, our findings
indicate that privatization has indeed resulted in substantial quality differences. The number of
employees per resident is significantly smaller (-10%) among private regimes. On the other
hand the participation (+7%), the proportion of elderly with a reasonable length of nightly fast
(+15%), and the number of food alternatives (+26%) are significantly in favour of private
contractors. The overall aim with this research project is not only to assess the effects of
privatization but also to use these findings to build exploratory models that explain these quality
differences and can be used as tools to improve care quality.
Still, there are many questions unanswered, in ongoing studies we focus on perceived quality
measured as e.g. elderly satisfaction. Are there any differences between private and public
regime in this aspect?
122
Re-centralization of Swedish health care – a way to enhance equity?
Participants: Mio Fredriksson, Ulrika Winblad
One specific feature of the Swedish health care governance is the high degree of local and
regional self-determination, reinforced through the Local Government Act. Another specific
feature is the strong tradition of what may be termed consensus-based governance, where the
intentions of the Swedish state are carried through in negotiations with local government rather
than through binding legislation. However, this model has been challenged recently. The
Swedish state has made efforts to increase equivalence in the whole country by imposing more
binding regulations and by standardizing health care practice. Examples are the development of
national quality registers, open comparisons, national guidelines and introduction of legislated
choice in primary care. At the same time, many of the county councils emphasize their selfdetermination and focus more on regional political collaboration. The conflict of interest
between the national and local political government is studied the doctoral thesis “Political
governance in Swedish health care – relations between national equality and local democracy”.
The project deals with political governance within Swedish health care and its effects on the
tensional relationship between national equity and local self-governance. The dissertation is
interdisciplinary and involves concepts and methods from health services research, political
science and philosophy.
How does the design of the reimbursement systems affect the behavior of primary care
providers?
Participants: David Isaksson, Ulrika Winblad
A new reform regarding free choice of primary health care provider was introduced in Sweden
during 2010. The intent of the reform was to make it possible for patients to visit the health care
provider of their choice. The reform aims at strengthening the patients and has a clear marketdriven component where the choice of the patient affects the remuneration for the different
health care centres – the money follows the patient. However, each county council has the right
to design their own reimbursement system which means that there exist 21 different systems
today. Through the design of the reimbursement system each county council creates financial
incentives and thus steer the providers in a desired direction. The aim of the project is to
examine how different designs of the reimbursement systems affect how private health care
providers operate. To conduct the study data regarding the reimbursement systems is collected
from each county council and a classification of each system is made. In a second stage it is
investigated how the design of the reimbursement system affects how the providers operate with
regard to number of GP visits, nurse visits, and number of new establishments.
Research projects on meso (organisational) level:
Telenursing in Sweden: what goes wrong and why?
Participants: Annica Ernesäter, Inger Holmström, Ulrika Winblad & Maria Engström
During the last years centralization of telenursing services has occurred in Sweden with a
national telephone number for the entire country. In connection with this, the use of
computerized decision support has increased. Hence, two studies have focused on telenurses’
experiences of working with computerized decision support from different angles. Qualitative
methods were used to analyze interviews with telenurses. The decision support was perceived to
be incomplete and lacking information, and not fully adapted to telenurses way of working. Yet
it was a useful tool that provided a sense of security.
Despite a large number of citizens are able to call SHD for medical advice, there are no studies
regarding adverse events within this expanding context. 450 incident reports regarding
perceived errors within the context of Swedish Health Care Direct (SHD). The aim of this study
was to describe errors that lead to an incident report and to analyze differences among incident
reports based on who is reporting the error. Data were collected from all county councils that
participated in SHD and yielded 426 incident reports describing 452 errors. The most frequent
outgoing incident reports (i.e., sent from SHD to other health care providers) regarded
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Accessibility Problems and the most frequently incoming ones (i.e., sent to SHD from other
health care providers) regarded Incorrect Assessment.
In another study, the communication between telenurses and callers was analyzed. During 2010,
analysis of 30 calls to SHD was carried out. The aim of the study was to analyze the
communication between telenurses and callers with a clear request for a specific level of care.
The conversation between the telenurses and callers was analyzed using the Roter Interaction
Analysis System (RIAS). Preliminary results suggests that the calls are short, mean time 4
minutes and 14 seconds, and slightly telenurse driven; hence telenurses did most of the talking
during telephone communication.
Developing gender competence in Swedish telenursing
Participants: Roya Hakimnia, Inger Holmström, Marianne Carlsson & Anna T Höglund
Telenursing is considered as first line health care and should, according to The Swedish
National Board of Health and Welfare be patients’ first contact with the healthcare system. The
telenurses’ assessment of the caller symptoms and their advice to the caller strongly affects the
type of care the caller will get. Most telenurses are female. The majority of calls for children
and elderly parents are made by women. Gender has become an increasingly observed aspect of
health inequalities but there is still a lack of studies on if and how gender can impact the
encounter between telenurses and callers.
The term gender refers to the social construction of femininity and masculinity. Theories of
intersectionality hold that in order to understand oppressive structures in a society one must take
into account that traditional markers of difference, such as race/ethnicity, gender, sexuality and
class interact in a complex way. The overall aim in this project is to use theories of gender and
intersectionality in order to investigate how factors such as gender, ethnicity, class and age can
play a role in Swedish telenursing. Furthermore, the aim is to develop an instrument that can
investigate gender competence in telenursing and to test an educational intervention for
telenurses.
Gender competency could improve telenursing and contribute to more rational medical care
system, more satisfied patients and contribute to diminish health equities. The results can also
have direct application in nursing education and probably be used in other areas of healthcare
and health care education.
Elderly care on contract-basis: How can quality be ensured?
Participants: Ulrika Winblad, Ragnar Stolt, David Isaksson
This project examines how Swedish municipalities supervise the quality of care services
contracted out to private firms. The practice of contracting is fairly new in Swedish elderly care,
but currently about 16% of all publicly financed care services for the elderly are carried out by
private providers, mostly large, for-profit firms. There is great local variety, where many of the
290 municipalities have no private contracting, whereas others contact out more than half of all
services they provide for the elderly to private firms. Even if care services are contracted out,
local authorities (municipalities) are still legally obliged to ensure that the services are of high
quality. The main question in the project is how they perform this function and what sanctions
they use against the private providers if they find the care quality to be low?
The methods used in the project includes analysis of juridical and political documents
(contracts, policy statements), interviews with politicians, civil servants and private providers in
four selected Swedish municipalities, as well as a web-survey to all municipalities. The project
brings knowledge about privatization which is a new mode of governance in Swedish health and
social care. The project is run in collaboration with the Department of Government, Uppsala
University.
Waiting-time guarantee – what is the role of the doctors?
Participants: Ulrika Winblad, Caroline Andersson
Different measures have been taken to shorten waiting times within Swedish health care. One
initiative was to introduce a so called waiting-time guarantee that determined that treatments
should be offered patients within a set time limit. The guarantee aims to put greater pressure on
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healthcare providers to shorten wait lists, but also question the usual procedure that doctors use
to determine when patients should be treated. The aim of the study was to investigate doctors’
attitudes and what actions they took to implement the guarantee. The result shows that most of
the doctors did not consider themselves as important actors for implementing the reform.
Information about the right to choose, for example, is still not part of physicians’ standard
response, but something that patients need to activate themselves. One possible explanation for
the lack of communication efforts may be that doctors in study show poor detail knowledge of
the content of the reform and what they are expected to do. This in turn can be explained by the
fact that hospital clinics so far have added little weight to inform their staff about the patient
choice reforms and what rules will apply to these.
What information do patients and citizens need to make informed choices of health care
providers?
Participants: Ulrika Winblad, Caroline Andersson
In 2008, the Swedish parliament passed a law that made it mandatory for all county councils to
introduce choice models in the primary care model. The main purpose of the law was to give
patients’ and citizens’ greater choice and control over care and treatment within the publicly
financed health care system, by allowing them to choose between a number of both public and
private health care givers on an open market.
A difficulty with choice models is the lack of transparency on the health care market. How can
patients value the quality of different care providers on a health care market which is most often
characterized by high complexity and product differentiation? On behalf of the Swedish
government we therefore investigate what kind of information patients and citizens need to be
able to choose a health care provider within the setting of health care choice models. Also, we
investigate what type of information patients might need to be able to choose between different
medical treatments.
Parts of the assignment is to describe what kind of information patients and citizens have
access to at present, to investigate how other countries comparable to Sweden have managed the
matter of patient information, and finally to give recommendations on how the information
should be developed further in order to support informed choices among citizens and patients.
Teamwork at an emergency ward. Efficiency, patient safety, patient satisfaction and
satisfaction with work environment.
Participant: Åsa Muntlin Athlin
It is a challenging time for the emergency care. The fact that there is an increasingly number of
patients at the emergency departments, but a decrease in number of hospital beds for emergency
care, will lead to new ways for optimizing care processes. The care time at the emergency wards
has to be used in a more effective way. However, quality of care and patient safety must still be
maintained. The overall aim of this study is to investigate how implementation of team work at
an emergency ward can affect efficiency, quality of care, patient safety and patient satisfaction
and work environment. The primary hypothesis is that teamwork will improve the
communication and the work routines and then in turn make the care process more effective. A
quasi-experimental design with pre- and posttest will be used. The intervention is teamwork at
an emergency ward. The team consists of one physician, one registered nurse and one licensed
practical nurse, which are responsible for a limited number of patients. Each team plan and
work together during the day. In the middle of the day a short debrief will be conducted to
ensure that the plans are followed. Patient questionnaires, staff questionnaires (diaries), review
of patient health records and observations will be used for data collection. Data will be collected
during spring 2011.
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Right care to the right patient at the right time, at the right care level. Commissioned
research/ Uppsala County Council
Participant: Åsa Muntlin Athlin
In 2008, a nurse led emergency care clinic was opened to meet the need for improvements in
access to care. A systematic evaluation of the clinic was required from the county council, to
assure patient safety and quality of care with this new level of care. The aim of the study is to
investigate patient safety and quality of care at an emergency care clinic from the patients’ and
the healthcare professionals’ perspective. Another aim is to identify if right categories of
patients seeking care at the right care level. A design with mixed methods was used. Part I and
III, has a cross sectional study design. A modified version of the questionnaire Quality from the
Patient’s Perspective – QPP, was used for data collection. Totally, 300 patients answered the
questionnaire. Health records for the included patients (n=300) were reviewed according to
visiting characteristics, symptoms for seeking care, type of treatment or advice. Part II, has an
explorative design. Three focus group interviews with staff (physicians, registered nurses,
licensed practical nurses) at the emergency care clinic were carried out. The interview guide
focused on patient safety and quality of care. Part IV, was a study with a descriptive
observational design where data has been analysed with both qualitative and quantitative
approach. Totally, 312 observations at the emergency department and 248 observations at the
child emergency department at a Swedish university hospital were conducted. Data will be
analysed during 2011.
The Swedish vaccination campaign – Why did not everybody get vaccinated against “the
new influenza”?
Participants: Margareta Sanner, Ingeborg Björkman, Inger Holmström
The main aim of this study is to explore the patterns of motives of individuals in Sweden who
did not get vaccinated against “the new influenza” in 2010, how they came to this decision, and
how they judged the risks of not getting the vaccination. As this kind of behavior is complex,
even the motives are complex; therefore the study applies a qualitative design with in-depth
interviews. The sample of informants is aimed at the most possible variation of the interview
material. Possibly groups of people needing special attention and efforts in relation to pandemic
vaccinations will be identified.
Learning anaesthesia induction - how to facilitate anaesthetists -professional development
Participant: Jan Larsson, Andrew Smith
This research project aims to study how trainees’ learning of anaesthesia induction can be
improved in a powerful way. We will study how trainees and specialist anaesthetists perform
anaesthesia induction and explore how they think about this procedure. Our aim is to understand
the variation in thinking about induction that lies behind the variation in how anaesthetists
perform and learn induction. Qualitative research methods are used. This research is important
because the induction of anaesthesia can serve as a model for learning the practical work of
giving anaesthetics: it is an often repeated procedure, it is associated with a number of potential
risks for the patient, and it combines needs for practical skills and theoretical knowledge. It is
our hypothesis that this procedure must be learnt by transfer of knowledge from the experienced
anaesthetist to the trainee; that is includes the development of tacit knowing; and that the
process may be disturbed by the trainee focusing too much on explicit knowledge. With this
project we aim to increase our knowledge about how teachers of anaesthesiology can facilitate
such trainees’ practical learning. This project is carried out in collaboration with Professor
Andrew Smith, Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK.
How expert anaesthetists perform in theatre – a qualitative study on non-technical skills.
Participants: Jan Larsson, Inger Holmström
This is a focus group study, where experienced anaesthesia nurses are being asked about how
expert anaesthesiologists act during anaesthesia work. The aim of the study is to explore,
through the eyes of experienced anaesthesia nurses, what it is that expert anaesthetists do during
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anaesthesia work that trainees or less competent anaesthetists do not do. Five focus group
interviews will be done, with three or four anaesthesia nurses in each group. The heads of five
clinics of anaesthesia in four Swedish hospitals have been contacted and asked to select,
together with the head anaesthesia nurse, experienced and competent nurse anaesthetists.
Drugs and patient behavior – the influence of organizational and professional actors
Participant: Cecilia Bernsten
Drugs do not work if people do not take them has been a mantra of those researchers
investigating how patients comply with directions given by a prescriber. Throughout the years
compliance has been replaced by notions such as adherence and coherence, moving the act of
compliance from blind obedience to a state of agreement between the professional health care
worker and the patient.
The aim of this research was to investigate, describe and analyze patients’ and pharmacy
customers’ drug use behavior and the factors influencing this behavior.
Randomized clinical trials with interventions as well as mapping of behavior have been used to
study the different phenomena in question. Quantitative as well as qualitative data collection
and analyze methods have been used.
Competence of physiotherapists working in new contexts
Participants: Madeleine Boll, Urban Rosenqvist, Eva Boström
The purpose of the project was to describe ways of understanding and approaching
physiotherapy by interviewing professionals who no longer work with individuals but with
groups or organizations. In the study seven physiotherapists in primary care working with health
promotion in compulsory schools have been interviewed. In the next study 21 physiotherapists
now working on organizational levels in health care organizations have been interviewed about
their understanding of their work. The overall aim of these studies was to investigate how
physiotherapists understand and approach their work when working with health promotion and
organizational developments in health care services. Qualitative methods have been used in the
two studies.
Research projects on micro (care provision) level:
Telenurses’ understanding of work
Participants: Elenor Kaminsky, Urban Rosenqvist, Inger Holmström
Telenursing is an expanding service in many western countries and telenursing is likely to be
understood in a variety of ways. The way in which work is understood influences how work is
performed. Telenursing demands a high level of competence. We investigated the variation in
ways of understanding work among a group of Swedish telenurses. Data from 17 interviews was
analyzed using a phenomenographic approach. Five different ways of understanding work were
identified: (1) Assess, refer and give advice to the caller. (2) Support the caller. (3) Strengthen
the caller. (4) Teach the caller. (5) Facilitate the caller’s learning. The first way can be seen as a
base for the work of telenursing, the second has components of traditional caring and the third is
a coaching function. In the fourth way the work of telenursing contains a teaching component,
but having the caller’s learning in focus is only expressed in the fifth way. Telenurses who
expressed the fifth way included all other ways of understanding. The categories can be seen as
a telenursing work map. They and can be used for reflection, to expand the understanding of
work, when developing telenursing further.
Pediatric health calls to Swedish telenurses
Participants: Elenor Kaminsky, Inger Holmström & Marianne Carlsson
During 2009 four million callas were made to Swedish Healthcare Direct. About 50% of them
concerned pediatric health issues. Data about telephone triage calls concerning children in
Sweden were collected. A sample of 110 pediatric calls was recorded. The transcribed data were
analyzed regarding word count, reasons for calling, results of calls, ages and gender of children,
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and gender of parents. The median call length was 4.4 min and the median child's age was 3.5
years. Mothers made 73% of the calls, but mothers and fathers called to the same extent about
daughters and sons, and regardless of age. The most common reasons for calls were ear
problems, rash/wound or fever. In nearly half the calls, the telenurses provided self-care advice.
Call length, word count or caller's part of word count did not differ according to gender of
parents or children. However, mothers were more likely to receive self-care advice while fathers
were more often referred to other health services by the telenurses. Telenurses might need to
improve their gender competence, and more male telenurses in the service would potentially be
beneficial to callers. This study aims at performing a descriptive and exploratory interview
study, with a strategic sample of 21 parents in Uppsala, Sweden. The transcribed interview data
is analyzed using qualitative content analysis. The findings will be used to design a parental
questionnaire. We intend to send 1,500 questionnaires to parents who recently called about
paediatric health issues, with the purpose of describing, exploring and comparing their
expectations and experiences. The intention is to perform frequencies and comparisons between
groups, e.g. mothers and fathers, old and young, native-born or not, etc.
Relatives’ experiences of the request on deceased organ donation
Participant: Margareta Sanner, Linda Gyllström Krekula
At Karolinska Hospital, Stockholm, a project with a special nurse responsible for deceased
organ donation has been carried out. This project is now being evaluated. The aim of this study
is to describe what factors are important for the relatives to be able to make a well-grounded
decision to the donation request, and what factors influence their experiences in connection with
the death. Relatives who had/had not contact with this special nurse are interviewed in-depth in
this qualitative study. This study is part of a forthcoming thesis by Linda Gyllström Krekula.
GPs and emergency care physicians’ views on their role in drug prescribing
Participants: Pia Bastholm Rahmner, Inger Holmström, Urban Rosenqvist, Göran
Tomson & Lars L. Gustafsson
Using qualitative methods, we have investigated emergency physicians’ expectations of a
computerized drug prescribing support system before it was implemented. The expectations
were high and the physicians were eager to use it.
However, in a further study we found that the physicians did not use it in practice due to
practical problems and lack of integration of systems. In addition, they did not find it as their
task to adjust the patients’ drug list. Their focus was on the “here and now” and they only dealt
with obvious side effects or well known interactions. In their view, other aspects of drug use
should be handled by the patients GPs. When we studied the GP’s view on drug prescribing,
they had five different views of it. Only a few had the patients’ entire life situation in focus, and
a particular difficulty was the use of drugs to prevent future diseases. Aspects of environmental
effects of drugs and economy were also mentioned. Drugs should be prescribed in a safe and
effective manner. Decision support systems were not an integrated part of their drug prescribing
work. Instead, they leaned on personal experiences and discussion with colleagues. This project
was run in collaboration with the Karolinska Institute.
Understanding life after stroke
Participants: Finn Hjelmblink, Cecilia Bernsten, Margareta Sanner, Inger Holmström,
Urban Rosenqvist
Qualitative methods based on different theories are used to investigate the meaning of stroke
and subsequent rehabilitation to 19 stroke survivors. The essence of the meaning of stroke to
those who postponed treatment was: Need of not giving up control. Three themes made up this
structure: Acting as if nothing has happened, Need of control of decision-making, Need of being
emotionally met as persons, not patients in consultations about stroke. Health care information
has to convey the notion that emergency care of early stroke symptoms is a prerequisite, and not
a threat to control. The core category of rehabilitation was social re-integration. The survivors
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responded with defenses and coping strategies to overcome loss of certainty, and rehabilitation
strategies to regain play in togetherness with near ones.
The stroke accident had caused a disruption in the lives of the patients, and a new awareness of
human temporality and their uncertain future. Confronted with these problems of time, the
stroke victims constructed narratives on the time models: time cycles and dissolution of time
limits, exchange of time and exclusion from time. In this way, stroke patients handled their
uncertain future by using temporal models in their narratives. Professionals can support stroke
patients by reinforcing these models. Furthermore, we tried to reveal the meaning of
rehabilitation to an aphasic person in a one person case study. The informant lived in a
dichotomized situation. He was supposed to train in a goal oriented way and to believe in
recuperation. At the same time he had to prepare himself and his next of kin for the
consequences of failure.
On-site determination of breath alcohol in emergency care patients.
Participants: Åsa Muntlin Athlin
Many patients seeking emergency care are under the influence of alcohol, which complicates
the medical assessment. There are also numerous common medical conditions for which the
patient may be falsely believed to be under the influence of alcohol. The state-of-the-art
alcometers are that they require cooperation from the patient and cannot provide quality
assurance of the breath sample. The clinical requirements on an alcometer are also challenging
with respect to measurement accuracy, specificity for ethanol, a small apparatus dead-space, fast
response time, robustness, and user-friendliness. The aim of the present study is to test the
reliability of a hand-held instrument based on Non-Dispersive Infra Red (NDIR) spectroscopy
for on-site determination of breath alcohol in non-cooperative patients. A clinical trial in the
emergency department at a university hospital in Sweden. Data collection in progress.
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Scientific Report
Oxidative Stress and Inflammation
Research Group Leader Professor Samar Basu
The research group “Oxidative Stress and Inflammation” is newly established in January 2009
and previously was a part of research groups Geriatrics, and later Clinical Nutrition and
Metabolism. The main research area of this group is “Oxidative stress and Clinical
Inflammation”.
This research group “Oxidative Stress and Inflammation” is dedicated to research on
inflammation in physiology and in disease state specifically with bioactive eicosanoids.
Additionally, oxidative stress which reflects increased levels of free radicals in the body that
implicated both in ageing and several inflammatory diseases is also a key research area. Lipid
peroxidation products catalysed by free radicals and cyclooxygenases have revealed to be of
importance in many inflammatory and oxidative stress related diseases. Bioactive prostaglandin
formation by cyclooxygenases from arachidonic acid and their contribution to physiology and
inflammation is well-described by our group in the past years in addition to the role of free
radicals-mediated products isoprostanes in a range of diseases. The research group has
developed crucial assays through raising specific antibodies against isoprostanes indicating
oxidative injury and prostaglandin F2α indicating inflammatory response, and is also involved in
development of assays on anti-inflammatory resolvins etc. In addition, we have also established
immunohistochemical methods using specific antibodies to study organ damage following an
acute or chronic inflammation and oxidative stress. These novel eicosanoids are imperative in
healthy individuals and also in development of different human diseases. Collectively, the
research group is devoted to experimental, clinical, epidemiological studies and also
development of methodology specifically on eicosanoids. The research group has many national
and international collaborative projects within the research vicinity.
Members of the group in 2010
Samar Basu, M.Sc., PhD, Professor
Johanna Helmersson, MD, PhD, Researcher
Elisabet Rytter, PhD student
Lillemor Källström, BMA, Bio Medical Technician
Maria Palm, MD, PhD student
Emma Lindström, M Sc., PhD student
Diana Larsson, MD, PhD student
Adriana Miclescu, MD, PhD
Erika Rodriguez (Guest Researcher from Spain)
The major projects include:
The sustainable aquafeeds to maximise the health benefits of farmed fish for consumers
Collaborators: Samar Basu, Johanna Helmersson, Philip Calder
Financed by the European Union (6th. Framework)
The project is performed in collaboration with Southampton, Granada, Bergen and China
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Effect of fish oil in functional food, capsules or fish in the blood lipids and markers of
oxidative stress in mice and humans
Collaborators: Samar Basu, Rune Blomhoff and Liver Fröyland
Financed by The Norweigian Research Council, Norway
The project is performed in collaboration with Oslo Medical Faculty and Bergen University,
Norway
Ambulatory (24-hour) bloodpressure, inflammation and free radicals
Collaborators: Johanna Helmersson, Kristina Björklund Bodegård, Samar Basu
Study design: A cross-sectional study of ambulatory bloodpressure during 24 hours and
prostaglandins and isoprostanes in elderly men from the ULSAM-cohort.
Magnesium intake and diabetes development
Collaborators: Arvo Hänni, Brita Karlström/Bengt Vessby, Johanna Helmersson
Study design: Estimated intake of diet magnesium in relation to the risk of diabetes
development in the ULSAM-cohort.
Polymorphisms in the PLA2, COX-2, PG endoperoxide reduktase, 15-PGDH, 13reduktase, interleukin-6, CRP, SAA, cystatin C gene and cardiovascular risk
Collaborators: Johanna Helmersson, Anders Larsson, Samar Basu
Study design: The project is performed in collaboration with the section of Molecular Medicine
and is financially supported by Wallenberg Consortium North.
Polymorhisms in the NF and TTPA gene, oxidative stress and cardiovascular risk
Collaborators: Johanna Helmersson, Samar Basu
Study design: The project is performed in collaboration with the section of Molecular Medicine
and is financially supported by Wallenberg Consortium North.
Polymorphisms in the 5-LO, 15-LO, FLAP, LTB4-R and LTC-4 synthase genes and
inflammation and risk for cardiovascular diseases
Collaborators: Lisa Kurland, Johanna Helmerson and Samar Basu
The project is performed in collaboration with Molecular Medicine, Uppsala University and is
financed by Wallenberg Consortium North.
Oxidative stress, inflammation and angiogenesis during normal pregnancy, parturition
and under normal menstrual cycle
Collaborators: Maria Palm, Ove Axelsson, Anders Larsson and Samar Basu
The project is a PhD project and performed in collaboration with the Department of Women's
Health and Clinical Chemistry, Uppsala University.
Oxidative stress among pregnant women exposed by iron, arsenic and cadmium
Collaborators: Eva-Charlotte Ekström, Marie Vahter and Samar Basu
The project is performed in collaboration with the International Maternal and Child Health,
Uppsala University, MINIMAT (Bangladesh) and Karolinska institutet and financed by The
Swedish Research Council.
Prenatal food and multiple micronutrient supplementation and effects on child body
composition, metabolic markers and mortality; mechanisms of early programming
Collaborators: Lars-Åke Persson, Eva-Charlotte Ekström, Shama Arifeen, Rubanna Ruqib,
Samar Basu.
This is a PhD project and financed by The Swedish Research Council.
Oxidativ stress, inflammation among 82-years ULSAM men and cardiovascular risk
Collaborators: Johanna Helmersson, Anders Larsson and Samar Basu
The project is performed in collaboration with the Clinical Chemistry, Uppsala University.
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Acute inflammation and oxidative stress in septic shock
Collaborators: Mats Eriksson and Samar Basu
The project is performed in collaboration with the Department of Surgery and Anesthesiology,
Uppsala University and financed by various sourses.
Effect of vitamin A on low-grade endotoxemia and inflammation
Collaborators: Christine Stabell Benn, Christian Erikstrup och Samar Basu
Study design: The project is in collaboration with the University in Copenhagen, Denmark and
Uppsala University.
Oxidative stress and neuroprotection following cardiac arrest by different therapy
Collaborators: Samar Basu and Lars Wiklund
The project is performed in collaboration with the Department of Surgery and Anaesthesiology,
Uppsala University.
Oxidative stress and neuroprotection following cardiac arrest by hypothemia
Collaborators: Samar Basu and Sten Rubertsson
The project is performed in collaboration with the Department of Surgery and Anaesthesiology,
Uppsala University.
Antibody and assay development on resolvins
Collaborators: Samar Basu and Charles Serhan
The project is performed in collaboration with Brigham and Women's Hospital, Harvard
Medical School, Boston, USA
Free radicals, inflammation during heart surgery
Collaborators: Mika Lahtinen, Samar Basu
The project is performed in collaboration with Clinical Chemistry, Uppsala Akademiska
Hospital.
Association between diet, obesity, oxidative stress and inflammation
Collaborators: Samar Basu, Bengt Vessby, David Jacobs, Alan Sinaiko
The project is performed in collaboration with University of Minnesota Medical School,
Minessota, USA.
Association of oxidative stress and inflammation in coronary revascularisation and
NSAID
Collaborators: Samar Basu, Kirsti Berg, Per Jynge
The project is performed in collaboration with Norwegian University of Science and
Technology, Trondheim, Norway.
F-isoprostane metabolism and detection of oxidative stress
Collaborators: Denis Calleweart, Samar Basu
The project is a performed in collaboration with University of Oakland (MI) and Vanderbilt
University, USA.
Multi-laboratory study on biomarkers of oxidative stress (BOSS-study)
Collaborators: Maria Kadiiska with international colleauges, Ron Mason, Samar Basu
The project is performed in collaboration with NIEHS, National Institute of Health (NIH), USA
and other institutions from several countries and is financed by NIEHS (NIH), USA
In situ localisation of oxidative stress and inflammation in the Alzheimer’s patients brain
Collaborators: Samar Basu, George Perry with colleauges
The project is performed in collaboration with Case Western Reserve University, Ohio, USA
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Effects of antioxidants on oxidative stress, inflammation and metabolic control in humans.
Collaborators: Elisabet Rytter, Rikard Åsgård, Lennart Möller, Anders Sjödin, Lilianne
Abramson-Zetterberg, Bengt Vessby and Samar Basu
The project is a PhD project, Uppsala University
Birth weight and inflammation in later life, a follow-up study of 70-80 years in a Swedish
population
Collaborators: Johanna Helmersson, Liisa Byberg, Samar Basu, Ilona Koupilova, Anders
Larsson, David Leon
The project is performed in collaboration with Clinical Chemistry and Pharmacology, Uppsala
University Hospital, Department of Surgical Sciences, Uppsala University, Epidemiology unit,
London School of Hygiene and Tropical Medicine, UK and Centre for Health Equity Studies,
Karolinska Institute/Stockholm University, Sweden
Complicated pregnancy and inflammation
Collaborators: Samar Basu and Osamu Ishihara
The project is performed in collaboration with Saitama Medical School, Tokyo, Japan
Blood pressure, oxidative stress and genetics
Collaborators: Samar Basu, Nicola Fenty and Michael Brown
The project is performed in collaboration with Temple University, Philadelphia, USA
Conjugated linoleic acid and oxidative stress
Collaborator: Samar Basu, IU Brouwer and Martjin B. Katan
The project is performed in collaboration with VU University, Amsterdam, Holland
Dietary fatty acids and oxidative stress
Collaborators: Samar Basu and Anders Sjödin
The project is performed in collaboration with Copenhagen, Denmark
Funding over 100,000 SEK
European Union (EU, 6th Framework)
The Swedish Research Council
The Norweigian Research Council
Dissertation 2009
Adriana Miclescu. Cerebral protection in experimental cardiopulmonary resuscitation, Uppsala
University, 2009
Half-way PhD
Emma Lindström, The development of chronic disease- Different mechanisms affecting
metabolic status? 2010
Publications 2008-2010
1. Larsson, A., J. Helmersson, L.-O. Hansson, S. Basu. Serum cystatin is associated with
other cardiovascular risk markers and cardiovascular disease in elderly men
International J. Cardiology, 2008, 125, 263-269.
2. Bräsen, J.H., O. Leppänen, T. Heikura, M. Levin, M. Inkala, F. Arhens, J. Rutanen, H.
Pietsch, E. Malle, D. Bergqvist, A.-L. Levonen, S. Basu, M.O. Laukanen and S. YläHerttuala. Catheter-mediated local intramural gene transfer of rabbits extra-cellular
superoxide dismutase (EC-SOD) inhibits experimental in-stent restenosis in
atherosclerotic WHHL rabbit aorta. J. American College of Cardiology, 2007, 50, 22492253.
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3. Bräuner, V., E., P. Moller, L. Forchhammer, L. Barregård, L. Gunnarsen, A. Afshari, P.
Wåhlin, M. Glasius, L. O. Dragstedt, S. Basu, O. Raaschou-Nielsen and S. Loft. Indoor
particles affect endothelial function in the elderly: An air filtration-based intervention
study. American. J. Resp. Crit. Care Med., 2008, 177, 419-425.
4. Åsgård, R., E. Rytter, S. Basu, L. Abrahamsson-Zetterberg, L. Möller and B. Vessby. A
high intake of fruit and vegetable is related to low oxidative stress and inflammation in
a group of diabetes type II patients. Scand. J. Food and Nutrition, 2007, 51, 149-158.
5. Petersson, H.I, S. Basu, T. Cederholm, U. Risérus. Serum fatty acid composition and
indices of stearoyl-CoA desaturase activity are associated with systemic inflammation:
longitudinal analyses in middle-aged men. Br. J Nutr., 2008, 99, 1186-1189.
6. Turpeinen A.M., N., Ylönen, E.von Willebrand, S. Basu, A. Aro. Immunological and
metabolic effects of cis-9, trans-11 CLA in subjects with birch pollen allergy. Br. J.
Nutr., 2007, 1122, 231-244.
7. Risérus, U., D. Sprecher, T. Johnson, E. Olson, S. Hirschberg, M. Liu, Z. Fang, P.
Hegde, D. Richards, L. Sarov-Blat, J. C.Strum, S. Basu, J. Cheeseman, B. A. Fielding,
S. M. Humphreys, T. Danoff, N. R. Moore, P. Murgatroyd, S. O’Rahilly, P. Sutton, T.
Willson, D. Hassall, K. N. Frayn, F. Karpe. Activation of PPAR−γ promotes reversal of
multiple metabolic abnormalities, reduces oxidative stress and increases fatty acid
oxidation in moderately obese men. Diabetes, 2007, 57, 332-339.
8. Zethelius, B., L. Berglund, J. Sundström, E. Ingelsson, S. Basu, A. Larsson, P. Venge,
J. Ärnlöv. Use of multiple biomarkers to improve the prediction of death from
cardiovascular causes. N. Eng. J. Med., 2008, 358, 2107-2116.
9. Raff, M., T. Tholstrup, S. Basu, P. Nonboe and E. M. Straarup. A diet rich with
conjugated linoleic acid and butter increases lipid peroxidation but does not affect
atherosclerotic, inflammatory, or diabetic risk markers in healthy young men. J. Nutr.,
2008, 138, 509-514.
10. Lipcsey, M., E. Söderberg, S. Basu, A. Larsson, J. Sjölin and M.B. Eriksson. F2Isoprostane associated changes in inflammation, cardiac function and oxygenation in
endotoxaemic pig. Prost. Leuk. Ess. Fatty Acids, 2008, 78, 209-217.
11. Sundelöf, J., J. Ärnlöv, E. Ingelsson, J. Sundström, S. Basu, B. Zethelius, A, Larsson,
M. Irrizarry, E. Rönnemaa, M. Degerman-Gunnarsson, L. Kilander, H. Basun, L.
Lannfelt. Serum cystatin C and the risk of Alzheimer’s disease. Neurology, 2008, 71,
1072-1079.
12. Johansson, C., E. Rytter, J. Nygren, B. Vessby, S. Basu and L. Möller. Downregulation of oxidative DNA lesions in human mononuclear cells after antioxidant
supplementation correlates to increase of gamma-tocopherol. Int. J. for Vitamins and
Nutrition, 2008, 78, 183-194.
13. Neprin, E., E. Risérus, E. Ingelsson, J. Sundström, M. Jobs, A. Larsson, S. Basu and J.
Ärnlöv. Insulin sensitivity measured with euglycemic hyperinsulinaemic clamp is
independently associated with glomerular filtration rate in a community-based cohort.
Diabetes Care, 2008, 31,1050-1055 .
14. Tholstrup, T., M. Raff, E.M. Staarup, P. Lund, S. Basu and J.N. Bruun. A oil mixture
with trans-10, cis-12 conjugated linoleic acid increases markers of inflammation and in
134
vivo oxidation compared to cis-7, trans-11 conjugated linoleic acid in post menopausal
women. J. Nutr. 2008, 138, 1445-1451.
15. Rytter, E., B. Vessby, R. Åsgård, A. Sjödin, L. Abramsson-Zetterberg, L. Möller, S.
Basu. Glycemic control in relation to oxidative stress and inflammation in well
metabolic controlled type 2 diabetes subjects. British Journal of Nutrition, 2009, 101,
1423-1426.
16. Dawczynski, C., R. Schubert, G. Hein, A. Muller, T. Eidner, H. Vogelsang, S. Basu and
G. Jaheris. Long-term moderate intervention with n-3 LC-PUFA-supplemented dairy
products: effects on pathophysiological biomarkers in rheumatoid arthiritis. British
Journal of Nutrition, 2008, 101, 1517-1576.
17. Larsson, A., M. palm, L.O. Hansson, S. Basu, O. Axelsson. Reference values for alpha
(1)-acid glycoprotein, alpha (1)-antitripsin, albumin, haptoglobin, C-reactive protein,
IgA, IgG and IgM during pregnancy. Acta Obstet. Gynecol. Scand., 2008, 87, 10841088.
18. Jonasson, S, J. Hjoberg, G. Hedenstierna and S. Basu. Allergen-induced formation of
F2-isoprostanes in a murine asthma model identifies oxidative stress in acute airway
inflammation in vivo. Prost. Leuk. Ess. Fatty Acids, 2008, 80, 1-7.
19. Ärnlöv, B. Zethelius, U. Risérus, S. Basu, C. Berne, B. Vessby, G. Alfthan, J.
Helmersson. Serum and dietary β-carotene and α-tocopherol and incidence of diabetes
in a community based study of Swedish men. Diabetologia, 2009, 52, 97-105.
20. Helmersson, J., J. Ärnlöv, A. Larsson and S. Basu. Low dietary intake of β-caroten, αtocopherol and ascorbic acod is associated with increased inflammatory and oxidative
stress status in Swedish cohort. Brit. J. Nutrition., 2008, 80, 51-56.
21. Basu, S., J. Helmersson, D. Jarosinska, G. Sällsten, B. Mazzolai, L. Barregård.
Regulatory factors of basal F2-isoprostane formation: Population, age, gender and
smoking habits in humans. Free Radical Research, 2009, 43, 85-91.
22. Helmersson, J., J. Ärnlöv, T. Axelsson and S. Basu. Cyclooxygenase-1 gene
polymorphism, prostaglandin F2α formation and clinical cardiovascular disease. . On
line published 2008, Dec 15, Prost. Leuk. Ess. Fatty Acids.
23. Helbig, D., A. Wagner, M. Glei, S. Basu, R. Schbert and G. Jaheris. Black current seed
press residues increase tocopherol concentration in serum and stool while biomarkers in
stool and urine indicate increased oxidative stress. British Journal of Nutrition, 2009,
102, 554-562.
24. Feairheller, D.L., M.D. Brown, Y-J. Park, T. Ellis, S. Basu, J.M. Hagberg, R.E. Ferrel,
and N. Fenty-Stewart. Exercise training, NADPH oxidase p22phox gene
polymorphisms, and hypertension. Medicine & Science in Sports & Exercise, 2009, 41,
1421-1428.
25. Sundelöf, J., L. Kilander, J. Helmersson, A. Larsson, E. Rönnemaa, M. DegermanGunnarsson, H. Basun, L. Lannfelt, S.Basu. Systemic Tocopherols and F2-isoprostanes
and the Risk of Alzheimer´s disease and Dementia: A Prospective Population-Based
Study. J. Alzheimer’s Disease, 18, 71-78.
26. Sundelöf, J., A. Larsson, L. Kilander, J. Helmersson, E. Rönnemaa, M. DegermanGunnarsson, H. Basun, L. Lannfelt, S. Basu. Systemic Inflammation and the Risk of
135
Alzheimer´s disease and Dementia: A Prospective Population-Based Study J.
Alzheimer’s Disease, 18, 79-87.
27. Palm, M., O. Axelsson, L. Wernroth, S. Basu. F2-Isoprostanes, potential in vivo
markers of oxidative stress, increase in normal human pregnancy. Free Radical
Research, 2009, 43, 546-552.
28. Östman, B., K. Michaelsson, J. Helmersson, L. Byberg, R. Gedeborg, H. Melhus and S.
Basu. Urinary F2-Isoprostanes, serum alpha-tocopherols and bone mineral density in
elderly men. Free Radical Biology and Medicine, 2009, 47, 668-673.
29. Fenty-Stewart, N., J.-Y. Park, S. Basu, J. Jones, M. Bathula, M. Hickey, M. Brown.
Relationship between Endothelin-1 and Oxidative Stress in Pre-hypertensives:
Implications of Exercise Training and Vascular Health. Blood Pressure , 2009, 10, 1-9.
30. Mostad, I.L., K. S. Bjerve, S. Basu and V. Grill. Effects of a 4 hour infusion of marine
n-3 fatty acids on insulin sensitivity, insulin secretion, energy metabolism and F2isoprostanes in subjects with type 2 diabetes. Metabolism, 2009, 58, 1753-1761.
31. Wennerberg, H.M., A. Smedman, A. Turpeinen, K. Retterstöl, S. Tengblad, E. Lipre, A.
Aro, P. Mutanen., I .Seljeflot, S. Basu, J.I. Pedersen, M. Mutanen, B. Vessby. Small
effects on metabolic variables and no change in body or blood pressure after increased
intake of diary products in the diet of overweight men and women-results from a 6month study. Am. J. Clin. Nutr., 2009, 90, 960-968.
32. Keen, C., A.-C. Olin, S. Eriksson, A. Ekman, A. Lindblad, S. Basu, C. Beermann and
B. Strandvik. Supplementation with n3 and n6 polyunsaturated fatty acids influences
the inflammatory response and airway nitric oxide in patients with cystic fibrosis. J.
Pediatr. Gastroenterol. Nutr. 2010, 50, 537-544.
33. Semenas, E., A. Nozari, S. Basu, S. Rubertsson, L. Wiklund. Evidence of gender
difference in hemodynamics and organ injury in a pig model of hemmorhage and
ventricular fibrillation resuscitated with different fluid regimens. Acta Anaesthesiol.,
2009, 54, 343-353.
34. Danesh et al., C-reactive protein concentration and the risk of coronary heart disease,
stroke and mortality. Collaborative analysis of data on 160,309 participants from 54
cohorts. Emerging Risk Factors Collaboration. Lancet, 2010, 375, 132-140.
35. Rytter, E. , C. Johansson, B. OH Vessby, A. M. Sjödin, L. Möller, B. Åkesson, and S.
Basu. Biomarkers of oxidative stress in overweight men are not influenced by a
combination of antioxidants. Free Radical Research, 2010, 44, 522-528.
36. Helal, O., C. Defoort, S. Robert, C. Marin, N. Lesavre, J. Lopez-Miranda, S. Basu, U.
Risérus, , J. Lovegrove, HM. Roche, F. Sabatier, F. Dignat-George and D. Lairon.
Increased levels of microparticles originating from endothelium, platelet and
erythrocyte in subjects with metabolic syndrome: relationship with oxidative
stress.Nutr., Met. Cardiovasc. Dis., 2010, E-published April 14.
37. Degerman Gunnarsson, M., M. Lindau, A., Wall, K. Blennow, T. Darreh-Shori, S.
Basu, A. Nordberg, A. Larsson, L- Lannfelt, H.Basun and Kilander, L. Pittsburg
compound-B and Alzheimer’s disease biomarkers in CSF, Plasma and urine, an
exploratory study. Dementia and Geriatrics Cognitive Dis. 2010, 29, 204-212.
136
38. Holt, E.M., L. M. Steffen, A. Moran, J. Steinberger, D. R. Jacobs, Jr., S. Basu, C.-P.
Hong, J.A. Ross, A. R. Sinaiko. Fruit and vegetable consumption and its relation to
markers of inflammation and oxidative stress in adolescents. J. Am. Diab. Assoc. 2009,
109, 414-421.
39. Jobs, E., U. Risérus., E. Ingelsson, J. Helmersson, E. Neprin,M. Jobs, J. Sundström, L.
Lind, A. Larsson, Basu. S. and Ärnlöv J. Serum cathepsin S independently associated
with serum C-reactive protein and interleukin-6 in elderly men. J. Clin. Endocr. Met.
2010, E-published July 7.
40. Petersson, H., U. Risérus, J. McMonagle, A.C. Tierney, J. Lovegrove, S. Morange, O.
Helal, H.L. Gulseth, J.A. Ruano, J. Lopez-Miranda, A. Dembinska-Kiec, E. Blaak,
I.M.F. Gjeldstad, C.A. Drevon, H. Roche and S. Basu. Effects of dietary fat
modification on oxidative stress and inflammatory markers in the LIPGENE study. Brit.
J. Nutr., 2010, 23, 1-6.
41. Lennmyr, F., M. Molnar, S. Basu, and L. Wiklund. Cerebral effects of hyperglycemia
on oxidative stress, inflammation and neurological assessment in experimental cardiac
arrest. Crit. Care. Med. 2010, 38, 1726-1732.
42. Rytter, E. , B. Vessby, R. Åsgård, C. Johansson, S. Moussavian, A. M. Sjödin, L. L.
Abrahamsson-Zetterberg, L. Möller and S. Basu. Supplementation with a combination
of antioxidants does not affect glycemic control, oxidative stress or inflammation in
type 2 diabetes sebjects. Free Radical Research, 2010, 44, 1445-53.
43. Stine, M. Ulven, Kirkhus, B., Lamglait, A., Basu, S., Elind, E., Haider, T., Berge, K.,
Vik, H., and Pedersen, J. I. Metabolic effects of krill oil as compared to fish oil in
healthy volunteers. E-published Lipids, Nov 2, 2010.
44. Delgado-Lista, J., B. Perez-Martinez, A., García-Rios, C.M. Phillips, C.M. Williams,
Gulseth HL, O., Helal, E.E. Blaak, B. Kiec-Wilk, S. Basu, C.A. Drevon, C. Defoort,
W.H. Saris, I. Wybranska, U. Riserus, L.A. Lovegrove, H.M.A. Roche, Lopez-Miranda,
J. Pleiotrophic effects of TCF7L2 gene variants and its modulation by modifible factors
in the metabolic syndrome: From the Lipgene study. E-published Atherosclerosis, Nov
3, 2010.
45. Basu, S., A. Miclescu, H. Sharma and L. Wiklund. Propofol mitigates systemic
oxidative injury during experimental cardiopulmonary resuscitation. Prost. Leuko. Ess.
Fatty Acids 2010 (In press).
46. Miles, E., P.S. Noakes, L.-S. Kremmyda, M. Vlachava, N.D. Diaper, G. Rosenlund, H.
Urwin, P. Yaqoob, A. Rossary, M.-P. Vasson, B. Laiset, L. Fröyland, J. Helmersson, S.
Basu, E. Garcia, M.D. Mesa, A. Gil and P.C. Calder. The salmon in pregnancy study.
Am. J. Clin. Nutr. (In press).
47. Semenas, E, H.S. Sharma, A. Nozari, S. Basu and L. Wiklund. Neuroprotective Effects
of 17-Beta-Estradiol after Hypovolemic Cardiac Arrest in Immature Piglets: The Role
of Nitric Oxide and Peroxidation. Shock, 2011, Feb., 15. E-published.
48. Neprin, E., E. Ingelsson, U. Risérus, J. Sundström, A. Larsson, E. Jobs, M. Jobs, S.
Hallan, B. Zethelius, L. Berglund, S. Basu and J. Ärnlöv. The combined contribution of
albuminuria and glomerular filtration rate to the prediction of cardiovascular mortality
in the community. Nephrol Dial Transplant. 2011 Feb 18. E-published.
137
Reviews
1. Basu S. Novel cyclooxygenase-catalysed bioactive prostaglandin F2α from physiology
to new principles in inflammation. Medicinal Research Reviews 2007, 27, 435-468.
2. Basu S. The enigma of in vivo oxidative stress assessment: isoprostanes as an emerging
target. Scand. J. Food and Nutrition, 2007, 51, 48-51.
3. Basu S. F2-Isoprostanes in human health and diseases: From molecular mechanisms to
clinical implications. Antioxidants and Redox Signaling, 2008, 10, 1405-1434.
4. Wiklund L., S. Basu, A. Miclescu, P. Wiklund, G. Ronnquist, H.S. Sharma. Neuro-and
cardioprotecitive effects of blocade of nitric oxide action by administration of
methylene blue. Ann. NY Acad. Sci., 2007, 1122, 231-244.
5. Basu, S. and J. Helmersson. Isoprostaner-nya markörer för oxidative stress och
inflammationsrelaterade sjukdomar. Biologisk aktiva föreningar som påvisar fria
radikalreaktioner hos människa. Läkartidningen, 2009, 5, 274-278.
6. Basu S. Fatty acid oxidation and isoprostanes: oxidative strain and oxidative stress.
Pros. Leuk. Ess. Fatty Acids 2010, 82, 219-226.
7. Basu, S. Bioactive Eicosanoids: Role of Prostaglandin F2α and F2-Isoprostanes in
Inflammation and Oxidative Stress Related Pathology. Molecules and Cells 2010, 30,
383-91.
Book Chapters
1. Basu, S. Radioimmunoassays of isoprostanes and prostaglandins as biomarkers of
oxidative stress and inflammation. Natural Antioxidants, Anticarcinogens in Nutrition,
260-267, 1999. Eds. Kumpulainen & Salonen. The Royal Society of Chemistry, UK.
2. Basu, S. Isoprostanes. Bioactive Lipids, Eds. Nicolaou and Kokotos, The Oily Press,
U.K. 2004, 265-285.
3. Basu S. Measurement of F2-isoprostanes in tissues and biological fluids as an index of
oxidative stress. Methods in Redox Signaling. Ed. D.K. Das, Mary Ann Liebert, N.Y.,
USA 2009.
4. Basu S. Carbontetrachloride induced oxidative stress- A classical model of
experimental oxidative stress. In: Oxidative Stress in Basic Research and Clinical
Practice. Experimental Models of Oxidative Stress. Ed. S. Basu, Humana Press/
Springer Science, N.Y., USA 2010 (In press).
5. Wiklund, L. and S. Basu. An Experimental model of myocardial and cerebral global
ischemia and reperfusion. In: Oxidative Stress in Basic Research and Clinical Practice.
Experimental Models of Oxidative Stress. Ed. S. Basu, Humana Press/ Springer
Science, N.Y., USA 2010 (In press).
6. Lipcecy, M., M. Eriksson and S. Basu. Oxidative in various animal models with special
reference to porcice endotoxemia. In: Oxidative Stress in Basic Research and Clinical
Practice. Experimental Models of Oxidative Stress. Ed. S. Basu, Humana Press/
Springer Science, N.Y., USA (In press).
Book Editor
Oxidative Stress in Basic Research and Clinical Practice. Experimental Models. Editor: S. Basu
and Co-Editor: Lars Wiklund, Humana Press/ Springer Science, N.Y., USA 2010 (In press).
138
Scientific Report
Preventive Medicine
Research Group Leader Professor Johan Hallqvist
The chair in preventive medicine was established in 2008 when Johan Hallqvist was installed as
the first professor in preventive medicine at Uppsala University. At present cooperation with
preventive activities in the county council and the regional primary communes are under
development. The research focuses on mechanisms explaining the social inequalities in risk of
disease and the aim is to contribute to evidence based health policy development, health
promotion and risk management. Research areas of special interest:
-
-
risk factors triggering the onset of health problems
theories of the life course approach in current epidemiology and pertinent empirical
topics like the combined effect of early life and later life risk factors on health and
morbidity
the role of social context in the causation of disease and how it interacts with human
biology
Publications 2008-2010
1. Janszky I, Ljung R, Ahnve S. Hallqvist J, Bennet AM, Mukamal KJ. Alcohol and longterm prognosis after a first acute myocardial infarction: the SHEEP study. Eur Heart J.
2008 Jan;29(1):45-53.
2. Modin B, Vågerö D, Hallqvist J, Koupil I. The contribution of parental and
grandparental childhood social disadvantage to circulatory disease diagnosis in young
Swedish men. Soc Sci Med. 2008 Feb;66(4):822-34.
3. Janszky I, Ljung R, Rohani M, Hallqvist J. Heavy snoring is a risk factor for case
fatality and poor short-term prognosis after a first acute myocardial infarction. Sleep.
2008 Jun 1;31(6):801-7.
4. Engström K, Mattsson F, Järleborg A, Hallqvist J. Contextual social capital as a risk
factor for poor self-rated health: a multilevel analysis. Soc Sci Med. 2008
Jun;66(11):2268-80.
5. Laflamme L, Möller J, Hallqvist J, Engström K. Peer victimization and intentional
injuries: quantitative and qualitative accounts of injurious physical interactions between
students. Int J Adolesc Med Health. 2008 Apr-Jun;20(2):201-8.
139
6. Månsdotter A, Backhans M, Hallqvist J. The relationship between a less genderstereotypical parenthood and alcohol-related care and death: a registry study of Swedish
mothers and fathers. BMC Public Health. 2008 Sep 15;8:312.
7. Macassa G, Hallqvist J, Lynch JF. Inequalities in child mortality in Subsaharan Africa –
a social epidemiologic framework. African Journal of Health Sciences 2008. (accept)
8. Janszky I, Hallqvist J, Ljung R, Ahlbom A, Hammar N. Prognostic role of the
glucometabolic status assessed in a metabolically stable phase after a first acute
myocardial infarction: the SHEEP study. J Intern Med. 2009 Apr;265(4):465-75. Epub
2008 Nov 14.
9. Möller J, Hallqvist J, Laflamme L, Mattsson F, Ponzer S, Sadigh S, Engström K.
Emotional stress as a trigger of falls leading to hip or pelvic fracture. Results from the
ToFa study - a case-crossover study among elderly people in Stockholm, Sweden. BMC
Geriatr. 2009 Feb 9;9:7.
10. Sidorchuk A, Agardh EE, Aremu O, Hallqvist J, Allebeck P, Moradi T. Socioeconomic
differences in lung cancer incidence: a systematic review and meta-analysis. Cancer
Causes Control. 2009 May;20(4):459-71. Epub 2009 Jan 31.
11. Hansson J, Pedersen NL, Galanti MR, Andersson T, Ahlbom A, Hallqvist J,
Magnusson C. Use of snus and risk for cardiovascular disease: results from the Swedish
Twin Registry. J Intern Med. 2009 Jun;265(6):717-24.
12. Mukamal KJ, Hallqvist J, Hammar N, Ljung R, Gémes K, Ahlbom A, Ahnve S,
Janszky I. Coffee consumption and mortality after acute myocardial infarction: the
Stockholm Heart Epidemiology Program. Am Heart J. 2009 Mar;157(3):495-501. Epub
2009 Jan 8.
13. Rajaleid K, Hallqvist J, Koupil I. The effect of early life factors on 28 day case fatality
after acute myocardial infarction. Scand J Public Health. 2009 Sep;37(7):720-7. Epub
2009 Aug 21.
14. Janszky I, Mukamal KJ, Ljung R, Ahnve S, Ahlbom A, Hallqvist J. Chocolate
consumption and mortality following a first acute myocardial infarction: the Stockholm
Heart Epidemiology Program. J Intern Med. 2009 Sep;266(3):248-57.
15. Janszky I, Hallqvist J, Tomson T, Ahlbom A, Mukamal KJ, Ahnve S. Increased risk
and worse prognosis of myocardial infarction in patients with prior hospitalization for
epilepsy--the Stockholm Heart Epidemiology Program. Brain. 2009 Oct;132(Pt
10):2798-804. Epub 2009 Aug 28.
16. Kosidou K, Magnusson C, Mittendorfer-Rutz E, Hallqvist J, Hellner Gumpert C,
Idrizbegovic S, Dal H, Dalman C. Recent time trends in levels of self-reported anxiety,
mental health service use and suicidal behaviour in Stockholm. Acta Psychiatr Scand.
2010 Jul;122(1):47-55. Epub 2009 Oct 13.
140
17. László KD, Ahnve S, Hallqvist J, Ahlbom A, Janszky I. Job strain predicts recurrent
events after a first acute myocardial infarction: the Stockholm Heart Epidemiology
Program. J Intern Med. 2010 Jun;267(6):599-611. Epub 2009 Nov 17.
18. Janszky I, Hallqvist J, Ljung R, Hammar N. Insulin-like growth factor binding protein-1
is a long-term predictor of heart failure in survivors of a first acute myocardial
infarction and population controls. Int J Cardiol. 2010 Jan 7;138(1):50-5. Epub 2008
Sep 14.
19. Hultin H, Hallqvist J, Alexanderson K, Johansson G, Lindholm C, Lundberg I, Möller
J. Low level of adjustment latitude--a risk factor for sickness absence. Eur J Public
Health. 2010 Dec;20(6):682-8. Epub 2010 Feb 8.
20. Moradi T, Sidorchuk A, Hallqvist J.Translation of questionnaire increases the response
rate in immigrants: Filling the language gap or feeling of inclusion? Scand J Public
Health. 2010 Dec;38(8):889-92. Epub 2010 Jun 9.
21. Berglind N, Ljungman P, Möller J, Hallqvist J, Nyberg F, Rosenqvist M, Pershagen G,
Bellander T. Air pollution exposure--a trigger for myocardial infarction? Int J Environ
Res Public Health. 2010 Apr;7(4):1486-99. Epub 2010 Mar 31.
22. Månsdotter A, Fredlund P, Hallqvist J, Magnusson C. Who takes paternity leave? A
cohort study on prior social and health characteristics among fathers in Stockholm. J
Public Health Policy. 2010 Sep;31(3):324-41.
23. Manrique-Garcia E, Sidorchuk A, Hallqvist J, Moradi T. Socioeconomic position and
incidence of acute myocardial infarction: a meta-analysis. J Epidemiol Community
Health. 2010 Sep 14. [Epub ahead of print]
24. Björkenstam C, Weitoft GR, Hjern A, Nordström P, Hallqvist J, Ljung R. School
grades, parental education and suicide--a national register-based cohort study. J
Epidemiol Community Health. 2010 Oct 19. [Epub ahead of print]
25. Rajaleid K, Janszky I, Hallqvist J. Small Birth Size, Adult Overweight, and Risk of
Acute Myocardial Infarction. Epidemiology. 2010 Oct 27. [Epub ahead of print]
26. Gray L, Merlo J, Mindell J, Hallqvist J, Tafforeau J, O'Reilly D, Regidor E, Næss O,
Kelleher C, Helakorpi S, Lange C, Leyland AH. International differences in selfreported health measures in 33 major metropolitan areas in Europe. Eur J Public Health.
2010 Dec 8. [Epub ahead of print]
27. Hultin H, Hallqvist J, Alexanderson K, Johansson G, Lindholm C, Lundberg I, Möller
J. Work-related psychosocial events as triggers of sick leave – results from a Swedish
case-crossover study. BMC Public Health 2010 (accepted).
141
Dissertations 2008-2010
Kristiina Rajaleid: Early and later life mechanisms in the aetiology of cardiovascular disease.
Stockholm: Karolinska Institutet 2010.
Ongoing PhD-projects
Hanna Hultin: Non-medical risk factors and triggers of sickness absence – cohort and casecrossover studies. Supervisors: Jette Möller (KI), Johan Hallqvist, Kristina Alexandersson (KI),
Ingvar Lundberg (Occupational medicine, Uppsala University).
Kyriaki Kosidou: Etiology of and trajectories in depression and suicidal behavior in young
adults. Determinants and gender differences. Supervisors: Cecilia Magnusson (KI), Christina
Dalman (KI), Göran Isacsson (KI), Johan Hallqvist.
Emma Björkenstam: Socioeconomic inequalities in mental illness - epidemiological life course
studies of morbidity, medication and mortality. Supervisors: Rickard Ljung (KI), Eleonor
Mittendorfer-Rutz (KI), Johan Hallqvist.
Charlotte Björkenstam: Socioeconomic inequalities in the risk of suicide – epidemiological
studies of school grades, criminal records, and medications in young adults. Supervisors:
Rickard Ljung (KI), Johan Hallqvist, Gunilla Ringbäck (SoS), Peter Nordström (KI).
Lena Lundholm: Use of psychoactive substances as a risk factor for extrovert and introvert
violence. Supervisors: Ingemar Thiblin (Forensic medicine, Uppsala University), Johan
Hallqvist, Claudia Fahlke (Psychology, Gothenburg University).
Frida Fröberg: Ung vuxna och problem med spel om pengar. (Adolescents, young adults and
problems from gambling for money) Supervisors: Anders Tengström (KI), Johan Hallqvist.
Mats Martinell: Behandling, morbiditet och mortalitet vid typ 2 diabetes – en praxisstudie i
Uppsala län åren 1993-2005. (Treatment, morbidity, and mortality of type 2 diabetes – a study
of health care practices in Uppsala County 1993 to 2005). Supervisors: Jan Stålhammar (Public
health and Caring Sciences, Uppsala University), Johan Hallqvist.
Ragnar Stolt: Privatisering av äldreomsorgen – orsaker och konsekvenser. (Privatization of
Elderly Care – Causes and Consequences). Supervisors: Ulrika Winblad (Public health and
Caring Sciences, Uppsala University), Johan Hallqvist.
142
Ongoing research projects
The aim is to study the social aetiology of health problems with an emphasis on mechanisms
explaining the social inequalities in risk of disease; hence, to contribute to evidence-based
health policy development, health promotion, and risk management.
The study of disease causation in contemporary international social epidemiology takes
advantage of the time and space dimensions of the causal field in a new and fruitful way. The
life course approach, depicted by the horizontal arrows in the figure, makes use of the time
dimension to discover how risk factors from different stages of life combine their health effects.
The questions span from long term effects of early life circumstances to triggers acting
immediately before disease onset. This research requires methodology able to handle issues like
interaction, conditional causation and induction time. The second approach, illustrated by the
vertical arrows, concerns the health impact of the social space conceptualized as social context.
How characteristics of the social context interact with human biology to induce changes on the
molecular level also calls for more advanced epidemiologic methodology like multi-level
techniques.
Most of these projects are conducted together with external collaborators but founded on joint
applications for funding.
Databases in use
Johan Hallqvist was responsible for the data collection in SHEEP (Stockholm Heart
Epidemiology Program) which is a very large (2246 cases) case-control study with
comprehensive exposure information set up in the early 1990-ies to study the causes of
myocardial infarction. The data has so far been used in 18 doctoral studies and new information
is still added and analyzed.
The case-crossover study Onset was nested in SHEEP with Johan Hallqvist as primary
investigator.Johan Hallqvist is also primary investigator in TUFS (Swedish acronym for
triggers of sickness absence), a case-crossover study in 2005-2007 of more than 1000 spells of
sickness absence nested in a cohort.
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As responsible for the Public Health Surveys in Stockholm County Council 2002 and 2006, that
each had sample sizes of more than 50000, Johan Hallqvist initiated the transformation of these
cross-sectional studies into a cohort called SPHC (Stockholm Public Health Cohort) with
extensive information from repeated questionnaires and follow up in registers. After the 2010
data collection the cohort contains approx 100000 participants.
A. Triggers of disease
The case-crossover methodology was developed at Harvard in the beginning of the 1990-ies and
it opened up a new field of research; the study of risk factors with short induction periods, that
is, triggers of disease. My group at Karolinska Institutet was early in adopting the new method
and the group still has a unique competence in Sweden. We have contributed to the
development of this particular methodology and we have published original findings regarding
acute stressors at the work place and onset of myocardial infarction, triggers of injuries and of
recurrent criminal violence among patients in forensic psychiatry. The group at Karolinska
Institutet is now headed by my former doctoral student Jette Möller who recently became
associate professor.
In the ongoing projects we aim to identify triggers of acute health events, and to quantify their
effects. In the first four case-crossover projects we are applying the design to data bases
extracted from Swedish National registers.
1. Side-effects of drugs.
The first aim is to identify harmful side-effects of pharmaceutical drug use and the second aim
is to potentially develop a system for surveillance. We use a record linkage between the new
drug prescription register (exposures and sometimes also outcomes) and the hospital discharge
register (outcomes). Collaborators: Jette Möller (KI), Johan Hallqvist, Mauricio Malfert (KI),
Johan Fastbom (KI), and Kristina Johnell (KI).
2. Psychiatric care as acute deterrant or trigger of suicide.
The inherent self-control in the design makes it possible to study the quality of the psychiatric
evaluation of suicide risk in consultations. The study is based on record linkage between
inpatient, outpatient and cause-of-death registers. Collaborators: Jette Möller (KI), Johan
Hallqvist, Mauricio Malfert (KI), Christina Dalman (KI), Susanne Wicks (KI), Eleonor
Mittendorfer-Rutz (KI).
3. Surgical procedures as triggers of myocardial infarction.
Based on record linkage between hospital registers and myocardial infarction incidence
registers. The trigger effect is well known and RCT’s testing beta blockers as profylaxis has
been undertaken. Our aim is to quantify the absolute and relative risks with different types of
surgical procedures. Collaborators: Jette Möller (KI), Johan Hallqvist, Mauricio Malfert (KI),
and Anders Ekbom (KI).
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4. Acute life events (like death of close relative) as triggers of acute diseases like myocardial
infarction and stroke.
Based on record linkage between the multigenerational register and the hospital and the cause of
death registers. Collaborators: Jette Möller (KI), Johan Hallqvist, Mauricio Malfert (KI), Anders
Ekbom (KI).
5. TUFS (Swedish acronym for triggers of sickness absence).
Part of Hanna Hultin’s thesis work. Based on extensive data collection from more than 1000
spells of sickness absence at six work places. Collaborators: Jette Möller (KI), Johan Hallqvist,
Kristina Alexandersson (KI), Ingvar Lundberg (Occupational medicine, Uppsala University),
Christina Lindholm (KI), Olle Lundberg (CHESS, Stockholm University).
6. TOFA (Triggers of falling).
Based on data collected from old men and women with hip fractures. Collaborators: Lucie
Laflamme (KI), Jette Möller (KI), Johan Hallqvist, Karin Engström (KI).
7. Psychoactive substances as triggers of violence.
Part of Lena Lundholm’s thesis work. Based on data collection from individuals in custody in
Stockholm because of criminal activities including violence (The Stockholm Social Medicine
Custody Project). Collaborators: Anders Thiblin (Forensic medicine, Uppsala University), Lena
Lundholm, Claudia Fahlke (Psychology, Gothenburg University), Johan Hallqvist.
8. Air pollution triggering myocardial infarction.
Based on the Onset part of the SHEEP study with data on air pollution added. Collaborators:
Niklas Berglind (KI), Johan Hallqvist, Petter Ljungman (KI), Tom Bellander (KI), Göran
Pershagen (KI), Jette Möller (KI).
B. Life course studies on the aetiology of health problems
Another line of research concerns life course mechanisms where we have shown that there are
inherent difficulties in the task of disentangling time-related exposure constructs like
accumulation, critical period and mobility. At present we pursue further in-depth analyses of
specific hypotheses related to these theoretically based mechanisms. We also have a general
interest in methodological issues related to the study of mechanisms behind inequalities in
health and we have for example shown the importance of distinguishing between differential
exposure and differential susceptibility when analyzing for example the effects of exposure to
job strain.
1. Life Time Health: the effect of fetal exposures, social trajectories and social transitions on
health and health behavior.
The aim is to study trajectories and transitions as important features of the life course and to
find out how health related parameters are influenced and through which mechanisms. In this
project we use the new Stockholm Public Health Cohort (SPHC) with repeated questionnaires
and all kinds of register information for approx 65000 participants. In associated projects we use
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the SHEEP data base and the Uppsala Birth Cohort to investigate the combined effects of fetal
growth impairment, cognitive development, social trajectories and adult obesity on
cardiovascular disease. Collaborators: Johan Hallqvist, David Blane (Imperial College, London
University), Jette Möller (KI), Mauricio Malfert (KI), Christina Halford (Uppsala University),
Kristiina Rajaleid, Bitte Modin and Denny Vågerö (Stockholm University).
2. Pain in the body and the soul
The aim is to identify life course factors that influence psychological well-being, psychological
ill-health, depression and musculoskeletal pain. In this project we also use the new Stockholm
Public Health Cohort (SPHC) and national register data bases. Part of the funding is from FAS’s
Women’s Health Program. Kyriaki Kosidou’s thesis work is part of this project but there are
also other sub-projects. Collaborators: Cecilia Magnusson (KI), Johan Hallqvist, Christina
Dalman (KI), Lars Alfredsson (KI), Eva Skillgate (KI).
3. Life course risk factors and socioeconomic differences in the risk of mental illness.
Concerns risk factors like adverse marital trajectories, school failures, and criminal carreers.
Register studies on the total population of Sweden. Collaborators: Charlotte och Emma
Björkenstam, Gunilla Ringbäck (SoS), Peter Nordström (KI), Eleonor Mittendorfer-Rutz (KI),
Johan Hallqvist. Rickard Ljung (KI)
4. How gender equality in early parenthood affects health and further welfare development
among parents and children.
Based on register information for all children in specific birth cohorts and their parents.
Collaborators: Anna Månsdotter (KI), Lars Lindholm (Umeå University), Johan Hallqvist,
Michael Lundborg (KI), Aki Tsuchiya (Sheffield University).
C. The social context as a risk factor of disease
The third line of research concerns the social environment and macro-determinants of disease.
In carefully designed studies we have contributed with further empirical evidence to the yet
unresolved questions on if and how social context in terms of socioeconomic deprivation or low
social capital on the aggregate level impinge on the etiology of specific individual diseases.
1. Social context in Swedish municipalities and juvenile delinquency
The question is whether contextual characteristics like socioeconomic deprivation or lack of
social integration influence crime rates among adolescents when individual characteristics are
controlled for. Family based designs and multi-level analyses will be employed on register data
of all Swedes. The projects is financed by NIH. Collaborators: Amir Sariaslan (KI), Johan
Hallqvist, Brian D’Onofrio (University of Indiana, US), Paul Lichtenstein (KI)
2. Social capital, social inequality and health (different outcomes)
Investigates the health effects of various forms of contextual social capital on the parish level.
Based on SPHC and registers of the total population in Stockholm County. Collaborators: Karin
Engström (KI), Johan Hallqvist.
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D. Other projects
1. Etiologic and prognostic risk factors in myocardial infarction.Based on SHEEP, which is a
very large case-control study of myocardial infarction (2246 cases) that also has follow-up data
for approx 8 years. The extensive exposure information makes it possible to study new
questions. Collaborators: Imre Janszky (KI), Staffan Ahnve (KI), Rickard Ljung (EpC), Anders
Ahlbom (KI), Johan Hallqvist.
2. How much of the population burden of disease can be attributed to socioeconomic
inequality.
Several meta-analyses are first conducted to obtain estimates of the necessary parameters and
then calculations of attributed disability adjusted live years (DALYs) will be made.
Collaborators: Tahereh Moradi (KI), Johan Hallqvist, Peter Allebeck (KI), Emilie Agardh (KI),
Edison Garcia (KI), Anna Sidorchuk (KI).
3. Psychosocial work environment and stroke.
Investigates this question in several different data bases. Collaborators: Sanna Toivanen
(CHESS, Stockholm University), Johan Hallqvist, Birgitta Stegmayr (EpC), Petra Lindfors
(Psykology, Stockholm University), Urban Janlert (Umeå University), Tomas Hemmingsson
(KI). Örjan Hemström (Board of higher education).
Related tasks
The work environment and musculoskeletal disease.
A project set up by SBU – The Swedish Council on Technology Assessment in Health Care to
examine the amount of scientific evidence supporting a causal effect of various work
environment characteristics on risk of musculoskeletal diseases. The aim is to establish the
evidence base for health promotion, prevention and for decisions regarding health and social
insurance. Chaired by Christer Edling. Experts: Maria Feychting, Johan Hallqvist, Carina
Nordander, Jorma Styf, Kjell Thorén, Ewa Wigeus-Törnquist.
Scientific advisor in preventive medicine to the National Board of Health and Welfare since
2009.
EPIHEALTH
Johan Hallqvist is a member of the EPIHEALTH network set up as joint collaborative effort
between epidemiologists at the universities of Lund and Uppsala. This excellence program is
headed by Peter Nilsson in Lund and Lars Lind in Uppsala.
147
Invited speaker
1. The second meeting of the French Association of Social Epidemiology (ADELF) in Toulouse
May 2009
2. The International Workshop on Mediation and Interaction in Copenhagen December 2009.
3. The conference on Life Course Perspectives on Social Inequalities in Health – Moving
towards an Interdisciplinary Science organized by the International Centres for Lifecourse
Studies in Bern and London at Bielefeld University in March 2010
Examinations and evaluations
Scientific advisor in preventive medicine to the National Board of Health and Welfare from
2009 and onwards.
Member of the Council for research at Gävleborg County Council from 2008 and onwards.
Member of the Committee for Public Health Science at the Swedish Council for Working Life
and Social Research from 2010 and onwards.
Member of the Committee for Public Health Science at the Norwegian Council for Research
2010.
Opponent/examiner for a thesis by Jeremy Walker at the University of Edinburgh, UK in
December 2009.
Since 2007 assignment as expert at evaluations for positions: two positions as professors,
Three positions as associate professor.
Teaching
An advanced one week course in epidemiology for doctoral students at Uppsala University.
The course was initiated in 2009 together with Karl Michaelsson, Liisa Byberg, Rolf Gedeborg
and Johan Sundström at Uppsala Clinical Research Centre (UCR) and was repeated in 2010.
Course leader and main teacher in the four week course in basic epidemiology for students in
the Public Health Master Program in 2009 and 2010.
148
Teaching introductory epidemiology at Uppsala Graduate School in Biomedical Research
(UGSBR) 2009 and 2010.
SINGS (Stockholm Interdisciplinary Graduate School in Register Based Reseach)
This graduate school in epidemiology received funding from the Swedish Research Council to
become the teaching support to the research group nodes that were created at different
universities as a result of the Swedish Research Council’s SIMSAM grant application call in
2008. Hallqvist was a member of the steering committee chaired by Olof Akre (KI) since the
beginning but resigned during 2010.
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Scientific Report
Psychosocial oncology and supportive care
Research Group Leader Professor Louise von Essen
With the help of the Swedish Government's funding of the Uppsala University Psychosocial
Care Programme: U-CARE, Uppsala University has been given the possibility to support our
research group Psychosocial oncology and supportive care, that is internationally strong in basic
and applied psychosocial care research. This immensely improved our possibility to reach
scientific renewal by new recruits during and collaborations with strong research groups. Our
group now consists of almost thirty persons, most senior and junior researchers and PhD
students. Our research activities are performed within the areas of paediatric oncology, adult
oncology, and cardiology in close collaboration with clinicians at Uppsala Akademiska Hospital
and other Swedish hospitals.
The overarching goal of our group’s research is to promote psychosocial health among patients
struck by somatic disease and their significant others, hopefully at a lower cost to the benefit of
individuals and society. The main aims of our current research are: to, among different groups
of patients with somatic diseases and their close ones, investigate psychological responses to
trauma, including posttraumatic and to, among different groups of patients with somatic
diseases and their close ones, investigate the clinical efficacy and cost-effectivness of online
self-help programmes of psychosocial care and cognitive behavioural therapy.
During 2010 we have, in connection with our collaborators, constructed a prototype for an
internationally competitive and innovative Internet platform that in a first step will be applied
within paediatric oncology, adult oncology, and cardiology to provide care and psychological
treatment to patients and significant others; started building a high quality research-based, transdisciplinary undergraduate and graduate education within the field of psychosocial care in the
interactive society; provided stimulating and challenging career opportunities for young
researchers; attracted approximately 8 000 000 SEK in external funding from the Swedish
research foundations and established a forum for interdisciplinary encounters and networking
across the borders between social and medical sciences where disciplinary differences lead to
methodological progress. By bridging scientific and organizational borders, we offer a meeting
place for researchers, clinicians, and students from different disciplinary backgrounds in a way
that is unique, nationally as well as internationally, within the field of care science.
Members of the group 2011
Persons recruited to work with our group’s activities are listed below. In addition to these
persons we have a large number of collaborators at different departments at Uppsala University
and at other Swedish universities. In addition we collaborate with researchers at Muhimbili
University in Dar es Salaam, Tanzania and at Nairobi University, Nairobi, Kenya.
Name
Academic title
Professional title
Department/University
Louise von Essen
PhD, Professor
Psychologist
Department of Public
Health and Caring
150
Pär Ågerfalk
PhD, Professor
System analyst
Claes Held
PhD, Associate
professor
MD
Annika Lindahl
Norberg
PhD, Associate
professor
Psychologist
Sciences, Uppsala
University
Department of
Informatics and Media,
Uppsala University
Uppsala Clinical
Research Centre and
Department of Public
Health and Caring
Sciences, Uppsala
University
Department of Public
Health and Caring
Sciences, Uppsala
University and
Department of Women’s
and Children’s Health,
Childhood Cancer
Research Unit, Karolinska
Institutet
Elly-Ann Lindström PhD, Post doc
researcher
MSc in Economy
Erik Olsson
PhD, Post doc
researcher
Psychologist
Jonas Sjöström
PhD, Post doc
researcher
System analyst
Erik Grönqvist
PhD, Researcher
MSc in Economy
Emma Hovén
PhD, Researcher
MSc in Behavioural
science
Birgitta Johansson
PhD, Researcher
Registered nurse
151
Department of Public
Health and Caring
Sciences and Office of
Labour Market Police
Evaluation, Uppsala
University
Department of Public
Health and Caring
Sciences, Uppsala
University
Department of
Informatics and media
and Department of Public
Health and Caring
Sciences, Uppsala
University
Department of Economics
and Department of Public
Health and Caring
Sciences, Uppsala
University
Department of Public
Health and Caring
Sciences, Uppsala
University and
Department of Women’s
and Children’s
Health,Childhood Cancer
Research Unit, Karolinska
Institutet
Department of Radiology,
Oncology and Radiation
Science and Department
Elisabet Mattsson
PhD, Researcher
Registered nurse
Niklas Zethraeus
PhD, Researcher
MSc in Economy
Gunilla Mårtensson
Registered nurse
Sven Alfonsson
PhD, Associated
researcher
MSc, PhD student
Malin Ander
MSc, PhD student
MSc in Psychology
Martin Cernvall
MSc, PhD student
Psychologist
Gunn Engvall
PhD student
Registered nurse
Susanne Mattsson
PhD student
Registered nurse
Fredrika Norlund
MSc, PhD student
Psychologist,
Licensed
psychotherapist
Teolinda Toft
MSc, PhD student
Social worker
Marina Forslund
MSc, Research
assistant
Dietician
Ruth Lochan
MSc, Research
assistant
Software engineer
Susanne Lorenz
Research assistant
Registered nurse
Psychologist
152
of Public Health and
Caring Sciences, Uppsala
University
Department of Public
Health and Caring
Sciences, Uppsala
University
Stockholm School of
Economics and
Karolinska Institutet
University of Gävle
Department of Public
Health and Caring
Sciences and Department
of Psychology, Uppsala
University
Department of Public
Health and Caring
Sciences, Uppsala
University
Department of Public
Health and Caring
Sciences, Uppsala
University
Department of Public
Health and Caring
Sciences and Department
of Women’s and
Children’s Health,
Uppsala University
Department of Public
Health and Caring
Sciences, Uppsala
University
Department of Public
Health and Caring
Sciences, Uppsala
University
Department of Public
Health and Caring
Sciences, Uppsala
University
Department of Radiology,
Oncology and Radiation
Science and Department
of Public Health and
Caring Sciences, Uppsala
University
Department of Public
Health and Caring
Sciences, Uppsala
University
Department of Public
Hafijur Rahman
Research assistant
Software engineer
Riyadh Ul-Islam
Research assistant
Software engineer
Anders Brantnell
MSc, Coordinator
MSc in Political
science
Inger Holmström
PhD, Associate
professor
Registered nurse
Health and Caring
Sciences, Uppsala
University
Department of Public
Health and Caring
Sciences, Uppsala
University
Department of Public
Health and Caring
Sciences, Uppsala
University
Department of Public
Health and Caring
Sciences, Uppsala
University
Department of Public
Health and Caring
Sciences, Uppsala
University
Publications from the group 20081. Engvall, G., Mattsson, E., von Essen, L. & Hedström, M. (2010). Findings on how
adolescents cope with cancer – a matter of methodology? Psycho-Oncology, July 28.
[Epub ahead of print]
2. Engvall, G., Skolin, I., Mattsson, E., Hedström, M. & von Essen, L. (2010). Are nurses
and physicians able to assess which coping strategies adolescents recently diagnosed
with cancer use to cope with disease- and treatment-related distress? Supportive Care in
Cancer, March 27. [Epub ahead of print]
3. Enskär, K. & von Essen, L. (2008). Physical problems and psychosocial function in
children with cancer. Paediatric Nursing, 20, 37-41.
4. Enskär, K., Hamrin, E., Carlsson, M. & von Essen, L. (2011). Swedish mothers and
fathers of children with cancer – perceptions of wellbeing, social life and good care.
Journal of Psychosocial Oncology, 29, 51-66.
5. von Essen, L. (2010). Better Care at a Lower Cost. Public Service Review. European
Union: Issue 19.
6. Fröjd, C., Lampic, C., Larsson, G. & von Essen, L. (2009). Is satisfaction with care
related to health-related quality of life, anxiety, and depression among Swedish patients
with carcinoid tumours. A longitudinal report. Scandinavian Journal of Caring Sciences,
23, 107-16.
7. Hedén, L., von Essen, L. & Ljungman, G. (2009). Randomized interventions for needle
procedures in children with cancer. European Journal of Cancer Care, 18, 358-63.
8. Hedén, L., von Essen, L., Frykholm, P. & Ljungman, G. (2009). Low dose oral
Midazolam reduces fear and distress during needle procedures in children with cancer.
Pediatric Blood and Cancer, 15, 1200-4.
153
9. Larsson, G., Mattsson, E. & von Essen, L. (2010). Aspects of quality of life, anxiety,
and depression among persons diagnosed with cancer during adolescence: a long-term
follow-up study. European Journal of Cancer, 46, 1062-8.
10. Lindahl Norberg, A., Pöder, U. & von Essen, L. (2011). Early avoidance of disease- and
treatment-related distress predicts posttraumatic stress in parents of children with
cancer. European Journal of Oncology Nursing, 15, 80-4.
11. Mattsson E., El Khouri B., Ljungman G. & von Essen, L. (2009). Empirically derived
psychosocial states among adolescents diagnosed with cancer during the acute and
extended phase of survival. Annals of Oncology, 20, 1722-7.
12. Mattsson, E., Lindgren, B. & von Essen, L. (2008). Are there any positive consequences
of childhood cancer? A review of the literature. Acta Oncologica, 47, 199-206.
13. Pöder, U. & von Essen, L. (2009). Perceptions of support among Swedish parents of
children on cancer treatment: a prospective, longitudinal study. European Journal of
Cancer Care, 18, 350-7.
14. Pöder, U., Ljungman, G. & von Essen, L. (2008). Posttraumatic stress disorder among
parents of children on cancer treatment: a longitudinal study. Psycho-Oncology, 17,
430-7.
15. Pöder, U., Ljungman, G. & von Essen, L. (2010). Parents' perceptions of their children's
cancer-related symptoms during treatment: a prospective, longitudinal study. Journal of
Pain and Symptom Management, 40, 661-70.
16. Wettergren, L., Mattsson, E. & von Essen, L. (2011). Mode of administration only has a
small effect on data quality and self-reported health status and emotional distress among
adolescents and young adults. Journal of Clinical Nursing, Feb 15. [Epub ahead of
print]
Dissertations 2008-2010
Mattsson, E. (2008). Cancer during Adolescence: Psychosocial Consequences and
Methodological Issues. Acta Universitatis Upsaliensis, Uppsala.
Pöder, U. (2008). Posttraumatic Stress among Parents of children on cancer Treatment: Support,
Care and Distress. Acta Universitatis Upsaliensis, Uppsala.
Agencies that support our work/Funding 2008-2010
The Swedish Research Society: 6 110 000 SEK
The Swedish Children’s Cancer Foundation: 2 700 000 SEK
The Swedish Cancer Society: 1 000 000 SEK
Uppsala County Council: 550 000 SEK
Indevelop: 50 000 SEK
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Research projects 2008Project: Cancer during adolescence. Psychosocial and health economic consequences
Overall aim
To investigate potential psychosocial and health economic consequences of adolescent cancer;
compare the psychosocial and health economic situation of those struck by cancer during
adolescence vs. matched controls and investigate whether there are any positive consequences
of adolescent cancer.
METHODS
The project has a comparative, longitudinal design with eight measurements from a month to
ten years after diagnosis. Sixty-one adolescents have been included. Data from a control group
of 300 healthy persons have been collected. All participants answer questions about quality of
life, anxiety and depression via telephone. Additionally those struck by cancer answer questions
about disease- and treatment-related distress, whether and if so how they cope with distress and
whether they experience any negative and positive cancer-related consequences.
FUNDING
The project started 1999 and is since then funded by the Swedish Children’s Cancer Foundation
and the Swedish Cancer Society.
Project: Occurrence and development of posttraumatic stress among parents of children
with cancer
Overall aim
To investigate occurrence of posttraumatic stress, predictors of posttraumatic stress and health
economic consequences among parents of children struck by cancer.
METHODS
The project has a longitudinal design with seven measurements from one week after diagnosis
to five years after end of treatment. 250 parents have been included. Parents answer questions
about e.g. posttraumatic stress, emotional support and the child’s medical situation via
telephone.
FUNDING
The project started 2002 and is since then funded by the Swedish Research Society, the Swedish
Children’s Cancer Foundation and the Swedish Cancer Society.
Project: Quality of life and needs of care and support among East Africans with cancer
Overall aim
To investigate quality of life and explore needs of care and support among East Africans struck
by cancer.
METHODS
The project has a comparative, explorative design. 100 patients have participated in focus-group
interviews and answered questions about quality of life.
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FUNDING
The projected started 2006 and has been funded by Indevelop and the Faculty of Medicine,
Uppsala University.
Project: U-CARE: Treatment of posttraumatic stress among parents of children with
cancer with cognitive behavioral therapy over the internet
Overall aim
To investigate the clinical efficacy and cost-effectiveness of a cognitive behavioural self-help
programme delivered via the internet to parents of children struck by cancer.
METOD
The study has a randomized, controlled design. 150 parents will be included and randomized to
early programme – starting 6 weeks after the child’s diagnosis or late programme – starting 70
weeks after the child’s diagnosis. Inclusion started 2010. Parents answer questions about e.g.
posttraumatic stress, anxiety, depression, quality of life and costs via the internet.
FUNDING
The project started 2008 and is funded by the Swedish Research Society, the Swedish Cancer
Society and the Swedish Children’s Cancer Foundation.
Project: U-CARE: A randomized controlled trial of the effect of a self-help programme
via internet on anxiety and depression among adolescents with cancer
Overall aim
To investigate the clinical efficacy and cost-effectiveness of a self-help programme consisting
of support and cognitive behavioural therapy delivered via the internet to adolescents struck by
cancer.
METHODS
The study has a randomized, controlled design. 150 adolescents will be included and
randomized to early programme – starting 5 weeks after diagnosis or late programme – starting
20 months after diagnosis. Adolescents answer questions about e.g. posttraumatic stress,
anxiety, depression, quality of life, posttraumatic growth and costs via the internet.
FUNDING
The project is funded by a strategic research grant to Uppsala University Psychosocial Care
Programme: U-CARE.
Project: U-CARE: A randomized controlled trial of the effect of a self-help program via
internet on anxiety and depression among adults with cancer
Overall aim
To investigate the clinical efficacy and cost-effectiveness of a self-help programme consisting
of support and cognitive behavioural therapy delivered via the internet to adults struck by
cancer.
METHODS
The study has a randomized, controlled design. 250 adults with prostate-, breast- or localized
colo- or rectal cancer will be included and randomized to a self-help programme or waiting-list.
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Participants answer questions about e.g. posttraumatic stress, anxiety, depression, quality of life,
posttraumatic growth and costs via the internet.
FUNDING
The project is funded by a strategic research grant to Uppsala University Psychosocial Care
Programme: U-CARE.
Project: U-CARE: A randomized controlled trial of the effect of a self-help program via
internet on anxiety and depression among adults after a myocardial infarct
Overall aim
To investigate the clinical efficacy and cost-effectiveness of a self-help programme consisting
of cognitive behavioural therapy delivered via the internet to adults struck by a myocardial
infarct.
METHODS
The study has a randomized, controlled design. 500 adults struck with a myocardial infarct will
be included and randomized to a self-help programme or waiting-list. Participants answer
questions about e.g. posttraumatic stress, anxiety, depression, quality of life, posttraumatic
growth and costs via the internet.
FUNDING
The project is funded by a strategic research grant to Uppsala University Psychosocial Care
Programme: U-CARE.
Education 2008-2010
Undergraduate education
Our group has been engaged in education in communication skills, psychosocial care and
research methodology in the Nursing programme and in education in research methodology in
the Psychology programme at Uppsala University.
Advanced education
Our group is engaged in advanced education in research designs and datacollection within
quantitative and qualitative research and statistics and we provide two courses in research
methodology at the postgraduate programme at the Faculty of Medicine, Uppsala University.
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Scientific Report
Research Ethics & Bioethics
Research Group Leader Professor Mats G. Hansson
Research Ethics involves the application of ethical principles and values to a variety of research
topics. It aims to create good research, while at the same time studying what good research is.
Bioethics, on the other hand, includes philosophical, theological, legal and social scientific
aspects of medicine and biology.
The Centre for Research Ethics & Bioethics (CRB) is an interfaculty centre placed at the
Department. Read more about CRB’s research under “Centres and Facilities”.
Centre for Research Ethics & Bioethics (CRB)
Research Ethics and Bioethics has become increasingly important for Uppsala University. As a
result, the Centre for Research Ethics and Bioethics was established on January 1 2008. The
centre is placed at the Faculty of Medicine and administratively associated to the Department of
Public Health and Caring Sciences.
Our research profile includes research ethics, bioethics and medical law. More specifically, we
conduct research on animal and environmental ethics, investigate autonomy, the ethics of
biobanking, dual-use issues related to biosafety and biosecurity, codes and guidelines for
research, clinical ethics, enhancement of human performance, genetic information and testing,
neuroethics and the philosophy of mind, ethics at the beginning of life, priorities in health care
and quality of life issues.
Research ethics involves the application of ethical principles and values to a variety of scientific
research topics. It has both a practical and a theoretical side. It aims to create good research,
while at the same time studying what good research is.
Bioethics includes philosophical, theological, legal and social scientific aspects of medicine and
biology. It deals with norms and value conflicts in health care and the biosciences. For example,
it looks at ethical questions that arise in connection with priorities in health care, informed
consent, palliative care, and neurobiological explanations of human consciousness, animal
welfare and the use of biotechnology.
Medical law spans a wide range of traditional branches of law and is associated to the Centre
through our collaboration with the Department of Law at Uppsala University
Our work in research ethics has recently received international recognition. The European
Science Foundation has completed a study of how institutions of higher education in different
countries proactively approach research ethical issues. Uppsala University is highlighted as a
good example and praised for its thorough efforts at preventing research misconduct and
promoting sound research practices. Special mention is made of the University’s Centre for
Research Ethics & Bioethics, which coordinates activities related to research ethics, bioethics
and medical law, pursues associated research and trains students and researchers.
Members of the group 2010
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Ashkan Atry, MA, PhD student
Ewa Axelsson, LLM, LLD student
Stefan Eriksson, ThD, Associate Professor of Research Ethics, Senior lecturer in
Research Ethics
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Lilianne Eninger, PhD, Associate Professor of Psychology, Senior researcher
Kathinka Evers, PhD, Associate Professor of Philosophy, Senior researcher
Josepine Fernow, BA, Co-ordinator
Joanna Forsberg, MD, PhD student
Tove Godskesen, RN, PhD student
Maria Gottvall, RN, PhD student
Roya Hakimnia, MD, PhD student
Mats G. Hansson, BS, ThM, ThD, Professor of Biomedical Ethics, Director
Anna T. Höglund, ThD, Associate Professor of Ethics, Senior Lecturer in Nursing
Ethics
Li Jalmsell, MD, PhD student
Linus Johnsson, MD, PhD student
Ulrik Kihlbom, PhD, Senior lecturer in Medical Ethics
Sofia Kälvemark Sporrong, PhD, Associated researcher
Frida Kuhlau, BA, PhD student
Malin Masterton, PhD, Postdoc
Mona Pettersson, RN, PhD student
Tobias Renberg, PhD, Postdoc
Alina Rodriguez, PhD, Senior researcher
Elisabeth Rynning, LLD, Professor of Medical Law, Senior researcher
Pär Segerdahl, PhD, Associate Professor of Philosophy, Senior researcher
Anna Lydia Svalastog, PhD, Associate Professor of Religious Studies, Associated
researcher
Kavot Zillén, LLM, LLD student
Publications 2008-2010
A characteristic feature of our interdisciplinarity is that we publish both in scientific journals,
often together with researchers from other disciplines, and in monographs. The monograph
format is customary in philosophy and humanities and it allows for more in depth analysis of
conceptual issues. In fact only publishing in shorter articles would be a little irregular from the
perspective of philosophers. Our monographs are often published in established series and
always scrutinized in a peer review.
During this three year period the following monographs have been published:
1. Evers, K, Neuroéthique. Quand la matière s'éveille, Éditions Odile Jacob, Paris, 2009,
249p. (In English: Neuroethics. When matter awakens), In Spanish: Evers, K,
Neuroética. Cuando la materia se despierta, Katz editores, 2010
2. Hansson Mats G, The Private Sphere. An Emotional Territory and Its Agent,
Philosophical Studies in Contemporary Culture, Springer, Vol. 15, 2008, X, 182 p.
3. Höglund, Anna T, Gender and the War on Terrorism. The Justification of War in a Post9/11 Perspective, Skrifter från Centrum för genusvetenskap/Crossroads of Knowledge
13, Uppsala universitet 2010. 248 pp.
4. Segerdahl, P., Gender, Language and Philosophical Reconciliation: what does Judith
Butler destabilize? Wittgensteinian Approaches to Ethics and the Philosophy of Culture.
Cambridge Scholars Publishing. (In press)
5. Segerdahl, P. (Ed.). Undisciplined Animals: Invitations to Animal Studies. Cambridge
Scholars Publishing (In press).
159
The complete list for this period is:
1. Arnetz JE, Höglund AT, Arnetz BB, Winblad U, Development and evaluation of a
questionnaire for measuring patient views of involvement in myocardial infarction care,
European Journal of Cardiovascular Nursing. 2008;7:229-238.
2. Arnetz JE, Winblad U, Arnetz BB, Höglund AT, Physicians’ and nurses’ perceptions of
patient involvement in myocardial infarction care, European Journal of Cardiovascular
Nursing. 2008;7:113-120.
3. Arnetz JE, Höglund AT, Arnetz BB, Winblad Spångberg U, Staff views and behaviour
regarding patient involvement in myocardial infarction care: Development and
evaluation of a questionnaire, European Journal of Cardiovascular Nursing. 2008;7:2735.
4. Arnetz JE, Winblad U, Höglund AT, Lindahl B, Spångberg K, Wallentin L et al. Is
patient involvement during hospitalization for acute myocardial infarction associated
with post-discharge treatment outcome? An exploratory study. Health Expectations.
Online pre-publication: doi: 10.1111/j.1369-7625.2009.00588.x.
5. Björnsson, G, Kihlbom, U, Ullholm, A, Argumentationsanalys - Färdigheter för kritiskt
tänkande, Natur & Kultur, Stockholm, 2009;ISBN 978-91-27-11808-9
6. Eriksson S, Höglund AT, Helgesson G, Do Ethical Guidelines give Guidance? A
Critical Examination of Eight Ethics Regulations, Cambridge Quarterly of Healthcare
Ethics. 2008;17:15-29.
7. Eriksson, S, On the need for improved protections of incapacitated and non-benefiting
research subjects, Bioethics, online pre-publication: ISSN 0269-9702 (print): 14678519 (online).
8. Evers, K, Neuroéthique. Quand la matière s'éveille, Éditions Odile Jacob, Paris, 2009
(In English: Neuroethics. When matter awakens)
9. Evers K, Philosophical challenges for neuroethics, European
Neuropsychopharmacology, Journal of the European College of
Neuropsychopharmacology, 2008;18: Supplement 4. Paper from the 21st ENCP
Congress, 30 August - 3 September 2008
10. Evers, K, Personalized medicine in psychiatry: ethical challenges and opportunities,
Dialogues in Clinical Neuroscience: Personalized Medicine: Prediction, Prevention,
Participation. 2009, 11:(4):427-433 2009.
11. Evers, K, Ethics in Science: A Socio-Political Challenge, in Sitter-Liver (ed.):
Universality: From Theory to Practice, Academic Press, Fribourg, 2009;393-404.
12. Evers, K, Uma Nova Visão do Cérebro: o Aparecimento da Neuroética, in Curado &
Oliveira (eds.): 2010, Pessoas Transparentes: Questões Actuais de Bioética,
EdicõesAlmedina, Coimbra, Portugal.2010;77 – 92.
13. Evers, K, Neuroética. Cuando la materia se despierta, Katz editores, 2010 (In English:
Neuroethics. When matter awakens)
14. Forsberg JS, Eriksson S, Hansson MG., Changing defaults in biobank research could
save lives too, Eur J Epidemiol. 2010;Feb;25(2):65-8.
15. Ferm Widlund, K, Gunnarsson, C, Nordin, K, Hansson, MG, Pregnant women are
satisfied with the information they receive about prenatal diagnosis, but are they well
informed?, Acta Obstetrica et Gynecologica Scandinavica. 2009;88(10):1128-1132.
16. Gottvall M, Larsson M, Hoglund AT, Tyden T, High HPV vaccine acceptance despite
low awareness among Swedish upper secondary school students, Eur J Contracept
Reprod Health Care. 2009;14:399-405
17. Gottvall M, Tydén T, Höglund AT, Larsson M, Knowledge of human papillomavirus
among high school students can be increased by an educational intervention,
International Journal of STD & AIDS. 2010;21:558-562.
18. Hansson, MG, Kihlbom, U, Tuvemo, T, Rodriguez, A, Concern for privacy in relation
to age in physical examination in children: An exploratory study, Acta Paediatrica.
2009;98(8):1349-1354.
160
19. Hansson, MG, Maschke KJ, Biobanks: Questioning Distinctions, Science.
2009;326:(5954):797.
20. Hansson, MG, Ethics and Biobanks, British Journal of Cancer British Journal of
Cancer- 2009;100:8–12
21. Hansson Mats G, The Private Sphere. An Emotional Territory and Its Agent,
Philosophical Studies in Contemporary Culture, Springer, Vol. 15, 2008, X, 182 p.,
ISBN: 978-1-4020-6651-1
22. Hansson, MG, Do we need a wider view of autonomy in epidemiological research?,
British Medical Journal. 2010;340:c(2335):1172-1174
23. Hansson, MG & Hakama, M, Ulysses contracts for the doctor and for the patient,
Contemporary Clinical Trials. 2010;31:202-206.
24. Hansson, MG, Taking the patient’s side: the ethics of pharmacogenetics, Personalized
Medicine. 2010;7(1): 75-85.
25. Hansson, MG, The need to down regulate. A minimal ethical framework for biobank
research, in: Dillner, J. (ed), Methods in Biobanking, Methods in Molecular Biology
Book Series No 675, p.39-59. The Humana press, Springer 2011.
26. Helgesson, G, Hansson, MG, Ludvigsson, J, Swartling, U, Practical matters, rather than
lack of trust, motivate non-participation in a long-term cohort trial, Pediatric Diabetes.
2009:10(6):408-412.
27. Helgesson G, Eriksson S, Against the principle that the individual shall have priority
over science, Journal of Medical Ethics. 2008;34:54-56.
28. Helgesson, G, Hansson, MG, Ludvigsson, J, Swartling, U, Practical matters, rather than
lack of trust, motivate non-participation in a long-term cohort trial, Pediatric Diabetes.
2009;10(6):408-412.
29. Helgesson, G, Eriksson S, The moral primacy of the human being: A reply to Parker,
Journal of Medical Ethics, 2011;37:56-57.
30. Helgesson, G, Eriksson S, Does Informed Consent Have an Expiry Date? A Critical
Reappraisal of Informed Consent as a Process, Cambridge Quarterly of Healthcare
Ethics, 2011;20:85-92.
31. Holmström I, Höglund AT, Det ansiktslösa mötets etik. Sjuksköterskors erfarenheter av
etiska dilemman vid telefonrådgivning, in Holmström, I. (ed.): Telefonrådgivning inom
hälso- och sjukvård. Lund: Studentlitteratur, 2008;91-105.
32. Holmström, I & Höglund AT, Response to commentary. Journal of Clinical Nursing.
2008;17:3251-3252.
33. Hultman, CM, Lindgren, A-C, Hansson, MG, Carlstedt-Duke, J, Ritzen, M, Persson, I,
Kieler, H, Ethical Issues in Cancer Register Follow-up of Hormone Treatment in
Adolescence, Public Health Ethics. 2009;2(1):30-36
34. Höglund AT, Holmström I, Ethical issues in telenursing, International Hospital
Equipment and Solutions. 2009;7(34):18-19.
35. Höglund AT, Holmström I, 'It's easier to talk to a woman'. Aspects of gender in
Swedish telenursing, Journal of Clinical Nursing. 2008;17:2979-2986.
36. Höglund AT, Tydén T, Hannerfors AK, Larsson M, Knowledge of human
papillomavirus and attitudes to vaccination among Swedish high school students,
International Journal of STD & AIDS. 2009; 20(2):102-7
37. Höglund, Anna T, Gender and the War on Terrorism. The Justification of War in a Post9/11 Perspective, Skrifter från Centrum för genusvetenskap/Crossroads of Knowledge
13, Uppsala universitet 2010. 248 pp.
38. Höglund AT, Gender and Bioethics, in: Never Mind the Gap! Gendering Science in
Transgressive Encounters, Blomqvist M & Ehnsmyr, E (eds), Skrifter från Centrum för
genusvetenskap / Crossroads of Knowledge 15, Universitetstryckeriet, Uppsala 2010.
39. Höglund AT, Eriksson S, Helgesson G, The role of guidelines in ethical competencebuilding: Perceptions among research nurses and physicians. Clinical Ethics. 2010;5:95102.
161
40. Höglund, AT, Winblad, U, Arnetz, B, Arnetz JE, Patient participation during
hospitalization for myocardial infarction: perceptions among patients and personnel,
Scand J Caring Sci. 2010; doi:10.1111/j.1471-6712.2009.00738 (online).
41. Höglund AT, Helgesson G, Eriksson S, Ethical dilemmas and ethical competence in the
daily work of research nurses. Health Care Analysis. 2010;18:239-251.
42. Johnsson L, Hansson MG, Eriksson S, Helgesson G, Opt-out from biobanks better
respects patients’ autonomy, BMJ. 2008;337:a1580
43. Jalmsell L, Kreichbergs U, onelöv E, Steineck G, Henter JI. Anxiety is contagioussymptoms of anxiety in the terminally ill child affect long-term psychological wellbeing in bereaved parents. Pediatr Blood Cancer, 2010 May; 54(5):751-7
44. Jalmsell L, Onelöv E, Steineck G, Henter JI, Kreichbergs U. Hematopoietic stem cell
transplantation in children with cancer and the risk of long-term psychological
morbidity in the bereaved parent. Bone Marrow Transplant. 2010, Nov 22, e-pub ahead
of print.
45. Johnsson L, Hansson MG, Eriksson S, Helgesson G, Patients' refusal to consent to
storage and use of samples in Swedish biobanks: cross sectional study, BMJ.
2009;337:24-26.
46. Johnsson, L, Helgesson, G, Rafnar, T, Halldorsdottir, I, Chia, KS, Eriksson, S, Hansson
MG, Hypothetical and factual willingness to participate in biobank research. European
Journal of Human Genetics advance online publication 21 July 2010; doi:
10.1038/ejhg.2010.106.
47. Kaminsky E, Carlsson M, Höglund AT, Holmström I, Paediatric health calls to Swedish
telenurses: a descriptive study of content and outcome, J Telemed Telecare.
doi:10.1258/jtt.2010.100110, online pre-publication
48. Kihlbom U, Autonomy and negatively informed consent, Journal of Medical Ethics
2008;34;146-149.
49. Kuhlau F, Höglund A T, Evers K, Eriksson S, A precautionary principle for dual use
research in the life sciences, Bioethics. 2011;25:1-8.
50. Kuhlau F, Eriksson S, Evers K, Höglund AT, Taking Due Care: Moral obligations in
dual use research, Bioethics Vol 22, 9 2008, 477-487
51. Kuhlau, F. and Hart, J.: Biosecurity. In: Burgess, J. P. (ed.) The Routledge Handbook of
New Security Studies. Routledge, 2010
52. Masterton, M, Hansson MG, Höglund AT, In search of the missing subject: narrative
identity and posthumous wronging, Studies in History and Philosophy of Science Part
C: Studies in History and Philosophy of Biological and Biomedical Sciences, Online
pre-publication 1 November 2010;doi:10.1016/j.shpsc.2010.10.010
53. Masterton M, Duties to Past Persons: Moral Standing and Posthumous Interests of Old
Human Remains, doctoral thesis, Acta Universitatis Upsaliensis, 2010.
54. Montgomery AT, Kälvemark Sporrong S, Tully MP, Kettis Lindblad Å. Follow-up of
patients receiving a pharmaceutical care service in Sweden. Journal of Clinical
Pharmacy and Therapeutics, 2008;33:653-662
55. Pedersen, J, Segerdahl, P, & Fields, WM, Why Apes Point: Indexical Pointing in
Spontaneous Conversation of Language-Competent Pan/Homo Bonobos. In: Columbus,
F. (Ed.). Primatology: Theories, Methods and Results. Nova Science Publishers. 2009.
56. Segerdahl, P, Förlåtelsens anda. Tankar tillägnade Sören Stenlund. Forsberg, N., Rider,
S., and Segerdahl, P. (Eds.). Uppsala Philosophical Studies 54. 2008.
57. Segerdahl, P, The Difficulty of Acknowledging Our Primary Culture. Forsberg, N. &
S. Jansson (Eds). Acknowledging Stanley Cavell. Uppsala: Uppsala Philosophical
Studies. 2009.
58. Segerdahl, P, Can non-human animals have cultural notions of sex? In: Holmberg, T
(Ed.). Investigating Human/Animal Relations in Science, Culture and Work. Skrifter
från Centrum för genusvetenskap, Uppsala universitet. 2009.
59. Segerdahl, P, Varför filosoferar man? Filosofisk tidskrift. 2011;11(1).
162
60. Stjernschantz Forsberg J, Hansson MG, Eriksson S., Changing perspectives in biobank
research – from individual rights to concerns about public health regarding the return of
results, European Journal of Human Genetics. 2009;17:1544-1549.
61. Svalastog, A-L, Att analysera och teoretisera kön och religion. Förslag till nytt
religionsbegrepp, Marburg Journal of Religion, 2009;14(1)
62. Svalastog, A-L, Gene myths in public perceptions, Public Understanding of Science,
Published online before print September 13, 2010, doi: 10.1177/0963662510376284
63. Svalastog A-L, Eriksson S, You can use my name; you don’t have to steal my story A
critique of anonymity in indigenous studies, Developing World Bioethics.
2010:10(2):104-110.
64. Swartling, U, Helgesson, G, Hansson, MG, Ludvigsson, J, Split views among parents
regarding children’s right to decide about participation in research: a questionnaire
survey, Journal of Medical Ethics, Journal of Medical Ethics 2009;35(7):450-455.
65. Swartling, U, Helgesson, G, Hansson, MG, Ludvigsson, J, Parental authority, research
interests and children’s right to decide in medical research – an uneasy tension?,
Clinical Ethics. 2008;3:69-74.
66. Truyers C, Kellen E, Arbyn M, Trommelmans L, Nys H, Hensen K, Aertgeerts B,
Bartholomeeusen S, Hansson M, Buntinx F, The use of human tissue in epidemiological
research; Ethical and legal considerations in two biobanks in Belgium, Medicine,
Health Care and Philosophy 2009; Nov 20, Epub ahead of print.
In press
67. Atry A, Hansson MG, Kihlbom U, Gene doping and the responsibility of bioethicists,
Sports, Ethics & Philosophy (In press)
68. Bergqvist D, Blomgren L, Hansson MG. Cost and reimbursement influence on
treatment strategy: is it ethical? In Wittens C (ed) Advances in venous therapy. Ed
Minerva Medica. Turin 2011 (In Press: ISBN 13:978-88-7711-703-8).
69. Hansson MG, Biobanking within the European regulatory framework – opportunities
and obstacles, Biopreservation and Biobanking, (In Press)
70. Hansson MG, Chadwick R, Is medical ethics doing its job?, Journal of Internal
Medicine (In press).
71. Helgesson G, Eriksson S: Four Themes in Recent Swedish Bioethics Debates,
forthcoming in Cambridge Quarterly of Heathcare Ethics 20:3 (2011).
72. Helgesson, G, Hansson, MG, Ludvigsson, J, Swartling, U, What parents find important
when participating in longitudinal studies: results from a questionnaire, Clinical Ethics
(In press)
73. Höglund, Anna T. Etiska aspekter på att rutinmässigt fråga om erfarenheter av våld i
nära relationer. I: Att fråga om våldsutsatthet som en del i anamnesen. NCK Rapport
2011, Uppsala (In press)
74. Höglund, Anna T. Genusperspektiv på att rutinmässigt tillfråga kvinnor om våld i nära
relationer. I: Att fråga om våldsutsatthet som en del i anamnesen. NCK Rapport 2011,
Uppsala (In press)
75. Magnusson H, Felländer-Tsai L, Hansson MG, Ryd L, Cancellations of elective surgery
may cause an inferior postoperative course. The ”invisible hand” of health care
prioritization?, Clinical Ethics (In Press).
76. Masterton M, Hansson MG, Höglund AT, In search of the missing subject. Narrative
identity and posthumous wronging, Studies in History and Philosophy of Biological and
Biomedical Sciences (In press).
77. Segerdahl, P., Human-Enculturated Apes: Towards a New Synthesis of Philosophy and
Psychology. In: Crossing Boundaries: Creating Knowledge about Ourselves with Other
Animals. Birke, L. and Hockenhull, J. (Eds.) (In press).
78. Segerdahl, P., Gender, Language and Philosophical Reconciliation: what does Judith
Butler destabilize? Wittgensteinian Approaches to Ethics and the Philosophy of Culture.
Cambridge Scholars Publishing. (In press)
163
79. Segerdahl, P. (Ed.). Undisciplined Animals: Invitations to Animal Studies. Cambridge
Scholars Publishing (In press).
80. Svalastog, Anna Lydia, Mapping Sami life and culture, in: Eva Forsgren and Per Bjarne
Boym (eds), The Image of the Sami, Arthub Publisher (In press)
81. Svalastog, Anna Lydia, book review: We have a religion. The 1920s Pueblo Indian
Dance Controversy and American Religious Freedom by Tisa Wenger, Marburg Journal
of Religion (In press).
Reviews 2008-2010
1. Kihlbom, Ulrik, review of Döden är förhandlingsbar by Torbjörn Tännsjö,
Tidsskrift för politisk filosofi, 2009;3.
Dissertations 2010
1. Masterton M, Duties to Past Persons: Moral Standing and Posthumous Interests of Old
Human Remains, doctoral thesis, Acta Universitatis Upsaliensis. 2010.
Agencies that support the work/Funding (figures from 2010)
Swedish Research Council (Vetenskapsrådet)
Controlling chronic inflammatory diseases with combined efforts
(COMBINE)
468 500
Combine consortium consists of: Vinnova, Vårdalstiftelsen,
Reumatikerförbundet, Invest in Sweden Agency, KK-stiftelsen, Stiftelsen
för strategisk forskning
The Swedish Childhood Cancer Foundation (Barncancerfonden)
At the intersection of curative and palliative treatment in paediatric
oncology
500 000
The Swedish Cancer Foundation (Cancerfonden)
Factors associated with participation in phase 1 and phase 3 oncology
trials
565 000
Swedish Research Council (Vetenskapsrådet)
BBMRI.se (Biobanking and Biomolecular Resources Research
Infrastructure)
972 084
Swedish Research Council (Vetenskapsrådet)
CODEX – Rules and Guidelines for Research
700 000
The Swedish Cancer Foundation (Cancerfonden)
Developing clearer definitions and clinical guidelines for Do Not
Resuscitate (DNR) orders in oncology care
265 000
Riksbankens Jubileumsfond (Bank of Sweden Tercentenary
Foundation)
Culture, health and bioethics. Conceptual clusters and cultural theory
400 000
European Union
AutoCure - Curing autoimmune rheumatic diseases
241 982
Journal of Internal Medicine
Is Medical Ethics Really in the Best Interest of the Patient?
700 000
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The Swedish National Centre for Research in Sports (Centrum för
Idrottsforskning)
Is Fair Play Compatible with Doping in Sport?
200 000
5 012 566
Research
1. Prevention of doping through increased understanding of the sense of fairness in
sport (PhD project)
Collaborators:
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Ashkan Atry, MA, PhD student
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Mats G. Hansson, Professor of biomedical ethics, supervisor
•
Ulrik Kihlbom, PhD, supervisor
This PhD project studies if, and in what sense doping is incompatible with fairness in sport and
whether notions of fairness and fair play may function as a foundation upon which arguments
opposing doping in sport can based on in a constructive manner.
Doping sometimes is perceived as an admissible method used in order to render the sport fairer
by levelling an otherwise unfair dispersal of natural talents in sport. In this view, those with less
talent are given a possibility to compensate by means of doping and this will make sport fairer.
However, the term fairness seems to have different meanings in the arguments concerning
doping in general and gene-doping in particular.
This project constitutes an attempt to achieve an “inside-out” perspective in regard to ethical
and philosophical questions concerning performance enhancement in sport. This entails that by
understanding sport as a form of social activity, and by placing this activity within the broader
social context, this project aims at addressing ethical and philosophical issues by considering, as
a starting point, qualities that are inherent to sport.
2. Ethical aspects of biobank research – Individual rights vs. the public good? (PhD
project)
Collaborators:
•
Joanna Forsberg, MD, PhD student
•
Mats Hansson, Professor of biomedical ethics, supervisor
•
Stefan Eriksson, Associate professor of research ethics, supervisor
The purpose of this project is to use bioethical methods and theories to analyze the implications
and tenability of viewing biobank based medical research from a public health perspective. The
relationship between rights and duties of individuals and society in the context of healthcare and
medical research will be investigated. Consequences of adapting a public health view on
biobank research will be analyzed, for instance regarding the issues of consent and returning
individual results. Possible prerequisites for accepting such an approach will also be explored,
primarily in association to confidentiality. This research project is undertaken from an applied
ethics perspective, and its focus will therefore be on practical consequences and policy
implications of different philosophical positions, rather than on their theoretical underpinnings.
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3. Vaccine against HPV – Ethical and social aspects: Survey, exploration and
intervention (PhD project)
Collaborators:
•
Maria Gottvall, RN, PhD student
•
Tanja Tydén, Professor of caring sciences, supervisor
•
Anna T. Höglund, Associate Professor of Ethics, supervisor
•
Margareta Larsson, Associate Professor, Department of Women’s and Children’s
Health, supervisor
Cervical cancer is caused by the human papillomavirus (HPV). Today, there are more than 100
different variants of HPV; of these, HPV types 16 and 18 are the most common oncogene virus
types, which cause approximately 70% of all cases of cervical cancer. This cancer affects about
450 women annually in Sweden. HPV is even related to vaginal and anal cancer and to known
cancers in the vulva, penis and pharynx.
Recently, two very effective vaccines against HPV have been registered. The National Board of
Health and Welfare has recommended that the new vaccine should be included in the general
vaccination program for children and youths in Sweden. The vaccine is very expensive and the
recommendation was preceded by an intense debate on its cost effectiveness. The new HPV
vaccine raises many questions from both ethical and gender perspectives, e.g., how youths and
their parents should be informed; what effects the vaccine would have on youngster’s sexual
habits; and how boys might be informed on HPV as the vaccine will only be given to girls.
The purposes of this project are:
•
•
•
•
To survey youth’s knowledge on sexually transmitted infections and their
consequences, together with their views on the use of condoms, with special focus upon
HPV and the new vaccine against it.
Through an explorative interview study, using focus group method, examine how
midwives and school nurses view their task of informing youths and their parents on the
vaccine against HPV.
With these results as a base, carry out a targeted intervention, with the aim of increasing
youth’s knowledge of STIs in general and of HPV in particular.
To present constructive suggestions of clinical guidance for midwives and school nurses
concerning the social and ethical aspects of the new HPV vaccine.
4. At the intersection of curative and palliative treatment in paediatric oncology
(PhD project)
Collaborators:
•
Li Jalmsell, MD, PhD student
•
Mats G. Hansson, Professor of biomedical ethics, supervisor
•
Britt-Marie Frost, Department of Paediatric Oncology, Uppsala University Hospital
(Akademiska sjukhuset), supervisor
Today there is no clear picture about how children in terminal care and their families perceive
the meaning and importance of palliative care in the Nordic countries. How patients and their
families see the distinction between curative and palliative treatment has primarily been a focus
for retrospective interviews with parents and there is a lack of knowledge in particular regarding
the clinical and moral significance of hope.
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The degree of activity for patients in the terminal phase of care varies, but there is only
anecdotal evidence available. We need to understand how different paediatric oncology
departments manage the intersection of curative and palliative treatment and how children and
their relatives perceive the different activities offered to them.
This project will:
•
•
•
examine to what extent there is a distinctive focus on palliative treatment in
departments of paediatric oncology in Denmark, Finland, Norway and Sweden.
examine how children in terminal care and their families perceive the meaning and
importance of palliative care
give an account of the clinical and moral significance of hope in paediatric oncology
The project is designed with an integration of three different methodologies. It has a descriptive,
a qualitative and a philosophical/theological component.
5. Autonomy and trust in biobank research (PhD project, part of 11, AutoCure)
Collaborators:
•
Linus Johnsson, MD, PhD student
•
Mats G. Hansson, Professor of biomedical ethics, supervisor
•
Gert Helgesson, Associate professor, Department of Learning, Information,
Management and Ethics (LIME), Karolinska Institutet, supervisor
•
Stefan Eriksson, Associate professor of research ethics, supervisor
People are often willing to participate in biobank research in spite of concerns raised in media
about potential risks to personal integrity. Moreover, information about the research is often
disregarded by participants. This suggests a connection between autonomy and trust; however,
neither the nature of this connection nor the relative importance of these concepts is clear. In
this project, these questions will be investigated. Factual inclination to participate in biobank
research will be determined and contrasted with estimations made through contemporary
attitude surveys. The concepts of autonomy and trust will be analyzed, their role in informed
consent procedures elucidated, and their ethical value discussed.
6. Dual use and responsible life science research – A bioethical approach (PhD
project)
Collaborators:
•
Frida Kuhlau, MA, PhD student
•
Anna T. Höglund, Associate professor of ethics, supervisor
•
Stefan Eriksson, Associate professor of research ethics, supervisor
•
Kathinka Evers, Associate professor of philosophy, supervisor
This project will examine the responsibility of biomedical researchers in circumventing
proliferation of biological material, technology and knowledge to actors with malicious intents.
Much of the biomedical research conducted today is of ‘dual-use' nature, which means that it
can have both peaceful (civil) and military applications. The current perception of a bio-terrorist
threat (due to recent terrorist events) and the subsequent security countermeasures, demands the
scientific community to take responsibility and assist in protecting biological material and
knowledge of concern. Central questions include; if biomedical researchers have a responsibility
to minimize the risk of proliferation and, if so, what does that responsibility entail, what is the
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response to proposed obligations among life science researchers, and how is security
consciousness to be implemented in life science research?
7. Retrospective DNA technologies and integrity for historical persons (PhD project)
Collaborators:
•
Malin Masterton, Msc, PhD student
•
Mats G. Hansson, Professor of biomedical ethics, supervisor
•
Anna T. Höglund, Associate professor of ethics, supervisor
The project investigated the question whether or not dead people in general, and historical
persons in particular, can be harmed. With the substantial successes of DNA technology it is
now possible to acquire genetic information from very old DNA. DNA-analysis could help to
answer questions regarding historical persons, for example whether or not Queen Christina of
Sweden was a pseudo-hermaphrodite. Should the dead be respected in these situations or are we
free to satisfy our curiosity? What duties (if any) do we have vis-à-vis the dead and what would
be the basis of these duties?
Dissertation May 2010: Masterton M, Duties to Past Persons: Moral Standing and Posthumous
Interests of Old Human Remains, doctoral thesis, Acta Universitatis Upsaliensis, 2010.
8. Factors associated with participation in phase 1 and phase 3 oncology trials (PhD
project)
Collaborators:
•
Tove Godskesen, RN, PhD student
•
Ulrik Kihlbom, supervisor
•
Karin Nordin, Professor, Department of Public Health and Caring Sciences, supervisor
•
Peter Nygren, Professor, Department of Radiology, Oncology and Radiation Science,
supervisor
The aim of this project is to understand on what premises Swedish patients decide to participate
in phase 1 and phase 3 oncology trials with emphasis on their attitudes regarding risk, own
benefits and benefits for future patients. We will also investigate the implications of this
understanding for information and consent procedures used when recruiting patients to such
trials.
9. Developing clearer definitions and clinical guidelines for Do Not Resuscitate
(DNR) orders in oncology care (PhD project)
Collaborators
•
Mona Pettersson, RN, PhD student
•
Anna Höglund, Associate Professor, supervisor
•
Mariann Hedström, Senior Lecturer, Department of Public Health and Caring
Sciences, supervisor
The aim of this project is to investigate attitudes to and perceptions of ‘Do Not Resuscitate’
(DNR) orders in oncology care among Swedish oncologists and oncology nurses. Further the
experiences of education in DNR and understanding of DNR orders among students in nursing
and medical school will be investigated.
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10. Gender aspects in telenursing (PhD project)
Collaborators
•
Roya Hakimnia, MD, PhD student
•
Anna T. Höglund, Associate Professor, supervisor
•
Inger Holmström, Associate Professor, supervisor
•
Marianne Carlsson, Professor of Caring Sciences, supervisor
This project will use theories on gender and intersectionality to investigate the role of factors
such as gender and ethnicity in Swedish telenursing. An instrument that can investigate gender
competence in telenursing and evaluate the effect of an educational intervention with focus on
gender competence for telenurses will also be developed.
This research will:
•
Investigate gender differences in the communication and outcome of telenursing
consultations (measured in GP appointments, self-care advice or referrals to other care
providers) and explore these differences through the use of theories on gender and
intersectionality.
•
Develop a tool for analysis of gender competence including aspects of power and
intersectionality.
•
Test an educational intervention for telenurses, with focus on gender and
intersectionality.
11. AutoCure - Curing autoimmune rheumatic diseases
Collaborators:
•
Mats G. Hansson, Professor of biomedical ethics
•
Linus Johnsson, MD, PhD student
AutoCure is an EU funded research project within the sixth framework programme. Involved in
the project are 26 different partners, of which 6 are industrial partners and 20 are fro m the
acadeaemia, from all over Europe. The project duration is 60 months from March 1st 2006 and
the total budget is 11 m€.
The objective is to transform knowledge obtained from molecular research particularly within
genomics, into a cure in an increasing number of patients suffering from inflammatory
rheumatic diseases. Rheumatoid arthritis (RA) is used as a prototype since this disease offers
unique opportunities to define and evaluate new therapies. Professor Lars Klareskog at
Karolinska Institutet is co-ordinator of AutoCure.
In addition to providing an ethics management structure, the Centre for Research Ethics &
Bioethics will actively work through a specific work-package in order to offer possible solutions
to urgent problems estimated to arise in association with the research. A doctoral student, Linus
Johnsson (MD) will work with a project comparing the attitudes to genetic and biobank research
as it is revealed in public surveys and in actual decisions made by research subjects. He will
examine and analyse the frequency of withdrawals to biobank sampling made by sample
providers and elaborate the concept of risk related to this kind of research including a critical
examination of what constitutes ”dignitary harms”. His theoretical framework will be developed
through a philosophical analysis of the concepts autonomy and trust. More information about
AutoCure is available at http://www.autocure.org/.
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12. Cancer control using population based registries and biobanks (CCPRB)
Collaborators:
•
Mats G. Hansson, Professor of Biomedical Ethics
CCPRB is an EU network of excellence. The CCPRB network has joined large biobanks with
up to 30 years of follow-up and >60.000 prospectively occurring cancer cases and cancer
registries with >40 years of population-based registration in order to provide the study base for
uniquely large population-based prospective studies on cancer and define and implement a
European Quality Standard for Biobanking. The aim is also to enable large-scale, populationbased research on evaluation of cancer treatment and design optimal strategies for cancer
prevention and its evaluation. Professor Joakim Dillner at Lund University is coordinator of the
CCPRB network.
In CCPRB collaboration between large national and international biobank studies is aimed at
validating the biological significance of previous research and detecting previously unknown
causes of cancer. In order to achieve this goal discrepancy in national policies and regulation
regarding information and consent procedures must be overcome. During the first period a
comparative analysis of national and international ethical and legal frameworks has been made
and on this basis a common ethical framework for all partners have been formulated, and also
decided by the assembly of CCPRB. The ethical framework is consistent with general European
guidelines, e.g. The Convention on Biomedicine and Human Rights by the European Council.
Solutions to specific problems regarding international biobank collaboration are based on sound
ethical research and results are published or submitted to international peer review journals in
order to gain academic credibility and international recognition. More information about
CCPRB is available at: http://www.cancerbiobank.org/.
13. Children's assent and participation in a longitudinal cohort study of child health
Collaborators:
•
Mats G. Hansson, Professor of Biomedical Ethics
•
Anders Nordgren, Professor of Bioethics, Director of the Centre for Applied Ethics,
Linköping University (PI)
•
Johnny Ludvigsson, Professor and PI of the ABIS-study and Chairman for Diabetes
Research Centre, Linköping University
•
Ulrica Swartling, PhD, Senior researcher, Division of Paediatrics, Linköping
University
This is a collaboration with the Centre for Applied Ethics and representatives of the ABIS study
at Linköping University, funded by the Swedish Research Council.
In this project will investigate how 11-year-old children in a longitudinal type-1-diabetes study
look upon their participation in research studies.
We have studied ethical and psychosocial issues within this context since 2000. The ABIS study
(All Babies in Southeast Sweden) is a population-based prospective cohort study in which
newborn infants have been followed from birth and onwards with regular biological samples
and questionnaires. The children will now be invited back for the 11-year control. From a
developmental perspective, this age group is of great interest, standing on the threshold of
adolescence and having reached a significant level of maturity, both cognitively and morally.
In this project we will investigate how these 11-year olds perceive medical research, what kind
of information they would like and if they would like to assume a more active role as research
partners when they participate in research. From this empirical vantage point, we will critically
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examine the tradition of designing children's assent to research on the elements of informed
consent and explore the possibility of a more participatory approach.
Methodologically the design includes focus groups and postal questionnaires. We believe that a
participatory model of the kind proposed is worth exploring as a good way to show respect for
children as persons.
14. Empower the patient: Hip fracture as outpatient care (R&D Project)
Collaborators:
•
Leif Ryd (Principal Investigator), Karolinska University Hospital, Huddinge
•
Mats G. Hansson, Professor of Biomedical Ethics
•
Lilianne Eninger, Associate Professor, Senior Researcher, Department of Psychology,
Uppsala University
This is a research and development project funded by the Stockholm County Council that
started in 2005. The project is a collaboration between Professor Leif Ryd (Principal
Investigator) at the Karolinska University Hospital, Huddinge, and researchers at CRB.
Within the health-care system, patients are often seen as helpless and in need of caretaking by
healthcare professionals. This view may many times be disabling for the health-care process,
extending rehabilitation, resulting in great costs both to the patient and to the health-care sector.
It would clearly be beneficial if the health-care process could be made more efficient, with more
expedient care, a shorter rehabilitation process involving more outpatient care and at the same
time could be tailored more specifically to the individual patient’s needs and resources.
Empowering patients to take charge of their own health and rehabilitation process is an
important step in actualizing the overall goal of a more efficient health-care process.
Hip fracture patients constitute a large and resource-consuming group which could benefit from
an increasing extent of outpatient care. A research project has been started, aimed at providing a
new treatment framework by combining vertebroplasty, as an effective operative technique for
hip fractures, with the patients’ personal involvement and control of the rehabilitation process.
Addressing and changing the views and attitudes commonly held within the health-care system
was determined to be essential in order for patient empowerment to be feasible. The first phase
of the project, which is currently underway, therefore involves an evidence-based program,
focused on educating health-care providers in a different way of interacting with patients,
highlighting individual patient strengths and resources. After completion of this program, the
subsequent phase of the project, involving the development of an individualized treatment and
care process, will ensue. This process is designed to be sensitive to the multiplicity of personal
values at stake and with self-control of the patient as the fundamental aim. The process starts
from the moment of emergency admission of the patient to the clinic and ends when the end
point in terms of quality of life during the post-operative rehabilitation phase has been attained.
15. Ethical dilemmas in telenursing
Collaborators:
•
Anna T. Höglund, Associate Professor of Ethics, Senior Lecturer, Centre for Research
Ethics & Bioethics
•
Inger Holmström, Associate Professor, Department of Public Health and Caring
Sciences, Health Services Research
This is a research collaboration between members of the health services research group and
CRB.
A qualitative interview study revealed that telenurses experience a wide range of ethically
troubling situations, covering subjects such as autonomy, integrity and prioritizing. Although
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several of the identified dilemmas also occur in other areas of nursing it is reasonable to argue
that these situations are particularly challenging in telenursing, as the encounter with the patient
is faceless and the nurse can not be sure of the callers’ identity.
A similar study has investigated how gender impacts the encounter between the caller and the
telenurse. The results revealed several aspects of how gender norms are present in telenursing.
Questions of power relations, the picture of the mother/woman as the primary care taker of
small children and distrusting men in their parental role were particularly highlighted.
16. Ethical aspects of longitudinal studies involving children
Collaborators:
•
Mats G. Hansson, Professor of biomedical ethics
•
Stefan Eriksson, Associate Professor of ethics
•
Johnny Ludvigsson, Professor, Linköping University
•
Gert Helgesson, Associate professor, Karolinska Institutet
•
Ulrika Gustafsson Stolt, PhD, Linköping University
The ABIS study (All Babies in South-East Sweden) is a longitudinal predictive screening for
type 1 diabetes (T1DM) that has followed a large birth cohort since 1997 (n=17, 055). ABIS I
followed children 0-7 years of age. Clinical data have been collected through diary, extensive
questionnaires (at birth, 1 year, 2,5-3 years, and 5-6 years), and biological samples (cord-and
capillary blood, hair, stool, saliva, urine). ABIS II will follow the same children at ages 9-14.
Tied to the ABIS biomedical research is a multi-disciplinary project aiming to analyse and
suggest criteria for information, consent, and disclosure issues in Swedish longitudinal medical
research involving children. This is a co-operation between the ABIS group and the Centre for
Bioethics. A number of publications stemming from this co-operation are under production.
The project is a collaboration between researchers at the Centre for Research Ethics & Bioethics
and the ABIS group at the Department of Molecular and Clinical Medicine, Linköping
University. More information: http://www.abis-studien.se/
17. How do patients prioritize in situations of limited resources?
Collaborators:
•
Mats G. Hansson, Professor of Biomedical Ethics
•
Lilianne Eninger, Associate Professor, Senior Researcher, Department of Psychology,
Uppsala University
•
Li Tsai, MD, Associate Professor, Orthopaedic Surgery, Karolinska University
Hospital, Huddinge
•
Leif Ryd, MD, Professor of Orthopaedic Surgery, Karolinska University Hospital,
Huddinge.
•
Håkan Magnusson, MD, Orthopaedic Surgery, Karolinska University Hospital,
Huddinge
This is a collaboration with researchers in orthopaedic surgery at the Karolinska University
Hospital.
In times of limited resources within the health care sector, a pertinent issue for both health care
administrators and politicians is that of making priorities between patients in need of treatment.
An interesting aspect is that neither the public, nor the patients themselves, have been involved
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in discussion on prioritizations. This research project aims to investigate how patients would
make priorities among other patients on a waiting-list for major joint (hip- or knee) replacement,
when resources are strained and it isn’t possible to provide treatment for all patients. A
spectrum of motivations guiding patient priorities will be identified and documented. The
prioritizations made by an orthopaedic patient group will be compared to priorities suggested by
orthopaedic surgeons, general practitioners, and a representative sample of the general
population.
Thirty patients on the waiting list for major joint replacement at the Karolinska University
Hospital in Huddinge were invited to participate in the first phase of the study, and experienced
orthopaedic surgeons assessed these patients’ relative priority for surgery using a validated
clinical scoring instrument. Patients were also asked to complete questionnaires including
psychosocial aspects of their health, such as quality of life. From these assessments, 10 patient
vignettes, including clinical as well as psychosocial aspects, have been constructed and included
in a questionnaire. In the second phase of the study, this questionnaire will be sent to a new
group of orthopaedic patients on the waiting list at the Karolinska University Hospital, to a
representative sample of the public, and to orthopaedic surgeons and general practitioners.
International Bilateral Collaborations
Centre for Biomedical Ethics (CBmE), National University of Singapore
The Centre for Biomedical Ethics (CBmE), National University of Singapore constitutes one of
the nodes in the network on ethics at the end of life. They hosted a network symposium in
Singapore in January 2010 where researchers from CRB, PEALS and ECEC participated. CBE
and CBmE are currently planning other forms of bilateral collaboration.
CESAGEN, Cardiff University and Lancaster University
CRB collaborates with Cardiff University and CESAGEN (at the universities of Cardiff and
Lancaster). This collaboration constitutes a joint conference series in medical ethics. The first
conference took place in Uppsala 14-16 June 2010 and was entitled “Is Medical Ethics Really in
the Best Interest of the Patient?”. The next conference will be held in Cardiff in 2012.
Expertise Center Ethics of Care at University Medical Center (ECEC), Groningen
University
CRB’s collaboration with ECEC holds joint supervision of PhD students, developing of elearning in medical ethics and we are learning from each other’s experiences of teaching
medical ethics to medical students. Apart from teaching, we are also exchanging knowledge and
experience in other fields. Researchers from ECEC will visit CRB to learn how from Swedish
experiences of dealing with biobanking. In line with this exchange, Mare Knibbe, postdoc at
ECEC presented her research on “The Good Patient” in our series of open higher seminars in
May 2010. We are also planning exchanges on professionalism and ethics and family ethics.
Policy, Ethics and Life Sciences Research Centre (PEALS), Newcastle University
CRB and PEALS are currently working on an agreement to formalise our bilateral
collaboration. This includes joint publications and project planning. Several research
collaborations are underway, for example regarding the relationship between normative and
empirical ethics, end of life care, reproductive ethics and patient perspectives in medical
research. During 2009, Mats G. Hansson was visiting professor at PEALS, Newcastle
University. Policy, Ethics and Life Sciences Research Centre (PEALS), Newcastle University.
In November 2010 both centres met to discuss methodological issues at the intersection of
ethics and social sciences, as well as future collaborations at a joint workshop.
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The Hastings Center, New York
We have an ongoing exchange with the Hastings Center in New York. Mats G. Hansson of
CRB is a Fellow of the Hastings Center and Tom Murray of the Hastings Centre has received a
honorary doctorate degree from the Faculty of Medicine at Uppsala University. A Science
publication resulted from Mats Hansson’s collaboration with Karen Maschke at Hastings
Center.
International Network Collaborations
Biobank Ethics
CRB has worked extensively on biobank ethics and participates in several European networks
and EU-funded projects on the ethical aspects of biobanking: the EU Network of Excellence
CCPRB (Cancer control using population based registries and biobanks) that ended recently;
AutoCure - Curing autoimmune rheumatic diseases, an EU funded research project within the
sixth framework programme; BBMRI.se (BioBanking and Molecular Resource Infrastructure of
Sweden) funded by the Swedish Research Council; and the IMI (Innovative Medicines
Initiative) and the IMI funded BTCure (Be The Cure) focusing on Rheumatoid Arthritis (RA)
and RA-like diseases.
End of Life
CRB collaborates with ECEC, CBmE and PEALS on issues relating to end of life care and
decisions. A joint anthology is in planning, edited by Ulrik Kihlbom of CRB and Marian
Verkerk of ECEC. This network held a first joint workshop workshop in Singapore in January
2010.
Family Ethics
CRB collaborates with ECEC, CBmE and PEALS on family ethics. A workshop in Groningen on
28-29 April 2011 will kick-off this collaboration that also includes Hilda Lindeman and James
Nelson, philosophers from Michigan State University. More information at www.family-ethics.com.
Health, Culture and Bioethics
Together with researchers from universities and museums in Australia, Norway, Sweden and
the United Kingdom, CRB has formed a multi-disciplinary network on health, culture and
bioethics. The network is funded by Riksbankens Jubileumsfond (Bank of Sweden Tercentenary
Foundation).
Neuroethics
Kathinka Evers of CRB has extensive collaborations on Neuroethics with Collège de France in
Paris, where she is a returning guest lecturer, and the Pasteur Institute in Paris. There are also
new collaborations with the Centro de Investigaciones Filosóficas (CIF), and the Institute of
Cognitive Neurology (INECO) in Buenos Aires In 2010, CRB launched a web-based course in
neuroethics, with lectures by several well known researchers in the neurosciences. Neuroethics
has important clinical perspectives.
Research Ethics & Bioethics
CRB collaborates with the Swedish University of Agricultural Sciences (SLU) and Karolinska
Institutet within the framework of the Network for Research Ethics and Bioethics (NRB). This
network was formally established on July 1 2007.
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More
CODEX - Rules and Guidelines for Research
CODEX is a website with rules and guidelines for research. The website, www.codex.vr.se, is a
collaboration between CRB and the Swedish Research Council.
EACME
CRB is an associate member of the European Association of Centres of Medical Ethics
(EACME).
Sustaining competitive edge through collaboration in applications
All researchers assign a significant amount of time in preparing and submitting research
proposals to different funding agencies. This represents an important part of innovation in
scientific work through formulation of innovative ideas, new research questions and hypotheses,
and sharpening of research methodologies. Through exploration of new networks and bringing
added value through collaboration across disciplinary domains CRB is sustaining a competitive
edge. CRB is often approached by international groups who have learned about our world
leading research in publications with high impact.
Current collaborations for the future
•
PREDICTION – Grant application to EU FP7-Health regarding Cardiovascular
genetics with 10 European partners. The application is co-ordinated by Colin Palmer at
the University of Dundee. The application was successful in the first stage and a full
application has been submitted. Our role is to investigate ethical issues related to
complex risk information in pharmacogenomics to patients.
•
EUGEDAS – Grant application to EU FP7-Science and Society regarding the use of
forensic databases with 9 European partners. The application is co-oordinated by Lucia
Scaffardi at Universita Degli Studi Di Parma. Our role is to investigate ethical issues
related to the balancing of public security and personal privacy and do a public survey
on attitudes to DNA surveillance.
•
COMPARE – CRB is co-ordinating a proposal to IMI (Innovative Medicines
Initiative) regarding the communication of pharmacogenetic information to patients and
clinicians. An Expression of Interest has been submitted with 10 European partners
including two European patient organisations. Models for shared decision-making and
communication of risk will be developed.
•
Getting old and staying well – what does it take? – CRB has co-ordinated a proposal
to the Knut and Alice Wallenberg Foundation in collaboration with two other dynamic
groups at Uppsala University: the Clinical nutrition and metabolism group at the
Department of Public Health and Caring Sciences and the Social gerontology group at
the Department of Sociology. This integrated multi-disciplinary project will address
three questions: 1) If and to what extent ageist attitudes of health care professionals and
their knowledge about age-specific needs affect the treatment of old people. 2) If and
how socio-economic circumstances, gender and old-age transitions affect the
understandings of successful ageing that older people uphold and the strategies they
employ in order to age well. 3) The prevalence, causes and consequences of ageassociated muscle loss (sarcopenia) in a population-based cohort of women and men in
their nineties.
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•
Clinical sequencing – NIH application under submission together with the LifeSciLab
Uppsala–Stockholm, co-ordinated by Kerstin Lindblad-Toh, Uppsala University and
Broad Institute. Our role is to investigate psychosocial aspects together with Yvonne
Brandberg at Karolinska Institutet and Karin Nordin in the Caring sciences group at the
Department of Public Health and Caring Sciences, Uppsala University. We will identify
patient and physician preferences and models for informed consent and shared decisionmaking.
•
When does pain and fear lead to suffering in animals? – CRB has co-ordinated an
Expression of Interest to Riksbankens Jubileumsfond (Bank of Sweden Tercentenary
Foundation) in collaboration with researchers at different departments at Uppsala
University: Dan Larhammar (Molecular Cell Biology), Bengt Meyerson (Behavioural
Neuroscience), Erika Roman (Behavioral Neuropharmacology), Svante Winberg
(Neuroscience). For animal suffering we will assume that both pain and fear matter. The
analysis of these concepts will draw on philosophical, evolutionary psychological and
neurophysiological accounts.
•
Improving the ethics climate in psychiatric outpatient clinics – An intervention
study – Project proposal sent to the Swedish Council for Working Life and Social
Research (FAS) and to AFA Insurance. In this project we will measure the ethical
climate in four psychiatric outpatient clinics. We will also do an intervention with
supervised ethics rounds, aiming at improving the ethical climate. Main applicant: Mats
G. Hansson, postdoc: Marit Silén in collaboration with Mia Ramklint and Kerstin
Haglund at the Department of Psychiatry, Akademiska sjukhuset (Uppsala University
Hospital).
•
Consensus or disagreement – How do health care stake holders prioritise in ethical
and political value conflicts? – Project proposal sent to the Swedish Council for
Working Life and Social Research (FAS).Main applicant: Anna T. Höglund, postdoc:
Mio Fredriksson, in collaboration with Ulrika Winblad Spångberg from the Health
Services Research group at the Department of Public Health and Caring Sciences at
Uppsala University. A similar application will be sent to the Swedish Research Council.
•
The experiences and ethics of sibling donations – Project proposal to be sent to the
Swedish Childhood Cancer Foundation. CRB collaborates with Britt-Marie Frost and
Margareta Stenmarker, paediatric oncologists from Akademiska sjukhuset (Uppsala
University Hospital) and the Regional hospital Ryhov, Jönköping, to investigate the
experiences among sibling donators and their parents and the ethical issues surrounding
this practice.
•
Native people, research and ethics: Ethical challenges when conducting research
on the Sami.– Project proposal to Riksbankens Jubileumsfond (Bank of Sweden
Tercentenary Foundation) dealing with the implementation and development of
biomedical ethics in medical-, quality-or-life and genetic research projects on the Sami.
This is a collaboration with Mikael Svonni at the University of Tromsö and part of the
network on Culture Health and Bioethics.
Undergraduate Teaching
At the Faculty of Medicine, ethics has for several years been part of the curriculum for nurses
and doctors. Within the nurse's programme, ethics courses totalling 7,5 credits are distributed
over the three years of the programme. For medical doctors, medical ethics and medical law is
part of the professional training curriculum that runs through the programme from the first to
the eleventh semester.
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In the midwifes programme we are responsible for 4,5 credits. We also teach within the
district/public health care nurses programme, the specialist nurses programmes and other
educational programmes at Uppsala University.
Every second year we offer a course on Nursing philosophy and ethics in theories and models of
caring sciences (7,5 credits) as an electable course for Caring Sciences B and OLVO A
(Organization and leadership in health care and caring sciences). This course was offered in
2009 and will be offered again in 2011.
Coming: During 2010 we have developed a course in bioethics (5 credits) for one of the
Engineering programmes at Uppsala University.
Advanced level courses
We offer an advanced level course in ethics and public health (7,5 credits) that can be taken
both as a single subject course and as an electable part of the master programme in public
health. The course is offered in Swedish. Starting 2011 this course will be mandatory for
programme students.
In 2010 we also offered a web based advanced level course in neuroethics (7,5 credits) for the
first time.
Coming: During 2010 we have developed courses for:
•
Master programmes in infection biology and biomedicine.
•
Archaeology and ethics, 3 credits, is a new electable evening course that will be offered
spring term 2012.
Postgraduate Teaching
•
Science and Technology: Research ethics A (1 credit) and Research ethics B (1 credit)
are compulsory for PhD students admitted after July 1, 2008. The courses are open to
all postgraduate students at the faculty.
•
Medicine and Pharmacy: Research ethics and philosophy of science (1,5 credit) is
compulsory for PhD students. The course can be taken separately, or as part of a 7,5
credit integrated course called Introduction to scientific research.
•
Social Sciences: 4 credit course tailored for the social sciences. This course is electable
and offered once a year since 2009.
The course research ethics A is open to PhD students from all faculties.
Awards and Appointments 2010
1. Maria Gottvall, Young Scientist Award (500 Euro) from the European Society for
Contraception (ESC) conference in the Hague, the Netherlands, 2010.
2. Mats G. Hansson, Elected Fellow Hastings Center New York, 2010.
3. Mats G. Hansson, Board Member, the Vårdal Foundation since 2010.
4. Kathinka Evers, Expert in Scientific Review Panels to evaluate applications for the
European Research Council ERC Advanced Investigator Grants: ‘The Human Mind and
Its Complexity’.
5. Stefan Eriksson, adjunct member to the Swedish Research Council’s Expert group on
ethics since 2007.
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6. Stefan Eriksson, Expert project reviewer to The Dutch Organisation for Health
Research and Development (ZonMw), 2010.
Conferences and symposia
The Centre for Research Ethics & Bioethics has hosted an annual international multidisciplinary symposia series on Biomedicine, Ethics and Society. This series ended in 2009 and
was replaced by a bi-annual conference hosted by CRB together with CESAGEN at the
universities of Cardiff and Lancaster. The first meeting in this series attracted 200 participants,
of which over 70 speakers from more than 20 countries. Main sponsor was The Journal of
Internal Medicine.
•
Searching for the Animal of Animal Ethics: IX Annual Symposium on Biomedicine,
Ethics and Society, June 11-12 June 2007
•
Dual Uses of Biomedicine: Whose responsibility? X Annual Swedish Symposium on
Biomedicine, Ethics and Society: Seglarhotellet, Sandhamn, 9-10 June 2008
•
End of Life Decisions: Ethics in clinical practice, research and policy: XI Annual
Swedish Symposium on Biomedicine, Ethics and Society: Seglarhotellet, Sandhamn, 89 June 2009
•
Is Medial Ethics Really in the Best Interest of the Patient? Uppsala Konsert &
Kongress, 14-16 June 2010
o
June 14: Should ideology be allowed to trump patient well-being?
o
June 15: What is the role of informed consent in medical research?
o
June 16 Ethical review boards: are they important ethical safeguards or overburdensome and unnecessary bureaucracy?
Public outreach
The CRB website, www.crb.uu.se had approximately 25 000 unique visitors in 2010.
CRB has several e-mail lists, together making up 2 800 subscribers. We use our lists to
distribute information about conferences, seminars and to distribute our electronic newsletter
and conference information.
Our higher seminar is open and invitations are distributed to a list where subscribers include the
practical philosophy group at the Department of Philosophy, and the ethics group at the
Department of Theology at Uppsala University, ethics lecturers at the Swedish University of
Agricultural Sciences and the ethics group at the Department of Learning, Information,
Management and Ethics at Karolinska Institutet.
CRB staffs are also giving lectures in different public settings in order to disseminate research
results, secure funding, encourage debate and discussion on ethical issues and learn more about
public concerns and interests.
PR activities
We collaborate with the press officers at Uppsala University on press releases. We also publish
news on the CRB website, primarily promoting new publications. During the conference “Is
Medical Ethics Really in the Best Interest of the Patient?” we also collaborated with the
Akademiska sjukhuset (Uppsala University Hospital) press office. Our press activities in 2010
include:
•
European Science Foundation report praises Uppsala University's work to secure
research integrity on the the European Science Foundation (ESF) study of how
178
institutions of higher education in different countries proactively approach research
ethical issues where Uppsala University is held up as a positive example.
•
Duties to human remains in universities and museums on Malin Masterton’s doctoral
thesis on the moral status of past people and protection for historical persons.
•
Press invitation, conference: Is Medical Ethics Really in the Best Interest of the Patient?
Followed by daily press briefings during the conference 14-16 June 2010.
o
Related: Uppsala Universitet rapporterar från konferens om medicinsk etik
o
Related: Etikregler diskriminerar dödssjuka, press release from Akademiska
sjukhuset (Uppsala University Hospital)
•
New ethical guidelines needed for dementia research, press release an article in the
journal Bioethics, where Stefan Eriksson proposes a new approach to the dilemma of
including dementia patients and others with limited decision making capabilities in
research.
•
International collaboration to meet ethical challenges, on the bilateral collaboration with
PEALS, Newcastle University.
. The activities we were involved in that received the most interest were:
•
•
•
•
•
Article: Gottvall M, Tydén T, Höglund AT, Larsson M, Knowledge of human
papillomavirus among high school students can be increased by an educational
intervention, International Journal of STD & AIDS 2010; 21:558-562.
o 2010-12-06: Svårt att påverka ungas sexattityd, UNT
Article: Kaminsky E, Carlsson M, Höglund AT, and Holmström I, Paediatric health
calls to Swedish telenurses: a descriptive study of content and outcome, J Telemed
Telecare doi:10.1258/jtt.2010.100110, online pre-publication, that was reported in
o 2010-10-09: Mammor och pappor får olika råd, UNT
o 2010-10-09: Pappor skickas oftare till läkare, Upplandsnytt, P4 Uppland,
Sveriges Radio
o 2010-10-12: Ojämställda telefonkontakter, Dagens Medicin
o 2010-10-11: Sjukvårdsrådgivningen ger olika råd till mammor och pappor,
Vårdförbundet
Conference: “Is Medical Ethics Really in the Best Interest of the Patient?” Conference,
Uppsala Konsert och Kongress, 14-16 June 2010.
o 2010-06-16 Etiknämnd stoppar forskning, UNT
o 2010-06-15: Medicinsk etik - för vems bästa?, Läkemedelsvärlden
o 2010-06-15 Etikmodell ska öka vårdsäkerheten, UNT
o 2010-06-14 UNT rapporterar från konferens om medicinsk etik, UNT
o 2010-05-10 Patientgrupper drabbas av strikta etiska regler, interview with Mats
G. Hansson, Vetenskapsradion Sveriges Radio P1
Dissertation: Masterton M, Duties to Past Persons: Moral Standing and Posthumous
Interests of Old Human Remains, doctoral thesis, Acta Universitatis Upsaliensis, 2010.
o 2010-05-25 Även döda människor har rättigheter, interview with Malin
Masterton, SR Sameradion
o 2010-05-20 Vem har rätt till Kristinas gener? interview with Malin Masterton,
Vetandets värld, Sveriges Radio P1
Book: Höglund, Anna T., Gender and the War on Terrorism. The Justification of War
in a Post-9/11 Perspective, Skrifter från Centrum för genusvetenskap/Crossroads of
Knowledge 13, Uppsala universitet 2010. 248 pp.
o 2010-03-29 Kriget mot terrorismen ur ett genusperspektiv, interview with Anna
T. Höglund, Vetenskapsradion Forum, Sveriges Radio P1
179
•
Grant: Gender aspects in telenursing, project funding from the Swedish Research
Council
o 2010-02-12 Genusmedveten vård på telefon, Interview with Anna T. Höglund
at Genusflödet
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Scientific Report
Social Medicine
Research Group Leader Professor Bengt Arnetz
The Division of Social Medicine (SocMed) focuses on three major and inter-related
research areas. 1) Health and social systems’ approaches to workplace integration of
vulnerable populations, 2) stress and performance management in high-risk populations,
including first responders and knowledge workers and 3) health systems reform and
patient-centred health care and its implications for quality of care and staff well-being.
SocMed’s mission is to carry out advanced laboratory-based research and translationary
community outreach and engagement research. Furthermore, to ensure that all work is
strongly anchored, not only in the academic environment, but also among key stakeholders
in the community, in order to ensure that research is implemented in real-life in order to
enhance cost-effectiveness of social and health care systems. A common factor for all our
research is enhancing the scientific understanding of risk- and resiliency factors, as well as
related bio-psycho-social mechanisms, of relevance for sustained and equitable
occupational and social health and well-being, in addition to effective use of limited
financial and human resources. Our research also focuses on the changing role of clients
and patients in the current transformation of health care and social service systems and its
implications for important stakeholders and efficacy.
1. Health and social systems’ approaches to workplace integration of vulnerable
populations
There is an increasing marginalization of a large number of vulnerable populations, including
employees with short- and long-term sickness absenteeism, immigrants, and refugees.
Vulnerable populations are exposed to numerous stressors and lack many of the social structures
that support resiliency. SocMed has developed and assessed risk factors for marginalization, as
well as means to counteract marginalization among vulnerable populations, especially persons
with complex, stress-related absenteeism, immigrants and refugees.
Immigrant and Refugee Health
We have ongoing international research on refugee health and integration. This research is done
in collaboration with Swedish and United States-based researchers, municipalities, and
numerous refugee integration agencies and refugee outreach support organization. The research
is supported by National institutes of Health (Principal Investigator (PI) Bengt Arnetz, Wayne
State University R01 grant), Wayne State University, Södertälje municipality, and by the
“Impact of Religion”; a nationally competitive decade-long grant awarded to Uppsala
University by the Swedish Research Council. Research in this area looks at psychosocial
determinants, including socioeconomics, coping, lifestyle, and biological disease pathways and
their relationship to important public health outcomes, such as disease, mortality, mental health,
and sick leave behaviour.
In the domain of tobacco health risks, we have also initiated studies concerning the role of water
pipe (hookah) smoking as a possible gateway drug, along with cigarettes, alcohol, and
marijuana, and its trajectories to heavier drugs and other risky behaviour.
In the area of domestic violence and health, we just published a pilot study investigating the
prevalence of domestic violence among a convenience sample of Iraqi immigrant women.
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Stress-related Absenteeism and Return to Work
In collaboration with the Swedish Social Insurance Administration, the Swedish Public
Employment Service, and the Primary Health Care sector, we have projects assessing the
efficacy of various innovative return-to-work strategies, including the concept “Pathway
Back to Work”. The aims of these projects are focusing on enhancing the pathway back to
work and to identify factors that will help long-listed individuals return to the working life.
We have developed and evaluated strategies to decrease sick leave and to improve the
return-to-work processes. The Pathway to Work focuses on assisting people on sick leave
to become more independent and to earn a living by targeting some of their health-related
barriers and by providing financial support. The program has achieved national recognition
as an innovative and cost-effective means to decrease sick-leave and facilitate return-towork for people with long-term absenteeism due to complex, and stress-related disorders.
2) Stress and performance management in high-risk populations, including First responders
and knowledge workers
A series of our projects focuses on the impact on health and well-being from our technologydriven society. We look at the impact on health, well-being and stress hormones from wireless
technologies, the information technology society and increasing globalizations. We recently
completed a large, multi-national study on the impact on health and performance of cell phone
radiofrequency exposure under controlled laboratory conditions. Results revealed changes in
cognitive functions, decreased deep sleep, and changes in salivary secretion of cortisol – a key
hormone in the body’s stress response. We are currently involved in community-based research
assessing the functionality of wireless sensor technologies and mobile phones to assess in realtime stress-related mental and cardiovascular responses in female middle managers – a risk
group for stress-related disorders.
Another important area of research concerns the impact of acute and chronic stress on the
health and performance among first responders, including police, fire fighters, EMS, coast
guards, and the military. These groups of professionals are critical to maintaining a civil
society and counteracting acts of violence and terrorism, yet little targeted work to
strengthen first responders’ health and well-being has been done to date. We work closely
with the Swedish Royal Foundation (Kungafonden) – to our knowledge, the world’s only
foundation dedicated solely to assisting firstresponders through direct support and
research.
Organizational Factors, Work Stress and Performance
Research in social medicine has shown a clear association between psychosocial factors in
the organization, stress, and performance. We develop and evaluate workplace intervention
programs and look at the effects on employee health, biological stress markers, and
organizational productivity. In an interdisciplinary research program we combine two
fields of knowledge; social medicine and Management control systems (MCS). The
purpose is to examine and explain how MCS design affects psychosocial factors in the
organization, stress, and performance. This is important because MCS are used for
planning and evaluation in organizations. MCS can thus be expected to influence the
psychosocial factors in organization that are associated with negative stress reactions,
work-related health, and performance outcomes.
We also have research concerning psychosocial and biological determinants of changes in
self-rated-health (SRH). One of our group members defended her PhD thesis on SRH. The
research project has looked specifically at possible gender-related differences in
determinants of and changes over time in SRH. SRH is an internationally-recognized
marker of future mortality and morbidity risks. However, little is known about the
biological underpinnings, linking psychosocial stressors to detrimental Self-Rated-Health.
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Thus, our SRH research plays an important role in furthering enhancing fundamental
knowledge contributing to the SRH-disease relationship.
3) Health systems’ reform and patient-centered health care and its implications for quality of
care and staff well-being
A number of studies aimed at evaluating the implications of current structural and economic
changes to patients, employees, health care organizations and society have been carried out. The
focus is specifically on the implication for staff, patients and quality of care outcome indicators,
including cost, morbidity and mortality, from enhancing patient involvement. Recently, we have
initiated studies of organizational determinants of safety climate and patient outcome in nursing
homes in order to design and evaluate effective measures to enhance quality-of-care in health
care environments. We are also involved in looking at the implications of patient involvement
and “patient centred care” on patient alignment with treatment goals, treatment outcomes, and,
possible implications for health care staff work environment and professional roles. These
studies make use of both self-rated as well as electronic medical records based data, thus
allowing for the comparison of patient-based and health system-based outcomes. Part of this
research is done in collaboration with the Uppsala Clinical Research Center.
As part of the multi-year, multidisciplinary research program, The Impact of Religion, financed
by the Swedish Research Council, Vetenskapsrådet, we are looking at the organizational and
individual role of spirituality and existential factors in promoting health and well-being among
health care staff as well as in patients. We are also interested in how health care personnel
utilize patients’ spiritual belief in the diagnostic and treatment processes.
In 2009, Professor Bengt Arnetz was appointed Chair of the Scientific Review Group for
REHSAM. REHSAM is a strategic national project, financed by the Swedish Government, and
managed financially and administratively by the Swedish Social Insurance Administration,
focusing on funding controlled intervention Return-to-Work research studies. The overall
budget for this multi-year program in 2011 is some 35 million SKR (approximately USD 5,5
million).
Centres and Facilities
CEOS, Center for Environmental Health and Stress Research is a collaborative effort between
Uppsala Academic Hospital and Uppsala University. This is an academic research and
development center with the overall purpose of improving basic and applied scientific
understanding of the mechanisms behind, and effective treatment and prevention of stressrelated disorders. The center is truly translationary in nature, with a multidisciplinary
composition of researchers and clinicians.
CEOS has in collaboration with the Swedish Social Insurance Administration, the Swedish
Public Employment Service, and the Primary Health Care sector, projects assessing the efficacy
of various innovative return-to-work strategies, including the concept “Pathway Back to Work”.
The aims of these projects are focusing on the pathway back to work and to identify factors that
could help long-listed individuals return to the working life. We are currently in negotiation
with the leadership of the Count County of Uppsala to transform CEOS into its natural next
phase – a competence development and translation center for stress-related and mental disorders
focusing on key primary care and public health stakeholders. A key characteristic for the
proposed next phase of CEOS is close integration and collaboration between key stakeholders
concerned about worker and population health
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Members of the Group in 2010
Ingrid Anderzén, PhD
Bengt Arnetz, PhD, Professor
Judith Arnetz, PhD, Associate Professor
Christina Halford, MD, PhD
Ann-Sophie Hansson, PhD
Anna Liljestam Hurtigh, Research assistant
Per Lytsy, MD, PhD
Clairy Wiholm, PhD, Research Associate
External
Lisa Ekselius, MD, PhD, Professor
Anna Finnes, Psychologist
Lars Frimanson, PhD
David Hallman, doctorial Student
Kerstin Hedborg, doctoral student
Lena Hillert, PhD, Associate Professor
Anna Höglund, PhD, Associate Professor
Per Johansson, PhD, Professor
Bo Karlsson, MD, Doctoral student
Niles Kuster, PhD, Professor
Mark Lumley, PhD, Professor
Eugene Lyskov, PhD, Associate Professor
Anna Löfgren, Psychologist
Linnea Molin, Psychologist
Johan Lökk, MD, PhD, Associate Professor
Arne Loweden, PhD, Assistant Professor
Scott Moffat, PhD, Associate Professor
Anna Olsson, MD
Weisong Shi, PhD, Professor
Kurt Svärdsudd, MD, PhD, Professor
Jenny Thorell, Psychologist
Anna Thunell, Economist
Emma Wallin, Psychologist
Carina Wennman, Psychologist
Ragnar Westerling, MD, PhD, Professor
Ulrika Winbladh, PhD, Associate Professor
Annica Åbring, Occupational Therapist
Torbjörn Åkerstedt, PhD, Professor
Publications 2008-2010
1. Arnetz JE, Höglund AT, Arnetz BB, Winblad U. Staff views and behaviour
regarding patient involvment in myocardial infarction care: Development and
evaluation of a questionnaire. European Journal of Cardiovascular Nursing
2008;7(1):27-35.
2. Hansson, Vingård, E., A-S, Arnetz, B.B., Anderzén, I. Organizational change,
health and sick leave among health care employees: a longitudinal study
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measuring stress hormones, individual and work site factors. Work and Stress,
2008: 22(1), 69-80.
3. Arnetz JE, Winblad U, Arnetz BB, Höglund AT. Physicians’ and nurses’
perceptions of patient involvement in myocardialinfarction care. European
Journal of Cardiovascular Nursing 2008;7(2):113-120.
4. Arnetz JE, Höglund AT, Arnetz BB, Winblad U. Development and evaluation
of a questionnaire for measuring patient views of involvement in myocardial
infarction care. European Journal of Cardiovascular Nursing 2008;7(3):229238.
5. Hasson, H, Arnetz JE. The impact of an educational intervention for elderly
care nurses on care recipients’ and family relatives’ ratings of quality of care: A
prospective, controlled intervention study. International Journal of Nursing
Studies 2008; 45(2):166-179.
6. Hasson H, Arnetz JE. Nursing staff competence, work strain, stress and
satisfaction in elderly care: A comparison of home-based care and nursing
homes. Journal of Clinical Nursing 2008; 17(4):468-481.
7. Hillert L, Akerstedt T, Lowden A, Wiholm C, Kuster N, Ebert S, Boutry C,
Moffat SD, Berg M, Arnetz BB. The effects of 884 MHz GSM wireless
communication signals on headache and other symptoms: an experimental
provocation study. Bioelectromagnetics. 2008;29:185-96.
8. Kajermo KN, Undén M, Gardulf A, Eriksson LE, Orton ML, Arnetz BB,
Nordström G. Predictors of nurses' perceptions of barriers to research
utilization. J Nurs Manag. 2008;16:305-14.
9. Schell E, Theorell T, Hasson D, Arnetz B, Saraste H. Impact of a Web-Based
Stress Management and Health Promotion Program on Neck-Shoulder-Back
Pain in Knowledge Workers? 12 Month Prospective Controlled Follow-Up. J
Occup Environ Med. 2008;50:667-676.
10. Schell E, Theorell T, Hasson D, Arnetz B, Saraste H. Stress biomarkers'
associations to pain in the neck, shoulder and back in healthy media workers:
12-month prospective follow-up. Eur Spine J. 2008;17:393-405.
11. Schell E, Theorell T, Hasson D, Arnetz B, Saraste H. Stress biomarkers’
associations to pain in the neck, shoulder and back in healthy media workers:
12-month prospective follow-up. Eur Spine J. 2007 Dec 13; [Epub ahead of
print]
12. Sha K, Zhan G, Shi W, Lumley M, Wiholm C, Arnetz BB. SPA: A smart phone
assisted chronic illness self-management system with participatory sensing.
ACM Healthnet 2008. In conjunction with ACM/USENIX MobiSys 2008.
Brenckenridge, Colorado, June 17, 2008 (peer-reviewed proceeding).
13. Wiholm C, Loweden A, Kuster N, Hillert L, Arnetz BB, Akerstedt T, Moffat
SD. Mobile phone exposure and spatial memory. Bioelectromagnetics. 2008;
Sept 15 [Epub ahead of print].
14. Hasson H, Arnetz JE. The impact of an educational intervention on nursing
staff ratings of quality of older people care: a prospective, controlled study.
International Journal of Nursing Studies 2009; 46:470-478.
15. Hansson A-S, Anderzén I. Goal Clarity Work as an Instrument for Improved
Organizational Well-being in the Church of Sweden. Work, 2009;33(1):53-8.
16. Lucas T, Lakey B, Alexander S, Arnetz B. Individuals and illnesses as sources
of perceived preventability. Psychol Health Med. 2009;14:322-330.
185
17. Arnetz BB, Nevedal DC, Lumley MA, Backman L, Lublin A. Trauma
resiliency training for police: psychophysiological and performance effects.
Journal of Police and Criminal Psychology. 2009;24:1-9.
18. Arnetz JE, Arnetz BB. Gender differences in patient perception of involvement
in myocardial infarction care. European Journal of Cardiovascular Nursing.
2009;8:174-181.
19. Wiholm C, Lowden A, Kuster N, Hillert L, Arnetz BB, Akerstedt T, Moffat
SD. Mobile phone exposure and spatial memory. Bioelectromagnetics.
2009;30:59-65.
20. Jamil H, Ventimiglia M, Makki H, Arnetz BB. Mental health and treatment
response among Iraqi refugees as compared to other non-war exposed Arab
immigrants. A pilot study in Southeast Michigan. Journal of Immigrant and
Refugee Studies. 2009; Accepted.
21. Jamil H, Ventimiglia M, Mahmoud R, Arnetz B. Somatic and psychiatric
disorders and health care utilization among Iraqi refugees and Yemeni
immigrant. The New Iraqi Journal of Medicine. 2009;5:14-22.
22. Arnetz BB, Hamdan TA, Grzybowski M, Severson R, Shukri W, Jamil H. Warrelated mental health disorders among Iraqis 10 years after the 1991 Gulf War:
A comparative study of soldiers and civilians living under sustained socioenvironmental stress. The New Iraqi Journal of Medicine. 2009;5:9-21.
23. Henriksson C, Larsson M, Arnetz J, Berglin-Jarlöv M, Herlitz J, Karlsson JE,
Svensson L, Thuresson M, Zedigh C, Wernroth L, Lindahl B. Knowledge and
attitudes toward seeking medical care for AMI-symptoms. International Journal
of Cardiology 2009 Oct 22 [Epub ahead of print].
24. Arnetz BB, Lucas T, Arnetz JE. Organizational climate, occupational stress,
and employee mental health: Mediating effects of organizational efficiency.
JOEM. 2011;53:34-42.
25. Hallman DM, Lindberg L-G, Arnetz BB, Lyskov E. Effects of static contraction
and cold stimulation on cardiovascular autonomic indices, trapezius blood flow
and muscle activity in chronic neck-shoulder pain. European Journal of Applied
Physiology. 2011, . In press
26. Lowden A, Akerstedt T, Ingre M, Wiholm C, Hillert L, Kuster N, Nilsson JP,
Arnetz B. Sleep after mobile phone exposure in subjects with mobile phonerelated symptoms. Biolectromagnetics. 2010, In Press. PMID: 20857453.
27. Jamil H, Ventimiglia M, Makki H, Arnetz BB. Mental health and treatment
response among Iraqi refugees as compared to other non-war exposed Arab
immigrants. A pilot study in Southeast Michigan. Journal of Immigrant &
Refugee Studies. 2010;8:431-444. 2010; In Press.
28. Halford C, Ekselius L, Anderzen I, Arnetz B, Svärdsudd K. Self-rated health,
life-style, and psychoendocrine measures of stress in healthy adult women.
Upsala J Med Sci. 2010;115:266-274.
29. Jamil H, Elsouhag D, Spencer H, Arnetz JE, Arnetz BB. Sociodemographic risk
indicators for hookah smoking among White Americans : A pilot study.
Nicotine & Tobacco Research. 2010;12:525-529. PMID: 20308223
186
30. Hasson H, Arnetz JE. A comparative study of nursing staff, care recipients’ and
their relatives perceptions of quality of older people care. International Journal
of Older People Nursing 2010; 5:5-15.
31. Arnetz JE, Winblad U, Höglund AT, Lindahl B, Spångberg K, Wallentin L,
Wang Y, Ager J, Arnetz BB. Is patient involvement during hospitalization for
acute myocardial infarction associated with post-discharge treatment outcome?
An exploratory study. Health Expectations. 2010;13:298-311. PubMed PMID:
20579120
32. Höglund AT, Winblad U, Arnetz BB, Arnetz JE. Patient participation during
hospitalization for myocardial infarction: perceptions among patients and
personnel. Scandinavian Journal of Caring Sciences. 2010;24:482-489. PMID:
20230518.
33. Lytsy P, Hansson A-S, Anderzén I. Returning to work after long-term sick leais
possible. Results from a cooperative project between health services and the
Swedish Social Insurance Agency]. Lakartidningen. 2010 Jun 28;107(22):1480-2.
34. Hasson H, Arnetz JE. Care recipients’ and family members’ perceptions of
quality of older people care: a comparison of home-based care and nursing
homes. Journal of Clinical Nursing; in press.
35. Barkho E, Fakhouri M, Arnetz JE. Intimate partner violence among Iraqi
immigrant women in metro Detroit: a pilot study. Journal of Immigrant and
Minority Health; in press.
Dissertations and Awards 2008-2010
Hansson AS Determinants of Individual and Organizational Health in Human Service
Professions, ISSN 1651-6206, Dept of Public Health and Caring Sciences, Uppsala University,
2008. Supervisor: Ingrid Anderzen.
Halford C. Self-rated Health with Special Reference to Prevalence, Determinants and
Consequences. Uppsala University. ISBN 978-91-554-7925-1. Dept of Public Health and
Caring Sciences, Uppsala University, 2010. Co-Advisor: Bengt Arnetz.
Lytsy P. Power of the Pill. Views about Cardiovascular Risk and the Risk-reducing Effect of
Statins. ISBN 978-91-554-7793-6. Dept of Public Health and Caring Sciences, Uppsala
University, 2010. Supervisor: Ragnar Westerling, co-advisor: Gunilla Burell
Awards: The Personal Renewal project was awarded the Uppsala County County’s Public
Health Award (Projektet NySatsa/ Uppsala Läns Folkhälsopris, 2008).
Agencies that support the work/Funding 2008-2010
The Royal Foundation of Sweden (Kungafonden) SEK 1,400,000
The Swedish Research Council (Impact of Religion Program, Program Leader, Professor
Anders Bäckström) Total SEK 50,000,000
The Swedish Council for Working Life and Social Research SEK 2,100,000
The Municapility of Södertälje SEK 2 100 000
The Swedish Social Insurance Agency SEK 6 467 650
Organisation for Financial Coordination Uppsala County SEK 1.055 000
187
The Swedish Public Employment in Uppsala SEK 1 095 000
Organisation for Financial Coordination Haninge SEK 1 400 000
Uppsala County Council SEK 1.500 000
The European Social Fund (ESF) SEK 4.655 000
Riksbankens Jubileumsfond, SEK 2 920 000
Dagmar (The Swedish Health Insurance System, The Uppsala County Council), Söderström
Königska foundation, ALF.
50% research fellowship at the Gävle high school/university, 50% research fellowship at the
Uppsala University, Selander´s foundation, and research funds from the Uppsala University.
Project 1: Spiritual and existential moderators of the stress – health relationship
Participant: Bengt Arnetz
This project concerns the adaptation and development of scales to assess to whether and to what
extent existential and spiritual factors modify individuals and organizations response to stress.
Furthermore, we will explore whether health care staff utilize patients’s existential and spiritual
belief in the diagnostic and treatment processes. This project entails collaboration with Swedish
and American researchers and study participants represent both countries as well. This project is
part of a large, multi-year Linne’ research grant awarded to Uppsala University under the
leadership of Professor Anders Bäckström.
Project 2: The importance of post-displacement institutional and stressors and resiliency
factors and its implications for refugee post-displacement mental health
Participant: Bengt Arnetz
This is a comparative study of the importance of post-displacement stressors and resiliency
factors in Iraqi refugees in the United States versus Sweden. In addition, there are plans to carry
out policy and cost-benefit analysis of the two countries refugee integration program.
Project 3: Stress and global Self-Rated Health: Exploration of Possible Psychophysiological Mechanisms and Implications for Public Health
Participants: Christina Halford, Lisa Ekselius, Ingrid Anderzén, Bengt Arnetz, Kurt
Svärdsudd
The main aim of this longitudinal project is to investigate associations between
psychobiological markers of daily-life stressors and global self-ratings of health, in 200 healthy
adult men and women. Among men, associations between SRH and endocrine variables were
observed, with a decrease in SRH below the level of good significantly associated with
differences in levels of testosterone and prolactin. In women some elements of the hypothesis,
i.e., effects of coping resources and psychological strain variables on SRH, were supported,
whereas other elements, i.e., effects of endocrine measures on SRH, were not.
Project 4: “Network of stress researchers concerning measurements and analyses of
cortisol reactivity focusing on cortisol levels from ambulatory saliva sampling” 2007-2009
Participant from Uppsala: Christina Halford
The project, supported by the Swedish Research Council, includes 19 researchers from three
Scandinavian countries. The aim of the network has been to discuss research issues concerning
measurements and analyses of cortisol reactivity, focussing on ambulatory measurements of
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cortisol in saliva. Collaboration within the network has resulted in an e-book, which is under
progress, and to be published during 2010.
Project 5: Management control systems and stress: interdisciplinary field experiments
Participants: Ingrid Anderzén, Lars Frimanson
Management control systems (MCS) in organizations have become more complex. They
measure performance on more objects, with new and more measurements, they provide
information more frequent and quicker, and they are used at lower levels in organizations. But
we do not know how these complex MCS influence the human body. Do they improve health,
well-being and performance in organizations? Or do they make people develop insomnia, stress
and other unhealthy outcomes that are economically and socially costly? This interdisciplinary
research program combines two fields of knowledge; social medicine and MCS. The purpose is
to examine and explain how MCS design affects psychosocial factors in the organization, stress,
and performance. This is important because MCS are used for planning and evaluation in
organizations. MCS can thus be expected to influence the psychosocial factors in organization
that are associated with negative stress reactions, work-related health, and performance
outcomes.
Project 6: “NySatsa Haninge” – A project to support individual’s on long term sick leave
to return to working life through individual development and guidance.
Participants: Ingrid Anderzén, Ann-Sophie Hansson, Per Lytsy, Anna Liljestam Hurtigh
The project ”NySatsa Haninge” has the overall aim to support individuals to return to working
life through individual guidance. Fifty participants on long term sick leave have been given the
opportunity to personal development and training through various tools for guidance. The
objective has been to facilitate the return to working life, full-time or part-time, school studies,
or other working life related activities based on the individual’s conditions, motivation and
participation. The project started in July 2008. The follow up after one year shows that 52% of
the participants have returned to working life. The study shows that’s long term sick absence
due to diffuse and subjective health problems is not a permanent condition even in participants
with substantial work absences periods. A cognitive approach to make individuals self
participate and develop a rehabilitation plan seems to be an effective method if combined with
close interaction with other rehabilitation agents. The results in this study also support the idea
that return to work is an important contributor to a better self-perceived and mental health for
people who have been outside the labor market for a long time. The project has been evaluated
in autumn 2010.
Project 7: “SAMKLANG”: In Cooperation – Acceptance, motivation and return to work
among long-term sick listed.
Participants: Ingrid Anderzén, Anna Liljestam Hurtigh, Anna Finnes, Annica Åbring,
Anna Thunell
The project “SAMKLANG” is founded by The European Social Fund (ESF) and the project is
in cooperation with The Swedish Social Insurance Administration, The Swedish Public
Employment Service and The Study Promotion Association. The aim of the project is to support
individuals to return to working life. Sixty participants on long term sick leave have been
treated with Acceptance and commitment therapy (ACT) by a Psychologist during three
months. After one year 68% of the participants are ready to return back to work or studies. The
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project will go on with an interview study with those participants that had return to working life.
The aim of this study is to find factors that predict Return to work for those individuals that had
been on a long term sick leave.
Project 8: VITALIS – An RTC study to support women on long term sick leave to return
to working life through ACT or Team evaluation
Participants: Ingrid Anderzén, Per Lytsy, Annica Åbring, Anna Finnes, Jenny Thorsell,
Linnea Molin, Emma Wallin, Anna Olsson, Carina Wennman and Ragnar Westerling
This project is in collaboration with the Swedish Social Insurance Administration, the Swedish
Public Employment Service, and the Primary Health Care sector. Fifty-five percent of people
presently sick listed in Uppsala County are diagnosed with psychological problems, such as
depression, anxiety and stress related symptoms, and/or chronic pain. The overall aim with this
project is to develop, provide and evaluate accessible rehabilitation programs, for these
complexes of problems, to help women on long term sick leave, to return to work. Vitalis
started in Spring 2010 and will be completed in 2011. Approximately 320 women on long term
sick leave due to pain, stress, depression and/or anxiety symptoms, identified by the National
Insurance Agency in Uppsala County have been randomized into one out of three conditions: a
multimodal team assessment and intervention, a home based internet supported unimodal
psychological intervention (Acceptance and Commitment Therapy) and a treatment as usual
(TAU) intervention. The project will evaluate the long term effects of those two different
rehabilitation packages: multidisciplinary team assessment/intervention and CBT/ACT home
based/internet treatment as compared to TAU, for the population of women who will lose
insurance payments within 4 months.
Project 9: Low impact stress among first responders. Implications for Health and
Performance
Participants: Bengt B Arnetz, Sarah Thomsen, Dana Nevedal, Matt Ventimiglia
Low impact stress among first responders (first line employees within the military, coast guard,
customs control, and the police) are at increased risk to suffer from low-level, chronic stress
exposure. We were interested to identify more in detail operational, organizational and personal
sources of low impact stressors, their impact on health and performance, as well as means to
cope with such stress. We carried out focus groups interviews with seventeen first responders.
Results generated distinct areas of low impact stress. Results were used to develop a First
Responder specific epidemiological survey. It will be distributed to a representative sample of
Sweden’s First Responders in 2010. This unique epidemiological survey will collect
representative prevalence data on specific low and high impact stressors, their relationships to
health and performance and effective means to increase stressor resiliency. The research is done
in close collaboration with Kungafonden (“The Swedish Royal Foundation”), and senior
management and unions representing all of Sweden’s major First Responders professions,
including the police, defence, coast guard, and customs.
Project 10: Real-time assess of psychophysiological stress responses
Participants: Bengt b Arnetz, Clairy Wiholm, Mark Lumley, Weisong Shi
Despite epidemiological research linking psychosocial stress to cardiovascular disease and other
stress-related disorders, we still lack convincing evidence about the biological mechanisms
190
linking stress to cardiovascular disease. In a collaborative study between researchers at Uppsala
University and Wayne State University, we have developed a prototype of a wireless heart rate
sensor and Smartphone system that allows for the immediate transmission of heart rate data to a
central server. The central server is programmed to send text messages to the phone when the
heart rate deviates from a normal average. Text messages concerns stress and related questions
of interest to identify possible reasons for the heart rate response. The pilot study will be critical
for the design of a system at will subsequently be used to trace cardiovascular and emotional
responses in inner-city inhabitants as well as female managers: a high-risk group for stressrelated disorders.
Project 11: The involved patient: implications for treatment outcome and secondary
prevention of myocardial infarction.
Group participants: Judy Arnetz, Anna Höglund, Ulrika Winblad, Bengt Arnetz
This project studied the implications of patient involvement for length of stay, compliance,
treatment outcomes, and the work of physicians and nurses caring for heart attack patients.
Initiated in 2004, this project was a multidisciplinary collaborative effort with Uppsala Clinical
Research Center which administers the Swedish national quality registry for cardiovascular
disease, RIKS-HIA.
191
Scientific Report
Sociomedical epidemiology
Research group leader Professor Ragnar Westerling
The primary objective of the research is to analyze mechanisms behind social differences in
health and health care and to develop and evaluate health system interventions in order to
increase equity in health.
The fields of the research programme is to 1) develop methods for identifying and analysing the
mechanisms behind preventable disease patterns in the population. 2) evaluate the impact of the
health care and other parts of the society on these preventable disease patterns.3) analyse the
associations between the social situation and psychosocial, behavioural and biological risk
factors for ill health and how these associations may be influenced in order to improve
preventivestrategies 4) develop, plan and evaluate health system interventions .
This program line is implemented for different fields of public health, in accordance with the
Swedish National Public Health Goals, such as the health of children and families, health
related to working life, health related life styles as well as health orientated medical care and
the prevention of adverse events in medical care. Several doctoral students are involved in
these studies and several collaboration projects are included. The research group is multi
professional including persons with the backgrounds as medical doctors as well
as from behavioural, economical and Public Health sciences. Several studies have been
performed in collaboration with national and international groups and organisations.
Members of the group during 2010
Ragnar Westerling, Professor
Per Lytsy, MD, PhD. University adjunct.
Annika Åhs, PhD, Researcher.
Marcus Westin, MD, PhD Research physician
Stefan Kunkel, PhD.
Marianne Hanning, PhD
Lars-Age Johansson, PhD
Ulrika Paulsson, Doctoral student
Peter Berg, M.D. Doctoral Student, Research physician
Achraf Daryani, PhD. Researcher
Mikael Skärlund, Research asssistent
Susanne Sundell Lecerof, Doctoral student, collaboration with Lunds and Malmö University
Anna Ohlsson, M.D. Clinical research assistant.
Hans Nordlöf, Doctoral student, Collaboration with University of Gävle
Ebba Hallberg, MPh student.
Josefin Wångdahl, MPh student
Erik Berglund, MPh.
192
Publications 2008-2010
1. Kunkel S. Quality Management in Hospital Departments : Empirical Studies of
Organisational Models.Digital Comprehensive Summaries of Uppsala
Dissertations from the Faculty of Medicine, 2008:309
2. Westerling R. Åtgärdbar dödlighet som en indikator i den folkhälsopolitiska
uppföljningen - en undersökning av regionala skillnader i Sverige 1989-2003
(In Swedish.Avoidable mortality as an indicator in the surveillance of the public
health policy a study on regional variation in Sweden 1989-2003). Statens
folkhälsoinstitut, Stockholm 2008.
3. Johansson LA. Targeting Non-obvious Errors in Death Certificates. Digital
Comprehensive Summaries of Uppsala Dissertations from the Faculty of
Medicine 2008:305.
4. Westerling R. Socialmedicinskt redaktörskap i tiden. (In Swedish;Timely
Sociomedical editoral work) Editorial. Socialmedicinsk tidskrift 2008:5.
5. Hanning M, Bergquist C, Kärvinge C, Moa G, Molin R, Nordlander B, Sjödin
JG. Nationella medicinska indikationer. Nyckeln till evidensbaserad, rättvis och
tillgänglig vård (In Swedish;National medical indications. The key to evidencebased, just and accessible care).Läkartidningen. 2008 Feb 6-12;105(6):363-6.
6. Hernes E, Johansson LA, Fosså SD, Pedersen AG, Glattre E. High prostate
cancer mortality in
Norway evaluated by automated classification of medical entities. Eur J Cancer
Prev. 2008 Aug;17(4):331-5.
7. Lytsy P, Westin M. Utmattningssyndrom - en diagnos med vetenskapliga
brister. (In Swedish;Fatigue syndrome--a diagnosis with scientific shortages).
Lakartidningen. 2008 May 21-27;105(21):1592-3.
8. Lundström M, Albrecht S, Wendel E, Hanning M. Mer jämlik vård för patienter
med katarakt.Resultat av införande av nationella operationsindikationer.(In
Swedish: More equal careof patients with cataract. Results after implementation
of national surgical indicators]. Läkartidningen 2009;106:1733-36.
9.
Johansson LA, Björkenstam C, Westerling R. Unexplained differences
between underlyingcause of death and hospital discharge diagnosis indicate
mistakes in cause-of-death certification - An investigation of 1094 deaths in
Sweden during 1995. J Clin Epidemiol. 2009 Nov;62(11):1202-9
10. Westerling R. The harmonisation of the medical speciality in Public Health in
the EU countries. – a challenge for the profession. Eur J Public Health
2009;19(3):230-2.
11. Kunkel S T, Rosenqvist U, Westerling R. Implementation strategies influences
the structure,process and outcome of quality systems. Qual Saf Health Care.
2009;18:49-54.
193
12. Westerling R, Burström B, Kristenson M. Säkerställ den socialmedicinska
kompetensen. (In Swedish: Secure the competence in social medicine!).
Läkartidningen 2009;106:1948-9.
13. Lytsy P, Anderzén I. Sjukskrivningsprocessen inom ortopeden, handkirurgen
och psykiatrin vid Akademiska sjukhuset. (In Swedish: The process of sich
leave in ortopedy, hand surgery and psychiatry at Academic hospital).
Department of Public Health and Caring Sciences,Uppsala University. CEOS,
Akademic hospital. Report 2009.
14. Sundell Lecerof S, Westerling R, Fryklund B, Östergren PO. The association
between health information and BMI among Iraqi migrants, settled in Sweden
2007-8. European J Public Health 2009;19:Suppl:162.
15. Westerling R. Socialmedicin som medicinsk specialitet. (In Swedish: Social
Medicine as a medical specialty). Socialmedicinsk tidskrift 2009(5):401
(Editorial).
16. Westerling R. Samarbete i Europa - specialiteten i socialmedicin gäller i hela
EU! (In Swedish: Collaboration in Europe: The specialty in Social Medicine is
recognized in the EU countries.) Socialmedicinsk tidskrift 2009(5):442-448.
17. Lytsy P, Hansson AS, Anderzén I. Sjukförsäkringen – ett decennium av
förändring.(In Swedish: Social insurance – a decade of change.)
Socialmedicinsk tidskrift 2009(6):561-571.
18. Lytsy, P. Utvärdering av samverkan i form av beredningsgrupper i
primärvården under 2008.(In Swedish: Evaluation of collaboration in
preparation groups in primary care 2008). Slutrapport 2009. Report 2009.
19. Lytsy, P. Någonting är sjukt – reflektioner kring stress, människoöden och vår
samtid. (InSwedish: Something is sick. Reflections about stress, persons fate,
and contemporary time) (ISBN 9789172411623), Optimal förlag, 2009.
20. Sundell Lecerof S, Westerling R, Moghaddassi M, Östergren PO. The
association between overweight and information on physical activity and
healthy diet among recently settled, 18-64-year-old Iraqi migrants in Sweden:
Implications for practice. (Accepted for publication.)
21. Lytsy P, Berglund L, Sundström J. A Proposal for an Additional Clinical Trial
OutcomeMeasure Assessing Preventive Effect as Delay of Events. (Submitted)
22. Berg P, Sundelin C, Westerling R. The connection between socioeconomic and
psycho-social factors and bicycle helmet use among school children and
teenagers. Department of Public Health and Caring Sciences, Social Medicine,
Uppsala University (Submitted)
23. Westin M, Sundelin C, Westerling R . Swedish parental characteristics and
children’s mental health. Department of Public Health and Caring Sciences,
Uppsala University, (submitted)
24. Lytsy P. Hansson AS, Anderzén I. Återgång till arbete är möjlig för
långtidssjukskrivna. Resultat från samverkansprojekt mellan sjukvården och
Försäkringskassan. (In Swedish: Return to work is possible for persons on long
194
term sick leave. Results from a collaboration project between health care and
the Social Insurance administration). Läkartidningen2010;307:1480-1482.
25. Lytsy P, Burell G, Westerling R. Views on treatment necessity, harm, and
benefits in patients using statins. Med Decis Making. 2010 Sep-Oct;30(5):594609. Epub 2009 Dec 11.
26. Lytsy P. Slutrapport. Utvärdering av samverkan med rehabkoordinatorer och
kontaktpersoner i primärvården respektive psykiatrin under 2010 (In Swedish:
Final report. Evaluation of collaboration between rehabilitation coordinators
and contact persons in primary care and psychiatry, respectively in 2010.). Dnr
PUBCARE 2010/1
27. Anderzén I, Hansson AS, Lytsy P, Liljestam Hurtigh A. Slutrapport – NySatsa
Haninge –Projekt med syfte att främja individens möjligheter till återgång i
arbete genom individuell utveckling och vägledning (In Swedish: Final report –
NySatsa haninge- a project aiming at promoting individuals possibilities to
return to work by personal development and guidance). Report 2010.
28. Lytsy P, Hansson AS, Anderzén I. Återgång till arbete för långtidssjukskrivna –
resultat från pilotprojektet Nysatsa.(In Swedish. Return to work for persons on
long term sick leave- results from a pilot study NySatsa). Läkartidningen
2010(107) 22; 1480-82.
29. Lytsy, P. Alternativmedicin som snyggt packad placebo. Recension av boken
Snake Oil Science. The Truth about Complementary and Alternative Medicine
(R. Barker Bausell). Svenska statistikfrämjandet tidskrift Qvintensen, nr 20103
30. Ahs A, Burell G, Westerling R. Care or Not Care-that is the Question:
Predictors of Healthcare Utilisation in Relation to Employment Status.Int J
Behav Med. 2010 Dec 3. [Epub ahead of print]
31. Lytsy P, Burell G, Westerling R.How do prescribing doctors anticipate the
effect of statins? J Eval Clin Pract. 2010 Jun 10. [Epub ahead of print]
32. Westerling R. Internationella jämförelser av åtgärdbar dödlighet. (In Swedish:
International compaisons of avoidable mortality) (Accepted for publication)
33. Hansson AS, Lytsy P, Anderzén I. Restart - Return To Work After Long-tem
Sickness Absence From Work: A Quasi-experimental Study. Webmedcentral
2010(www.webmedcentral.com on 03-Dec-2010, 05:44:24 PM).
34. Johansson LA, Korpi H, Pedersen AG. NOMESCO Report on Mortality
Statistics for theNordic/Baltic Countries. Copenhagen 2010. Nordic MedicoStatistical Committee 92:2010.
35. Fugelstad A, Johansson LA, Thiblin I. Allt fler dör av metadon. »Läckage« från
dagens mer liberala behandlingsprogram kan vara en orsak.(In Swedish: More
people die from Metadon. A ”leackage” from todays more liberal treatment
programs may be an explanation. Läkartidningen, 2010, 18:1225-8.
36. Lytsy P. Power of the Pill: Views about Cardiovascular Risk and the Riskreducing Effect of Statins. Department of Public Health and Caring Sciences,
195
Social Medicine, Uppsala University, Dissertations from the Faculty of
Medicine. Uppsala 2010. (Thesis)
37. Paulsson U, Edlund B, Westerling R. Relationship between unhealthy
behaviours and a general unhealthy behavioural factor in Swedish school
students. . Department of Public Health and Caring Sciences, Social Medicine,
Uppsala University (Submitted).
38. Lytsy P. Patienter överskattar statiners preventiva effekt. (In Swedish: Patients
overestimate the effects of statins) Läkartidningen 2010;107:1692.
39. Daryani A. Hälsa – en rättighet för alla? En beskrivning av hälsan bland irakier,
som kom till Malmö 2005-2007. (In Swedish: Health – a right for all ? A
description of healthamong Iraqi immigrants to Malmö 2005-2007) Report, IMHad
2010. MIM, Malmö högskola, Social Medicine, Uppsala University. Social
Medicine and Global Health, Lunds University.
40. Sundell Lecerof S. Olika villkor – olika hälsa. Hälsan bland irakier i åtta av
Sveriges län2008.(In Swedish: Different conditions –diferent health. Health
among Iraqi immigrants in eight Swedish counties 2008. Report, IMHad 2010.
MIM, Malmö högskola, Social Medicine, Uppsala University. Social Medicine
och Global Health, Lunds Universitet.
41. Rey G, Aouba A, Pavillon G, Hoffman R, Plug I, Westerling R, Jougla E,
Mackenbach J.Cause-specific mortality time series analysis: a general method
to detect and correct for abrupt data production changes. INSERM, CépiDc, Le
Vésinet, France, Erasmus MC, Department of Public Health, Rotterdam, The
Netherlands and Department of Public Healthand Caring Sciences, Social
Medicine, Uppsala University, Uppsala, Sweden, 2010. (Submitted)
42. Lytsy P, Burell G, Westerling R. Cardiovascular risk factor assessments and
health behaviours in patients using statins compared to a non-treated
population. Department ofPublic Health and Caring Sciences, Social Medicine,
Uppsala University. ( Submitted).
43. Gjertsen F, Johansson LA. Changes in statistical methods affected the validity
of officialsuicide rates. (Accepted for publication J Clin Epidemiol).
Dissertations 2008-2010
Stefan Kunkel. Quality Management in Hospital Departments : Empirical Studies of
Organisational Models. Uppsala University 2008
Lars Age Johansson. Targeting Non-obvious Errors in Death Certificates. Uppsala University
2008.
Per Lytsy. Power of the Pill: Views about Cardiovascular Risk and the Risk-reducing Effect of
Statins. Uppsala University 2010.
Agencies that support the work/Funding 2008-2010
International Health Communicators (partnership with Malmö University, Lund’s University
and the region of Skåne). 1 850 tkr, 2007-2008. European refugee fund.
196
International Health Communicators (partnership with Malmö University, Lund’s University
and the region of Skåne and Västra Götaland, the county of Blekinge, the municipalities of
Botkyrka, Eskilstuna, Kinda, Malmö, Blekinge institute of technology, Östsam and the National
Board of Health and Welfare). 6835 tkr, 2009-2011. European refugee fund.
Avoidable mortality in the European Union: towards better indicators for the effectiveness of
health systems (European partnership; with Erasmus University in Rotterdam, London School
of Hygiene and Tropical Medicine and INSERM in Paris). European Union: Programme for
community action in the field of Public Health 1150 tkr, 2008-2011.
Health information for immigrants. Public health funds, Uppsala county, 300 tkr 2009-2010,
298 tkr 2010-2011.
Health, Migration and Integration. ((partnership with Malmö University, Lunds University, the
municipalities of Bollebygds, Herrljunga, Marks, Svenljunga, Tranemo, Ulricehamn and the
employment office of Borås. European Integration Fund. 3 635 000 2010-2012.
Academic hospital, Uppsala.
Project 1: Studies of Avoidable mortality and diffusion of innovations
Ragnar Westerling, Marcus Westin, Anna Ohlsson, Marianne Hanning
According to the concept of studying "avoidable" mortality the health care may prevent
mortality from a number of causes of death by means of preventive or therapeutic measures.
An agglomeration of deaths from avoidable causes is a warning signal motivating further
investigation of factors which may increase the possibilities to prevent these causes of death.
The method has been used in several studies from different countries and has been applied to
Swedish conditions by our research group. We have contributed to the development of the
studies of avodiable mortality by integrating this concept into the field of quality and equity in
health care, by introducing a gender perspective, by developing methods for small-area
analyses, by performing comparisons with former Soviet Baltic states and by evaluating
studies of avoidable factors preceeding death.
Our research group is one of the partners of a European research initiative aiming at further
developing the method. The partners are Johan Mackenbach's group at the Department of
Public Health at Erasmus
University in Rotterdam, Martin Mckee´s group at London School of Hygiene and Tropical
Medicine and Eric Jouglas´group at INSERM in Paris. We also collaborate with researchers in
Spain, Germany and Estonia.
In this project a systematic review of the literature is performed in order to assess the extent to
which different causes of death can now, in the light of available evidence, be considered
avoidable. The project also include trend analyses as well as analyses of the timing of
introduction of innovations, i.e. whether these coincides with measurable declines in deaths
from the corresponding causes. Furthermore the potential influence of changes and variations in
cause of death classification rules has been assessed and the time trends adjusted for changes in
classification. The findings are presently used in a Delphi study involving experts from across
Europe, in order to update a set of avoidable mortality-based indicators of the effectiveness of
health systems which can be used in surveillance systems. We are presently also preparing an
in-depth study of equity in treatment of heart failure in Sweden as part of this research field.
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Project 2: Targeting non-obvious errors in cause of death statistics
Lars Age Johansson, Harry Rosenberg, Charlotte Björkenstam, Ragnar Westerling
In our studies we have found considerable differences between death certificates and
corresponding hospital discharge records. These differences have been further examined in
order to find out whether this can be explained by the ICD selection rules. The ACME, a
standard software for the selection of underlying cause of death was used to examine the
compatibility between the underlying cause of death and the final main conditions. This is to
our knowledge the first study of this kind. One third of the difference could not be explained
by ICD selection rules. Adding hospital discharge data changed the underlying cause in 11 %
of the deaths.
We have performed a structured assessment of the causes of death based on 1200 medical acts.
The death certificates identified to be problematic by the ACME-test were about twice as often
as other death certificates questioned also in this assessment. For these death certificates a
change of the choice of cause of death was suggested. Thus, this test should be useful in
screening for potential quality problems in the cause of death statistics, which was the objective
of Lars Age Johansson’s thesis. Futhermore, an in-depth analyses of the cause of death
statistics for suicide and for prostate cancer has been performed. These assessments would be
useful also since we in a methodological review have found considerable quality problems in
studies aiming at evaluating the quality of causes of death statistics.
Project 3: Patients and physicians expectations on lipid-lowering drugs
Per Lytsy, Gunilla Burell, Ebba Hallberg, Erik Berglund, Ragnar Westerling
Preventive treatment with statins is shown to significantly reduce the absolute risk of coronary
heart disease; yet long-term compliance is poor. We have studied the expectations and factors
that might affect expectations on statin treatment among patients. A total of 909 Swedish
statins users were identified and a questionnaire was used to obtain information on the health
of the study objects, cardiovascular risk factors, life style and expectations on statin treatment.
On average, statin treated patients believed that 53.6% of statin users would avoid a coronary
event as a result of a five-year treatment period. Thus, patients highly over-estimate the
general preventive effect of statins. Higher education lowered expectations, but factors
commonly used to assess cardiovascular risk, such as age, sex, BMI and previous coronary
heart disease, did not affect expectations at all. Patients’ expectations of their own possible
treatment benefits were found to be more negative among those with a poor social network
and patients not socially active. The health related habits of statin users were compared
to non-statin users are analysed showing more concern with meal habits and exercise among
statin-users. In a second questionnaire to 600 statins users the expectations were also related to
questions about the adherence to the medication. The quantitative studies of the expectations on
statin use is presently also combined with an interview study with patients newly prescribed
statins.
The physicians expectations and attitudes towards statin treatment has also been analysed
showing some gender differences in the prescription habits among physicians. This study is
performed in collaboration with the pharmaceutical committees in the county of Uppsala and
Gävle and supported by the Academic hospital in Uppsala and is included in Per Lytsy’s thesis
together with studies of the patient’s expectations.
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Project 4: Quality systems in hospital departments
Stefan Kunkel, Urban Rosenqvist, Ragnar Westerling
In a recent thesis Stefan Kunkel has analysed what organisational factors that influence the
quality of quality systems in medical care. Stefan Kunkel, has analysed interviews with heads
and quality managers of hospital departments and surveys to about 600 such departments.
The studies include both qualitative analyses and advanced statistical modelling, such as
LisRel-analyses.
The result was a new framework with three organisational aspects of quality systems each
with two sub-aspects: structure (resources and administration), process (culture and
cooperation), and outcome (evaluation of goal achievement and development of competence).
Strong positive relationships were confirmed among structure, process, and outcome.
Quality systems could be classified into three organisational degrees. For instance, quality
systems of high organisational degree often had adequate resources and administration as well
as positive organisational cultures and high cooperation among different professions.
Advanced designs required quality systems of high organisational degrees. Examples of such
designs were coordination between departments, random check ups, and accreditation. The
organisationally demanding quality systems had been implemented through cooperative
implementation, that is, directed by managers while at the same time giving opportunities for
staff to participate in planning and designing.
Project 5: Health and health care utilization among the unemployed
Annika Åhs. Gunilla Burell, Mikael Skärlund, Ragnar Westerling
The last decades there have been considerable changes in the Swedish labour market. During
the 1990s the level of unemployment increased considerably and the last years the level of
sick leave has been high. In a number of studies we are analysing the risk factors for ill-health
among different employment groups. In a recent study we have found that the unemployed
experiences depressive mood and indications of potential depression already after a few months
of unemployment to a higher extent than employed persons. This depressive pattern occurs
irregardless of sociodemographic factors, economic situation and social network factors.
However, the unemployed abstained from seeking medical care although when they perceived a
need for that more often then the employed did. This was the case also when there were signs
of depression or of the so called burned out syndrome. Presently we are analysing the social and
health related factors that may predict the chances that the unemployed will be employed one
year after the unemployment period started. Economic stress, ill health, and being an immigrant
to Sweden seems to have predicted a higher risk of being unemployed also one year later.
Project 6: Health promoting information among immigrants to Sweden
Achraf Daryani, Josefin Wångdahl, Ragnar Westerling
We are evaluating the impact of international health advisors on health and health
care utilization among immigrants to Sweden. The health advisors are working with
information to immigrants about health related factors and medical care in Sweden.
In the first part of the project a cross-sectional study of health and health care utilization and
experiences of contacts with health advisors among refugees from Iraq has been performed as
a post-doctoral project for Achraf Daryani. In another part a longitudinal study has been
designed aiming at analysing the effects of contacts with health advisors on the health as well
as on the health related knowledge and behaviours of Iraqi migrants to Sweden. Furthermore,
focus group interviews are performed with immigrants from Somalia and Thailand, on health
related factors in order to get a basis for planning interventions also for these groups. The
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studies are performed in collaboration with Lund’s University and Malmö University. The
projects are funded by the European Refuge Fund and Immigrant Fund, respectively. In the
longitudinal study, Ragnar Westerling is jointly supervising doctoral student Susanne Sundell
Lecerof.
Furthermore, a project has started in Uppsala, in which information about health issues and the
Swedish health care is developed for study groups among immigrants in Uppsala. A study
material has been translated to several immigrant languages and presently study group leaders
are being trained. This project is supported by The Public Health Fund in Uppsala and the
project is performed in collaboration with municipality of Uppsala, the county of Uppsala, the
County Administrative Board and NBV (The Educational Association of the sobriety
movement- a study circle organization).
Project 7: Health and health care utilization among lone parent families
Marcus Westin, Claes Sundelin, Ragnar Westerling
We have studied inequity in health and health care utilization with regard to whether parents in
Sweden are single or couple. Besides traditional sociodemographic factors, economy and social
network. In the project we also analyse what contribution the concept of social capital may give
to the understandingof the health situation of the families.
Both single fathers and single mothers were reporting worse health than their married or
cohabiting counterparts. However, single fathers had contact with a physician more frequently
than married or cohabiting fathers, whereas single mothers had not. On the contrary, single
mothers refrained from seeing a physician, despite a medical need, much more often than
non-single mothers. Low level of social capital, when adjusted for socio-economic and sociodemographic variables, was clearly and positively associated with less than good self-rated
health. Social capital was unevenly distributed between single and couple mothers but not
between single and couple fathers. The thesis also showed, that both lone parenthood and low
level of social capital influences also the children’s mental health negatively. The analyses
were based on SDQ (Strengths and Difficulties Questionnaire) measures of the children’s
mental health. Presently, the social and health related situation of the families is followed up in
a longitudinal study.
Project 8: Unhealthy life habits and vulnerability among school-children
Ulrika Paulsson, Birgitta Edlund, Ragnar Westerling
The objective of this project is to study factors that influence health behaviours in general
among schoolchildren. We analyse the associations between different health related
behaviours, socio-demographic factors and psychosocial vulnerability. Health related
behaviours included in the study are alcohol habits, smoking, exercise and food habits.
Furthermore, we analyse the influence of health information in school on these different
factors.
The study is based on two questionnaires to school children in school classes 7-9. The first
is the survey Life and Health conducted by the county of Uppsala. This material includes
data from about 10 000 pupils in 2007. The second is a questionnaire developed for this
project and directed to a strategic sample of schools in Sweden. Structural equation models
is used in order to analyse the relation between sociodemographic factors, psychosocial
vulnerability factors, health behaviours in general as well as specific health related
behaviours. The studies will be included in a doctoral thesis by Ulrika Paulsson. The
preliminary results shows that a general unhealthy behavioural factor is related to the selfesteem and well-being of the children, factors that differ between gender and socioeconomic
position.
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Project 9: Bicycle helmet use among school-children
Peter Berg, Claes Sundelin, Ragnar Westerling
We have analysed the use of bicycle helmets among school children as well as the associations
with the involvement of parents and school. There was a clear link between parental
involvement, children’s attitudes and children’s helmet use. However, parental involvement
decreased as the children grew older. An intervention study has been performed in a Swedish
municipality – Bålsta – aiming at increasing the voluntary bicycle helmet use among school
children. A nearby municipality is a reference area in the study. The activities has been
conducted towards parents, children and schools. There has been a significantly higher increase
of bicycle helmet use among schoolchildren in ages 11-14 years in the intervention community
compared to the reference community. We have continued the evaluation after the introduction
of a bicycle helmet law for children under the age of 15. The helmet law seemed to have had
limited effect on the children’s helmet use, especially when it was not combined with
intervention campaigns like those performed in our study in Bålsta. In a recent study we have
further analysed the impact of socioeconomic and psychosocial factors on helmet use as well as
the association with other health related behaviours, such as alcohol, smoking,
exercise and eating habits.
Project 10: Health system intervention for persons on long term sick leave
Social Medicine department/CEOS, Academic hospital.
We are involved in intervention projects for persons on long term sick leave at the Social
Medicine department/CEOS at Academic hospital (See other part of Social Medicine
presentation :Vitalis and Samklang).
Project 11: Implementing safety promotion in an industrial working environment
Hans Nordlöf, Katarina Wijk, Ulrika Winblad, Ragnar Westerling
In a recently started doctoral project for Hans Nordlöf the process of change and learning when
implementing a safer work environment in an industrial company is explored. The study is
performed in a large Swedish steel industry in collaboration with University of Gävle . The
project is organized as a case study of the implementation of a Behavioural Based Safety
program and the enabling and obstructing factors in the process of change of framework for the
safer work environment. The study includes analyses of documents, questionnaires to and
interviews with key persons as well as observations at strategic meetings and of working
processes at the industry.
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