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  • 1. Björkelund, Cecilia
    et al.
    Hasselgren, Mikael
    Primary Care Research Centre, County Council of Värmland, Karlstad, Sweden; Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    [Psychiatry and primary health care have common responsibility]2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 14, p. 786-786Article in journal (Refereed)
  • 2.
    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.

  • 3.
    Bornehag, Carl-Gustaf
    et al.
    Swedish Natl. Testing/Res. Institute, Borås, Sweden; Technical University of Denmark, Lyngby, Denmark; Public Health Science, Karlstad University, Karlstad, Sweden.
    Sundell, Jan
    Technical University of Denmark, Lyngby, Denmark.
    Weschler, Charles J
    Technical University of Denmark, Lyngby, Denmark; University of Medicine and Dentistry, NJ-Robert Wood Johnson Med. School, Piscataway, NJ, United States.
    Sigsgaard, Torben
    Aarhus University, Aarhus, Denmark.
    Lundgren, Björn
    Swedish Natl. Testing/Res. Institute, Borås, Sweden.
    Hasselgren, Mikael
    Public Health Science, Karlstad University, Karlstad, Sweden.
    Hägerhed-Engman, Linda
    Swedish Natl. Testing/Res. Institute, Borås, Sweden.
    The association between asthma and allergic symptoms in children and phthalates in house dust: a nested case-control study2004In: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 112, no 14, p. 1393-1397Article in journal (Refereed)
    Abstract [en]

    Global phthalate ester production has increased from very low levels at the end of World War II to approximately 3.5 million metric tons/year. The aim of the present study was to investigate potential associations between persistent allergic symptoms in children, which have increased markedly in developed countries over the past three decades, and the concentration of phthalates in dust collected from their homes. This investigation is a case-control study nested within a cohort of 10,852 children. From the cohort, we selected 198 cases with persistent allergic symptoms and 202 controls without allergic symptoms. A clinical and a technical team investigated each child and her or his environment. We found higher median concentrations of butyl benzyl phthalate (BBzP) in dust among cases than among controls (0.15 vs. 0.12 mg/g dust). Analyzing the case group by symptoms showed that BBzP was associated with rhinitis (p = 0.001) and eczema (p = 0.001), whereas di(2-ethylhexyl) phthalate (DEHP) was associated with asthma (p = 0.022). Furthermore, dose-response relationships for these associations are supported by trend analyses. This study shows that phthalates, within the range of what is normally found in indoor environments, are associated with allergic symptoms in children. We believe that the different associations of symptoms for the three major phthalates-BBzP, DEHP, and di-n-butyl phthalate-can be explained by a combination of chemical physical properties and toxicologic potential. Given the phthalate exposures of children worldwide, the results from this study of Swedish children have global implications.

  • 4.
    Carlstedt, Fredrik
    et al.
    Primary Care Research Centre, County Council of Värmland, Karlstad, Sweden.
    Lazowska, Dagmara
    Primary Care Research Centre, County Council of Värmland, Karlstad, Sweden.
    Bornehag, Carl-Gustaf
    Public Health Science, Karlstad University, Karlstad, Sweden.
    Olin, Anna-Carin
    Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
    Hasselgren, Mikael
    Primary Care Research Centre, County Council of Värmland, Karlstad, Sweden; Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Exhaled nitric oxide and urinary EPX levels in infants: a pilot study2011In: Clinical and Molecular Allergy, ISSN 1476-7961, E-ISSN 1476-7961, Vol. 9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Objective markers of early airway inflammation in infants are not established but are of great interest in a scientific setting. Exhaled nitric oxide (FeNO) and urinary eosinophilic protein X (uEPX) are a two such interesting markers.

    OBJECTIVE: To investigate the feasibility of measuring FeNO and uEPX in infants and their mothers and to determine if any relations between these two variables and environmental factors can be seen in a small sample size. This was conducted as a pilot study for the ongoing Swedish Environmental Longitudinal Mother and child Asthma and allergy study (SELMA).

    METHODS: Consecutive infants between two and six months old and their mothers at children's health care centres were invited, and 110 mother-infant pairs participated. FeNO and uEPX were analysed in both mothers and infants. FeNO was analyzed in the mothers online by the use of the handheld Niox Mino device and in the infants offline from exhaled air sampled during tidal breathing. A 33-question multiple-choice questionnaire that dealt with symptoms of allergic disease, heredity, and housing characteristics was used.

    RESULTS: FeNO levels were reduced in infants with a history of upper respiratory symptoms during the previous two weeks (p < 0.002). There was a trend towards higher FeNO levels in infants with windowpane condensation in the home (p < 0.05). There was no association between uEPX in the infants and the other studied variables.

    CONCLUSION: The use of uEPX as a marker of early inflammation was not supported. FeNO levels in infants were associated to windowpane condensation. Measuring FeNO by the present method may be an interesting way of evaluating early airway inflammation. In a major population study, however, the method is difficult to use, for practical reasons.

  • 5.
    Choi, Hyunok
    et al.
    Department of Environmental Health, Harvard School of Public Health, Boston MA, United States.
    Schmidbauer, Norbert
    Norwegian Institute for Air Research, Kjeller, Norway.
    Sundell, Jan
    Department of Building Science, School of Architecture, Tsinghua University, Beijing, China.
    Hasselgren, Mikael
    Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden.
    Spengler, John
    Department of Environmental Health, Harvard School of Public Health, Boston MA, United States.
    Bornehag, Carl-Gustaf
    Public Health Sciences, Karlstad University, Karlstad, Sweden; SP Technical Research Institute of Sweden, Borås, Sweden.
    Common household chemicals and the allergy risks in pre-school age children2010In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 5, no 10, article id e13423Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The risk of indoor exposure to volatile organic compounds (VOCs) on allergic airway diseases in children remains unknown.

    OBJECTIVE: We examined the residential concentrations of VOCs, emitted from building materials, paints, furniture, and other lifestyle practices and the risks of multiple allergic diseases as well as the IgE-sensitization in pre-school age children in Sweden.

    METHODS: In a case-control investigation (198 case children with asthma and allergy and 202 healthy controls), air samples were collected in the room where the child slept. The air samples were analyzed for the levels of eight classes of VOCs.

    RESULTS: A natural-log unit of summed propylene glycol and glycol ethers (PGEs) in bedroom air (equal to interquartile range, or 3.43 - 15.65 µg/m(3)) was associated with 1.5-fold greater likelihood of being a case (95% CI, 1.1 - 2.1), 1.5-fold greater likelihood of asthma (95% CI, 1.0 - 2.3), 2.8-fold greater likelihood of rhinitis (95% CI, 1.6 - 4.7), and 1.6-fold greater likelihood of eczema (95% CI, 1.1 - 2.3), accounting for gender, secondhand smoke, allergies in both parents, wet cleaning with chemical agents, construction period of the building, limonene, cat and dog allergens, butyl benzyl phthalate (BBzP), and di(2-ethylhexyl)phthalate (DEHP). When the analysis was restricted to the cases, the same unit concentration was associated with 1.8-fold greater likelihood of IgE-sensitization (95% CI, 1.1 - 2.8) compared to the non-IgE sensitized cases. No similar associations were found for the other classes of VOCs.

    CONCLUSION: We propose a novel hypothesis that PGEs in indoor air exacerbate and/or induce the multiple allergic symptoms, asthma, rhinitis and eczema, as well as IgE sensitization respectively.

  • 6.
    Hasselgren, Mikael
    Department of Cancer Epidemiology, University Hospital, Uppsala, Sweden; Primary Health Care Centre, Skoghall, Sweden.
    [It is possible to measure activities of primary health care]1997In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 94, no 9, p. 708-708Article in journal (Refereed)
  • 7.
    Hasselgren, Mikael
    et al.
    Centre for Public Health Research, University of Karlstad, Sweden.
    Arne, M
    Centre for Public Health Research, University of Karlstad, Sweden.
    Lindahl, A
    Centre for Public Health Research, University of Karlstad, Sweden.
    Janson, S
    Centre for Public Health Research, University of Karlstad, Sweden.
    Lundbäck, B
    Respiratory Epidemiology Unit, Department of Occupational Medicine, National Institute for Working Life, Umeå and Solna, Sweden.
    Estimated prevalences of respiratory symptoms, asthma and chronic obstructive pulmonary disease related to detection rate in primary health care2001In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 19, no 1, p. 54-57Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the prevalence of respiratory symptoms, asthma and chronic obstructive pulmonary disease (COPD), and to relate it to an estimated detection rate in primary health care.

    DESIGN: A two-staged study with a cross-sectional survey and a clinical validation.

    SETTING: The adult population of Värmland, a county in Sweden.

    SUBJECTS: 4814 persons completed the survey and 206 the confirmative validation study.

    MAIN OUTCOME MEASURES: Prevalence of respiratory symptoms, of asthma and COPD.

    RESULTS: More than 40% reported respiratory symptoms. Wheeze was reported by 8.0%, shortness of breath by 11.4% and sputum production by 14.1%. Smoking was more common among women than among men. The prevalence of asthma was 8.2% and COPD 2.1%. Of persons with asthma, 33% were estimated to be undiagnosed, 67% used medication and nearly 60% attended primary health care services.

    CONCLUSION: Respiratory symptoms as well as asthma were common in this study and equivalent to earlier findings. The difference between the epidemiologically estimated prevalence of asthma and the lower detection rate in primary health care can be explained by at least three factors: persons who did not seek any care, were underdiagnosed or attended other health care providers.

  • 8.
    Hasselgren, Mikael
    et al.
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden; Primary Care Research Unit, Vårdcentralen Kronoparken, Karlstad, Sweden.
    Gustafsson, D
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Ställberg, B
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Lisspers, K
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Johansson, G
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Management, asthma control and quality of life in Swedish adolescents with asthma2005In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 6, p. 682-688Article in journal (Refereed)
    Abstract [en]

    AIM: In Sweden, paediatricians or general practitioners treat most adolescents with asthma. This study compares management, treatment goals and quality of life for adolescents aged 15-18 y in paediatric or primary care.

    MATERIAL AND METHODS: A random sample of patients answered a disease-specific and a quality-of-life (MiniAQLQ) questionnaire.

    RESULTS: The 146 adolescents in paediatric care had more years with asthma, better continuity of annual surveillance, higher use of inhaled steroids and a stated better knowledge of their asthma than the 174 patients in primary care. No difference could be detected in asthma control or quality of life. Of all 320 adolescents, approximately 20% had woken at night due to asthma symptoms during the last week. About 15% had made unscheduled, urgent care visits and a third had used short-acting beta-agonist relievers more than twice a week. Quality-of-life scores were high and similar in both settings.

    CONCLUSIONS: Swedish adolescents with asthma are managed and treated somewhat differently in paediatric and primary care but with equal and, for the most part, satisfying results. The difference between the two settings probably reflects both differences in severity of asthma and different treatment traditions. For all adolescents, better fulfilment of goals regarding symptoms and exacerbations would be desirable, whereas a good quality of life including normal physical activity seems to have been achieved.

  • 9.
    Hederos, Carl-Axel
    et al.
    Primary Care Research Unit, Karlstad, Sweden; Karolinska Institute, Astrid Lindgrens Children's Hospital, Stockholm, Sweden; Primary Care Research Unit, BUM VC Gripen, Karlstad, Sweden.
    Hasselgren, Mikael
    Section of Family Medicine and Clinical Epidemiology, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Hedlin, Gunilla
    Karolinska Institute, Astrid Lindgrens Children's Hospital, Stockholm, Sweden.
    Bornehag, Carl-Gustaf
    Division for Public Health, Department of Social Sciences, Karlstad University, Karlstad, Sweden; Swedish National Testing and Research Institute, Borås, Sweden; International Centre for Indoor Environment and Energy, Technical University of Denmark, Copenhagen, Denmark.
    Comparison of clinically diagnosed asthma with parental assessment of children's asthma in a questionnaire2007In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 18, no 2, p. 135-141Article in journal (Refereed)
    Abstract [en]

    Epidemiological evaluations of the prevalence of asthma are usually based on written questionnaires (WQs) in combination with validation by clinical investigation. In the present investigation, we compared parental assessment of asthma among their preschool children in response to a WQ with the corresponding medical records in the same region. An International Study of Asthma and Allergies in Childhood (ISAAC)-based WQ was answered by 75% of the parents of 6295 children aged 1-6 yr. Clinically diagnosed asthma, recorded in connection with admissions to the hospital or a visit to any of the outpatient clinics in the same region, were analysed in parallel. Finally, a complementary WQ was sent to the parents of children identified as asthmatic by either or both of this approaches. In response to the WQ 5.9% were claimed to suffer from asthma diagnosed by a doctor. According to the medical records, the prevalence of clinically diagnosed asthma was 4.9%. The estimated prevalence among children requiring treatment for their asthma was 4.4%. The sensitivity of the WQ was 77%, the specificity 97.5%. In the 1-2 yr age group the sensitivity was only 22%. This WQ was able to identify 54% of the children with a medical record of asthma. Forty percent of the children claimed by their parents to be asthmatic had no medical record of asthma. An ISAAC-based parentally completed WQ provided an acceptable estimation of the prevalence of asthma in children 2-6 yr of age, although only half of the individual patients identified in this manner are the same as those identified clinically.

  • 10.
    Lisspers, Karin
    et al.
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Science Park, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Science Park, Uppsala, Sweden.
    Hasselgren, Mikael
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Science Park, Uppsala, Sweden.
    Johansson, Gunnar
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Science Park, Uppsala, Sweden.
    Svärdsudd, Kurt
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Science Park, Uppsala, Sweden.
    Organisation of asthma care in primary health care in Mid-Sweden2005In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 14, no 3, p. 147-153Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate the organisation of asthma care in 240 primary health care centres (PHCCs) in Mid-Sweden.

    METHODS: A cross-sectional study. Main outcomes were occurrence and structure of nurse-based asthma clinics according to nationally recommended criteria, and access and use of spirometers.

    RESULTS: 238 PHCCs (99%) responded. 16% reported a complete, and 37% an incomplete, asthma clinic. 47% of PHCCs had no asthma clinic. The incomplete asthma clinics usually lacked sufficient asthma nurse time, a scheduled nurse surgery and a responsible GP. 77% of the PHCCs had access to a spirometer and on average 19 spirometries/1000 inhabitants/year were performed. There was a large variation in the use of spirometers.

    CONCLUSION: Half of the PHCCs had an asthma clinic and a majority had access to a spirometer. More frequent use of spirometry and increased time provision for the asthma nurse would be likely to produce a substantial improvement in the standard of asthma care in primary health care.

  • 11.
    Lisspers, Karin
    et al.
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Hasselgren, Mikael
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Johansson, Gunnar
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Svärdsudd, Kurt
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Primary health care centres with asthma clinics: effects on patients knowledge and asthma control2010In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 19, no 1, p. 37-44Article in journal (Refereed)
    Abstract [en]

    AIM: To evaluate outcomes for patients attending primary care centres with and without asthma clinics.

    METHODS: A cross-sectional survey at 42 primary health care centres randomly selected according to organisation of asthma care, 14 with complete, 14 with incomplete and 14 with no asthma clinic according to national criteria. 1,477 randomly selected patients 15-45 years received two questionnaires. Outcomes were: patients' knowledge of asthma; asthma control; and quality of life.

    RESULTS: Patients attending primary health care centres with asthma clinics reported more knowledge of asthma but similar levels of asthma control and quality of life. Patients who reported they had visited the asthma nurse during the last year had more knowledge but similar asthma control and quality of life compared to patients who reported they had not. However, with more time allocated for the nurse, 44% achieved asthma control compared with 27% at asthma clinics with less time (p<0.003).

    CONCLUSIONS: Having an asthma clinic at a primary health care centre improves asthma patients' knowledge of the disease, and better asthma control is achieved if the nurse is allocated more time.

  • 12.
    Lisspers, Karin
    et al.
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Hasselgren, Mikael
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Johansson, Gunnar
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Svärdsudd, Kurt
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Quality of life and measures of asthma control in primary health care2007In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 44, no 9, p. 747-751Article in journal (Refereed)
    Abstract [en]

    AIM: To study quality of life and asthma control in primary care. A total of 1,477 patients 15 to 45 years of age received questionnaires regarding asthma control (77% responded) and quality of life, Mini Asthma Quality of Life Questionnaire (MiniAQLQ), (74% responded). Patients using short-acting beta-agonists more than twice in the last week had clinically significant lower MiniAQLQ scores (5.17 versus 5.91). This finding was consistent for night awakenings during the previous week (4.42 versus 5.86), courses of oral corticosteroids (4.82 versus 5.69), and reported emergency consultations during the last 6 months (4.85 versus 5.71). Good asthma control is associated with better quality of life in asthma patients in primary care.

  • 13.
    Nordén, T
    et al.
    Department of Surgery, University Hospital, Uppsala, Sweden; Department of Cancer Epidemiology, University Hospital, Uppsala, Sweden; Department of Surgery, Kullbergska Hospital, Katrineholm, Sweden.
    Thurfjell, E
    Department of Diagnostic Radiology, University Hospital, Uppsala, Sweden.
    Hasselgren, Mikael
    Department of Cancer Epidemiology, University Hospital, Uppsala, Sweden; Primary Health Care Centre, Skoghall, Sweden.
    Lindgren, A
    Department of Pathology, University Hospital, Uppsala, Sweden; Department of Pathology, Central Hospital, Falun, Sweden.
    Norgren, A
    Department of Pathology, University Hospital, Uppsala, Sweden; Department of Clinical Physiology, University Hospital, Uppsala, Sweden.
    Bergström, R
    Department of Statistics, Uppsala University, Uppsala, Sweden.
    Holmberg, L
    Department of Surgery, University Hospital, Uppsala, Sweden; Department of Cancer Epidemiology, University Hospital, Uppsala, Sweden.
    Mammographic screening for breast cancer: What cancers do we find?1997In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 33, no 4, p. 624-628Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to compare lymph node involvement of breast cancer cases detected at mammography screening with clinically-detected cases. During a 3-year period, 273 primary breast cancers were detected in a population-based screening programme, and 149 primary breast cancers were diagnosed clinically. Lymph node involvement was evaluated in univariate and multivariate logistic regression models correcting for tumour size, histological grade, steroid receptor status and DNA-ploidy. Patients with screen-detected cancers had a low relative risk of having lymph node metastases (univariate, OR = 0.31; 95% confidence interval = 0.19-0.52). In the multivariate logistic regression model, the relative risk was halved (OR = 0.47; 0.28-0.78). The reduced risk was more pronounced for women younger than 50 years of age compared to older women. The risk for screen-detected cases of having lymph node metastases at diagnosis was statistically significantly lower than for clinically-detected cases. The marked reduction, even when correcting for tumour size, makes it less likely that factors such as detection of clinically innocent tumours, length bias sampling or clinical symptoms related to axillary metastases can explain the whole difference. The results indicate at least part of the effect may be explained by tumour progression in the late preclinical detectable phase.

  • 14.
    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.

  • 15.
    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, School of 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.

  • 16.
    Ställberg, Björn
    et al.
    Department of Public Health and Caring Sciences - Family Medicine and Clinical Epidemiology, Uppsala University, Science Park, Uppsala, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Sciences - Family Medicine and Clinical Epidemiology, Uppsala University, Science Park, Uppsala, Sweden.
    Hasselgren, Mikael
    Department of Public Health and Caring Sciences - Family Medicine and Clinical Epidemiology, Uppsala University, Science Park, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Sweden.
    Johansson, Gunnar
    Department of Public Health and Caring Sciences - Family Medicine and Clinical Epidemiology, Uppsala University, Science Park, Uppsala, Sweden.
    Svärdsudd, Kurt
    Department of Public Health and Caring Sciences - Family Medicine and Clinical Epidemiology, Uppsala University, Science Park, Uppsala, Sweden.
    Asthma control in primary care in Sweden: a comparison between 2001 and 20052009In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 18, no 4, p. 279-286Article in journal (Refereed)
    Abstract [en]

    AIM: To compare the degree of asthma control in 2001 and 2005 in a primary care setting in Sweden.

    METHOD: Two similar questionnaire surveys were performed in 2001 and 2005 with 1,012 and 224 asthma patients aged 18-45 randomly selected from 42 and 56 primary health care centres, respectively. A classification of asthma control similar to the GINA guidelines was made using information obtained from the questionnaire.

    RESULTS: In 2001, 36.6% had achieved asthma control, 23.8% were partly controlled and 39.6% uncontrolled. In 2005, the corresponding figures were 40.2%, 26.8% and 33.0%, respectively, with no difference between the two surveys (p=0.114). Uncontrolled asthma was more common in women (p<0.001 in the first and p<0.05 in the second survey) and smokers (p<0.01 in the first and p<0.01 in the second survey). The use of combination corticosteroid/long-acting bronchodilator inhalers had increased - 34.2% and 48.2%, respectively (p<0.001) - and many patients used their inhaled corticosteroids periodically.

    CONCLUSION: In spite of treatment guidelines many patients in Swedish primary care still have insufficient asthma control.

  • 17.
    Ställberg, Björn
    et al.
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Hasselgren, Mikael
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Johansson, Gunnar
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Svärdsudd, Kurt
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Factors related to the level of severity of asthma in primary care2007In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, no 10, p. 2076-2083Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The severity of asthma varies in patients in primary care. The aim of this study was to identify factors related to asthma severity in a primary care setting.

    METHODS: In this cross-sectional asthma study a random sample of 1477 patients, aged 15-45 years, from 42 primary health care centres received two questionnaires: one disease oriented and one quality of life oriented, MiniAQLQ. A classification of the asthma severity similar to the GINA guidelines was made with the information obtained from the questionnaire. The classification was based on current treatment, use of rescue medication, night symptoms, emergency consultations and use of oral steroids for treatment of exacerbations.

    RESULTS: Thirty-five per cent of the women and 24% of the men were classified as having severe asthma. Women used more inhaled corticosteroids, more often took long acting beta-2 agonists or a leukotrien antagonist in addition to corticosteroids, experienced more frequent night awakenings and were more often smokers than men. In a multivariable analysis, female sex increased the odds of having severe asthma by 60% as compared with male sex, age by 3% per year, not having the asthma prescription filled owing to cost by 59%, daily smoking by 66% and pollen allergy by 85%.

    CONCLUSIONS: Female sex, age, pollen and pet allergy, not having the asthma prescription filled owing to cost, and daily smoking were all independently associated with asthma severity.

  • 18.
    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.

  • 19.
    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: NPD Bulletin, ISSN 1892-8110, 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.

  • 20.
    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.

  • 21.
    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.

  • 22.
    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.

  • 23.
    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.

  • 24.
    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, ISSN 1471-5945, 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.

  • 25.
    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.

  • 26.
    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)
  • 27.
    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, 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.

  • 28.
    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.

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