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  • 1. Bengtsson, Linus
    et al.
    Lu, Xin
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Thorson, Anna
    Garfield, Richard
    von Schreeb, Johan
    Improved Response to Disasters and Outbreaks by Tracking Population Movements with Mobile Phone Network Data: A Post-Earthquake Geospatial Study in Haiti2011In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 8, no 8, p. e1001083-Article in journal (Refereed)
    Abstract [en]

    Background: Population movements following disasters can cause important increases in morbidity and mortality. Without knowledge of the locations of affected people, relief assistance is compromised. No rapid and accurate method exists to track population movements after disasters. We used position data of subscriber identity module (SIM) cards from the largest mobile phone company in Haiti (Digicel) to estimate the magnitude and trends of population movements following the Haiti 2010 earthquake and cholera outbreak. Methods and Findings: Geographic positions of SIM cards were determined by the location of the mobile phone tower through which each SIM card connects when calling. We followed daily positions of SIM cards 42 days before the earthquake and 158 days after. To exclude inactivated SIM cards, we included only the 1.9 million SIM cards that made at least one call both pre-earthquake and during the last month of study. In Port-au-Prince there were 3.2 persons per included SIM card. We used this ratio to extrapolate from the number of moving SIM cards to the number of moving persons. Cholera outbreak analyses covered 8 days and tracked 138,560 SIM cards. An estimated 630,000 persons (197,484 Digicel SIM cards), present in Port-au-Prince on the day of the earthquake, had left 19 days post-earthquake. Estimated net outflow of people (outflow minus inflow) corresponded to 20% of the Port-au-Prince pre-earthquake population. Geographic distribution of population movements from Port-au-Prince corresponded well with results from a large retrospective, population-based UN survey. To demonstrate feasibility of rapid estimates and to identify areas at potentially increased risk of outbreaks, we produced reports on SIM card movements from a cholera outbreak area at its immediate onset and within 12 hours of receiving data. Conclusions: Results suggest that estimates of population movements during disasters and outbreaks can be delivered rapidly and with potentially high validity in areas with high mobile phone use.

  • 2. Bruun Kristensen, Kasper
    et al.
    Karlstad, Øystein
    Martikainen, Jaana E.
    Pottegård, Anton
    Wastesson, Jonas W.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Zoega, Helga
    Schmidt, Morten
    Nonaspirin Nonsteroidal Antiinflammatory Drug Use in the Nordic Countries from a Cardiovascular Risk Perspective, 2000-2016: A Drug Utilization Study2019In: Pharmacotherapy, ISSN 0277-0008, E-ISSN 1875-9114, Vol. 39, no 2, p. 150-160Article in journal (Refereed)
    Abstract [en]

    Study Objective

    Evidence on the cardiotoxicity of nonaspirin nonsteroidal antiinflammatory drugs (NSAIDs), particularly diclofenac and the newer selective cyclooxygenase (COX)-2 inhibitors, has accumulated over the last decade. Our objective was to examine whether the use of NSAIDs in the Nordic countries changed with the emerging evidence, regulatory statements, and clinical guidelines advocating caution for the use of specific NSAIDs.

    Design

    Drug utilization study.

    Data Sources

    Nationwide wholesale statistics and prescription registries in Denmark, Finland, Iceland, Norway, and Sweden (2000-2016).

    Measurements and Main Results

    Our main outcome measures were yearly total sales, expressed as number of sold defined daily doses (DDDs)/1000 inhabitants/day, and yearly prevalence of prescription use, expressed as number of prescription users per 1000 inhabitants. The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. Total sales of NSAIDs increased in all countries and were highest in Iceland, with 74.3 DDDs/1000 inhabitants/day sold in 2016, followed by Finland (73.9), Sweden (54.4), Norway (43.8), and Denmark (31.8). Diclofenac use declined after 2008 in all countries but remained the most widely prescribed NSAID in Norway, with 63 prescription users/1000 inhabitants in 2016. Diclofenac sales also remained high in Iceland (12.7 DDD/1000 inhabitants/day), Norway (8.1), and Sweden (7.8). Since its introduction in 2003, the use of etoricoxib, a newer selective COX-2 inhibitor, increased in all countries except Denmark, with highest sales in Finland (6.7 DDD/1000 inhabitants/day in 2016).

    Conclusion

    Sales and prescription patterns of NSAIDs in the Nordic countries has changed along with the accumulating evidence for the cardiovascular risks of specific NSAIDs. However, given existing evidence on the cardiovascular risks associated with the use of diclofenac and etoricoxib, the persistent high use of diclofenac in Iceland, Norway, and Sweden, the persistent over-the-counter availability of diclofenac in Norway and Sweden, and the increasing use of etoricoxib in most of the Nordic countries pose a cardiovascular health concern.

  • 3. Dragano, Nico
    et al.
    Siegrist, Johannes
    Nyberg, Solja T.
    Lunau, Thorsten
    Fransson, Eleonor I.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Jönköping University, Sweden.
    Alfredsson, Lars
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Erbel, Raimund
    Fahlén, Göran
    Goldberg, Marcel
    Hamer, Mark
    Heikkilä, Katriina
    Jöckel, Karl-Heinz
    Knutsson, Anders
    Madsen, Ida E. H.
    Nielsen, Martin L.
    Nordin, Maria
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Umeå University, Sweden.
    Oksanen, Tuula
    Pejtersen, Jan H.
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Schupp, Jürgen
    Singh-Manoux, Archana
    Steptoe, Andrew
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Vahtera, Jussi
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Virtanen, Marianna
    Zins, Marie
    Batty, G. David
    Kivimäki, Mika
    Effort-Reward Imbalance at Work and Incident Coronary Heart Disease A Multicohort Study of 90,164 Individuals2017In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 28, no 4, p. 619-626Article in journal (Refereed)
    Abstract [en]

    Background: Epidemiologic evidence for work stress as a risk factor for coronary heart disease is mostly based on a single measure of stressful work known as job strain, a combination of high demands and low job control. We examined whether a complementary stress measure that assesses an imbalance between efforts spent at work and rewards received predicted coronary heart disease.

    Methods: This multicohort study (the IPD-Work consortium) was based on harmonized individual-level data from 11 European prospective cohort studies. Stressful work in 90,164 men and women without coronary heart disease at baseline was assessed by validated effort-reward imbalance and job strain questionnaires. We defined incident coronary heart disease as the first nonfatal myocardial infarction or coronary death. Study-specific estimates were pooled by random effects meta-analysis.

    Results: At baseline, 31.7% of study members reported effort-reward imbalance at work and 15.9% reported job strain. During a mean follow-up of 9.8 years, 1,078 coronary events were recorded. After adjustment for potential confounders, a hazard ratio of 1.16 (95% confidence interval, 1.00-1.35) was observed for effort-reward imbalance compared with no imbalance. The hazard ratio was 1.16 (1.01-1.34) for having either effort-reward imbalance or job strain and 1.41 (1.12-1.76) for having both these stressors compared to having neither effort-reward imbalance nor job strain.

    Conclusions: Individuals with effort-reward imbalance at work have an increased risk of coronary heart disease, and this appears to be independent of job strain experienced. These findings support expanding focus beyond just job strain in future research on work stress.

  • 4.
    Eneroth, Mari
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Gustafsson Sendén, Marie
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Personality, Social and Developmental Psychology.
    Gustafsson, Karin Schenck
    Wall, Maja
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Fridner, Ann
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology. Karolinska Institute, Sweden.
    Threats or violence from patients was associated with turnover intention among foreign-born GPs - a comparison of four workplace factors associated with attitudes of wanting to quit one's job as a GP2017In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 2, p. 208-213Article in journal (Refereed)
    Abstract [en]

    Objective: General practitioners (GPs) are crucial in medical healthcare, but there is currently a shortage of GPs in Sweden and elsewhere. Recruitment of GPs from abroad is essential, but foreign-born physicians face difficulties at work that may be related to turnover intention, i.e. wanting to quit one's job. The study aims to explore the reasons to why foreign-born GPs may intend to quit their job. Design: Survey data were used to compare four work-related factors that can be associated with turnover intentions; patient-related stress, threats or violence from patients, control of work pace, and empowering leadership, among native-born and foreign-born GPs. These work-related factors were subsequently examined in relation to turnover intention among the foreign-born GPs by means of linear hierarchical regression analyses. The questionnaire consisted of items from the QPS Nordic and items constructed by the authors. Setting: A primary care setting in a central area of Sweden. Subjects: Native-born (n = 208) and foreign-born GPs (n = 73). Results: Turnover intention was more common among foreign-born GPs (19.2% compared with 14.9%), as was the experience of threats or violence from patients (22% compared with 3% of the native-born GPs). Threats or violence was also associated with increased turnover intention. Control of work pace and an empowering leadership was associated with reduced turnover intention.

  • 5.
    Falkstedt, Daniel
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; University of Strasbourg, France; Stockholm County Council, Sweden.
    Wolff, Valerie
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; University of Strasbourg, France; Stockholm County Council, Sweden.
    Allebeck, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; University of Strasbourg, France; Stockholm County Council, Sweden.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; University of Strasbourg, France; Stockholm County Council, Sweden.
    Danielsson, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; University of Strasbourg, France; Stockholm County Council, Sweden.
    Cannabis, Tobacco, Alcohol Use, and the Risk of Early Stroke: A Population-Based Cohort Study of 45000 Swedish Men2017In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 48, no 2, p. 265-270Article in journal (Refereed)
    Abstract [en]

    Background and Purpose - Current knowledge on cannabis use in relation to stroke is based almost exclusively on clinical reports. By using a population-based cohort, we aimed to find out whether there was an association between cannabis use and early-onset stroke, when accounting for the use of tobacco and alcohol.

    Methods - The cohort comprises 49321 Swedish men, born between 1949 and 1951, who were conscripted into compulsory military service between the ages of 18 and 20. All men answered 2 detailed questionnaires at conscription and were subject to examinations of physical aptitude, psychological functioning, and medical status. Information on stroke events up to approximate to 60 years of age was obtained from national databases; this includes strokes experienced before 45 years of age.

    Results - No associations between cannabis use in young adulthood and strokes experienced 45 years of age or beyond were found in multivariable models: cannabis use >50 times, hazard ratios=0.93 (95% confidence interval [CI], 0.34-2.57) and 0.95 (95% CI, 0.59-1.53). Although an almost doubled risk of ischemic stroke was observed in those with cannabis use >50 times, this risk was attenuated when adjusted for tobacco usage: hazards ratio=1.47 (95% CI, 0.83-2.56). Smoking 20 cigarettes per day was clearly associated both with strokes before 45 years of age, hazards ratio=5.04 (95% CI, 2.80-9.06), and with strokes throughout the follow-up, hazards ratio=2.15 (95% CI, 1.61-2.88).

    Conclusions - We found no evident association between cannabis use in young adulthood and stroke, including strokes before 45 years of age. Tobacco smoking, however, showed a clear, dose-response shaped association with stroke.

  • 6. Forouzanfar, Mohammad H.
    et al.
    Kivipelto, Miia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Murray, Christopher J. L.
    Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 20152016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 388, no 10053, p. 1659-1724Article in journal (Refereed)
    Abstract [en]

    Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context.

    Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI).

    Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57.8% (95% CI 56.6-58.8) of global deaths and 41.2% (39.8-42.8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211.8 million [192.7 million to 231.1 million] global DALYs), smoking (148.6 million [134.2 million to 163.1 million]), high fasting plasma glucose (143.1 million [125.1 million to 163.5 million]), high BMI (120.1 million [83.8 million to 158.4 million]), childhood undernutrition (113.3 million [103.9 million to 123.4 million]), ambient particulate matter (103.1 million [90.8 million to 115.1 million]), high total cholesterol (88.7 million [74.6 million to 105.7 million]), household air pollution (85.6 million [66.7 million to 106.1 million]), alcohol use (85.0 million [77.2 million to 93.0 million]), and diets high in sodium (83.0 million [49.3 million to 127.5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa.

    Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden.

  • 7.
    Gyan, Ben
    Stockholm University.
    Immune responses and genetic polymorphisms in Plasmodium falciparum malaria infection2002Doctoral thesis, comprehensive summary (Other academic)
  • 8. Hodgins, S.
    et al.
    Larm, P.
    Westerman, Johan
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Individuals developing schizophrenia are hidden among adolescent substance misusers2016In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 14, p. 3041-3050Article in journal (Refereed)
    Abstract [en]

    Background Strategies are needed to identify youth developing schizophrenia. The present study aimed to determine whether adolescents treated for substance misuse were at elevated risk to develop schizophrenia, whether this risk has changed since the late 1960s, and whether substance misuse in adolescence predicted poorer outcomes through adulthood. Method In a Swedish city, since the mid-1960s there has been only one clinic for adolescent substance misuse. Three samples from this clinic were studied: 1992 individuals treated from 1968 to 1971 followed to age 50 years; 1576 treated from 1980 to 1984 followed to age 35 years; and 180 treated in 2004 followed to age 22 years. Each clinical sample was matched on age, sex and place of birth to an equal, or larger, number of randomly selected individuals from the general population. Schizophrenia, substance use disorders, physical disorders related to substance misuse, criminal convictions, poverty and death were identified using national registers. Results Individuals treated for substance misuse in adolescence were at increased risk to subsequently develop schizophrenia: in males the increase was approximately four-fold and in females between five- and seven-fold. There was no difference in risk for those treated in 1968-1971 and from 1980 to 1984 when cannabis use increased from 37.6% to 49.8% of the clinical samples. Among males who developed schizophrenia, treatment for substance misuse was associated with increased risk of substance use disorders and criminal convictions through adulthood. Conclusions Treatment programmes for adolescents misusing substances include a disproportionate number developing schizophrenia. Early detection and treatment have the potential to improve long-term outcomes.

  • 9.
    Kivipelto, Miia
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Finland National Institute for Health & Welfare, Finland; University of Eastern Finland, Finland.
    Mangialasche, Francesca
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Solomon, Alina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Eastern Finland, Finland.
    Pointing the FINGER at multimodal dementia prevention Reply2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 10004, p. 1627-1627Article in journal (Refereed)
  • 10.
    Lundgren, Tobias
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Parling, Thomas
    Swedish Acceptance and Action Questionnaire (SAAQ): A psychometric evaluation2017In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, no 4, p. 315-326Article in journal (Refereed)
    Abstract [en]

    Psychological inflexibility and experiential avoidance are equivalent (with somewhat different connotations) concepts and refer to an unwillingness to remain in contact with particular private events. This concept is most often measured by the Acceptance and Action Questionnaire (AAQ-II) and is strongly related to psychopathology and behavioral effectiveness. In this study, the preliminary psychometric properties of the Swedish version of the AAQ-II (Swedish Acceptance and Action QuestionnaireSAAQ) are presented. The study is done in two steps. In the first step, the 10-item version of the AAQ-II is investigated through principal component analysis (n=147). Secondly, due to problems with the component structure, the instrument is reduced to a six-item version and its validity and internal consistency are investigated (n=154). The six-item version shows good concurrent and convergent validity as well as satisfying internal consistency (=.85). Furthermore, the Swedish six-item version of the AAQ-II showed one strong component. Test-retest reliability was satisfactory (r=.80; n=228). In future research, predictive and external validity would be important to investigate in order to further ensure that the SAAQ is a useful measure for clinical research. In conclusion, the SAAQ has satisfactory psychometric properties, but more data need to be gathered to further explore the possibilities for the instruments in Swedish contexts.

  • 11. Nyberg, Solja T.
    et al.
    Batty, G. David
    Pentti, Jaana
    Virtanen, Marianna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Finnish Institute of Occupational Health, Finland; Uppsala University, Sweden.
    Alfredsson, Lars
    Fransson, Eleonor I.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Jönköping University, Sweden.
    Goldberg, Marcel
    Heikkilä, Katriina
    Jokela, Markus
    Knutsson, Anders
    Koskenvuo, Markku
    Lallukka, Tea
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lindbohm, Joni V.
    Madsen, Ida E. H.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Nordin, Maria
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Umeå University, Sweden.
    Oksanen, Tuula
    Pietiläinen, Olli
    Rahkonen, Ossi
    Rugulies, Reiner
    Shipley, Martin J.
    Stenholm, Sari
    Suominen, Sakari
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Vahtera, Jussi
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Zins, Marie
    Hamer, Mark
    Singh-Manoux, Archana
    Bell, Joshua A.
    Ferrie, Jane E.
    Kivimäki, Mika
    Obesity and loss of disease-free years owing to major non-communicable diseases: a multicohort study2018In: The Lancet Public Health, ISSN 2468-2667, Vol. 3, no 10, p. e490-e497Article in journal (Refereed)
    Abstract [en]

    Background

    Obesity increases the risk of several chronic diseases, but the extent to which the obesity-related loss of disease-free years varies by lifestyle category and across socioeconomic groups is unclear. We estimated the number of years free from major non-communicable diseases in adults who are overweight and obese, compared with those who are normal weight.

    Methods

    We pooled individual-level data on body-mass index (BMI) and non-communicable diseases from men and women with no initial evidence of these diseases in European cohort studies from the Individual-Participant-Data Meta-Analysis in Working Populations consortium. BMI was assessed at baseline (1991-2008) and non-communicable diseases (incident type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease) were ascertained via linkage to records from national health registries, repeated medical examinations, or self-report. Disease-free years from age 40 years to 75 years associated with underweight (BMI <18.5 kg/m(2)), overweight (>= 25 kg/m(2) to <30 kg/m(2)), and obesity (class I [mild] >= 30 kg/m(2) to < 35 kg/m(2); class II-III [severe] >= 35 kg/m(2)) compared with normal weight (>= 18.5 kg/m(2) to <25 kg/m(2)) were estimated.

    Findings

    Of 137 503 participants from ten studies, we excluded 6973 owing to missing data and 10 349 with prevalent disease at baseline, resulting in an analytic sample of 120 181 participants. Of 47 127 men, 211 (0.4%) were underweight, 21 468 (45.6%) normal weight, 20 738 (44.0%) overweight, 3982 (8.4%) class I obese, and 728 (1.5%) class II-III obese. The corresponding numbers among the 73 054 women were 1493 (2.0%), 44 760 (61.3%), 19 553 (26.8%), 5670 (7.8%), and 1578 (2.2%), respectively. During 1 328 873 person-years at risk (mean follow-up 11.5 years [range 6.3-18.6]), 8159 men and 8100 women developed at least one non-communicable disease. Between 40 years and 75 years, the estimated number of disease-free years was 29.3 (95% CI 28.8-29.8) in normal-weight men and 29.4 (28.7-30.0) in normal-weight women. Compared with normal weight, the loss of disease-free years in men was 1.8 (95% CI -1.3 to 4.9) for underweight, 1.1 (0.7 to 1.5) for overweight, 3.9 (2.9 to 4.9) for class I obese, and 8.5 (7.1 to 9.8) for class II-III obese. The corresponding estimates for women were 0.0 (-1.4 to 1.4) for underweight, 1.1 (0.6 to 1.5) for overweight, 2.7 (1.5 to 3.9) for class I obese, and 7.3 (6.1 to 8.6) for class II-III obese. The loss of disease-free years associated with class II-III obesity varied between 7.1 and 10.0 years in subgroups of participants of different socioeconomic level, physical activity level, and smoking habit.

    Interpretation

    Mild obesity was associated with the loss of one in ten, and severe obesity the loss of one in four potential disease-free years during middle and later adulthood. This increasing loss of disease-free years as obesity becomes more severe occurred in both sexes, among smokers and non-smokers, the physically active and inactive, and across the socioeconomic hierarchy.

  • 12. Onder, Graziano
    et al.
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Marengoni, Alessandra
    Bell, J. Simon
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Palmer, Katie
    Accounting for frailty when treating chronic diseases2018In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 56, p. 49-52Article, review/survey (Refereed)
    Abstract [en]

    Chronic diseases are considered to be major determinants of frailty and it could be hypothesized that their treatment may counteract the development of frailty. However, the hypothesis that intensive treatment of chronic diseases might reduce the progression of frailty is poorly supported by existing studies. In contrast, some evidence suggests that intensive treatment of chronic diseases may increase negative health outcomes in frail older adults. In particular, if treatment of symptoms related to chronic diseases (i.e. pain in osteoarthritis, dyspnoea in respiratory disease, motor symptoms in Parkinson disease) might potentially reverse frailty, the benefits related to preventive pharmacological treatment of chronic diseases (i.e. antihypertensive treatment) in patients with prevalent frailty is not certain. In particular, several factors might alter the risk/benefit ratio of a given treatment in persons with frailty. These include: exclusion of frail persons from clinical studies, reduced life expectancy in frail persons, increased susceptibility to iatrogenic events, and functional deficits associated with frailty. Therefore, frailty acts as an effect modifier, by modifying the risks and benefits of chronic disease treatments. This hypothesis must be considered and tested in future clinical intervention studies and clinical guidelines should provide specific recommendations for the treatment of frail people, underlining the pros and the cons of pharmacological treatment and possible targets for therapy in this population. Meanwhile, in older patients, the prescribing process should be individualized and flexible.

  • 13.
    Oscarsson, Karin
    Stockholm University.
    Rational design and synthesis of protease inhibitors: targeting HIV-1, Malaria Plm I and II and Hepatitis C virus NS3 proteases2002Doctoral thesis, comprehensive summary (Other academic)
  • 14. Rehm, Jürgen
    et al.
    Arbesu Prieto, Jose Angel
    Beier, Markus
    Duhot, Didier
    Rossi, Alessandro
    Schulte, Bernd
    Zarco, Jose
    Aubin, Henri-Jean
    Bachmann, Michael
    Grimm, Carsten
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Manthey, Jakob
    Scafato, Emanuele
    Gual, Antoni
    The role of alcohol in the management of hypertension in patients in European primary health care practices - a survey in the largest European Union countries2016In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 17, article id 130Article in journal (Refereed)
    Abstract [en]

    Background: Even though addressing lifestyle problems is a major recommendation in most guidelines for the treatment of hypertension (HTN), alcohol problems are not routinely addressed in the management of hypertension in primary health care. Methods: Internet based survey of 3081 primary care physicians, recruited via the mailing lists of associations for general practitioners (GPs) in France, Germany, Italy, Spain and the UK. Clinical practice, attitudes, knowledge, education and training were assessed. Logistic regression to predict screening, brief intervention and treatment for alcohol dependence in the management of hypertension were assessed. Results: Overall, about one third of the interviewed GPs reported sufficient screening in cases with HTN (34.0 %, 95 % confidence interval (CI):32.1-35.8 %). One out of five GPs screened and delivered brief interventions in HTN patients with hazardous consumption (22.2 %, 95 % CI: 20.6-23.8 %) and about one in 13 GPs provided treatment for HTN patients with alcohol dependence other than advice or brief intervention (7.8 %, 95 % CI: 6.8-8.9 %). Post-graduate training and belief in their effectiveness predicted interventions. There were marked differences between countries. Conclusions: While current interventions were overall low, marked differences between countries indicate that current practices could be improved. Education and post-graduate training seems to be key in improving clinical practice of including interventions for problematic alcohol consumption and alcohol dependence in primary health care.

  • 15. Rehm, Jürgen
    et al.
    Gmel, Gerhard E.
    Gmel, Gerrit
    Hasan, Omer S. M.
    Imtiaz, Sameer
    Popova, Svetlana
    Probst, Charlotte
    Roerecke, Michael
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Samokhvalov, Andriy V.
    Shield, Kevin D.
    Shuper, Paul A.
    The relationship between different dimensions of alcohol use and the burden of disease—an update2017In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 112, no 6, p. 968-1001Article, review/survey (Refereed)
    Abstract [en]

    Background and aims Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs). Methods Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others. Results In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently. Conclusions Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.

  • 16. Richard, Edo
    et al.
    Jongstra, Susan
    Soininen, Hilkka
    Brayne, Carol
    van Charante, Eric P. Moll
    Meiller, Yannick
    van der Groep, Bram
    Beishuizen, Cathrien R. L.
    Mangialasche, Francesca
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Barbera, Mariagnese
    Ngandu, Tiia
    Coley, Nicola
    Guillemont, Juliette
    Savy, Stephanie
    Dijkgraaf, Marcel G. W.
    Peters, Ron J. G.
    van Gool, Willem A.
    Kivipelto, Miia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Eastern Finland, Finland; National Institute for Health and Welfare, Finland; Karolinska Institutet, Sweden.
    Andrieu, Sandrine
    Healthy Ageing Through Internet Counselling in the Elderly: the HATICE randomised controlled trial for the prevention of cardiovascular disease and cognitive impairment2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 6, article id e010806Article in journal (Refereed)
    Abstract [en]

    Introduction Cardiovascular disease and dementia share a number of risk factors including hypertension, hypercholesterolaemia, smoking, obesity, diabetes and physical inactivity. The rise of eHealth has led to increasing opportunities for large-scale delivery of prevention programmes encouraging self-management. The aim of this study is to investigate whether a multidomain intervention to optimise self-management of cardiovascular risk factors in older individuals, delivered through an coach-supported interactive internet platform, can improve the cardiovascular risk profile and reduce the risk of cardiovascular disease and cognitive decline. Methods and analysis HATICE is a multinational, multicentre, prospective, randomised, open-label blinded end point (PROBE) trial with 18months intervention. Recruitment of 2600 older people (65years) at increased risk of cardiovascular disease will take place in the Netherlands, Finland and France. Participants randomised to the intervention condition will have access to an interactive internet platform, stimulating self-management of vascular risk factors, with remote support by a coach. Participants in the control group will have access to a static internet platform with basic health information. The primary outcome is a composite score based on the average z-score of the difference between baseline and 18months follow-up values of systolic blood pressure, low-density-lipoprotein and body mass index. Main secondary outcomes include the effect on the individual components of the primary outcome, the effect on lifestyle-related risk factors, incident cardiovascular disease, mortality, cognitive functioning, mood and cost-effectiveness.

  • 17.
    Saqr, Mohammed
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences. Qassim University, Kingdom of Saudi Arabia.
    Fors, Uno
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Tedre, Matti
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    How learning analytics can early predict under-achieving students in a blended medical education course2017In: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 39, no 7, p. 757-767Article in journal (Refereed)
    Abstract [en]

    Aim: Learning analytics (LA) is an emerging discipline that aims at analyzing students' online data in order to improve the learning process and optimize learning environments. It has yet un-explored potential in the field of medical education, which can be particularly helpful in the early prediction and identification of under-achieving students. The aim of this study was to identify quantitative markers collected from students' online activities that may correlate with students' final performance and to investigate the possibility of predicting the potential risk of a student failing or dropping out of a course.Methods: This study included 133 students enrolled in a blended medical course where they were free to use the learning management system at their will. We extracted their online activity data using database queries and Moodle plugins. Data included logins, views, forums, time, formative assessment, and communications at different points of time. Five engagement indicators were also calculated which would reflect self-regulation and engagement. Students who scored below 5% over the passing mark were considered to be potentially at risk of under-achieving.Results: At the end of the course, we were able to predict the final grade with 63.5% accuracy, and identify 53.9% of at-risk students. Using a binary logistic model improved prediction to 80.8%. Using data recorded until the mid-course, prediction accuracy was 42.3%. The most important predictors were factors reflecting engagement of the students and the consistency of using the online resources.Conclusions: The analysis of students' online activities in a blended medical education course by means of LA techniques can help early predict underachieving students, and can be used as an early warning sign for timely intervention.

  • 18. Secnik, Juraj
    et al.
    Cermakova, Pavla
    Fereshtehnejad, Seyed-Mohammad
    Dannberg, Pontus
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Winblad, Bengt
    Eriksdotter, Maria
    Religa, Dorota
    Diabetes in a Large Dementia Cohort: Clinical Characteristics and Treatment From the Swedish Dementia Registry2017In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 40, no 9, p. 1159-1166Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE We aimed to investigate the differences in clinical characteristics and pharmacological treatment associated with the presence of diabetes in a large cohort of patients with dementia.

    RESEARCH DESIGN AND METHODS A cross-sectional registry-based study was conducted using data from the Swedish Dementia Registry (SveDem). Data on dementia diagnosis, dementia type, and demographic determinants were extracted from SveDem. Data from the Swedish Patient Register and Prescribed Drug Register were combined for the diagnosis of diabetes. Data on antidiabetic, dementia, cardiovascular, and psychotropic medications were extracted from the Swedish Prescribed Drug Register. Logistic regression was used to determine whether the variables were associated with diabetes after adjustment for confounders. In total, 29,630 patients were included in the study, and 4,881 (16.5%) of them received a diagnosis of diabetes.

    RESULTS In the fully adjusted model, diabetes was associated with lower age at dementia diagnosis (odds ratio [OR] 0.97 [99% CI 0.97-0.98]), male sex (1.41 [1.27-1.55]), vascular dementia (1.17 [1.01-1.36]), and mixed dementia (1.21 [1.06-1.39]). Dementia with Lewy bodies (0.64 [0.44-0.94]), Parkinson disease dementia (0.46 [0.28-0.75]), and treatment with antidepressants (0.85 [0.77-0.95]) were less common among patients with diabetes. Patients with diabetes who had Alzheimer disease obtained significantly less treatment with cholinesterase inhibitors (0.78 [0.63-0.95]) and memantine (0.68 [0.54-0.85]).

    CONCLUSIONS Patients with diabetes were younger at dementia diagnosis and obtained less dementia medication for Alzheimer disease, suggesting less optimal dementia treatment. Future research should evaluate survival and differences in metabolic profile in patients with diabetes and different dementia disorders.

  • 19. Thern, Emelie
    et al.
    de Munter, Jeroen
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Smith, George Davey
    Ramstedt, Mats
    Tynelius, Per
    Rasmussen, Finn
    Effects of increased alcohol availability during adolescence on the risk of all-cause and cause-specific disability pension: a natural experiment2017In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 112, no 6, p. 1004-1012Article in journal (Refereed)
    Abstract [en]

    Aim To test if being exposed to increased alcohol availability during adolescence is associated with an increased risk of receiving disability pension due to all-cause, alcohol use disorders and mental disorders. Design Register-based population-based study using a natural experiment setting, the alcohol policy change in Sweden (1967-68), with increased access to strong beer in a narrow time window and geographical area. The individuals exposed to the policy change were compared with non-exposed individuals living in the rest of Sweden, excluding a border area. Setting Sweden. Participants A total of 518810 individuals (70761 in the intervention group; 448049 in the control group) born 1948-1953, aged 14-20 years during the policy change. Measurements Date and diagnosis of the outcome variable of disability pension due to all-cause, alcohol use disorders and mental disorders were obtained from the Swedish National Social Insurance Agency database from 1971 to 2013. Individual and family level socio-demographic and health-related covariates, as well as a regional level covariate, were included. Findings Compared with the control group, adolescents exposed to the alcohol policy change were at an increased risk of receiving disability pension due to all-causes [hazard ratio (HR)=1.09, 95% confidence interval (CI)=1.07-1.11], alcohol use disorders (HR=1.17, 95% CI=1.05-1.30) and mental disorders (HR=1.19, 95% CI=1.15-1.23). Conclusion In Sweden, a natural experiment with a 43-year follow-up suggests that exposure to increased alcohol availability during adolescence is associated with an increased risk of receiving a disability pension due to all-cause, alcohol use disorder and mental disorder diagnoses.

  • 20. Villani, Emanuele R.
    et al.
    Tummolo, Anita M.
    Palmer, Katie
    Manes Gravina, Ester
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of the Sacred Heart, Italy.
    Bernabei, Roberto
    Onder, Graziano
    Acampora, Nicola
    Frailty and atrial fibrillation: A systematic review2018In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 56, p. 33-38Article, review/survey (Refereed)
    Abstract [en]

    Atrial fibrillation (AF) is a common cardiac arrhythmia and its prevalence increases with age. There is a significant correlation between frailty, morbidity and mortality in elderly patients with cardiovascular disease, but the relation between AF and frailty is still under debate. The aim of this study is to systematically review evidence on the association between AF and frailty. A systematic review of articles published between 02/01/2002 and 09/28/2017 according to PRISMA recommendations was carried out. PubMed, Web of Science, and Embase were searched for relevant articles. 11 studies were included; one longitudinal, 10 cross-sectional. Only 4 studies assessed the association of frailty with AF, while 7 studies were performed in a sample of participants with AF and did not provide any measure of association between these two conditions. The prevalence of frailty in AF patients ranged from 4.4%-75.4% while AF prevalence in the frail population ranged from 48.2%-75.4%. Selected studies enrolled an overall sample of 9420 participants. Among them, 2803 participants were diagnosed with AF and of these 1517 (54%) were frail and 1286 (46%) were pre-frail or robust. The four studies assessing the association of AF and frailty provided conflicting results. Evidence suggests that frailty is common in persons with AF. More research is needed to better assess the association of these conditions and to identify the optimal therapeutic approach to AF in persons with frailty.

  • 21.
    Zucchelli, Alberto
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Brescia, Italy.
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of Rome, Italy.
    Marengoni, Alessandra
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Brescia, Italy.
    Grande, Giulia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Romanelli, Giuseppe
    Calderón-Larrañaga, Amaia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Rizzuto, Debora
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Frailty predicts short-term survival even in older adults without multimorbidity2018In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 56, p. 53-56Article in journal (Refereed)
    Abstract [en]

    Background

    Frailty and multimorbidity are both strongly associated with poor health-related outcomes, including mortality. Being multimorbidity one of the major determinants of frailty, we aimed to explore whether, and to what extent, frailty without multimorbidity plays an independent role in shortening life.

    Methods

    We used data from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Among the 3363 adults aged 60+ enrolled at baseline, those without multimorbidity (i.e.: less than two chronic diseases) (N = 1115) have been characterized according to Fried's frailty phenotype (i.e. robust, prefrail, and frail). The association between frailty and mortality was estimated using piecewise proportional hazard regression models in three five-year time periods.

    Results

    Among participants without multimorbidity, 424 (38%) were prefrail and 19 (2%) were frail. During the 15-year follow-up, 263 (24%) participants died: 19%, 29%, and 63% of those who were robust, prefrail, and frail at baseline, respectively. Within the first 5 years of follow-up, prefrail and frail participants had more than doubled mortality risk in comparison to robust ones (HR for pre-frailty 2.08, 95% CI 1.15-3.76; HR for frailty 2.69, 95% CI 1.22-5.97). Beyond 5 years, a trend of increased mortality rate was still detectable for prefrail and frail subjects in comparison to robust ones.

    Conclusions

    Physical frailty and pre-frailty are associated with short-term mortality in a cohort of older adults free from multimorbidity. Frailty could be a clinical indicator of increased risk of negative health outcomes even among subjects without multiple chronic conditions.

  • 22. Ödesjö, H.
    et al.
    Anell, A.
    Boman, A.
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Franzén, S.
    Thorn, J.
    Björck, S.
    Pay for performance associated with increased volume of medication reviews but not with less inappropriate use of medications among the elderly - an observational study2017In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 3, p. 271-278Article in journal (Refereed)
    Abstract [en]

    Objective: A pay for performance programme was introduced in 2009 by a Swedish county with 1.6 million inhabitants. A process measure with payment linked to coding for medication reviews among the elderly was adopted. We assessed the association with inappropriate medication for five years after baseline.

    Design and setting: Observational study that compared medication for elderly patients enrolled at primary care units that coded for a high or low volume of medication reviews.

    Patients: 144,222 individuals at 196 primary care centres, age 75 or older.

    Main outcome measures: Percentage of patients receiving inappropriate drugs or polypharmacy during five years at primary care units with various levels of reported medication reviews.

    Results: The proportion of patients with a registered medication review had increased from 3.2% to 44.1% after five years. The high-coding units performed better for most indicators but had already done so at baseline. Primary care units with the lowest payment for coding for medication reviews improved just as well in terms of inappropriate drugs as units with the highest payment - from 13.0 to 8.5%, compared to 11.6 to 7.4% and from 13.6 to 7.2% vs 11.8 to 6.5% for polypharmacy.

    Conclusions: Payment linked to coding for medication reviews was associated with an increase in the percentage of patients for whom a medication review had been registered. However, the impact of payment on quality improvement is uncertain, given that units with the lowest payment for medication reviews improved equally well as units with the highest payment.

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