Department of Public Health and Caring Sciences

Transcription

Department of Public Health
and Caring Sciences
Annual Report 2012
Avsändare/Fastställd av Johan Hallqvist 2013-04-30
Introduction
The Department of Public Health and Caring Sciences employs 170 persons and has a yearly
economic turnover of approximately 130 million SEK. The research activities are organized in ten
research groups; Caring Sciences, Clinical Nutrition and Metabolism, Disability and Habilitation,
Family Medicine and Preventive Medicine, Geriatrics, Health Services Research, Oxidative Stress
and Inflammation, Psychosocial Oncology and Supportive Care and U-CARE, Research Ethics and
Bioethics, and Sociomedical Epidemiology, with the following research foci:
Caring Sciences
The research has a multidisciplinary and multiprofessional perspective including preventive,
supportive, caring, and rehabilitation actions. The focus is on clinically relevant problems in the
health care sector. There are four research themes; 1) health and care among children adolescents
and young adults, 2) health and care among elderly, 3) psychosocial genetics and cancer care, 4)
quality of care and patient safety.
Clinical Nutrition and Metabolism
Metabolic and dietary interaction during health and disease is the research focus. 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.
Disability and Habilitation
Research activities focus disability as a function of the interplay between a person’s health condition
and his or her physical, social and societal environment. There are three main research tracks:
Disability Services, Systems and Policies, Clinical Assessment Methods and Documentation and
The Perspectives of Persons with Disabilities in which the facilitating and restraining aspects of the
environment as well as the participation and perspectives of persons with disabilities, professionals
and significant others are highlighted.
Family Medicine and Preventive Medicine
Social Insurance Medicine: the course of events leading to sick-listing and disability pension to
detect predictors for sickness absence and return to work aiming at future guidance to patients and
profession.
Pain: prevalence, determinants and consequences of pain to deepen the patho-physiologic
knowledge to develop adequate diagnostic and treatment strategies.
Reproductive health: effects of positive and negative influences in early pregnancy on outcome of
pregnancy and childbirth aiming at optimizing the conditions of the fetus.
Develop reproductive health care for young adult men in primary health care.
Asthma, allergy and COPD: asthma control and quality of life during different periods of life.
Pharmacoepidemiology: natural history of diseases including respiratory and inflammatory diseases.
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Cardiovascular disease and diabetes: risk factor control to develop risk factor models to be
conveyed into clinical practice. Optimal glucose lowering treatment guided by pharmaco-genetics.
Behavioural modification as secondary prevention of myocardial infarction.
Stress: biological mechanisms linking stress to cardiovascular disease. How management control
systems affect the human body.
Geriatrics
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. The group applies a broad repertoire of experimental
techniques, e.g. molecular biology, biochemistry, histology and behavioural analyses in our research.
Health Services Research
Health Service Research (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
high quality and patient safety care, especially within telecare. The group is multidisciplinary and the
researchers have different professional backgrounds such as medicine, psychology, nursing and
political science.
Oxidative Stress and Inflammation
The key research areas are inflammation in physiology and in disease state, specifically with
bioactive eicosanoids. Additionally, oxidative stress that reflects increased levels of free radicals that
are implicated both in ageing and in several inflammatory diseases is also a major research area.
Psychosocial Oncology and Supportive Care and U-CARE
The research activities mainly concern cross-disciplinary basic and applied research within the area
of psychological treatment and psychosocial support for patients and significant others experiencing
psychological distress in connection to a somatic disease. Knowledge from Economics, Information
Systems, and Psychology are used to reach the research goals. The main research projects concern
investigations of: psychological and economic effects of childhood cancer for those struck by the
disease, their parents and siblings; the clinical efficacy and cost-effectiveness of self-help programs
consisting of cognitive behavioral therapy via the internet or face-to-face to persons struck by
various diseases such as cancer or myocardial infarction. In order to raise the quality of the research
the public and the patients are involved in all the research activities.
Research Ethics and Bioethics
The Centre for Research Ethics & Bioethics (CRB) looks at ethical, legal and social aspects of
medicine and biology (bioethics) and the application of ethical principles and values to different
scientific topics (research ethics). The research topics cover a wide range of ethical questions related
to biobanks and registry research, ethical review, informed consent, medical treatment of patients,
nursing, explanations of human consciousness, quality of life, end of life care and more. The
methods in use range from analytical philosophical methods to empirical studies using both
qualitative and quantitative methods
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Sociomedical Epidemiology
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 main fields of the research programme are quality and equity in medical care and health
system interventions for vulnerable groups like unemployed, lone parents and immigrants.
Methodological aspects of avoidable mortality is also an important research interest.
Education
The Department of Public Health and Caring Sciences has extensive responsibilities in the teaching
of nursing students, medical students, master of public health students and graduate students. There
were about 3530 students registered at the department in 2012, in terms of funding corresponding to
about 525 full time students. About 1350 registered students were educated in the Nursing
programme, 1600 in the Medicine programme, 20 in the Master-programme in public health and
about 560 in separate courses. Through well-established collaboration with several universities
abroad and different exchange programmes nursing students and teachers were able to get
international experience.
About 100 doctoral students were also registered during 2012. In contract education about 950
students were registered.
Developments
After a period of planning the department’s organization for under-graduate education was
centralised at the end of 2012 under a new leadership. The aim was to further increase quality and
efficiency in our education system and to facilitate strategic decisions on new courses and in the
recruitment of new teachers in senior positions.
Another strategic development during 2012 was the recruitment of a senior researcher in health
economics. The ambition of both the department and the university is to create a strong research
group in health economics. To support this process the Health Economic Forum at Uppsala
University (HEFUU) is organized as a collaborative effort between the Department of Public Health
and Caring sciences, the department of Economics and Uppsala Clinical Research Centre.
Uppsala April 30, 2013
Johan Hallqvist
Head of Department
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List of Contents
Introduction_________________________________________________________________ 2
List of Contents _____________________________________________________________ 5
Organization ________________________________________________________________ 8
Address List ___________________________________________________________ 10
Centres ___________________________________________________________________ 19
Centre for Disability Research (CDR) _______________________________________ 19
Centre for Research Ethics and Bioethics (CRB) ______________________________ 19
Education _________________________________________________________________ 20
First-cycle courses and study programs _____________________________________ 20
Courses within Medicine Programme __________________________________ 20
Courses within Nursing Programme ___________________________________ 21
Second-cycle courses and study programs ___________________________________ 22
Third-cycle course and study program _______________________________________ 22
Education project _______________________________________________________ 23
Dissertations 2012 __________________________________________________________ 24
Licentiate 2012 _____________________________________________________________ 24
Scientific Reports ___________________________________________________________ 25
Caring Sciences ________________________________________________________ 25
Members of the group during 2012 ____________________________________ 25
Publications 2010-2012 _____________________________________________ 27
Dissertations 2012 _________________________________________________ 38
Agencies that support the work/Funding ________________________________ 38
Centre for Disability Research (CDR) _______________________________________ 41
Agencies supporting CDR work/Funding ________________________________ 42
Centre for Research Ethics & Bioethics (CRB) ________________________________ 44
Publications 2010-2012 _____________________________________________ 48
Dissertation 2012 __________________________________________________ 53
Research projects _________________________________________________ 54
Clinical Nutrition and Metabolism ___________________________________________ 72
Publications 2010-2012 _____________________________________________ 73
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Future promising research at CNM ____________________________________ 82
Disability and Habilitation _________________________________________________ 84
Publications 2010-2012 _____________________________________________ 85
Dissertation 2012 __________________________________________________ 88
Research projects _________________________________________________ 90
Family Medicine and Preventive Medicine____________________________________ 95
Publications 2010-2012 _____________________________________________ 97
Dissertation 2012 _________________________________________________ 110
Agencies that support our work/Funding 2012 __________________________ 110
Research projects ________________________________________________ 111
Geriatrics ____________________________________________________________ 143
Members of the group during 2012 ___________________________________ 143
Publications 2010-2012 ____________________________________________ 143
Dissertation 2012 _________________________________________________ 153
Agencies that support the work/Funding _______________________________ 154
Health Services Research _______________________________________________ 158
Publications 2010-2012 ____________________________________________ 158
Dissertations 2012 ________________________________________________ 162
Oxidative Stress and Inflammation ________________________________________ 172
Publications 2010-2012 ____________________________________________ 172
Dissertations 2012 ________________________________________________ 176
Psychosocial Oncology and Supportive Care ________________________________ 180
Members of and external partners to the group during 2012 _______________ 180
Publications 2010-2012 ____________________________________________ 184
Dissertation 2012 _________________________________________________ 186
Half time controls 2012 ____________________________________________ 187
Social Medicine _______________________________________________________ 191
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Publications 2010-2012 ____________________________________________ 192
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Organization
Head of Department
Professor Johan Hallqvist
Deputy Head of Department
Professor Karin Sonnander
Department Board
Carina Ahlstedt, Teacher and Researcher Representative
Birgitta Edlund, Teacher and Researcher Representative
Margaretha Eriksson, Teacher and Researcher Representative
Mats G Hansson, Teacher and Researcher Representative
Calle Martinsson, Technical and Administrative Representative
Martin Cernvall, Graduate Student Representative
Carl-Johan Bergling, Student Representative
Björn Eriksson, Student Representative
Madeleine Grenå, Student Representative
Li Haglund, Student Representative
Karin Björkegren, Teacher and Researcher Representative, Deputy
Tommy Cederholm, Teacher and Researcher Representative, Deputy
Anna T Höglund, Teacher and Researcher Representative, Deputy
Karin Nordin, Teacher and Researcher Representative, Deputy
Ulrika Winblad, Teacher and Researcher Representative, Deputy
Anders Brantnell, Technical and Administrative Representative, Deputy
Ritva Rissanen, Graduate Student Representative, Deputy
Jakob Forsgren, Student Representative, Deputy
Viktor Knaust, Student Representative, Deputy
Tove Näslund, Student Representative, Deputy
Fanny Sundin, Student Representative, Deputy
Charlotte Traneus, Economist
Catarina Olsson, Protocol
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
Barbro Wadensten
Directors of Undergraduate Studies
Karin Björkegren, Head
Birgitta Edlund, Head
Carina Ahlstedt
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Lena Kilander
Sören Kjellberg
Karin Nordin
Ragnar Westerling
Director of Clinical Issues
Lars Lannfelt
Professors and Research Groups Leaders
Bengt Arnetz
Samar Basu
Marianne Carlsson
Tommy Cederholm
Louise von Essen
Lena Gunningberg
Johan Hallqvist
Mats G Hansson
Lars Lannfelt
Per Kristiansson
Karin Nordin
Karin Sonnander
Tanja Tydén
Ragnar Westerling
Ulrika Winblad
Adj Professors, Guest Professors and adj Senior Lecturers
Annika Bardel
Hans Basun
Mats Gulliksson
Gunnar Johansson
Marianne Omne-Pontén
Thorne Wallman
Anna Christina Åberg
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Address List
Department of Public Health and Caring Sciences (Institutionen för folkhälso- och vårdvetenskap,
IFV)
Address: The department is situated at three different locations:
BMC, Husargatan 3,
Dag Hammarskjölds väg 14B,
The Rudbeck Laboratory, Dag Hammarskjölds väg 20.
E-mail address: firstname.lastname@pubcare.uu.se
Aarts Clara
Adolfsson Päivi
Ahlstedt Carina
Alfonsson Sven
Ander Malin
Andersén Åsa
Anderzén Ingrid
Anshelm Cecilia
Arnetz Bengt
Arnetz Judith
Arving Cecilia
Atry Ashkan
Ax Erika
Bardel Annika
Basu Samar
Basun Hans
Berglund Erik
Berglund Marie
Bergström Joakim
Bjerg-Bäckström Rie
Björkegren Karin
Blom Johansson Monica
Brantnell Anders
Bratteby-Tollerz Linda
Bäcklund Linus
Carlsson Maria
Carlsson Marianne
Cato Linda
Cederholm Tommy
Cernvall Martin
Cooray Anna
Daryani Achraf
Edlund Birgitta
Ekholm-Pettersson Frida
Eriksson Helène
Eriksson Margaretha
Eriksson Stefan
Eriksson-Öhman Solveig
Ernesäter Annica
Evers Katinka
Fagerqvist Therese
Fernow Josepine
ashkan.atry@crb.uu.se
stefan.eriksson@crb.uu.se
katinka.evers@crb.uu.se
josepine.fernow@crb.uu.se
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Forsberg Joanna
Frantzén Love
Fredriksson Mio
Giedraitis Vilmantas
Godskesen Tove
Gottvall Maria
Grönqvist Erik
Grönqvist Helena
Gumucio Gatica Astrid
Gunningberg Lena
Gustafsson Gabriel
Hakimnia Roya
Hallqvist Johan
Hansson Mats G
Hedlund Lena
Hedström Mariann
Holm Marta
Holmbäck Ulf
Honkanen Kirsti
Hovstadius Eva
Hurtigh Anna L
Hägglund Doris
Höglund Anna T
Ihse Elisabet
Ingelsson Martin
Ingvoldstad Charlotta
Isaksson David
Isaksson Stina
Jalmsell Li
Jansson Håkan
Johansson Gunnar
Johnsson Linus
Jonasson Sören
Jöreskog Karin
Kaminsky Elenor
Kihlbom Ulrik
Kilander Lena
Kirsebom Marie
Kjellberg Sören
Koochek Afsaneh
Kristiansson Anna-Lovisa
Kristiansson Per
Kuhlau Frida
Källström Lillemor
Lagerkvist Johanna
Lannfelt Lars
Lindstedt Helena
Lindström Veronica
Ljungberg Anne-Marie
Ljungman Lisa
Lobo Pachebo Lubin
Lochan Ruth
Lundberg Annie
joanna.forsberg@crb.uu.se
tove.godskesen@crb.uu.se
maria.gottvall@crb.uu.se
mats.hansson@crb.uu.se
anna.hoglund@crb.uu.se
li.jalmsell@crb.uu.se
linus.johnsson@crb.uu.se
ulrik.kihlbom@crb.uu.se
frida.kuhlau@crb.uu.se
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Lundberg Pranee C
Lundin Birgit
Lundquist Annika
Lytsy Per
Magnusson Kristina
Marcusson Rose-Marie
Marnell Harriet
Martinsson Carl Magnus
Masterton Malin
Mattsson Elisabet
Mattsson Susanne
Modin Karin
Mohseni-Nazari Minoo
Nilsson Lars
Nordin Karin
Norinder Camilla
Norlund Fredrika
Normark Lena
Näsström Thomas
Ohlsson Anna
Olsson Catarina
Olsson Erik
Olsson Mona
Olsson Roger
Omne-Ponten Marianne
O’Callaghan Paul
Paulsson Ulrica
Peippo Maria
Pettersson Carina
Pettersson Mona
Pöder Ulrika
Rahman Mohammad Hafijur
Riserus Ulf
Rissanen Ritva
Roshanai Afsaneh
Rosvall Paula
Saletti Anja
Schmidt Meta
Segerdahl Pär
Sehlin Dag
Silén Marit
Sjögren Per
Skogseid Ellen
Sonnander Karin
Staaf Anita
Stenhammar Christina
Stern Jenny
Stolt Ragnar
Svanberg Ann-Carin
Svedberg Marie
Swenne Christine L
Syvänen Sofia
Söllvander Sofia
malin.masterton@crb.uu.se
mona.pettersson@crb.uu.se
par.segerdahl@crb.uu.se
marit.silen@crb.uu.se
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Tengblad Siv
Terner Annika
Thoudal Berit
Thörnqvist Eva
Tirkkonen Leena
Toft Teolinda
Torbratt Karin
Traneus Charlotte
Tydén Tanja
Törmä Johanna
Ul Islam Riyadh
Umb-Carlsson Õie
Viberg Jennifer
von Essen Louise
Waara Sandra
Wadensten Barbro
Wallman Thorne
Welander Hedvig
Westerling Ragnar
Wiholm Clairy
Winblad Ulrika
Wångdahl Josefin
Zarekohan Nafiseh
Zethelius Björn
Åberg Anna Christina
Åkerman Eva
Ärnlöv Johan
jennifer.viberg@crb.uu.se
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Associated Researchers
E-mail adress: firstname.lastname@pubcare.uu.se
Alemi Mansour
Anderberg Ulla-Maria
André Malin
Athlin Åsa Muntlin
Berglund Gunilla
Bernsten Cecilia
Bjermo Helena
Björkman Ingeborg
Bodegård Kristina Björklund
Bogefeldt Johan
Boll Madeleine
Boström Eva
Brattberg Gunilla
Brorsson Bengt
Bröms Kristina
Burell Gunilla
Cederholm Jan
Edlund Birgitta
Ekstrand Maria
Englund Lars
Engström Maria
Engvall Gunn
Eriksson Gunilla
Falkeborn Margareta
Ferdous Tamanna
Gulliksson Mats
Gustafsson Carina
Gustavsson Catharina
Hagerman Heidi
Halford Christina
Hallström Björn
Hanning Marianne
Hansson Ann-Sophie
Hedov Gerth
Helmersson Johanna
Hjelmblink Finn
Hofsten Anna
Holmström Inger Knutsson
Horwitz Eva Bojner
Hovén Emma
Häggström Elisabeth
Hänni Arvo
Ingelsson Erik
Jacobson Josefin Westerberg
Janeslätt Gunnel
Jansson Pia von Vultée
Johansson Gunnar
Johansson Hans-Erik
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Johansson Lars Age
Kallings Lena
Karlström Brita
Kjeldmand Dorte
Kristofferzon Marja-Leena
Kullberg Kerstin
Kunkel Stefan
Kälvemark Sofia
Larsson Bo
Larsson Jan
Larsson Kjerstin
Lennernäs Maria
Lidström Helene
Lindberg Magnus
Lindberg Maria
Lindqvist Ragny
Lindström Veronica
Lisspers Karin
Ljunggren Birgitta
Lord Anna
Lunner Katarina
Lyskov Eugene
Löfvander Monica
Magnusson Kristina
Mamhidir Anna-Greta
Mårtensson Gunilla
Möller Kristina Ström
Nerelius Charlotte
Nilsson Annika
Nilsson Lars
Norberg Annika Lindahl
Olai Lena
Oscarsson Marie
Pless Mia
Reine Ieva
Ring Lena
Rodhe Nils
Rytter Elisabet
Röing Marta
Skytt Bernice
Sanner Margareta
Seidel Carina
Skoglund Lena
Smedman Annika
Smide Bibbi
Sobestiansky Sigvard
Stenhammar Christina
Ståhlhammar Jan
Ställberg Björn
Sundelöf Johan
Svalastog Anna Lydia
Svartling Malin
Söderback Ingrid
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Thyselius Vanja
Wallman Thorne
Wasteson Elisabet
Vég Anikó
Wettergren Lena
Winterling Jeanette
Vogt Petra
Åhs Annika
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Doctoral Students
Adamsson Viola
Alfonsson Sven
Ander Malin
Andér Gottvall Maria
Atry Ashkan
Ax Erika
Berg Peter
Bjermo Helena
Bjurling Sjöberg Petronella
Björk Anne
Björn Catrine
Blom Johansson Monica
Boll Madeleine
Boman Jill
Brantnell Anders
Cedervall Ylva
Cernvall Martin
Degerman Gunnarsson Malin
Engström Sevek
Ernesäter Annica
Fagerqvist Therese
Franzon Kristin
Fredriksson Mio
Frid Hanna
Glad Johan
Godskesen Tove
Grandahl Maria
Gumucio-Gatica Astrid
Gustafsson Gabriel
Hagerman Heidi
Hakimina Roya
Hallman David
Hedman Maria
Hedman Nils Olof
Hellerstedt Börjesson Susanne
Hellström Charlotta
Höyer Lundh Marie
Iggman David
Isaksson David
Isaksson Stina
Jalmsell Li
Jansson Stefan
Jobs Elisabeth
Johnsson Linus
Kaminsky Elenor
Karlsson Bo
Karlsson Lars
Kerstis Birgitta
Kirsebom Marie
Knudsen Kati
Kuhlau Frida
Lavén Sofia
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Lindberg Maria
Lindgren Anne
Ljungman Lisa
Lännerström Linda
Martinell Mats
Mattsson Susanne
Nerpin Elisabeth
Nordin Jenny
Nordlöf Hasse
Norlund Fredrika
Ohlsson Anna
Olsson Erika
Paulsson Ulrica
Pettersson Mona
Randmaa Maria
Rissanen Ritva
Roos Charlotte
Rosqvist Fredrik
Rönnemaa Elina
Sobestiansky Sigvard
Star Kristina
Stjernschantz Forsberg Joanna
Stolt Ragnar
Sundgren Elisabet
Sving Eva
Söderström Lisa
Söllvander Sofia
Terner Annika
Thorell Eva
Toft Teolinda
Torstensson Thomas
Törmä Johanna
Vaegter Keld
Vandin Helena
Wiberg Jennifer
Widarsson Margareta
von Celsing Anna-Sophia
Östlund Ann-Sofi
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Centres
During 2012 the Department of Public Health and Caring Sciences was the host of three Centres; the
Centre for Disability Research, the Centre for Research Ethics and Bioethics, and the Uppsala
University Psychosocial Care Program (U-CARE).
Centre for Disability Research (CDR)
(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. (p 41).
Centre for Research Ethics and Bioethics (CRB)
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 44).
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Education
The Department of Public Health and Caring Sciences is funded for about 525 full time students,
which in themselves represent about 3530 students registered at the department in 2012
(GLIS130327). The students belong to different courses and programmes, about 1350 registered
student were educated within Nursing programmes, 1600 within Medicine programme, 20 within
Master-programme in public health and about 560 in separate courses.
In contract education were about 950 students registered. About 100 doctoral students were also
registered.
First-cycle courses and study programs
Courses within Medicine Programme
Medical education in Uppsala means early patient contact.
Throughout the program the students train patient contact, examination and other clinical skills in
primary care, as well as ethical and scientific questions within the course in Professional Skills and
Communication, which start as early as the first semester.
The program involves the integration between the biological basis and clinical science but also
integration between basic science and clinical subject areas. This means that the theoretical parts are
studied in context, not as separate courses.
Semester 1: Introduction course, 3 credit points
Semester 1: Professional Skills and Communication 1, 2.5 credit points
Semester 4-11: Leadership training, 4 credit points
Semester 5: Geriatrics. The course covers gerontology, Alzheimer's disease and other
neurodegenerative dementia disorders, various aspects on frail elderly patients with multiple comorbidities and poly-pharmacy, falls, delirium and other geriatric syndromes, orthogeriatrics, stroke
rehabilitation and palliative care, during a total of three weeks. The students ranked geriatrics as
number 5 out of 25 in their evaluation of the clinical training at the hospital wards.
Semester 1-11: Medical Ethics and Medical Law, 3 credit points
The course extends over the entire program. The different elements are related to the other courses
that students take during the current period. Each session includes a half day or full day. The course
involves close collaboration with various clinical specialties, with group exercises based on actual
patient cases that are either presented by the participating teacher/doctor or generated by the students
themselves. Group discussions are integrated with the lectures. The course is examined by an
individual moral case deliberation. An ethics toolkit on the course web is under development.
Semester 11: Family Medicine, 6.5 credit points.
The students have theoretical education mixed with seminars for two weeks and have practical
training in a health care centre by managing patients by themselves.
Tutor education: Training doctors for supervision of students at the health care centre, each course
lasts for three days.
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Courses within Nursing Programme
Nursing Programme has 180 credit points – the research group Caring Sciences is responsible for
91.5 of the credit points (Nursing Methods I and II, Nursing and Medical Science in Internal
Medicine, Nursing and Medical Science in Surgery and Acute Medicine, Nursing and Medical
Science in Public Health Practice and Primary Health Care, Nursing and Medical Science in
Geriatrics and Elderly Care, Scientific Methodology and Thesis in caring science).
Radiography Nursing programme Courses
Radiography nursing programme has 180 credit points – the research group Caring Sciences is
responsible 37.5 of the credit points (Medicine, Geriatrics, Paediatrics and Obstetrics; Surgery,
Emergency Care and Pharmacology, Nursing Care in Surgery and Medicine, Work Placed Education
Surgical Care).
Separate courses at the first-cycle level
The following courses are offered as separate courses at the first-cycle level: Culture and Health,
Trends in Global Health, Motivational Interviewing in Health Promotion, Impairment and Disability,
Nursing Care Planning and Quality Improvement, Bachelor's essay in caring sciences, Health
Politics and Health Economics, Introduction to Theory of Science with Focus on Medical Research,
Public Health, Methods in Public Health C, Public Health, Especially Health Pedagogy.
Contract education
The course Understanding and Providing Leadership Based on the National Basic Value System for
the Elderly, 7.5 credits, is given as a contract education in cooperation between the Department of
Public Health and Caring Sciences and the Division for Contract Education at Uppsala University,
on behalf of the Swedish National Board of Health and Welfare. The course is given to leaders
within the elderly care sector in Sweden. The course consists of 4 modules: The national basic value
system, Ethics & humanism, Communication and Improvement management. The students are given
the tools needed to implement and maintain the National Basic Value system for elderly in their
daily work.
The course Working with Disease-prevention Methods in Practice, 7.5 credits, is given as a
contract education in cooperation between primary care in Uppsala county and the Department of
Public Health and Caring Sciences. Participants were professional nurses, dieticians and
physiotherapists in primary care. The course includes the National Board of Health national
guidelines for disease prevention practices regarding tobacco use, hazardous use of alcohol,
insufficient of physical activity and unhealthy eating habits. Methods and tools for working with
unhealthy habits in an evidence-based way for individuals and groups are given. Working under
improvement model is done to implement national guidelines for disease prevention in the clinical
practice.
The course Motivational Interviewing in Occupational Rehabilitation, 7.5 credits is given as a
contract education in cooperation between the Department of Public Health and Caring Sciences and
the Division for Contract Education. One course was offered to the County Council of Västmanland
in collaboration with the Government Agency for Employment and the Swedish Social Insurance
Agency. This course was also offered to the Swedish Social Insurance Agency in the region of
Stockholm South in collaboration with the Government Agency for Employment within the
context of Project Dirigo, financed by EFS.
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Second-cycle courses and study programs
Postgraduate Diploma in Specialist Nursing with focus on District nurse, 75 credit points – the
research group Caring Sciences is responsible for Pharmacology related to Diseases and the
Extended Role of the District nurse, Nursing Care and Public Health in Adults and Elderly in
Primary Health Care, Nursing Care and Public Health in Children and Adolescents at Child Health
Centres and Schools, Nursing Care in Children and Adolescents with Common and Specific
Conditions, Advanced Studies in Primary Health Care Nursing.
Postgraduate Diploma in Specialist Nursing with focus on care of elderly, 60 credit points – the
research group Caring Sciences is responsible for all the courses (Geriatrics, Pharmacology and
Gerontological Nursing, Gerontology and Nursing Focused on Healthy Ageing, Dementia and
nursing care).
Postgraduate Diploma in Specialist Nursing with focus on oncology care, 60 credit points and 30
credit points at our department: The research group Caring Sciences is responsible for Courses;
Psychosocial Cancer Care I and II, Palliative Care I and II,
Separate courses
The following courses are offered as separate courses at the second-cycle level: Research Designs,
Methods and Statistics in Public Health, Public Health Ethics, Theories in Caring Sciences, The
Organization and Management of Swedish Health Care, Health Promoting Management, Diet
Nutrition and Public Health, Equity in Health, Clinical Nutrition and Energy Balance, Psychosocial
Cancer Care, Palliative Care, Challenges in Global Health, Community Interventions, Neuroethics,
Behavioural medicine with applications to lifestyle related health problems, Dementia and Nursing
Care - Basic Course for Nurses, Genetic Counselling, Gerontology and Nursing Focused on Healthy
Ageing.
Master in Public Health
Two years full-time studies, 120 credit points, started year 2007.
The modules are: Public Health (advanced level, 15 credit points), Research Designs, Methods and
Statistics in Public Health (advanced level, 15 credit points), Behavioural medicine with applications
to lifestyle related health problems (7.5 credit points), Community Interventions (7.5 credit points),
Organisation and Management of Swedish Health Care (7.5 credit points), Equity in Health (7.5
credit points), Diet, Nutrition and Public Health (7.5 credit points), Public Health Ethics (7.5 credit
points), Health Promoting Management (7.5 credit points), Thesis (advanced level, 30 credit points).
The aims of the program are to increase knowledge, understanding and skills in public health and
public health work. This means that students will be competent both for further research and for
practical strategic public health initiatives. An important profiling of the program is a focus on health
promotion interventions at individual and community levels, design and evaluation of public
programs and analysis of the management of the Swedish health care system.
Third-cycle course and study program
Doctoral courses and study programme
In the beginning of the year 2012, 90 doctoral students were in education and during the year 8 of
them have past their theses and 17 new applicants have been admitted to studies at the doctoral level.
Different research groups at the department are taking part in the training courses in the theory
components of the doctoral education. In the obligatory courses at the Faculty of Medicine, members
from Centre for Research Ethics & Bioethics are involved in “The introduction to scientific
22
research” (7.5 ECTS, given two times a year). The Centre for Research Ethics & Bioethics is also
responsible for the course “Research Ethics and Philosophy of Science” (1.5 ECT, given two times a
year). Family Medicine and Preventive Medicine participated in “Medical epidemiology” (1.5 ECT,
given once a year). The research group Research in Psychosocial Oncology and Supportive Care is
co-organizer for the course “Health economics and cancer prevention” (1.5 ECT, given once a year).
Uppsala University Psychosocial Care Programme (U-CARE) research school has been launched in
2012. The eight students admitted are anchored at four different Departments: Public Health and
Caring Sciences, Psychology, Informatics and Media, and Economics. The postgraduate course
given, also open to students outside the research schools framework, includes 15 credits divided into
two modules. The first module “Psychosocial care in the interactive society” (7.5 ECTS) has been
given in autumn 2012.
The Centre for Research Ethics & Bioethics is also responsible for doctoral courses given at other
faculties at Uppsala University: “Research Ethics for Natural Science”, “Research Ethics for Science
and Technology” and “Research Ethics for Social Science”, 2.5, 2 and 4 ECTS, respectively.
To give new doctoral students a good introduction to their doctoral studies the directors of doctoral
studies in IFV set up a two days ”Introduction course” where all the research group leaders give
lectures in their own special research areas; the intention is also to offer the students opportunity to
meet these senior ones. The doctoral students give a short presentation of their own research as well.
Beside this, the doctoral students are given basic information on goals, rules and regulations, among
all annual follow-up, the half-time review, the different research seminars, the obligatory registration
of publication in DiVA, the organization of Uppsala University as a whole, specific the Faculty of
Medicine and our own department. An important item is of the course the new doctoral students
meeting with the older doctoral ones.
Education project
Two new web-based basic level courses was further developed in the fields of public health and
scientific theory. Also, an overview of the total set of basic level web-based courses in Public Health
started, and a new structure and content was developed for one of these.
International activity
We have well-established collaboration with different universities abroad within several exchange
programmes for nursing students on undergraduate level, nursing students on advanced level in
different specialties, and teachers. The main programmes are Erasmus Life Long Learning
Programme for European countries, Nordplus (Norlys for the Scandinavian and Baltic countries, and
Danosfi for the Nordic countries), and Linnaeus-Palme and Mini Field Study for developing
countries such as Vietnam, Tanzania, Thailand and Uganda. In 2012 about 34 of our students studied
abroad during 2-12 weeks, while 13 foreign students visited our department during 4-12 weeks. In
the same year three of our teachers taught abroad during 1-3 weeks, while two foreign teachers
taught in our department during 5 weeks. The exchange programmes give students and teachers
knowledge, experiences and international contacts which are highly valuable for their personal
development as well as for their careers.
23
Dissertations 2012
(Registered at the Department of Public Health and Caring Sciences)
Sevek Engström, Dental Health Care Cooperating with Primary Health Care as a Resource in Early
Case Finding of Patients with Diabetes or Hypertension
Annica Ernesäter, National Telephone Advice Nursing in Sweden: Patient Safety and
Communication
Joanna Stjernschantz Forsberg, Biobank Research: Individual Rights and Public Benefit
Mio Fredriksson, Between Equity and Local Autonomy: A Governance Dilemma in Swedish
Healthcare
Monica Blom Johansson, Aphasia and Communication in Everyday Life: Experiences of persons
with aphasia, significant others, and speech-language pathologists
Maria Lindberg, Methicillin-resistant Staphylococcus aureus (MRSA) an Unclear and Untoward
Issue: Patient-Professional Interactions, Experiences, Attitudes and Responsibility
Elina Rönnemaa, Predictors of Dementia: Insulin, Fatty Acids and Vascular Risk Factors
Licentiate 2012
Birgitta Kerstis, Expectant parents needs of support and early parenthood
24
Scientific Reports
Caring Sciences
Research group leader professor Tanja Tydén, chair
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 advanced nursing programs, single subject course and within the master program in
Public Health. Some teachers are also engaged in teaching within other departments at Uppsala
University.
Our research in Caring Sciences emanates from a multi-scientific and multi-professional perspective
including preventive, supportive, caring, and rehabilitative actions. Our research group has a broad
focus and is studying clinically relevant problems in the health care sector. Resources within the
health care system for support to the individuals and their families are of great interest, particularly
when such resources are lacking and in palliative care.
In 2010-2012, we had following four research themes; 1) health and care among children
adolescents and young adults, 2) health and care among elderly, 3) psychosocial genetics and cancer
care, 4) quality of care and patient safety.
Research is a process we are in a phase of developing our research into new themes. Various projects
are ongoing and planned within the group cancer care and rehabilitation; cross-disciplinary
randomized controlled intervention studies focusing on lifestyle (e.g. physical exercise, stress
management, nutrition) in cancer patients. The aim is to find evidence-based interventions for
changing life styles factors to decrease the burden for the patients and care givers during and after
cancer treatments, cost-effective rehabilitation programs and more person-centered health care.
Within the group reproductive health the aim is to contribute to the prevention of sexually
transmitted infections (STI) and cancer related to Human papillomavirus (HPV) with focus on
Chlamydia, HPV and the vaccine against HPV. The aim is to examine Chlamydia, oral and genital
HPV prevalence and correlate these results to sexual behaviour among adolescents. We aim to find
evidence-based interventions to improve behaviour towards the use of STI preventive measures.
Lifestyle in the period prior to conception and during pregnancy is an important determinant of
maternal and foetal health. In a longitudinal study we are investigating health, lifestyle and
wellbeing prior to conception, during and after pregnancy among women, their partners and their
new-borns. Another study evaluates the effect of Reproductive Life Plan (RLP) on knowledge,
attitudes and behaviour related to reproductive health and lifestyle prior to conception.
The aim within the group of quality of care and patient safety is to reduce the incidence of patients
with hospital-acquired pressure ulcers. One project will investigate if it is feasible for registered
nurses, assistant nurses, and student nurses to reposition the patients in bed, using the ”Continuous
Bedside Pressure Mapping System”, so interface pressure is consistent with PU prevention? Another
project will investigate terminal ulcers in patients in late palliative phases, i.e. prevalence,
classification and relationship to imminent death.
Members of the group during 2012
Arving Cecilia, RN, PhD, research assistant
Carlsson Maria, RN, PhD, associate professor, senior lecturer
25
Carlsson Marianne, PhD in psychology, professor
Edlund Birgitta, RN, PhD, associate professor, senior lecturer
Gunningberg Lena, RN, PhD, professor
Hedström Mariann, RN, PhD, senior lecturer
Ingvoldstad Charlotte, PhD
Leo Swenne Christine, RN, PhD, senior lecturer
Lundberg Pranee, RNM, PhD, associate professor, senior lecturer
Nordin Karin, licensed psychologist, professor 50% at Uppsala University and 50% chair of genetic
counseling, University of Bergen,
Pöder Ulrika, RN, PhD, senior lecturer
Svanberg Annacarin, RN, PhD
Tydén Tanja, RNM, PhD, professor, chair
Wadensten Barbro, RN, PhD, associate professor, senior lecturer
Lecturers fulltime or part time
Ahlstedt Carina
Eriksson-Öhman Solveig
Hedlund Lena
Holm Marta
Hovstadius Eva
Kjellberg Sören
Lundin Birgit
Norinder Camilla
Normark Lena
Harriet Marnell
Pettersson Mona
Rosvall Paula
Schmidt Meta
Staaf Anita
Svanberg Ann Carin
Thoudal Berit
Thörnqvist Eva
Associated researchers
Ekstrand Maria, RNM, PhD
Häggström Elisabeth, RN, PhD, associate professor
Kristofferzon Marja-Leena, RN, PhD
Lindberg Magnus, RN, PhD
Lindqvist Ragny, RN, PhD
Nilsson Annika, RN, PhD
Oscarsson Marie, RNM, PhD
Skytt Bernice, RN, PhD
Christina Stenhammar, RN, PhD
Westerberg Jacobson Josefin, PhD
Ongoing PhD students
Bjurling sjöberg Petronella
Björn Catrine
Gottvall Maria
Grandahl Maria
Hagerman Heidi
Hedman Maria
Hellerstedt-Börjesson Susanne
26
Höyer Marie
Isaksson Stina
Kerstis Birgitta
Kirsebom Marie
Knudsen Kati
Nordin Jenny
Randmaa Maria
Rissanen Ritva
Roos Charlotte
Star Kristina
Stern Jenny
Sving Eva
Widarsson Margareta
Östlund Ann-Sofi
Publications 2010-2012
Health and Care among Children, Adolescents and Young Adults
2010
1.
Aarts C, Holm M (2010). Barnhälsoteam: ett exempel på framgångsfaktorer för god
samverkan kring förebyggande arbete för barn. Socialmedicinsk tidskrift, 4:28-34.
2.
Engvall G, Mattsson E, von Essen E & Hedström M (2010). Findings on how adolescents
cope with cancer – a matter of methodology? Psycho-Oncology. Published online July 28.
3.
Engvall G, Skolin I, Mattsson E, Hedström M &von Essen L (2010). Are nurses and
physicians able to assess which strategies adolescents recently diagnosed with cancer use to
cope with disease- and treatment-related distress? Supportive Care in Cancer Published online
Mars 27.
4.
Gottvall M, Tydén T, Höglund A & Larsson M (2010). Knowledge of Human Papilloma
Virus can be increased by an educational intervention. International Journal of STD and
AIDS, 21:558-62.
5.
Gustafsson SA, Edlund B, Dalén J, Kjellin L & Norring C (2010). Perceived expectations in
daily life among adolescent girls with an eating disorder- a phenomenographic study. Eating
Disorders-The Journal of treatment and prevention, 18(1):25-42.
6.
Gustafsson SA, Edlund B, Kjellin L & Norring C (2010). Psychological characteristics
measured by EDI-C as predictors of disordered eating in adolescent girls. International
Journal of Women´s Health, 2:375-379.
7.
Häggström-Nordin E, Borneskog C, Eriksson M & Tydén T (2010). Sexual behaviour and use
of contraceptives among Swedish high school students in two cities: comparisons between
genders, study programs and over time. Eur J Contracept Reprod Health Care, Dec 7 Epub
ahead of print
8.
Johansson K, Aarts C & Darj E (2010). First time parents’ experiences of post-natal home
care in Sweden. Upsala Journal of Medical Sciences, Early Online, 1–7,
http://informahealthcare.com/doi/pdf/10.3109/03009730903431809?cookieSet=1
9.
Kaminsky E, Carlsson M, Höglund A & Holmström I (2010). Paediatric health calls to
Swedish telenurses – a descriptive study of content and outcome. Journal of Telemedicine and
Telecare, 16(8):454-460.
27
10.
Lindahl Norberg A, Pöder U & von Essen L (2010). Early avoidance of disease- and
treatment-related distress predicts post-traumatic stress in parents of children with cancer.
European Journal of Oncology Nursing, doi: 10.1016/j.ejon.2010.05.009
11.
Lundberg PC & Trieu Thi Ngoc Thu (2010). Vietnamese women’s cultural beliefs and
practices related to the postpartum period. Midwifery, doi:10.1016/j.midw.2010.02.006
12.
Mbwilo GSK, Smide B & Aarts C (2010). The family perceptions in caring of children and
adolescents with mental disabilities: a qualitative study from Dar es Salaam. Tanzania Journal
of Health Research, 12(2):1-12. Available at
http://ajol.info/index.php/thrb/article/viewFile/56400/44835
13.
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 Symptom and Management, 40: 660-670.
14.
Stenhammar C, Olsson GM, Bahmanyar S, Hulting AL, Wettergren B & Edlund B,
Montgomery SM (2010). Maternal psychosocial stress and body mass among infants. Acta
Peadiatrica, 99(8):1205-12.
15.
Westerberg-Jacobson J, Edlund B & Ghaderi A (2010). A 5-year longitudinal study of the
relationship between the wish to be thinner, lifestyle behaviours and disturbed eating in 9-20year old girls. European Eating Disorders Review, 18:207-219.
2011
16.
Mattebo M, Larsson M, Tydén T, Olsson T, Häggström-Nordin E. (2011). Hercules and
Barbie? Reflections on the influence of pornography and its spread in the media and society in
groups of adolescents in Sweden. The European Journal of Contraception and Reproductive
Health Care 17(1):40-49.
17.
Wätterbjörk I, Häggström-Nordin E, Hägglund D. (2011). Provider strategies for
contraceptive counselling among Swedish midwives. British Journal of Midwifery 19(5);291296.
18.
Häggström-Nordin E, Borneskog C, Eriksson M, Tydén T. (2011). Sexual behaviour and
contraceptive use among Swedish high school students in two cities: comparisons between
genders, study programmes, and over time. The European Journal of Contraception and
Reproductive Health Care 16:36-46.
19.
Häggström-Nordin E, Borneskog C, Eriksson M, Tydén T. (2011) Sexual behaviour and use
of contraceptives among Swedish high school students in two cities: comparisons between
genders, study programs and over time. Eur J Contracept Reprod Health Care 16(1):36-46.
20.
Stålhandske ML, Ekstrand M, Tydén T. (2011) Women’s existential experiences within
Swedish abortion care. J Psychosom Obstet Gynaecol 32(1):35-41.
21.
Tydén T, Stern J, Nydahl M, Berglund A, Larsson M, Rosenblad A, Aarts C. Pregnancy
planning in Sweden. (2011) Acta Obstet Gynecol Scand 90(4):408-12.
22.
Ekstrand M, Engblom C, Larsson M, Tydén T. (2011) Sex education in Swedish schools as
described by young women Eur J Contracept Reprod Health Care 16(3):210-24.
23.
Ekstrand M, Tydén T, Larsson M. (2011) Exposing onself and one´s partner to sexual
risktaking as perceived by young Swedish men who requested a Chlamydia test. Eur J
Contracept Reprod Health Care 16(2):100-7.
24.
Gemzell-Danielsson K, Thunell L, Lindeberg M, Tydén T, Marintcheva-Petrova M, Oddens
BJ. (2011) Comprehensive counseling about combined hormonal contraceptives changes the
choice of contraceptive methods: results of the CHOICE program in Sweden. Acta Obstet
Gynecol Scand. 90(8):869-77.
25.
Oscarsson MG, Dahlberg A, Tydén T. Midwives at youth clinics attitude to HPV vaccination
and their role in cervical cancer prevention. (2011) Sex Reprod Healthc. 2 (4):137-42.
28
26.
Makenzius M, Tydén T, Darj E, Larsson M. (2011) Repeat induced abortion - a matter of
individual behaviour or societal factors? A cross-sectional study among Swedish women. Eur
J Contracept Reprod Health Care. 16(5):369-77.
27.
Gottvall M, Tydén T, Larsson M, Stenhammar C, Höglund AT. (2011) Challenges and
opportunities of a new HPV immunization program perceptions among Swedish school
nurses. Vaccine. 29(28):4576-83.
28.
Engvall G, Mattsson E, von Essen E & Hedström M. (2011) Findings on how adolescents
cope with cancer – a matter of methodology? Psycho-Oncology (20)10: 1053-60
29.
Engvall G, Skolin I, Mattsson E, Hedström M & von Essen L. (2011) Are nurses and
physicians able to assess which strategies adolescents recently diagnosed with cancer use to
cope with disease- and treatment-related distress? Supportive Care in Cancer (19)5: 601-612.
30.
Lundberg PC & Trieu TNT. (2011) Vietnamese women’s cultural beliefs and practices related
to the postpartum period. Midwifery 27, 731-736.
31.
Lundberg PC & Trieu TNT. (2011) Breastfeeding attitudes and practices among Vietnamese
mothers in Ho Chi Minh City. Midwifery, doi:10.1016/j.midw.2011.02.012.
32.
Norberg AL, Pöder U & von Essen L. (2011) Early avoidance of disease- and treatment
related distress predicts post-traumatic stress in parents of children with cancer. European
Journal of Oncology Nursing 15(1): 80-84. doi:10.1016/j.ejon.2010.05.009
2012
33.
Tydén T, Palmqvist M, Larsson M (2012). A repeated survey of sexual behavior among
female university students in Sweden. Acta Obstet Gynecol Scand 91:215-9
34.
Eriksson C, Larsson M, Tydén T (2012). Reflections on having children in the futureinterviews with highly educated women and men without children. Ups J Med Sci. 117:328.
35.
Mattebo M, Larsson M, Tydén T, Olsson T, Häggström-Nordin E (2012). Hercules and
Barbie? Reflections on the influence of pornography and its spread in the media and society in
groups of adolescents in Sweden. Eur J Contracept Reprod Health Care 17:40-9.
36.
Makenzius M, Tydén T, Darj E, Larsson M (2012). Risk factors among men who have
repeated experience of being the partner of a woman who requests an induced abortion. Scand
J Public Health 40:211-6.
37.
Stålhandske ML, Makenzius M, Tydén T, Larsson M (2012). Existential experiences and
needs related to induced abortion in a group of Swedish women: a quantitative investigation. J
Psychosom Obstet Gynaecol.33:53-61.
38.
Makenzius M, Tydén T, Darj E, Larsson M (2012).Women and men's satisfaction with care
related to induced abortion. Eur J Contracept Reprod Health Care 17:260-9.
39.
Makenzius M, Tydén T, Darj E, Larsson M (2012).Autonomy and dependence - experiences
of home abortion, contraception and prevention. Scand J Caring Sci. Aug 22. doi:
10.1111/j.1471-6712.2012.01068.x. [Epub ahead of print]
40.
Oscarsson MG, Hannerfors AK, Tydén T (2012). Young women's decision-making process
for HPV vaccination. Sex Reprod Health. 3:141-6.
41.
Danielsson M, Berglund T, Forsberg M, Larsson M, Rogala C, Tydén T (2012). Sexual and
reproductive health: Health in Sweden: The National Public Health Report 2012. Chapter 9.
Scand J Public Health. 40(9 Suppl):176-96.
42.
Grandahl M, Tydén T, Gottvall M, Westerling R, Oscarsson M (2012). Immigrant women's
experiences and views on the prevention of cervical cancer: a qualitative study. Health
Expect. Dec 16. doi: 10.1111/hex.12034. [Epub ahead of print]
43.
Norberg AL, Pöder U, Ljungman G & von Essen L (2012) Objective and subjective factors as
predictors of post-traumatic stress symptoms in parents of children with cancer--a
longitudinal study. PLoS ONE 7(5): e36218. doi: 10.1371/journal.pone.0036218
29
44.
Hedén L, Pöder U, von Essen L & Ljungman G (2013) Parents' perceptions of their child's
symptom burden during and after cancer treatment. Journal of Pain and Symptom
Management doi: 10.1016/j.jpainsymman.2012.09.012
45.
Widarsson M, Engström G, Rosenblad A, Kerstis B, Edlund B & Lundberg P (2012) Parental
stress in Early Parentalhood among Mothers and Fathers ij Sweden. Scandinavian Journal of
Caring Sciences, September 1-9: doi.10.1111/j.1471-6712.2012.01088.x.
Psychosocial Genetics and Cancer Care
2010
46.
Carlsson M (2010). The significance of fatigue in relatives of palliative patients. Palliative
and Supportive Care, 8:137-142.
47.
Hamang A, Eide GE, Nordin K, Rokne B, Bjorvatn C, Øyen N (2010). Health status in
patients at risk of inherited arrhythmias and sudden unexpected death compared to the general
population. BMC Med Genet, 17(11):27.
48.
Johansson B, Börjeson S, Nordin K, Langius-Eklöf A (2010). Editorial comment on
"Disregarding clinical trial-based patient-reported outcomes is unwarranted: Five advances to
substantiate the scientific stringency of quality-of-life measurement". Acta Oncol, 49(2):1635.
49.
Mårtensson G, Carlsson M, Lampic C (2010). Do oncology nurses provide more care to
cancer patients with high levels of emotional distress? Oncology Nursing Forum, 37(1): E34E42.
50.
Mårtensson G, Carlsson M, Lampic C (2010). Are cancer patients with problems that are
overestimated by nurses less satisfied with their care? European Journal of Cancer Care,
19:382-392.
51.
Mårtensson G, Carlsson M, Lampic C (2010). Is nurse-patient agreement of importance to
oncology nurses’ satisfaction with care? Journal of Advanced Nursing, 66(3):573-582.
52.
Roshanai AH, Lampic C, Rosenquist R, Nordin K (2010). Disclosing cancer genetic
information within families: perspectives of counselees and their at-risk relatives. Familial
Cancer, 9(4):669-79.
Sundberg K, Doukkali E, Lampic C, Eriksson LE, Arvidson J, Wettergren L (2010). Longterm survivors of childhood cancer report quality of life and health status in parity with a
comparison group. Pediatric Blood Cancer, 55(2):337-343.
53.
54.
Winterling J, Wasteson E, Arving C, Johansson B, Glimelius B, Sjödén PO, Nordin K (2010).
Factors affecting spouses’ psychological distress and grief resolution after the death of a
patient with advanced gastrointestinal cancer. Supportive Care in Cancer, 18(11): 1377-1384.
55.
Wolff K, Brun W, Kvale G, Ehrencrona H, Soller M & Nordin K (2010). How to handle
genetic information: a comparison of attitudes among patients and the general population.
Public Health Genomics, 13(7-8):396-405. Epub 2010 Jul 7.PMID: 20606381
2011
56.
Sundberg K, Lampic C, Arvidson J, Helström L, Wettergren L (2011). Sexual function and
experience among long-term survivors of childhood cancer. Eur J Cancer, 47(3):397-403.
57.
Enskär K, Hamrin E, Carlsson M, von Essen L (2011) Swedish mothers and fathers of
children with cancer – perceptions of wellbeing, social life and quality care. Journal of
Psychosocial Oncology. 29:51-66.
58.
Star K (2011) Detecting unexpected adverse drug reactions in children. Paediatric Drugs.
13(2):71-73.
59.
Star K, Norén GN, Nordin K, Edwards IR (2011) Suspected Adverse Drug Reactions
Reported For Children Worldwide: An Exploratory Study Using VigiBase. Drug Safety.
34(5):415-428.
30
60.
Star K, Caster O, Bate A, Edwards IR. (2011) Dose Variations Associated with Formulations
of NSAID Prescriptions for Children: A Descriptive Analysis of Electronic Health Records in
the UK. Drug Safety. 34(2):93-96.
61.
Hamang A, Eide GE, Rokne B, Nordin K, Øyen N (2011) General anxiety, depression, and
physical health in relation to symptoms of heart-focused anxiety- a cross sectional study
among patients living with the risk of serious arrhythmias and sudden cardiac death. Health
Qual Life Outcomes. 14;9:100.
62.
Hayat Roshanai A, Lampic C, Ingvoldstad C, Askmalm MS, Bjorvatn C, Rosenquist
R, Nordin K. (2011) What Information Do Cancer Genetic Counselees Prioritize? J Genet
Couns. 2011
63.
Nordin K, Roshanai A, Bjorvatn C, Wollf K, Mikkelsen EM, Bjelland I, Kvale G (2011) Is
genetic counseling a stressful event? Acta Oncol. 2011 Oct;50(7):1089-97. Epub Aug 24.
64.
Hamang A, Eide GE, Rokne B, Nordin K, Bjorvatn C, Øyen N (2011) Predictors of heartfocused anxiety in patients undergoing genetic investigation and counseling of long QT
syndrome or hypertrophic cardiomyopathy: a one year follow-up. J Genet Couns. Epub Jul
20.
65.
Høyer M, Johansson B, Nordin K, Bergkvist L, Ahlgren J, Lidin-Lindqvist A, Lambe M,
Lampic C (2011) Health-related quality of life among women with breast cancer - a
population-based study. Acta Oncol. 50(7):1015-26. Epub 2011 May 23.
66.
Wolff K, Nordin K, Brun W, Berglund G, Kvale G. Affective and cognitive attitudes,
uncertainty avoidance and intention to obtain genetic testing: an extension of the Theory of
Planned Behaviour. Psychol Health. 2011 Sep;26(9):1143-55. Epub 2011 May 24.
67.
Petersson L-M, Arving C. Omvårdnad vid rehabilitering. Nationellt vårdprogram 2011.
Omvårdnad vid bröstcancer. http://www.karolinska.se/oc. S. 51-61.
68.
Arving C, Holmström I (2011) Creating a new profession in cancer nursing? Experiences of
working as a psychosocial nurse in cancer care. J Clin Nurs. doi: 10.1111/j.13652702.2011.03709.x.
69.
Carlsson M. Strukturerade samtal med närstående till patienter anslutna till den avancerade
hemsjukvården i Uppsala. 2011. Slutrapporten. Cancerfonden.
2012
70.
Høyer, M; Nordin, K; Ahlgren, J; Bergkvist, L; Lambe, M; Johansson, B; Lampic, C. (2012)
Change in working time in a population-based cohort of patients with breast cancer. Journal
of Clinical Oncology 2012 ; 30.(23) s. 2853-2860
71.
Nordin, K; Rissanen, R; Ahlgren, J; Burell, G; Fjällskog, M- L; Börjesson, S; Arving, C.
(2012) Design of the study: How can health care help female breast cancer patients reduce
their stress symptoms? A randomized intervention study with stepped-care. BMC Cancer ;
12.([167]) s. –
72.
Roshanai, AH; Lampic, C; Ingvoldstad, C; Askmalm, MS; Bjorvatn, Cathrine; Rosenquist, R;
Nordin, K. What Information Do Cancer Genetic Counselees Prioritize?.Journal of Genetic
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96.
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103. Pöder U, Fogelberg Dahm M, Wadensten B (2011) Implementation of a multi-professional
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104. Muntlin A, Carlsson M, Säfwenberg U, Gunningberg L (2011) Outcomes of a nurse-initiated
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in a surgical team: a qualitative study. International Journal for Quality in Health Care 23(1):
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106. Jangland E, Larsson J, Gunningberg L (2011) Surgical nurses' different understandings of
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107. Gunningberg L, Donaldson N, Aydin C, Idvall E (2011) Exploring variation in pressure ulcer
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33
108. Gunningberg L, Stotts NA, Idvall E (2011) Hospital-acquired pressure ulcers in two Swedish
County Councils: cross-sectional data as the foundation for future quality improvement.
International Wound Journal 8(5): 465-73.
109. Arakelian E, Gunningberg L, Larsson J, Norlén K, Mahteme H (2011) Factors influencing
early postoperative recovery after cytoreductive surgery and hyperthermic intraperitoneal
chemotherapy. European Journal of Surgical Oncology, 37(10): 897-903.
110. Häggström E, Rehnman M, Gunningberg L (2011) Quality of life and social life situation in
Islet transplante patients. Time for a change in outcome measures? International Journal of
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111. Jangland E, Carlsson M, Lundgren E, Gunningberg L (2011) The impact of an intervention to
improve patient participation in a surgical care unit: A quasi-experimental study. International
Journal of Nursing Studies Nov 18
112. Lundberg PC, Thrakul S (2011) Diabetes type 2 self-management among Thai Muslim
women. Journal of Nursing and Healthcare of Chronic Illness 3, 52-60.
113. Lundberg PC, Thrakul S (2011) Type 2 diabetes: How do Thai Buddhist patients practise selfmanagement? Journal of Advanced Nursing 00(0), doi: 10.1111/j.1365-2648.2011.05756.x.
114. Albarran J, Rosser E, Bach S, Uhrenfeldt L, Lundberg P, Law K (2011) Health and Care –
From a European perspective: Exploring the development of a cultural care framework for
European caring science. International Journal of Qualitative Study Health and Well-being 6,
11457, doi: 10.3402/qhw.v6i4.11457.
2012
115. Ernesäter A, Winblad U, Engström M, Holmström K I. Malpractice claims regarding calls to
Swedish telephone advice nursing: what went wrong and why? Telemed Telecare, Epub 2012
Aug 24
116. Gillespie U, Mörlin C, Hammarlund-Udenaes M, Hedström M. (2012). Perceived value of
ward-based pharmacists from the perspective of physicians and nurses. International Journal
of Clinical Pharmacy (34), 1, 127-35.
117. Gunnarsson A-K, Åkerfeldt T, Larsson S, Gunningberg G. Increased energy intake in hip
fracture patients affects nutritional biochemical markers. Scand J Surg. 2012;101(3):204-10.
118. Gunningberg L, Hommel A, Bååth C, Idvall E.The first national pressure ulcer prevalence
survey in county council and municipality settings in Sweden. J Eval Clin Pract. 2012 May
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119. Helmersson-Karlqvist J, Åkerfeldt T, Gunningberg L, Swenne CL, Larsson L. Serum MMP-9
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humans. Clinical Chemistry and Laboratory Medicin 2012; 50: 1115-1119
120. Jangland E, Carlsson M, Lundgren E, Gunningberg L. The impact of an intervention to
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121. Lindberg, M. (2012). Monitoring and blunting styles in fluid restriction consultation.
Hemodialysis International 16(2):282-285.
122. Lindberg, M., & Lindberg, M. (2012). Haemodialysis nurses knowledge about Methicillinresistant staphylococcus aureus. Journal of Renal Care 38(2):82-85.
123. Lindberg, M., Lundström-Landegren, K., Johansson, P., Lidén, S., & Holm, U. (2012).
Competencies for practice in renal care: a national Delphi Study. Journal of Renal Care
38(2):69-75.
124. Lindberg, M., & Ludvigsen, M.S. (2012). Ultrafiltration rate as a nursing-sensitive quality
indicator in haemodialysis. International Journal of Nursing Studies 49(10):1320-4.
34
125. Sving E, Gunningberg L, Högman M, Mamhadir A-G. Registered nurses’ attention to and
perceptions of pressure ulcer prevention in hospital settings. J Clin Nurs 2012 May;21(910):1293-303
126. Swenne CL, Alexandrén K. Surgical team members’ compliance to and knowledge of basic
hand hygiene guidelines and intraoperative hygiene. Journal of Infection Prevention 2012; 13:
114-119
127. Star K, Nordin K, Pöder U, Edwards IR (2013) Challenges of safe medication practice in
paediatric care - A nursing perspective. Acta Paediatrica doi: 10.1111/apa.12212
128. Lundberg PC & Thrakul S (2012) Religion and self-management of Thai Buddhist and
Muslim women with type 2 diabetes. Journal of Clinical Nursing, doi: 10.1111/jocn.12130.
129. Lindberg M, Skytt B, Högman M & Carlsson M (2012) The Multidrug-Resistant Bacteria
Attitude Questionnaire: validity and understanding of responsibility for infection control in
Swedish registered district, hematology and infection nurses. Accepted for publication in
Journal of Clinical Nursing. 21(3-4):424-36.
Health and Care among Elderly
2010
130. Abdelrazek F, Skytt B, Aly M, Abd El-Sabour M, Ibrahim N & Engström M (2010).
Leadership and management skills of first-line managers of elderly care and their work
environment. Journal of Nursing Management, 18:736-745.
131. Engström M, Wadensten B & Häggström E (2010). Caregivers’ job satisfaction and
empowerment before and after an intervention focused on caregiver empowerment. Journal of
Nursing Management, 18:14-23.
132. Kullberg K, Björklund A, Sidenvall B, Åberg AC (2010). ‘I start my day by thinking about
what we’re going to have for dinner’: A qualitative study on approaches to food-related
activities among older men with somatic diseases. Scandinavian Journal of Caring Sciences,
Early view (Article on line in advance of print) Article first published online: 26 Jul 2010.
DOI: 10.1111/j.1471-6712.2010.00813.x
133. Stolt R, Blomqvist P, Winblad U (2010). Privatization of social services: Quality differences
in Swedish elderly care, Social Science & Medicine, doi:10.1016/j.socscimed. 2010.11.012
134. Wadensten B (2010). Changes in nursing home residents during an innovation based on the
theory of gerotranscendence. International Journal of Older People Nursing, 5(2):108-115.
2011
135. Engström M, Skytt B, Nilsson A (2011) Working life and stress symptoms among caregivers
in elderly care with formal and no formal competence. J Nurs Manag. 19:732-41.
136. Stolt R, Blomqvist P, Winblad U (2011) Privatization of social services: Quality differences
in Swedish elderly care. Social Science & Medicine, 72(4):560-7.
137. Winblad U, Hopfgarten J, Andersson C. (2011). ”Informationens roll i kundvalsmodeller
inom äldreomsorgen”. FoU-rapport 2011/4, Uppsala: Regionförbundet i Uppsala län.
138. Olsson AK, Engström M, Skovdahl K, Lampic C. My, your and our needs for safety and
security: relatives’ reflections on using information and communication technology in
dementia care. Scand J Caring Sci Epub 2011 Aug 15.
2012
139. Kirsebom M, Wadensten B, Hedström M. (2012). Communication and administration during
transition of older persons between nursing homes and hospital still in need of improvement.
Epub ahead of print in Journal of Advanced Nursing.
140. Lejman E, Westerbotn M, Pöder U, Wadensten B (2013) The ethics of coercive treatment of
people with dementia. Nursing Ethics. doi: 10.1177/0969733012463721
35
141. Olsson AK, Engström M, Lampic C, Skovdahl K. A passive positioning alarm used by
persons with dementia and their spouses -- a qualitative intervention study. BMC Geriatrics
2013, 13:11 doi:10.1186/1471-2318-13-11
Other
2010
142. Aarts C, Nordstrom PM, Koskinen L, Juhansoo T, Mitchell M.P. Marquis F, Chassé F,
Critcley K, Campbell B & Hemmingway A (2010). Enabling Nursing Students to Focus on
the Ottawa Charter and the Nurses Role in Tackling Inequalities in Health trough
International Exchange. Nurse Education Today, 30:448-452.
143. Ahlström G & Wadensten B (2010). Encounters in close care relations from the perspective of
personal assistants working with severely disabled persons. Health and Social Care in
community, 18(2):180-188.
144. Arenhall E, Kristofferzon ML, Fridlund B, Nilsson U (2010). The female partners view of
intimate relationship after a myocardial infarction. Journal of Clinical Nursing,
doi:10.1111/j.1365-2702.2010.03312.x
145. Arenhall E, Kristofferzon ML, Fridlund B, Malm D & Nilsson U (2010). The male partners’
experiences of the intimate relationships after a first myocardial infarction. European Journal
of Cardiovascular Nursing doi:10.1016/j.ejcnurse.2010.05.003
146. Blom Johansson M, Carlsson M, Sonnander K. Working with families of persons with
aphasia: A survey of Swedish speech and language pathologists. Disability and rehabilitation,
2010; 33(1): 51-62
147. Candell A, Engström M (2010). Dental hygienists’ work environment: motivating,
facilitating, but also trying. International Journal of Dental Hygiene, 8:204-212.
148. Gustavsson C, Denison E, von Koch L (2010). Self-management of persistent neck pain: A
randomized controlled trial of a multicomponent group intervention in primary health care.
European Journal of Pain, 14(6):630.e1-630.e11.
149. Hedlund, M, Ronne-Engström E, Carlson M, Ekselius L. Coping strategies, health-related
quality of life and psychiatric history in patients with aneurysmal subarachnoid haemorrhage.
Acta Neurochirurgica, 2010; 152(8) 1375-1382
150. 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; 16(8): 454-46
151. Kristofferzon ML, Johansson I, Brännström M, Nilsson U, Baigi A, Brunt D, Arenhall E,
Fridlund B, Persson S. Rask M, Wieslander I, Ivarsson B and the SAMMI-study Group
(2010). Evaluation of a Swedish version of the Watts Sexual Function Questionnaire (WSFQ)
in persons with heart disease: A pilot study. European Journal of Cardiovascular Nursing,
9:168-174.
152. Kristofferzon ML, Lindqvist R, Nilsson A (2010). Relationships between coping, coping
resources and quality of life in patients with chronic illness: a pilot study. Scandinavian
Journal of Caring Sciences, doi:10.1111/j1471- 6712.2010.00851.x
153. Mani M, Carlsson M , Marcusson A (2010). Quality of life varies with gender and age among
adults treated for unilateral cleft lip and palate. The Cleft Palate-Craniofacial Journal, Febr 23
Epub ahead of print PMID: 20180705
154. Nilsson A, Lindberg P, Denison E (2010). Predicting of pain, disability, and sick leave
regarding a non-clinical sample among Swedish nurses. Scandinavian Journal of Pain, 1:160–
166.
155. Rask M, Malm D, Kristofferzon ML, Roxberg Å, Svedberg P, Baigi A, Brunt D, Arenhall E,
Fridlund B, Ivarsson B, Nilsson U, Sjöström A, Benzein E and the SAMMI-study group
36
(2010). Validity and reliability of a Swedish version of the Relationship Assessment Scale
(RAS): A pilot study. Canadian Journal of Cardiovascular Nursing, 20:16-21.
156. Staun M, Bergström B & Wadensten B (2010). Evaluation of a PBL strategy in clinical
supervision of nursing students: Patient-centred training in student-dedicated treatment rooms.
Nurse Education Today, 30:631-637.
2011
157. Skytt B, Engström M, Ljunggren B, Carlsson M (2011) Different development programmes –
does it make a difference? Leadership in Health Services. 24 (1):29-50.
158. Ahlström G & Wadensten B (2011) Family members’ experiences of personal assistance
given to a disabled relative. Health and Social Care in community, 19(6) 645-652.
159. Arenhall E, Kristofferzon M-L, Fridlund B, Malm D, Nilsson U (2011) The male partners’
experiences of the intimate relationships after a first myocardial infarction. European Journal
of Cardiovascular Nursing 10: 108-114.
160. Blom Johansson M, Carlsson M, Östberg P, Sonnander K. Communication difficulties and
use of communication strategies: From the perspective of individuals with aphasia.
International Journal of Language and Communications Disorders (Acc 2011).
161. Hedlund M, Zetterling M, Ronne-Engström E, Carlsson M, Ekselius L. Depression and
posttraumatic hemorrhage in relation to lifetime psychiatric morbidity. British Journal of
Neurosurgery 2011;25(6):693-700
162. Kristofferzon, M-L, Lindqvist R & Nilsson A (2011) Relationships between coping, coping
resources and quality of life in patients with chronic illness: a pilot study. Scandinavian
Journal of Caring Sciences 25: 476-483.
163. Winblad U, Andersson C (2011). ”Vilken information behöver patienter och medborgare för
att välja vårdgivare och behandling? Patienters och medborgares behov av kvalitetssäkrad och
lättillgänglig information”. Rapport, Uppsala universitet.
164. Nilsson A, Denison E, Lindberg P (2011) Life values as predictors of pain, disability and sick
leave among Swedish registered nurses: a longitudinal study. BMC Nursing, 10 (17):2-9.
2012
165. Mårtensson G, Engström M, Mamhidir AG, Kristofferzon ML. What are the structural
conditions of importance to preceptor performance? Nurse Education Today, 2012;17:
doi:10.1016/j.nedt.2012.04.015
166. Ahlström G & Wadensten B (2012) Enjoying Work or Burdened by it? How Personal
Assistants Experience and Handle Stress at Work. Journal of Social Work in Disability &
Rehabilitation, 11, 112-127.
167. Borg T, Carlsson M, Larsson S. A new questionnaire for assessment of outcome following
surgical treatment of acetabular fractures. Journal of Orthopaedic Surgery , 2012; 20(1): 5560.
168. Blom Johansson M, Carlsson M, Östberg P, Sonnander K Communication changes and SLPservices according to significant others of persons with aphasia. Aphasiology 2012; 26(8):
1005-1028
169. Akbarin M, Aarts C (2012) Being a close relative of a patient with a left ventricular assist
device. European Journal of Cardiovascular Nursing published online 11 January 2012 as
doi:10.1177/1474515111432996
170. Hemmingway A, Aarts C, Koskinen L, Juhansoo T, Mitchell MP, Marquis F, Chassé F,
Critcley K & Campbell B (2012) Public Health Nursing: Where are we now? A European
Union/Canadian Critical Perspective. Public Health Nursing published online as
doi:10:1111/j.1525-1446.2012.01048.x
171. Wiitavaara B, Björklund M, Nilsson A. An initial factor analysis of prominent aspects of
health experiences for women with neck-shoulder pain. Disabil Rehabil. 2012;34(11):934-42
37
172. Kristofferzon, M., Mårtensson, G., Mamhidir, A. & Löfmark, A. (2012). Nursing students'
perceptions of clinical supervision: the contributions of preceptors, head preceptors and
clinical lecturers. Nurse Education Today. (accepted) 10.1016/j.nedt.2012.08.017
173. Hellström-Hyson E, Mårtensson G & Kristofferzon M-L (2012) To take responsibility or to
be an onlooker. Nursing students’ experiences of two models of supervision. Nurse Education
Today 32 (1):105-110.
174. Koskinen L, Taylor Kelly H, Bergknut E, Lundberg P, Muir N, Olt H, Richardson E, Sairanen
R & De Vlieger V (2012). European Higher Health Care Education Curriculum: Development
of a Cultural Framework. Journal of Transcultural Nursing, 23, 313-319.
175. Sairanen R, Richardson E, Kelly H, Bergknut E, Koskinen L, Lundberg P, Muir N, Olt H &
De Vlieger L (2012). Putting culture in the curriculum: A European project. Nurse Education
in Practice, http:dx.doi.org/10.1016/j.nepr.2012.08.002.
Dissertations 2012
Lindberg Maria, ”Methicillin-resistant Staphylococcus aureus (MRSA) an Unclear and Untoward
Issue”, PhD examination.
Kerstis Birgitta, “Expectant Parents’ Needs of Support and Early Parenthood in Sweden”. Licentiate
examination.
Awards 2012
Jenny Stern, PhD student received Paramedical Nurses Award at the 28th Annual meeting of
European Society of Human Reproduction and Embryology (ESHRE). Istanbul 2012. Women’s
experiences of a midwife initiated Reproductive Life Plan discussion and its effect on knowledge: a
pilot study.
Mariann Hedström, main responsible for developing, and coordinating the project connected to
PHASE-20, a symptom rating scale for identification of possible drug related symptoms in older
people. In 2012, the PHASE-20 project was awarded ”the Golden pill”, for the best national
initiative for improving the medication use within the Swedish health care.
Magnus Lindberg, received Johanna Diepenveen-Speekenbrinkwetenschpsprijs, given by
UniversitairMedisch Centrum Utrecht, The Netherlands (as co-supervisor to MSc Marian Winters)
September 2012
Agencies that support the work/Funding
Medical Faculty Uppsala University
1 975 000SEK
Regional Research Council Uppsala/Örebro
300 000 SEK
AFA 2 years
1 797 000 SEK
The Swedish Cancer Foundation
1 250 000 SEK
The National Board of Health and Wellfare
200 000 SEK
Uppsala County Council
200 000 SEK
InDevelop
120 000 SEK
Uppsala County
200 000 SEK
The Swedish Research Council
450 000 SEK
38
International collaboration
Adjunct Assistant Professor at School of Nursing, University of California San Francisco
Trustee of the European Pressure Ulcer Advisory Panel (board member)
Member of European Academy of Caring Science
International Co-coordinator for Nordic countries (Nordplus network: Norlys), European countries
(Erasmus), and Linnaeus-Palme (Vietnam), Department of Public Health and Caring Sciences,
Uppsala University
Guest Lecturer, Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital,
Mahidol University, Thailand.
National commissions
Expert group – Pressure Ulcer/Patient Safety – The Swedish Association of Local Authorities and
Regions
Member of the Board of European Pressure Ulcer Advisory Panel
Advisor to Vice Chancellor concerning gender equality
Fellow of Royal Academy of Science in Uppsala
Assistant Head of the Center for Clinical Research Uppsala University and County Council of
Gävleborg
Member of the research board, Swedish cancer society
Co-member of the board of director, Swedish cancer society
Member of the Council of the Center for Clinical Research, Dalarna County Council.
Member of Pool of External Experts, Medicine and Care, International Programme Office for
Education and Training, Swedish International Cooperation Agency (SIDA)
Member of the Board for Stiftelsen InDevelops u-landsfond
Special mandate for Swedish National Agency for Higher Education. Evaluation of pediatric nurse
specialist education in Borås, 2012.
European Academy of Caring Science (EACS), Core member.
Member of the Scientific Board of Investigación y Educación en Enfermería -Research and
Education in Nursing - (ISSN_p: 0120-5307, ISSN_e:2216-0280)
Invited speaker 2010-2012
Key note. CALNOC Conference- The Global Reach of Nursing Quality, San Francisco, USA, 2010.
EPUAP 13th Annual European Pressure Ulcer Meeting, Birmingham, United Kingdom, 2010.
Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan, 2010.
Conference of the Japanese Psychological Association, Osaka, Japan, 2010.
The 33rd National Pharmacovigilance Centres’ Annual Meeting. Accra, Ghana, 2010.
Forskning pågår…om barn och ungdomar. Uppsala universitet, Regionförbundet Uppsala län,
Uppsala, 2011.
University of Basel and University hospital, Basel, and University hospital, Zurich, Switzerland,
2011.
39
EPUAP 14th Annual European Pressure Ulcer Meeting, Oporto. Portugal, 2011.
Key note. Trykksårskonferansen, Norske Sykepleierforbundet Oslo, Norway, 2011.
Forskning pågår om äldre och åldrande Uppsala universitet, Regionförbundet Uppsala län, Uppsala,
2011.
European Society of Human Reproduction and Embryology, Stockholm, 2011.
Läkarstämman 2011, Stockholm.
The13th Biannual European Society for Developmental, Perinatal, and Paediatric Pharmacology.
Oslo, Norway, 2011.
Skejby University Hospital, Aarhus, Denmark April 2011
Swedish National School Health conference. Göteborg 2011.
The 1st International Nursing Conference, Active Healthy Ageing toward the future, Seoul,
Sydkorea, 2012
Trycksårskonferens. Hjælpemiddelinstituttet Kolding, Denmark, Feb 29, 2012
The 1st International Clinical Nursing Research Congress, Izmir, Turkey, 30 May-2 June, 2012
European Society of Human reproduction and Embryology (ESHRE). Stockholm 2011.
Opponent for PhD 2010-2012
Sahlgrenska Akademin, Göteborg. Living with amyotrophic lateral sclerosis-perspective of patients
and next of kin, 2010
Sahlgrenska Akademin, Göteborg. Helath-related quality of life after stem cell transplantation – The
first year, 2010.
Linköpings universitet. Aspects of Health-related Quality of Life. Associations with psychosocial
and biological factors, and use as patient reported outcome on routine health care. 2012
Sahlgrenska Akademin, Göteborg. Upplevelse och lindring av fatigue och gastrointestinala symptom
– hos patienter som genomgår strålbehandling, 2012
40
Centre for Disability Research (CDR)
The Centre for Disability Research (CDR) was established in 1988 to coordinate disability issues in
scientific fields represented at the faculties at Uppsala University and to interact with the wider
community on issues relating to disability research. The Centre is placed at the Faculty of Medicine
and administratively associated with the Department of Public Health and Caring Sciences.
In 2012 the CDR arranged a second conference Forskning pågår (“Research Underway”) in
collaboration with the Uppsala Regional Council. The 2012 theme was “Interaction for Inclusion”.
The conference brought together researchers from Uppsala University, practitioners, individuals with
own experience of disability, interest groups, artists, etc. Besides lectures on topics representing all
disciplinary domains at Uppsala University, there was an art exhibition with exhibitors from Uppsala
County and Iran.
During 2012 an application for continued operations in the Swedish Network for Disability Research
was submitted to and approved by the Swedish Council for Working Life and Social Research
(FAS). The CDR will thereby be able to continue to function as coordinator of this network for the
period 2012 – 2014. In the autumn the CDR hosted a network meeting. Thirty scientists from all
over Sweden participated in the meeting, where important matters were discussed regarding the
future of the network.
Within the framework of regular operations, eight lectures were arranged for the purpose of
disseminating information about current research in the disability field at Uppsala University.
Four issues of the newsletter Forskning om funktionshinder pågår (Current Disability Research)
have been published. The newsletter presents Swedish research on disabilities. Funding for 2013 –
2015 has been applied for and secured.
The CDR administers Uppsala nätverket (the Uppsala Network), which is an e-mail network for
individuals with either a personal or a professional interest in research on disabilities. CDR sends out
current information. Information reaching the CDR is forwarded to the ca. 450 recipients.
The CDR homepage (www.cff.uu.se) presents information about activities at CDR, its board
members, lecture and course programmes, etc. The newsletter Forskning om funktionshinder pågår
(Current Disability Research) is available in PDF format. All issues from the start in 1992 are now
available.
The Board of the Centre for Disability Research
Professor Karin Sonnander, (Disciplinary domain of medicine and pharmacy) chairperson
PhD Faculty of Medicine, Åsa Myrelid (Disciplinary domain of medicine and pharmacy)
Professor Håkan Lanshammar (Disciplinary domain of science and technology), vice chairperson
Professor Anders Rydberg (Disciplinary domain of science and technology)
Professor Åke Viberg (Disciplinary domain of humanities and social science) (until 2012-11-30)
Professor Margareta Sandström (Disciplinary domain of humanities and social science)
Professor Rafael Lindqvist (Disciplinary domain of humanities and social science) (from 2012-0601)
Professor Karin Barron (Disciplinary domain of humanities and social science) (until 2012-06-01)
PhD student Johan Gladh
41
PhD student Gunilla Sandberg
Student Cecilia Bohlin (until 2012-06-30)
Former Senior lecturer, Sonja Calais van Stokkom (The swedish disability federation)
Director Research and Development, Mia Pless (Uppsala county council)
Managing Director, Marie Palmgren (Municipalities in Uppsala county)
Agencies supporting CDR work/Funding
Funding has been received for 2012 for the newsletter Forskning om funktionshinder pågår (Current
Disability Research). The financiers are:
Norrbacka-Eugenia Foundation
SEK133 000
Sunnerdahl Handicap Fund Foundation
SEK 133 000
Sävstaholm Foundation
SEK 74 000
Council for Working Life and Social Research (FAS)
SEK 250 000
Funding has been received for the Swedish Network for Disability Research from:
Council for Working Life and Social Research (FAS)
SEK 250 000
Conference
In 2012 CDR arranged a second Forskning Pågår (“Research Underway”) conference in
collaboration with the Uppsala Regional Council. The 2012 theme was “Interaction for Inclusion”.
The conference gathered some one hundred individuals.
Public outreach
The Uppsala Network
The Uppsala Network is an e-mail network for individuals with either a personal or a professional
interest in research on disabilities. Information reaching the CDR is forwarded to the network’s ca.
450 recipients. Recipients include researchers, representatives of care and social caring operations,
personnel, relatives of individuals with disabilities, civil servants in county, municipal, or state
administration, and other interested parties.
Homepage
The CDR homepage (www.cff.uu.se) presents information about the Centre, board members, lecture
and course programmes, etc. The newsletter Forskning om funktionshinder pågår (Current Disability
Research) is available in PDF format. All issues from the start in 1992 are now available. The
homepage is updated frequently and has many visitors.
Lectures
Each semester, CDR arranges a number of lectures for the purpose of disseminating information
about on-going research and making it available to individuals both at Uppsala University and in the
wider community. In 2012 eight lectures were arranged, and we have seen an increase in the number
42
of people in the audience. The media have contacted the CDR about recording some of the lectures
(UR Samtiden (Swedish Educational Radio: Our Times) and National Assembly Television in South
Korea).
The newsletter Forskning om funktionshinder pågår (Current Disability
Research)
The launching of the newsletter was a way of meeting an expressed need from the Swedish disability
organisations, who asked for easily accessible written information on current disability research. The
newsletter is published by the CDR, Uppsala University. However, the content is not limited to
research activities from Uppsala University but includes disability research from all over Sweden.
As of a few years ago, the introduction of every article is written in easy-to-read Swedish. Every
issue is available as a PDF document, to be found on the website of the Centre for Disability
Research, Uppsala University. Those interested in a particular topic or looking for a special article
can search all published issues on the website, using keywords (in Swedish). The current number of
recipients is 3,900 (September 2012), 3150 of whom subscribe to a printed version and 750
subscribe to a PDF document distributed by e-mail. Many subscribers are workplaces, so there is
reason to believe that the newsletter is made available to and is read by multiple individuals. The
audience is varied and includes, besides a significant number of disability researchers, national,
regional and local governmental agencies, universities and university colleges, libraries, schools,
non-governmental organisations, workplaces and individual employees in local government
organisations, persons with a personal interest in the field, national newspapers and media, etc. Most
recipients are Swedish, although there are also subscribers in the Scandinavian countries.
43
Centre for Research Ethics & Bioethics (CRB)
Director: Professor Mats G. Hansson
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.
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.
In the 2011 research evaluation at Uppsala University (KoF), CRB’s research was graded worldleading level. After the evaluation, CRB, initiated an internal process to work with the feedback
from the international expert panel that looked at the centre’s research. According to the
international panel, the centre's publications “range among the top-quality in the field” and they were
impressed with the creative research environment.
CRB decided to use this opportunity to start a process to develop the research profile. The panel
suggested efforts could be developed into larger, focused research themes, and the Centre started
working towards that in September 2011. This work continued in 2012. In the evaluation, the KoFpanel encouraged the centre to become more visible. This led to the launch of the Ethics Blog,
focusing on the international bioethics debate, and its Swedish sister Etikbloggen, which also
focuses on debates in Swedish media. Our website also received a facelift and work to improve the
structure is ongoing.
(In alphabetical order)
Ashkan Atry, MA, PhD student
Ashkan Atry started his PhD studies in April 2008. He holds a degree of Master of Arts in
Theoretical Philosophy from Uppsala University (2008). His main area of interest is bioethics
(questions about doping and fairness in sports), value theory, ethics, philosophy of action,
epistemology and philosophy of culture.
Ewa Axelsson, LLM, LLD student
Ewa Axelsson started her LLD studies in Medical Law in March 2004. Her thesis focuses on quality
assurance in Swedish health care, responsibility and regulation. She holds a LLM from Uppsala
University (2002). She defended her disseration entitled "Patientsäkerhet och kvalitetssäkring i
svensk hälso- och sjukvård" on December 9 2011.
Stefan Eriksson, ThD, Associate Professor of Research Ethics, Senior lecturer
Stefan Eriksson is a senior lecturer in research ethics at the Centre for Research Ethics & Bioethics
and has conducted research on issues such as informed consent and autonomy, biobank ethics, and
the function and impact of research ethics codes. He is the editor of CODEX - a web resource run by
the Swedish Research Council. He received his doctoral degree on a dissertation regarding
44
Wittgenstein's influence on philosophy of religion (1999). In January 2010 Stefan was appointed
Associate Professor of Research Ethics.
Kathinka Evers, PhD, Associate Professor of Philosophy, Senior researcher
Kathinka Evers is a senior researcher at the Centre for Research Ethics & Bioethics. Her main
research focus is neuroethics and the neural basis of consciousness and she teaches an advanced
level course in neuroethics. Kathinka Evers’ research also includes biobank ethics and she is part of
the BBMRI.se network. She conducted her doctoral studies in philosophy at Balliol College,
University of Oxford, at the Research School of Social Sciences, Australian National University,
Canberra, and at Lund University, Sweden, where she received her doctoral degree in 1991. She has
been a research fellow at Balliol College, University of Oxford (1994); at the Department of
Philosophy and Human Rights Centre, University of Essex, Colchester (1996-97); invited professor
at the University of Tasmania, Hobart (1999), at École Normale Supérieure, Paris (2002), and at
Collège de France, Paris (2006-7). For six years (1997-2002) she was the Executive Director for the
Standing Committee on Responsibility and Ethics in Science (SCRES) of the International Council
for Science (ICSU). She is also division leader for ethical and societal implications of the EUflagship Human Brain Project.
Josepine Fernow, BA, Co-ordinator
Josepine Fernow is the centre co-ordinator and communications officer. She is also the editor of the
centre website and electonic newsletter and arranges our conferences. Her background is
undergraduate studies in Cultural Anthropology and Sociology at Uppsala University.
Joanna Forsberg, MD, PhD student
Joanna Forsberg defended her PhD thesis on biobank research (individual rights and public benefit)
on October 6, 2012. She started her PhD studies in bioethics in 2007. She holds a degree in Medicine
from Uppsala University (1998) and a license to practice (2002). Her main area of interest is the
relationship between rights and duties of individuals and society in healthcare and medical research,
in particular in biobank based research and public health ethics.
Tove Godskesen, RN, PhD student
Tove Godskesen started her PhD studies in October 2010 after advanced level studies in both Caring
Sciences and Public Health. She is a registered nurse (2006) and has worked at the Akademiska
sjukhuset (Uppsala University Hospital) hematology clinic.
Maria Gottvall, RN, PhD student
Maria Gottvall started her PhD studies in December 2008. She is a registered nurse (2008). Her main
area of interest is sexual and reproductive health.
Roya Hakimnia, MD, PhD student
Roya Hakimnia started her PhD studies in November 2010. She holds a degree in medicine from
Karolinska Institutet (2010). Her main area of interest is using intersectional gender theories on
medicine and health care. Her Phd project aims to use theories of gender and intersectionality on
telenursing and to develop a tool for improving gender competence
Mats G. Hansson, BS, ThM, ThD, Professor of Biomedical Ethics, Director
Mats Hansson is the director of the Centre for Research Ethics & Bioethics and has conducted
extensive research in biomedical ethics as principal investigator in several multi-disciplinary
research projects dealing with issues ranging from ethical, social and legal aspects of the
implementation of genetic diagnosis in clinical practice and the use of human tissue materials in
research, to clinical and medical ethics. He holds an undergraduate degree in biology (1974) and a
doctoral degree of theology (1991). Mats Hansson is Professor of Biomedial Ethics, funded by
Uppsala University and the Uppsala County Council together. He also works as a clinical consultant
at Akademiska sjukhuset (Uppsala University Hospital).
Anna T. Höglund, ThD, Associate Professor of Ethics, Senior lecturer
Anna T. Höglund is senior lecturer in nursing ethics and gender studies. She has worked extensively
45
on the question of ethical competence for health care practitioners. Related research areas are moral
distress in clinical settings and prioritization in health care. She has also published substantially on
the topic of gender and ethics. She holds an undergraduate degree in Arts (1997) and a doctoral
degree in Theology (2001) from Uppsala University. She became Associate Professor of Ethics in
2006.
Yusuke Inoue, MPH, PhD, Guest researcher from the Department of Public Policy, Institute of
Medical Science, University of Tokyo (IMSUT)
Yusuke Inoue joined CRB in October, 2012. His research interest deals with regulatory bioethics in
biomedical research, especially concerning human tissue research and banking. He is also interested
in the publication ethics of medical journals. Yusuke Inoue holds an undergraduate degree in SocioBehavioral Science (2001), a master of Public Health (2003), and a doctoral degree in Public Health
(2010) from Kyoto University, Japan. He has experience from several ethics advisory activities on
large cohort studies and brain biobanking, including BioBank Japan, the Japan Environment and
Children's Study, and the Japanese Society for Hygiene.
Li Jalmsell, MD, PhD student
Li Jalmsell started her PhD studies in Bioethics in 2008. She holds a degree in Medicine from
Karolinska Institutet (2005) and a license to practice (2007) She also works as a medical doctor at
the oncology unit in Visby, Gotland. Her main area of interest is the palliative care of dying children
and how to improve it. Before joining the Centre for Research Ethics & Bioethics she worked with
these issues at Karolinska Institutet.
Linus Johnsson, MD, PhD
Linus Johnsson defended his PhD thesis (Trust in Biobank Research) on March 9 2013. He works
part-time as a medical doctor at a health care centre in Strängnäs. He holds a degree in Medicine
from Uppsala University (2004) and license to practice (2006). Starting 2013, Linus Johnsson is also
part of the Family Medicine and Preventive Medicine research group at the Department of Public
Health and Caring Sciences.
Ulrik Kihlbom, PhD, Senior lecturer
Ulrik Kihlbom is senior lecturer in medical ethics at the Centre for Research Ethics & Bioethics. He
teaches ethics to medical students and is responsible for an advanced level course on public health
ethics. His research interests cover bioethics in general, the methodology of applied ethics and
metaethics. His PhD in Practical Philosophy at Stockholm University 2002 discussed the
formulation and tenability of Ethical Particularism. Before joining CRB in 2009, Ulrik Kihlbom
collaborated with us on clinical ethics in a project on monitoring and improving ethical and medical
praxis in perinatal medicine. He has taught philosophy and medical ethics at Stockholm University
and most recently at Örebro University where he was head of the Philosophy unit.
Sofia Kälvemark Sporrong, PhD, Associated researcher
Sofia Kälvemark Sporrong received her PhD from Uppsala University in 2007. Her research deals
with ethical competence and moral distress in health care, including pharmacies. Currently her
research focuses on pharmacy practice and policy, and the pharmacy professions. Her background is
undergraduate studies in social sciences.
Frida Kuhlau, PhD
Frida Kuhlau defended her thesis on dual use and responsible life science research in March 2013.
She started her PhD studies in bioethics in 2007. She holds a degree in Political Science and was
previously working in a project on chemical and biological warfare at the Stockholm International
Peace Research Institute (SIPRI) (2001-2007). Her main area of interest is how means and methods
in bioethics can be used to prevent proliferation of biological weapons.
Sofia Lavén, MD, PhD student
Sofia Lavén joined CRB in September 2011 and started her PhD studies in January 2012. She is
specialized in Family Medicine and works at Samariterhemmets Vårdcentral in Uppsala. Sofia
Lavén holds a degree in Medicine from Uppsala University (2000) and a license to practice (2002).
46
Anna-Sara Lind, Associate Professor of Public Law
Anna-Sara Lind joined CRB in September 2011 to work with the legal aspects of research conducted
on human tissue samples within the BBMRI.se network. Anna-Sara Lind is a senior lecturer at the
Department of Law at Uppsala Univerisiy and is tied part-time to CRB.
Malin Masterton, PhD, Postdoc
Malin Masterton's main area of interest is bioethics, and in particular ethical aspects connected to
molecular biology. Her background is undergraduate studies in biology (molecular biology) at the
University of Edinburgh (2002), followed by courses in practical philosophy at Uppsala University,
and PhD studies in bioethics. Malin Masterton defended her thesis "Duties to Past Persons: Moral
Standing and Posthumous Interests of Old Human Remains" in 2010. She started her post-doc at
CRB looking at disaster victim identification and the role of the dead body. Before that, she looked
at public opinion of science and animal testing within the framework of the COMBINE consortium.
Karin Nordin, Professor of Caring Sciences
Karin Nordin is a licencsed psychologist and Professor of Caring Sciences at the Department of
Public Health and Caring Sciences. Her research at CRB foucuses on genetic counselling and risk
information. This research is also conducted in close collaboration with the University of Bergen,
Norway.
Mona Pettersson, RN, PhD student
Mona Pettersson started her PhD studies in September 2010. She is a registered nurse (1991), a
teacher in health care for Upper Secondary School (2002) and holds a Master of Medical Science
(2008). She works part time as lecturer in the Nursing Programme.
Jane Reichel, Associate Professor of Administrative Law
Jane Reichel joined CRB in September 2011 to work with the legal aspects of research conducted on
human tissue samples within the BBMRI.se network. Jane Reichel is senior lecturer at the
Department of Law at Uppsala University and is tied part-time to CRB.
Lena Ring, Associated Researcher, Associate Professor of Pharmaceutical Outcomes Research
Lena Ring is senior researcher in Outcomes research, focusing on Patient Reported Outcomes (PRO)
studies, e.g., Quality of Life at the Medical Products Agency (MPA). She has worked extensively on
incorporation the patient perspectives into outcomes assessments in relation to the evaluation of
treatment and care of patients. Specific research areas are Quality of life Assessments in clinical
oncology practice and patient-provider communication. She has also published substantially on the
topic of patient reported outcomes, such as quality of life assessments both quantitative and
qualitative studies. She holds an undergraduate Masters degree in Pharmacy (1993) and a doctoral
degree in Pharmaceutical Services Research (1999) from Uppsala University. She did her post-doc
as a Marie Curie Fellow at the Department of Psychology at Royal College of Surgeons in Ireland
(2002-2004). She became Associate Professor of Pharmaceutical Outcomes Research in 2007.
Pär Segerdahl, PhD, Associate Professor of Philosophy, Senior researcher
Pär Segerdahl investigates notions of nature and animal in animal ethics, animal welfare and various
eco-philosophies, as well as in contemporary culture more generally. He holds a PhD in theoretical
philosophy from Uppsala University (1993). He was a guest researcher at the Centre for Gender
Research at Uppsala University from 2007-2009. Pär Segerdahl became associate professor of
theoretical philosophy at Åbo Akademi Univeristy in 1998 and Uppsala University in 2001. He
currently develops new ideas for research on absolutism and relativism in the notion of morality. Pär
Segerdahl is also involved in research communication for the BBMRI.se (Biobanking and
Biomolecular Resources Research Infrastructure Sweden) and editor of the ethics blog and
etikbloggen.
Pär Segerdahl is a member of Nordic Network for Philosophical Anthropology and The Nordic
Wittgenstein Society.
47
Marit Silén, PhD, Postdoc
Marit Silén joined CRB in December 2011 to work on a project aimed at improving the ethical
climate for staff in psychiatric outpatient care. She received her PhD in nursing from Jönköping
University in 2011 and is also a registered nurse (2005).
Anna Lydia Svalastog, PhD, Associate Professor of Religious Studies, Associated researcher
Anna Lydia Svalastog has worked primarily on questions about cultural heritage and religion. She
has conducted extensive studies on how images structure personal life and wrote her PhD thesis on
reproduction and heterosexuality. Post doc projects have analysed how medical ethics structures risk
handling procedures for plant science, and how research history and national politics have structured
academic teaching and academic theories about Sámi people’s history and culture. Anna Lydia
Svalastog holds a doctoral degree in Theology, History of Religion from Uppsala University (1998),
and became Associate Professor in religious studies at Umeå University (2005).
Anna Lydia Svalastog is currently looking at bioethical concerns regarding native people, and at the
relation between public debate, cultural history and myths, and public opinion. She is a member of
the research network Bio-objects and their boundaries, governing matters at the intersection of
society, politics and science, and UppSam. She co-ordinates the research network Culture Health and
Bioethics and the ad hoc group Riekkis,
Jennifer Viberg, BSc, MSc, PhD Student
Jennifer Viberg joined CRB in October 2011 where she is involved in the IMI-funded BTCure
project on Rheumatoid Arthritis. She is a licensed Prosthetist and Orthotist. Before joining CRB she
was a teacher at the Orthopeadics Engeineering Programme (prosthetics and orthotics) at Jönköping
University, School of Health Science.
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:
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
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.
Segerdahl P, Gender, Language and Philosophical Reconciliation: What Does Judith Butler
Destabilize? In: Ethics and the Philosophy of Culture: Wittgensteinian Approaches. Gustafsson, Y.,
Kronqvist, C., and Nykänen, H. (Eds.). Cambridge Scholars Publishing, 2013.
Segerdahl P (Ed.), Undisciplined Animals: Invitations to Animal Studies. Cambridge Scholars
Publishing, 2011.
Axelsson E, Patientsäkerhet och kvalitetssäkring i svensk hälso- och sjukvård: En medicinrättslig
studie, Iustus förlag, SJFU Skrifter från juridiska fakulteten i Uppsala 119, 2011. (LLD dissertation)
48
The complete list for this period is:
1.
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 postdischarge treatment outcome? An exploratory study. Health Expectations, 2010:13(3):298311.
2.
Atry A, Hansson MG, Kihlbom U, Beyond the Individual: Sources of Attitudes Towards Rule
Violation in Sport, Sport, Ethics and Philosophy, 2012;6(4):467-479.
3.
Atry A, Hansson MG, Kihlbom U, Gene Doping and the Responsibility of Bioethicists, Sport,
Ethics and Philosophy, 2011;5(2):149-160.
4.
Axelsson E, Patientsäkerhet och kvalitetssäkring i svensk hälso- och sjukvård: En
medicinrättslig studie, Iustus förlag, SJFU Skrifter från juridiska fakulteten i Uppsala 119,
2011.
5.
Eriksson S, Moral obligations for synthetic biology research, EUBARnet Review series on
policy, ethics and security, Paper no 7. [Electronic].
6.
Eriksson S, H, How can the ethics of dementia research be ensured?, Dementia Europe
2012:4;10-11.
7.
Eriksson, S, On the need for improved protections of incapacitated and non-benefiting
research subjects, Bioethics, 2012:26(1):15-21.
8.
Evers K, Stjernschantz Forsberg J, Hansson MG, Commercialisation of biobanks,
Biopreservation and Biobanking, 2012;10(1):45-47
9.
Evers K, Stjernschantz Forsberg J & Eliason JF, What Are Your Views on Commercialization
of Tissues for Research?, Biopreservation and Biobanking, 2012;10(6):476-478.
doi:10.1089/bio.2012.1062.
10.
Evers K, Neuroética. Cuando la materia se despierta, Katz editores, 2010
11.
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.
12.
Fagerlind H, Kettis Å, Berstgröm I, Glimelius B, Ring L, Different perspectives on
communication quality and emotional functioning during routine oncology consultations,
Patient Education and Counseling 2012:88(1):16-22.
13.
Forsberg JS, Eriksson S, Hansson MG, Changing defaults in biobank research could save
lives too, Eur J Epidemiol. 2010;Feb;25(2):65-8.
14.
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.
15.
Gottvall M, Tydén T, Larsson M, Stenhammar C, Höglund AT, Challenges and opportunities
of a new HPV immunization program - Perceptions among Swedish school nurses, Vaccine,
2011;29(28):4576-4583.
16.
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.
17.
Hamang A, Eide GE, Rokne B, Nordin K, Bjorvatn C, Oyen N, Predictors of Heart-Focused
Anxiety in Patients Undergoing Genetic Investigation and Counseling of Long QT Syndrome
or Hypertrophic Cardiomyopathy: A One Year Follow-up, Journal of Genetic Counseling
2012;21(1):72-84.
49
18.
Hansson, MG, Validate DNA-findings before telling donors, Letter, Nature,
2012;484(7395):455
19.
Hansson MG, Simonsson B, Feltelius N, Stjernschantz Forsberg J, Medical registries
represent vital patient interests and should not be dismantled by stricter regulation, Hasford J,
Cancer Epidemiology, 2013;36(6):575-578.
20.
Hansson MG, Where should we draw the line between quality of care and other ethical
concerns related to medical registries and biobanks?, Theoretical Medicine and Bioethics,
2012; 33(4 ):313-323.
21.
Hansson MG, Gattorno M, Stjernschantz Forsberg J, Feltelius N, Martini A & Ruperto N,
Ethics bureaucracy: a significant hurdle for collaborative follow-up of drug effectiveness in
rare childhood diseases, Arch Dis Child doi:10.1136/archdischild-2011-301175
22.
Hansson MG, Biobanking Within the European Regulatory Framework: Opportunities and
Obstacles, Biopreservation and Biobanking 2011;9(2):165-167
23.
Hansson MG, The need to downregulate. A minimal ethical framework for biobank research,
in: Dillner J. (ed.), Methods in Biobanking, Methods in Molecular Biology Book Series No
675, The Humana press, Springer 2011.
24.
Hansson MG, Do we need a wider view of autonomy in epidemiological research?, British
Medical Journal 2010;340:c.(2335):1172-1174.
25.
Hansson MG & Hakama M, Ulysses contracts for the doctor and for the patient,
Contemporary Clinical Trials, 2010;31:202-206.
26.
Hansson MG, Taking the patient’s side: the ethics of pharmacogenetics, Personalized
Medicine, 2010:7(1): 75-85.
27.
Hayat Roshani A, Lampic C, Involdstad C, Askmalm MS, Borvatn C, Rosequist R, Nordin K,
What Information Do Cancer Genetic Counselees Prioritize?, Journal of Genetic Counceling
2012;21(4):510-526.
28.
Helgesson, G, Eriksson S, The moral primacy of the human being: A reply to Parker, Journal
of Medical Ethics, 2011;37:56-57.
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Dissertation 2012
Stjernschantz Forsberg, J, Biobank Research: Individual Rights and Public Benefit, doctoral thesis,
Acta Universitatis Upsaliensis
EU
2 717 489
COMBINE
600 000
BT Cure
553 586
RD-Connect
962 780
Euro-TEAM
601 123
The Swedish Cancer Society (Cancerfonden)
1 800 000
Factors associated with participation in phase 1
and phase 3 oncology trials
600 000
Developing clearer definitions and clinical
guidelines for DNR orders in oncology care
600 000
Quality of life assessments in clinical practice
600 000
The Swedish Research Council (Vetenskapsrådet)
SIMSAM-INFRA
208 407
Codex
700 000
BBMRI.se
2 705 858
Riksbankens Jubileumsfond (Bank of Sweden Tercentenary Foundation)
Mind the risk
3 614 265
166 500
166 500
AFA Insurance (AFA försäkring)
742 000
Improving the ethical climate in psychiatry
outpatient clinics
742 000
Total
9 040 254
We also received 466 666 SEK as a result of the KoF evaluation.
53
Research projects
Autonomy and trust in biobank research (PhD project)
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.
Funding: AutoCure, BT-Cure, BBMRI.se
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.
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.
Li Jalmsell will have her halftime thesis seminar in May 2013.
Funding: The Swedish Childhood Cancer Foundation (Barncancerfonden)
BBMRI.se - Biobanking and Molecular Resource Infrastructure of Sweden:
Ethical and legal aspects (WP7)
Collaborators: Mats G. Hansson, Professor of Biomedical Ethics (WP leader), Kathinka Evers,
Associate Professor, Senior Researcher, Joanna Stjernschantz Forsberg, MD, PhD Student, Anna54
Sara Lind, Associate professor of Public Law, Jane Reichel, Associate Professor of Administrative
Law, Pär Segerdahl, Associate Professor of Philosophy
BBMRI.se is a national effort for efficient and automated collection of biological material.
WP7 works with pressing ethical and legal questions rising from biobank related research. There are
a number of ethical and legal aspects of research conducted on human tissue samples that need to be
addressed in a professional and constructive manner. The proposed new act on biobanks, existing
laws on personal data and public access to information and secrecy, exert an influence on what can
and can’t be done with biobanks and data. A major obstacle for researchers is that laws in part
overlap, but provide slightly different answers to some questions and fail to address certain aspects
of research activities. This poses major challenges for the scientific community in their strife to
produce knowledge that can benefit patients.
To meet these challenges, WP7 was expanded in the autumn 2011 to examine the legal aspects.
Some questions have also been raised in the media on the ethics of biobank research, especially in
connection to the large population studies. WP7 will examine these questions and also provide
answers to frequently asked questions (FAQ). WP7, together with the other work packages, plans to
host a national biboank fair in Uppsala, Hands on biobanks.
Within the framework of BBMRI.se WP7 will:
•
•
•
•
•
•
•
•
•
•
Assist the management of BBMRI.se and researchers with qualified legal and ethical advise
and training.
Be a knowledge centre for ethical management of biobank related research.
Contribute to a constructive weighing of ethical interests in the field of biobanking.
Constitute a competitive and attractive node for international co-operation on ethical and
legal aspects of biobank research.
Contribute to an initiated discussion on biobank related issues in society.
Investigate how biobank research that protects integrity can be conducted.
Investigate how biobanks can collaborate with national quality registries in an efficient and
legal manner.
Investigate the legal requirements for updating collections of samples thorough single masswithdrawals from health-data registries.
Investigate the legal prerequisites for using databases and biobanks for future unspecified
purposes.
Investigate the legal requirements for supplementing quality registries within the health care
sector with blood and tissue samples.
Funding: The Swedish Research Council (Vetenskapsrådet)
BTCure (Be The Cure)
Collaborators: Mats G. Hansson, Professor of Biomedical Ethics, Kathinka Evers, Associate
professor of Philosophy, Joanna Forsberg, PhD, Researcher, Jennifer Viberg, PhD student
The development of new therapeutic agents against Rheumatoid arthritis (RA) and RA-like diseases
requires a dynamic interaction between studies in humans and in animal models of disease. BTCure
aims to advance this parallel work and bring it to a new level by recognising (1) the need for
recognition of pre-symptomatic and emerging disease in humans; (2) the heterogeneous nature of
human RA and RA-like diseases; (3) the need for new alignments between several animal models
and the variants of human RA and RA-like disease and (4) the potentials that an increased
understanding of adaptive immunity provides for better prevention, therapy and eventual cure of RA.
With these tools at hand, we will be able to use new understanding of aetiology and early pathology
of human disease for a program aimed at early and curative treatment of human RA and RA-like
diseases.
55
BTCure (Be The Cure) focuses on Rheumatoid arthritis (RA) and RA-like diseases.
BTCure has 33 partners. It is co-ordinated by professor Lars Klareskog, Karolinska Institutet and
Professor Tom Huizinga, Leiden University Medical Centre
CRB are part of a subroject on ethics in the work package (WP5) on ethical issues and
dissemination, led by professor Steffen Gay, University Hospital Zürich. The ethics subproject will
address ethical aspects of the project and foster patient participation.
BTCure has received funding from the IMI call on Inflammation – Translational Research and
Adaptive Immunity.
Funding: IMI (Innovative Medicines Initiative)
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, Gunnar Birgegård, Professor, Department of Medical Sciences
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.
Within oncology care, patients in a terminal phase of cancer sometimes have such a poor prognosis
that Coronary Pulmonary Rescue (CPR) is not considered justifiable in case of cardiac arrest. This
can lead to a DNR order to be issued by the responsible physician, implying that in case of a cardiac
arrest neither basic nor advanced CPR is to be performed. DNR situations can lead to severe ethical
dilemmas and moral distress among the staff.
Research design:
Two interview studies, using qualitative methodology, will be performed with oncology nurses and
oncologists concerning their experiences of DNR decisions.
Nursing and medical students will be interviewed in a qualitative study concerning their
understanding of DNR and their education on this concept.
In a study using Delphi-methodology a panel of oncologists and oncology nurses will be asked to
assess a suggestion of definition of DNR and guidelines for DNR in oncology care. The goal is to
establish clearer definitions and guidelines with relevance for both oncologists and oncology nurses
on DNR orders in oncology care.
Funding: The Swedish Cancer Society (Cancerfonden)
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
56
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 response to proposed
obligations among life science researchers, and how is security consciousness to be implemented in
life science research?
Frida Kuhlau defended her thesis “Responsible Conduct in Dual Use Research: Towards an Ethic of
Deliberation in the Life Sciences” in March 2013.
Funding: Uppsala University
Controlling chronic inflammatory diseases with combined efforts
(COMBINE)
Collaborators: Mats G. Hansson, Professor of Biomedical Ethics, Sofia Kälvemark, PhD,
Researcher, Malin Masterton, PhD, Researcher, Tobias Renberg, PhD, Researcher
The COMBINE consortium aims to investigate how patients perceive research on chronic
inflammation by creating a network of scientists, clinicians, patients and industrial representatives,
which together can use unique Swedish advantages to improve understanding of why inflammatory
diseases develop, what are the most essential goals for patients to achieve, and to develop and
implement novel prevention and therapy for these diseases. The operational strategy is to create
infrastructure and programs where systematic capture of data takes place in routine healthcare and is
utilised in research, and where the same infrastructure is used to feed information from research back
to healthcare.
The consortium consists of clinicians/scientists, biomedical scientists, epidemiologists, care
scientists, bioethicists, members of patient organisation, and representatives from industry. The
steering committee has been chosen to both represent all medical faculties/universities in Sweden
and to have a track record of building functional national research networks. We suggest the
formation of a new structure for a public private partnership between academia, care and industry in
translational research, clinical trials and longitudinal patient studies where unique resources in
Swedish health care and epidemiology are utilised. We also suggest a new structure for international
collaboration utilising the same Swedish resources where investments from international partners
can supplement investments from the Foundations and other national agencies.
The aims will be approached within 13 work packages (WP), each with distinct goals and budgets.
The Centre for Research Ethics & Bioethics participates with Work Package 13: Ethics.
Funding: COMBINE Consortium (Vinnova, Vårdalstiftelsen, Reumatikerförbundet, Invest in
Sweden Agency, KK-stiftelsen, Stiftelsen för strategisk forskning)
Developing and evaluating an interactive mobile phone system to support
self-management of hypertension
Collaborators: Karin Kjellgren, Professor, University of Gothenburg and Linköping University
(Principal Investigator), Ulrika Bengtsson, PhD Student, University of Gothenburg, Inger
Hallberg, PhD, Post doc, University of Gothenburg, Åsa Mäkitalo, Professor, University of
Gothenburg, Dick Kaperowski, Associate Professor University of Gothenburg, Stefan Höfer,
Associate Professor, University of Innsbruck, Lena Ring, Associate Professor of Pharmaceutical
Outcomes Research
This research programme will develop and evaluate the feasibility, utility and effectiveness of an
interactive mobile phone-based system for use in supporting patients in their efforts to self-manage
their hypertension treatment. The self-management system we will use is person-centered, where the
patient is actively involved in the treatment and care.
An interdisciplinary group of researchers will have a participatory orientation while working
together with persons with hypertension and health care professionals in the development process.
57
CRBs role is to contribute with expert knowledge in patient-reported outcomes approaches and
measurements. The program consists of four phases:
Phase 1: Exploring patients’ and health care professionals’ experiences of high blood pressure and
antihypertensive treatment
Phase 2: Design and pilot testing of a mobile phone self-management system
Phase 3: Analysis of patient self-reports and patient/professional experiences using the interactive
mobile phone self-management system
Phase 4: Evaluating patient- nurse/physician consultations using the interactive mobile phone selfmanagement systemFunding: The Swedish government's strategic investment in health and care
research and the University of Gothenburg
Hypertension remains being an important risk factor for cardiovascular disease and the burden of
this disease is quite severe when it comes to having an impact on daily life. Despite a profound
evidence base for a combined medication and lifestyle intervention and despite guidelines and
education programmes only one third to one quarter of people receiving treatment for hypertension
reach a well-controlled blood pressure well controlled. Factors explaining this might be that 50% of
persons receiving treatment for hypertension do not adhere to treatment and that life-style
adjustments in general are hard to maintain. An increased understanding among patients as well as
health care personnel of the interrelationships between blood pressure, symptoms, medication use,
side-effects, life-style and well-being may support the self-management of hypertension including
medication adherence and treatment effect.
Increased interaction and effective communication between health care providers and the patient
may support self-management of hypertension. Self-reports systems can be a tool to facilitate
adherence to hypertension treatment, and improve the management of hypertension by engaging the
patient as an active partner in care. Recent reviews conclude that self-monitoring appears to be
useful in care and is likely to lead to a reduction in cardiovascular events and mortality. In this
project, we plan to use mobile phone technology to do this.
Funding: The Swedish government's strategic investment in health and care research and the
University of Gothenburg
Efficacy and costs-effectiveness of physical training and behavioral
medicine strategies in reducing fatigue, improving well-being and disease
outcome in cancer patients – a randomized intervention study with long
term follow-up
Collaborators: Karin Nordin, Professor of Caring Sciences (PI), Lena Ring, Associate Professor
of Pharmaceutical Outcomes Research, Birgitta Johansson, PhD, senior lecturer, Department of
Radiology, Oncology and Radiation Science, Uppsala University, Cecilia Arving, PhD, Department
of Public Health and Caring Sciences, Uppsala University
This project will evaluate the efficacy and cost-effectiveness of individually tailored high and low
intensity physical training, with or without behavioural medicine support strategies (BM).
Recent relevant reviews have shown evidence for positive effects of physical training during and
after cancer treatments but they emphasized the lack of well-designed randomized controlled
intervention studies with large sample sizes.
The project will look at:
•
•
•
•
Cancer Related Fatigue (CRF)
Quality of Life (QoL)
Mood disturbance
Adherence to the cancer treatment
58
•
•
•
Adverse effects
Disease outcome
Return to a daily life after completed treatment
We will also describe changes in inflammatory markers and cytokines related to physical training
and gene expressions following training to investigate whether these serve as mediators for the
effects of physical training on CRF and QoL.
This project is a collaboration between researchers from Uppsala University, Lund University and
Linköping University in Sweden and the University of Bergen in Norway. It is a controlled multicentre study looking at newly diagnosed breast, colorectal and prostate cancer patients during
adjuvant therapy at three different centres in Sweden; Uppsala, Lund and Linköping.
Researchers at CRB are responsible for parts of a work package that deals with outcomes.
Ethical aspects of biobank research – Individual rights vs. the public
good? (PhD project)
Collaborators: Joanna Forsberg, MD, PhD, Mats Hansson, Professor of biomedical ethics,
supervisor, Stefan Eriksson, Associate professor of research ethics, supervisor
In this project bioethical methods and theories are used to analyze the tenability and implications of
viewing biobank based medical research from a public health perspective. Consequences of adopting
such a view on biobank research are investigated, for instance regarding the issues of obtaining
informed consent and returning individual results to participants. Putative rights and duties of
individuals and society in the context of healthcare and medical research are explored. This research
project is undertaken from an applied ethics perspective, and its focus is therefore on the practical
consequences and policy implications of different philosophical positions, rather than on their
theoretical underpinnings.
Joanna Forsberg defended her thesis “Biobank Research: Individual Rights and Public Benefit” in
September 2012.
Funding: AutoCure, BBMRI.se, CCPRB and Pfizer
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/
Funding: The Swedish Research Council (Vetenskapsrådet) and the Swedish Council for Working
Life and Social Research (FAS).
59
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 at the
Department of Public Health and Caring Sciences 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 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.
Funding: Uppsala University
Euro-TEAM
Collaborators: Mats G. Hansson, Professor of Biomedical Ethics (WP-leader)
EURO-TEAM aims towards early diagnosis and biomarker validation in arthritis management. An
ideal intervention in a chronic inflammatory disease such as Rheumatoid Arthritis (RA) would be a
preventive one. In order to develop preventive strategies and therapies two key developments need
to occur: (1) Biomarkers need to be identified that can be used to predict an individual’s risk of
developing RA. (2) Modifiable disease mechanisms need to be identified and characterized in the
early phases of disease. The key objective of the TEAM consortium is to specifically identify
diagnostic biomarkers and disease mechanisms operating during the transition from health to
rheumatoid arthritis. The consortium will achieve this by developing a collaborative, integrated
programme of work that links researchers with key SMEs involved in biomarker development to
produce a “personalized predictive bioprofile” for patients destined to develop RA.
A separate work package will address issues on risk communication, with these objectives:
•
•
•
•
To understand the current perspective of individuals in different pre-RA phases about: (1)
RA; (2) the meaning and perception of “risk” and “risk assessment”; (3) the utility of
predictive tests in the context of RA; (4) their willingness to undergo predictive tests for
RA.
To develop strategies and tools for communication with and education of individuals in
different pre-RA phases about: (1) the different stages of RA and the prognosis of RA; (2)
the role of interacting biomarkers in prediction of the development of RA; (3) how lifestyle
and behaviour factors affect the risk of developing RA and how these can / should be
modulated.
To assess the impact of these communication and education strategies on an individual’s
willingness to undergo predictive tests and their subsequent behaviour.
To disseminate information from this project to relevant stakeholders.
EURO-TEAM is coordinated by Christopher Buckley at the University of Birmingham. Uppsala
University with Mats Hansson and the CRB team working with ethical and legal issues associated
with biobank and registry research is partner of EURO-TEAM and will work with issues related to
risk communication.
Funding: EU, 7th Framework Programme
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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.
There is a lack of both philosophical analysis and empirical support of for patients views to guide the
selection of appropriate information and consent procedures for patients with progressive cancer.
A common conception is that patients participate in order to reap benefits of their own, while the
scientific objective is to benefit future patients, i.e. the therapeutic misconception. However, the
concept of benefit is complex and there are different ways patients may perceive their participation.
There is a need of empirical studies that focus specifically on the balancing of benefits and risks, the
issue of voluntariness and the role of doctors and research associates in promoting patient autonomy
for clinical cancer trials. In particular, there is a lack of information on these issues from the
perspective of the Swedish health care system and how Swedish patients reason.
In this project we want to find answers to the following questions:
•
•
•
•
•
How do cancer patients participating in phase 1 and phase 3 clinical trials perceive their
participation with regard to risk, benefits (own and for future patients) and information?
What is their perception of the role of physicians and clinical research associates with
regard to recommendations to participate, success of information transfer, time assigned for
making decision?
Do they regard their participation as voluntary and on what conditions would they like to
withdraw?
Is willingness to participate related to patients’ quality of life?
How may the risk of treatment/therapy misconception be handled in association with
randomized controlled clinical cancer trials?
The project consists of two parts: interviews with phase 1 trial participants and, using the results
from these interviews, a questionnaire to patients who participate in phase 3 trials.
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.
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•
•
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.
Funding: The Swedish Research Council (Vetenskapsrådet)
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 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.
Funding: The Vardal Foundation For Health Care Sciences and Allergy Research (Vårdalstiftelsen)
and the Uppsala County Council (Landstinget i Uppsala län).
Improving the ethical climate in psychiatry outpatient clinics
Collaborators: Marit Silén, PhD, Post doc, Kristina Haglund, Senior lecturer, Department of
Neuroscience, Uppsala University & Uppsala University Hospital, Mats G. Hansson, Professor of
Biomedical Ethics, Mia Ramklint, MD PhD, clinical lecturer, Department of Neuroscience,
Uppsala University
Children, adolescents and adults come to psychiatric outpatient clinics to be assessed, diagnosed and
treated. Their symptoms and diagnosis range depression, anxiety disorders, bipolar disorders, eating
disorders to obsessive compulsive disorders and post-traumatic stress disorder.
At these clinics they meet a number of professions: physicians, nurses, social workers, psychologists
and physiotherapists. Sometimes, difficult decisions have to be made regarding referral to inpatient
care or restraint. For the staff, these decisions raise a number of ethical questions. These questions
range from how to balance the wish to do good with the respect for the patient’s autonomy to
priorities between different kinds of need. Ethical questions to be solved while handling balancing a
high workload and demanding patients.
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The staff at outpatient psychiatric clinics needs to be prepared to handle these kinds of ethical
challenges. Previously, the ethics rounds method has been used in order to try to strengthen
healthcare staff’s ability to handle ethically difficult situations. It has been shown to increase mutual
understanding and decrease professional hierarchies. This could have consequences for the way in
which ethical problems are handled: Besides legal and other regulations and the healthcare ethical
principles, the relationships at the specific workplace have an impact on how ethical problems are
handled. Business ethics research has used the concept of ethical climate in order to describe how
ethical problems are handled, and what relationships and practices that either hinder or facilitate a
positive ethical climate.
In the present project we will investigate whether ethics rounds can improve the ethical climate in
psychiatry outpatient clinics. The project will have a quasi-experimental design, using both control
and intervention groups measured before and after the intervention.
Funding: AFA Insurance (AFA Försäkring)
Mind the Risk
Collaborators: Mats Hansson, Professor of Biomedical ethics and director of the Centre for
Research Ethics & Bioethics at Uppsala University. Principal Investigator, Silke Schicktanz,
Professor of Philosophy, Dept. of Medical Ethics and History of Medicine, George-August
University of Göttingen, Julia Inthorn, PhD in philosophy, Senior Researcher, Dept. of Medical
Ethics and History of Medicine, George-August University of Göttingen. Candidate for Pro Futura
VIII, Gabriella Pravettoni, Professor of Cognitive Psychology, Centre for Interdisciplinary
Research and Intervention on Decision (IRIDe), University of Milano, Alessandra Gorini, PhD,
Senior Researcher, Centre for Interdisciplinary Research and Intervention on Decision (IRIDe),
University of Milano, Claudio Lucchiari, PhD Senior Researcher, Centre for Interdisciplinary
Research and Intervention on Decision (IRIDe), University of Milano, Frederic Bouder, PhD,
Associate Professor, Department of Technology and Society Studies, Maastricht University,
Katherine Payne, Professor of Health Economics, Centre for Health Economics, The University of
Manchester, Karim Raza, PhD, MD, Associate Professor, Rheumatology Research Group, College
of Medical and Dental Sciences, The University of Birmingham, Rebecca Stack, PhD, Clinical
psychologist, Rheumatology Research Group, , College of Medical and Dental Sciences, The
University of Birmingham, Susanne Georgsson-Öhman, PhD, University Lecturer,
Sophiahemmets Högskola, Marit Silén, PhD, Post doc, Centre for Research Ethics & Bioethics at
Uppsala University.
The following PhD students will participate in the program based on already funded projects: Sofia
Lavén, MD, PhD-student, Centre for Research Ethics & Bioethics at Uppsala University; Jennifer
Viberg, PhD-student, Centre for Research Ethics & Bioethics at Uppsala University; Caroline Vass,
Centre for Health Economics, The University of Manchester.
The purpose of this initiation grant is to prepare a joint proposal of a European research programme
to be prepared during summer/autumn 2012 and finalised at a workshop at Krusenberg in
November/December 2012. The research programme has the following aims:
Assess the ethical, psychological and social implications of the increased focus on risk information
within genetic information technology.
Develop a conceptual framework for genetic risk perception and genetic risk management.
Assess perceptions of genetic risk in the general public, in patient populations and among health care
professionals and policy makers.
Funding: Planning grant from Riksbankens Jubileumsfond (Bank of Sweden Tercentenary
Foundation)
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Prevention of doping through increased understanding of the sense of
fairness in sport (PhD project)
Collaborators: Ashkan Atry, MA, PhD student, 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.
Ashkan Atry will defend his thesis in October 2013.
Funding: The Swedish National Centre for Research in Sports (Centrum för idrottsforskning) and
the Swedish School of Sport and Health Sciences (Gymnastik och idrottsskolan)
RD-Connect
Collaborators: Mats G. Hansson, Professor of Biomedical Ethics, (WP leader)
RD-Connect aims to build an integrated platform connecting registries, biobanks and clinical
bioinformatics for rare disease research.
Despite examples of excellent practice, rare disease (RD) research is still mainly fragmented by data
and disease types. Individual efforts have little interoperability and almost no systematic connection
between detailed clinical and genetic information, biomaterial availability or research/trial datasets.
The project will build on and transform the current state-of-the-art across databases, registries,
biobanks, bioinformatics, and ethical considerations to develop a quality-assured and comprehensive
integrated hub/platform in which complete clinical profiles are combined with -omics data and
sample availability for RD research.
A separate work package will address ethical, legal and social issues (ELSI) with the following
objectives:
Develop best ethical practices for balancing patient-related interests associated with RD research
using databases/registries, biobanks and omics databases in global networks of clinicians and
researchers.
Engage with relevant stakeholders, e.g. patient organizations and patient groups, clinical and
research networks, legislators and policymakers, pharma industry.
Develop a proposal for an expedient regulatory framework for linking of medical and personal data
related to RD on a European and global level.
Funding: EU, 7th Framework Programme
Research biobanks and custodianship
Collaborators: Yusuke Inoue, Guest researcher from the Department of Public Policy, Institute of
Medical Science, University of Tokyo (IMSUT)
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This project looks at biobank custodians: who can control and manage a sustainable use of these
resources and how they manage it. A previous study on biobank laws in Nordic countries found that
there are contrasting understandings of “custodianship”.
What should the relationship between researchers and biobanks look like? The recent trend towards
a broader consent gives each sample a wider potential for use. This means that each sample has a lot
of potential users, and can be used in several ways. However, given the limited and depleteable
nature of the samples, their use needs to be carefully controlled. We also have to take the future
needs of researchers into account when we decide what to do with samples today.
This project is an empirical study of:
How to set a standard for allocation of samples: Priority setting vs equality of access - the conflict
between open access (equality) and the sustainability of biobanks.
Incentives for the researchers who originally collects samples: The collector's incentive vs the
neutrality of access/decision making.
The methods used are document analysis on legal and ethical discussions on biobank custodianships
along with interviews with experts with biobank custodians, researchers (as users) and opinion
leaders.
Funding: the Japanese Society for the Promotion of Science and the Royal Swedish Academy of
Sciences (Kungliga vetenskapsakademin)
SIMSAM-INFRA
Collaborators: Magnus Stenbeck, project manager, Department of Clinical Neuroscience,
Insurance medicine, Karolinska Institutet, Anna Holmström, Unit of Epidemiology and Global
Health, Umeå University, Joanna Forsberg, PhD, Peter Somogyi, Deptartment of Medical
Epidemiology and Biostatistics (MEB), Karolinska Institutet
SIMSAM is short for ”Swedish Initiative for Research on Microdata in the Social And Medical
Sciences”, an initiative supported by the Swedish Research Council via its Committee for Research
Infrastructure. By giving priority to interdisciplinary, innovative register-based research, SIMSAM
will contribute to better public health and increased knowledge of social issues, for instance which
factors in childhood that result in increased risk for obesity or cancer later in life. The initiative is
also intended to promote improved and expanded use of registers in research and to increase the
knowledge of how registry research is organized in Sweden and internationally. Six research nodes
and one graduate school have been granted funding for five years from December 2008 until
November 2013.
This is an infrastructure project for population registers in epidemiology and in the social sciences
funded by the Swedish Research Council. The project priorities are to A) develop the information
from SIMSAM to the research community and provide descriptions of the SIMSAM research data
bases, data management work performed on the register data, contact persons, availability, and other
additional information related to these. The project will also B) develop a website for register data
containing overarching information in Swedish and English on available register data from the
central and regional/local authorities (including social, demographic, health care, biobank data
sources). CRB is involved in C) the analysis of the ethical foundation on which current legislation is
based, in order to propose rules and applications more appropriate for research. Finally, SIMSAMINFRA will D) review security solutions, ethical principles and ongoing reforms in the area of
personal data for research, and propose legally acceptable security solutions for distributed
(federated and other) data systems involving person identified data.
Funding: The Swedish Research Council
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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.
Funding: The Swedish Cancer Society (Cancerfonden).
Quality of life assesments in clinical practice
Collaborators: Hanna Fagerlind, PhD, Department of Pharmacy, Uppsala University, Bengt
Glimelius, Professor, Department of Radiology, Oncology and Radiation Science, Uppsala
University, Mathilde Hedlund-Lindberg, PhD, Department of Neurobiology, Care Sciences and
Society (NVS), Karolinska Institutet, Åsa Kettis, Associate Professor, Planning division, Uppsala
University, Lena Ring, Associate Professor of Pharmaceutical Outcomes Research
This project started in 2005 and is funded by The Swedish Cancer Society. The main aim is to
evaluate the effectiveness of QoL instruments as means of individualizing cancer care and treatment.
We want to explore differences related to cancer patients QoL and to doctor-patient communication.
This project consists of a recently completed psychosocial randomised study focusing on the benefits
from regular assessments of Quality of Life (QoL) and Health-related Quality of Life (HRQoL)
during patient care in daily oncology practice.
Objectives of special interests are:
•
•
•
To evaluate the effectiveness of QoL/HRQoL instruments as means of individualizing
cancer care and treatment, focusing on the influence on satisfaction with care,
communication and patient management (e.g. medical decisions and referrals.
To identify appropriate instruments for this purpose, the cancer specific instrument EORTCQOL-C30 or/and the individualized instrument SEIQoL-DW
To identify the minimally important difference (MID) for SEIQoL and EORTC-QOL-C30
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•
To explore the experiences of, and attitudes towards the clinical usefulness and the
implementation of QoL/HRQoL assessments among patients and health care personnel.
The project now enters the final phase. Data collection has been completed and the on-going focus is
to finalize the data set and to perform analysis as well as write up more publications. The most
recent publications have focused on qualitative aspects of the study, which is very important as a
foundation for the quantitative analysis. However, now when the data collection is completed we are
performing the main quantitative analysis to answer the main research question evaluating the
effectiveness of QoL/HRQoL instruments as means of individualizing cancer care and treatment.
Funding: The Swedish Cancer Society
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.
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?”.
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 e-learning 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.
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.
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
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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.
Culture, Health 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).
The network is divided into five sub groups: 1: Bioethics and native peoples, 2: The ethics in
prospecting biological diversity, 3: Native peoples and quality of life, 4: Cultures of knowledge and
organisations and 5: Creativity
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 health and social care. A
workshop in Groningen was held on 28-29 April 2011 started this collaboration that also includes
Hilda Lindeman and James Nelson, philosophers from Michigan State University. CRB has received
funding from Riksbankens Jubileumsfond for the initiation of this international multi-centre research
collaboration on family ethics, currently working on a white paper. The group held its second
meeting in Uppsala on October 6-7 2011 and will hold a third meeing in Michigan in 2012.
Neuroethics
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 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. Kathinka Evers from CRB is also one of the division
leaders for ethics and society in the EU-flagship Human Brain Project.
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.
More
CODEX - Rules and Guidelines for Research
CODEX is a website with rules and guidelines for research. The website, www.codex.vr.se, is run in
collaboration between CRB and the Swedish Research Council.
EACME
CRB is an associate member of the European Association of Centres of Medical Ethics (EACME).
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
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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.
In the midwifes programme we are responsible for 4,5 credits. We also teach within the specialist
nurses programmes and other educational 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.
Our web based advanced level course in neuroethics (7,5 credits) has increased in popularity and
was offered again in Spring 2012.
We teach ethics at the Uppsala Graduate School for Biomedical Research (UGSBR), in a curriculum
offered also to students at the master programmes in infection biology and biomedicine.
Postgraduate Teaching
Science and Technology: A course in research ethics (2 credits) is compulsory for PhD students
admitted after July 1, 2008. Preciously, this course was divided into two separate courses (Research
ethics A [1 credit] and Research ethics B [1 credit]. The B-course now runs parallel to allow those
students who have taken the A course to meet the requirements. 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: the electable 4 credit course tailored for the social sciences was not offered in 2013
but will be in 2013.
Conferences and symposia
In 2012 we were responsible for arranging the BBMRI.se user conference “HandsOn: Biobanks”
on September 20-21. The conference was organized by BBMRI.se together with BBMRI.fi and
Biobank Norway. We were also involved in arranging the pre-conference “International
Biobanking Summit: Future directions” on September 19. The pre-conference was organized by
P3G, ISBER, BioSHaRE.eu, ENGAGE, BBMRI.se and ESBB.
Both meetings attracted around 400 participants from 27 different countries. The HandsOn-concept
was interactive. Apart from plenary lectures, seminars and poster presentations, we organized “idea
labs” and other kinds of interactive workshops. We also had an interactive exhibition as part of the
conference programme. This exhibition called “The Route” allowed participants to follow the
sample through the research process and discuss the value of research.
The concept was very successful and BBMRI-NL asked to bring it to the Netherlands in 2013. The
next meeting will be held in the Hague on November 21-22.
In 2010, Is Medial Ethics Really in the Best Interest of the Patient? was held in Uppsala on 14-16
June. This meeting was arranged by CRB together with CESAGEN at the Universities of Cardiff and
Lancaster. Tbhe conferences attracted 200 participants from more than 20 countries. Main sponsor
was The Journal of Internal Medicine. The conference had different themes each day: June 14:
Should ideology be allowed to trump patient well-being, June 15: What is the role of informed
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consent in medical research? June 16:Ethical review boards: are they important ethical safeguards or
over-burdensome and unnecessary bureaucracy?
In 2009 we co-organized the Nordic Committee on Bioethics conference Nordic Biobank
Research: Obstacles and opportunities in Uppsala on 3-4 May 2011
Public outreach
Due to the commitment to HandsOn: Biboanks, the rest of our public outreach work suffered
slightly. Our newsletter was put on hold to be resumed in 2013. Instead, our lists were used to
promote the HandsOn: Biobanks conference and to recruit researchers.
The CRB website, www.crb.uu.se had around 26495 unique visitors in 2012, (compared to 22985 in
2011), on average visiting our website 1,65 times (43814 visits). Most visits were from Sweden,
followed by Germany, Norway, the Netherlands, Italy, the United Kingdom, USA and (with 500
page views or more).
CRB has several e-mail lists, together making up around 2 500 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 people
who have registered for more information, plus 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. We also collaborate with
the seminar on medical law at the Department of law, whose LLD students are also on this list.
CRB’s staff 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.
Social media: The Ethics Blog and Etikbloggen
After the KoF research evaluation, CRB started an ethics blog to meet the panel’s suggestion that
CRB could become more visible. Pär Segerdahl, Associate Professor of Theoretical Philosophy, was
recruited as editor.
The blog is funded by BBMRI.se. It is published in two versions, in Swedish
(www.etikbloggen.crb.uu.se) and in English (www.ethicsblog.crb.uu.se). The Swedish blog
comments current debate and often links to opinion pages in the daily papers, while the English
version is more aimed at the scientific community and debates in the field of bioethics.
The blog has a variety of functions. These functions are reflected in the brief self-reflective remarks
that end each blog post, such as:
“We think about bioethics”
“Following the news”
“We follow debates”
“We discuss questions of current interest”
“We find new aspects”
“We like challenging questions”
“We have a clinical perspective”
“In dialogue with the public”
70
The blog serves to update readers about bioethically relevant news. It participates in ethical debates.
It explains bioethical research. It comments on recent publications and current events. It spreads
information about CRB research and explains our ideas. It communicates with researchers,
practitioners, politicians, and the general public. Finally, the blog tries to vitalize the ethical debate
by identifying questions and perspectives that are novel, challenging and scientifically wellgrounded.
In 2012, the Swedish “Etikbloggen” had 9 289 visits, with an average 25 visits per day. Most of the
visitors were of course from Sweden, but the blog also had substantial numbers of visits from
Finland and Norway. The English version, the “Ethics blog” have a little less visits. In 2012, the
blog was visited 6 208 times, with an averge of 17 visits per day. Most of the visitors were from
Sweden, closely followed by the United States. The rest of the visitors were mainly from France, the
United Kingdom, Germany, Canada and Finland. Together, the blogs were visited 15 497 times last
year.
We also tried using Facebook to promote the HandsOn: Biobanks conference as a complement to the
conference website. This page has around 70 likes and is now used for the next HandsOn-meeting
which will be held in the Hague on November 21-22 2013.
CRB in Swedish and international media
The strategy to become more visible also included the Swedish media. In 2011, the Centre director
Mats G. Hansson, signed two debate articles dealing with the decision by the Swedish Data
Inspection Board to stop LifeGene (Alltför diffust hänvisa till framtida forskning - Svenska
Dagbladet 2011-12-27 and Trångsynt beslut hotar forskningen - Svenska Dagbladet 2011-12-25).
This debate ended with a final article in January 2012 with “DI:s beslut måste omprövas (2012-0104)
CRB in Swedish and international media (a selection)
Biobanker fråga för stormöte
KI Bladet nummer 6 2012
Kathinka Evers: On 'Responsible Neuroethics' and Neuro-rubbish
The Neuroethics blog 2012-07-19
To the Origins of the Human Mind
CCCB - Centre de Cultura Contemporània de Barcelona
Interview 2012-05-30
Utställd
Sveriges Radio P1, Tendens 2012-02-01
Forskare som tar på sig munkaveln
Sveriges Radio P1, 2012-01-31
Forskningen och tystnadsplikten
Sveriges Radio P1, Vetandets Värld 2012-01-17
DI:s beslut måste omprövas
Svenska Dagbladet 2012-01-04
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Clinical Nutrition and Metabolism
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 air-displacement and bioelectrical
impedance, and energy expenditure.
Epidemiological studies consider nutritional, metabolic and dietary factors in relation to long-term
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.
Academic title
Professional title
Tommy Cederholm
Professor
MD
Brita Karlström
Professor emeritus
Dietitian
Bengt Vessby
Professor emeritus
MD
Ulf Risérus
Associate professor
Researcher
Ulf Holmbäck
Post-doc
Researcher
Anja Saletti
Post-doc
Dietitian
Per Sjögren
Post-doc
Researcher
Afsaneh Koochek
Post-doc
Dietitian
Viola Adamsson
PhD student
Nutrition manager
David Iggman
PhD student
MD
Elisabet Rytter
PhD student
Johanna Törmä
PhD student
Dietitian
72
Sigvard Sobestiansky
PhD student
MD
Erika Olsson
Licentiat student
Dietitian
Erika Ax
PhD student
Fredrik Rosqvist
PhD student
Roger Olsson
Lecturer/Universitetsadjunkt
Siv Tengblad
Laboratory technician
Eva Lena Andersson
Tutor
Linda Bratteby-Tollerz
Physiotherapist
Marie Berglund
Research assistant
Love Franzen
Research assistant
Partly affiliated or associated to CNM
Wulf Becker
Associate professor
Chief nutritionist
Stefan Branth
Postdoc
MD
Anders Forslund
Postdoc
MD
Anders Sjödin
Ass professor
MD
Annika Smedman
Postdoc
Torbjörn Åkerfeldt
PhD student
MD
1.
Wennberg M, Strömberg U, Bergdahl IA, Jansson JH, Kauhanen J, Norberg M, Salonen JT,
Skerfving S, Tuomainen TP, Vessby B, Virtanen JK. Myocardial infarction in relation to
mercury and fatty acids from fish: a risk-benefit analysis based on pooled Finnish and
Swedish data in men. Am J Clin Nutr 2012;96:706-13.
2.
Perez-Martinez P, Garcia-Rios A, Delgado-Lista J, Gjelstad I, Gibney J, Kieć-Wilk B,
Camargo A, Helal O, Karlström B, Blaak E, Hall W, Risérus U, Dembińska-Kieć A,
Defoort C, Saris C, Lovegrove J, Drevon C, Roche H, Lopez-Miranda J. Gene-nutrient
interactions on the phosphoenolpyruvate carboxykinase influence insulin sensitivity in
metabolic syndrome subjects. Clin Nutr 2012 [Epub ahead of print].
3.
Nerpin E, Helmersson J, Riserus U, Sundström J, Larsson A, Jobs E, Basu S, Ingelsson E,
Arnlöv J. Inflammation, oxidative stress, glomerular filtration rate, and albuminuria in elderly
men: a cross-sectional study. BMC Res Notes 2012 [Epub ahead of print].
4.
Garcia-Rios A, Perez-Martinez P, Delgado-Lista J, Phillips CM, Gjelstad IM, Wright JW,
Karlström B, Kiec-Wilk B, van Hees AM, Helal O, Polus A, Defoort C, Riserus U, Blaak
EE, Lovegrove JA, Drevon CA, Roche HM, Lopez-Miranda J. A period 2 genetic variant
interacts with plasma SFA to modify plasma lipid concentrations in adults with metabolic
syndrome. J Nutr 2012;142:1213-8.
5.
Nerpin E, Ingelsson E, Risérus U, Helmersson-Karlqvist J, Sundström J, Jobs E, Larsson A,
Lind L, Arnlöv J. Association between glomerular filtration rate and endothelial function in
an elderly community cohort. Atherosclerosis 2012;224:242-6.
73
6.
Jans A, van Hees A, Gjelstad I, Sparks L, Tierney A, Risérus U, Drevon C, Schrauwen P,
Roche H, Blaak E. Impact of dietary fat quantity and quality on skeletal muscle fatty acid
metabolism in subjects with the metabolic syndrome. Metabolism 2012 [Epub ahead of print]
7.
Bjermo H, Iggman D, Kullberg J, Dahlman I, Johansson L, Persson L, Berglund J, Pulkki K,
Basu S, Uusitupa M, Rudling M, Arner P, Cederholm T, Ahlström H, Risérus U. Effects of
n-6 polyunsaturated fat compared with saturated fat on liver fat, lipoproteins and
inflammation in abdominal obesity: a randomized controlled trial. Am J Clin Nutr
2012;95:1003-12.
8.
Olszewski P, Rozman J, Jacobsson J, Rathkolb B, Strömberg S, Hans W, Klockars A, Alsiö J,
Risérus U, Becker L, Hölter S, Elvert R, Ehrhardt N, Gailus-Durner V, Fuchs H, Fredriksson
R, Wolf R, Klopstock T, Wurst W, Levine A, Marcus C, Hrabě de Angelis M, Klingenspor
M, Schiöth H, Kilimann M. Neurobeachin, a Regulator of Synaptic Protein Targeting, is
Associated ith Body Fat Mass and Feeding Behavior in Mice and Body-Mass Index in
Humans. PLoS Genetics 2012 (Epub ahead of print).
9.
Perez-Martinez P, Delgado-Lista J, Garcia-Rios A, Tierney A, Gulseth H, Williams C,
Karlström B, Kieć-Wilk B, Blaak E, Helal O, Saris W, Defoort C, Drevon C, Lovegrove J,
Dembinska-Kieć A, Riserus U, Roche H, Lopez-Miranda J. Insulin receptor substrate-2 gene
variants in subjects with metabolic syndrome: Association with plasma monounsaturated and
n-3 polyunsaturated fatty acid levels and insulin resistance. Mol Nutr Food Res 2012 ;56:30915.
10.
Delgado-Lista J, Perez-Martinez P, Garcia-Rios A, Phillips C, Hall W, Gjelstad I, Lairon D,
Saris W, Kieć-Wilk B, Karlström B, Drevon C, Defoort C, Blaak E, Dembinska-Kieć A,
Risérus U, Lovegrove J, Roche H, Lopez-Miranda J. A gene variation (rs12691) in the
CCAT/enhancer binding protein α (CEBPα, CEBPA) modulates glucose metabolism in
metabolic syndrome. Nutr Metab Cardiovasc Dis 2012 [Epub ahead of print].
11.
Gjelstad I, Haugen F, Gulseth H, Norheim F, Jans A, Bakke S, Raastad T, Tjønna A, Wisløff
U, Blaak E, Risérus U, Roche H, Birkeland K, Drevon C. Expression of perilipins in human
skeletal muscle in vitro and in vivo in relation to diet, exercise and energy balance. Arch
Physiol Biochem 2012;118:22-30.
12.
Söderström L, Thors Adolfsson E, Rosenblad A, Frid H, Saletti A, Bergkvist L. Mealtime
habits and meal provision are associated with malnutrition among elderly patients admitted to
hospital. Clin Nutr e-pub 2012.
13.
Rönnemaa E, Zethelius B, Vessby B, Lannfelt L, Byberg L, Kilander L. Serum fatty acid
composition and the risk of Alzheimer's disease: a longitudinal population-based study. Eur J
Clin Nutr 2012;66:885-90.
14.
Sundström B, Johansson G, Kokkonen H, Cederholm T, Wallberg-Jonsson S. Plasma
phospholipid fatty acid content is related to disease activity in ankylosing spondylitis. J
Rheumatol 2012;39:327-33.
15.
Huang X, Stenvinkel P, Rashid Qureshi A, Risérus U, Cederholm T, Bárány P, Heimbürger
O, Lindholm B, Carrero JJ. Essential polyunsaturated fatty acids, inflammation and mortality
in dialysis patients. Nephrol Dial Transpl 2012;e-pub
16.
Vedin I, Cederholm T, Freund-Levi Y, Basun H, Garlind A, Faxén Irving G, EriksdotterJönhagen M, Wahlund L, Dahlman I, Palmblad J. Effects of DHA- rich n-3 fatty acid
supplementation on gene expression changes in blood mononuclear leukocytes: the OmegAD
study. PLOS One 2012;e-pub
17.
Adamsson V, Reumark AC, Cederholm T, Vessby B, Riserus U, Johansson G. What is a
healthy Nodic Diet. Foods and nutrients in the NORDIET Study. Food & Nutrition Research
2012 56 18189 – http://dxdoi.org/10.3402/fnr.v56i0.18189
74
18.
Huang X, Stenvinkel P, Qureshi A, Cederholm T, Barany P, Heimburger O, Lindholm B,
Riserus U, Carrero J. Clinical determinants and mortality predictability of stearoyl-CoA
desaturase-1 activity indices in dialysis patients. J Intern Med e-pub 2012
19.
Sjögren P, Sierra-Johnson J, Kallings L, Cederholm T, Kolak M, Halldin M, Brismar K, de
Faire U, Hellénius M, Fisher RM. Functional changes in adipose tissue in a randomised
controlled trial of physical activity. Lipids Health Dis e-pub 2012.
20.
Titova O, Sjögren P, Brooks S, Kullberg J, Ax E, Kilander L, Riserus U, Cederholm T,
Larsson EM, Johansson L, Ahlström H, Lind L, Schiöth H, Benedict C. Dietary intake of
eicosapentaenoic and docosahexaenoic acids is linked to gray matter volume and cognitive
function in elderly. Age 2012;e-pub
21.
The Emerging Risk factor Collaboration. Adult height and the risk of cause-specific people:
individual participant meta-analysis. Int J Epidemiol 2012 e-pub.
22.
Huang X, Stenvinkel P, Qureshi AR, Cederholm T, Bárány P, Heimbürger O, Lindholm B,
Risérus U, Carrero JJ. Clinical determinants and mortality predictability of stearoyl-CoA
desaturase-1 activity indices in dialysis patients. J Intern Med 2012;e-pub.
23.
Huang X, Sjögren P, Cederholm T, Arnlöv J, Lindholm B, Risérus U, Carrero JJ. Serum
and adipose tissue fatty acid composition as biomarkers of habitual dietary fat intake in
elderly men with chronic kidney disease. Nephrol Dial Transpl 2012, e-pub.
24.
Ekström W, Al-Ani A, Sääf M, Cederholm T, Ponzer S, Hedström M. Health related quality
of life, reoperation rate and function in patients with diabetes mellitus and hip fracture – a 2
year follow-up study. Injury e-pub Nov 1, 2012.
25.
Holst M, Yifter-Lindgren, E, Surowiak M, Nielsen K, Mowe M, Carlsson M, Jacobsen B,
Cederholm T, Fenger-Groen M, Rasmussen H. Nutritional Screening and Risk Factors in
Elderly Hospitalized Patients: Association to Clinical Outcome. J Caring Sciences e-pub
2012.
26.
The Emerging Risk factor Collaboration. C-reactive protein, fibrinogen, and cardiovascular
disease prediction. N Engl J Med 2012;367:1310-20.
27.
Torma J, Winblad U, Cederholm T, Saletti A. Does undernutrition still prevail among
nursing home residents? Clin Nutr 2012 e-pub.
28.
Sand S, Becker W. Assessment of dietary cadmium exposure in Sweden and population
health concern including scenario analysis. Food Chem Toxicol 2012;50(3-4):536-544.
29.
Grönberg M, Tsolakis AV, Holmbäck U, Stridsberg M, Grimelius L, Janson ET. Ghrelin and
Obestatin in Human Neuroendocrine Tumors: Expression and Effect on Obestatin Levels after
Food Intake. Neuroendocrinology 2012, e-pub.
30.
Klingenberg L, Chaput JP, Holmbäck U, Jennum P, Astrup A, Sjödin A. Sleep restriction is
not associated with a positive energy balance in adolescent boys. Am J Clin Nutr
2012;96:240-8.
31.
Klingenberg L, Sjödin A, Holmbäck U, Astrup A, Chaput JP. Short sleep duration and its
association with energy metabolism. Obes Rev 2012;13:565-77.
32.
Faxén Irving G, Cederholm T. Energy dense oleic acid rich formula to newly admitted
geriatric patients - feasibility and effects on energy intake. Clin Nutr 2011;30:202-8.
33.
Schumacher MC, Laven B, Petersson F, Cederholm T, Onelöv E, Ekman P, Brendler C. A
comparative study of tissue ω-6 and ω-3 polyunsaturated fatty acids (PUFA) in benign and
malignant pathologic stage pT2a radical prostatectomy specimens. Urol Oncol 2011, e-pub.
34.
Malmgren A, Wärn Hede G, Karlström B, Cederholm T, Lundquist P, Wirén M, FaxénIrving G. Indications for percutaneous endoscopic gastrostomy and survival in old adults.
Food & Nutrition Research 2011;55.
35.
Jobs E, Ingelsson E, Risérus U, Nerpin E, Jobs M, Sundström J, Basu S, Larsson A, Lind L,
Ärnlöv J. Serum cathepsin S and the risk for mortality. JAMA 2011;306:1113-21.
75
36.
Garcia-Rios A, Delgado-Lista J, Perez-Martinez P, Phillips C, Ferguson J, Gjelstad I,
Williams C, Karlström B, Kieć-Wilk B, Blaak E, Lairon D, Planells R, Malczewska-Malec
M, Defoort C, Risérus U, Saris W, Lovegrove J, Drevon C, Roche H, Lopez-Miranda J.
Genetic variations at the lipoprotein lipase gene influence plasma lipid concentrations and
interact with plasma n-6 polyunsaturated fatty acids to modulate lipid metabolism.
Atherosclerosis 2011;218:416-22.
37.
Paniagua JA, Pérez-Martinez P, Gjelstad IM, Tierney AC, Delgado-Lista J, Defoort C, Blaak
EE, Risérus U, Drevon CA, Kiec-Wilk B, Lovegrove JA, Roche HM, López-Miranda J;
LIPGENE Study Investigators. A low-fat high-carbohydrate diet supplemented with longchain n-3 PUFA reduces the risk of the metabolic syndrome. Atherosclerosis 2011;218:44350.
38.
Jans A, Sparks L, van Hees A, Gjelstad I, Tierney A, Risérus U, Drevon C, Roche H,
Schrauwen P, Blaak E. Transcriptional Metabolic Inflexibility in Skeletal Muscle Among
Individuals With Increasing Insulin Resistance. Obesity 2011;19:2158-66.
39.
Perez-Martinez P, Delgado-Lista J, Garcia-Rios A, Ferguson JF, Gulseth HLc, Williams CM,
Karlström B, Kiec-Wilk B, Blaak EE, Helal O, Malczewska-Malec M, Defoort C, Risérus
U, Saris WHM, Lovegrove JA, Drevon CA, Roche HM, Lopez-Miranda J. Calpain-10
(CAPN10) genetic variants interact with plasma saturated fatty acid levels to influence insulin
resistance in individuals with the metabolic syndrome. Am J Clin Nutr 2011; 93:1136-41.
40.
Iggman D, Gustafsson I-B, Berglund L, Vessby B, Marckmann P Risérus U. Replacing dairy
fat with rapeseed oil causes rapid improvement of hyperlipidaemia: a randomised controlled
study. J Intern Med 2011;270(4):356-64.* Tillägnad editorial I samma nummer.
41.
The Emerging Risk Factors Collaboration. Separate and combined associations of body-mass
index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58
prospective studies. Lancet 2011;377:1085-95.
42.
The Emerging Risk Factors Collaboration. Diabetes Mellitus, Fasting Glucose, and Risk of
Cause-specific Mortality. New Engl J Med 2011;364:829-41.
43.
Astrup A, Dyerberg J, Elwood P, Hermansen K, Hu FB, Jakobsen M, Kok FJ, Krauss R,
Lecerf JM, LeGrand P, Nestel P, Risérus U, Sanders T, Sinclair A, Stender S, Tholstrup T,
Willett W. The role of reducing intake of saturated fat in the prevention of cardiovascular
disease. Where does the evidence stand in 2010? Am J Clin Nutr 2011;93:684-8.
44.
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.
Nephrology Dialysis Transplantation 2011;26:2820-7.
45.
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,
Risérus 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 2011;214:110-6.
46.
Perez-Martinez P, Delgado-Lista J, Garcia-Rios A, Mc Monagle J, Gulseth H, Ordovas J,
Shaw D, Karlström B, Kiec-Wilk B, Blaak E, Helal O, Malczewska-Malec M, Defoort C,
Risérus U, Saris W, Lovegrove J, Drevon C, Roche H, Lopez-Miranda J. Glucokinase
Regulatory Protein Genetic Variant Interacts with Omega-3 PUFA to Influence Insulin
Resistance and Inflammation in Metabolic Syndrome. PLoS One 2011;6(6):e20555.
47.
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 and Lairon D. Increased levels of
microparticles originating from endothelial cells, platelets and erythrocytes in subjects with
metabolic syndrome: relationship with oxidative stress. Nutrition, Metabolism &
Cardiovascular Diseases 2011;21:665-71.
76
48.
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 atients with coronary heart disease: Secondary Prevention in Uppsala Primary
Health Care project (SUPRIM). Arch Intern Med 2011;171(2):134-40.
49.
Adamsson V, Reumark A, Fredriksson I-B, Hammarstrom E, Vessby B, Johansson G,
Risérus U. Effects of a healthy Nordic diet on cardiovascular risk factors in
hypercholesterolemic subjects: a randomised controlled trial (NORDIET). J Intern Med
2011;269:150-9. *Tillägnad Editorial i samma nummer.
50.
Wang H, Steffen LM, Vessby B, Basu S, Steinberger J, Moran A, Jacobs DR Jr, Hong CP,
Sinaiko AR. Obesity (Silver Spring). Obesity modifies the relations between serum markers
of dairy fats and inflammation and oxidative stress among adolescents. Obesity
2011;19:2404-10.
51.
Swenne I, Rosling A, Tengblad S, Vessby B. Omega-3 polyunsaturated essential fatty acids
are associated with depression in adolescents with eating disorders. Randomized controlled
events in patients with coronary heart disease: Secondary Prevention in Uppsala Primary
Health Care project (SUPRIM). Acta Paediatr 2011;100:1610-5.
52.
Karlström BE, Järvi AE, Byberg L, Berglund LG, Vessby BO. Fatty fish in the diet of
patients with type 2 diabetes: comparison of the metabolic effects of foods rich in n-3 and n-6
fatty acids. Am J Clin Nutr 2011;94:26-33.
53.
Engström KS, Wennberg M, Strömberg U, Bergdahl IA, Hallmans G, Jansson JH, Lundh T,
Norberg M, Rentschler G, Vessby B, Skerfving S, Broberg K. Environ Health 2011 Apr
19;10:33.
54.
Swenne I, Rosling A, Tengblad S, Vessby B. Essential fatty acid status in teenage girls with
eating disorders and weight loss. Acta Paediatr 2011;100:762-7.
55.
events in patients with coronary heart disease: Secondary Prevention in Uppsala Primary
Health Care project (SUPRIM). Arch Intern Med 2011;171:134-40.
56.
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 2011;93:27-36.
57.
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. J Obes
2011;35:800-9.
58.
Faxén Irving G, Cederholm T. Energy dense oleic acid rich formula to newly admitted
geriatric patients - feasibility and effects on energy intake. Clin Nutr 2011;30(2):202-8.
59.
Tierney AC, McMonagle J, Shaw DI, Gulseth HL, Helal O, Saris WH, Paniagua JA,
Gołąbek-Leszczyñska I, Defoort C, Williams CM, Karlström 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)
2011;35(6):800-9.
60.
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 2011;93(1):27-36.
77
61.
Nettleton J et al (Risérus U is co-author # 41). Interactions of dietary whole grain intake with
fasting glucose- and insulin-related genetic loci in individuals of European descent: a metaanalysis of 14 cohort studies Diabetes Care 2010;33:2684-91.
62.
Rytter E, Vessby B, Asgård R, Ersson C, Moussavian S, Sjödin A, Abramsson-Zetterberg 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;44:1445-53.
63.
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.
64.
Aro A, Becker W. Improving nutrition in Finland. Public Health Nutr 2010;13(6A):899-900.
65.
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.
66.
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.
67.
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.
68.
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, Leszczyńska-Gołabek I, KiecWilk 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;211:539-44.
69.
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;91:794-801.
70.
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.
71.
Gulseth HL, Gjelstad IM, Tierney AC, Lovegrove JA, Defoort C, Blaak EE, Lopez-Miranda
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;33:923-5.
72.
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, Lopez-Miranda 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;104:160-3.
73.
Iggman D, Arnlöv J, Vessby B, Cederholm T, Sjögren P, Risérus U. Adipose tissue fatty
acids and insulin sensitivity in elderly men. Diabetologia 2010;53:850-7.
78
74.
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.
75.
Jobs E, Risérus U, Ingelsson E, Helmersson J, Nerpin E, Jobs M, Sundström J, Lind L,
Larsson A, Basu S, Ärnlöv 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;95:4460-4.
76.
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.
77.
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.
78.
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.
79.
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.
80.
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.
81.
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.
82.
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.
83.
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, Risérus U, Lopez-Miranda 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.
84.
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.
85.
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 [Epub 2010].
86.
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.
79
87.
Rytter E, Vessby B, Asgård R, Ersson C, Moussavian S, Sjödin A, Abramsson-Zetterberg 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.
88.
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.
89.
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 2010;64(12):1450-6.
90.
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.
91.
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.
92.
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.
93.
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.
94.
Bjermo H, Risérus U. Role of hepatic desaturases in obesity related metabolic disorders.
Curr Opin Clin Nutr Metab Care 2010;13:703-8.
95.
Risérus U. Right diet can prevent cardiometabolic diseases. Läkartidningen 2010;107: 27782.
96.
The Emerging Risk Factors Collaboration. Diabetes, fasting glucose, and risk of vascular
disease: collaborative analysis of 96 prospective studies. Lancet 2010;375:2215-22.
Reviews 2010-2012
97.
Muscaritoli M, Lucia S, Molina A, Cederholm T, Rossi Fanelli F. Muscle atrophy in aging
and chronic disease: is it sarcopenia or cachexia. Intern Emerg Med 2012 DOI
10.1007/s11739-012-0807-8.
98.
Thornell LE, Gustafsson T, Cederholm T, Ulfhake B. Sarcopenia has earned its living (Letter
to the Editor). J Appl Physiol 2012;113:683-4.
99.
CederholmT, Morley J. Editorial: Aging: Biology and Nutrition. Curr Opin Clin Nutr
Metabol 2012;e-pub.
100. Cederholm T, Cruz-Jentoft AJ, Maggi S. Sarcopenia and fragility fractures. Eur J Phys
Rehabil Med 2012 accepted
101. Cederholm T. Sarcopenia, osteoporosis and fractures. Chapter in Sarcopenia, Wiley 2012
102. Becker W. Trans fatty acids and fetal growth. Am J Clin Nutr 2012;95(4):984-5.
103. Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, Abellan van Kan G,
Andrieu S, Bauer J, Breuille D, Cederholm T, Chandler J, De Meynard C, Donini L, Harris
T, Kannt A, Keime Guibert F, Onder G, Papanicolaou D, Rolland Y, Rooks D, Sieber C,
Souhami E, Verlaan S, Zamboni M. Sarcopenia: an undiagnosed condition in older adults.
Current consensus definition: prevalence, etiology, and consequences. International working
group on sarcopenia. J Am Med Dir Assoc 2011;12:249-56.
104. Iggman D, Risérus U. Role of different saturated fatty acids for cardiometabolic diseases.
Clin Lipidol 2011;6:209-223.
80
105. Cederholm T, Bauer J, Boirie Y, Schneider S, Sieber C, Rolland Y. Toward a definition of
sarcopenia. Clin Ger Med 2011;27:341-53.
106. Vandewoude MFJ, Cederholm T, Cruz-Jentoft AJ. Relevant outcomes in intervention trials
for sarcopenia. J Amer Ger Soc 2011;59:1566.
107. Morley JE, Abbatecola AM, Argiles JM, Baracos V, Bauer J, Bhasin S, Cederholm T,
Stewart Coats AJ, Cummings SR, Evans WJ, Fearon K, Ferrucci L, Fielding RA, Guralnik
JM, Harris TB, Inui A, Kalantar-Zadeh K, Kirwan BA, Mantovani G, Muscaritoli M,
Newman AB, Rossi-Fanelli F, Rosano GM, Roubenoff R, Schambelan M, Sokol GH, Storer
TW, Vellas B, von Haehling S, Yeh SS, Anker SD; the Society on Sarcopenia, Cachexia and
Wasting Disorders Trialist Workshop. Sarcopenia with Limited Mobility: An International
Consensus. J Am Med Dir Assoc 2011;12:403-9.
108. Inzitari M, Doets E, Bartali B, Benetou V, Di Bari M, Visser M, Volpato S, Gambassi G,
Topinkova E, De Groot L, Salva A; International Association Of Gerontology And Geriatrics
(IAGG) Task Force For Nutrition In The Elderly. Nutrition in the age-related disablement
process. J Nutr Health Aging 2011;15:599-604
109. 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
2011;21:219-32
110. Bjermo H, Risérus U. Role of hepatic desaturases in obesity-related metabolic disorders.
Curr Opin Clin Nutr Metab Care 2010;13(6):703-8.
111. 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.
112. 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.
113. 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.
114. 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 pre-cachexia: Joint
document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting
diseases” and “nutrition in geriatrics”. Clin Nutr 2010;29;154-59.
Other articles 2010-2012
115. Adamsson V, Palmdahl K. Nordens Bästa Mat. ICA Förlaget 2012.
116. Cederholm T. Sarkopeni – ett begrepp med tiden för sig. Svensk Geriatrik 2012 nr 4:7-9
117. Cederholm T. D-vitaminbrist hos äldre – ska alla behandlas? Nordisk Nutrition 2012 nr 1:26
118. Cederholm T. Sarcopenia, osteoporosis and fractures. Chapter in Sarcopenia, Wiley 2012
119. Socialstyrelsen. Näring för god vård och omsorg – en vägledning för att förebygga och
behandla undernäring. 2011-9-2. ISBN 978-91-86885-39-7.
120. Cederholm T. “Ernaering og aldring”. Kapitel i Klinisk ernaering 5. udgave. Red. Ib Hessov
& Palle Bekker Jeppesen. Munksgaard Danmark, Kobenhavn 2011
121. Raynaud-Simon A, Cederholm T. Malnutrition in the elderly: Epidemiology and
consequences. Module 36.1 in ESPEN LLL Educational Program
www.espen.org/lllprogramme.html
122. Bosaeus I, Cederholm T, Rothenberg E, Ödlund Olin A. Nationell satsning för ökad
patientsäkerhet. Undernäring – åtgärder för att förebygga. Sveriges Kommuner och Landsting,
2011. ISBN 978-91-7164-631-6.
81
123. Cederholm T. Åldrande, mat och näring, i Vetenskapligt underlag till råd om Bra mat i
äldreomsorgen, Livsmedelsverkets rapportserie, s. 3-11, nr 3/2011.
124. Bjermo H. Fettets kvalitet viktigare än mängden. Nordisk Nutrition 2010;3:9-13.
125. 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.
126. Risérus U. [Right diet can prevent cardiometabolic diseases]. Läkartidningen
2010;107(36):2077-82.
127. Sjögren P, Hellenius ML. Lågkolhydratkost bör baseras på vegetabilier.
Läkartidningen 2010;46:2877.
128. Sjögren P. Ökad dödlighet hos män som äter lågkolhydratkost.
Läkartidningen 2010;45:2784.
129. Sjögren P. Kostmönster och dödlighet hos äldre svenska män. Livsmedel i fokus 2010;8:48.
The Swedish Research Council (VR)
900 000
The Swedish Research Council (VR)
800 000
FAS
400 000
Formas
700 000
Hjärt-Lungfonden
300 000
Zetterlings stiftelse
400 000
Uppsala County Council – ALF
843 000
Stockholm County Council – ALF (The OmegAD Trial)
400 000
Uppsala Municipality
1 500 000
Uppsala Municipality
1 066 000
Nestec
2 500 000
Arla
150 000
Semper
150 000
Svensk Mjölk
200 000
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)
82
- Impact of structural membranes for health effects by milk products
- 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
83
Disability and Habilitation
Research Group Leader Professor Karin Sonnander
Persons with disabilities often experience extensive difficulties in handling 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 physical, social and societal environment. A joint
conceptual perspective is found in the WHO Classification ICF. Contextual Factors as outlined in
the ICF in particular serve as a framework for research activities in elucidating environmental
aspects as facilitators and barriers for persons with disabilities 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. There are three main research tracks: Disability Services,
Systems and Policies, Clinical Assessment Methods and Documentation and The Perspectives of
Persons with Disabilities in Theory and Practice in which the facilitating and restraining aspects of
the environment as well as the participation and perspectives of persons with disabilities,
professionals and significant others are highlighted.
Monica Blom Johansson, BA, PhD student
Gunilla Eriksson, PhD Faculty of Medicine, associated researcher
Johan Glad, BA, PhD student
Carina Gustafsson, PhD Faculty of Medicine, associated researcher
Gerth Hedov, PhD Faculty of Medicine, associated researcher
Gunnel Janeslätt, PhD Faculty of Medicine, associated researcher
Kjerstin Larsson, PhD Faculty of Medicine, associated researcher
Helene Lidström, 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
Ieva Reine, PhD Faculty of Medicine, associated researcher
Karin Sonnander, PhD, professor
Annika Terner, BA, PhD student
Õie Umb-Carlsson, PhD Faculty of Medicine, senior researcher
Helena Wandin, BA, PhD student
External partners
Päivi Adolfsson, PhD, Centre for Disability Research, Uppsala University
Marianne Carlsson, PhD, professor, Department of Public Health and Caring Sciences, Uppsala
University
Ann-Britt Ivarsson, PhD Faculty of Medicine, associate professor, School of Health and Medical
Sciences, Örebro University
Ulla Jergeby, PhD, National Board of Health and Welfare, Stockholm
Per Lindberg, PhD, professor, Department of Psychology, Uppsala University
Liselotte Norling Hermansson, PhD Faculty of Medicine, Clinical Research Centre, Örebro
University Hospital, Örebro
Edward Palmer, PhD, adjunct professor, Department of Economics, Uppsala Center for Labor
Studies, Uppsala University
Ingvor Pettersson, PhD Faculty of Medicine, senior lecturer, School of Health and Medical Sciences,
Örebro University
84
Birgitta Rosberg, registered occupational therapist, Uppsala University Hospital
Anna Cristina Åberg, PhD Faculty of Medicine, associate professor, Department of Public Health
and Caring Sciences
Per Östberg, PhD Faculty of Medicine, Department of Neuroscience, Speech-Language Pathology,
Uppsala University
1.
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
2.
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, 33, (13-14): 1230-44
3.
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 frame of reference for practice. Disability and Rehabilitation, 32, 1: 125-138
4.
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
5.
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
6.
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
7.
Blom Johansson, M., Carlsson, M., Sonnander, K. (2011). Working with families of
persons with aphasia: a survey of Swedish speech and language pathologists. Disability &
Rehabilitation, 33 (1), 51-62
8.
Blom Johansson, M., Carlsson, M., Sonnander, K. (2011). AAC devices in aphasia
rehabilitation- the experiences of Swedish speech-language pathologists. Paper presented at
the 3rd Nordic Aphasia Conference, Helsinki, Finland
9.
Blom Johansson, M., Carlsson, M., Sonnander, K. (2011). Beskrivning av den svenska
logopedkårens sammansättning samt av "afasilogopeders" arbetsmässiga förutsättningar resultat från en enkätstudie. Logopednytt (2), 14-19. (In Swedish)
10.
Blom Johansson, M., Carlsson, M., Sonnander, K. (2011). Svenska logopeders insatser till
personer med afasi. Logopednytt (3), 18-23. (In Swedish)
11.
Granlund, M., Arvidsson, P., Niia, A., Björck-Åkesson, E., Simeonsson, R., Maxwell, G.,
Adolfsson, M., Eriksson-Augustine, L., Pless, M. (2011). Differentiating Activity and
Participation of Children and Youth with Disability in Sweden - A Third Qualifier in ICFCY? American Journal of Physical Medicine & Rehabilitation (Dec 20 Epub ahead of print).
12.
Klang, N., Pless, M., Adolfsson, M., Granlund, M., Björck-Åkesson, E. (2011). Using content
analysis to link texts on assessment and intervention to the International Classification of
Functioning, Disability and Health - version for Children and Youth (ICF-CY). Journal of
Rehabilitation Medicine, 43(8):728-33.
13.
Lejonclou, F., Pless, M. (2011). Vardagsförmågor hos barn med måttlig synnedsättning Funktionella färdigheter, hjälpbehov och föräldrars uppfattning om barnens motorik.
85
Habilitering och hjälpmedels rapportserie, 56, ISSN: 16507371. Landstinget Uppsala län. (In
Swedish)
14.
Lindstedt, H., Grann, M., Söderlund, A. (2011). Mentally disordered offenders’ daily
occupations after one year of forensic care. Scandinavian Journal of Occupational Therapy,
18:302-311
15.
Pless M., Granlund, M. (2011). Handbok i att använda ICF och ICF-CY. Lund:
Studentlitteratur. (In Swedish)
16.
Umb-Carlsson, Õ., Lindstedt, H. (2011). The prerequisites for QoL of people with
intellectual disabilities. Scandinavian Journal of Disability Research,13, 241-53
17.
Anmyr, L., Olsson, M., Larson, K., Freijd, A. (2011). Children with hearing impairment
living with cochlear implants or hearing aids. Int J Ped Otorhinolaryng 75:844-849
18.
Lejelind, E., Larsson, K., Strand, A. (2011). It is difficult to make people use condoms – or is
it? Forum for Nord Derm Ven 16 (3): 86-88
19.
Glad, J., Jergeby, U., Gustafsson, C. & Sonnander, K. (2012). Social work practitioners’
experience of the clinical utility of the Home Observation for Measurement of the
Environment (HOME) Inventory. Child & Family Social Work, 17 (1)23-33
20.
Granat, T., Nordgren, I., Rein, G. & Sonnander, K. (2012). Group intervention for siblings of
children with disabilities: a pilot study in a clinical setting. Disability & Rehabilitation, 34 (1)
69-75
21.
Blom Johansson, M., Carlsson, M., & Sonnander, K. (2012). Communication difficulties
and use of communication strategies: From the perspective of individuals with aphasia.
International Journal of Language & Communication Disorders,47 (2), 144-155
22.
Terner, A., Lindstedt, H. & Sonnander, K. (2012). Predefined headings in a multiprofessional electronic health record system. J Am Med Inform Assoc 19: 1032-1038
23.
Blom Johansson, M., Carlsson, M., Östberg, P. & Sonnander, K. (2012). Communication
changes and SLP services according to significant others of persons with aphasia.
Aphasiology, 26 (8): 1005-1028
24.
Blom Johansson, M., Carlsson, M., Östberg, P. & Sonnander, K. (2012). A multiple-case
study of a family-oriented intervention practice in the early rehabilitation phase of persons
with aphasia. Aphasiology,early on line 1-26
25.
Eriksson, G., Aasnes, M., Tistad, M., Guidetti, S. & von Koch, L. (2012). Occupational gaps
in everyday life one year after stroke and the association with life satisfaction and the impact
of stroke. Top Stroke Rehabil 19 (3): 244-255
26.
Blom Johansson, M. (2012). Aphasia and Communication in Everyday Life, experiences of
persons with aphasia, significant others, and speech-language pathologists. (Doctoral thesis),
Department of public health and caring sciences, research in disability and habilitation,
Uppsala University, Uppsala
27.
Wandin, H. (2012) Språk hos barn med funktionsnedsättning: alternative kommunikation och
ätsvårigheter I Barn med funktionsnedsättning, Lagerkvist, B. & Lindgren, C (red), Lund.
Studentlitteratur (In Swedish)
28.
Terner A, Lindstedt H, Sonnander K. (2012) Pre-defined Headings in a Multi-professional
Electronic Health Record System. In: Karlsson D, Bellika JG, Elberg PB, Fossum M, Galster
G, Hartvigsen G, Koch S, Nilsson G, editors. Scandinavian Conference on Health
Informatics; Linköping, Sweden
29.
Eriksson, T., Jonsson, H., Tham, K. & Eriksson, G. (2012). A comparison of perceived
occupational gaps in everyday life between people with stress-related ill-health or
musculoskeletal pain and a reference group. Scandinavian Journal of Occupational Therapy,
19, (5) 411-420.
86
30.
Bergström, A., Guidetti, S., Tistad, M., von Koch, L., Tham, K., Eriksson, G. (2012).
Perceived occupational gaps one year after stroke – an explorative study. Journal of
Rehabilitation Medicine, 44(1):36-42.
31.
Eriksson, G, Aasnes, M, Guidetti, S, Tistad, M, von Koch, L. (2012) Occupational gaps in
everyday life one year after stroke and the association to life satisfaction and impact of stroke.
Topics in Stroke Rehabilitation, 19(3):244–255.
32.
Eriksson, G., Tham, K. & Kottorp, A. (2012). A cross-diagnostic validation of an instrument
measuring participation in everyday occupations: the Occupational Gaps Questionnaire
(OGQ) E-published in Scandinavian Journal of Occupational Therapy.
33.
Eriksson, G., Baum, C., Wolf, T.,Tabor Connor, L. Perceived Participation after Stroke: The
Influence of Activity Retention, Reintegration, and Perceived Recovery. (Submitted)
34.
Ekstam, L , Johansson, U, Guidetti, S, Eriksson, G , Tham, K, von Koch, L , Ytterberg, C.
Dyads' combined perception of rehabilitation needs one year after stroke: a mixed methods
study (Submitted)
35.
Pless, M. & Sonnander, K. (2012). Evidensbaserad praktik. Utbildning och stöd till personal.
Rapport 57, Habilitering och Hjälpmedel, Landstinget i Uppsala län (In Swedish)
36.
Granlund, M., Arvidsson, P., Niia, A., Björck-Åkesson, E. Simeonsson, R., Maxwell. G.,
Adolfsson, M., Eriksson-Augustine, L., Pless, M. (2012). Differentiating Activity and
Participation of children and youth with disability in Sweden – A third qualifier in ICF-CY?
American Journal of Physical Medicine & Rehabilitation, 91 (13 Suppl 1): S84-96
37.
Klang, N., Pless, M., Granlund, M. (2012). Changes in individual habilitation plans after inservice training in ICF-CY- a document analysis (Submitted)
38.
Pless, M. & Granlund, M. (2012). Implementation of the International Classification of
Functioning, Disability and Health (ICF/ICF-CY) within the context of augmentative
alternative communication. Augmentative Alternative Communication. 28 (1): 11-20
39.
Umb-Carlsson, Õ. (2012). Assessing validity of the Uppsala Quality of Life Model. Journal
of Intellectual Disability Research, 56 (7-8): 797 (Conference abstract)
40.
Adolfsson, M. & Granlund, M. & Pless, M. (2012). Professionals’ views of everyday life
situations and the relation to participation. Disability & Rehabilitation, 34 (7):581-92
41.
Glad, J., Anders Kottorp, Jergeby, U., Gustafsson, C. & Sonnander, K. (2012).
Psychometric properties of the HOME-Inventory using Rasch analysis (Submitted)
42.
Glad, J., Jergeby, U., Gustafsson, C. & Sonnander, K. (2012).Social worker and teacher
apprehension and caregivers’ perspective of the HOME Inventory in Sweden (Submitted)
43.
Bolic V, Lidström H, Thelin N, Kjellberg A, Hemmingsson H. (2012).Computer use in
educational activities by students with ADHD. Scandinavian Journal of Occupational
Therapy. (Accepted)
44.
Anmyr, L., Larsson, K., Olsson, M., Freijd, A. (2012). Strengths and difficulties in children
with cochlear implants – comparing self-reports with reports from parents and teachers. Int 3
Ped Otorhinolaryngol, 76:1107-1112
Reviews
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
87
Conference oral presentations and poster presentations
Lindstedt, H. et al. (2011). Environmental help or hindrance? Environmental factors’ impact on the
use and utility of electronic planning devices for people with mental disability. ID-dagarna, Uppsala
(Poster presentation in Swedish)
Blom Johansson, M. (2012). Aphasia and Communication in Everyday Life I. The National
Conference in Logopedics [Nationell konferens i logopedi], Jönköping, (Oral presentation)
Blom Johansson, M. (2012). Aphasia and Communication in Everyday Life II.
The National Conference in Logopedics [Nationell konferens i logopedi], Jönköping, (Oral
presentation)
Eriksson, G., Tham, K., Kottorp, A. (2012). Development and validation of Occupational Gaps
Questionnaire – an assessment measuring participation in everyday occupations. International Brain
Injury Association 9th World conference, Edinburgh, Scotland (Poster presentation)
Ehrenfors, R., Borell,L., Hemmingsson,H. & Eriksson, G. (2012). Assessments used in school-aged
children with acquired brain injury - Linking to the international classification of functioning,
disability and health. International Brain Injury Association 9th World conference in Edinburgh,
Scotland (Poster presentation).
Eriksson, G. (2012). Participation in everyday occupations among Swedish people. COTEC,
Congress of Occupational Therapy, Stockholm (Oral presentation).
Janeslätt, G. (2012). Evaluation intervention including time aids in children with disabilities.
COTEC, Congress of Occupational Therapy, Stockholm (Oral presentation).
Wallin Ahlström, S., Lindstedt, H. & Janeslätt, G. (2012). Evaluation of a new method to
remediate time processing ability in children with disability in special schools. COTEC, Congress of
Occupational Therapy, Stockholm (Oral presentation).
Dissertation 2012
Blom Johansson, Monica. Aphasia and Communication in everyday life. Experiences of persons
with aphasia, significant others, and speech-language pathologists. Uppsala University 2012
Swedish Council for Working Life and Social Research (FAS)
1 230 000
Regional Research Council in Uppsala-Örebro Region
350 000
The Sävstaholm Foundation
430 000
Södermalm District Council, Stockholm City/The National Board of Health and Welfare
100 000
The Swedish Institute of Assistive Technology (SIAT)
450 000
Medical Faculty (Uppsala University)
125 000
142 000
Related tasks (members)
Chairperson, member of the board, Centre for Disability Research, Uppsala University (Karin
Sonnander)
88
Member of the board, Centre for Disability Research, Uppsala University (Johan Glad)
Member of the board of the Sävstaholm Foundation, Stockholm (Karin Sonnander)
Chairperson, member of the board of the Carola and Erik Tengström Foundation, Uppsala (Karin
Sonnander)
National editor Scandinavian Journal on Disability Research (Karin Sonnander)
Reviewer of grant applications, The Swedish Association of Occupational Therapists (FSA) (Helena
Lindstedt)
Examinations and evaluations (members)
During 2012 assignments as expert at evaluation for one position as senior lecturer (Karin
Sonnander).
Third stream activities (members)
Associated member of the management group, Centre for Disability, Uppsala County Council (Karin
Sonnander)
Associated member of the committee for Research and Development, Uppsala Regional Council
(Karin Sonnander)
Editor National Newsletter on Disability Research (Forskning om funktionshinder pågår), published
by Centre for Disability Research, Uppsala University (Karin Sonnander)
Undergraduate teaching 2012 (members)
Nursing Program
Scientific Method 4.5 Higher Education Credits (Helena Lindstedt seminars and examinations in
basic statistics). Monica Blom Johansson and Johan Glad contributed with lectures and group work
on Statistical Package for the Social Sciences (SPSS). Nursing and Nursing methods 15 Higher
Education Credits (Õie Umb-Carlsson lectures on Discrimination Act and Act concerning support
and service for persons with certain functional impairments and seminar on Treatment and
Disability.
Caring Science Freestanding courses
Course coordinator (Helena Lindstedt) for the following courses:
Scientific Methodology II including biostatistics 7.5 Higher Education Credits (including lectures,
seminars and examination).
Care Planning and Quality Improvement 7.5 Higher Education Credits
Essay Course 15 Higher Education Credits (including essay tutorials and examination)
Monica Blom Johansson and Johan Glad contributed with lectures and group work on Statistical
Package for the Social Sciences (SPSS), single lectures and examinations (Õie Umb-Carlsson), and
essay examination (Karin Sonnander).
Master Program in Public Health
Essay tutorials and essay examination (Karin Sonnander) and lectures and examination (Õie UmbCarlsson, Monica Blom Johansson).
89
Freestanding courses
Course coordinator including lectures and seminars (Õie Umb-Carlsson), single lectures (Monica
Blom Johansson, Helena Lindstedt) .and examination (Karin Sonnander) for the course Impairment
and Disability-Introductory Course 7.5 Higher Education Credits. The course is free-standing and
elective within the Medical Program, the Nursing Program and the Physiotherapy Program.
Joint course coordinator (Õie Umb-Carlsson) for the commissioned course Understanding and
Providing Leadership Based on the National Basic Value System for the Elderly, 7.5 Higher
Education Credits
Speech-Language Pathology Programme (Department of Neuroscience)
Course coordinator, lectures, group work and tutorials (master’s thesis) on introductory and
advanced levels (Monica Blom Johansson)
Social Work Programme (Department of Sociology)
Lectures on advanced level (Johan Glad)
Extra mural teaching
Single lectures Karolinska Institutet (Õie Umb-Carlsson)
Research projects
Disability Services, Systems and Policies
People with disabilities often experience extensive difficulties in handling everyday life and thus
may need and receive lifelong professional service and support. Studies focus effectiveness of
specialized re/habilitation and community intervention including assistive technology, the
participation of people with disabilities and significant others in the re/habilitation process and staff
in service training of evidence practice in habilitation services.
Aphasia and communication in everyday life - experiences of persons
with aphasia, significant others, speech- language pathologists, and a trial
of intervention
Participants: Monica Blom Johansson, Marianne Carlsson, Per Östberg, Karin Sonnander
The aim of this thesis is to obtain more knowledge about how the person with aphasia, the
significant other and the speech- language pathologists perceive the communication 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.
People with mental health disorder, implementing individual treatment
goals and long-term follow-up in psychiatric rehabilitation.
Participants: 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.
90
Cognitive assistive technology and ADHD: an evaluation
Participants: Helena Lindstedt, Õie Umb-Carlsson
The aim is to develop new forms of assistance in daily life settings for people with ADHD
(Attention-Deficit/Hyperactivity Disorder). Evaluated project activities concern the effective use of
assistive technology at home, at work and in educational settings as well as in terms of target group,
professional and proxy experiences (n=19).
Environmental help or hindrance?
Participants: Helene Lidström, Gunnel Janeslätt, Päivi Adolfsson, Ingvor Pettersson, Liselotte
Norling Hermansson
Cognitive assistive technology (CAT) prescribed to people with mental/ neuropsychiatric disabilities
are not used as intended. The aim is to clarify the detailed methodology of the prescribing process of
CAT. What environmental factors constitute help or hindrance for individual use and perceived
utility of CAT for the target group? Advisory group of four CAT users contribute to the research
methodology. Forty-five CAT users answer study-specific questionnaires on environmental factors
and time-management. A sample (10-15) of CAT users are interviewed about their experiences of
how environmental factors influence their use and utility of electronic planning devices.
Evaluation of individual treatment goals for people with mental disabilities
Participant: Helena Lindstedt
The aim is to evaluate the outcomes of four evidence based methods (Single System Design, Goal
Attainment Scaling, Cognitive assistive devices and Motivational Interviewing) implemented in
regular practice in a municipality based service setting.
Stroke patients' experiences and opinions of care and rehabilitation.
Participants: Kjerstin Larsson, Õie Umb-Carlsson, Karin Sonnander
The aim is to analyze qualitative text, i.e. patients’ comments, in follow up questionnaires from the
National Qualitative Register of care and rehabilitation (RiksStroke).
In-service training and implementation of evidence based practice in a
multi-professional specialized habilitation setting
Participants: Mia Pless, Karin Sonnander
The aim is to describe and analyze staff’s experiences of barriers and facilitators in evidence based
practice following a three-year systematic in-service training program (n=143).
Aided communication between persons with Rett syndrome and their
interaction partners
Participants: Helena Wandin, Per Lindberg, Karin Sonnander
The aim is to increase the knowledge of aided communication intervention targeting people with
Rett syndrome. The different studies aim at 1) examining Swedish speech and language pathologist's
experiences of communication intervention, especially aided communication intervention provided
to persons with Rett syndrome 2) examining how interaction partners assess aided communication
and if the assessment differ according to relation to the individual with Rett syndrome 3) evaluating
an aided communication intervention targeting the social network of persons with Rett syndrome.
91
Returning to work after stroke
Participants: Gunilla Eriksson, Therese Hallman, Ulla Johansson, Annie Hansen-Falkdal, Birgitta
Bernspång, Elin Ekbladh, Birgitta Svensson, Karin Sonnander
The purpose of the project is to develop an evidence-based client-centered intervention programme
addressing return to work after stroke and evaluate the effect of and the experiences of participating
in the intervention programme.
Importance of personal assistance financed by the Swedish social
insurance for meeting national health objectives for men and women with
serious functional impairment
Participants: Ieva Reine, Heléne von Granitz, Edward Palmer, Karin Sonnander
The aim of this project is to analyze the significance of the state assistance benefit for the well being
and health of people with state personal assistance. A direct relationship is drawn to the public health
objectives and the project is conducted with a gender perspective. The study will be based on cohorts
from 2010 to 2014 and contains a large number of analysis variables, such as demographic and
health variables, including health-related selection, participation and empowerment, labor market
participation and economic factors. Identification of the mechanisms that explain the relationship
between personal assistance and self-perceived health is central to the analysis.
Clinical Assessment and Documentation
Professional decision making in healthcare as well as social welfare services is laden with risk and
uncertainty, when assessment is not systematic or a standardized clinical terminology shared by
professionals involved is lacking. Present studies concern adaptation and clinical application of
assessment instruments of the home environments of children, an international standard language
and framework for the description of health and health-related issues (ICF), and multi-professional
use of the electronic health record system.
The HOME Inventory, Home Observation for Measurement of the
Environment - A Swedish Adaptation
Participants: 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).
Parents' use of ICF and ICF-CY when reporting on focus in habilitation
services for their children with developmental disabilities
Participants: 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 of the ICF model and with
questions concerning identification, goal setting and intervention of function and health.
92
Prevalence of psychosocial factors in ICF categories in a tertiary Swedish
Pain Clinic.
Participants: Kjerstin Larsson, Ruth Kusec Fredriksson, Carl Molander
The aim is to investigate the prevalence of ICF categories in social worker evaluation of chronic pain
patients in a Swedish tertiary pain clinic setting.
The electronic health record system: professional use and patient safety
Participants: Annika Terner, Helena Lindstedt, Karin Sonnander
The aim of this thesis is to investigate health professional documentation, inter-professional use and
patient safety by studying a multi-professional 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.
The Perspectives of Persons with Disabilities in Theory and Practice
Recent decades have seen a growing emphasis, in a number of contexts, on acknowledging and
acting on the views of people with disabilities. This trend was given added weight by the UN
Convention on the Rights of Persons with Disabilities, ratified in 2008. Studies focus quality of life
from the perspectives of persons with intellectual disabilities and a participatory research approach.
Men and women with intellectual disabilities and quality of life
Participants: 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).
People with intellectual disabilities as participants in the research process
Participant: 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.
Other
The concept of successful aging from the perspective of elderly men
Participants: Õie Umb-Carlsson, Birgitta Rosberg, 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.
93
Using motivational interviewing to support the use of safer sex
Participants: Eva Lejelind, Kjerstin Larsson
The aim is to develop new procedures to inform people about condom use and study whether a
motivational interviewing approach when informing about condoms and the practice of safer sex
would increase condom use among visitors to a clinic for sexually transmitted infections (STI).
94
Family Medicine and Preventive Medicine
Research Group Leader Per Kristiansson, MD, PhD, Lecturer
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. In the
research programme the focus is on patient-centred research, using clinical as well as
epidemiological techniques. We also pay special attention on social insurance medicine to identify
factors that will help long-listed individuals return to working life, assessing the efficacy of various
innovative return-to-work strategies.
The research within preventive medicine addresses mechanisms of social inequalities in health,
theories of the life course approach in current epidemiology, 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, and the feasibility and efficiency of interventions.
A common theme for the stress research is enhancing the scientific understanding of risk- and
resiliency factors, including bio-psycho-social mechanisms, of relevance for sustained and equitable
occupational and social health and wellbeing. Research includes effective use of health care
resources, and its implications for major health care stakeholders, including patients, staff, and thirdparty payers.
Research supervisors:
Mansour Alemi
Åsa Andersén
Dan Andersson
Ingrid Anderzén
Malin André
Bengt Arnetz
Judith Arnetz
Annika Bardel
Karin Björkegren
Stefan Blomberg
Johan Bogefeldt
Kristina Bröms
Gunilla Burell
Jan Cederholm
Lars Englund
Sevek Engström
Margaretha Eriksson
Marie Grunnesjö
Mats Gulliksson
Christina Halford
Johan Hallqvist
Björn Hallström
Anna Hofsten
Sara Holmberg
Gunnar Johansson
Associate researcher, PhD, Faculty of Medicine
Research assistant, RN, Master in Public Health
Associate researcher, postdoc, MD, PhD
Researcher, PhD, Faculty of Medicine
Associate researcher, MD, PhD
Professor, MD, PhD
Associate professor, PhD
Associate lecturer, postdoc, MD, PhD
Lecturer, MD, PhD
Postdoc, MD, PhD
Postdoc, MD, PhD
Senior researcher, Psychologist, PhD
Associate professor, MD, PhD
Postdoc, MD, PhD
Postdoc, PhD, dentist
Researcher, postdoc, PhD, Faculty of Medicine
Postdoc, PhD, Faculty of Medicine
Postdoc, MD, PhD
Postdoc, MD, PhD
Professor, MD, PhD
Associate researcher, lecture, MD, licentiate
Postdoc, MD, PhD
Adjunct professor, MD, PhD
95
Lena Kallings
Per Kristiansson
Kjerstin Larsson
Anna Liljestam Hurtigh
Karin Lisspers
Monica Löfvander
Gunilla Norrmén
Lena Olai
Magnus Peterson
Carina Pettersson
Nils Rodhe
Åke Schwan
Carina Seidel
Jan Stålhammar
Björn Ställberg
Kurt Svärdsudd
Malin Swartling
Petra Vogt
Rolf Wahlström
Mari-Ann Wallander
Thorne Wallman
Clairy Wiholm
Ture Ålander
Visiting teacher, postdoc, Doctor of Medical Science
Associate professor, MD, PhD
Researcher, PhD, Faculty of Medicine
Research assistant, Master in Education
Postdoc, MD, PhD
Postdoc, RN, PhD, Faculty of Medicine,
Postdoc, MD, PhD
Research assistant, Physiotherapist
Postdoc, MD, PhD
Professor emeritus, MD, PhD
Postdoc, MD, PhD
Associate professor, Epidemiologist, PhD, Faculty of Medicine
Associate lecturer, postdoc, MD, PhD
Associate researcher, PhD
Postdoc, MD, PhD
Doctorial students:
Anne Björk
Charlotte Björkenstam
Emma Björkenstam
Anders Carlberg
Lars Carlsson
Anna-Sophia von Celsing
Frida Fröberg
David Hallman
Stefan Jansson
Bo Karlsson
Kyriaki Kosidou
Anne Lindgren
Lena Lundholm
Linda Lännerström
Mats Martinell
Elisabet Sundgren
Eva Thorell
Thomas Torstensson
Keld Vaegter
PhD student, MD
PhD student, BSc
PhD student, BSc
PhD student, Psychotherapist
PhD student, MD
PhD student, MD
PhD student, BSc
PhD student, Master of Science in Psychology
PhD student, MD
PhD student, MD
PhD student, MD
PhD student, Physiotherapist
PhD student, BSc
PhD student, RN
PhD student, MD
PhD student, RN
PhD student, MD
PhD student, Physiotherapist
PhD student, MD
External:
Kerstin Ekberg, Professor, Psychologist, Department of Medical and Health Sciences, Linköping
University
Anna Finnes, psychologist, Uppsala University Hospital
Lars Frimanson, PhD, lecturer, Department of Business Studies, Uppsala University
Hikmet Jamil, Professor, Wayne State University
Lena Hillert, PhD, Associate Professor, Karolinska Institutet
96
Anna Höglund, PhD, Associate Professor, Centre for Research Ethics & Bioethics, Dept of Public
Health and Caring Sciences
Thomas Karlsson, PhD student, Centre for Musculoskeletal Research, University of Gävle,
Niels Kuster, PhD, Professor, ITIS Foundation, Switzerland
Per Lindberg, lecturer, Associate Professor, Centre for Musculoskeletal Research, University of
Gävle,
Mark Lumley, PhD, Professor, Wayne State University
Carina Lundeén, psychologist, Uppsala University Hospital
Eugene Lyskov, PhD, Associate Professor, College of Gävle
Per Lytsy, MD, PhD, Sociomedical epidemiology, Dept of Public Health and Caring Sciences
Anna Löfgren, psychologist
Johan Lökk, MD, PhD, Associate Professor, Karolinska Institutet
Arne Loweden, PhD, Assistant Professor, University of Stockholm
Scott Moffat, PhD, Associate Professor, Wayne State University
Linnea Molin, psychologist, Uppsala University Hospital
Nnamdi Pole, Associate Professor, Smith College
Douglas Ruden, Associate Professor, Wayne State University
Weisong Shi, PhD, Professor, Wayne State University
Christian Ståhl, PhD, Department of Medical and Health Sciences, Linköping University
Eva Toreberg, physiotherapist, Uppsala University Hospital
Carina Wennman, psychologist
Ulrika Winblad, Associate Professor, Health Services Research, Dept of Public Health and Caring
Sciences
Eva Vingård, MD, Professor
Ragnar Westerling, MD, Professor, sociomedical epidemiology, Dep of Public Health and Caring
Sciences
Annica Åbrink, occupational therapist, Uppsala University Hospital
Torbjörn Åkerstedt, PhD, Professor, University of Stockholm
1)
Articles from former Family Medicine and Clinical Epidemiology
2)
Articles from former Preventive Medicine
3)
Articles from former Social Medicine
2012
1. 1)
Andersson SO, Björkegren K, Foldevi M, Lindgren S, Rödjer S, Seeberger A, Troein
Töllborn M, Wahlqvist M. Professionell utveckling inom läkaryrket. Liber, 306s. Stockholm
2012. ISBN 978-91-47-09967-2. [Chapter in book]
2. 1)
Andre M, Anden A, Borgquist L, Rudebeck CE. GPs' decision-making: perceiving the
patient as a person or a disease. BMC Fam Pract 2012;13:38-
3. 3)
Arfken CL, Jamil H, Arnetz BB. Marijuana and non-medical prescription drug use among
immigrant Arab Americans. New Iraqi Med J 2012;8:7-13
4. 3)
Arnetz B, Drutchas A, Sokol R, Kruger M, Jamil H. Gulf War exposures and pregnancy
outcomes: A retrospective study of Iraqi immigrants. American Journal of Obstetrics and
Gynecology 2012;206:S261-S262.
5. 1)
Arvidsson E, André M, Borgquist L, Andersson D, Carlsson P. Setting priorities in primary
health care - on whose conditions?: A questionnaire study. BMC Fam Pract 2012; 13:114-
97
6. 1)
Berglund L, Berne C, Svärdsudd K, Garmo H, Melhus H, Zethelius B. Seasonal variations
of insulin sensitivity from a euglycemic insulin clamp in elderly men. Ups J Med Sci 2012;
117(1):35-40.
7. 2)
Björkenstam E, Hallqvist J, Dalman C, Ljung R. Risk of new psychiatric episodes in the
year following divorce in midlife: Cause or selection? A nationwide registerbased study of
703,960 individuals. Int J Soc Psychiatry 2012; publ Oct 15.
8. 2)
Björkenstam E, Ljung R, Burström B, Mittendorfer-Rutz E, Hallqvist J, Weitoft Ringbäck
G. Quality of medical care and excess mortality in psychiatric patients: a nationwide
register-based study in Sweden. BMJ Open 2012;1(2):e000778-
9. 1)
Bröms K, Norbäck D, Sundelin C, Eriksson M, Svärdsudd K. A nationwide study of asthma
incidence rate and its determinants in Swedish pre-school children. Eur J Epidemiol
2012;27(9):695-703.
10. 1)
Carlsson R, Burell G, Hambraeus K, Johansson P, Lisspers J, Perk J. The challenge of
lifestyle counselling after percutaneous coronary intervention. Congress of the EuropeanSociety-of-Cardiology (ESC), AUG 25-29, 2012, Munchen, GERMANY.
11. 1)
Cea-Soriano L, Wallander MA, Garcia Rodriguez LA. Epidemiology of Meningioma in the
United Kingdom. Neuroepidemiology 2012;39(1):27-34.
12. 1)
Cea-Soriano L, Blenk T, Wallander MA, García Rodríguez LA. Hormonal therapies and
meningioma: is there a link? Cancer epidemiol 2012;36(2):198-205.
13. 1)
Cederholm J, Gudbjornsdottir S, Eliasson B, Zethelius B, Eeg-Olofsson K, Nilsson PM.
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104. 1) Kiotseridis H, Bjermer L, Pilman E, Ställberg B, Svensson K, Romberg K, Tunsäter A.
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105. 1) Kindblom-Rising K, Wahlstrom R, Nilsson-Wikmar L, Buer N. Nursing staff's movement
awareness, attitudes and reported behaviour in patient transfer before and after an
educational intervention. Applied Ergonomics 2011;42(3):455-63.
106. 2) Kosidou K, Dalman C, Lundberg M, Hallqvist J, Isacsson G, Magnusson C. Socioeconomic
status and risk of psychological distress and depression in the Stockholm Public Health
Cohort: A population-based study. J Affect Disord 2011;134(1-3):160-67.
107. 3) Lowden A, Åkerstedt T, Ingre M, Wiholm C, Hillert L, Kuster N, Nilsson JP, Arnetz B.
Sleep after mobile phone exposure in subjects with mobile phone-related symptoms.
Bioelectromagnetics 2011;32:4-14.
108. 1) Lytsy P, Burell G, Westerling R. How do prescribing doctors anticipate the effect of statins?
J Eval Clin Pract 2011;17(3):420-28.
104
109. 1) Lytsy P, Burell G, Westerling R. Cardiovascular risk factor assessments and health
behaviours in patients using statins compared to a non-treated population. Int J Behav Med
2011;(Apr 15).
110. 1) Lännerström L, Wallman T, Söderbäck M. Nurses' experiences of managing sick-listing
issues in telephone advisory services. In 17th Nordic Congress of General Practice.
Tromsö, Norway. 2011.
111. 2) Macassa G, Hallqvist J, Lynch JF. Inequalities in child mortality in Subsaharan Africa: a
social epidemiologic framework. African J Health Sci 2011;18(1-2):14-26.
112. 3) Maghout Juratli S, Janisse J, Schwartz K, Arnetz BB. Demographic and lifestyle factors
associated with perceived stress in the primary care setting: a MetroNet study. Fam Pract
2011;28:156-62.
113. 2) Manrique-Garcia E, Sidorchuk A, Hallqvist J, Moradi T. Socioeconomic position and
incidence of acute myocardial infarction: a meta-analysis. J Epidemiol Community Health
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114. 1) Nilsson PM, Cederholm J. Diabetes, hypertension, and outcome studies: overview 2010.
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115. 1) Nilsson PM, Cederholm J, Zethelius B, Eliasson B, Eeg-Olofsson K, Gudbjornsdottir S.
Trends in blood pressure control in patients with type 2 diabetes - Data from the Swedish
National Diabetes Register (NDR). Blood Pressure 2011;20(6):348-54.
116. 1) Peterson M, Butler S, Eriksson M, Svärdsudd K. A randomized controlled trial of exercise
versus wait-list in chronic tennis elbow (lateral epicondylosis). Ups J Med Sci
2011;116(4):269-79.
117. 2) Pyshchyta G, Mukamal KJ, Ahnve S, Hallqvist J, Gémes K, Ahlbom A, Janszky I. Tea
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SHEEP study. Clin Nutr 2012;Apr 31(2):267-72 [Epub 2011 Nov 8].
118. 2) Rajaleid K, Janszky I, Hallqvist J. In defense of "biological interaction". Epidemiology
2011;22(2):151-52.
119. 2) Rajaleid K, Janszky I, Hallqvist J. Small birth size, adult overweight, and risk of acute
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120. 1) Ruigomez A, Hungin AP, Lundborg P, Johansson S, Wallander MA, Rodriguez LAG.
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chronic obstructive pulmonary disease in a primary care population with respiratory
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105
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146. 1,3) Halford C, Ekselius L, Anderzen I, Arnetz B, Svärdsudd K. Self-rated health, life-style, and
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147. 3) Hasson H, Arnetz JE. A comparative study of nursing staff, care recipients and their
relatives’ perceptions of quality of older people care. Int J Older People Nurs 2010;5:5-15.
148. 1) He J, Ma XQ, Zhao YF, Wang R, Yan XY, Yan H, Yin P, Kang XP, Fang JQ, Hao YT et al.
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149. 1) Hedin K, Andre M, Håkansson A, Mölstad S, Rodhe N, Petersson C. Infectious morbidity in
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150. 1) Hofsten A, Gustafsson C, Häggström E. Case seminars open doors to deeper understanding:
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151. 1) Holmberg SAC, Thelin AG. Predictors of sick leave owing to neck or low back pain: a 12year longitudinal cohort study in a rural male population. Ann Agric Environ Med
2010;17:251-57.
152. 2) Hultin H, Hallqvist J, Alexanderson K, Johansson G, Lindholm C, Lundberg I, Möller J.
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153. 3) Höglund AT, Winblad U, Arnetz BB, Arnetz JE. Patient participation during hospitalization
for myocardial infarction: perceptions among patients and personnel. Scand J Caring Sci
2010;24:482-89.
154. 3) Jamil H, Campbell-Voytal K, Arnetz JE. Perceptions of training in occupational and
environmental medicine among family medicine residents. J Occup Environ Med
2010;52(2):202-06.
155. 3) Jamil H, Elsouhag D, Spencer H, Arnetz JE, Arnetz BB. Sociodemographic risk indicators
for hookah smoking among White Americans : a pilot study. Nicotine Tob Res 2010;12:52529.
107
156. 3) Jamil H, Nassar-McMillan S, Lambert R, Wang Y, Ager J, Arnetz BB. Pre- and postdisplacement stressors and time of migration as related to self-rated health among Iraqi
immigrants and refugees in Southeast Michigan. Medicine, Conflict and Survival
2010;26:207-22.
157. 3) 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. J Immigrant & Refugee Studies 2010;8:431-44.
158. 2) 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
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159. 1) 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.
160. 1) 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):551-56.
161. 1) 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):223-32.
162. 1) Kallings LV, Hellénius M-L. Mindre stillasittande och mer fysisk aktivitet bra för hälsan.
Läkartidningen 2010;107(36):2090-95.
163. 1) Kallings LV. Fysisk aktivitet på recept (FaR) en fungerande metod! . Svensk Idrottsmedicin
2010;1:29-31.
164. 1) Kallings LV. Fysisk aktivitet på recept i Norden: erfarenheter och rekommendationer
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165. 1) 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
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166. 1) 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):263-73.
167. 2) 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].
168. 2) 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
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169. 1) 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
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170. 1) 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.
171. 3) Lucas T, Lakey B, Arnetz J, Arnetz B. Do ratings of African-American cultural competency
ratings reflect characteristics of providers or perceivers? Initial demonstration of the
generalizability theory approach. Psychol Health Med 2010;15:445-53.
108
172. 1) Lytsy P, Burell G, Westerling R. Views on treatment necessity, harm, and benefits in
patients using statins. Medical decision making 2010;30(5):594-609.
173. 3) Lytsy P, Hansson A-S, Anderzén I. Returning to work after long-term sick leave is possible.
Results from a cooperative project between health services and the Swedish Social
Insurance Agency]. Läkartidningen 2010;107(22):1480-82.
174. 3) Maghout-Juratli S, Janisse J, Schwartz K, Arnetz BB. The causal role of fatigue in the
stress-perceived health relationship: a MetroNet study. J Am Board Fam Med 2010;23:21219.
175. 2) Mansdotter 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;31(3):324-41.
176. 1) 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.
177. 1) 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.
178. 1) 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.
179. 1) 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):611-22.
180. 2) 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;38(8):889-92.
181. 1) 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):118-27.
182. 1) 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. Scand J Prim
Health Care 2010;28(2):76-81.
183. 1) Olesen HV, Pressler T, Hjelte L, Mared L, Lindblad A, Knutsen PK, Laerum BN,
Johannesson M. Gender Differences in the Scandinavian Cystic Fibrosis Population.
Pediatric Pulmonology 2010;45(10):959-965.
184. 1) 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.
185. 1) 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.
186. 1) 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.
187. 1) 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.
109
188. 1) 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. Respir Med
2010;104(11):1691-99.
189. 1) 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):814-21.
190. 1) 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):139-46.
191. 1) 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.
192. 1) 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.
193. 1) 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.
194. 1) 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
Obstet Gynecol Scand 2010;89(9):1140-48.
195. 1) 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. Ups J Med Sci 2010;115(4):238-44.
196. 1) Wallman T, Svärdsudd K. Do disability pensioners have a higher mortality rate than nonpensioners? Adjusting for potential confounding: A commentary on Hult, Stattin, Janlert
and Jarvholm. Soc Sci Med 2010;70(10):1487-88.
197. 1) Varelogianni G, Oliynyk I, Roomans GM, Johannesson M. The effect of N-acetylcysteine
on chloride efflux from airway epithelial cells. Cell Biol Int 2010;34(3):245-52.
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Dissertation 2012
Engström Sevek. Dental health care cooperating with primary health care as a resource in early
case finding of patients with diabetes or hypertension. Medical sciences. Uppsala University, 2012.
Agencies that support our work/Funding 2012
Uppsala County Council (ALF)
2 240 000
The Swedish Social Insurance Agency
2 000 000
2 920 000
AFA
130 000
REHSAM
2 700 000
110
ArbetsRehab -- Organization for Financial Coordination Uppsala County
2 970 000
The Royal Foundation of Sweden (Kungafonden)
1 400 000
The Swedish Research Council (Impact of Religion Program,
Program Leader, The Swedish Council for Working
Life and Social Research)
2 100 000
The Municapility of Södertälje
2 100 000
Education
Medical Programme - Professional Development
Annika Bardel, responsible for training of student tutors
Karin Björkegren, responsible for terms 1 and 2 and director of undergraduate studies
Bo Karlsson, responsible for terms 3, 4 and 11
Beside the above mentioned many other members from Family Medicine and Preventive Medicine
are taking part on different educational levels:
Kristina Bröms, Gunilla Burell, Anders Carlberg, Anna-Sophia von Celsing, Sevek Engström,
Margaretha Eriksson, Christina Halford, Johan Hallqvist, Anna Hofsten, Per Kristiansson, Karin
Lisspers, Mats Martinell, Magnus Peterson, Åke Schwan, Jan Stålhammar, Björn Ställberg, Kurt
Svärdsudd, Thorne Wallman.
Research projects
Research area I:
Social Insurance Medicine
Participants: Ingrid Anderzén, Lars Englund, Johan Hallqvist, Gunilla Norrmén, Kurt Svärdsudd,
and Thorne Wallman
Regional social insurance research group in the Uppsala-Örebro region
(RUFS) (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, Uppsala and Örebro universities and one pharmacist, PhD, from Umeå University. It was
established in May 2010 and has every semester at least one full-day meeting at which regional
social insurance research is presented and discussed. Members are participating in one national
social insurance research group, SPID, with four annual meetings. The group was represented at
the 2nd Nordic Conference in work-related rehabilitation, Grenå, Denmark, September 2012 with
three posters: “Early multidiciplinary assessment resulted in longer periods of sick-leave – a
randomized controlled trial in a Primary health center” [1], “Nurses’ experiences of managing sicklisting issues in telephone advisory Services” [2], and “Early prediction of patients at risk for long
term sickness absence” [3].
111
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 in 2009 [4] and another has been submitted for publication during
2012 [5].
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
Preventive Medicine 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 [6], 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 [7]. 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 [8].
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 taken into account
[9].
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. Timedependent analysis was used in order to disclose a possible relationship to retirement [10].
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 [11]. In the
second report, patient-related medical factors and functioning were analysed [12]. 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
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[13]. 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. In the fourth report, attitudes towards statements concerning health and social
insurance matters among physicians and patients in relation to the probability of the patient being
sick-listed was analysed. 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 [14]. The project has generated one PhD thesis (Gunilla Normén
2010) [15].
Determinants for return to work among sickness certified patients in
general practice (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 be at 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. The aim of this study was to analyse
possible determinants of return to work and their relative impact. All 943 patients aged 18 to 63
years, sickness certified at this Primary Health Care Centre from January until 31 August 2004, were
followed up for three years. Baseline information on age, sex, sick leave diagnosis, extent of sick
leave, employment status, and sickness absence during the year before baseline was obtained, as was
information on all compensated days of sick leave, disability pension and death during follow-up.
The two most influential variables on return to work was sick leave because of psychiatric disease
and sick leave track record [16]. The study was presented in an oral presentation and a poster at the
2nd Nordic Conference in work-related rehabilitation, Grenå, Denmark, September 2012 [3].
We will also study whether the most important determinants for return to work may be used in a risk
assessment tool (nomogram). The results will be compared to a categorisation, performed by a team
of experienced rehabilitation professionals, considering six risk factors for long-term sickness
absence from the sickness certificate, The team categorised all sick-listed individuals into two
groups, group 1 (n=447) at high risk, and group 2 (n=496) with less risk for long-term sickness
absence.
Furthermore, the effects of the rehabilitation intervention in cooperation with primary health care,
the Swedish Social Insurance Agency, Jobseekers Agency and the County Council for Social
support, will be studied. 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).
Experiences of sick-listing – Nurses’ and patients’ participation in the
sick-listing process (I:6)
The objective of this project is to describe experiences of sick-listing from a nurse and a patient
perspective. In study I fourteen nurses working with telephone advisory services in primary health
care centres in Sweden were interviewed in groups. In the group interviews the nurses’ experiences
of managing sick-listing issues were explored. The nurses experienced stress and difficulties related
to being gatekeepers and related to the act of balancing different demands from patients, co-workers
and the organisation. The project was presented by a poster at The second Nordic conference on
work-oriented rehabilitation, in September 2012 in Grenå, Denmark (Abstract) [2] and has generated
one published article [17]. Sixteen people on long-term sick-leave were interviewed individually in
study II. Findings revealed that the participants’ experienced that their life-worlds were radically
changed when they became sick-listed. They described losing their independence in the process of
stepping out of working society, attending the mandatory steps in the rehabilitation chain and having
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numerous encounters with professionals. The most conspicuous findings were the fact that stopping
working brought with it so many changes, the participants’ feelings of powerlessness in the process,
and their experiences of offensive treatment by and/or encounters with professionals. The article is
submitted for publication [18]. The project is generating one PhD thesis (Linda Lännerström).
Factors among doctors, and patients affecting the risk of long-term sick
leave periods, and effect 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 “regular care”, which did 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. One article is under review. This
project was also presented by a poster at 2nd Nordic Conference in Occupational Rehabilitation,
Grenå, Denmark, in September 2012 [1] and one submitted article under review [19].
In another project data on GP´s perception of sick leave assignment are being analyzed. Data were
gathered through qualitative focus group interviews. The project is generating one PhD thesis (Lars
Carlsson).
Absenteeism and Return to Work -- Social Medicine (I:8)
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.
“SAMKLANG” – In Co-operation – Acceptance, motivation and return to
work among long-term sick listed (I:9)
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 study is to find factors that predict
return to work for those individuals that had been on a long term sick leave. A Psychologist has
treated sixty participants on long term sick leave with Acceptance and commitment therapy (ACT)
during three months. After one year 68% of the participants are ready to return back to work or
studies. Participants that had return to working life were interviewed and will result in one article.
Participants in the project are Ingrid Anderzén, Anna Liljestam Hurtigh, Anna Finnes, and Annica
Åbrink.
VITALIS – An RTC study to support women on long term sick leave to
return to working life through ACT or Team evaluation (I:10)
This project started as 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 were during 2010 diagnosed with psychological problems,
such as depression, anxiety and stress related symptoms, and/or chronic pain. The overall aim with
this project was 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 data collection will be completed in 2013. Approximately 400 women on long term
sick leave due to pain, stress, depression and/or anxiety symptoms, identified by the National
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Insurance Agency in Uppsala County were randomized into one out of three conditions. One as a
multimodal team assessment and intervention, one with a home based internet supported unimodal
psychological intervention (Acceptance and Commitment Therapy) and one condition as a treatment
as usual (TAU) intervention. The project will evaluate the long term effects (after one, and after two
years) of those two different rehabilitation packages: multidisciplinary team assessment/intervention
and CBT/ACT home based/internet treatment as compared to TAU. The one year follow-up data
collection is completed and the two year data collection is on-going. The evaluation of the project is
receiving financial support from Rehsam. Participants in the project are Ingrid Anderzén, Åsa
Andersén, Anna Finnes, Anna Liljestam Hurtigh, Carina Lundeén, Per Lytsy, Linnea Molin, Eva
Toreberg, Ragnar Westerling, and Annica Åbrink.
DIRIGO – “latin word for I drive” (I:11)
Dirigo is an ongoing project funded by The European Social Fund (ESF) and is operated by The
Social Insurance Office, in co-operation with The Public Employment Service and the municipality,
in parts of Stockholm. Participants in the project are sick listed individuals, young individuals with
activity compensation from The Social Insurance Office and individuals that receive their
compensation through their local municipality. About 1800 individuals will participate in the project.
The overall aim with the project is to support and strengthen the individual and its view on their
work capacity to return to/come closer to the labour market/employment. Together with the
Linköping University we evaluate the project both with quantitative measurements (data from
registry and questionnaires) and qualitative measurements during open ended interviews and focusgroups with service users and professionals working in the area of vocational rehabilitation. The
project started 2012 and will be completed in 2014. Participants in the evaluation process are Ingrid
Anderzén, Åsa Andersén Kerstin Ekberg, Kjerstin Larsson, Christian Ståhl, and Eva Vingård.
UMiA - Youth Mobilization for Working Life (I:12)
The project ”UMiA” is founded by the European Social Fund (ESF) and is operated by The Social
Insurance Office in Stockholm. The aim of the project is to develop, and evaluate different methods
and interactions in order to support and enhance the ability for young individuals with disabilities to
increase their work or study capacity. About 900 individuals, age 19-29 years will participate in the
project.
We evaluate the project and the evaluation consists of both quantitative measurements (data from
registry and questionnaires) and an on-going evaluation (qualitative) with service users and
professionals working in the area of vocational rehabilitation perspective. UMiA started 2013 and
will be completed in 2014. Participants in the evaluation process are Ingrid Anderzén, Åsa Andersén
Kjerstin Larsson, and Eva Vingård.
Research area II:
Musculo-skeletal disorders
Participants: Karin Björkegren, Stefan Blomberg, Johan Bogefeldt, Marie Grunnesjö, Per
Kristiansson, Magnus Peterson, 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
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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 [23, 24].
In the Gotland study pain drawings were tested for their clinical value as predictors of pain course
[25], the nomenclature used by different categories of physicians for the same pain condition were
described [26, 27] and the effect on health-related quality of life [28]. The project has generated
three PhD theses (Stefan Blomberg 1993 [23], Johan Bogefeldt 2009 [29] and Marie Grunnesjö 2011
[30]). 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 outcomeaffecting 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 [31, 32]. The project
has generated one PhD thesis (Johan Bogefeldt 2009 [29]) 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 parts: 1) An epidemiologcial study
of treatment methods in primary health care, 2) A randomized controlled trial of different types of
graded exercise as treatment for this condition and 3) an experimental study investigate the
pathophysiology of the condition by imaging methods.
The first part 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 [33].
The second part 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-and-see has been published
[34]. A manuscript on eccentric versus concentric exercise is submitted [35].
The third part was fulfilled by positron emission tomography (PET) of physiological processes
associated with pain in the peripheral painful tissue of the healthy compared to the affected elbow.
The PET scan data have been analysed in cooperation with the Uppsala PET-centre and a manuscript
has been submitted. The project has generated one PhD thesis (Magnus Peterson [36]) and has
received financial support from the Medical Research Council, the Amersham Fund, the General
Medicine Fund and Uppsala University.
The PET-project is currently expanded to involve imaging of more and new mechanisms in the
peripheral tissue. The research group at Uppsala PET-centre has been expanded and an application
for ethical approval is in progress.
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Cognitive behavioural therapy in fibromyalgia (II:4)
This project, which is being performed in collaboration with 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 women with a fibromyalgia diagnosis in Mid-Sweden 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 has been analysed. The project is generating one PhD
thesis (Bo Karlsson) and is supported by grants from the Söderström-Königska Foundation, the
Swedish Rheumatism association, the Swedish Social Insurance Agency, Uppsala County Council
and Uppsala University. The funding authorities had no influence on the design and performance of
the study.
Persistent pregnancy-related low back and pelvic pain (II:5)
Pregnancy-related low back and pelvic pain is a common complaint described by women all over the
world. The severity of pain varies from mild discomfort to severely debilitating pain. In most
women, the back pain disappears within six month after delivery, although in several instances
disabling back pain persists many years after delivery. Almost 1 of 10 women still experienced
disabling daily low back and pelvic pain 2 years after childbirth with high impact on the individual,
family, and society. On spite of this, the sources of pain and effective treatment are uncertain.
In a randomized double blind controlled clinical trial the purpose was to evaluate the pain relief
effect of locally injected corticosteroid treatment in women with persistent pregnancy-related low
back and pelvic pain. Thirty-six women were allocated to injection treatment, with slow-release
triamcinolone and lidocaine or saline and lidocaine, given at the sacrospinous ligament insertion on
the ischiadic spine bilaterally with 4 weeks follow-up time.
The corticosteroid treatment group has significantly reduced pain intensity, number of pain
locations, and pain-provoking test results between baseline and follow-up as compared with the
saline treatment group [37]. Beside this, the corticosteroid group has significantly improved
disability rating index, gait speed and endurance and strength and endurance of trunk muscles [38].
The anatomic region around the sacrospinous ligament insertion on the ischial spine is suggested to
be one source of persistent pregnancy-related low back and pelvic pain. A half-time review was done
in 2011 [39]. The project was appointed as a key note presentation given by the project leader Per
Kristiansson at the 7th Interdisciplinary World Congress on Low Back & Pelvic Pain in Los Angeles
2010 [40], is generating two PhD theses (Thomas Torstensson and Anne Lindgren) and is receiving
financial support by grants from the Västernorrland County 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 [41].
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Research area III:
Asthma, allergy and COPD
Participants: 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 [42]. 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.
The first results from the questionnaire are focused on providing reliable age and sex-specific
prevalence. There are several earlier studies but they are 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 physician-neutral 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 [43]. 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 [44]. A
fourth publication is submitted in which the asthma incidence is estimated [45]. The project has
generated one PhD thesis (Kristina Bröms 2010 [46]) 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 [47].
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 [47].
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 [48]. A third report has been published showing a strong association between
perceived quality of life and the asthma disease control [49].
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 [50].
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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 [51].
The project was led by Gunnar Johansson, has generated three PhD theses (Mikael Hasselgren 2006
[52], Karin Lisspers and Björn Ställberg in 2008 [53, 54]) and has received financial support from
the county councils of the Uppsala-Örebro Region, and Uppsala University. The study has now been
concluded.
Asthma during childhood and adolescence (III:3)
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 follow-up study
demonstrated that many adolescents with current asthma do not achieve asthma control. One reason
might be under-treatment with inhaled corticosteroids. This study was part of Björn Ställberg’s
dissertation; he is the project leader [55]. The project was supported by Sörmland’s county council.
The Praxis-study asthma/COPD (III:4)
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.
Several 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
[56]. The second evaluated how often a diagnosis of COPD was confirmed with spirometry [57].
The third report has evaluated the associations of comorbidity and body mass index with quality of
life in COPD [58]. A fourth report about sex-related differences in asthma was part of Karin
Lisspers’ dissertation [53]. A fifth report regarding dyspnea. obstruction, smoking and exacerbations
(DOSE index) and mortality has been published [59]. A sixth report about quality of life in COPD
(CCQ) and mortality has been published (Sundh et al) and a seventh about exacerbations in COPD
has been submitted (Sundh et al). A follow-up investigation has been started in 2012 with new
longitudinal data from the cohort of asthma and COPD patients from 2005. 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, Uppsala-Örebro
Regional Research Council, the Swedish Heart and Lung Association, the Swedish Asthma and
Allergy Association, the Bror Hjerpstedt Foundation, Uppsala, and Uppsala University. A
predoctoral student, Anna Ericson, has started to work with the asthma part of the PRAXIS-study in
2012.
International research collaboration in asthma and COPD in primary care
(III:5)
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) [60]. A publication about the needs of prioritising respiratory research
in primary care has also been published [61]. They are also involved in an international research
project comparing the management of COPD in primary care in different countries, the UNLOCK
study [62]. A manuscript about a comparison of COPD patients in large clinical trials and COPD
patients attending primary care has been submitted [63].
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The physicians’ actions in the management of COPD (III:6)
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). One publication has been
published from this research collaboration [64].
Validation study (III:7)
Björn Ställberg, in collaboration with researchers at the Karolinska Institute, has published a
validation study of the Clinical COPD Questionnaire (CCQ) in primary care [65].
COPD rehabilitation study (III:8)
Björn Ställberg and Karin Lisspers have members in the steering committee of a national
investigation of resourses for rehabilitation in COPD. A first paper has been submitted [66].
Clinical trials (III:9)
Björn Ställberg has been involved as coordinator in two clinical trials in asthma and COPD
respectively [67, 68].
Björn Ställberg was a member in the steering committee for a study about treatment of rhinosinuites, the SOSAR-study [69].
Karin Lisspers was a member of the steering committee for a study regarding screening for COPD,
the DETECT-study [70].
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
an 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 [71]. The project is being led by Gunnar Johansson and
Kjell Alving and has received 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 anti-inflammatory
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
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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:11)
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 has been
extracted anonymously from electronic patient records in primary care. By extraction of data from
80 primary health care centres data were obtained on approximately 25,000 patients. In addition,
data regarding morbidity and mortality has been collected from the Hospital Discharge Register
(Slutenvårdsregistret) and the Cause of Death Register and information on prescribed drugs was
collected from the Prescription Register. Data on social-economic status has also be collected from
Statistics Sweden (SCB). The merging of data has been performed by the National Board of Health
and Welfare. The software program Pygargus Customized eXtraction Program (CXP) was 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
R03 (pharmaceuticals for obstructive lung diseases). The social security number of identified
patients was immediately replaced with a study ID-number for further anonymous processing of
data. No identification of patients is 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. Abstracts for congresses have been presented and the first article has been accepted for
publication in Journal of Internal Medicine: Combination of budesonide/formoterol more effective
than fluticasone/salmeterol in preventing exacerbations in chronic obstructive pulmonary disease.
The PATHOS study. (Kjell Larsson, Christer Janson, Karin Lisspers, Leif Jørgensen, Georgios
Stratelis, Gunilla Telg, Björn Ställberg & Gunnar Johansson). Doi: 10.1111/joim.12067.
Research area IV:
Utilisation of pharmaceuticals
Participants: 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 [72]. In a second report the use of hormone
replacement therapy at menopaus and symptoms reported by users and non-users was presented [73].
In a third report adherence to the prescribed drug and its determinants were presented [74].
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 [75]. Symptom reporting has now been 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. We have now examined the relationship between 30 symptoms reported
by men and women and have presented this in Sörmland county R&D 2011 and 2012. We intend to
examine the relationship between symptom reporting among men and women and their sick-listing,
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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 [76]), and is
receiving financial support by 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 [77].
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 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 [78].
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 [79-81], diabetes
[82], gastroesophageal reflux disease and irritable bowel disorder [83] [84], reumatoid arthritis [85]
cardiovascular diseases like atrial fibrillation [86], MI [87], chest pain [88] and also studies
investigating the safety and utilization of a new statin, rosuvastatin [89, 90].
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 [91] and researchers from several Chinese
Universities [92-94].
In recent years, we have also had research collaboration with Professor John Dent, Adelaide [84,
95], 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.
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Research area V:
Cardiovascular disease and diabetes
Dan Andersson, Bengt Arnetz, Judy Arnetz, Jan Cederholm, Sevek Engström, Mats Gulliksson,
Johan Hallqvist, Gunnar Johansson, Lena Kallings, Lena Olai, Jan Stålhammar and Kurt Svärdsudd
Determinants for the survival of diabetes patients (V:1)
This project is based on the 760 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 [96] as well as a study of mortality
trends in subjects with and without diabetes during 33 years of follow up [97]. A third report will be
forthcoming studying the effect of blood pressure, anti-hypertension treatment, fasting blood glucose
and diabetes treatment on cardiovascular disease incidence. The project is being led by Dan
Andersson and Stefan Jansson, is generating one PhD thesis (Stefan Jansson) and is receiving
financial support from the Primary Health Care Research Unit, Örebro, the Örebro County Council
Research Unit, Örebro University and Uppsala University.
The Swedish National Diabetes Register (V:2)
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. About 30 articles have been published in 2002-2011, as
presented at www.ndr.nu [98-127]. 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 [115], 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 [116] and type 2 diabetes
[120], and in patients with a history of CVD in type 2 diabetes.
It has also been shown that blood pressure (BP) <140/80 mmHg strongly reduced risk of CVD,
indicating a BP treatment target well below 140 mmHg like 130-135/75 mmHg, where half of the
patients in the NDR register still have a SBR >140 mmHg. However, no significant differences in
CVD risk were seen between SBP 130-139 mmHg and 110-129 mmHg [118, 121-123, 129].
Specific statistical graphical technique was applied to illustrate in detail the variation of CVD risk
across the BP distribution [123, 129]. A BP target 130-135/75 mmHg found in the NDR is in
accordance with recent guidelines from the European Societies of Hypertension and Cardiology and
the American Diabetes Association.
Normal weight reduced risks of CHD and CVD by 15% and 22%, as compared with overweight or
obesity [111], and non-smoking at middle age reduced risks of CHD and CVD by 57% and 38%
[111].
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
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of CHD and CVD by 31% and 33%, with additive effects of HbA1c and BP on outcomes risks
[113]. High pulse pressure >75 mmHg (indirect measure of increased arterial stiffness) has been
shown as an independent risk factor for CHD and CVD [114].
Different blood lipids have been analysed for risk of CHD in type 2 diabetes, where the ratio nonHDL/HDL cholesterol was a stronger risk factor than LDL-cholesterol. With attained target value
for this lipid ratio, more improved values were found for HDL-cholesterol and triglycerides than
with attained target for LDL-cholesterol [124]. Combined analysis of blood lipids and HbA1c
showed additive effects for risk of CVD, where the ratio total-/HDL-cholesterol had a stronger
effect, although HbA1c also showed a considerable effect. The combination of the highest quartiles
of both these risk factors showed 150% higher CVD risk of CVD, compared to the combination of
the lowest quartiles of them. No increased CVD risk (no J-shaped curve) was seen at the lowest
levels of HbA1c (DCCT values 5.0-6.4%) or ratio total-/HDL-cholesterol [125].
Long-term tight control of HbA1c [108] and BP were related to low BMI, HbA1c also to nonsmoking, and BP also to absence of albuminuria [104]. 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 [102] [119]. Treatment in the early years of followup in newly diagnosed patients with type 2 diabetes has been analysed, showing an improvement in
estimated CVD risk during the last years among patients in the NDR [126].
Studies of the effect of pharmacological treatment on risk for diabetic complications have been
performed in recent years using linking with the Swedish Prescribed Drug Register [128]. Among 51
000 patients with type 2 diabetes followed for 4 years, metformin showed lower risk than insulin for
CVD and all-cause mortality and slightly lower risk for all-cause mortality compared with other
sulphonylurea. Patients with renal impairment showed no increased risk of CVD, all-cause mortality
or acidosis/serious infection. In clinical practice, the benefits of metformin use clearly outbalance the
risk of severe side effects [130].
Another study on pharmacological treatment analysed use of aspirin in patients with type 2 diabetes
and no previous cardiovascular disease in the NDR. No association was found between aspirin use
and risks of CVD or death, also when separating the patients into those with higher or lower
predicted CVR risk with use of a risk model. There was a trend towards increased risk of a
composite of bleedings associated with aspirin [131].
The association between hyperglycemia and risk for various types of cancer has been analysed in the
NDR. A cohort study on 25 000 patients with type 2 diabetes
was followed for around 10 years until 2009, with estimation of incidences of and hazard ratios for
cancer in groups categorized by HbA1c, lower <58 mmol/ mol versus higher >58 mmol/mol, by
quartiles of HbA1c, and by HbA1c continuously at Cox regression, adjusting for relevant covariates
also with use of a propensity score. There were no associations between HbA1c and risks for all
cancers or specific types of cancer in patients with type 2 diabetes [132].
Two risk models for estimation of 5-year CVD risk in type 1 diabetes or type 2 diabetes have been
published based on several cardiovascular risk factors and clinical characteristics, and both risk
models have shown good validation when applied to patients with diabetes in Sweden. These two
risk models are presented at www.ndr.nu and can be useful for diabetes care in daily clinical practice
[120, 127]. A simplified risk model for estimation of 5-year CVD risk has also been introduced for
clinical use, although less thoroughly validated [109].
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, and the Swedish Association of Local Authorities
and Regions funds the NDR.
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Real-life Effectiveness and Care Patterns of Diabetes Management –
Recap-DM (V:3)
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 [133-136]. The first study described the incidence and prevalence of T2DM [133]. The
second and third studies provided an in depth analysis of the resource use and costs of T2DM [134,
135]. In the fourth study the time to insulin treatment and factors associated with insulin prescription
are described [136]. 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 Preventive Medicine), the Karolinska
Institute (A. Ringborg, PhD, MD; the project was generating her PhD thesis) 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:4)
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 were
collected from 1994-2007 electronic patient records in public primary health care centres 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 [137]. Almost 60% of patients
experience persistent high-density lipoprotein and/or triglyceride abnormality independent of lowdensity lipoprotein levels. The project is generating one PhD thesis (Billie Pettersson, Linköping
University).
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 Preventive Medicine)
and the Karolinska Institute.
A retrospective epidemiological study to investigate outcome and
mortality with glucose lowering drug treatment in primary care - ROSE
(V:5)
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 real-life primary care
during the first ten years of the 21st century. Data has been extracted anonymously from electronic
patient records in primary care. By extraction of data from 80 primary health care centres data were
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obtained on approximately 80,000 patients. In addition, data regarding morbidity and mortality were
collected from the Hospital Discharge Register (Slutenvårdsregistret) and the Cause of Death
Register and information on prescribed drugs were collected from the Prescription Register. Data on
social-economic status were also be collected from Statistics Sweden (SCB). The merging of data
has been performed by the National Board of Health and Welfare. The software program Pygargus
Customized eXtraction Program (CXP) was 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 was 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 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 Preventive Medicine section. Data has been
presented at international diabetes congresses and publications are under progress.
Cardiovascular events during primary treatment of hypertension – REALLIFE (V:6)
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 [138] irrespective of sex,
age, previous antihypertensive treatment, baseline blood pressure, and presence diabetes [139]. 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 Preventive Medicine
section.
Effects of angiotensin converting enzyme inhibitors vs candesartan in
reducing cardiovascular events in primary treatment of hypertension –
ARB-ACE study (V:7)
The planned study will be a retrospective study on the effect of ACEs 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:6). The estimated number of
patients is 50,000. The project is being led by Jan Stålhammar and is receiving financial support
from AstraZeneca. The data management will be performed by Pygargus and the Family Medicine
and Preventive Medicine section.
SUPRIM (V:8)
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. All patients were randomised to behavioural modification or
no modification.
After a baseline examination immediately after discharge, all patients were followed up with new
examinations every six months for 30 months, where the risk factor levels were measured. A
nutritional examination was done twice, as well as a video interview to measure the effects of the
behavioural modification programme. 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 well126
being, with gender status apparently the strongest [140]. 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. A high attendance
rate lowered the risk. During the first 2 years of follow up there were no significant group
differences in traditional risk factors [141]. The project has generated one PhD thesis (Mats
Gulliksson 2009 [142]). 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:9)
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 [143]. 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 [144]. The project has generated
one PhD thesis (Mats Gulliksson 2009 [142]), 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:10)
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 [145]. 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 [146]. Health problem prevalence according to
interview and record scrutiny was modest, peaked early after discharge and then declined [147].
Support from informal caregivers increased significantly after discharge and remained high during
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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 [148]. The project has
generated one PhD thesis (Lena Olai 2010 [149]), 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:11)
The dental care 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 care 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 care clinics in Gävleborg County, measured blood pressure and blood sugar in patients
attending the dental service, approximately 1,600 patients. All patients who had blood pressure or
blood sugar concentration above preset levels were referred to the primary health care centre for
follow-up. 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, and if those referred came for follow-up and,
if so, they 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 [150]. In a second report the efficacy of blood pressure screening in dental care and primary
care follow-up was analysed, showing that the blood pressure screening was very efficient [151]. In
the third report the diabetes screening showed the need for inclusions criteria, as age and BMI, for
efficient finding those at risk [152]. The forth project is calculating the direct cost for this type of
screening organisation. The project has generated one PhD thesis (Sevek Engström 2012 [153]), and
is receiving financial support from Gävleborg county council, Public Dental Service Gävleborg and
Uppsala University.
Physical activity in prevention and treatment of disease (V:12)
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 [154-156]. 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 [157]. 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 [158], financially supported
by the Nordic Council of Ministers. This work has been reported on both Nordic level and
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international level (HEPA meeting in Czech Republic). As a result a similar work for the whole
Europe will be planned in Slovakia Mars 2011.
Pregnancy and physical activity (V:13)
Physical fitness and physical exercise before and during pregnancy positively influences the course
and outcome of pregnancy with reduced risk of prenatal complications such as excessive weight
gain, abnormal glucose tolerance, gestational diabetes and musculoskeletal problems. Moderate
prenatal exercise is useful in improving physiological reserves and aerobic fitness without affecting
fetal growth. Thus, maintaining light to moderate physical activity is recommended during an
uncomplicated pregnancy, whereas higher levels of physical activity may be questioned. Women in
general are at increased risk of sedentary and low physical activity lifestyles compared with men.
During pregnancy a further decline in women’s physical activity across the trimesters has been
documented. Thus, it is important to know whether reductions in physical activity during pregnancy
lead to reduced fitness. If so, this could affect pregnancy outcome as well as other chronic health
conditions for which lower oxygen uptake or inactivity increases the risk (such as metabolic
syndrome, diabetes type II). The influence of full-term pregnancy on maternal health, physical
fitness and activity has not been very much studied. Population-based studies have relied on selfreported questionnaires and data from prospective studies of physical measurements are thoroughly
performed but from small numbers of selected pregnant women. Data from the general population
are scarce. In Sweden, the County Health Care Board offers all pregnant women free maternity
health care during the pregnancy at local antenatal clinics. More than 95 % of women make use of
this offer, which makes this organization suitable for clinical epidemiological studies.
In a prospective study from maternal health care centers, information in early pregnancy and
postpartum on oxygen uptake, physical activity and perceived health was retrieved allowing for the
study of pregnancy-related changes. In the first study there was shown that pregnancy had a
moderate influence on physical fitness and perceived health half a year postpartum despite less
regular physical activity during pregnancy. In addition, estimated peak oxygen uptake in early
pregnancy was positively correlated to perceived physical health [159]. Physical fitness don’t
prevent pregnancy-related back pain but fit women experience less pain [160]. Both serum relaxin
and absolute VO2 peak, est. was associated to mean diastolic blood pressure levels. Fitness were also
associated to gestational length and women with miscarriage has higher absolute VO2 peak, est .
The involved patient: implications for treatment outcome and secondary
prevention of myocardial infarction (V:14)
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. Participants
are Judy Arnetz, Anna Höglund, Ulrika Winblad, Bengt Arnetz.
Research area VI:
Stress
Participants: Ingrid Anderzén and Bengt Arnetz
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Management control systems and stress: interdisciplinary field
experiments (VI:1)
In an interdisciplinary research program we combine two fields of knowledge; Medicine and
Management control systems (MCS). 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. Data collection was finished during year 2012 and the analyses are ongoing. One article is
in manuscript. This project is running in collaboration with Department of Business Studies, Uppsala
University, receiving financial support from Riksbankens Jubileumsfond. Participants in the project
are Ingrid Anderzén, and Lars Frimanson.
GodA - Good working environment and healthy workplace – test of a
model linking the work environment, employee well-being and corporate
development (VI:2)
"Promoting factors" at work are supposed to promote both the individual's physical and mental
health and the company's competitiveness and profitability, thus providing "healthy workplaces".
Which factors act health promoting, as well as how an organization can work to promote the health
of the employees while ensuring a commercially sound business, is still in its infancy. The GodAstudy aims to test whether a development project organized by the so-called PATH-model
(Grawitchet al.,2006) results in increased employee well-being and concurrent organizational
improvements. In 2012, a pre-study in form of focus groups and individual interviews in three
medium sized enterprises was undertaken. The interviews sought to examine what employees and
managers considered to characterize a "good” work environment and what gives them wellbeing at
work. The results from the interviews and known health and safety parameters have constituted the
basis for a questionnaire with which employees of the three companies are followed for 2 years.
Parallel, data concerning the companies’ key indicators and internal developments are collected. One
of the companies’ designs its work with their internal development according to the PATH-model.
At the two-year follow-up the results from the “PATH-company” concerning the well-being of both
employees and the company will be compared with the results from the other two companies
designing their internal development after their own choice. This study aims to increase knowledge
about how to achieve sustainable health and wellbeing of both the individual and the company
parallel. Such conditions can be assumed to save suffering for the individual and reduced costs for
the company and society. This project is running in collaboration with Centre for Musculoskeletal
Research, University of Gävle, receiving financial support from AFA. Participants in the project are
Ingrid Anderzén, Per Lindberg and Thomas Karlsson.
Spiritual and existential moderators of the stress – health relationship
(VI:3)
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. Participant is Bengt
130
Arnetz. This project is part of a large, multi-year Linne’ research grant awarded to Uppsala
University under the leadership of Professor Anders Bäckström.
The importance of post-displacement institutional and stressors and
resiliency factors and its implications for refugee post-displacement
mental health (VI:4)
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. Participant is Bengt Arnetz.
Low impact stress among first responders. Implications for Health and Performance (VI:5)
This three-phase collaborative research project focuses on better defining, measuring and managing
low-impact, job-derived stressors among first responders (first line employees within the military,
coast guard, customs control, and the police). During phase 1, we carried focus groups interviews to
define low-impact stressors and its perceived effects on health and performance. In phase 2, we used
this knowledge in designing a national survey that was distributed to a large random sample of
Swedish first responders. In phase 3, we will make use of results based on advanced modelling from
this survey to design a state-of-the-art web-based self-assessment and intervention program. 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. Participants are Bengt Arnetz, Sarah
Thomsen, Dana Nevedal and Matt Ventimiglia.
Real-time assess of psychophysiological stress responses (VI:6)
Despite epidemiological research linking psychosocial stress to cardiovascular disease and other
stress-related disorders, we still lack convincing evidence about the biological mechanisms 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 stress-related disorders. Participants are Bengt
Arnetz, Clairy Wiholm, Mark Lumley and Weisong Shi.
Research area VII:
Triggers of the onset of disease and other health problems
Johan Hallqvist
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. In the ongoing projects all conducted in collaboration with research groups at
Karolinska Institutet 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. In studies of 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). Another study concerns
131
Psychiatric care as acute deterrent or trigger of suicide, in which 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. In a third study we examine Non-cardiac surgery as trigger of myocardial infarction. It is
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
but our aim is to quantify the absolute and relative risks with different types of surgical procedures.
We also examine Acute life events (like death of close relative) as triggers of acute diseases like
myocardial infarction and stroke, in a study based on record linkage between the multigenerational
register and the hospital and the cause of death registers. TUFS (Swedish acronym for triggers of
sickness absence) was a part of a thesis work and aimed at identifying non-medical triggers
interacting with reduced work ability due to illness. It was based on extensive data collection from
more than 1000 spells of sickness absence at six work places. TOFA (Triggers of falling) is based
on data collected from old men and women with hip fractures. Finally Psychoactive substances as
triggers of violence is a study based on data collection from individuals in custody in Stockholm
because of criminal activities including violence (The Stockholm Social Medicine Custody Project).
Research area VIII:
Social epidemiology: the role of life course and social context
Johan Hallqvist
We have earlier shown that there are inherent difficulties in the task of disentangling time-related
exposure constructs like accumulation, critical period and mobility in life course epidemiology. At
present we pursue further in-depth analyses of specific hypotheses related to these theoretically
based mechanisms in collaboration with researchers at Karolinska Institutet. 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. In 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 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.
In 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. This project
is based at Karolinska Institutet and makes use of the new Stockholm Public Health Cohort (SPHC)
and national register data bases. Life course risk factors and socioeconomic differences in the risk
of mental illness concerns risk factors like adverse marital trajectories, school failures, and criminal
careers. The project is also base at Karolinska Institutet and concerns register studies on the total
population of Sweden.
The other aspect 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. An ongoing study at
Karolinska Institutet concerns 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
132
for. Family based designs and multi-level analyses will be employed on register data of all Swedes.
In another study the effect of contextual and individual social capital on psychological distress and
self-rated health is analyzed in the Stockholm County using neighborhoods as the contextual level.
Research area IX:
Feasibility and efficiency of interventions
Johan Hallqvist and Lennart Fredriksson
As a part of Elisabet Sundgren’s thesis work we are studying to what extent it is possible to help
people diagnosed with psychosis to stop smoking through an organized effort including health
screening and follow-up procedures with motivational support and advice. The study employs both
qualitative and quantitative methodology. We are also involved in studies evaluating the efficiency
of repeated brief moments of advice in dental care as a method for helping people to quit smoking.
Research area X:
Reproductive health
Per Kristiansson
Reproductive health is a new field of interest that is under development. The overarching questions
are reproductive health for women and men in relation to primary health care. The research program
will involve about four doctoral students. In this program a unique digital version of pain drawing is
developed.
Research area XI:
Varia
Self-rated health (XI:1)
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 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 populationbased 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. Four articles have been published [161, 162, 163, 164],
and one manuscript is forthcoming [165] The project has generated one PhD thesis (Halford 2010,
[166]). The project is being financially supported by the Uppsala University.
133
Vitamin D status among immigrated women from countries in the Middle
East as compared with Swedish women (XI:2)
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 have been investigated by a physician and a dietician in terms of different aspects of
their vitamin D status and possible associated diseases. They were 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) (XI:3)
Many patients with advanced COPD are affected by their decreased lung function and often have
reduced muscular function as well. They consequently 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.
References to the eleven research areas
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Early multidiciplinary assessment resulted in longer periods of sick-leave- a randomized controlled trial in a
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konference om arbeidsrettet rehabilitering. Grenå Danmark 12-14 september 2012
Nurses’ experiences of managig sick-listing issues in telephone advisory Services. Lännerström L, Wallman
T, Söderbäck M. (poster) 2. nordiske konference om arbeidsrettet rehabilitering. Grenå Danmark 12-14
september 2012.
Early prediction of patients at risk for long term sickness absence. von Celsing AS, Björkegren K, Eriksson
HG, Eriksson M, Svärdsudd K, Wallman T. (poster) 2. nordiske konference om arbeidsrettet rehabilitering.
Grenå Danmark 12-14 september 2012.
Eriksson HG, von Celsing AS, Wahlström R, Janson L, Zander V, Wallman T: Sickness absence and selfreported health a population-based study of 43,600 individuals in central Sweden. BMC Public Health 2008,
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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: 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.
Wallman T, Wedel H, Palmer E, Johansson S, Rosengren A, Eriksson H, Welin L, Svärdsudd K: Quality of
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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 time, and work
situation with sickness certification in primary care in Sweden. Scandinavian Journal of Primary Health Care
2010, 28(2):76-81.
Norrmén G, Svärdsudd K, Andersson DK: Influence on sickness certification of opinions and attitudes
towards health related and insurance system related matters among general practitioners and their patients.
Preprint.
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 AS, Eriksson HG, Björkegren K, Eriksson M, Svärdsudd K, Wallman T. Determinants for return
to work among sickness certified patients in general practice. BMC Public Health 2012, 12:1077
doi:10.1186/1471-2458-12-1077.
Linda Lännerström, Thorne Wallman, Maja Söderbäck. Nurses’ experiences of managing Sick-listing Issues
in Telephone Advisory Service at Primary Health Care Centers. Scand J Caring Sci 2012 Oct 16
Lännerström L, Wallman T, Holmström I. Losing independence – The lived experience of being long-term
sick-listed (submitted).
Lars Carlsson, Lars Englund, Johan Hallqvist, Thorne Wallman. Early multidisciplinary assessment resulted
in longer periods of sick leave - a randomized controlled trial in a primary health care centre. (Submitted
SJPHC Dec 2011).
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):199212.
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.
Grunnesjö M, Bogefeldt JP, Blomberg SIE, Strender L-E, Svärdsudd K: A randomized controlled trial of the
effects of muscle stretching, manual therapy and steroid injections in addition to 'stay-active' care on healthrelated quality of life in acute and sub-acute low back pain. Clin Rehab 2011, 25(11):999-1010.
Bogefeldt J: Low Back Pain: With Special Reference to Prevalence, Diagnosis, Treatment and Prognosis.
Medical sciences. Uppsala University; 2009.
Grunnesjö M: Low back pain: with special reference to manual therapy, outcome and its prognosis. Medical
sciences. Uppsala University; 2011.
Bogefeldt J, Wallman T, Eriksson M, Welin L, Eriksson H, Johansson S, Grunnesjö M, Svärdsudd K: Age
and time trends in back pain prevalence among men and women 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, Butler S, Eriksson M, Svärdsudd K: A randomized controlled trial of exercise versus wait-list in
chronic tennis elbow (lateral epicondylosis). Upsala Journal of Medical Sciences 2011, 116(4):269-279.
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Peterson M, Butler S, Eriksson M, Svärdsudd K: A randomised controlled trial of eccentric versus concentric
exercise in chronic tennis elbow (lateral epicondylosis). Preprint. Submitted.
Peterson M: Chronic tennis elbow: aspects on pathogenesis and treatment in a soft tissue pain condition.
Medical sciences. Uppsala University; 2011.
Torstensson T, Lindgren A, Kristiansson P: Corticosteroid injection treatment to the ischiadic spine reduced
pain in women with long-lasting sacral low back pain with onset during pregnancy: a randomized, double
blind, controlled trial. Spine 2009, 34(21):2254-2258.
Torstensson T, Lindgren A, Kristiansson P: Improved function in women with persistent pregnancy related
low back pain. Submitted 2011.
Torstensson T: Långvarig graviditetsrelaterad rygg- och bäckensmärta: ursprung, diagnostik och behandling.
Uppsala univetsitet: Institutionen för folkhälso- och vårdvetenskap; 2011.
Kristiansson P: Corticosteroid injection treatment to the ischiadic spine reduced pain in women with longlastig sacral low back pain with onset during pregnancy: a randomized double blind controlled trial. In 7th
Interdisciplinary Wold Congress on Low Back & Pelvic Pain. Los Angeles November 9-12; 2010.
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 urbanisation on age and
sex-specific asthma prevalence in Swedish preschool children. BMC Public Health 2009, 9.
Bröms K, Norbäck D, Eriksson M, Sundelin C, Svärdsudd K: Prevalence and co-occurrence 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. Eur J Epidemiol 2012 Sep;27(9):695-703.
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, 14(3):147-153.
Hasselgren M, Gustafsson D, Ställberg B, Lisspers K, Johansson G: Management, asthma control and quality
of life in Swedish adolescents with asthma. Acta Paediatr 2005, 94(6):682-688.
Lisspers K, Ställberg B, Hasselgren M, Johansson G, Svärdsudd K: Quality of life and measures of asthma
control in primary health care. J Asthma 2007, 44(9):747-751.
Ställberg B, Lisspers K, Hasselgren M, Johansson G, Svärdsudd K: Factors related to the level of severity of
asthma in primary care. Respir Med 2007, 101(10):2076-83.
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.
Hasselgren M: Epidemiological aspects of astma in primary care: special references to prevalence, clinical
detection and validation. Medical Sciences. Uppsala University; 2005.
Lisspers K: Organisation of asthma in primary care, quality of life and sex-related aspects in asthma
outcomes. Medical science. Uppsala University; 2008.
Ställberg B: Asthma in primary care: severity, treatment and level of control. Medical science. Uppsala
University; 2008.
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 control in primary care
in Sweden: a comparison between 2001 and 2005. Prim Care Respir J 2009, 18(4):279-286.
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):550-56.
Sundh J, Stallberg B, Lisspers K, Montgomery SM, Janson C: Co-morbidity, body mass index and quality of
life in COPD using the clinical COPD questionnaire. COPD: Journal of Chronic Obstructive Pulmonary
Disease 2011, 8(3):173-81.
Sundh J, Jansson C, Lisspers K, Ställberg B, Montgomery SM: The Dyspnea, Obstruction, Smoking and
Exacerbation (DOSE) index is predictive of mortality in COPD. Prim Care Respir J. 2012 Sep;21(3):295-301.
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JW et al: The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010. Prim
Care Respir J 2010, 19(Suppl 1):S1-20.
Pinnock H, Ostrem A, Román Rodríguez M, Ryan D, Ställberg B, Thomas M, Tsiligianni I, Williams S,
Yusuf O: Prioritising the respiratory research needs of primary care: the International Primary Care
Respiratory Group (IPCRG) e-Delphi exercise. Prim Care Respir J 2012, 21(1):19-27.
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.
Kruis A, Ställberg B, Jones R, Tsiligianni I, Lisspers K, Molen T, Kocks J W, Chavannes N. Real-life COPD
patients compared to large COPD study populations: an UNLOCK external validity study. Submitted
Sandelowsky H, Ställberg B, Nager A, Hasselstrom J: High prevalence of undiagnosed chronic obstructive
pulmonary disease in a primary care population with respiratory infections. BMC Family Practice 2011,
12:122.
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.
Wadell K, Janaudis Ferreira T, Arne M, Lisspers K, Ställberg B, Emtner M. Hospital-based pulmonary
rehabilitation for patients with COPD in Sweden – a national survey. Submitted
Ställberg B, Ekström T, Neij F, Olsson P, Skoogh BE, Wennergren G, Löfdahl CG: A real-life costeffectiveness evaluation of budesonide/formoterol maintenance and reliever therapy in asthma. Respir Med
2008, 102(10):1360-1370.
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, noninferiority, parallel-group, multicentre study. Respir Res 2009, 10:11.
Stjärne P, Odebäck P, Ställberg B, Lundberg J, Olsson P. High costs and burden of illness in acute
rhinosinusitis- real life treatment patterns and outcomes in Swedish primary care. Prim Care Respir J. 2012
Jun;21(2):174-79.
Thorn J, Tilling B, Lisspers K, Jörgensen L, Stenling A, Stratelis G: Improved prediction of COPD in at-risk
patients using lung function pre-screening in primary care: a real-life study and cost-effectiveness analysis.
Prim Care Respir J 2012.
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, Svardsudd K: Factors associated with adherence to drug therapy: a populationbased study. European Journal of Clinical Pharmacology 2007, 63(3):307-314.
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.
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.
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Ekstrom N, Schioler L, Svensson A-M, Eeg Olofsson K, Jonasson JM, Zethelius B, Cederholm J, Eliasson, B,
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Ekström N, Cederholm J, Zethelius B, Eliasson B, Fhärm E, Rolandsson O, Miftaraj M, Svensson A-M,
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142
Geriatrics
Research Group Leader Professor Lars Lannfelt
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 applying a broad repertoire of experimental
techniques, e.g. molecular biology, biochemistry, histology and behavioural analyses in our research.
Professors – Lars Lannfelt (chair), Hans Basun (adjunct)
University lecturer – Lena Kilander
Researchers – Martin Ingelsson, Vilmantas Giedraitis, Anna Erlandsson, Joakim Bergström, Stina
Syvänen, Johan Ärnlöv, Björn Zethelius, Anna Cristina Åberg
Postdocs and research assistants – Hedvig Welander, Veronica Lindström, Dag Sehlin, Elisabet
Ihse, Bernice Wiberg, Hans-Erik Johansson
PhD students – Astrid Gumucio, Sofia Söllvander, Therese Fagerqvist, Gabriel Gustafsson, Malin
Degerman-Gunnarsson, Ylva Cedervall, Kristin Franzon
Other personnel – Linda Cato (BMA), RoseMarie Brundin, Käthe Ström (research nurses).
Associated professors - Martin Ingelsson 2009, Johan Ärnlöf 2009, Anna Cristina Åberg 2010,
Lena Kilander 2010, Frida Ekholm Pettersson 2010
2012
1.
Arefalk G, Hergens MP, Ingelsson E, Ärnlöv J, Michaëlsson K, Lind L, Ye W, Nyrén O,
Lambe M, Sundström J. Smokeless tobacco (snus) and risk of heart failure: results from two
Swedish cohorts. Eur J Prev Cardiol 2012; 19: 1120-1127.
2.
Benedict C, Brooks SJ, Kullberg J, Burgos J, Kempton MJ, Nordenskjöld R, Nylander R,
Kilander L, Craft S, Larsson EM, Johansson L, Ahlström H, Lind L, Schiöth HB. Impaired
insulin sensitivity as indexed by the HOMA score is associated with deficits in verbal fluency
and temporal lobe gray matter volume in the elderly. Diabetes Care 2012; 35: 488-494.
3.
Berglund L, Berne C, Svärdsudd K, Garmo H, Melhus H, Zethelius B. Seasonal variations of
insulin sensitivity from a euglycemic insulin clamp in elderly men. Ups J Med Sci 2012; 117:
35-40.
4.
Beyer AS, von Einem B, Schwanzar D, Keller IE, Hellrung A, Thal DR, Ingelsson M,
Makarova A, Deng M, Chhabra ES, Pröpper C, Böckers TM, Hyman BT, von Arnim CA.
Engulfment adapter PTB domain containing 1 interacts with and affects processing of the
amyloid-β precursor protein. Neurobiol Aging 2012; 33: 732-743.
5.
Byberg L, Gedeborg R, Cars T, Sundström J, Berglund L, Kilander L, Melhus H,
Michaëlsson K. Prediction of fracture risk in men: a cohort study. Journal of bone and
mineral research : the official journal of the American Society for Bone and Mineral
Research 2012; 27: 797-807.
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Cederholm J, Gudbjörnsdottir S, Eliasson B, Zethelius B, Eeg-Olofsson K, Nilsson PM,
NDR. Blood pressure and risk of cardiovascular diseases in type 2 diabetes: further findings
from the Swedish National Diabetes Register (NDR-BP II). J Hypertens 2012; 30: 2020-2030.
7.
Cedervall Y, Kilander L, Åberg AC. Declining physical capacity but maintained aerobic
activity in early Alzheimer's disease. American journal of Alzheimer's disease and other
dementias 2012; 27: 180-187.
8.
Diógenes MJ, Dias RB, Rombo DM, Vicente Miranda H, Maiolino F, Guerreiro P, Näsström
T, Franquelim HG, Oliveira LM, Castanho MA, Lannfelt L, Bergström J, Ingelsson M,
Quintas A, Sebastião AM, et al. Extracellular alpha-synuclein oligomers modulate synaptic
transmission and impair LTP via NMDA-receptor activation. The Journal of neuroscience :
the official journal of the Society for Neuroscience 2012; 32: 11750-11762.
9.
Ekström N, Miftaraj M, Svensson AM, Andersson Sundell K, Cederholm J, Zethelius B,
Gudbjörnsdottir S, Eliasson B. Glucose-lowering treatment and clinical results in 163 121
patients with type 2 diabetes: an observational study from the Swedish national diabetes
register. Diabetes, obesity & metabolism 2012; 14: 717-726.
10.
Ekström N, Schiöler L, Svensson AM, Eeg-Olofsson K, Miao Jonasson J, Zethelius B,
Cederholm J, Eliasson B, Gudbjörnsdottir S. Effectiveness and safety of metformin in 51 675
patients with type 2 diabetes and different levels of renal function: a cohort study from the
Swedish National Diabetes Register. BMJ open 2012; 2.
11.
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measures of vascular function and morphology. J Clin Endocrinol Metab 2010; 95: 29272934.
100. Gustafsson S, Lind L, Zethelius B, Venge P, Flyvbjerg A, Söderberg S, Ingelsson E.
Adiponectin and cardiac geometry and function in elderly: results from two community-based
cohort studies. Eur J Endocrinol 2010; 162: 543-550.
101. Hagström E, Ingelsson E, Sundström J, Hellman P, Larsson TE, Berglund L, Melhus H, Held
C, Michaëlsson K, Lind L, Ärnlöv J. Plasma parathyroid hormone and risk of congestive heart
failure in the community. Eur J Heart Fail 2010; 12: 1186-1192.
102. Hånell A, Clausen F, Björk M, Jansson K, Philipson O, Nilsson LN, Hillered L, Weinreb PH,
Lee D, McIntosh TK, Gimbel DA, Strittmatter SM, Marklund N. Genetic deletion and
pharmacological inhibition of Nogo-66 receptor impairs cognitive outcome after traumatic
brain injury in mice. J Neurotrauma 2010; 27: 1297-1309.
150
103. Iggman D, Ärnlöv J, Vessby B, Cederholm T, Sjögren P, Risérus U. Adipose tissue fatty
acids and insulin sensitivity in elderly men. Diabetologia 2010; 53: 850-857.
104. Ingelsson E, Langenberg C, Hivert MF, Prokopenko I, Lyssenko V, Dupuis J, Mägi R, Sharp
S, Jackson AU, Assimes TL, Shrader P, Knowles JW, Zethelius B, Abbasi FA, Bergman RN,
et al. Detailed physiologic characterization reveals diverse mechanisms for novel genetic Loci
regulating glucose and insulin metabolism in humans. Diabetes 2010; 59: 1266-1275.
105. Israelsson C, Bengtsson H, Lobell A, Nilsson LN, Kylberg A, Isaksson M, Wootz H, Lannfelt
L, Kullander K, Hillered L, Ebendal T. Appearance of Cxcl10-expressing cell clusters is
common for traumatic brain injury and neurodegenerative disorders. The European journal of
neuroscience 2010; 31: 852-863.
106. Jobs E, Risérus U, Ingelsson E, Helmersson J, Nerpin E, Jobs M, Sundström J, Lind L,
Larsson A, Basu S, Ärnlöv 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:
4460-4464.
107. Johansson HE, Haenni A, Karlsson FA, Edén-Engström B, Ohrvall M, Sundbom M, Zethelius
B. Bileopancreatic diversion with duodenal switch lowers both early and late phases of
glucose, insulin and proinsulin responses after meal. Obes Surg 2010; 20: 549-558.
108. Kamali-Moghaddam M, Pettersson FE, Wu D, Englund H, Darmanis S, Lord A, Tavoosidana
G, Sehlin D, Gustafsdottir S, Nilsson LN, Lannfelt L, Landegren U. Sensitive detection of Aβ
protofibrils by proximity ligation--relevance for Alzheimer's disease. BMC Neurosci 2010;
11: 124.
109. Lambert JC, Sleegers K, González-Pérez A, Ingelsson M, Beecham GW, Hiltunen M,
Combarros O, Bullido MJ, Brouwers N, Bettens K, Berr C, Pasquier F, Richard F, Dekosky
ST, Hannequin D, et al. The CALHM1 P86L polymorphism is a genetic modifier of age at
onset in Alzheimer's disease: a meta-analysis study. J Alzheimers Dis 2010; 22: 247-255.
110. Lannfelt L, Pettersson FE, Nilsson LN. Translating research on brain aging into public health:
a new type of immunotherapy for Alzheimer's disease. Nutr Rev 2010; 68 Suppl 2: S128-134.
111. Larsson TE, Olauson H, Hagström E, Ingelsson E, Ärnlöv J, Lind L, Sundström J. Conjoint
effects of serum calcium and phosphate on risk of total, cardiovascular, and
noncardiovascular mortality in the community. Arterioscler Thromb Vasc Biol 2010; 30: 333339.
112. Leavy B, Åberg AC. "Not ready to throw in the towel": perceptions of physical activity held
by older adults in Stockholm and Dublin. J Aging Phys Act 2010; 18: 219-236.
113. Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, Coresh J,
Gansevoort RT, Consortium CKDP. Association of estimated glomerular filtration rate and
albuminuria with all-cause and cardiovascular mortality in general population cohorts: a
collaborative meta-analysis. Lancet 2010; 375: 2073-2081.
114. Melhus H, Snellman G, Gedeborg R, Byberg L, Berglund L, Mallmin H, Hellman P,
Blomhoff R, Hagström E, Ärnlöv J, Michaëlsson K. Plasma 25-hydroxyvitamin D levels and
fracture risk in a community-based cohort of elderly men in Sweden. J Clin Endocrinol
Metab 2010; 95: 2637-2645.
115. Michaëlsson K, Baron JA, Snellman G, Gedeborg R, Byberg L, Sundström J, Berglund L,
Ärnlöv J, Hellman P, Blomhoff R, Wolk A, Garmo H, Holmberg L, Melhus H. Plasma
vitamin D and mortality in older men: a community-based prospective cohort study. Am J
Clin Nutr 2010; 92: 841-848.
116. Nathanson D, Zethelius B, Berne C, Holst JJ, Sjöholm A, Nyström T. Reduced plasma levels
of glucagon-like peptide-1 in elderly men are associated with impaired glucose tolerance but
not with coronary heart disease. Diabetologia 2010; 53: 277-280.
117. Nettleton JA, McKeown NM, Kanoni S, Lemaitre RN, Hivert MF, Ngwa J, van Rooij FJ,
Sonestedt E, Wojczynski MK, Ye Z, Tanaka T, Garcia M, Anderson JS, Follis JL, Djousse L,
151
et al. Interactions of dietary whole-grain intake with fasting glucose- and insulin-related
genetic loci in individuals of European descent: a meta-analysis of 14 cohort studies. Diabetes
Care 2010; 33: 2684-2691.
118. Petersson H, Ärnlöv 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: 379-384.
119. Petzold A, Altintas A, Andreoni L, Bartos A, Berthele A, Blankenstein MA, Buee L,
Castellazzi M, Cepok S, Comabella M, Constantinescu CS, Deisenhammer F, Deniz G, Erten
G, Espiño M, et al. Neurofilament ELISA validation. J Immunol Methods 2010; 352: 23-31.
120. Philipson O, Lord A, Gumucio A, O'Callaghan P, Lannfelt L, Nilsson LN. Animal models of
amyloid-beta-related pathologies in Alzheimer's disease. FEBS J 2010; 277: 1389-1409.
121. Sandberg A, Luheshi LM, Söllvander S, Pereira de Barros T, Macao B, Knowles TP,
Biverstål H, Lendel C, Ekholm-Petterson F, Dubnovitsky A, Lannfelt L, Dobson CM, Härd T.
Stabilization of neurotoxic Alzheimer amyloid-beta oligomers by protein engineering. Proc
Natl Acad Sci U S A 2010; 107: 15595-15600.
122. Sandwall E, O'Callaghan P, Zhang X, Lindahl U, Lannfelt L, Li JP. Heparan sulfate mediates
amyloid-beta internalization and cytotoxicity. Glycobiology 2010; 20: 533-541.
123. 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,
et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a
collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375: 2215-2222.
124. Saxena R, Hivert MF, Langenberg C, Tanaka T, Pankow JS, Vollenweider P, Lyssenko V,
Bouatia-Naji N, Dupuis J, Jackson AU, Kao WH, Li M, Glazer NL, Manning AK, Luan J, et
al. Genetic variation in GIPR influences the glucose and insulin responses to an oral glucose
challenge. Nat Genet 2010; 42: 142-148.
125. Sehlin D, Söllvander S, Paulie S, Brundin R, Ingelsson M, Lannfelt L, Pettersson FE,
Englund H. Interference from heterophilic antibodies in amyloid-β oligomer ELISAs. J
Alzheimers Dis 2010; 21: 1295-1301.
126. Soscia SJ, Kirby JE, Washicosky KJ, Tucker SM, Ingelsson M, Hyman B, Burton MA,
Goldstein LE, Duong S, Tanzi RE, Moir RD. The Alzheimer's disease-associated amyloid
beta-protein is an antimicrobial peptide. PLoS One 2010; 5: e9505.
127. Sundelöf J, Sundström J, Hansson O, Eriksdotter-Jönhagen M, Giedraitis V, Larsson A,
Degerman-Gunnarsson M, Ingelsson M, Minthon L, Blennow K, Kilander L, Basun H,
Lannfelt L. Cystatin C levels are positively correlated with both Abeta42 and tau levels in
cerebrospinal fluid in persons with Alzheimer's disease, mild cognitive impairment, and
healthy controls. J Alzheimers Dis 2010; 21: 471-478.
128. Sundelöf J, Sundström J, Hansson O, Eriksdotter-Jönhagen M, Giedraitis V, Larsson A,
Degerman-Gunnarsson M, Ingelsson M, Minthon L, Blennow K, Kilander L, Basun H,
Lannfelt L. Higher cathepsin B levels in plasma in Alzheimer's disease compared to healthy
controls. J Alzheimers Dis 2010; 22: 1223-1230.
129. Uronen RL, Lundmark P, Orho-Melander M, Jauhiainen M, Larsson K, Siegbahn A,
Wallentin L, Zethelius B, Melander O, Syvänen AC, Ikonen E. Niemann-Pick C1 modulates
hepatic triglyceride metabolism and its genetic variation contributes to serum triglyceride
levels. Arterioscler Thromb Vasc Biol 2010; 30: 1614-1620.
130. Vedin I, Cederholm T, Freund-Levi Y, Basun H, Hjorth E, Irving GF, Eriksdotter-Jönhagen
M, Schultzberg M, Wahlund LO, Palmblad J. Reduced prostaglandin F2 alpha release from
blood mononuclear leukocytes after oral supplementation of omega3 fatty acids: the OmegAD
study. J Lipid Res 2010; 51: 1179-1185.
152
131. 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.
132. 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.
133. 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.
134. 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.
135. 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.
136. 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 A{beta} oligomers in Alzheimer
disease: a novel tool for therapy and diagnosis. The Journal of biological chemistry 2010;
285: 41517-41524.
137. Zhou XH, Qiao Q, Zethelius B, Pyörälä K, Söderberg 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.
138. 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.
139. 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.
Books
140. Läkemedelsboken 2011-2012. Läkemedelsverket, 2011. Zethelius is an author of one chapter.
141. L.-O. Wahlund, C. Nilsson & A. Wallin (Eds.) Kognitiv medicin. Norstedt, 2011. Kilander is
an author of the chapter “Depression och bipolär sjukdom”.
142. Lingren S, Engström-Laurent A, Karason K, Jansson ET (Eds.). Internmedicin.
Studentlitteratur, 2011. Zethelius is an author of one chapter.
143. Zhang X, Li J-P. Heparan Sulfate Proteoglycans in Amyloidosis. Progress in Molecular
Biology and Translational Science, 2010. Vol. 93, p. 309-34.
144. Äldres Hälsa – ett sjukgymnastiskt perspektiv. Red Rydwik E. Studentlitteratur. Stockholm
2012. Åberg is an author of one chapter.
Dissertation 2012
Elina Rönnemaa. Predictors of Dementia: Insulin, Fatty Acids and Vascular Risk Factors.
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Vetenskapsrådet (2012-1593, 2011-4519; 2010-6745;
2009-4567; 2009-4389; 2006-3464)
4 300 000 SEK/year
Hjärnfonden, project grants + donators
1 500 000 SEK/year
Berzelii Center for Neurodiagnostics, Uppsala
2 500 000 SEK/year
ALF-medel, Uppsala läns landsting
4 000 000 SEK/year
Fakultetsmedel, Uppsala universitet
2 500 000 SEK/year
Parkinsonfonden
500 000 SEK/year
PET-forskning
500 000 SEK/year
Diverse fonder
1 800 000 SEK/year
Hjärt-kärlfonden
400 000 SEK/year
Wallenberg-stiftelsen
700 000 SEK/year
International collaborations
Guest visits in foreign laboratories
Thomas Näsström (with Dr. Tiago Outiero, Lisbon, Portugal; Febr-May 2010)
Foreign collaborative partners
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, 2010-11
Research Consortias
The research group is a member of the Berzelii Technology Centre for Neurodiagnostics, the
Swedish Brain Power network and the U4 network (together with the Universities of Göttingen,
Ghent and Groningen).
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 and 2011. (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).
154
Research projects
Aβ protofibrils in Alzheimer’s disease
(Anna Erlandsson, PhD)
We are testing our hypothesis that large soluble Aβ oligomers, i.e. protofibrils, are neurotoxic to the
brain 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 a transgenic mouse model for the
disease. 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 have recently established cell culture
models with primary neurons and astrocytes in order to clarify mechanisms behind initiation and
spreading of AD.
Pathology and amyloid imaging in transgenic Alzheimer’s disease mice
(Stina Syvänen, PhD)
The over-all purpose of this project is to improve clinical Positron Emission Tomography (PET)
imaging in Alzheimer’s disease (AD) such that the technique can be used to monitor disease
progression and therapeutic efficacy of intervention with drug candidates. The project will include
development of new radioligands as well as development of imaging paradigms based on already
existing radioligands that target neuroreceptors believed to be involved in the pathogenesis of AD.
We have developed a 125I-labelled new imaging agent based on mAb158 by using its F(ab’)2
fragment. The advantages with using a F(ab’)2 fragment compared to a whole antibody is mainly
two-fold; first, the smaller fragment is likely to be distributed across the blood-brain barrier to a
higher degree compared to the larger antibody, and second, F(ab’)2 fragments have considerably
shorter half-life than antibodies. This is beneficial as it reduces the radioactivity in the blood volume
of the brain and thereby also reduces contamination of the radioactivity signal in the brain area (that
should reflect radioactivity in tissue only) detected in the PET-scanner. The focus of our present
research is to further improve the brain distribution of the 125-I labelled F(ab’)2 fragment and thus
develop a new amyloid PET radioligand for use in the clinic.
Parkinson’s disease
(Assoc. Prof. Martin Ingelsson and Joakim Bergström, PhD)
As aggregation of pathological proteins in the brain is a general feature for neurodegeneration,
immunotherapy could have potential also for other disorders than AD. In Parkinson’s disease (PD),
alpha-synuclein deposits as Lewy bodies and Lewy neurites inside the neurons. As with Aβ in AD,
large soluble oligomeric or protofibrillar forms of alpha-synuclein are believed to be particularly
neurotoxic in PD and Lewy body dementia. By working with recombinant forms of α-synuclein
oligomers / protofibrils, we are analyzing the formation and effects of such intermediately sized
species of α-synuclein in vitro and on cell models. The most toxic protein forms have been used as
antigen to generated conformation-selective monoclonal antibodies. A number of such antibodies
have now been developed and several of these have been evaluated for immunotherapy on cell and
animal models for the actual diseases. Importantly, we have found that intraperitoneal injections
with one of these antibodies can lower the levels of toxic alpha-synuclein oligomers/protofibrils in
transgenic mice. Moreover, we seek to adopt the antibodies in assays, such as ELISA; to be able to
measure the presence of toxic oligomers / protofibrils as a novel disease biomarker for PD and Lewy
body dementia. We are also investigating the underlying mechanisms by alpha-synuclein impair key
155
cellular function. A focus is investigating how oligomers impair cellular degradation systems and
how alpha-synuclein oligomers present in the endoplasmic reticulum preturb cellular function.
Genetics
(Vilmantas Giedraitis, PhD)
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 and epidemiological research
(Assoc. Profs. Lena Kilander, Björn Zethelius, Johan Ärnlöv, 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. Data on 196 AD patients, followed for
2-9 years since the lumbar puncture, show that high baseline concentrations of total tau and
phospho-tau are powerful predictors of negative long-term outcome. Interestingly, high tau and
phospho-tau levels were correlated to conversion from mild to moderate dementia, rapid clinical
decline, institutionalization and death in advanced dementia (Degerman-Gunnarsson, manuscript in
preparation). Thus, CSF tau and phospho-tau are not only markers of dementia stage and predictors
of conversion from MCI to AD, but also reflect the rate of neurodegeneration and long-term
prognosis. 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 CSFbiomarkers.
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. In one substudy, we are assessing the
correlation between cognitive, radiological, biochemical and neuropathological features of healthy
aging, by performing cognitive testing, CT-scans of the brain, CSF analyses and post-mortem
evaluation on a fraction of the ULSAM subjects. Finally, 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. In an 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. 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.
156
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 AD and exploring
possibilities for novel future therapeutics against PD and Lewy body dementia. We are one of
several groups in Uppsala focusing on protein aggregation and age-related amyloid diseases. The
local scientific environment thus provides a unique opportunity for collaborative efforts to increase
the knowledge on mechanisms underlying amyloid disorders, especially within the Berzelii Centre
for Neurodiagnostics and in SciLifeLab. Compared to other dementia research teams in Sweden our
focus on molecular mechanisms in the pathogenesis of AD has been very successful. We have a
clear scientific strategy and a good research structure. The preclinical and clinical activities have
been successfully integrated in Uppsala, which enables a more efficient translational research
process.
157
Health Services Research
Research group leader Ulrika Winblad, PhD, Associate Professor
Health Service Research (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, interorganisational 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 high
quality and patient safety care, especially within telecare. The group is multidisciplinary and the
researchers have different professional backgrounds such as medicine, psychology, nursing and
political science.
Ulrika Winblad, PhD, associate professor, group leader
Åsa Muntlin Athlin, RN, PhD
Cecilia Bernsten, Registered pharmacist, PhD, associate professor
Ingeborg Björkman, Registered pharmacist, PhD
Madeleine Boll, Physiotherapist, Licentiate, PhD student
Eva Boström, RN, PhD
Linn Boström, research assistant
Gunilla Brattberg, MD, PhD, associate professor
Tobias Dahlström, PhD
Love Edberg, research assistant
Helène Eriksson, Administrator
Annica Ernesäter, RN, MSc, PhD student
Mio Fredriksson, MSc, PhD student
Roya Hakimnia, MSc (Medicine), PhD student
Finn Hjelmblink, MD, PhD
David Isaksson, MSc, Phd Student
Elenor Kaminsky, RN, BSc, PhD student
Dorte Kjeldmand, MD, PhD
Jan Larsson, MD, PhD
Linda Lännerström, PhD student
Anna Mankell, research assistant
Linda Moberg, PhD student
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
1.
von Thiele Schwarz U, Hasson H, Muntlin Athlin Å. (2012). Perceived efficiency in the
Emergency Department – low throughput rates or having a lot to do? Arbete och Hälsa [Work
and Health]. In Press.
158
2.
Röing M, Rosenqvist U, Holmström I. (2012). Safety threats in telenursing as revealed in
reflections on authentic Swedish telenursing dialogues. Accepted for publication in
Scandinavian Journal of Caring Sciences.
3.
Fredriksson M, Blomqvist P, Winblad U. (2012). The trade-off between choice and equity:
Swedish policymakers’ arguments when introducing patient choice. Accepted for publication
in Journal of European Social Policy.
4.
Björkman I, Berg J, Viberg N, Stålsby Lundborg C. (2012). Awareness of antibiotic
resistance a prerequisite for restrictive antibiotic prescribing in UTI treatment. A qualitative
study among primary care physicians in southern Sweden. Accepted.
5.
Foss S, Sanner M, Mathiesen R, Eide H. (2012). Norske legers holdninger, ressurser
/rammebetingelser og lovverkets diagnostiske krav. Submitted.
6.
Gunningberg L, Mårtensson G, Mamhidir A-G, Florin J, Muntlin Athlin Å, Bååth C. (2012).
Pressure ulcer knowledge of registered nurses, assistant nurses and nurse students. A
descriptive, comparative multi-centre study in Sweden. Submitted.
7.
Muntlin Athlin Å, Carlsson M, Gunningberg L. (2012). To receive or not to receive
analgesics in the emergency department: The importance of pain intensity assessment and
initial nursing assessment. Submitted.
8.
Ernesäter A, Engström M, Winblad U, Rahmqvist M, Holmström IK. (2012).
Communication patterns in authentic Swedish telenursing encounters. Submitted.
9.
Björkman I, Berg J, Viberg N, Stålsby Lundborg C. (2012). Awareness of antibiotic
resistance a prerequisite for restrictive antibiotic prescribing in UTI treatment. A qualitative
study among primary care physicians in southern Sweden. Submitted.
10.
Törmä J, Saletti A, Winblad U, Cederholm C. (2012). Does undernutrition still prevail
among nursing home residents? Clinical Nutrition, 2012 Oct 23. [Epub ahead of print].
11.
Larsson J, Holmström IK. (2012). How excellent anaesthetists perform in the operating
theathre. A qualitative study on non-technical skills. British Journal of Anaesthesia, 2012 Oct
9. [Epub ahead of print].
12.
Björkman I, Sanner MA. The Swedish A(H1N1) vaccination campaign - why did not all
Swedes take the vaccination? Health Policy, 2012 Oct 5. [Epub ahead of print].
13.
Röing M, Holmström IK. (2012). Involving patients in treatment decisions – a delicate
balancing act for Swedish dentists. Health expectations, 2012 Apr 19. [Epub ahead of print].
14.
Larsson J, Holmström IK. Understanding anaesthesia training and trainees. Current opinion
in anaesthesiology, 2012 Dec;25(6):681-5.
15.
Ernesäter A, Winblad U, Engström M, Holmström IK. Malpractice claims regarding calls
to Swedish telephone advice nursing: what went wrong and why? Journal of telemedicine and
telecare, 2012 Oct;18(7):379-83.
16.
Hanning M, Åhs A, Winblad U, Lundström M. Impact of increased patient choice of
providers in Sweden: cataract surgery. Journal of Health Services Research & Policy, 2012
Apr;17(2):101-5.
17.
Fredriksson M, Blomqvist P, Winblad U. Conflict and Compliance in Swedish Health Care
Governance: Soft Law in the ‘Shadow of Hierarchy’. Scandinavian Political Studies, 2012
Mar;35(1):48-70.
18.
Vrangbæk K, Robertson R, Winblad U, Van de Bovenkamp H, Dixon A. Choice policies in
Northern European health systems. Health Economics, Policy and Law, 2012 Jan;7(1):47-71.
19.
Eide H, Foss S, Sanner M, Mathisen JR. Organdonasjon og norske legers behov for
opplæring – En nasjonal kartleggingsundersøkelse i donorsykehus. Tidsskrift for den Norske
legeforening, 2012;132:1235-8
20.
Saltman RB, Vrangbæk K , Lehto J, Winblad U. Consolidating national authority in Nordic
health systems. Eurohealth, 2012;18(3):21-4.
159
21.
Winblad U, Isaksson D, Bergman, P. (2012). Effekter av valfrihet inom hälso- och sjukvård
– en kartläggning av kunskapsläget. (pp. 1–181). Rapport. Vårdanalys, Stockholm.
22.
Larsson J, Holmström IK. Fenomenografi. I: Henricsson M. (red) Från idé till examination
– vetenskaplig teori och metod för examensarbete. Studentlitteratur, Lund 2012.
23.
Jangland E, Larsson J, Carlsson M, Gunningberg L. Patients’ complaints about negative
interactions with health professionals. International Journal of Person Centered Medicine,
2011 Dec;1(4):756-65.
24.
Flodén A, Persson LO, Rizell M, Sanner MA, Forsberg A. Attitudes to organ donation
among Swedish ICU nurses. Journal of Clinical Nursing, 2011 Nov;20(21-22):3183-95.
25.
Kallström AP, Björkman I, Lundborg CS. The 'sterile' doctor: doctors' perceptions of
infection control in hospitals in Sweden. Journal of Hospital Infection, 2011 Oct;79(2):187188.
26.
Arakelian E, Gunningberg L, Larsson J, Norlén K, Mahteme H. Factors influencing early
postoperative recovery after cytoreductive surgery and hyperthermic intraperitoneal
chemotherapy. European Journal of Surgical Oncology, 2011 Oct;37(10):897-903.
27.
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, 2011 Sep;20(1920)2939-47.
28.
Jangland E, Larsson J, Gunningberg L. Surgical nurses' different understandings of their
interactions with patients: a phenomenographic study. Scandinavian Journal of Caring
Sciences, 2011 Sep;25(3):533-41.
29.
Wihlman U, Holmström I, Lundborg CS, Axelsson R. Organising vocational rehabilitation
through interorganisational integration – a case study in Sweden. International Journal of
Health Planning and Management, 2011 Jul/Sep;26(3):e169-e185.
30.
Arakelian E, Gunningberg L, Larsson J. Defining operating room efficiency from the
perspective of the staff member and the supervisor. International Journal for Quality in
Health Care, 2011 Jun;23(3):220-1.
31.
Boll M, Rosenqvist U. Variations in how physiotherapists understand their work on
organizational and societal levels. Physiotherapy Research International, 2011
Jun;16(2):101-8.
32.
Björkman I, Lundborg CS. Allmänläkares infektionsbehandling varierar. Läkartidningen,
2011 Apr;108(16-17):916.
33.
Tully MP, Beckman-Gyllenstrand A, Bernsten CB. Factors predicting poor counselling about
prescription medicines in Swedish community pharmacies. Patient Education and
Counseling, 2011 Apr;83(1):3-6.
34.
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 and Transplantation, 2011 Mar;26(3):1053-7.
35.
Stolt R, Blomqvist P, Winblad U. Privatization of social services: Quality differences in
Swedish elderly care. Social Science & Medicine, 2011 Feb;72(4):560-7.
36.
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, 2011
Feb;23(1):100-6.
37.
Björkman I, Erntell M, Röing M, Lundborg CS. Infectious disease management in primary
care: perceptions of GPs. BMC Family Practice, 2011 Jan;12:1
38.
Muntlin Å, Carlsson M, Säfwenberg U, Gunningberg L. Outcomes of a nurse-initiated
intravenous analgesic protocol for abdominal pain in an emergency department: a quasiexperimental study. International Journal of Nursing Studies, 2011 Jan;48(1):13-23.
160
39.
Rahmqvist M, Ernesäter A, Holmström I. Triage and patient satisfaction among callers in
Swedish computer supported telephone advice nursing. Journal of Telemedicine and
Telecare, 2011;17(7):397-402.
40.
Muntlin Athlin Å. (2011). Patient safety and quality of care at an emergency care clinic.
Report. Uppsala County Council, Sweden.
41.
Winblad U, Hopfgarten J, Andersson C. (2011). ”Informationens roll i kundvalsmodeller
inom äldreomsorgen”. FoU-rapport 2011/4, Uppsala: Regionförbundet i Uppsala län.
42.
Winblad U, Andersson C. (2011). ”Vilken information behöver patienter och medborgare
för att välja vårdgivare och behandling? Patienters och medborgares behov av kvalitetssäkrad
och lättillgänglig information”. Rapport, Uppsala universitet.
43.
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.
44.
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. Stockholm: Regeringskansliet.
45.
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):e8.
46.
Kaminsky E, Carlsson M, Höglund AT, 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.
47.
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.
48.
Arnetz JE, Winblad U, Höglund AT, 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.
49.
Höglund AT, Winblad U, Arnetz B, Arnetz JE. Patient participation during hospitalization
for myocardial infarction: Perceptions among patients and personnel. Scandinavian Journal of
Caring Sciences, 2010 Sep;24(3):482-89.
50.
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 Aug;32(4):472-87.
51.
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.
52.
Larsson J, Sanner MA. 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.
53.
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.
54.
Larsson J, Gordh TE. Testing whether the epidural works: too time consuming? Acta
Anaesthesiologica Scandinavica, 2010 Jul;54(6):761-3.
55.
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.
161
56.
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.
57.
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.
58.
Hjelmblink F, Holmström I, Kjeldmand D. Stroke patients’ delay of emergency treatment.
Scandinavian Journal of Caring Sciences, 2010 Jun;24(2):307-11.
59.
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.
60.
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.
61.
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.
62.
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.
63.
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.
64.
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.
65.
Eiermann B, Bastholm Rahmner P, Korkmaz S, Lilja B, Vég A, Wettermark B. Knowledge
databases for clinical decision support in drug prescribing-development, quality assurance,
management, integration, implementation and evaluation of clinical value. Chapter in Clinical
Decision Support, Vienna 2010.
66.
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.
67.
Blomqvist P, Winblad U, Isaksson D. (2010). ”Analysis of contracts in Swedish elder care:
can quality aspects be monitored?” Work report 2010:2 in project: Äldreomsorg på
entreprenad: hur bevakas kvaliteten?
68.
Isaksson D, Blomqvist P, Winblad U. (2010). ”Äldreomsorgens utveckling 1993-2009”.
Arbetsrapport 2010:1 in project: Äldreomsorg på entreprenad: hur bevakas kvaliteten?
69.
Hanning M, Åhs A, Winblad U. (2010). ”Gränslös vård – en studie av patientrörlighet inom
gråstarrskirurgi”. Konferensbidrag, Svenska läkaresällskapets handlingar 2010.
Dissertations 2012
Annica Ernesäter, National Telephone Advice Nursing in Sweden: Patient Safety and
Communication
Mio Fredriksson, Between Equity and Local Autonomy: A Governance Dilemma in Swedish
Healthcare
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Ulrika Winblad
Inger K Holmström
1 257 000 kr
725 000 kr
Swedish Council for Working Life and Social Research (FAS) Ulrika Winblad
800 000 kr
Swedish Competition Authority (Konkurrensverket)
Ulrika Winblad
393 000 kr
AFA Insurance
Inger K Holmström
866 868 kr
AFA Insurance
Åsa Muntlin Athlin
2 404 380 kr
The National Board of Health and Welfare (Socialstyrelsen)
Ulrika Winblad
262 950 kr
The Swedish Agency for Health and Care Services Analysis
Ulrika Winblad
130 950 kr
Swedish Association of Local Authorities and Regions (SKL) Ulrika Winblad
1 365 850 kr
Mio Fredriksson
302 940 kr
Åsa Muntlin Athlin
175 000 kr
Medical Products Agency – Sweden (Läkemedelsverket)
Inger K Holmström
148 870 kr
Uppsala-Örebro Regional Research Council
Åsa Muntlin Athlin
375 000 kr
Uppsala University
Åsa Muntlin Athlin
203 000 kr
Department of Health and Ageing, Australian Government
Australia
Åsa Muntlin Athlin
50 000 AUD
Total
9 410 808 kr
and
50 000 AUD
External Reviews 2010-2012
Ingeborg Björkman: External reviewer of research application for ZonMw - The Netherlands
Organisation for Health Research and Development, 2012.
Margareta Sanner: External reviewer of research applications, Health and Medical Research Fund,
Food and Health Bureau, Government secretariat, Hong Kong 2012.
Ulrika Winblad: External reviewer of the Research Program for Health Services 2006-2010,
Research Council of Norway, Oslo, Jan 2011.
Ulrika Winblad: External reviewer of research applications for the Research Program for Health
Services 2011, Research Council of Norway.
Ulrika Winblad: External reviewer of research applications, Vårdalstiftelsen, Stockholm, 2011.
Inger K Holmström: External reviewer in gender studies for the Swedish research council. 2011
Inger K Holmström: Expert reviewer in Health Services Research for the Researh council of
Norway, 2010
Åsa Muntlin Athlin: External reviewer of research applications. Uppsala County Council, Uppsala.
2010
National and international commitments
Ulrika Winblad, Organizer of the national Conference: “Uppsala Public Management Seminar” nov
2011 and nov 2012.
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Ulrika Winblad: First opponent (1:a föredragande i betygdsnämnd). Disputation of Camilla
Palmhøj Nielsen, 9 Dec 2010, Samnfundsvidenskablige Fakultet, Copenhagens University.
Jan Larsson: Basel 2011: invited lecturer at a block course for staff and residents based on, New
Tools in Anesthesia” at the Department of Anesthesia, University Hospital Basel, Switzerland.
Jan Larsson: Pedagogical advisor at the Västra Götaland Region project “Building a training
program tailored for doctors with their basic medical training abroad.”
Jan Larsson: Lecturer at the Swedish annual course for tutors in anaesthesia.
Research projects
Choice in primary care in Uppsala county council - External review of
access, choice, financial resources and quality
(Vårdval i Uppsala län - Extern granskning av tillgänglighet, valfrihet, resurser och kvalitet)
Participants: Mio Fredriksson, Linn Boström, Love Edberg, Andreas Karlsson, Therese
Persson
During the latter half of 2012, the Health Services Research group evaluated the introduction of
choice in primary care in Uppsala county council (Vårdval Uppsala län). Mio Fredriksson led the
work of the evaluation which was commissioned by Uppsala county council. According to the
decision of the county council executive board, the evaluation approached questions about
healthcare quality, access, choice, economics and patient satisfaction.
Among other things, the evaluation shows that the access to primary care providers (both phone
access and physician access) has improved since 2009 when “choice in primary care” was
introduced in the county council. Choice of provider has increased only in the larger urban areas.
Most primary care providers are today available in parts of Uppsala where residents have the most
resources. The number of visits to a primary care physician or nurse has increased, and so has the
costs. Particularly with regard to antibiotic prescribing there are differences between private and
public health centers. Patient satisfaction has increased only marginally since “choice in primary
care” was introduced.
In the evaluation report, it is concluded that it is difficult to establish the impact of the choice reform
in Uppsala county council. During the studied time period the regulatory framework has changed, so
also the financial compensation model and reporting methods. Other national reforms such as the
Waiting-time guarantee also affect the delivery of primary care in the county councils.
Media coverage and public awareness, knowledge and attitudes to the
Swedish waiting-time guarantee
Participant: Mio Fredriksson
In this project, the focus is media coverage of access-enhancing policies in Sweden. The central
question is whether media coverage of access-enhancing policies in Sweden is linked to the public’s
level of knowledge of the Swedish waiting-time guarantee and the public’s opinions on how well the
time-limits in the Swedish waiting-time guarantee are met. Another more general way to phrase the
question is: what role do media play to convey a message from national decision-makers to the
population? The project (reported in December 2012) was commissioned by the National Board of
Health and Welfare being a part of the authority’s yearly evaluation of the Waiting-time guarantee
and the “Queue-billion”. The results of an analysis of the relationship between the regional media
coverage of the waiting-time guarantee (WTG) and the queue billion (QB) and the public awareness,
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knowledge and attitudes show that media coverage in the county councils does not seem to correlate
with public awareness or knowledge of the WTG. There is however a strong correlation to the
public’s negative as well as positive attitudes. When controlled for actual waiting-times in the
county councils, there is still a significant correlation between media coverage and the public’s
negative attitudes to how well they perceive the waiting-time guarantee to be met.
How can public authorities monitor private social service providers?
Participants: Ulrika Winblad, Linda Moberg
The entrance of private actors into the welfare sector represents a significant development in
Swedish politics and creates new demands on steering on part public authorities. Previous research
has demonstrated that, in order for societies to reap the benefits of privatization, public authorities
must carefully supervise the performance of private actors. In the absence of such supervision, or
monitoring, there is a significant risk that quality will be undermined, rather than improved and there
will be an unwanted selection of the most profitable users (the brightest pupils, the healthiest
patients, etc). The reason is the strong economic incentives created by the competition for public
contracts, particularly if providers are (like in the Swedish case) primarily for-profit firms. In the
project we investigate with the help of a distinct analytical model, how Swedish public authorities
supervise private service providers in the social area today and whether it can be said that there exist
sufficient political and legal preconditions for effective monitoring. Research methods used include
document analysis, interviews and a web-based survey to Swedish municipalities and county
councils. The areas studied are health care, primary education, child care, elder care and substance
abuse treatment. The project is run in collaboration with the Department of Government and
Department of Business Studies, Uppsala University.
Obstacles and opportunities for quality improvement - a process study of
the National quality registers in Sweden
Participants: Ulrika Winblad, Mio Fredriksson, Tobias Dahlström
In 2011 the Swedish Association of Local Authorities and Regions (Sveriges kommuner och
landsting) and the state agreed on a five-year investment in the development of national quality
registers. This initiative followed a review that showed that Sweden can take a leading position in
the development of a more efficient and equitable health care based on the use of national quality
registers. What obstacles and / or opportunities are there to bring about such a development? This
question is investigated in a national research project carried out by three research groups (in
Uppsala, Stockholm and Jönköping). The national research project is commissioned by the Swedish
Association of Local Authorities. During 2012, the work of the Uppsala research group has consisted
of project design and preparations for a case study in four county councils (and nine hospitals) and
an upcoming national web survey to hospitals using three selected quality registers.
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 national government has, however, given each county council the
responsibility to design their own reimbursement system which means that there exist 21 different
systems today. The systems vary in many aspects such as the degree of capitation reimbursement
(number of listed patient) compared to the reimbursement based on performance. The design of the
reimbursement system is the foundation for the competition in the primary care. Via the
reimbursement system each county councils creates financial incentives and thus steer the providers
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in desired direction. The aim of the project is to examine how the different designs of the
reimbursement systems affect how private health care providers operate.
To conduct the study, data regarding the different reimbursement levels, is collected from each
county council and a classification of each system is made. In a second stage data regarding number
of GP visits, nurse visits, number of new establishments will be collected from each county council.
Finally we will use statistical analysis to analyze how the design of the reimbursement system
affects how the providers behave. The project is run in collaboration with the Department of
Government, Uppsala University.
Universalism, Choice systems and social citizenship in the Swedish
welfare state
Participants: Linda Moberg, Ulrika Winblad
The Swedish welfare state, as emerged in the post war era, is characterized by a publicly funded
social service sector and based on the concept of universalism, implying that the service quality
should be high and equal to all recipients. In an attempt to achieve this objective the state has
traditionally taken on the role as provider of carefully planned and standardized services. However,
it has been argued that the public dominance prohibit recipients to influence how these services are
carried out and since the 1990’s demands for increased pluralism and user empowerment has been
put forward. During the last decades one of the most comprehensive reform trends within the social
service sector is the introduction of choice systems. The prime objectives behind these reforms are to
make it easier for private providers to establish service facilities with public reimbursement, to
enhance user choice and control and to improve the overall service quality. In addition, choice
systems are based on the theoretical assumption that when users are given the right to choose and rechoose service providers only high quality providers are expected to withstand the competition.
As choice systems emphasize the values of heterogeneity and provider pluralism, these reforms
indicate a shift from the welfare system that was constructed in the post war era. As the introduction
of choice system also entails that citizens are given the right to assess what constitute service quality,
the traditional means through which these sectors are governed has changed. However, the state still
has a legislated responsibility to ensure high and equal quality for all citizens. It is this relation
between the states and the individual citizen’s responsibility for service quality that constitute the
backdrop for this project, which aims to study whether the introduction of choice systems is
consistent with the objective of universalism.
The question will be addressed through four different studies where theoretical assumption
underpinning choice systems will be empirically tested. The first study, which has been initiated
during 2012, should be understood against the theoretical assumption that when recipients are given
the right to choose and re-choose service providers the overall service quality will enhance since
only high quality providers are expected to withstand the competition. However, in order for choice
system to have quality enhancing effects recipients need access to information on the relative quality
of these providers and they must exercise their right to choose based on these quality indicators. The
study therefore aims to investigate what kind of information social service recipients have access to
and whether it can be used to make a qualitative and informed choice of provider. The project is run
in collaboration with the Department of Government, Uppsala University.
Telenursing in Sweden: what goes wrong and why?
Participants: Annica Ernesäter, Inger Knutsson Holmström, Ulrika Winblad
During the last years centralization of telenursing services has occurred in Sweden with a national
telephone number for the entire country. Within this service computerized decision support (CDSS)
are used and two studies have focused on telenurses’ experiences of working with CDSS. The CDSS
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was perceived as incomplete, lacking information, not fully adapted to telenurses way of working.
Yet it was a useful tool, proving security.
SHD is one of Sweden’s largest healthcare providers there are no studies regarding patient safety
within this context. A study of 450 incident reports was analyzed with the aim of this to describe
errors reported within this context. Data were collected from all county councils that participated in
SHD and the most frequent outgoing incident reports (i.e., sent from SHD) regarded Accessibility
Problems and the most frequently incoming ones (i.e., sent to SHD) regarded Incorrect Assessment.
During 2010 a study aimed at analyzing communication between telenurses and callers with a clear
request for a specific level of care. 30 calls to SHD were analyzed using the Roter Interaction
Analysis System (RIAS). Results show a mean call time of 4 minutes and 14 seconds and that
telenurses mostly used close-ended questions.
Analysis of all malpractice claims (n=33) regarding SHD showed how male patients (n=19) were in
majority and the most common reason for calling were abdominal pain (n=11). Thirteen of the
patients died and 12 were admitted to intensive care. Communication failure was the most common
reason as identified by the National Board of Health and Welfare. Measures made by the health care
provider was discussion in work group (n=13).
Developing gender competence in Swedish telenursing
Participants: Roya Hakimnia, Inger Knutsson Holmström
The overall aim of 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 telenursing in
Sweden. The aim is also to develop an instrument that can investigate and contribute to gender
competence in telenursing and to test an educational intervention for telenurses.
Telenursing is considered as first line health care. Most telenurses are female. The majority of calls
for children and elderly parents are made by women and a study showed that fathers received advice
to seek physician twice as often as mothers. Gender refers to the social constructions of femininity
and masculinity and 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
and how other social factors interact with each other.
Intersectionality hold that gender interacts with other markers of difference, such as ”race”/ethnicity,
sexuality, social class and (dis)ability. The results can also have direct application in nursing
education and probably be used in other areas of healthcare and health care education.
We have analyzed 800 authentic calls to Swedish healthcare Direct from an intersectional
perspective. The service was not used equally. The most common caller was a woman proficient in
Swedish, and the least likely caller was a man that was not proficient in Swedish. Calling a telenurse
seems to clash with hegemonic masculinity, while being in line with ideal femininity, where seeking
help and taking care of others’ health are central aspects. Health behavior is hence a part of “doing
gender”. Furthermore, we made an in-depth analyzis of 20 calls to SHD with Roter Ineractional
Analysis System and Critical Discourse Analysis. The calls are dominated by task-focused
utterances such as giving medical information. Open medical questions are rare while close ended
medical questions are common. Three types of ideological work were found in the calls:
gatekeeping, hegemonic masculinity and traditional medicine ideology. These three types of
ideological works was part of the dominating discourse in telenursing echoing macro-aspects of
society. A counter discourse was however also found where open questions, questions about the
social, information giving and challenging hegemonic masculinity were defining ingredients.
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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. 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.
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 as ways of restructuring
Participants: Madeleine Boll, Urban Rosenqvist, Cecilia Bernsten
The overall aim of my doctoral thesis in process is to describe and explore physiotherapists
understanding of and being in their work in contexts at the system level within health care
organizations. The thesis comprehends four qualitative studies where totally thirty four
physiotherapists has been interviewed. In study I the focus was on understanding of and approaches
to work, where seven physiotherapists in primary care were working with health promotion in
compulsory schools. Study II was about how twenty one physiotherapists working on organizational
and societal levels varied in their understanding of their work. In Study III understanding of work
was explored as a transforming process regarding experiences and developed skills on individual
level into work on organizational and societal levels. In study IV former made interviews in study I
to III were explored concerning ways of sense making in managerial work. The thesis offers
possibilities of challenging traditional use of physiotherapy as just treating individuals.
Teamwork in an emergency department
Participant: Åsa Muntlin Athlin
Increasing waiting times and long lead-times in emergency departments are well-known problems,
which could influence efficiency, patient safety and patient satisfaction in a negative way. The
healthcare needs to use the limited resources in a more effective way. Working in multidisciplinary
168
teams could improve care processes in the healthcare. The overall aim was to investigate how
implementation of team work in an emergency department can effect efficiency, quality of care,
patient safety and patient satisfaction and work environment. In addition, the implementation process
will be further studied. A longitudinal non-randomized intervention study design with three follow
ups was used. The intervention was teamwork in the specialty of medicine in an emergency
department. Patient questionnaires, staff questionnaires (diaries), patient health records and
observations have been used for data collection.
PUP – Pressure Ulcer Prevention
Despite guidelines for pressure ulcer prevention, clinical reports indicating that pressure ulcer is still
common in the healthcare. Research has shown that the pressure ulcer prevalence is higher in
Swedish hospitals, compared to other hospitals in Europe and in USA. In 2010, a group of
researchers from county councils and universities in Uppsala, Värmland, Dalarna and Gävleborg
started a collaboration project with pressure ulcer prevention as the topic. One of the research
projects is a randomized clinical trial, where the aim is to study the effect of a pressure reducing heel
protection and health economic related effects. This study follows the care chain; from pre-hospital
care to discharge from the hospital. Another research project is about describing and comparing
Swedish nurses’ and nursing students’ knowledge and attitudes to pressure ulcer prevention.
Fundamentals of care
This is an ongoing research collaboration project with an international and multidisciplinary group
of clinicians, researchers and scholars from Australia, UK and Sweden. According to healthcare
reforms around the world, reports are emphasizing that fundamental aspects of care are being
neglected in acute hospital settings. The overall aim with the Fundamentals of Care project is to
investigate how fundamental aspects of care are delivered to patients within health systems.
Examples of ongoing subprojects are: exploring stroke patients’ experiences of fundamentals of care
and cancer patients’ experiences of fundamentals of care. Another collaboration project is between
the Hampstead Rehabilitation Centre (Australia) and the University of Adelaide in Australia,
focusing on improving the fundamentals of care in the sub-acute care. The main purpose with the
research project is to evaluate method of introducing change (Knowledge Translation (KT) toolkit)
and to evaluate the fundamentals of care framework. An additional project is to investigate clinical
rounding and nursing clinical handovers with special attention to fundamental aspects of care.
The Future Shape of the Nursing Workforce: A Synthesis of the Evidence
of Factors that Impact on Quality Nursing Care
An informal group of Australian nurse leaders highlighted the need for looking at the nursing future
and identify the evidence around what makes a positive environment for nursing, in order to
influence the direction of health care and nursing’s future. This led to the commissioning of an
umbrella review, funded by the Department of Health and Ageing, Australian Government. A total
of 79 systematic reviews published between 1995 and 2012 were included in the umbrella review.
Recommendations for practice, research, education and policy initiatives were provided.
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Teamwork in emergency care: Using behaviour analysis to understand
how changes in practice can be achieved and sustained.
Multi-professional teamwork is a promising method to improve patient outcomes and patient safety
in health care. Introduction of teamwork always includes some type of behaviour change, however,
this behaviour change has been proven to be a major challenge when implementing teamwork. Thus,
understanding how and why behaviour change interventions influence behaviour is emphasized as a
prioritized area in implementation research. Sustainability has also been highlighted as one of the
most challenging aspects of implementation. The overall aim with the research project is to deepen
our understanding of what works when implementing teamwork in a complex context such as the
emergency department and how to sustain changes.
A synthesis of phenomenographic studies on patients’ ways of
experiencing illness.
Participants: Marta Röing och Margareta Sanner
The focus of interest in this study is patients’ experiences of illness, or aspects of their illness.
Phenomenography, originally developed within an educational framework in Sweden, is a research
approach which studies the variations in ways that people understand or experience phenomena in
the world around them. It is based on the notion that phenomena or aspects of reality in the world
can be understood or experienced in a limited number of ways.
Given this potential, we explore research literature as to the application of phenomenography as a
qualitative research method in the study of patients’ experiences of illness and ask the following
questions: What can the uniqueness of a phenomenographic approach to data add to knowledge of
patient illnesses? How effective is phenomenography as a tool in patient education and patient
empowerment?
Selection criteria for articles applicable for a possible review were that they focused on patient’
experiences of illness (or aspects of their illness) and really used a phenomenographic approach to
data collection and analysis. These articles will be read in-depth and a meta-syntesis will eventually
be performed, using the meta-ethnographic method of syntesis. In this work we will also make a
critical review of how the method of phenomenography is applied in the various studies.
Non-prescription drugs and self-medication among adolescents in
Sweden
Participants: Ingeborg Björkman, Marta Röing, Pia Bastholm-Rahmner, Inger Knutsson
Holmström
Consumers in Sweden were given greater access to OTC drugs in 2009 after the reregulation of the
pharmacy market, which allowed for the establishment of private pharmacies and sale of specific
over-the-counter (OTC) drugs in retail stores and gas stations.
Increased access to OTC drugs can give Swedish teenagers new opportunities for self-care.
However, the ability to buy OTC drugs outside pharmacies gives little opportunity for the traditional
expert surveillance of pharmacists, thus increasing the possibility of careless or inappropriate use of
OTC drugs. This study explores and describes Swedish teenagers' views on OTC drugs, with special
regard to analgesic drugs, and asks the following questions: How and where to Swedish teenagers
acquire their knowledge and attitudes regarding OTC drugs? What perceptions do they have about
the use of OTC drugs? This study has a descriptive design with a qualitative approach. Data was
collected in 2011 with 10 focus group discussions with high school students aged 16 to 19 years
from different parts of Sweden. The group discussions revealed teenagers’ attitudes and knowledge
gaps regarding OTC drugs, and the significant influence of parents and peers on their OTC drug use.
170
This study gives insight into how vulnerable some Swedish teenagers can be as new consumers of
OTC drugs and underscores their need for more guidance and information about OTC drugs and
their use.
Experiences and participation in sick-listing
Participant: Inger Knutsson Holmström
This project is run in collaboration with participants in the research group for Family Medicine
(Thorne Wallman, Linda Lännerström, Lars Carlsson). The project aims at studying both general
practitioners views of sick-listing, and experiences and participation in the process of being on longterm sick-leave from the patients view. Sixteen patients on long-term sick-leave have been
interviewed about their experiences and about participation in the process. This data-collection was
carried out during 2011 and data analysis conducted during 2012 with a phenomenological analysis
of the lived experience of being on long-term sick-leave. The findings revealed that the participants’
experience of being long-term sicklisted was losing independence. They had to stop working and
start to rely on the state for support. Most of the participants experienced their present life as a
constant, uncertain pending meanwhile being questioned by authorities and society. They all were
exposed to the rules of the social insurance but the rules and the encounters with professionals
affected them differently. A few were treated well and went through changes that in the end led to a
better life. Many were not treated well which caused impaired confidence in themselves and in
authorities. The interview-parts about participation in the sick-listing process will be separately
analyzed during 2013 with qualitative content analysis. In addition, general practitioners have been
interviewed in five focus-groups sessions during 2012 about their experiences of their work
with sick-listing.
Parents’ expectations and experiences of calling Swedish Healthcare
Direct regarding paediatric health issues
Participants: Elenor Kaminsky, Inger Knutsson Holmström, Marta Röing.
During 2012, 5.2 million calls were made to the Swedish Healthcare Direct. About 50% are
paediatric calls made by parent callers. The Study aims at performing a descriptive and exploratory
interview study, with a strategic sample of 21 parents who had used the service for their child within
the last six months. Seventeen hours of transcribed interview data was analyzed using qualitative
content analysis. Conclusions made from the findings are that parents desire an equal relationship
with telenurses. Moreover, exploring parents’ expectations will reduce their worry, increase their
learning and result in greater trust in telenurses’ recommendations. Telenurses’ awareness of gender
impact can further develop the telenursing health service in providing safe care on equal terms for a
vulnerable patient group, children. The manuscript has been submitted and is under review. The
project is ongoing during 2010-2013.
The Swedish Healthcare Direct managers’ views on the telenursing work
Participants: Elenor Kaminsky, Inger Knutsson Holmström, Jan Larsson, Mio Fredriksson.
The Swedish Healthcare Direct (SHD) is Sweden’s largest healthcare provider. It aims at increased
public sense of security and healthcare efficiency. How this matches legal goals of health promotion
and equitable healthcare and what the SHD managers hold as the goals of the telenursing work is
unknown. The Study aims at performing a descriptive and explorative interview study with the 23
employed SHD managers regarding their views on the telenursing work. Data was analysed using
directed content analysis and the manuscript will be submitted during spring 2013. The preliminary
findings show that managers mainly echo the organisational goals of the SHD. The project is
ongoing during 2011-2013.
171
Oxidative Stress and Inflammation
Research Group Leader Samar Basu, M.Sc., PhD., Professor
The research group “Oxidative Stress and Inflammation” was established in January 2009. The main
research area of this group is “Oxidative stress and Clinical Inflammation”.
Research Group Leader Samar Basu is a Professor of Biochemistry and Medical Inflammation at the
Universite d’Auvergne, Faculte d’ Pharmacie, Clermont-Ferrand, France, and he holds a Chaire
d’Excellence Professor and Director position.
This research group “Oxidative Stress and Inflammation” is dedicated to research on inflammation
in physiology and in disease state. Additionally, the role of oxidative stress that reflects an increased
levels of free radicals that are implicated both in ageing and in several inflammatory diseases is also
a major research area. Lipid peroxidation products catalysed by free radicals and cyclooxygenases
have shown to be of importance in many inflammatory and oxidative stress-related diseases.
Bioactive prostaglandin formation by cyclooxygenases from arachidonic acid and their contribution
in inflammation is well described by our group in the past years in addition to the role of free
radicals-mediated product isoprostanes in physiology and a range of diseases such as cardiovascular
diseases and cancer. The research group have developed crucial assays through raising specific
antibodies against isoprostanes indicating oxidative injury and prostaglandin F2 indicating
inflammatory response, and also involved in development of assays on anti-inflammatory resolvins.
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 implicated in healthy individuals and also in development of different human
diseases. Collectively, the research group 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.
Samar Basu
Johanna Helmersson
Lillemor Källström
Elisabet Rytter
External
Maria Palm
Emma Lindström
Adriana Miclescu
1.
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.
2.
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.
172
3.
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.
4.
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, 21, 665-667.
5.
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.
6.
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, 95, 44604464.
7.
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.
8.
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.
9.
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.
10.
Ulven, S. M., 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.
Lipids, 2011, 46, 37-46.
11.
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. Atherosclerosis, 2011, 214, 110-116.
12.
Basu, S., A. Miclescu, H. Sharma and L. Wiklund. Propofol mitigates systemic oxidative
injury during experimental cardiopulmonary resuscitation. Prost. Leuko. Ess. Fatty Acids
2010, 84, 123-130.
13.
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. 2011, 94, 1986S-1992S.
14.
Semenas, E, H.S. Sharma, A. Nozari, S. Basu and L. Wiklund. Neuroprotective Effects of 17Beta-Estradiol after Hypovolemic Cardiac Arrest in Immature Piglets: The Role of Nitric
Oxide and Peroxidation. Shock, 2011, 36, 30-37.
15.
Nerpin, 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, 26, 2820-2827.
173
16.
Palm, M., S. Basu, A. Larsson, L. Wernroth, H. Åkerrud and O. Axelsson. A longitudinal
study of plasma levels of soluble fms-like tyrosin kinase, placental growth factor,
sFLT1:PLGF ratio and vascular endothelial growth factor in normal pregnancy. Acta
Obstetricia et Gynecologica Scandinavica, 2011, 90, 1244-1251.
17.
Basu, S., B. Zethelius, J. Helmersson, C. Berne, A. Larsson and J. Ärnlöv. Cytokine-mediated
inflammation is independently associated with insulin glucose disposal measured by the
euglycemic insulin clamp in a community-based cohort of elderly men. Int. J. Clin. & Exp.
Med. 2011, 4, 164-168.
18.
Wang, H., L.M. Styffen, B. Vessby, S. Basu, J. Steinberger, A. Moran, D.R. Jacobs, C.-P.
Hong and A.R. Sinaiko. Obesity modifies the relations betweed serum markers of dairy fats
and inflammation and oxidative stress among adolescents. Obesity, 2011, 19, 2404-2410.
19.
Clausen, F., N. Marklund, A. Lewén, S. Basu, P. Enblad and L. Hillered. Interstitial
isoprostane 8-iso-PGF2 as a biomarker of oxidative stress following severe human traumatic
brain injury. J. Neurotrauma, 2011, 29, 766-7.
20.
Smit, L., M. Katan, A. Wanders, S. Basu and I. Brower. Effect of trans fatty acid consumption
on markers of oxidative stress and inflammation in humans, A randomized cross-over study.
J. Nutr., 2011, 141, 1673-1678.
21.
Kirkhus, B., A. Lamglait, K.-E. Eilertsen, E. Falch, T. Haider, H. Vik, N. Hoem, T.A. Hagve,
S. Basu, E. Olsen, I. Seljeflot, E. Elind and S.M. Ulven. Effects of similar intakes of marine
n-3 fatty acids from enriched food products and fish oil on cardiovascular risk markers in
healthy humans. British J. Nutrition, 2011, 15, 1-11.
22.
Jobs, E., E. Ingelsson, U. Riserus, E. Neprin, M. Jobs, J. Sundstrom, S. Basu, A. Larsson, L.
Lind and J. Arnlov. Serum cathepsin and the risk of mortality. Journal of American Medical
Association (JAMA), 2011, 306, 1113-1121.
23.
Garcia-Rodriguez, E.C., J. Helmersson-Karlqvist, M.D. Mesa, E.A. Miles, P.S. Noakes, M.
Vlachava, L.-S. Kremmyda, N.D. Diaper, K.M. Godfrey, P.C. Calder, A. Gil and S. Basu.
Does intake of salmon increase markers of oxidative stress in pregnant women?-The salmon
in pregnancy study. Antioxidants & Redox Signaling. 2011, 15, 2819-2823.
24.
Bredsen, N.T., S. Stender, P.B. Szecsi, S.B. Pedersen, S. Basu, L.I. Hellgren, J.W. Newman,
T.M. Larsen, S.B. Hauggard and A. Astrup. Trans fatty acid intake induces low-grade
systyemic inflammation: evidence from a randomized, controlled trial in overweight
postmenopausal women. J. Lipid Res. 2011, 52,1821-1828.
25.
Helmersson-Karlqvist, J., E. A. Miles, M. Vlachava, L.-S. Kremmyda, P.S. Noaks, N.D.
Diaper, K. M. Godfrey, P. Calder and S. Basu. Enhanced prostaglandin F2 formation in
human pregnancy and the effect of increased oily fish intake; results from the Salmon in
Pregnancy Study. Prost. Leuk. Ess. Fatty Acids, 2012. 86, 35-38.
26.
Lindström, E., L.-Å. Persson, R. Raqib, S. E. Arifeen, S. Basu, E.-C. Ekström. Associations
between free radical-mediated oxidative parameters in pregnancy and birth anthropometry in
a cohort of women and children in rural Bangladesh, the MINIMat-trial. Free Radical
Research, 2012, 46, 253-264.
27.
García-Rodríguez, C.E., M.D. Mesa, J. Olza, M. Vlachava, L.-S. Kremmyda, N. D. Diaper, P.
S. Noakes, E. A. Miles, M. C. Ramírez-Tortosa, B. Liaset, L. Frøyland, A. Rossary, M.-C.
Farges, M.-P. Vasson, C. M. Aguilera, J. Helmersson-Karlqvist, K. M. Godfrey, P. C. Calder,
S. Basu and Á. Gil. Does two portions of salmon per week consumption enhance the
antioxidant defense system in pregnant women? Antioxidants & Redox Signaling, 2012, 16,
1401-1406.
28.
Bjermo, H., D., Iggman, J., Kullberg, I., Dahlman, L. Johansson, L. Persson, J. Berglund, K.
Pulkki, S. Basu, M. Uusitupa, M. Rudling, P. Arner , T. Cederholm, H. Ahlström, U. Risérus.
Dietary fat modification and liver fat content in abdominal obesity. Am J. Clin. Nutr., 2012,
95, 1003-1012.
174
29.
Helmersson-Karlqvist, J., K. Bjorklund-Bodegard, A. Larsson, S. Basu. 24-Hour ambulatory
blood pressure associates inversely with prostaglandin F, interleukin-6 and F2-isoprostane
formation in a Swedish population of older men. Int. J. Clin. & Exp. Med. 2012, 5, 145-153.
30.
Jobs, E., U. Risérus, E. Ingelsson, J. Sundström, M. Jobs, E. Nerpin, D. Iggman, S. Basu, A.
Larsson, L. Lind L, and J. Ärnlöv. Serum cathepsin S is associated with decreased insulin
sensitivity and the development of diabetes type 2 in a community based cohort of elderly
men. Diabetes Care, e-published 24 August, 2012.
31.
IL6R Genetics Consortium Emerging Risk Factors Collaboration (S. Basu Collaborator).
Interleukin-6 receptor pathways in coronary heart disease: a collaborative meta-analysis of 82
studies. Lancet, 2012, 379, 1205-1213.
32.
Nerpin, E. , E. Ingelsson, U. Risérus, J. Sundström, A. Larsson A., E. Jobs E., S. Basu, J.
Helmersson and J. Ärnlöv J. Inflammation, oxidative stress, glomerular filtration rate and
albumin creatinine ratio in elderly men. BMC Res Notes. 2012 Sep 27;5(1) (Epub ahead of
print).
33.
Larsson, A., M. Palm, S. Basu and A. Larsson. Insulin-like growth factor binding protein-1
(IGFBP-1) during normal pregnancy. Gynecological Endocrinology (In press).
34.
Berg, K., M. Langaas, M. Ericsson, H. Pleym H, S. Basu, I.S. Nordrum, N. Vitale,
Haaverstad, R. Acetylsalicylic acid treatment until surgery reduces oxidative stress and
inflammation in patients undergoing coronary artery bypass grafting. European Journal of
Cardio-Thoracic Surgery & Interactive CardioVascular and Thoracic Surgery (In press).
35.
The Emerging Risk Factors Collaboration Consortium (Basu, S. Collaborator). C-reactive
protein, fibrinogen, and cardiovascular disease prediction. N Engl J Med 2012; 367:13101320.
36.
Lennmyr, F., M. Molnar, S. Basu and L. Wiklund. Cerebral effects of hyperglycemia in
experimental cardiac arrest. Crit. Care. Med, 2012, 38, 1726-1732.
37.
Nachat-Kappes, R., A. Pinel, K. Combe, B. Lamas, M.-C. Farges, A. Rossary, N. GoncalvesMendes, F. Caldefie-Chezet, M.-P. Vasson and S. Basu. Effects of enriched environment on
COX-2, leptin and eicosanoids in a mouse model of breast cancer. PLoSONE 7(12): e51525.
doi:10.1371/journal.pone.0051525.
Peer-reviewed review articles in scientific journals
38.
Basu S. Fatty acid oxidation and isoprostanes: oxidative strain and oxidative stress. Pros.
Leuk. Ess. Fatty Acids 2010, 82, 219-226.
39.
Basu, S. Bioactive Eicosanoids: Role of Prostaglandin F2 and F2-Isoprostanes in
Inflammation and Oxidative Stress Related Pathology. Molecules and Cells 2010, 30, 383-91.
40.
Basu, S., R. Nachat-Kappes, F. Caldefie-Chezet and M.-P. Vasson. Eicosanoids and
adipokines in breast cancer: From molecular mechanisms to clinical considerations.
Antioxidants and Redox Signaling. On-line published July 1, 2012.
Peer-reviewed review articles in books, conference proceedings, popular science and
thesis.
Book Chapters
41.
Basu S. Carbontetrachloride induced oxidative stress- A classical model of experimental
oxidative stress. In: Studies of Experimental Models. Oxidative Stress in Basic Research and
Clinical Practice. Eds. S. Basu & L. Wiklund, SpringerN.Y., USA 2011.
42.
Wiklund, L. and S. Basu. An Experimental model of myocardial and cerebral global ischemia
and reperfusion. In: Studies of Experimental Models. Oxidative Stress in Basic Research and
Clinical Practice. Eds. S. Basu & L. Wiklund, Springer N.Y., USA 2011.
43.
Lipcecy, M., M. Eriksson and S. Basu. Oxidative in various animal models with special
reference to porcine endotoxemia. In: Studies of Experimental Models. Oxidative Stress in
175
Basic Research and Clinical Practice. Experimental Models of Oxidative Stress. Eds. S. Basu
& L. Wiklund, Springer N.Y., USA 2011.
Book Editor
Studies of Experimental Models. Oxidative Stress in Basic Research and Clinical Practice. Editor: S.
Basu and Co-Editor: Lars Wiklund, Springer N.Y., USA 2011, ISBN 978-1-60761-955-0. Library of
Congress Control Number: 2011923976.
Reviews 2010
Basu S. Fatty acid oxidation and isoprostanes: oxidative strain and oxidative stress. Pros. Leuk. Ess.
Fatty Acids 2010, 82, 219-226.
Basu, S. Bioactive Eicosanoids: Role of Prostaglandin F2 and F2-Isoprostanes in Inflammation and
Oxidative Stress Related Pathology. Molecules and Cells 2010, 30, 383-91.
Dissertations 2012
Maria Palm
Emma Lindström
The Norweigian Research Council
The Conseil Regional d’Auvergne, France
Research projects
Smartfish
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. Financed by Norweigian Research Council.
Impact of inflammation, oxidative stress and adipokines
Collaborators: Samar Basu, Alicja Wolk, Anders Larsson, Marie-Paule Vasson
The project is performed in collaboration with Karolinska Institute, Clinical Biochemistry, Uppsala
University, Sweden and Universite d’Auvergne, Clermont-Ferrand, France. Financed by Conseil
d’Auvergne, France
176
Eicosanoids, COXs, ROS and adipokines in in experimental model of
mammary cancer
Collaborators: Collaborators: Samar Basu and Marie-Paule Vasson
The project is performed in collaboration with Uppsala University, Sweden and Universite
d’Auvergne, Clermont-Ferrand, France.
Oxidative stress, inflammation and angiogenesis during normal pregnancy, parturition process
Collaborators: Maria Palm, Ove Axelsson, Anders Larsson and Samar Basu
The project is a 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 a 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, Sham Arifeen, Rubanna Ruqib,
Samar Basu. Financed by The Swedish Research Council.
Oxidative stress, inflammation among 82-years ULSAM men and
cardiovascular risk
Collaborators: Johanna Helmersson, Anders Larsson and Samar Basu
The project is a performed in collaboration with the Clinical Chemistry, Uppsala University.
Oxidative stress and neuroprotection following cardiac arrest by different
therapy
Collaborators: Samar Basu and Lars Wiklund
The project is a performed in collaboration with the Department of Surgery and Anaesthesiology,
Uppsala University.
Oxidative stress and neuroprotection following cardiac arrest by
hypothermia
Collaborators: Samar Basu and Sten Rubertsson
The project is a performed in collaboration with the Department of Surgery and Anaesthesiology,
Uppsala University.
Oxidative stress and regional pain syndrome
Collaborators: Samar Basu and Torsten Gordh
The project is a performed in collaboration with the Smart Centrum, Akademiska Hospital, Uppsala
University.
177
Oxidative stress and acute traumatic brain injury
Collaborators: Samar Basu and Lars Hillered
The project is a performed in collaboration with the Department of Neurosurgery, Uppsala
University.
Antibody and assay development on resolvins
Collaborators: Samar Basu, Charles Serhan
The project is a performed in collaboration with Brigham and Women's Hospital/ Harvard Medical
School, Boston, USA.
Oxidative stress and cataract formation: The Swedish Mammography
Cohort
Collaborators: Samar Basu, Anders Larsson and Alicja Wolk
The project is performed in collaboration with Clinical Biochemistry, Uppsala University and
Karolinska Institute, Sweden. Financed by Conseil Regional d’Auvergne, France.
F-isoprostane metabolism and detection of oxidative stress
Collaborators: Denis Calleweart and Samar Basu
The project is a performed in collaboration with University of Oakland (MI) and Vanderbilt
University, USA.
AQUAMAX: 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, China.
(BOSS-study) Multi-laboratory study on biomarkers of oxidative stress at
NIH
Collaborators: Maria Kadiiska, Ron Mason, Samar Basu
The project is a performed in collaboration with NIEHS, National Institute of Health (NIH), USA
and other institutions from several countries and is financed by NIEHS (NIH).
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
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.
178
Prostaglandin F2α as a predictor of cardiovascular morbidity and
mortality
Collaborators: Johanna Helmersson, Johan Ärnlöv, Anders Larsson, Samar Basu
The project is performed in collaboration with Clinical Chemistry and Pharmacology, Uppsala
University Hospital and Geriatrics.
Complicated pregnancy and inflammation
Collaborators: Samar Basu and Osamu Ishihara
The project is performed in collaboration with Saitama Medical School, Tokyo, Japan.
Sleep Apnoea and oxidative stress
Collaborators: Marie Marklund and Samar Basu
The project is performed in collaboration with Umeå Universitet, Sweden.
Conjugated Linoleic acid supplementation and lipid peroxidation
Collaborators: Ronny Kramer, Gerhard Jaheris and Samar Basu
The project is performed in collaboration with University of Jenna, Germany.
179
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
Program: 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. 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. To reach our aims we mainly use knowledge from
Economics, Information systems, and Psychology.
Members of and external partners to the group during 2012
Members of and external partners to the group during 2012 are listed in Table 1 and 2 respectively.
Table 1. Members of the group during 2012.
Name
Task/s in group
Title/s
Department/University
Louise von Essen
Research group
leader and
Program director
for U-CARE
Researcher
Professor, PhD, MSc
in Psychology,
Licensed psychologist
Department of Public
Health and Caring
Sciences, Uppsala
University
Health and Caring
Sciences, Uppsala
University
Department of Women’s
and Children’s Health,
Uppsala University
Health and Caring
Sciences, Uppsala
University
Annika Lindahl
Norberg
Gunn Engvall
Researcher
Helena Grönqvist
Post doc
researcher and
Research
coordinator for UCARE
Post doc
researcher
Researcher
Erik Grönqvist
Claes Held
Associate Professor,
PhD, MSc in
Psychology, Licensed
psychologist
Senior lecturer, PhD,
Registered nurse
PhD, MSc in
Cognitive Sciences
PhD, MSc in Social
Sciences
Associate professor,
PhD, MD
PhD, MSc in
Behavioral Sciences
Emma Hovén
Post doc
researcher
Birgitta Johansson
Researcher
Registered nurse
Elisabet Mattsson
Researcher
PhD, Registered
nurse, Registered
midwife
Erik Olsson
Post doc
PhD, MSc in
180
Department of Economics,
Uppsala University
Uppsala Clinical Research
Centre, Uppsala University
Health and Caring
Sciences, Uppsala
University
Department of Radiology,
Oncology and Radiation
Science, Uppsala
University
Health and Caring
Sciences, Uppsala
University
researcher
psychologist
Jonas Sjöström
Post doc
researcher and IT
coordinator for
U-CARE
PhD, MSc in
Information systems
Sven Alfonsson
PhD student and
Clinical assistant
MSc in Psychology,
Malin Ander
PhD student
MSc in Psychology
Anders Brantnell
MSc in Political
Sciences
Martin Cernvall
PhD student and
Program
coordinator for UCARE
PhD student
Lisa Ljungman
PhD student
MSc in Psychology
Ruth Lochan
PhD student
MSc in Information
systems
Susanne Mattsson
PhD student
Registered nurse
Mudassir Imram
Mustafa
PhD student
MSc in Information
systems
Fredrika Norlund
PhD student and
Clinical assistant
Hafijur Mohammad
Rahman
Research assistant
MSc in Psychology,
Licensed
psychologist,
Licensed
psychotherapist
MSc in Information
systems
MSc in Psychology,
181
Health and Caring
Sciences, Uppsala
University
Department of Informatics
and Media, and
Health and Caring
Sciences, Uppsala
University
Health and Caring
Sciences, Uppsala
University
Health and Caring
Sciences, Uppsala
University
Health and Caring
Sciences, Uppsala
University
Health and Caring
Sciences, Uppsala
University
Health and Caring
Sciences, Uppsala
University
Health and Caring
Sciences, and Department
of Informatics and Media,
Uppsala University
Health and Caring
Sciences, Uppsala
University
Health and Caring
Uppsala University
Health and Caring
Sciences, Uppsala
University
Health and Caring
Teolinda Toft
PhD student
BSc in Social Work
Susanne Lorenz
Research assistant
Registered nurse
Madelen Hermelin
Research assistant
MSc in Information
systems
Sofia Leijon
Research assistant
Student at the
Psychology program
Ellen Skogseid
Research assistant
MSc in Psychology
Sandra Waara
Psychologist
MSc in Psychology
Uppsala University
Health and Caring
Sciences, Uppsala
University
Health and Caring
Sciences, Uppsala
University
Health and Caring
Uppsala University
Health and Caring
Sciences, Uppsala
University
Health and Caring
Sciences, Uppsala
University
Health and Caring
Sciences, Uppsala
University
Table 2. External partners to the group during 2012.
Name
Task/s
Title/s
Department/University
Enrico Baraldi
Researcher
Matz Dahlberg
Researcher
Thecla Kohi
Researcher
Professor, PhD, MSc
in Business
administration
Professor, PhD, MSc
in Economics
Professor, PhD,
Registered nurse
Pär Ågerfalk
Researcher
Maria Carlsson
Researcher
Timo Hursti
Researcher
Department of Engineering
Sciences, Uppsala
University
Uppsala University
Muhimbili University of
Health and Allied
Sciences, School of
Nursing, Dar es Salaam,
Tanzania
and Media, Uppsala
University
Health and Caring
Sciences, Uppsala
University
Department of
Psychology, Uppsala
University
Professor, PhD, MSc
in Information
systems
PhD, Registered
nurse
PhD, MSc in
182
Psychologist
PhD, MD
Gustaf Ljungman
Researcher
Christine Rubertsson
Researcher
Agneta Skoog
Svanberg
Researcher
Niklas Zethraeus
Researcher
Jenny Eriksson
Lundström
Researcher
Lena Hedén
Researcher
PhD, Registered
nurse
Brjánn Ljótsson
Researcher
Gunilla Mårtensson
Researcher
Anna Hauffman
PhD student
PhD, MSc in
psychologist
Registered nurse
Registered nurse
Tove Kamsvåg
Magnusson
PhD student
MD
Pernilla Jernerén
Maathz
PhD student
MSc in Psychology,
Anna Norén
PhD student
MSc in Economics
Jenny Thorsell
PhD student
MSc in Psychology,
Emma Wallin
PhD student
MSc in Psychology,
Mattias Öman
PhD student
MSc in Economics
Marina Forslund
Research assistant
MSc in Nutrition
Golden Masika
Research assistant
Registered nurse
Registered nurse,
Registered midwife
Registered nurse,
Registered midwife
PhD, MSc in
Economics
PhD, MSc in
Information systems
183
Uppsala University
Uppsala University
Uppsala University
Stockholm School of
Economics
and Media, Uppsala
University
Uppsala University
Department of Clinical
Neuroscience, Karolinska
Institutet
University of Gävle
Science, Uppsala
University
Uppsala University
Department of
Psychology, Uppsala
University
Uppsala University
Uppsala University
Department of
Psychology, Uppsala
University
Uppsala University
Science, Uppsala
University
University of Dodoma,
Dodoma, Tanzania
Publications 2010-2012 (From persons listed in Table 1)
2012
1.
Hedén, L., Pöder, U., von Essen, L. & Ljungman, G. (2013). Parents’ perceptions of their
child’s symptom burden during and after cancer treatment. Journal of Pain and Symptom
Management. doi:pii: S0885-3924(13)00102-4. 10.1016/j.jpainsymman.2012.09.012. [Epub
ahead of print].
2.
Hovén, E., von Essen, L. & Lindahl Norberg, A. (2013). A longitudinal assessment of work
situation, sick leave, and household income of mothers and fathers of children with cancer in
Sweden. Acta Oncologica. Jan 23. [Epub ahead of print].
3.
Thalén-Lindström, A., Larsson G., Hellbom, M., Glimelius B. & Johansson, B. (2013).
Validation of the Distress Thermometer in a Swedish population of oncology patients;
accuracy of changes during six months. European Journal of Oncology Nursing. pii: S14623889(12)00139-1. doi: 10.1016/j.ejon.2012.12.005. [Epub ahead of print].
4.
Alfonsson, S., Parling, T. & Ghaderi, A. (2012). Screening of adult ADHD among patients
presenting for bariatric surgery. Obesity Surgery, 22, 918-926.
5.
Brodd, K.S., Grönqvist, H., Holmström, G., Grönqvist, E., Rosander, K. & Ewald, U. (2012).
Development of smooth pursuit eye movements in very preterm born infants: Association
with perinatal risk factors. Acta Paediatrica, 101, 164-171.
6.
Byström, P., Berglund, A., Nygren, P., Wernroth, L., Johansson, B., Larsson, A. & Glimelius,
B. (2012). Evaluation of predictive markers for patients with advanced colorectal cancer. Acta
Oncologica, 51, 849-859.
7.
Böhlmark, A., Grönqvist, E., & Vlachos, J. (2012). The headmaster ritual. Working Papers in
Social Insurance.
8.
Cernvall, M., Alaie, I. & von Essen, L. (2012). The factor structure of traumatic stress in
parents of children with cancer: A longitudinal analysis. Journal of Pediatric Psychology, 37,
448-457.
9.
Friberg, R. & Grönqvist, E. (2012). Do expert reviews affect the demand for wine? American
Economic Journal: Applied Economics, 4, 193-211.
10.
Grönqvist, E. (2012). Efterfrågan på tandvård: analyser av prisets och inkomsters betydelse.
Working Papers in Social Insurance.
11.
Held, C. (2012). Lessons from platelet inhibition and patient outcomes. Current Opinion in
Cardiology, 27, 355-360.
12.
Held, C., Iqbal, R., Lear, S., Rosengren, A., Islam, S., Mathew, J. & Yusuf, S. (2012).
Physical activity levels, ownership of goods promoting sedentary behaviour and risk of
myocardial infarction: Results of the INTERHEART study. European Heart Journal, 33, 452466.
13.
Høyer, M., Nordin, K., Ahlgren, J., Bergkvist, L., Lambe, M., Johansson, B. & Lampic, C.
(2012). Change in working time in a population-based cohort of patients with breast cancer.
Journal of Clinical Oncology, 30, 2853-2860.
14.
Imran, M.M. (2012). Design principles for data export: Action Design research design in UCARE. Master thesis. Department of Informatics and Media, Uppsala University.
15.
James, S. & Held, C. (2012). Improving longterm outcome after myocardial infarction.
Lancet, 380, 1290-1291.
16.
Kahan, T., Forslund, L., Held, C., Björkander, I., Billing, E., Eriksson, S., Näsman, P.,
Rehnqvist, N. & Hjemdahl, P. (2012). Risk prediction in stable angina pectoris – the Angina
Prognosis in Stockholm. European Journal of Clinical Investigation, 43, 141-151.
184
17.
Larsson, M., Ljung, L. & Johansson, B. (2012). Health related quality of life in advanced non
small cell lung cancer: correlates and comparisons to normative data. European Journal of
Cancer Care, 21, 642-649.
18.
Lindahl, C., Lundqvist, P. & Lindahl Norberg, A. Animal-related injuries in diary farming:
farmers’ experience, perceptions and attitudes. Journal of Agromedicine. Accepted 2012.
19.
Lindahl Norberg, A., Pöder, U., Ljungman, G. & von Essen, L. (2012). Objective and
subjective factors as predictors of post-traumatic stress symptoms in parents of children with
cancer – a longitudinal study. PLoS ONE, 7, e36218.
20.
Masika, G., Wettergren, L., Kohi, T. & von Essen, L. (2012). Health-related quality of life
and needs of care and support among adult Tanzanians with cancer: a mixed methods study.
Health and Quality of Life Outcomes, 10, 133.
21.
Olsson, E., von Schéele, B. & Theorell, T. Heart rate variability during choral singing. Music
and Medicine. Accepted 2012.
22.
Parling, T., Cernvall, M., Stewart, I., Barnes-Holmes, D. & Ghaderi, A. (2012). Using the
implicit relational assessment procedure to compare implicit pro-thin/anti-fat attitudes of
patients with anorexia nervosa and non-clinical controls. Eating Disorders, 20, 127-143.
23.
Paulsson, J.M., Moshfegh, A., Dadfar, E., Held, C., Jacobson, S.H. & Lundahl, J. (2012). Invivo extravasation induces the expression of interleukin 1 receptor type 1 in human
neutrophils. Clinical and Experimental Immunology, 168, 105-112.
24.
Pettersson, A., Johansson, B., Persson, C., Berglund, A. & Turesson, I. (2012). Effects of a
dietary intervention on acute gastrointestinal side effects and other aspects of health-related
quality of life: A randomized controlled trial in prostate cancer patients undergoing
radiotherapy. Radiotherapy and Oncology, 103, 333-340.
25.
Rahman, M.H. (2012). Designing framework for web development. Master thesis.
Department of Informatics and Media, Uppsala University
26.
Silberleitner, N. (2012). Posttraumatic stress symptoms in parental dyads of children
diagnosed with cancer. Master thesis. Faculty of Sciences. University of Konstanz.
27.
Skogseid, E. (2012). En tvärsnittsstudie av upplevelsebaserat undvikande, traumatisk stress,
livskvalitet och depression hos föräldrar till cancerdrabbade barn. Master thesis. Department
of Psychology, Uppsala University.
28.
Tricoci, P., Huang, Z., Held, C. et al. and the TRACER Steering Committee on behalf of the
TRACER investigators. (2012). Vorapaxar, a Platelet Thrombin Receptor Antagonist, in
Non–ST-Segment Elevation Acute Coronary Syndromes: Results of the TRACER Trial New
England Journal of Medicine, 366, 20-33.
29.
Varenhorst, C., Alstrom, U., Scirica, B.M., Hogue, C.W., Asenblad, N., Horrow, J.,
Brandrup-Wognsen, G., Wallentin, L. & Held, C. (2012). Cardiac events, infections and
bleeds contribute to higher vascular and non-vascular mortality with clopidogrel compared to
ticagrelor treatment in patients undergoing coronary artery bypass surgery, ACC, 60, 16231630.
30.
Vedin, O., Hagström, E., Stewart, R., Brown, R., Krug-Gourley, S., Davies, D., Smith, P.,
Wallentin, L., White, H. & Held, C. (2012). Secondary prevention and risk factor target
achievement in a global, high-risk population with established coronary heart disease –
baseline results from the STABILITY study. European Journal of Preventive Cardiology. Apr
10. [Epub ahead of print].
2011
31.
Engvall, G., Cernvall, M., Larsson, G., von Essen, L. & Mattsson, E. (2011). Cancer during
adolescence: negative and positive consequences reported three and four years after diagnosis.
PLoS ONE. Epub ahead of print.doi.org/10.1371/journal.pone.0029001
185
32.
Engvall, G., Mattsson, E., von Essen, L. & Hedström, M. (2011). Findings on how
adolescents cope with cancer: a matter of methodology? Psycho-Oncology, 20, 1053-1060.
33.
Engvall, G., Skolin, I., Mattsson, E., Hedström, M. & von Essen, L. (2011). 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, 19, 605611.
34.
Enskär, K., Hamrin, E., Carlsson, M. & von Essen, L. (2011). Swedish mothers and fathers of
children with cancer: perceptions of well-being, social life, and quality care. Journal of
Psychosocial Oncology, 29, 51-66.
35.
Hallman, D., Olsson, E., von Schéele, B., Melin, L. & Lyskov, E. (2011). Effects of heart rate
variability boíofeedback in subjects with stress-related chronic pain: a pilot study. Applied
Psychophysiology and Biofeedback, 36, 71-80.
36.
Hedén, L., von Essen, L. & Ljungman, G. (2011). Effect of morphine in needle procedures in
children with cancer. European Journal of Pain, 15, 1056-1060.
37.
Hirvikoski, T., Olsson, E., Nordenström, A., Lindholm, T., Nordström, A. et al. (2011).
Deficient cardiovascular stress reactivity predicts poor executive functions in adults with
attention-deficit/hyperactivity disorder. Journal of Clinical and Experimental
Neuropsychology, 33, 63-73.
38.
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, 80-84.
39.
Lindström, C., Aman, J. & Norberg, A. (2011). Parental burnout in relation to
sociodemographic, psychosocial and personality factors as well as disease duration and
glycaemic control in children with Type 1 diabetes mellitus. Acta Paediatrica, 100, 10111017.
40.
Olsson, E. & von Schéele, B. (2011). Relaxing on a bed of nails: an exploratory study of the
effects on the autonomic, cardiovascular, and respiratory systems, and salivia cortisol. Journal
of Alternative and Complementary Medicine, 17, 5-12.
41.
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 Swedish
adolescents and young adults. Journal of Clinical Nursing, 20, 1568-1577.
2010
42.
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, 1062-1068.
43.
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, 661-670.
Dissertation 2012
Lena Hedén. (2012). Distressing Symptoms in Children with Cancer in General; During Needle
Procedures in Particular. Akademisk Avhandling. Acta Universitatis Upsaliensis.
186
Half time controls 2012
Sven Alfonsson. (2012). Binge Eating Disorder in Obesity: Impulsivity and Negative Mood.
Martin Cernvall. (2012). Symptoms of Posttraumatic Stress in Parents of Children with Cancer:
Factor Structure, Experiential Avoidance, and Guided Self-Help.
The Swedish Research Society
10 750 000 SEK
The Swedish Childhood Cancer Foundation
500 000 SEK
The Swedish Cancer Society
600 000 SEK
800 000 SEK
Hjärtlungfonden
273 000 SEK
During 2012 our main activities have been
Start feasibility/pilot studies via the U-CARE-Portal.
Provide stimulating and challenging career opportunities for young Swedish and international
researchers and students.
Start cross-disciplinary research between researchers from the academic fields of Caring Sciences,
Economics, Implementation Sciences, Information Systems, and Psychology.
Provide access to the U-CARE-Portal to researchers/research groups at Uppsala University and other
Swedish universities.
Consolidate research collaborations with researchers at South Florida, US and Innovation Value
Institute, Ireland.
Initiate research collaborations with researchers at Radboud University Nijmegen Medical Centre,
the Netherlands and University Medical Centre Groningen, University of Groningen, the
Netherlands.
Start the cross-disciplinary, trans-faculty research school Psychosocial Care in the Interactive
Society with 8 PhD students partly financed by strategic research funding to U-CARE and partly by
the Departments of Economics, Informatics and Media, and Psychology and the Disciplinary
Domain of Medicine and Pharmacy, Uppsala University respectively.
Provide part I of the high-quality research-based, cross-disciplinary PhD course in Psychosocial care
in the interactive society.
Build up part II of the high-quality research-based, cross-disciplinary PhD course in Psychosocial
care in the interactive society.
Build up a high-quality research-based, cross-disciplinary PhD course in Implementation of complex
interventions in collaboration with scholars at Radboud University Nijmegen Medical Centre, the
Netherlands.
Implement the concepts behind U-CARE research and educational activities in the educational
programs for nurses and psychologists and in the Master program for management, communication
and IT.
Set up “Lived experience groups” as used by PenCLAHRC in the UK to involve service users in the
U-CARE research and educational activities.
Attract major external funding.
187
Research projects
Cancer during adolescence. Psychosocial and health economic
consequences
OVERALL AIM
To investigate psychological and economic consequences of adolescent cancer; compare the
psychological and economic situation of those struck by cancer during adolescence vs. matched
controls and investigate whether there are any positive psychological consequences of adolescent
cancer.
METHODS
The project has a comparative, longitudinal design with eight measurements from one month to ten
years after diagnosis. Sixty-one adolescents were 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 Childhood Cancer Foundation and
the Swedish Cancer Society.
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 were 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
Childhood Cancer Foundation and the Swedish Cancer Society.
U-CARE: Betsy. 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 behavioral self-help
program delivered via the internet to parents of children struck by cancer.
METHOD
The study has a randomized, controlled design. 150 parents will be included and randomized to early
program, starting 6 weeks after the child’s diagnosis or late program, 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 Childhood Cancer Foundation.
188
U-CARE: Petra. Treatment of posttraumatic stress among parents of
children diagnosed with cancer with face-to-face cognitive behavioral
therapy
OVERALL AIM
To investigate the clinical efficacy of face-to-face cognitive behavioral therapy to parents of children
struck by cancer after completion of successful treatment.
METOD
The study has an uncontrolled, within group design where cognitive behavioral therapy (CBT) is
given to parents of children off cancer treatment. Each parent receives 10-15 sessions of face-to-face
individual CBT. Approximately 20 parents will be included. Inclusion started December 2012.
Parents answer semi-structured questions about experienced suffering and questions measuring e.g.
posttraumatic stress, anxiety, experiential avoidance, depression, and quality of life.
FUNDING
The project started 2012 and is funded by the Swedish Research Society, the Swedish Cancer
Society and the Swedish Childhood Cancer Foundation.
U-CARE: TeenCan. A randomized controlled trial of the effect of a selfhelp program via internet on anxiety and depression among adolescents
with cancer
OVERALL AIM
To investigate the clinical efficacy and cost-effectiveness of a self-help program consisting of
support and cognitive behavioral 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 program, starting 5 weeks after diagnosis or late program, starting 20 months after diagnosis.
Adolescents answer questions about e.g. posttraumatic stress, anxiety, depression, quality of life,
posttraumatic growth and costs via the U-CARE-Portal. A pilot study has started.
FUNDING
The project is funded by a strategic research grant to Uppsala University Psychosocial Care
Program: U-CARE.
U-CARE: AdultCan. A randomized controlled trial of the effect of a selfhelp program via internet on anxiety and depression among adults with
cancer
OVERALL AIM
support and cognitive behavioral 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 coloor rectal cancer will be included and randomized to a self-help program or waiting-list. Participants
answer questions about e.g. posttraumatic stress, anxiety, depression, quality of life, posttraumatic
growth and costs via the U-CARE-Portal.
FUNDING
Program: U-CARE.
189
U-CARE: Heart. 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
cognitive behavioral 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 program or waiting-list. Participants answer questions about
e.g. posttraumatic stress, anxiety, depression, quality of life, posttraumatic growth and costs via the
U-CARE-Portal.
FUNDING
Program: U-CARE.
190
Social Medicine
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 main fields of the research programme are quality and equity in medical care and health
system interventions for vulnerable groups.
The research of the group is established internationally in the field of quality and equity in health
care, and includes international collaboration with several universities. We have contributed to the
development of the studies of avoidable mortality, i.e. mortality from causes of death amenable to
medical intervention, 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
preceding death. Furthermore we have contributed to the methodological development of cause of
death statistics by introducing validity analyses based on international classification rules (ICD) and
by targeting for non-obvious errors in causes of death.
We have published several studies on mechanisms behind social differences in health and equity in
health care utilization, including studies of potentially vulnerable groups such as unemployed, lone
parents and immigrants. We are also studying the consequences of inequity on for instance the health
of the children of lone parents and the prognosis for unemployed to return to employment.
The research field also include studies of the diffusion of innovations and implementation of
evidence based medicine as well as evaluation of the implementation of organizational programs,
such as waiting time guarantee and quality systems in health care.
We are presently developing a research line on health system interventions for vulnerable groups in
which a health system and a health promotion approach is combined. In this research field we are
collaborating with several counties, municipalities and other authorities in Sweden as well as other
research groups and departments at Uppsala University and outside Uppsala. For instance, we are
performing evaluations of health system interventions for immigrants, and for persons on long-term
sick leave and for school children.
The research group is multi- professional including persons with the backgrounds as medical doctors
as well as from behavioural, economical and Public Health sciences.
Ragnar Westerling, Professor
Per Lytsy, MD, PhD. University adjunct.
Achraf Daryani, PhD. Researcher
Annika Åhs, PhD, Researcher.
Marcus Westin, MD, PhD
Marianne Hanning, PhD
Lars-Age Johansson, PhD
Afsaneh Roshanai, PhD
Stefan Kunkel, PhD.
Ulrika Paulsson, Doctoral student
Peter Berg, M.D. Doctoral Student,
Mikael Skärlund, Research asssistent
Susanne Sundell Lecerof, Doctoral student, collaboration with Lunds and Malmö University
Anna Ohlsson, M.D. Clinical research assistant.
191
Hans Nordlöf, Doctoral student, Collaboration with University of Gävle
Ebba Hallberg, MPh
Josefin Wångdahl, MPh, University adjunct
Eva Flodström, Mph, Project coordinator
Erik Berglund, MPh.
Anna Cooray, Clinical research assistent.
1.
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 term sick leave. Results from a collaboration
project between health care and the Social Insurance administration). Läkartidningen
2010;307:1480-1482.
2.
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):594-609.
3.
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
4.
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.
5.
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 leaveresults from a pilot study NySatsa). Läkartidningen 2010(107) 22; 1480-82.
6.
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 2010-3
7.
Hanning M.Hälsoeconomi- en vetenskapsgren I tillväxt. (In Swedish: Health economic – a
growing scientific field). SMT 2010(87):407-413.
8.
Lytsy P, Burell G, Westerling R.How do prescribing doctors anticipate the effect of statins? J
Eval Clin Pract 2011 Jun;17(3):420-8
9.
Westerling R. Internationella jämförelser av åtgärdbar dödlighet. (In Swedish: International
comparisons of avoidable mortality). SMT 2010(87):356-369.
10.
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).
11.
Johansson LA, Korpi H, Pedersen AG. NOMESCO Report on Mortality Statistics for the
Nordic/Baltic Countries. Copenhagen 2010. Nordic Medico-Statistical Committee 92:2010.
12.
Lytsy P. Power of the Pill : Views about Cardiovascular Risk and the Risk-reducing Effect of
Statins. SMT 2010(87):433.
13.
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.
192
14.
Lytsy P. Power of the Pill: Views about Cardiovascular Risk and the Risk-reducing Effect of
Statins. Department of Public Health and Caring Sciences, Social Medicine, Uppsala
University, Dissertations from the Faculty of Medicine. Uppsala 2010. (Thesis)
15.
Lytsy P. Patienter överskattar statiners preventiva effekt. (In Swedish: Patients overestimate
the effects of statins) Läkartidningen 2010;107:1692.
16.
Plug I, Hoffmann R, Khoshaba B, Westerling, Jougla E, Rey G, Mckee, M, Mackenbach, JP.
AMIEHS, avoidable mortality in the European Union: towards better indicators for the
effectiveness of health systems. European J Public Health 2010; 20(suppl 1):93-93.
17.
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.
18.
Sundell Lecerof S. Olika villkor – olika hälsa. Hälsan bland irakier i åtta av Sveriges län
2008.(In Swedish: Different conditions – different 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.
19.
Daryani A. Olika villkor – olika hälsa. Hälsan bland irakier folkbokförda i Malmö2005-2007.
(In Swedish;Different conditions – different health. Health among Iraqi immigrants in
Malmö). MIM, Malmö högskola, Social Medicine, Uppsala University. Social Medicine,
Department of Public Health and Caring Sciences, Uppsala University och Global Health,
Lunds University, Rapport IMHAD 2010.
20.
Sundell Lecerof S, Westerling R, Moghaddassi M, Östergren PO. Health information for
migrants: the role of educational level in prevention of overweight. Scand J Public Health.
2011 Mar;39(2):172-8.
21.
Westerling R. Country specific report on mortality trends in Sweden. In:Plug I, Hoffmann R,
Macheknbach J (eds). AMIEHS. Avoidable mortality in the European Union: Towards better
indicators for the effectiveness of health systems. : EU Public Health Program 2007106,
August 2011.
22.
Westerling R, Plug I, Hoffmann R, Khoshaba B, Jougla E, Rey G, Lang K, Parna K,
Hellmeier W, Alfonso J, Mckee, M, Mackenbach JP. Between-country variations in the
timing of introduction of new interventions. Eur J Public Health 2011;21(suppl 1):183-183
23.
Paulsson U, Edlund B, Westerling R. Underlying structure of vulnerability for unhealthy
behaviours in 13-16 year old Swedish Adolescents. Department of Public Health and Caring
Sciences, Social Medicine, Uppsala University 2011 (Submitted).
24.
Westerling R, Westin M. Analysis of the introduction of new health care interventions. In:
Plug I, Hoffmann R, Macheknbach J (eds). AMIEHS. Avoidable mortality in the European
Union: Towards better indicators for the effectiveness of health systems. EU Public Health
Program 2007106, August 2011.
25.
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. Popul Health Metr. 2011 Sep 19;9:52.
26.
Lytsy P, Anderzén I. Slutrapport. Vitalisprojektet 2010-2011. (In Swedish: Vitalis. Final
report 2010-2011. CEOS, Academic hospital, Uppsala 2011.
27.
Gjertsen F, Johansson LA. Changes in statistical methods affected the validity of official
suicide rates. J Clin Epidemiol 2011 Oct;64(10):1102-8.
28.
Mackenbach J P. Hoffmann R, Khoshaba B, Plug I, Rey G, Westerling R, Pärna K, Jougla E,
Alfonso J, Looman CWN, McKee M. Using ‘amenable mortality’ as indicator of health care
effectiveness in international comparisons: results of a validation study. Department of Public
Health, Erasmus Medical Center, Rotterdam, London School of Hygiene & Tropical
Medicine, London, INSERM , France, Nordrhein-Westfalen Institute of Health and Work,
193
Düsseldorf, Germany, Department of Public Health, University of Tartu, Department of
Preventive Medicine and Public Health, University of Valencia and Department of Public
Health and caring sciences, Uppsala University 2011 (Submitted)
29.
Grandahl M, Tyden T,Gottvall M, Westerling R,Oscarsson M. Immigrant women’s
experiences and views on prevention of cervical cancer: A qualitative study. Department of
Public Health and Caring Scinces, Uppsala University and School of Health and Caring,
Linneus University, Kalmar 2011. (Submitted)
30.
Wångdahl J, Mårtensson L. The Communicative and critical health literacy scale- Swedish
version. Department of Public Health and Caring Sciences, Uppsala University and
Department of Social Medicine, Gothenbourg 2011. (Submitted).
31.
Daryani A, Löthberg K. Olika villkor – olika hälsa. Modersmålbaserade
hälsokommunikation.(In Swedish; Different conditions .-different health: Home language
based health communication. MIM, Malmö högskola, Social Medicine, Department of Public
health and Caring Sciences, Uppsala University. Social Medicine och Global Health, Lunds
University. Rapport IMHAD 2011.
32.
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)
33.
Westin M, Sundelin C, Westerling R . Swedish parental characteristics and children’s mental
health. Department of Public Health and Caring Sciences, Uppsala University, (submitted).
34.
Hoffmann R, Plug I, McKee M, Khoshaba B, Westerling R, Looman C, Rey G, Jougla E,
Luis Alfonso J, Lang K, Pärna K, Mackenbach JP. Innovations in medical care and mortality
trends from four circulatory diseases between 1970 and 2005. Department of Public Health,
Erasmus Medical Center, Rotterdam, London School of Hygiene & Tropical Medicine,
London, INSERM , France, Nordrhein-Westfalen Institute of Health and Work, Düsseldorf,
Germany, Department of Public Health, University of Tartu, Department of Preventive
Medicine and Public Health, University of Valencia and Department of Public Health and
caring sciences,Uppsala University 2011 (Accepted for publication in Eur J Public Health)
35.
Lytsy P, Berglund L, Sundström J. A proposal for an additional clinical trial outcome measure
assessing preventive effect as delay of events. Eur J Epidemiol. 2012 Dec;27(12):903-9. doi:
10.1007/s10654-012-9752-0. Epub 2012 Dec 7.
36.
Hanning M, Åhs A, Winblad U, Lundström M: Impact of increased patient choice of
providers in Sweden: cataract surgery. J Health Serv Res Policy 2012(Apr);17(2):101-5
37.
Roshanai AH, Lampic C, Ingvoldstad C, Björvatn C, Rosenquist R, Nordin K. What
Information Do Cancer Genetic Counselees Prioritize? J Genet Couns. 2012 Aug;21(4):51026.
38.
Roshanai, A H, Nordin K., Berglund G. Factors influencing primary Care physicians’
decision to order prostate-specific antigen (PSA) test for healthy men. [Accepted for
publication in Acta Oncologica)
39.
Westerling R. Utveckla formerna för att främja invandrares hälsa och integration. (In
Swedish; Develop the methods for promoting the health and integration of immigrants) SMT
2012;89:99-103.
40.
Daryani A, Löthberg K, Feldman I, Westerling R. Olika villkor – olika hälsa. (In Swedish;
Different conditions – different health) SMT 2012;89:112-125.
41.
Tillman A, Westerling R. Nyinvandrade irakiers syn på hälsa och den svenska hälso- och
sjukvården. (In Swedish; Newly immigrated iraques perceptions on health and the Swedish
health care) SMT 2012;89:126-130.
42.
Löthberg K, Fryklund B. Westerling R, Daryani A, Stafström M. Hälsokommunikation på
modersmål –gör den någon skillnad ? Etablering, utveckling och värdering. (In Swedish;
194
Health communication in home language –does it make any difference? Establishment,
development and evaluation) SMT 2012;89:131-139.
43.
Skärlund M, Annika Åhs A, Westerling R. Health-related and social factors predicting nonreemployment amongst newly eunemployed. BMC Public Health 2012 Oct 23;12(1):893.
44.
Mackenbach J P. Hoffmann R, Khoshaba B, Plug I, Rey G, Westerling R, Pärna K, Jougla E,
Alfonso J, Looman CWN, McKee M. Using ‘amenable mortality’ as indicator of health care J
Epidemiol Community Health 2012 Sep 25. [Epub ahead of print)]
45.
Grandahl M, Tyden T,Gottvall M, Westerling R, Oscarsson M. Immigrant women’s
experiences and views on prevention of cervical cancer: A qualitative study. Health Expect.
2012 Dec 16. doi: 10.1111/hex.12034. [Epub ahead of print]
46.
Berglund E. Lytsy P. Westerling R. Adherence to and beliefs in lipid lowering medical
treatments: A structural equation modelling approach including the Necessity-Concern
framework and locus of control factors. Department of Public Health and Caring Sciences,
Social Medicine. Uppsala University. (In press in Patient Education and Counseling)
47.
Westerling R, Westin M, McKee M, Hoffmann R, Plug I, Rey G, Jougla , Lang K, Pärna K,
Alfonso JL, Mackenbach, JP. The timing of introduction of pharmaceutical innovations in
seven European countries Department of Public Health, Erasmus Medical Center, Rotterdam,
London School of Hygiene & Tropical Medicine, London, INSERM , France, Department of
Public Health, University of Tartu, Department of Preventive Medicine and Public Health,
University of Valencia and Department of Public Health and caring sciences, Uppsala
University 2012. (submitted)
48.
Åhs 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. Int J Behav Med.
2012 Mar;19(1):29-38
49.
Lytsy P, Burell G, Westerling R. Cardiovascular risk factor assessments and health
behaviours in patients using statins compared to a non-treated population. Int J Behav Med.
Int J Behav Med. 2012 Jun;19(2):134-42
50.
Hoffmann R, Plug I, Khoshaba B, McKee M, Mackenbach JP, AMIEHS working group.
Amenable mortality revisited: the AMIEHS study. Gac Sanit. 2012 Nov 30. doi:pii: S02139111(12)00258-0. 10.1016/j.gaceta.2012.08.004. [Epub ahead of print]
51.
HELMI – Health, Migration and Integration. Somaliska och thailändska kvinnors hälsa och
arbetsmarknadsanknytning i Sverige. (In Swedish; Health and working life associations of
immigrants from Somalia and Thailand). MIM, Malmö högskola, Social Medicine,
Department of Public health and Caring Sciences, Uppsala University. Social Medicine och
Global Health, Lunds University. Research report 2012.
52.
Sundell Lecerof S, Stafström M, Westerling R, östergren P O. Can social capital protect
individuals from the negative effects of post-migration risk factors for poor mental health
among Iraqi migrants in Sweden? Social medicine and global health, Department of Clinical
Sciences Malmö, Lund University and Social Medicine, Department of Public Health and
Caring Sciences, Uppsala University 2012. (Submitted)
53.
Flodström E. Unga irakiers syn på sexuell och reproduktiv hälsa och rättigheter. (In Swedish;
Young Iraqis view on sexual and reproductive health and rights) SMT 2012;89: 140-149140149
54.
Paulsson U, Edlund B, Westerling R. Age-related differences in vulnerability structure for
unhealthy behaviours in Swedish Adolescents: a cross-sectional study. Department of Public
Health and Caring Sciences, Social Medicine, Uppsala University 2012 (Submitted).
195
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 skr 2010-2012.
Health examinations for asylum seekers: (partnership with the Swedish Institute for Communicable
Disease Control, the Migration Board, the National Board of Health and Welfare, the Swedish
organization of local authorities, Umeå University and regions and the counties(regions) of
Stockholm, Östergötland, Skåne and Norrbotten):30 000 000 (3 441 000 managed at our department)
year 2012-2014 European refugee fund.
Athena (partnership with the municipality, county and employment office of Uppsala):4 389 146 skr
(2 056 000 skr managed at our department) year 2012-2014. European Social fund.
Academic Hospital, Uppsala.
Research projects
Studies of Avoidable mortality and diffusion of innovations
Participants: Ragnar Westerling, Marcus Westin, Anna Ohlsson, Marianne Hanning, Anna
Cooray
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 investigations of avoidable
factors preceding death. The method has been used in several studies from different countries and
has been applied to Swedish conditions by our research group.
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 Jougla´s group at INSERM in Paris. We also collaborate with
researchers in Spain, Germany and Estonia.
In this project a systematic review of the literature has been 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. For instance, a
linkage in time was found for preventive innovations in cardiovascular medical care. The findings
have been 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 performing an in-depth study of equity in treatment of
heart failure in Sweden as part of this research field as well as on the impact of incidence changes on
mortality trends.
Validity in cause of death statistics and trends
Participants: Lars Age Johansson, Ragnar Westerling
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
196
underlying cause of death was used to examine the compatibility between the underlying cause of
death and the final main conditions. 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. 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. Recently, in-depth analyses of the cause of death statistics
for suicide, methadone -related deaths and for prostate cancer has been performed. We are also
collaborating with Eric Jouglas´group at INSERM in Paris in order to analyze validity in cause of
death trends and statistics.
Patients and physicians expectations on lipid-lowering drugs
Participants: 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 statin 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. Recently, we have also analysed the association between the
patient’s locus of control and the beliefs about statin medications.
The physicians expectations and attitudes towards statin treatment has also been analysed showing
some gender differences in the prescription habits among physicians. This study was performed in
collaboration with the pharmaceutical committees in the county of Uppsala and Gävle and supported
by the Academic hospital in Uppsala and was included in Per Lytsy’s thesis together with studies of
the patient’s expectations.
Health promoting interventions among immigrants to Sweden
Participants: Achraf Daryani, Josefin Wångdahl, Eva Flodström, Annika Åhs, Afsaneh
Roshanai, Ragnar Westerling
We are evaluating the impact of international health advisors and other health promotion programs
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. 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
197
migrants to Sweden. Furthermore, focus group interviews are performed with immigrants from
Somalia and Thailand and a questionnaire has been developed based on the results of these
inteviews, on health related factors in order to get a basis for planning interventions also for these
groups. The studies were performed in collaboration with Lund’s University and Malmö University
as well as with several municipalities, county councils and other organisations. The projects was
funded by the European Refuge Fund and Immigrant Fund, respectively.
In a recently started project we are analysing the views and expectations of health examinations for
asylum seekers in Sweden. In an explorative phase of the project focus group interview and
interviews
With key informants have been performed and a questionnaire has been developed. This project is
performed in collaboration with the Swedish Institute for Communicable Disease Control, the
Migration Board, the National Board of Health and Welfare, the Swedish organization of local
authorities, Umeå University and regions and the counties(regions) of Stockholm, Östergötland,
Skåne and Norrbotten.
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 study group leaders have been 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).
Recently a project has been started in which these study circles is included as part of an intervention
for marginalized female immigrants. This project is performed in collaboration with the
municipality, county and employment office of Uppsala).
Unhealthy life habits, vulnerability and mental health among schoolchildren
Participants: Ulrika Paulsson, Birgitta Edlund, Marcus Westin, Peter Berg, Ragnar
Westerling
The objective of this project is to study factors that influence health behaviours in general as well as
mental health 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 results show that a general unhealthy
behavioural factor is related to the self-esteem and well-being of the children, factors that differ
between gender and socioeconomic position. In another study psychosocial factors were found to
have an impact also in the bicycle helmet use of school children. We have also shown that both lone
parenthood and low level of social capital influences the children’s mental health negatively. The
analyses were based on SDQ (Strengths and Difficulties Questionnaire) measures of the children’s
mental health.
198
Health and health system interventions among non-working populations.
Participants: Annika Åhs. Gunilla Burell, Mikael Skärlund, Per Lytsy, 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 have analysed 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 predicted a higher risk of
being unemployed also one year later. We are also involved in evaluation of an intervention project
for persons on long term sick leave at the Academic hospital.
Implementing safety promotion in an industrial working environment
Participants: Hans Nordlöf, Birgitta Wiitavaara, Katarina Wijk, Ulrika Winblad, Ragnar
Westerling
In a doctoral project in collaboration with University of Gävle, 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. The project is organized as a case study of the
implementation of a Behavioral 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 and focus group interviews with the employed.
199

Department of Public Health and Caring Sciences

Transcription

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