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Leepe, K. A., Li, M., Fang, X., Hiyoshi, A. & Cao, Y. (2019). Acute effect of daily fine particulate matter pollution on cerebrovascular mortality in Shanghai, China: a population-based time series study. Environmental science and pollution research international, 26(25), 25491-25499
Open this publication in new window or tab >>Acute effect of daily fine particulate matter pollution on cerebrovascular mortality in Shanghai, China: a population-based time series study
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2019 (English)In: Environmental science and pollution research international, ISSN 0944-1344, E-ISSN 1614-7499, Vol. 26, no 25, p. 25491-25499Article in journal (Refereed) Published
Abstract [en]

Numerous studies have investigated the impacts of ambient fine particulate matter (PM2.5) on human health. In this study, we examined the association of daily PM2.5 concentrations with the number of deaths for the cerebrovascular disease on the same day, using the generalized additive model (GAM) controlling for temporal trend and meteorological variables. We used the data between 2012 and 2014 from Shanghai, China, where the adverse health effects of PM2.5 have been of particular concern. Three different approaches (principal component analysis, shrinkage smoothers, and the least absolute shrinkage and selection operator regularization) were used in GAM to handle multicollinear meteorological variables. Our results indicate that the average daily concentration of PM2.5 in Shanghai was high, 55 μg/m3, with an average daily death for cerebrovascular disease (CVD) of 62. There was 1.7% raised cerebrovascular disease deaths per 10 μg/m3 increase in PM2.5 concentration in the unadjusted model. However, PM2.5 concentration was no longer associated with CVD deaths after controlling for meteorological variables. The results were consistent in the three modelling techniques that we used. As a large number of people are exposed to air pollution, further investigation with longer time period including individual-level information is needed to examine the association.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Cerebrovascular mortality, Fine particulate matter, Generalized additive model, Least absolute shrinkage and selection operator, Multicollinearity, Principal component analysis, Shrinkage smoother
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:oru:diva-75607 (URN)10.1007/s11356-019-05689-8 (DOI)000483698500009 ()31264151 (PubMedID)2-s2.0-85068737714 (Scopus ID)
Note

Funding Agencies:

Karolinska Institutet, Sweden  C62400032 

Junior Faculty Grant of the Institute of Environmental Medicine, Karolinska Institutet  C62412022 

Joint China-Sweden Mobility Grant of the Swedish Foundation for International Cooperation Research and Education  CH2015-6145 

Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-09-20Bibliographically approved
Smith, K. A., Burkill, S., Hiyoshi, A., Olsson, T., Bahmanyar, S., Wormser, D., . . . Montgomery, S. (2019). Burden of comorbid diseases among MS patients in Sweden. Paper presented at 35th Congress of the European-Committee-for-Treatment-and-Research-in-Multiple-Sclerosis (ECTRIMS 2019) / 24th Annual Conference of Rehabilitation in MS, Stockholm, Sweden, September 11-13, 2019. Multiple Sclerosis, 25(Suppl. 2), 646-646
Open this publication in new window or tab >>Burden of comorbid diseases among MS patients in Sweden
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2019 (English)In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 25, no Suppl. 2, p. 646-646Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Introduction: A raised risk for several comorbid diseases among MS patients has been identified. Most previous studies examined diseases separately rather than considering the overall burden of comorbidity. Multiple comorbidities may have important implica-tions for clinicians managing MS patients.

Aims: To describe the lifetime burden of comorbid diseases among MS patients and the rate of these diseases compared with the general population in Sweden.

Methods: MS patients identified using the MS Register and the Patient Register (PR) between 1964-2012 (n=25476) were matched by sex, age and county of residence with up to 10 general population comparators (n=251170). Prevalent and incident diag-noses of diseases other than MS for seven diseases categories were identified using the PR between 1987-2012. The total num-ber of comorbid diseases were compared using chi-square tests and prevalence rate ratios (PRR) were calculated. Hazard ratios (HR) were estimated using Cox regression and flexible non-para-metric survival models with age as the underlying time scale, MS as exposure, an additional comorbid disease as the outcome, adjusted for matching variables, education, number of previous comorbid diseases, and duration since study entry.

Results: The proportion of MS patients with 1,2 or 3+ comorbid disease diagnoses was greater than in the comparison cohort across all age groups (p< 0.001). The largest PRR (range 1.22-9.99) were among younger age groups (6-18,19-40,41-60 years) in autoim-mune, cardiovascular, diabetes and seizure disease categories. Additionally, PRR were elevated in depression and respiratory dis-eases, but not for renal diseases. PRR between 61-80 and 81-100 years were reduced compared to younger groups across all comorbid diseases, but remained elevated for respiratory, seizure and renal dis-eases. The adjusted HR for an additional diagnosis in MS patients was 1.7 (95% CI 1.66-1.75). Flexible modelling showed signifi-cantly higher risk for all ages of an additional disease diagnosis in MS patients; twice the risk (95% CI 1.8-2.2) up to age 35 years and decreasing with age to 1.3 (95% CI 1.5-1.25) over age 80 years.

Conclusions: MS patients in Sweden experience an increased burden of comorbidity and tend to be diagnosed with these dis-eases at an earlier age than the general population. This increased disease burden demonstrates the clinical reality of treating MS, indicating the need for integrated treatment approaches over sev-eral medical specialties.

Place, publisher, year, edition, pages
Sage Publications, 2019
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-77233 (URN)000485303102374 ()
Conference
35th Congress of the European-Committee-for-Treatment-and-Research-in-Multiple-Sclerosis (ECTRIMS 2019) / 24th Annual Conference of Rehabilitation in MS, Stockholm, Sweden, September 11-13, 2019
Available from: 2019-10-16 Created: 2019-10-16 Last updated: 2019-10-16Bibliographically approved
Lindner, H. Y., Montgomery, S. & Hiyoshi, A. (2019). Risk of depression following traumatic limb amputation: a general population-based cohort study. Scandinavian Journal of Public Health, Article ID 1403494819868038.
Open this publication in new window or tab >>Risk of depression following traumatic limb amputation: a general population-based cohort study
2019 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, article id 1403494819868038Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Individuals with traumatic limb amputation (TLA) may be at risk of depression, but evidence of increased depression after TLA from longitudinal studies has been limited. It is also unknown whether physical function, cognitive function, and employment prior to amputation affects depression risk. We aimed to examine longitudinal associations between TLA and depression in working age men, and to explore the role of pre-amputation occupational and individual characteristics.

Methods: A Swedish national register-based cohort of 189,220 men born between 1952 and 1956, and who attended conscription assessments in adolescence, was followed from 1985 to 2009. Physical, cognitive, and psychological characteristics were measured at the conscription examination, and occupational information was obtained from the 1985 census. Main outcome measures were hospital inpatient and outpatient admissions for depression.

Results: In total, 401 men underwent TLA; mean age at amputation was 42.5 years (SD 7.4). Cox regression produced an unadjusted hazard ratio (95% confidence interval) of 2.61 (1.62–4.21) for risk of subsequent depression associated with TLA compared with the general population. Adjustment for occupational, physical, cognitive, and psychological characteristics did not change the association much, producing a hazard ratio of 2.53 (1.57–4.08).

Conclusions: TLA is associated with an increased risk of depression in men over more than two decades of follow up. Occupational and individual characteristics prior to amputation did not greatly change depression risk following amputation. We speculate that a coordinated combination of social support and medical management may help reduce persistent depression risk in men who experience amputation.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Amputation, cohort, depression, traumatic
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:oru:diva-75828 (URN)10.1177/1403494819868038 (DOI)000482801800001 ()31405332 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-01236
Note

Funding Agencies:

Örebro University Hospital Research Foundation  OLL-488821  429431 

UK Economic and Social Research Council (ESRC)  RES-596-28-0001  ES/JO19119/1 

Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2019-09-10Bibliographically approved
Bergh, C., Hiyoshi, A., Eriksson, M., Fall, K. & Montgomery, S. (2019). Shared unmeasured characteristics among siblings confound the association of Apgar score with stress resilience in adolescence. Acta Paediatrica
Open this publication in new window or tab >>Shared unmeasured characteristics among siblings confound the association of Apgar score with stress resilience in adolescence
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2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIM: We investigated the association between low Apgar score, other perinatal characteristics and low stress resilience in adolescence. A within-siblings analysis was used to tackle unmeasured shared familial confounding.

METHODS: We used a national cohort of 527,763 males born in Sweden between 1973 and 1992 who undertook military conscription assessments at mean age 18 years (17-20). Conscription examinations included a measure of stress resilience. Information on Apgar score and other perinatal characteristics was obtained through linkage with the Medical Birth Register. Analyses were conducted using ordinary least squares and fixed-effects linear regression models adjusted for potential confounding factors.

RESULTS: Infants with a prolonged low Apgar score at five minutes had an increased risk of low stress resilience in adolescence compared to those with highest scores at one minute, with an adjusted coefficient and 95% confidence interval of -0.26 (-0.39, -0.13). The associations were no longer statistically significant when using within-siblings models. However, the associations with stress resilience and birthweight remained statistically significant in all analyses.

CONCLUSION: The association with low Apgar score seems to be explained by confounding due to shared childhood circumstances among siblings from the same family, while low birthweight is independently associated with low stress resilience.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019
Keywords
Apgar score, adolescence, low birth weight, psychological stress, resilience
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-74554 (URN)10.1111/apa.14881 (DOI)31140196 (PubMedID)
Available from: 2019-06-05 Created: 2019-06-05 Last updated: 2019-06-05Bibliographically approved
Sato, Y., Hiyoshi, A., Melinder, C., Suzuki, C. & Montgomery, S. (2018). Asthma and atopic diseases in adolescence and antidepressant medication in middle age. Journal of Health Psychology, 23(6), 853-859
Open this publication in new window or tab >>Asthma and atopic diseases in adolescence and antidepressant medication in middle age
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2018 (English)In: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 23, no 6, p. 853-859Article in journal (Refereed) Published
Abstract [en]

This Swedish register-based cohort study examined whether asthma, hay fever and allergic dermatitis in late adolescence identified in the early 1970s are associated with antidepressant medication in middle age, between 2006 and 2009. After adjustment for childhood and adulthood sociodemographic characteristics, psychological, cognitive and physical function, and comorbidity, the magnitude of the associations diminished for asthma, while hay fever and atopic dermatitis retained associations. Hay fever and atopic dermatitis in adolescence have potentially important implications for future mental health, while asthma may already have influenced an individual's ability to cope with stress by late adolescence.

Place, publisher, year, edition, pages
London, United Kingdom: Sage Publications, 2018
Keywords
Adolescence, adults, allergy, asthma, cohort, depression
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-51473 (URN)10.1177/1359105316660181 (DOI)000430332700009 ()27466290 (PubMedID)2-s2.0-85045628411 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-01365
Note

Funding Agencies:

UK Economic and Social Research Council (ESRC)  RES-596-28-0001  ES/J019119/1 

Japan Allergy Foundation  

Scandinavia-Japan Sasakawa Foundation  15-15 

Lindhes Advokatbyrå AB  LA2015-0219 

Available from: 2016-08-05 Created: 2016-08-02 Last updated: 2018-07-19Bibliographically approved
Cable, N., Hiyoshi, A., Kondo, N., Aida, J., Sjöqvist, H. & Kondo, K. (2018). Identifying Frail-Related Biomarkers among Community-Dwelling Older Adults in Japan: A Research Example from the Japanese Gerontological Evaluation Study. BioMed Research International, Article ID 5362948.
Open this publication in new window or tab >>Identifying Frail-Related Biomarkers among Community-Dwelling Older Adults in Japan: A Research Example from the Japanese Gerontological Evaluation Study
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2018 (English)In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, article id 5362948Article in journal (Refereed) Published
Abstract [en]

We examined correlating clinical biomarkers for the physical aspect of frailty among community-dwelling older adults in Japan, using Japanese Gerontological Evaluation Study (JAGES). We used information from the JAGES participants (N = 3,128) who also participated in the community health screening in 2010. We grouped participants' response to the Study of Osteoporotic Fracture (SOF) Frailty Index into robust (=0), intermediate frail (=1), and frail (=2+) ones to indicate physical aspect of frailty. Independent of sex and age, results from multinomial logistic regression showed above normal albumin and below normal HDL and haemoglobin levels were positively associated with intermediate frail (RRR = 1.99, 95% CI = 1.22-3.23; RRR = 1.36, 95% CI = 1.33-1.39; RRR = 1.36, 95% CI = 1.23-1.51, resp.) and frail cases (RRR = 2.27, 95% CI = 1.91-2.70; RRR = 1.59, 95% CI = 1.51-1.68; RRR = 1.40, 95% CI = 1.28-1.52, resp.). Limited to women, above normal Hb1Ac level was similarly associated with intermediate frail and frail cases (RRR = 1.18, 95% CI = 1.02, 1.38; RRR = 2.56, 95% CI = 2.23-2.95, resp.). Use of relevant clinical biomarkers can help in assessment of older adults' physical aspect of frailty.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2018
National Category
Medical Biotechnology (with a focus on Cell Biology (including Stem Cell Biology), Molecular Biology, Microbiology, Biochemistry or Biopharmacy)
Identifiers
urn:nbn:se:oru:diva-64827 (URN)10.1155/2018/5362948 (DOI)000422965600001 ()
Note

Funding Agencies:

UK Economic and Social Research Council (ESRC)  ES/J019119/1 

Research Committee of Orebro County Council  OLL-346981 

MEXT (Ministry of Education, Culture, Sports, Science and Technology, Japan) Supported Program for the Strategic Research Foundation at Private Universities  

JSPS (Japan Society for the Promotion of Science) KAKENHI  JP22330172  JP22390400  JP23243070  JP23590786  JP23790710  JP24390469  JP24530698  JP24683018  JP25253052  JP25870573  JP25870881 

Health Labour Sciences Research Grants from the Japan Ministry of Health, Labour and Welfare  H22-Choju-Shitei-008  H24-Junkanki[Seishu]-Ippan-007  H24-Chikyukibo-Ippan-009  H24-Choju-Wakate-009  H25-Kenki-Wakate-015  H26-Irryo-Shitei-003[Fukkou]  H25-Choju-Ippan-003  H26-Choju-Ippan-006 

Research and Development Grants for Longevity Science from AMED (Japan Agency for Medical Research and Development)  

National Centre for Geriatrics and Gerontology, Japan  24-17  24-23 

Available from: 2018-02-06 Created: 2018-02-06 Last updated: 2018-08-20Bibliographically approved
Hiyoshi, A., Kondo, N. & Rostila, M. (2018). Increasing income-based inequality in suicide mortality among working-age women and men, Sweden, 1990-2007: is there a point of trend change?. Journal of Epidemiology and Community Health, 72(11), 1009-1015
Open this publication in new window or tab >>Increasing income-based inequality in suicide mortality among working-age women and men, Sweden, 1990-2007: is there a point of trend change?
2018 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 11, p. 1009-1015Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Income inequalities have risen from the 1990s to 2000s, following the economic recession in 1994, but little research has investigated socioeconomic inequalities in suicide mortality for working-age men and women (aged between 30 and 64 years) over the time using longitudinal data in Sweden.

METHODS: Using Swedish national register data between 1990 and 2007 as a series of repeated cohort studies with a 3-year follow-up (sample sizes were approximately 3.7 to 4.0 million in each year), relative and slope indices of inequality (RII and SII respectively) based on quintiles of individual disposable income were calculated and tested for temporal trends.

RESULTS: SII for the risk of suicide mortality ranged from 27.6 (95% CI 19.5 to 35.8) to 44.5 (36.3 to 52.6) in men and 5.2 (0.2 to 10.4) to 16.6 (10.7 to 22.4) in women (per 100 000 population). In men, temporal trends in suicide inequalities were stable in SII but increasing in RII by 3% each year (p=0.002). In women, inequalities tended to increase in both RII and SII, especially after the late-1990s, with 10% increment in RII per year (p<0.001).

CONCLUSIONS: Despite universal social security and generous welfare provision, income inequalities in suicide were considerable and have widened, especially in women. The steeper rise in women may be partially related to higher job insecurity and poorer working conditions in the female dominated public sector after the recession. To reduce health consequences following an economic crisis and widened income inequalities, additional measures may be necessary in proportion to the levels of financial vulnerability.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
Keywords
cohort studies, health inequalities, socio-economic, suicide
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-70021 (URN)10.1136/jech-2018-210696 (DOI)000450417500008 ()30021795 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Note

Funding Agencies:

Ministry of Education, Culture, Sports, Science and Technology, MEXT, Japan  21119002  25253052  18H04071 

Ministry of Health, Labour and Welfare, Japan  H24-chikyukibo-ippan-009 

Available from: 2018-11-06 Created: 2018-11-06 Last updated: 2018-12-05Bibliographically approved
Lindner, H. Y., Hiyoshi, A. & Hermansson, L. (2018). Relation between capacity and performance in paediatric upper limb prosthesis users. Prosthetics and orthotics international, 42(1), 14-20
Open this publication in new window or tab >>Relation between capacity and performance in paediatric upper limb prosthesis users
2018 (English)In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 42, no 1, p. 14-20Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The International Classification of functioning, disability and health refers capacity to what an individual can do in a standardised environment and describes performance as what an individual really does and whether the individual encounters any difficulty in the real-life environment. Measures of capacity and performance can help to determine if there is any gap between them that may restrict participation. The aim of this study was to explore the relationship between capacity scores obtained in a standardised clinical setting and proportional ease of performance obtained from a real-life environment.

METHODS: The Assessment of Capacity for Myoelectric Control and the Prosthetic Upper Extremity Functional Index were used to assess capacity and performance in 62 prosthetic users (age 3-17). Spearman coefficient and generalised linear model were used to examine the association between these measures.

RESULTS: A strong correlation (Spearman = 0.75) was found between the capacity scores and the ease of performance. In both unadjusted and adjusted models, capacity was significantly associated with proportional ease of performance. The adjusted model showed that, by 1 unit increase in the Assessment of Capacity for Myoelectric Control score, the ratio of proportional ease of performance increases by 45%.

CONCLUSION: This implies that Assessment of Capacity for Myoelectric Control can be a predictor for ease of performance in real-life environment.

Clinical relevance: The ACMC scores may serve as an indicator to predict the difficulties that the children may encounter in their home environment. This prediction can help the clinician to make decisions, such that if the child requires more control training or is ready to move on to learn more complex tasks.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Upper limb prosthetics, prosthetics, rehabilitation, rehabilitation of prostheses users
National Category
Occupational Therapy Orthopaedics
Identifiers
urn:nbn:se:oru:diva-59060 (URN)10.1177/0309364617704802 (DOI)000424669100003 ()28639478 (PubMedID)2-s2.0-85041794635 (Scopus ID)
Available from: 2017-08-15 Created: 2017-08-15 Last updated: 2019-03-27Bibliographically approved
Melinder, C., Hiyoshi, A., Kasiga, T., Halfvarson, J., Fall, K. & Montgomery, S. (2018). Resilience to stress and risk of gastrointestinal infections. European Journal of Public Health, 28(2), 364-369
Open this publication in new window or tab >>Resilience to stress and risk of gastrointestinal infections
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2018 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 2, p. 364-369Article in journal (Refereed) Published
Abstract [en]

Background: Exposure to psychological stress can elicit a physiological response that may influence characteristics of the gastrointestinal mucosa, including increased intestinal permeability, in turn possibly increasing susceptibility to gastrointestinal infections. We investigated whether low stress resilience in adolescence is associated with an 'increased' risk of gastrointestinal infections in subsequent adulthood.

Methods: Data were provided by Swedish registers for a cohort of 237 577 men who underwent military conscription assessment in late adolescence (1969-76). As part of the assessment procedure, certified psychologists evaluated stress resilience through semi-structured interviews. The cohort was followed from conscription assessment until 31 December 2009 (up to age 57 years). Cox regression assessed the association of stress resilience with gastrointestinal infections (n = 5532), with adjustment for family background measures in childhood and characteristics in adolescence. Peptic ulcer disease (PUD) in adulthood was modelled as a time-dependent covariate.

Results: Compared with high stress resilience, lower stress resilience was associated with a 'reduced' risk of gastrointestinal infections after adjustment for family background in childhood, characteristics in adolescence and PUD in adulthood, with hazard ratios (and 95% confidence intervals) of 0.88 (0.81-0.97) and 0.83 (0.77-0.88) for low and moderate stress resilience, respectively.

Conclusion: Lower stress resilience in adolescence is associated with reduced risk of gastrointestinal infections in adulthood, rather than the hypothesized increased risk.

Place, publisher, year, edition, pages
Oxford, United Kingdom: Oxford University Press, 2018
National Category
Gastroenterology and Hepatology Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-62194 (URN)10.1093/eurpub/ckx179 (DOI)000429036800032 ()29048469 (PubMedID)
Note

Funding Agency:

Stiftelsen Olle Engkvist Byggmästare, UK Economic and Social Research Council (ESRC)  RES-596-28-0001  ES/JO19119/1

Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2018-08-16Bibliographically approved
Lindner, H., Montgomery, S. & Hiyoshi, A. (2018). Risk of depression following traumatic limb amputation: a general population-based cohort study. In: Burger, Helena & Mlakar, Maja (Ed.), Book of Abstracts: . Paper presented at ISPO International Central European ISPO Conference 2018 Portoroz, Slovenia, 20th September–22nd September, 2018 (pp. 9-9). Ljubjana, Slovenia: ISPO Slovena
Open this publication in new window or tab >>Risk of depression following traumatic limb amputation: a general population-based cohort study
2018 (English)In: Book of Abstracts / [ed] Burger, Helena & Mlakar, Maja, Ljubjana, Slovenia: ISPO Slovena , 2018, p. 9-9Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

INTRODUCTION: Traumatic limb amputation (TLA) is a sudden event that accompanies life changes in physical functioning, body image and challenges in daily lives. Amputees may experience significant levels of distress and be at risk of depression may be at risk of depression. However, evidence for depression risk after TLA has been limited because of the use of cross-sectional study design of a small or selected sample and the lack of a comparison with non-amputees. Confounding from pre-amputated occupational and individual characteristics was possible but no study has controlled for these.  AIMS: We aimed to examine whether amputation may be associated with an increased risk of depression required inpatient and outpatient hospital treatment. 

METHODS: Our study population was drawn from a cohort of men (n=284,257) who underwent a compulsory conscription assessment for between 1969 and 1976. Complete data were available for 189,220 men. We followed these men from 1st January 1985, when these men were between age 29 and 34 years until the date of depression. We used the ICD codes in Swedish patient register to identify TLA (primary and secondary diagnosis) and depression after TLA (primary diagnosis). Cox regression was used to calculate hazard ratios and 95% confidence intervals [CI] for the association of amputation with depression. Age was used as the underlying time scale, and the diagnosis of amputation was included as a time-dependent exposure status, with the value zero before amputation and one after the date of amputation. Birth year, region, occupation, cognitive and physical function and stress resilience in adolescence were considered as potential confounding factors and adjusted for in the analysis. 

RESULTS: In total 401 men experienced amputation between 1985 and 2009, with the mean age of amputation was age 42.5 years (SD 7.4). Those who experience amputation were more likely to have low stress resilience and cognitive function in adolescence and engaged in farming and manual work in 1985.  Cox regression produced unadjusted hazard ratio 2.61 (CI 1.62-4.21, p<0.001), i.e. 2.61 times risk of subsequent depression diagnosis for risk of subsequent depression compared with amputation-free individuals. Moderate and low cognitive function, physical fitness and stress resilience were associated with elevated risk of depression. Working for farms and manual work was also associated with higher depression risk. When the analysis was adjusted for these factors, the risk of depression after amputation changed little, 2.53 (CI 1.57-4.08, p <0.001) times risk of depression remained compared with amputation-free individuals.

CONCLUSIONS: As we hypothesized, TLA was associated with an increased risk of depression over more than two decades of follow-up of men from age 29 to 57 years. Higher levels of depressive symptoms were noted among working age amputees and our study group also comprised of working age amputees.  Future research may benefit from investigating potential influence of different amputation sites, degree, and prosthesis use involved in order to set intervention target. 

Place, publisher, year, edition, pages
Ljubjana, Slovenia: ISPO Slovena, 2018
Keywords
Prosthetics
National Category
Health Sciences Orthopaedics
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:oru:diva-72023 (URN)978-961-288-734-6 (ISBN)
Conference
ISPO International Central European ISPO Conference 2018 Portoroz, Slovenia, 20th September–22nd September, 2018
Available from: 2019-02-02 Created: 2019-02-02 Last updated: 2019-04-17Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2088-0530

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