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  • 1.
    Ahlroth Pind, Caroline
    et al.
    Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden; Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Respiratory Medicine.
    Kisiel, Marta A.
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Sandelowsky, Hanna
    NVS, Section for Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden; Academic Primary Care Centre, Region Stockholm, Sweden; Department of Medicine, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden.
    Nager, Anna
    NVS, Section for Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences. Centre for Clinical Research and Education, Karlstad, Sweden.
    Montgomery, Scott
    Department of Medicine, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden; Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Pharmacological treatment of asthma in Sweden from 2005 to 20152023In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Despite access to effective therapies many asthma patients still do not have well-controlled disease. This is possibly related to underuse of inhaled corticosteroids (ICS) and overuse of short-acting β2-agonists (SABA). Our aim was to investigate longitudinal trends and associated factors in asthma treatment.

    METHODS: Two separate cohorts of adults with physician-diagnosed asthma were randomly selected from 14 hospitals and 56 primary health centers in Sweden in 2005 (n = 1182) and 2015 (n = 1225). Information about symptoms, maintenance treatment, and use of rescue medication was collected by questionnaires. Associations between treatment and sex, age, smoking, education, body mass index (BMI), physical activity, allergic asthma, and symptom control were analyzed using Pearson's chi2-test. Odds ratios (ORs) were calculated using logistic regression.

    RESULTS: Maintenance treatment with ICS together with long-acting β2-agonists (LABA) and/or montelukast increased from 39.2% to 44.2% (p = 0.012). The use of ICS + LABA as-needed increased (11.1-18.9%, p < 0.001), while SABA use decreased (46.4- 41.8%, p = 0.023). Regular treatment with ICS did not change notably (54.2-57.2%, p = 0.14). Older age, former smoking, and poor symptom control were related to treatment with ICS + LABA/montelukast. In 2015, 22.7% reported daily use of SABA. A higher step of maintenance treatment, older age, obesity, shorter education, current smoking, allergic asthma, low or very high physical activity, and a history of exacerbations were associated with daily SABA use.

    CONCLUSIONS: The use of ICS + LABA both for maintenance treatment and symptom relief has increased over time. Despite this, the problem of low use of ICS and high use of SABA remains.

  • 2.
    Athlin, Åsa
    et al.
    Örebro University, School of Medical Sciences.
    Giezeman, Maaike
    Örebro University, School of Medical Sciences. Centre foClinical Research, Region Värmland, Karlstad, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, UK.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine.
    Prediction of Mortality Using Different COPD Risk Assessments: A 12-Year Follow-Up2021In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 16, p. 665-675Article in journal (Refereed)
    Abstract [en]

    Purpose: A multidimensional approach in the risk assessment of chronic obstructive pulmonary disease (COPD) is preferable. The aim of this study is to compare the prognostic ability for mortality by different COPD assessment systems; spirometric staging, classification by GOLD 2011, GOLD 2017, the age, dyspnea, obstruction (ADO) and the dyspnea, obstruction, smoking, exacerbation (DOSE) indices.

    Patients and Methods: A total of 490 patients diagnosed with COPD were recruited from primary and secondary care in central Sweden in 2005. The cohort was followed until 2017. Data for categorization using the different assessment systems were obtained through questionnaire data from 2005 and medical record reviews between 2000 and 2003. Kaplan-Meier survival analyses and Cox proportional hazard models were used to assess mortality risk. Receiver operating characteristic curves estimated areas under the curve (AUC) to evaluate each assessment systems´ ability to predict mortality.

    Results: By the end of follow-up, 49% of the patients were deceased. The mortality rate was higher for patients categorized as stage 3-4, GOLD D in both GOLD classifications and those with a DOSE score above 4 and ADO score above 8. The ADO index was most accurate for predicting mortality, AUC 0.79 (95% CI 0.75-0.83) for all-cause mortality and 0.80 (95% CI 0.75-0.85) for respiratory mortality. The AUC values for stages 1-4, GOLD 2011, GOLD 2017 and DOSE index were 0.73, 0.66, 0.63 and 0.69, respectively, for all-cause mortality.

    Conclusion: All of the risk assessment systems predict mortality. The ADO index was in this study the best predictor and could be a helpful tool in COPD risk assessment.

  • 3.
    Athlin, Åsa
    et al.
    Örebro University, School of Medical Sciences.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences. Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Giezeman, Maaike
    Örebro University, School of Medical Sciences. Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
    Kisiel, Marta
    Department of Medical Sciences, Occupational and Environment Medicine, Uppsala University, Uppsala, Sweden.
    Nager, Anna
    Division of Family Medicine and Primary Care, Inst NVS, Karolinska Institutet, Stockholm, Sweden.
    Sandelowsky, Hanna
    Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Division of Family Medicine and Primary Care, Inst NVS, Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden.
    Arne, Mats
    Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden; Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine.
    Diagnostic spirometry in COPD is increasing, a comparison of two Swedish cohorts2023In: npj Primary Care Respiratory Medicine, E-ISSN 2055-1010, Vol. 33, no 1, article id 23Article in journal (Refereed)
    Abstract [en]

    Spirometry should be used to confirm a diagnosis of chronic obstructive pulmonary disease (COPD). This test is not always performed, leading to possible misdiagnosis. We investigated whether the proportion of patients with diagnostic spirometry has increased over time as well as factors associated with omitted or incorrectly interpreted spirometry. Data from medical reviews and a questionnaire from primary and secondary care patients with a doctors' diagnosis of COPD between 2004 and 2010 were collected. Data were compared with a COPD cohort diagnosed between 2000 and 2003. Among 703 patients with a first diagnosis of COPD between 2004 and 2010, 88% had a diagnostic spirometry, compared with 59% (p < 0.001) in the previous cohort. Factors associated with not having diagnostic spirometry were current smoking (OR 2.21; 95% CI 1.36-3.60), low educational level (OR 1.81; 1.09-3.02) and management in primary care (OR 2.28; 1.02-5.14). The correct interpretation of spirometry results increased (75% vs 82%; p = 0.010). Among patients with a repeated spirometry, 94% had a persistent FEV1/FVC or FEV1/VC ratio <0.70.

  • 4.
    Bornehag, Carl-Gustaf
    et al.
    Department of Health and Environmental Sciences, Karlstad University, Karlstad, Sweden; SP Technical Research Institute of Sweden, Borås, Sweden.
    Moniruzzaman, Syed
    Department of Health and Environmental Sciences, Karlstad University, Karlstad, Sweden.
    Larsson, Malin
    Department of Health and Environmental Sciences, Karlstad University, Karlstad, Sweden.
    Lindström, Cecilia Boman
    Department of Health and Environmental Sciences, Karlstad University, Karlstad, Sweden.
    Hasselgren, Mikael
    Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden.
    Bodin, Anna
    Clinical Research, County Council of Värmland, Karlstad, Sweden.
    von Kobyletzkic, Laura B.
    Clinical Research, County Council of Värmland, Karlstad, Sweden; Institute of Clinical Research, Lund University, Lund, Sweden.
    Carlstedt, Fredrik
    Clinical Research, County Council of Värmland, Karlstad, Sweden.
    Lundin, Fredrik
    Clinical Research, County Council of Värmland, Karlstad, Sweden.
    Nånberg, Eewa
    Department of Chemistry and Biomedical Sciences, Karlstad University, Karlstad, Sweden.
    Jönsson, Bo A. G.
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Sigsgaard, Torben
    Department of Public Health, Unit of Environmental and Occupational Medicine, University of Aarhus, Aarhus, Denmark.
    Janson, Staffan
    Department of Health and Environmental Sciences, Karlstad University, Karlstad, Sweden; Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden.
    The SELMA study: a birth cohort study in Sweden following more than 2000 mother-child pairs2012In: Paediatric and Perinatal Epidemiology, ISSN 0269-5022, E-ISSN 1365-3016, Vol. 26, no 5, p. 456-467Article in journal (Refereed)
    Abstract [en]

    Background:  This paper describes the background, aim and study design for the Swedish SELMA study that aimed to investigate the importance of early life exposure during pregnancy and infancy to environmental factors with a major focus on endocrine disrupting chemicals for multiple chronic diseases/disorders in offspring.

    Methods: The cohort was established by recruiting women in the 10th week of pregnancy. Blood and urine from the pregnant women and the child and air and dust from home environment from pregnancy and infancy period have been collected. Questionnaires were used to collect information on life styles, socio-economic status, living conditions, diet and medical history.

    Results: Of the 8394 reported pregnant women, 6658 were invited to participate in the study. Among the invited women, 2582 (39%) agreed to participate. Of the 4076 (61%) non-participants, 2091 women were invited to a non-respondent questionnaire in order to examine possible selection bias. We found a self-selection bias in the established cohort when compared with the non-participant group, e.g. participating families did smoke less (14% vs. 19%), had more frequent asthma and allergy symptoms in the family (58% vs. 38%), as well as higher education among the mothers (51% vs. 36%) and more often lived in single-family houses (67% vs. 60%).

    Conclusions: These findings indicate that the participating families do not fully represent the study population and thus, the exposure in this population. However, there is no obvious reason that this selection bias will have an impact on identification of environmental risk factors.

  • 5.
    Bouhuis, Dennis
    et al.
    School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Giezeman, Maaike
    Örebro University, School of Medical Sciences. Centre for Clinical Research and Education, Karlstad, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences. Centre for Clinical Research and Education, Karlstad, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Kisiel, Marta A.
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, UK.
    Nager, Anna
    Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.
    Sandelowsky, Hanna
    Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Stockholm, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Respiratory Medicine.
    Factors Associated with the Non-Exacerbator Phenotype of Chronic Obstructive Pulmonary Disease2023In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 18, p. 483-492Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) and no exacerbations may need less maintenance treatment and follow-up. The aim was to identify factors associated with a non-exacerbator COPD phenotype.

    METHODS: Cross-sectional analysis of 1354 patients from primary and secondary care, with a doctor's diagnosis of COPD. In 2014, data on demographics, exacerbation frequency and symptoms using COPD Assessment Test (CAT) were collected using questionnaires and on spirometry and comorbid conditions by record review. The non-exacerbator phenotype was defined as having reported no exacerbations the previous six months. Multivariable logistic regression with the non-exacerbator phenotype as dependent variable was performed, including stratification and interaction analyses by sex.

    RESULTS: The non-exacerbator phenotype was found in 891 (66%) patients and was independently associated with COPD stage 1 (OR [95% CI] 5.72 [3.30-9.92]), stage 2 (3.42 [2.13-5.51]) and stage 3 (2.38 [1.46-3.88]) compared with stage 4, and with CAT score <10 (3.35 [2.34-4.80]). Chronic bronchitis and underweight were inversely associated with the non-exacerbator phenotype (0.47 [0.28-0.79]) and (0.68 [0.48-0.97]), respectively. The proportion of non-exacerbators was higher among patients with no maintenance treatment or a single bronchodilator. The association of COPD stage 1 compared with stage 4 with the non-exacerbator phenotype was stronger in men (p for interaction 0.048). In women, underweight and obesity were both inversely associated with the non-exacerbator phenotype (p for interaction 0.033 and 0.046 respectively), and in men heart failure was inversely associated with the non-exacerbator phenotype (p for interaction 0.030).

    CONCLUSION: The non-exacerbator phenotype is common, especially in patients with no maintenance treatment or a single bronchodilator, and is characterized by preserved lung function, low symptom burden, and by absence of chronic bronchitis, underweight and obesity and heart failure. We suggest these patients may need less treatment and follow-up, but that management of comorbid conditions is important to avoid exacerbations.

  • 6.
    Flygare, Anna-Lena
    et al.
    Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
    Engström, Ingemar
    University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences. University Health Care Research Centre.
    Jansson-Fröjmark, Markus
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Frejgrim, Rikard
    Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
    Andersson, Gerhard
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Holländare, Fredrik
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Internet-based CBT for patients with depressive disorders in primary and psychiatric care: Is it effective and does comorbidity affect outcome?2020In: Internet Interventions, ISSN 2214-7829, Vol. 19, article id UNSP 100303Article in journal (Refereed)
    Abstract [en]

    Internet-based cognitive behavior therapy (ICBT) has proved effective in reducing mild to moderate depressive symptoms. However, only a few studies have been conducted in a regular healthcare setting which limits the generalizability of the results. The influence of psychiatric comorbidity on outcome is not well understood. In the current study, patients with mild to moderate depressive symptoms in primary and psychiatric care were interviewed using the SCID-I and SCID-II to assess psychiatric diagnoses. Those included were randomly allocated to ICBT (n = 48) or to an active control condition (n = 47). Both groups received therapist support. At post-treatment, ICBT had reduced depressive symptoms on the BDI-II more than the active control intervention (p = .021). However, the difference between groups was no longer significant at the 6-, 12- or 24-month followups. The within-group effect size after ICBT (BDI-II) was large (d = 1.4). A comorbid anxiety disorder didn't moderate the outcome, while the presence of a personality disorder predicted significantly less improvement in depressive symptoms. ICBT had a large effect on depressive symptoms in a sample from regular healthcare. It is possible to obtain a large effect from ICBT despite comorbid anxiety, however, including patients with a comorbid personality disorder in the current form of ICBT seems questionable.

  • 7.
    Gagatek, S.
    et al.
    Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Wijnant, S. R. A.
    Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Department of Epidemiology, Erasmus Medical Centre, Rotterdam, Netherlands; Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
    Ställberg, B.
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Lisspers, K.
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Brusselle, G.
    Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Department of Epidemiology, Erasmus Medical Centre, Rotterdam, Netherland; Department of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, Netherlands .
    Zhou, X.
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden; Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden .
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine.
    Janson, C.
    Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Emilsson, Ö.
    Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Lahousse, L.
    Department of Epidemiology, Erasmus Medical Centre, Rotterdam, Netherlands; Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
    Malinovschi, A.
    Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.
    Validation of Clinical COPD Phenotypes for Prognosis of Long-Term Mortality in Swedish and Dutch Cohorts2022In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 19, no 1, p. 330-338Article in journal (Refereed)
    Abstract [en]

    Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with variable mortality risk. The aim of our investigation was to validate a simple clinical algorithm for long-term mortality previously proposed by Burgel et al. in 2017. Subjects with COPD from two cohorts, the Swedish PRAXIS study (n = 784, mean age (standard deviation (SD)) 64.0 years (7.5), 42% males) and the Rotterdam Study (n = 735, mean age (SD) 72 years (9.2), 57% males), were included. Five clinical clusters were derived from baseline data on age, body mass index, dyspnoea grade, pulmonary function and comorbidity (cardiovascular disease/diabetes). Cox models were used to study associations with 9-year mortality. The distribution of clinical clusters (1-5) was 29%/45%/8%/6%/12% in the PRAXIS study and 23%/26%/36%/0%/15% in the Rotterdam Study. The cumulative proportion of deaths at the 9-year follow-up was highest in clusters 1 (65%) and 4 (72%), and lowest in cluster 5 (10%) in the PRAXIS study. In the Rotterdam Study, cluster 1 (44%) had the highest cumulative mortality and cluster 5 (5%) the lowest. Compared with cluster 5, the meta-analysed age- and sex-adjusted hazard ratio (95% confidence interval) for cluster 1 was 6.37 (3.94-10.32) and those for clusters 2 and 3 were 2.61 (1.58-4.32) and 3.06 (1.82-5.13), respectively. Burgel's clinical clusters can be used to predict long-term mortality risk. Clusters 1 and 4 are associated with the poorest prognosis, cluster 5 with the best prognosis and clusters 2 and 3 with intermediate prognosis in two independent cohorts from Sweden and the Netherlands.

  • 8.
    Gagatek, Sebastian Grzegorz
    et al.
    Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Wijnant, Sara
    Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala, Sweden.
    Brusselle, Guy
    Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
    Zhou, Xing Wu
    Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine.
    Christer, Janson
    Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Emilsson, Össur
    Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Lahousse, Lies
    Department of Epidemiology, Erasmus Medical Centre, Rotterdam, Netherlands.
    Malinovschi, Andrei
    Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden.
    Validation of clinical clusters for long-term mortality in two European COPD cohorts2020In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 56, no Suppl. 64Article in journal (Other academic)
    Abstract [en]

    Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous disease with a variable mortality risk. A simple clinical algorithm has been validated for short-term mortality by Burgel et al. (ERJ 2017).

    Aim: To study if Burgel’s clinical algorithm is valid to predict long-term mortality.

    Methods: Data from two COPD cohorts, the Swedish PRAXIS Study (PS) (n=784, mean age (SD) 64.0 years (7.5), 42% males) and the Rotterdam Study (RS) (n=735, mean age (SD) 72 years (9.2), 57% males), with 9-years of follow-up data including mortality was used. The five clinical clusters were derived from baseline data on age, body mass index, dyspnea grade (mMRC), FEV 1 (%pred) and comorbidity (cardiovascular disease or diabetes). Mortality risk was estimated by unadjusted Cox models.

    Results: The distribution of clinical clusters (1-5) was: 29%/45%/8%/6%/12% in PS and 23%/26%/36%/0/15% in RS. The cumulative proportion of deaths after 9-years of follow-up was highest among COPD clusters 1 (65%) and 4 (72%), and lowest among cluster 5 (10%) in the PS cohort. In RS, Cluster 1 (44%) had the highest cumulative mortality and cluster 5 (5%) the lowest. Compared to cluster 5, the meta-analysed hazard ratio (HR) (95%CI) for cluster 1 was 9.95 (6.52–15.19) and for cluster 4, 13.49 (6.41–28.38). The meta-analysed HR for clusters 2 and 3, compared with cluster 5, were: 2.80 (1.77 – 4.36) and 4.73 (3.02 – 7.42), respectively.

    Conclusions: Burgel’s clinical clusters can be used to predict long-term mortality risk. Clusters 1 and 4 are associated with the poorest prognosis, cluster 5 with best prognosis and clusters 2 and 3 with intermediate prognosis in two independent COPD cohorts from Sweden and Netherlands.

  • 9.
    Giezeman, Maaike
    et al.
    Örebro University, School of Medical Sciences. Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, Örebro University, Örebro, Sweden; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, UK.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Influence of comorbid heart disease on dyspnea and health status in patients with COPD - a cohort study2018In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 13, p. 3857-3865Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to examine the changing influence over time of comorbid heart disease on symptoms and health status in patients with COPD.

    Patients and methods: This is a prospective cohort study of 495 COPD patients with a baseline in 2005 and follow-up in 2012. The study population was divided into three groups: patients without heart disease (no-HD), those diagnosed with heart disease during the study period (new-HD) and those with heart disease at baseline (HD). Symptoms were measured using the mMRC. Health status was measured using the Clinical COPD Questionnaire (CCQ) and the COPD Assessment Test (CAT; only available in 2012). Logistic regression with mMRC $2 and linear regression with CCQ and CAT scores in 2012 as dependent variables were performed unadjusted, adjusted for potential confounders, and additionally adjusted for baseline mMRC, respectively, CCQ scores.

    Results: Mean mMRC worsened from 2005 to 2012 as follows: for the no-HD group from 1.8 (+/- 1.3) to 2.0 (+/- 1.4), (P=0.003), for new-HD from 2.2 (+/- 1.3) to 2.4 (+/- 1.4), (P=0.16), and for HD from 2.2 (+/- 1.3) to 2.5 (+/- 1.4), (P=0.03). In logistic regression adjusted for potential confounding factors, HD (OR 1.71; 95% CI: 1.03-2.86) was associated with mMRC $ 2. Health status worsened from mean CCQ as follows: for no-HD from 1.9 (+/- 1.2) to 2.1 (+/- 1.3) with (P=0.01), for new-HD from 2.3 (+/- 1.5) to 2.6 (+/- 1.6) with (P=0.07), and for HD from 2.4 (+/- 1.1) to 2.5 (+/- 1.2) with (P=0.57). In linear regression adjusted for potential confounders, HD (regression coefficient 0.12; 95% CI: 0.04-5.91) and new-HD (0.15; 0.89-5.92) were associated with higher CAT scores. In CCQ functional state domain, new-HD (0.14; 0.18-1.16) and HD (0.12; 0.04-0.92) were associated with higher scores. After additional correction for baseline mMRC and CCQ, no statistically significant associations were found.

    Conclusion: Heart disease contributes to lower health status and higher symptom burden in COPD but does not accelerate the worsening over time.

  • 10.
    Giezeman, Maaike
    et al.
    Örebro University, School of Medical Sciences.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Sundh, Josefin
    Örebro University, School of Medical Sciences.
    Zakrisson, Ann-Britt
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Theander, Kersti
    Region Värmland, Karlstad, Sweden.
    Exploration of the feasibility to combine patients with COPD and chronic heart failure in self management groups with focus on exercise self-efficacy2021In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 58, no Suppl. 65, article id PA3638Article in journal (Other academic)
    Abstract [en]

    Background: High exercise self-efficacy is required for optimal exercise training in both patients with COPD and chronic heart failure (CHF).

    Aim: To compare exercise self-efficacy, symptoms, functional capacity and health status in COPD and CHF patients, and explore the association of symptoms and exercise self-efficacy.

    Method: Baseline data from a self-management group-intervention on 150 primary care patients with COPD (n=60), CHF (n=60) and a possible double diagnosis (n=30). Exercise self-efficacy (Swedish SCI Exercise Self-Efficacy Score), dyspnea (mMRC), fatigue (Fatigue Score), pain (five-level question), anxiety and depression (Hospital Anxiety and Depression Scale), functional capacity (six-minute Walking Test) and health status (VAS) were assessed.

    Results: The COPD group had fewer men than the CHF group (23vs 40 males; p<0.05) and lower mean age (69 (SD8) vs 78 (SD8) years; p<0.05), but had similar levels of self-efficacy, health status and symptoms. Functional capacity was similar after age-correction. Associations with self-efficacy were found for mMRC=1 (R -4.45; 95% CI-8.41- -0.50), mMRC=2 (-6.60;-10.68- -2.52), mMRC=3 (-9.94;-15.07- -4.80), fatigue (-0.87;-1.41- -0.32), moderate (-3.87;-7.52- -0.21) and severe pain (-5.32;-10.13- -0.52), depression (-0.98;-1.42- -0.55) and anxiety (-0.65;-0,10- -0.32) after adjustment for diagnosis, sex and age.

    Conclusion: Similar levels of exercise self-efficacy, symptoms, functional capacity, and health status were found. Symptoms are associated with self-efficacy regardless of diagnosis, sex and age. Joint self-management groups with focus on self-efficacy seem feasible.

  • 11.
    Giezeman, Maaike
    et al.
    Örebro University, School of Medical Sciences. Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Athlin, Åsa
    Örebro University, School of Medical Sciences.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Kisiel, Marta A.
    Department of Medical Sciences, Occupational and Environment Medicine, Uppsala University, Uppsala, Sweden.
    Nager, Anna
    Division of Family Medicine and Primary Care, Inst NVS, Karolinska Institutet, Stockholm, Sweden.
    Sandelowsky, Hanna
    Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Family Medicine and Primary Care, Inst NVS, Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden .
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Comorbid heart disease in patients with COPD is associated with increased hospitalization and mortality – a 15 year follow-upManuscript (preprint) (Other academic)
  • 12.
    Giezeman, Maaike
    et al.
    Örebro University, School of Medical Sciences. Centre for Clinical Research and Education, Karlstad, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Athlin, Åsa
    Örebro University, School of Medical Sciences. School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Kisiel, Marta A.
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Nager, Anna
    Division of Family Medicine and Primary Care, Inst NVS, Karolinska Institutet, Stockholm, Sweden.
    Sandelowsky, Hanna
    Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Division of Family Medicine and Primary Care, Inst NVS, Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Region Stockholm, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences. School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Centre for Clinical Research and Education, Karlstad, Sweden.
    Comorbid Heart Disease in Patients with COPD is Associated with Increased Hospitalization and Mortality: A 15-Year Follow-Up2023In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 18, p. 11-21Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study was to examine the association of comorbid heart disease, defined as chronic heart failure or ischemic heart disease, on all-cause and cause-specific hospitalization and mortality in patients with COPD over a period of nearly 15 years.

    MATERIALS AND METHODS: The cohort study included patients with COPD from primary and secondary care in 2005 with data from questionnaires and medical record reviews. The Swedish Board of Health and Welfare provided hospitalization and mortality data from 2005 through 2019. Cox regression analyses, adjusted for sex, age, educational level, smoking status, BMI, exacerbations, dyspnea score and comorbid diabetes or hypertension, assessed the association of comorbid heart disease with all-cause and cause-specific time to first hospitalization and death. Linear regression analyses, adjusted for the same variables, assessed this association with hospitalization days per year for those patients that had been hospitalized.

    RESULTS: Of the 1071 patients, 262 (25%) had heart disease at baseline. Cox regression analysis showed a higher risk of hospitalization for patients with heart disease for all-cause (HR (95% CI) 1.55; 1.32-1.82), cardiovascular (2.14; 1.70-2.70) and other causes (1.27; 1.06-1.52). Patients with heart disease also had an increased risk of all-cause (1.77; 1.48-2.12), cardiovascular (3.40; 2.41-4.78) and other (1.50; 1.09-2.06) mortality. Heart disease was significantly associated with more hospitalization days per year of all-cause (regression coefficient 0.37; 95% CI 0.15-0.59), cardiovascular (0.57; 0.27-0.86) and other (0.37; 0.12-0.62) causes. No significant associations were found between heart disease and respiratory causes of hospitalization and death.

    CONCLUSION: Comorbid heart disease in patients with COPD is associated with an increased risk for all-cause hospitalization and mortality, mainly due to an increase of hospitalization and death of cardiovascular and other causes, but not because of respiratory disease. This finding advocates the need of a strong clinical focus on primary and secondary prevention of cardiovascular disease in patients with COPD.

  • 13.
    Giezeman, Maaike
    et al.
    Örebro University, School of Medical Sciences. Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
    Theander, Kersti
    Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
    Zakrisson, Ann-Britt
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Exploration of the feasibility to combine patients with chronic obstructive pulmonary disease and chronic heart failure in self-management groups with focus on exercise self-efficacy2022In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 40, no 2, p. 208-216Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare the level of exercise self-efficacy, symptoms, functional capacity and health status and investigate the association between these variables in patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). Additionally, to investigate how diagnosis, symptoms and patient characteristics are associated with exercise self-efficacy in these patient groups.

    DESIGN: Cross-sectional study.

    SETTING: Primary care.

    SUBJECTS: Patients (n = 150) with COPD (n = 60), CHF (n = 60) and a double diagnosis (n = 30).

    MAIN OUTCOME MEASURES: Swedish SCI Exercise Self-Efficacy score, modified Medical Research Council Dyspnea score (mMRC), fatigue score, pain severity score, Hospital Anxiety and Depression Scale, functional capacity measured as six-minute walking distance and health status measured by a Visual Analogue Scale.

    RESULTS: Levels of exercise self-efficacy, health status and symptoms were alike for patients with COPD and patients with CHF. Functional capacity was similar after correction for age. Associations with exercise self-efficacy were found for slight dyspnea (mMRC = 1) (R -4.45; 95% CI -8.41- -0.50), moderate dyspnea (mMRC = 2) (-6.60;-10.68- -2.52), severe dyspnea (mMRC ≥ 3) (-9.94; -15.07- -4.80), fatigue (-0.87;-1.41- -0.32), moderate pain (-3.87;-7.52- -0.21) and severe pain (-5.32;-10.13- -0.52), symptoms of depression (-0.98;-1.42- -0.55) and anxiety (-0.65;-0,10- -0.32), after adjustment for diagnosis, sex and age.

    CONCLUSION AND IMPLICATIONS: Patients with COPD or CHF have similar levels of exercise self-efficacy, symptoms, functional capacity and health status. More severe symptoms are associated with lower levels of exercise self-efficacy regardless of diagnosis, sex and age. When forming self-management groups with a focus on exercise self-efficacy, it seems more relevant to consider level of symptoms than the specific diagnosis of COPD or CHF.Key pointsExercise training is an important part of self-management in patients with COPD and chronic heart failure (CHF). High exercise self-efficacy is required for optimal exercise training.Patients with COPD and CHF have similar symptoms and similar levels of exercise self-efficacy, functional capacity and health status.Not the diagnosis, but symptoms of dyspnea, fatigue, pain, depression and anxiety are important factors influencing exercise self-efficacy and need to be addressed.When forming self-management groups with a focus on exercise self-efficacy, it seems more relevant to consider the level of symptoms than the specific diagnosis of COPD or CHF.

  • 14.
    Hasselgren, Mikael
    et al.
    Örebro University, School of Medical Sciences.
    Molarius, Anu
    Centre for Clinical Research, Region Värmland, Sweden; Department of Public Health Sciences, Karlstad University, Sweden.
    Socioeconomic status, lifestyle factors and asthma prevalence: Results from a population-based study in Sweden2021In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 58, no Suppl. 65, article id PA636Article in journal (Other academic)
    Abstract [en]

    Conclusion: In this population-based study, self-reported diagnosed asthma was independently associated with economic difficulties but not with educational level. Lifestyle factors did not explain the association between economic difficulties and asthma prevalence.These findings apply to both men and women as well as younger and older age groups.

    Introduction: Previous studies have reported inconsistent findings about socioeconomic differences in asthma prevalence among adults. The aim of this study was to examine differences in the prevalence of self-reported diagnosed asthma by socioeconomic status and the contribution of lifestyle factors to these differences.

    Methods: The study was based on 28,531 persons aged 18 years or older who answered a survey questionnaire sent to a random population sample in Mid-Sweden in 2017. The overall response rate was 44%. Socioeconomic status was measured with educational level and economic difficulties, and lifestyle factors with physical activity, smoking, snuff use, risk-drinking of alcohol and obesity. The associations were analysed using multivariate logistic regression.

    Results: The overall asthma prevalence was 9% among women and 7% in men. Asthma was most prevalent in the youngest age group 18-29 years.

    Educational level was not independently associated with asthma.

    Statistically significant odds ratios for the prevalence of asthma were observed for economic difficulties 1.5 (95% CI: 1.3-1.7), physical inactivity 1.2 (95% CI: 1.1- 1.3) and obesity 1.6 (95% CI: 1.4-1.8).

    Persons born outside the Nordic countries had lower prevalence of asthma than persons born in Sweden.

    Smoking was not associated with asthma.

  • 15.
    Kisiel, Marta
    et al.
    Uppsala University, Department of Medical Sciences, Environmental and Occupational Medicine, Uppsala, Sweden.
    Berglund, Charlotte
    Region Dalarna, Falun, Sweden.
    Janson, Christer
    Uppsala Universitet, Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences.
    Nager, Anna
    Karolinska Institutet, NVS, Section for Family Medicine and Primary Care, Stockholm, Sweden.
    Sandelowsky, Hanna
    Karolinska Institutet, Clinical Epidemiology Division, Department of Medicine, Stockholm, Sweden.
    Ställberg, Björn
    Uppsala University, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine.
    Lisspers, Karin
    Uppsala University, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala, Sweden.
    Quality of life and asthma control related to hormonal transitions in women's lives2022In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 59, no 9, p. 1869-1877Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim was to investigate if menstruation and use of exogenous sex hormones influence self-reported asthma related quality of life (QoL) and asthma control.

    Methods: The study is based on two asthma cohorts randomly selected in primary and secondary care. A total of 622 female patients 18-65 years were included and classified as premenopausal ≤46 years (n = 338) and peri/postmenopausal 47-65 years (n = 284). Questionnaire data from 2012 and 2014 with demographics, asthma related issues and sex hormone status. Outcome measures were Mini Asthma Quality of Life Questionnaire (Mini-AQLQ) and asthma control including Asthma Control Test (ACT) and exacerbations last six months.

    Results: Premenopausal women with menstruation related asthma worsening, perimenstrual asthma (PMA) (9%), had a clinically relevant lower Mini-AQLQ mean score 4.9 vs. 5.8 (p < 0.001), lower asthma control with ACT score <20, 72% vs. 28% (p < 0.001) and higher exacerbation frequency 44% vs. 20% (p = 0.004) compared with women without PMA. Women with irregular menstruation had higher exacerbation frequency than women with regular menstruation (p = 0.023). Hormonal contraceptives had no impact on QoL and asthma control. Peri/postmenopausal women with menopausal hormone therapy (MHT) had a clinically relevant lower Mini-AQLQ mean score compared to those without MHT, 4.9 vs 5.4 (p < 0.001), but no differences in asthma control.

    Conclusion: Women with PMA had lower QoL and more uncontrolled asthma than women without PMA. Peri/postmenopausal women with MHT had lower QoL than women without MHT. Individual clinical management of women with asthma may benefit from information about their sex hormone status.

  • 16.
    Lindgren, Helena
    et al.
    Department of Respiratory Medicine, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, UK.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine.
    Factors associated with well-controlled asthma: A cross-sectional study2020In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 75, no 1, p. 208-211Article in journal (Refereed)
  • 17.
    Molarius, Anu
    et al.
    Centre for Clinical Research, Region Värmland, Sweden; Department of Public Health Sciences, Karlstad University, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Socioeconomic status, lifestyle factors and asthma prevalence: results from a population-based study in Sweden2023In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 51, no 4, p. 561-569Article in journal (Refereed)
    Abstract [en]

    AIM: To examine differences in the prevalence of self-reported diagnosed asthma by socioeconomic status and the contribution of lifestyle factors to these differences.

    METHODS: The study was based on 28,531 persons aged 18 years or older who answered a survey questionnaire sent to a random population sample in mid-Sweden in 2017. The overall response rate was 44%. Socioeconomic status was measured with educational level and economic difficulties, and lifestyle factors with physical activity, smoking, snuff use, risk-drinking of alcohol and obesity. The associations between socioeconomic status and asthma were analysed using multivariate logistic regression.

    RESULTS: The overall asthma prevalence was 9% among women and 7% in men and decreased with increasing age. Educational level was not independently associated with asthma, but a statistically significant odds ratio (with 95% confidence intervals) for the prevalence of asthma was observed for economic difficulties 1.5 (1.3-1.7). Also, physical inactivity 1.2 (1.1-1.3) and obesity 1.6 (1.4-1.8) were associated with increased asthma prevalence. Smoking and risk-drinking were not statistically significantly associated with asthma whereas snuff users had a higher prevalence of asthma among women. Adjusting for lifestyle factors did not affect the association between socioeconomic status and asthma.

    CONCLUSIONS: In this population-based study, self-reported diagnosed asthma was independently associated with economic difficulties but not with educational level. Lifestyle factors did not explain the association between economic difficulties and asthma prevalence. This applies to both men and women as well as younger and older age groups.

  • 18.
    Olsson, Ann
    et al.
    Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medicine, Örebro University, Sweden. Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden.
    Hagquist, Curt
    Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.
    Janson, Staffan
    Division of Public Health, Karlstad University, Karlstad, Sweden.
    The association between medical conditions and gender, well-being, psychosomatic complaints as well as school adaptability2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 5, p. 550-555Article in journal (Refereed)
    Abstract [en]

    Aim: The aim was to assess the association between medical conditions and gender, well-being, psychosomatic complaints and school adaptability. The second aim was to determine whether self-reported medical conditions should be included in class-room questionnaires that deal with well-being and risk behaviour.

    Methods: A cross-sectional class-room questionnaire was given to all 15- to 16-year-olds within a Swedish county. The questionnaire included background factors, subjective health, well-being, psychosomatic complaints, self image, drug use and also several themes from the school context. In addition, there were 13 medical conditions/problems to tick (yes or no) and an open alternative for other problems/medical conditions.

    Results: 3108 questionnaires (response rate 84%) were analysed. The majority of the girls and the boys reported no medical conditions; however, 49% of the girls and 39% of the boys reported at least one medical condition. The medical conditions were associated with gender, well-being, psychosomatic complaints and school adaptability. The association was stronger for girls than for boys.

    Conclusion: Medical conditions among these teenagers were associated with gender, well-being, psychosomatic complaints and school adaptability, particularly for girls. Our results suggest that medical conditions could preferably be included in regular classroom questionnaires.

  • 19.
    Smith, Carolina
    et al.
    Örebro University, School of Medical Sciences. Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden. Carolina.smith@oru.se.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Kisiel, Marta A.
    Department of Medical Sciences, Occupational and Environment Medicine, Uppsala University, Uppsala, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Nager, Anna
    NVS, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.
    Sandelowsky, Hanna
    Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Does multimorbidity result in de-prioritisation of COPD in primary care?2023In: npj Primary Care Respiratory Medicine, E-ISSN 2055-1010, Vol. 33, no 1, article id 2Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe factors associated with having COPD regularly reviewed in primary care by a nurse or physician and assess whether there was de-prioritisation for COPD in multimorbid patients. We defined de-prioritisation as not having at least one check-up by a physician during a two-year period. Among 713 COPD patients in the Swedish PRAXIS study, 473 (66%) had at least one check-up during the study period (ending in 2014). Patients with check-ups were more likely to have three or more comorbid conditions (31.9% vs. 24.6%) and exacerbations (35.1% vs. 21.7%) than those without. Compared with those without comorbidity, those with three or more diagnoses had increased relative risk ratios (and 95% CI) for consultations discussing COPD with only a physician (5.63 (2.68-11.79)), COPD-nurse only (1.67 (0.83-3.37)) or both (2.11 (1.09-4.06)). COPD patients received more frequent check-ups considering COPD if they had comorbidity or a history of exacerbations. We found no evidence of de-prioritisation for COPD in multimorbid patients.

  • 20.
    Stegberg, Marcus
    et al.
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, UK .
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Changes in smoking prevalence and cessation support, and factors associated with successful smoking cessation in Swedish patients with asthma and COPD2018In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 5, article id 1421389Article in journal (Refereed)
    Abstract [en]

    Introduction: Our aim was to investigate changes in smoking prevalence, smoking cessation support and factors associated with successful smoking cessation in patients with asthma and COPD.

    Methods: Questionnaires about available smoking cessation resources were completed by 54 primary health-care centers and 14 hospitals in central Sweden in 2005 and 2012. Patient data were collected using record reviews and patients questionnaires for two cohorts of randomly selected asthma and COPD patients in 2005 (n = 2306; with a follow up in 2012), and in 2014/ 2015 (n = 2620). Smoking prevalence, available individual and group smoking cessation support, and factors associated with successful smoking cessation were explored.

    Results: Smoking prevalence decreased from 11% to 6% (p < 0.0001) in patients with asthma but was almost unchanged in patients with COPD (28 to 26%, p = 0.37). Smoking cessation support increased from 53% to 74% (p = 0.01). A high cardiovascular risk factor level, including diabetes mellitus and hypertension was associated with improved smoking cessation in patients with asthma (OR (95% CI) 3.87 (1.04-14.4), p = 0.04). A higher magnitude success was observed in men with asthma (OR (95% CI) 27.9 (1.73-449), p = 0.02). More highly educated women with asthma had successful greater smoking cessation (4.76 (1.22-18.7), p = 0.04). No significant associations were found in COPD.

    Conclusions: The smoking prevalence in patients with asthma but not in COPD has almost halved in Sweden during a 7-year period. The availability of smoking cessation support has increased. Suggested factors related to successful smoking cessation are higher level of education in women with asthma and cardiovascular risk factors in men and women with asthma.

  • 21.
    Sundh, Josefin
    et al.
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Lindgren, Helena
    Medical Programme, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Pulmonary rehabilitation in COPD - available resources and utilization in Swedish primary and secondary care2017In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 12, p. 1695-1704Article in journal (Refereed)
    Abstract [en]

    Introduction: Pulmonary rehabilitation is effective in all stages of COPD. The availability and utilization of pulmonary rehabilitation resources, and the characteristics of COPD patients receiving rehabilitation, were investigated in primary and secondary care in central Sweden.

    Materials and methods: Data on available pulmonary rehabilitation resources were collected using questionnaires, to 14 hospitals and 54 primary health care centers, and information on utilization of different rehabilitation professionals was obtained from questionnaires completed by 1,329 COPD patients from the same centers. Multivariable logistic regression examined associations with having received rehabilitation in the previous year.

    Results: In primary care, nurse- based asthma/COPD clinics were common (87%), with additional separate access to other rehabilitation professionals. In secondary care, rehabilitation was more often offered as part of a multidisciplinary teamwork (71%). In total, 36% of the patients met an asthma/COPD nurse in the previous year. Utilization was lower in primary than in secondary care for physiotherapists (7% vs 16%), occupational therapists (3% vs 10%), nutritionists (5% vs 13%), and counselors (1% vs 4%). A higher COPD Assessment Test score and frequent exacerbations were associated with higher utilization of all rehabilitation professionals.

    Conclusion: Pulmonary rehabilitation resources are available but underutilized, and receiving rehabilitation is more common in severe COPD. Treatment recommendations need to be better implemented, especially in mild and moderate COPD.

  • 22.
    Sundh, Josefin
    et al.
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Montgomery, Scott M.
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Kämpe, Mary
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Change in health status in COPD: a seven-year follow-up cohort study2016In: npj Primary Care Respiratory Medicine, E-ISSN 2055-1010, Vol. 26, article id 16073Article in journal (Refereed)
    Abstract [en]

    Health status is a prognostic factor included in the assessment of chronic obstructive pulmonary disease (COPD). The aim of our study was to examine the associations of clinical factors with change in health status over a 7-year follow-up period. In 2005, 970 randomly selected primary and secondary care patients with a COPD diagnosis completed questionnaires including the Clinical COPD Questionnaire (CCQ); and in 2012, 413 completed the CCQ questionnaire again. Linear regression used difference in mean total CCQ score between 2005 and 2012 as the dependent variable. Independent variables were CCQ score at baseline 2005, sex, age, educational level, body mass index (BMI), smoking status, heart disease, diabetes, depression, number of exacerbations in the previous 6 months, dyspnoea (modified Medical Research Council (mMRC)). Health status worsened from mean total CCQ (s.d.) 2.03 (1.26) in 2005 to 2.16 (1.37) in 2012 (P=0.011). In linear regression with adjustment for baseline CCQ; older age, lower education, higher mMRC and BMI below 25 kg/m(2) at baseline were associated with worsened health status in 2012. When sex, age and all statistically significant measures were included simultaneously in the analysis of the main study group, higher mMRC and BMI below 25 kg/m(2) were were associated with deteriorated health status (P<0.0001). A higher level of dyspnoea and lower weight were associated with worse health status in COPD. Strategies for decreasing dyspnoea and awareness of the possible increased risk of worsening disease in under- and normal-weight COPD patients are clinically important.

  • 23.
    Sundh, Josefin
    et al.
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Wireklint, Philip
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Health-related quality of life in asthma patients: A comparison of two cohorts from 2005 and 20152017In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 132, p. 154-160Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim was to investigate temporal variation in Health-Related Quality of Life (HRQL) and factors influencing low HRQL, in patients with asthma.

    Material and methods: Questionnaire data on patient characteristics and the mini-Asthma Quality of Life Questionnaire (mini-AQLQ) scores from two separate cohorts of randomly selected Swedish primary and secondary care asthma patients, in 2005 (n = 1034) and 2015 (n = 1126). Student's t-test and analysis of covariance with adjustment for confounders compared mini-AQLQ total and domain scores in 2005 and 2015. Multivariable linear regression analyzed associations with mini-AQLQ scores.

    Results: The mean Mini-AQLQ scores were unchanged between 2005 and 2015 (adjusted means (95% CI) 2005: 5.39 (5.27-5.33) and in 2015: 5.44 (95% CI 5.32 to 5.38), p = 0.26). Overweight (regression coefficient 95% CI) (0.21 (-0.36 to -0.07)), obesity (-0.34 (-0,50 to -0.18)), one or more exacerbations during the previous six months (-0.64 (-0.79 to -0.50)), self-rated moderate/severe disease (-1.02 (-1.15 to-0.89)), heart disease (-0.42 (-0.68 to-0.16)), anxiety/depression (-0.31 (-0.48 to -0.13)) and rhinitis (-0.25 (-0.42 to -0.08)) were associated with lower HRQL. Higher educational level (0.32 (0.19-0.46)) and self-reported knowledge of self-management of exacerbations (0.35 (0.19-0.51)) were associated with higher HRQL.

    Conclusions: HRQL in Swedish patients with asthma is generally good and unchanged during the last decade. Overweight, obesity, exacerbations, self-rated moderate/severe disease, heart disease, depression/anxiety and rhinitis were associated with lower HRQL, and high educational level and knowledge on self-management with higher HRQL.

  • 24.
    Sundh, Josefin
    et al.
    Örebro University, School of Medical Sciences.
    Åberg, Joakim
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 20142017In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 4, article id 1409060Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim was to investigate how the pattern of pharmacological treatment in Swedish patients with chronic obstructive pulmonary disease (COPD) has changed over a decade, and to identify factors associated with treatment.

    Methods: Data on patient characteristics and pharmacological treatment were collected using questionnaires from two separate cohorts of randomly selected primary and secondary care patients with a doctor's diagnosis of COPD in central Sweden, in 2005 (n = 1111) and 2014 (n = 1329). Cross-tabulations and chi-square tests were used to compare maintenance treatment in 2005 and 2014, and to investigate the distribution of treatment by the 2017 Global Initiative for Obstructive Lung Disease (GOLD) ABCD groups. Multinomial logistic regression was used to analyze associations with the major types of recommended treatments: bronchodilator therapy, combined long-acting beta-2-antagonists (LABA) + inhaled corticosteroids (ICS), and triple inhaled therapy.

    Results: The proportion of patients with no maintenance treatment, with only LABA + ICS, and with sole ICS statistically significantly decreased (36 vs. 31%, 16 vs. 12% and 5 vs. 2%, respectively), and the proportion with triple inhaled therapy statistically significantly increased (29 vs. 40%). In 2014, triple inhaled therapy was the most common treatment in all GOLD groups except group A. In 2014, previous frequent exacerbations [OR (95% CI) 2.34 (1.62 to 3.36)], worse COPD Assessment Test score [1.07 (1.05 to 1.09)], female sex [2.13 (1.56 to 2.91)], and access to a specific responsible doctor [1.95 (1.41 to 2.69)] were associated with triple inhaled therapy. Current smoking [0.40 (0.28 to 0.57)] and overweight [0.62 (0.41 to 0.93)] were inversely associated with triple inhaled therapy.

    Conclusions: Over the last decade, triple inhaled therapy has increased, and no maintenance treatment, ICS, or LABA + ICS has decreased. Triple inhaled therapy is the most common treatment and is associated with previous exacerbations, higher symptom level, female sex, and having a specific responsible doctor.

  • 25.
    Theander, Kersti
    et al.
    Department of Nursing, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden; Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medicine, Örebro University, Sweden. Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden.
    Luhr, Kristina
    Family Medicine Research Centre, Örebro County Council, Örebro, Sweden.
    Eckerblad, Jeanette
    Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Unosson, Mitra
    Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Karlsson, Ingela
    Department of Nursing, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden.
    Symptoms and impact of symptoms on function and health in patients with chronic obstructive pulmonary disease and chronic heart failure in primary health care2014In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 9, p. 785-794Article in journal (Refereed)
    Abstract [en]

    Background: Patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) seem to have several symptoms in common that impact health. However, methodological differences make this difficult to compare.

    Aim: Comparisons of symptoms, impact of symptoms on function and health between patients with COPD and CHF in primary health care (PHC).

    Method: The study is cross sectional, including patients with COPD (n=437) and CHF (n=388), registered in the patient administrative systems of PHC. The patients received specific questionnaires - the Memorial Symptom Assessment Scale, the Medical Research Council dyspnea scale, and the Fatigue Impact Scale - by mail and additional questions about psychological and physical health.

    Results: The mean age was 70 +/- 10 years and 78 +/- 10 years for patients with COPD and CHF respectively (P=0.001). Patients with COPD (n=273) experienced more symptoms (11 +/- 7.5) than the CHF patients (n=211) (10 +/- 7.6). The most prevalent symptoms for patients with COPD were dyspnea, cough, and lack of energy. For patients with CHF, the most prevalent symptoms were dyspnea, lack of energy, and difficulty sleeping. Experience of dyspnea, cough, dry mouth, feeling irritable, worrying, and problems with sexual interest or activity were more common in patients with COPD while the experience of swelling of arms or legs was more common among patients with CHF. When controlling for background characteristics, there were no differences regarding feeling irritable, worrying, and sexual problems. There were no differences in impact of symptoms or health.

    Conclusion: Patients with COPD and CHF seem to experience similar symptoms. There were no differences in how the patients perceived their functioning according to their cardinal symptoms; dyspnea and fatigue, and health. An intervention for both groups of patients to optimize the management of symptoms and improve function is probably more relevant in PHC than focusing on separate diagnosis groups.

  • 26.
    von Kobyletzki, L. B.
    et al.
    Department of Dermatology, Skåne University Hospital, Lund University, Malmö , Sweden; Department of Public Health Sciences, Karlstad University, Karlstad, Sweden.
    Berner, A.
    Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden.
    Carlstedt, F.
    Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medicine, Örebro University, Sweden. Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden.
    Bornehag, C. G.
    Department of Public Health Sciences, Karlstad University, Karlstad, Sweden; SP Technical Research Institute of Sweden, Borås , Sweden.
    Svensson, A.
    Department of Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden.
    Validation of a parental questionnaire to identify atopic dermatitis in a population-based sample of children up to 2 years of age2013In: Dermatology, ISSN 1018-8665, E-ISSN 1421-9832, Vol. 226, no 3, p. 222-226Article in journal (Refereed)
    Abstract [en]

    Background: Validated eczema questionnaires have been available for schoolchildren only, but the incidence of atopic dermatitis (AD) is highest during infancy. Objective: To validate a parental questionnaire to identify AD in children up to 2 years of age.

    Methods: Parents of 476 children answered a written questionnaire prior to an examination by a physician. Sensitivity, specificity, predictive values and test-retest reliability of the questionnaire were assessed.

    Results: A total of 245 (51%) girls and 231 (49%) boys, aged 1-24 months, with and without physician-diagnosed AD participated. Seventy-one children (15%) had physician-diagnosed AD. Validation of the questionnaire by comparisons with physicians' diagnoses showed a sensitivity of 0.87 (95% confidence interval, CI, 0.77-0.94) and a specificity of 0.98 (95% CI, 0.96-0.99). The positive predictive value was 0.90 (95% CI, 0.80-0.96) and the negative predictive value was 0.98 (95% CI, 0.96-0.99). Conclusion: The questionnaire identified AD in children aged 0-2 years with high accuracy.

  • 27.
    von Kobyletzki, Laura B.
    et al.
    Skåne University Hospital, Lund University, Malmö, Sweden.
    Bornehag, Carl-Gustaf
    Karlstad University, Karlstad, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. County Council of Värmland, Karlstad, Sweden.
    Larsson, Malin
    Karlstad University, Karlstad, Sweden.
    Lindström, Cecilia Boman
    Karlstad University, Karlstad, Sweden.
    Svensson, Åke
    Skåne University Hospital, Lund University, Malmö, Sweden.
    Eczema in early childhood is strongly associated with the development of asthma and rhinitis in a prospective cohort2012In: BMC Dermatology, E-ISSN 1471-5945, Vol. 12, no 11, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Background: This study aimed to estimate the association between eczema in early childhood and the onset of asthma and rhinitis later in life in children.

    Methods: A total of 3,124 children aged 1-2 years were included in the Dampness in Building and Health (DBH) study in the year 2000, and followed up 5 years later by a parental questionnaire based on an International Study of Asthma and Allergies in Childhood protocol. The association between eczema in early childhood and the incidence of asthma and rhinitis later in life was estimated by univariable and multivariable logistic regression modelling.

    Results: The prevalence of eczema in children aged 1-2 years was 17.6% at baseline. Children with eczema had a 3-fold increased odds of developing asthma (adjusted odds ratio [aOR], 3.07; 95% confidence interval (CI) 1.79-5.27), and a nearly 3-fold increased odds of developing rhinitis (aOR, 2.63; 1.85-3.73) at follow-up compared with children without eczema, adjusted for age, sex, parental allergic disease, parental smoking, length of breastfeeding, site of living, polyvinylchloride flooring material, and concomitant allergic disease. When eczema was divided into subgroups, moderate to severe eczema (aOR, 3.56; 1.62-7.83 and aOR, 3.87; 2.37-6.33, respectively), early onset of eczema (aOR, 3.44; 1.94-6.09 and aOR, 4.05; 2.82-5.81; respectively), and persistence of eczema (aOR, 5.16; 2.62-10.18 and aOR, 4.00; 2.53-6.22, respectively) further increased the odds of developing asthma and rhinitis. Further independent risk factors increasing the odds of developing asthma were a parental history of allergic disease (aOR, 1.83; 1.29-2.60) and a period of breast feeding shorter than 6 months (aOR, 1.57; 1.03-2.39). The incidence of rhinitis was increased for parental history of allergic disease (aOR, 2.00; 1.59-2.51) and polyvinylchloride flooring (aOR, 1.60; 1.02-2.51).

    Conclusion: Eczema in infancy is associated with development of asthma and rhinitis during the following 5-year period, and eczema is one of the strongest risk factors. Early identification is valuable for prediction of the atopic march.

  • 28.
    von Kobyletzki, Laura B.
    et al.
    Department of Dermatology, Institute of Clinical Research in Malmö, Skåne University Hospital, Lund University, Malmö, Sweden; Department of Public Health Sciences, Karlstad University, Karlstad, Sweden.
    Janson, Staffan
    Department of Public Health Sciences, Karlstad University, Karlstad, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bornehag, Carl-Gustaf
    Department of Public Health Sciences, Karlstad University, Karlstad, Sweden.
    Svensson, Ake
    Department of Dermatology, Institute of Clinical Research in Malmö, Skåne University Hospital, Lund University, Malmö, Sweden.
    Evaluation of a parental questionnaire to identify atopic dermatitis in infants and preschool children2012In: Journal of Allergy, ISSN 1687-9783, E-ISSN 1687-9791, Vol. 2012, article id 945617Article in journal (Refereed)
    Abstract [en]

    Aim: To develop and validate a questionnaire for detecting atopic dermatitis in infants and small children from the age of 2 months.

    Methods: Parents to 60 children answered a written questionnaire prior to a physical examination and individual semistructured interview. Qualitative and quantitative analyses of validity, sensitivity, specificity, and predictive values of the questionnaire were performed.

    Results: A total of 27 girls and 33 boys, aged 2 to 71 months, 35 with and 25 without physician-diagnosed eczema, participated. Validation of the questionnaire by comparisons with physicians' diagnoses showed a sensitivity of 0.91 (95% CI 0.77-0.98) and a specificity of 1 (95% CI 0.86-1).

    Conclusions: Three questions in a parental questionnaire were sufficient for diagnosing eczema in infants and small children.

  • 29.
    Wireklint, Philip
    et al.
    School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, UK.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences.
    Factors associated with knowledge of self-management of worsening asthma in primary care patients: a cross-sectional study2021In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 58, no 8, p. 1087-1093Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Self-management is important for asthma control. We examined associations of patient- and healthcare-related factors with self-reported knowledge of self-management of worsening asthma.

    METHOD: Two asthma patient cohorts from 2012 (n = 527) and 2015 (n = 915) were randomly selected from 54 primary health care centers (PHCC) in central Sweden. Data were collected using patient questionnaires and questionnaires to the PHCCs. Logistic regression analyzed associations of relevant variables with knowledge of self-management of worsening asthma.

    RESULTS: In total, 63% of patients reported moderate to complete knowledge of self-management procedures. The adjusted OR for moderate to complete knowledge relative to high education level was 1.38 [95% CI 1.03-1.85)]; for physician continuity 2.19 (95% CI 1.62-2.96); for a written action plan, 11.9 (95% CI 6.16-22.9); for Step 2 maintenance treatment, 1.53 (95% CI 0.04-2.24); and 2.07 (95% CI 1.44-2.99) for Step 3. An asthma/COPD nurse visit within the previous 12 months was associated with greater knowledge in women but not in men (p for interaction =0.042). Smoking [OR 0.56 (95% CI 0.34-0.95)], co-morbidities ≥1 [OR 0.68 (95% CI 0.49-0.93)], and self-rated moderate/severe disease [OR 0.68 (95% CI 0.51-0.90)] were associated with low self-management knowledge.

    CONCLUSION: Self-reported knowledge of self-management procedures was associated with a higher educational level, physician continuity, a written action plan, advanced treatment and, in women, visiting an asthma/COPD nurse. The results reinforce the importance of implementing guidelines of patient access to a specific physician, a written action plan, and structured education by an asthma/COPD nurse.

  • 30.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Arne, M.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Lisspers, K.
    Sandelowsky, H.
    Ställberg, B.
    Thors Adolfsson, E.
    Theander, K.
    A description of requests for self-management support among patients with COPD in Primary Health Care2017In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 50, no Sup. 61, article id PA1605Article in journal (Refereed)
  • 31.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Arne, Mats
    Centre for Clinical Research, County Council of Värmland, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Lisspers, Karin
    Uppsala University, Uppsala, Sweden.
    Lundh, Lena
    Division of Family Medicine and Priamry Care, Stockholm, Sweden.
    Sandelowsky, Hanna
    Division of Family Medicine and Priamry Care, Stockholm, Sweden.
    Ställberg, Björn
    Uppsala University, Uppsala, Sweden.
    Thors Adolfsson, Eva
    Primary Health Care, Region Västmanland, Västerås, Sweden.
    Theander, Kersti
    Karlstad University, Karlstad, Sweden.
    Improved quality of care by the PRISMS form in supporting self-management in patients with COPD: A Randomized Controlled Trial (RCT)2017Conference paper (Refereed)
    Abstract [en]

    Patient Report Informing Self-Management Support (PRISMS) could be a useful tool to improve quality of care in supporting self-management. Personal attention is an important part of a person-centered approach.

  • 32.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of University Healthcare Research Centre.
    Arne, Mats
    Centre for clinical research, County Council of Värmland, Sweden; Department of Medical Sciences, Lung allergy and sleep research, Uppsala University, Uppsala, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Theander, Kersti
    Centre for clinical research, County Council of Värmland, Sweden.
    A complex intervention of self-management for patients with COPD or CHF in primary care improved performance and satisfaction with regard to own selected activities: a longitudinal follow-up2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 1, p. 175-186Article in journal (Refereed)
    Abstract [en]

    AIM: To test a self-management intervention in primary health care for patients with Chronic Obstructive Pulmonary Disease or Chronic Heart Failure on self-efficacy, symptoms, functioning and health.

    BACKGROUND: Patients with Chronic Obstructive Pulmonary Disease or Chronic Heart Failure experience often the same symptoms such as shortness of breath, cough, lack of energy, dry mouth, numbness or tingling in hands and feet, pain and sleeping problems.

    DESIGN: A multicentre randomized control trial.

    METHOD: The trial was conducted with one intervention group (n=73) and one control group (n=77). The trial was performed from September 2013 - September 2015 at nine primary health care centres in three county councils in Sweden. At baseline patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure experienced any symptom. Follow-ups were performed after three months and one year. The intervention was structured on Bandura's theory of self-efficacy in six meetings and individual action plans based on personal problems were performed and discussed.

    RESULTS: At baseline, there were no differences between the groups except for SF-36 social function. After three months, the intervention group improved performance and satisfaction with regard to own selected activities, otherwise no differences were found.

    CONCLUSION: When designing a program, the patient's own difficulties must be taken into consideration if person-centered care is to be established. It is feasible to include both patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure in the same group in primary health care. Health care professionals need supervision in pedagogics during intervention in self-management.

  • 33.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Engfeldt, Peter
    Örebro University, School of Health and Medical Sciences.
    Hägglund, Doris
    Örebro University, School of Health and Medical Sciences.
    Odencrants, Sigrid
    Örebro University, School of Health and Medical Sciences.
    Hasselgren, Mikael
    Arne, Mats
    Theander, Kersti
    Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial2011In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 20, no 4, p. 427-433Article in journal (Refereed)
    Abstract [en]

    AIM:To investigate the effects of a nurse-led multidisciplinary programme (NMP) of pulmonary rehabilitation in primary health care with regard to functional capacity, quality of life (QoL), and exacerbations among patients with chronic obstructive pulmonary disease (COPD).

    METHOD:A 1-year longitudinal study with a quasi-experimental design was undertaken in patients with COPD, 49 in the intervention group and 54 in the control group. Functional capacity was assessed using the 6-minute walking test, and quality of life (QoL) was assessed using the Clinical COPD Questionnaire. Exacerbations were calculated by examination of patient records.

    RESULTS:No significant differences were found between the groups in functional capacity and QoL after 1 year. The exacerbations decreased in the intervention group (n = -0.2) and increased in the control group (n = 0.3) during the year after NMP. The mean difference of change in exacerbation frequency between the groups was statistically significant after one year (p=0.009).

    CONCLUSIONS:The NMP in primary care produced a significant reduction in exacerbation frequency, but functional capacity and QoL were unchanged. More and larger studies are needed to evaluate potential benefits in functional capacity and QoL.

  • 34.
    Åberg, Joakim
    et al.
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, Örebro University, Örebro, Sweden; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, UK.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine.
    Sex-related differences in management of Swedish patients with a clinical diagnosis of chronic obstructive pulmonary disease2019In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 14, p. 961-969Article in journal (Refereed)
    Abstract [en]

    Purpose: Women with chronic obstructive pulmonary disease (COPD) have more symptoms, more exacerbations, lower health status scores, and more comorbidity. However, it is unclear whether management of COPD differs by sex. The aim of the study was to investigate differences by sex in the care of patients with COPD.

    Patients and methods: The population included 1329 primary and secondary care patients with a doctor ' s diagnosis of COPD in central Sweden. Data were obtained from patient questionnaires and included patient characteristics and data on achieved COPD care. Analyses included cross-tabulations, chi-squared test and multiple logistic regression using several measures in COPD management as dependent variables, female sex as independent variable, and with adjustment for age groups, previous exacerbations, COPD Assessment Test, level of dyspnea assessed by the modified Medical Research Council scale, comorbid conditions, self-rated moderate/severe disease, level of education and body mass index.

    Results: Women were more likely to receive triple therapy (OR 1.86 (95% CI 1.38-2.51)), to have any maintenance treatment (OR 1.82 (95% CI 1.31-2.55)), to be on sick leave (OR 2.16 (95% CI 1.19-3.93)), to have received smoking cessation support (OR 1.80 (95% CI 1.18-2.75)) and to have had pneumococcal vaccination (OR 1.82 (95% CI 1.37-2.43)), all independently of age, severity of disease or other potential confounders.

    Conclusion: Management of COPD differs by sex, with women being more actively managed than men. It is unclear whether this is due to patient-or care-related factors.

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