Center for Family and Community Medicine

Huddinge, Sweden

Center for Family and Community Medicine

Huddinge, Sweden
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Hagvide M.-L.,Center for Family and Community Medicine | Hagvide M.-L.,Karolinska Institutet | Larsson T.J.,KTH Royal Institute of Technology | Borell L.,Karolinska Institutet
Scandinavian Journal of Occupational Therapy | Year: 2013

Objective. Falls and fall-related injuries among older women constitute a major public health problem with huge costs for the society and personal suffering. The aim of this study was to describe and illustrate how a number of circumstances, conceptualized as a scenario, that were related to the individual, the environment, and the ongoing occupation contributed to a fall that led to a hip fracture among women. The sample included 48 women over 55 years old. Methods. Interviews were conducted during home visits and the analysis provided a descriptive picture of circumstances in the shape of a scenario related to the risk of falling. A number of scenarios were developed based on the data and named to provide an understanding of the interplay between the individual, the environment, and the ongoing occupation at the time of the fall. Results. By applying the concept of a scenario, occupational therapists can increase the awareness of fall risks among older people, and are relevant also for interior designers, architects, and town planners to consider when designing the local environment as well as furniture and other objects. © 2013 Informa Healthcare.


Olsson C.B.,Primarvardsrehab Serafen | Olsson C.B.,Center for Family and Community Medicine | Olsson C.B.,Karolinska Institutet | Nilsson-Wikmar L.,Karolinska Institutet | Grooten W.J.A.,Karolinska Institutet
Disability and Rehabilitation | Year: 2012

Purpose: To evaluate potential determinants of self-reported lumbopelvic pain 6 months postpartum for pregnant women with and without lumbopelvic pain. Methods: Questionnaires were answered in weeks 19-21 of pregnancy and at 6 months postpartum. The Pain Catastrophizing Scale was used to assess exaggerated negative thoughts about pain experiences, the Fear-Avoidance Beliefs Questionnaire to assess beliefs about how physical activity affects back pain, the Visual Analogue Scale to assess pain intensity, the Disability Rating Index to assess physical ability, and the Nottingham Health Profile to assess health-related quality of life. A Cox proportional hazards model was used to analyse the data. Results: Of the 273 women who answered at both occasions, 112 had lumbopelvic pain in pregnancy and 161 did not. For pregnant women with lumbopelvic pain a higher level of catastrophizing and a more restricted physical ability both doubled the risk for postpartum lumbopelvic pain. Conclusions: We conclude that catastrophizing and physical ability, in weeks 19-21 of pregnancy determine postpartum lumbopelvic pain, and hence that, women at risk might be identified by the use of a biopsychosocial approach in pregnancy. It seems important to take these results into consideration both when forming preventive strategies and in rehabilitation. © 2012 Informa UK, Ltd.


Wandell P.E.,Center for Family and Community Medicine | Carlsson A.C.,Center for Family and Community Medicine | Andersson K.,Center for Family and Community Medicine | Gafvels C.,Center for Family and Community Medicine | Tornkvist L.,Center for Family and Community Medicine
Open Diabetes Journal | Year: 2010

A 0.8% reduction in glycosylated hemoglobin (hemoglobin A1c) by tactile massage (TM) in patients with diabetes has been shown in a pilot study. The present study was carried out in patients with type 2 diabetes at primary healthcare centers as a parallel-arm clinical study with intention-to-treat analysis, of 10 weeks of TM once/week (n=26) or relaxation using a compact disc once/week (n=27). Anthropometrics were measured, i.e. weight, height, waist and calculation of BMI, blood samples were drawn, i.e. fP-glucose, B-HbA1c, fS-insulin, high-sensitive P-CRP, S-TNF-alpha, S-Interleukin-6, S-Adiponectin, S-Leptin and fP-Ghrelin, urine was collected for 24 hours for catecholamines and cortisol, and questionnaires including lifestyle variables were completed at baseline, after the 10-week intervention and at a followup 3 months after the intervention. There was no significant change in HbA1c in either the TM or the relaxation group. Waist circumference was reduced in both groups (p=0.01) but mostly in the TM group, with an adjusted difference between the groups of 4.0 cm (95% confidence interval 1.6-6.4 cm). The S-Adiponectin level increased significantly in the TM group (p=0.0095). TM therapy could not be recommended as a general treatment in subjects with type 2 diabetes. However, further studies in patients with high perceived level of stress and in other patient groups could be of value. The significance of the reduced waist is unclear, but could be of some importance in the long run. © Faisal et al.; Licensee Bentham Open.


Lundh L.,Center for Family and Community Medicine | Hylander I.,Center for Family and Community Medicine | Tornkvist L.,Center for Family and Community Medicine
Scandinavian Journal of Caring Sciences | Year: 2012

Aim: To investigate why some patients with chronic obstructive pulmonary disease (COPD) have difficulty quitting smoking and to develop a theoretical model that describes their perspectives on these difficulties. Methods: Grounded theory method was used from the selection of participants to the analyses of semi-structured interviews with 14 patients with COPD. Four additional interviews were conducted to ensure relevance. Results: The analysis resulted in a theoretical model that illustrates the process of 'Patients with COPD trying to quit smoking'. The model illuminates factors related to the decision to try to quit smoking, including pressure-filled mental states and constructive or destructive pressure-relief strategies. The constructive strategies lead either to success in quitting or to continuing to try to quit. The destructive strategies can lead to losing hope and becoming resigned to continuing to smoke. Conclusion: The theoretical model 'Patients trying to quit smoking' contributes to a better understanding of the pressure-filled mental states and destructive strategies experienced by some patients with COPD in the process of trying to quit. This better understanding can help nurses individualise counselling. Moreover, patients' own awareness of these states and strategies may facilitate their efforts to quit. The information in the model can also be used as a supplement to methods such as motivational interviewing (MI). © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.


Barimani M.,Center for Family and Community Medicine | Oxelmark L.,Gothenburg University | Johansson S.-E.,Center for Family and Community Medicine | Hylander I.,Center for Family and Community Medicine
Scandinavian Journal of Caring Sciences | Year: 2015

Objectives: To investigate mothers' perceived satisfaction with support from antenatal care (AC), postpartum care (PC) and child health care (CHC), respectively, during the first two weeks after childbirth. Design: Cross-sectional survey, mixed-method design. Ethical issues: The study was approved by the Regional Research and Ethics Committee at the Karolinska Insititutet, Sweden. Methods: Data were collected using a study-specific questionnaire that focused on mothers' satisfaction with support from AC, PC and CHC during the first 2 weeks after childbirth. All mothers in Stockholm County (n = 546) who gave birth to a live infant during a 1-week period in 2009 were invited to participate. Descriptive and logistic regression analyses and a content analysis were performed. Results: A large discrepancy was found between levels of satisfaction with AC, PC and CHC. Mothers were satisfied with the support from CHC healthcare nurses, but missed follow-up contact from AC and PC midwives. Nearly 40% of all mothers commented on insufficient support including that continuity in the chain of care was lacking and support for mothers' physical and emotional health was insufficient. Delivery at <37 weeks of gestation was associated with reduced satisfaction with both AC and CHC, but not with PC. Mothers who made emergency visits during the first two weeks were more likely to be dissatisfied with support from PC. Conclusion: All links in the chain of care are important for the support of mothers during the first 2 weeks after childbirth, but continuity needs to be improved to raise the quality of care for mothers. © 2015 Nordic College of Caring Science.


Walker M.M.,Imperial College London | Murray J.A.,Mayo Medical School | Ronkainen J.,Center for Family and Community Medicine | Aro P.,Center for Family and Community Medicine | And 6 more authors.
Gastroenterology | Year: 2010

Background & Aims: Although serologic analysis is used in diagnosis of celiac disease, histopathology is considered most reliable. We performed a prospective study to determine the clinical, pathologic, and serologic spectrum of celiac disease in a general population (Kalixanda study). Methods: A random sample of an adult general population (n = 1000) was analyzed by upper endoscopy, duodenal biopsy, and serologic analysis of tissue transglutaminase (tTg) levels; endomysial antibody (EMA) levels were analyzed in samples that were tTg+. The cut off values for diagnosis of celiac disease were villous atrophy with 40 intraepithelial lymphocytes (IELs)/100 enterocytes (ECs). Results: Samples from 33 subjects were tTg+, and 16 were EMA+. Histologic analysis identified 7 of 1000 subjects (0.7%) with celiac disease; all were tTg+, and 6 of 7 were EMA+. Another 26 subjects were tTg+ (7/26 EMA+). This was addressed by a second quantitative pathology study (nested case control design) using a threshold of 25 IELS/100 ECs. In this analysis, all 13 samples that were tTg+ and EMA+ had ≥25 IELs/100 ECs. In total, 16 subjects (1.6%) had serologic and histologic evidence of gluten-sensitive enteropathy. IELs were quantified in duodenal biopsy samples from seronegative individuals (n = 500); 19 (3.8%) had >25 IELs and lymphocytic duodenosis. Conclusions: Measurement of ≥25 IELs/100 ECs correlated with serologic indicators of celiac disease; a higher IEL threshold could miss 50% of cases. Quantification of tTg is a sensitive test for celiac disease; diagnosis can be confirmed by observation of ≥25 IELs/100ECs in duodenal biopsy specimens. Lymphocytic enteropathy (celiac disease and lymphocytic duodenosis) is common in the population (5.4%). © 2010 AGA Institute.


Barimani M.,Center for Family and Community Medicine | Oxelmark L.,Gothenburg University | Johansson S.-E.,Center for Family and Community Medicine | Langius-Eklof A.,Karolinska Institutet | Hylander I.,Center for Family and Community Medicine
Scandinavian Journal of Caring Sciences | Year: 2014

Objectives: The aim of the study was to assess mothers' perceived satisfaction with professional support during the first 2 weeks after childbirth and the extent to which mothers seek emergency care during the same period. Design: A cross-sectional study was conducted of all mothers (n = 546) in Stockholm County, Sweden, who gave birth to a live baby during the same week in 2009. Ethical issues: The study was approved by the regional Research and Ethics Committee at the Karolinska Insititutet, Sweden. Methods: The mothers responded to a study-specific questionnaire on perceived satisfaction with professional support and the sense of coherence scale, which measures coping strategies. The mothers also provided information about their socio-demographic background, obstetric and infant data, and visits to hospital emergency departments. Descriptive and logistic regression analyses were performed. Results: Fifty-three percent of the mothers rated the support received as sufficient or more than sufficient, 29.7% as neither sufficient nor insufficient and 17.7% as insufficient or completely insufficient. The results indicate a lack of continuity in postpartum care. As many as 17% of the mothers in the study population visited hospital emergency departments during the first 2 weeks after childbirth, as a result of problems related to delivery, breastfeeding or infant health. A higher frequency of such emergency visits was associated with poor perception of professional support, low sense of coherence and delivery complications. Conclusions: Relative to otherwise comparable mothers, mothers who experience complications with delivery are less satisfied with professional support and turn more frequently to hospital emergency departments for support. © 2013 Nordic College of Caring Science. Published by Blackwell Publishing Ltd.


Wandell P.E.,Center for Family and Community Medicine | Carlsson A.C.,Center for Family and Community Medicine | Steiner K.H.,Center for Family and Community Medicine
Current Diabetes Reviews | Year: 2010

Some immigrant groups in Europe show an increased prevalence of diabetes, e.g. South Asians in the UK and Moroccans and Turks in the Netherlands. This study aimed at reviewing the literature among immigrants in the Nordic countries. Search was performed primarily of Medline through PubMed, and secondarily of other databases and by using information from reference lists. Terms used were: "Diabetes Mellitus", "Immigrant", and "Nordic countries" or "Scandinavia" or "Denmark", "Finland", "Iceland", "Norway" or "Sweden". Altogether 17 articles on diabetes were found. Excess risk of diabetes was found in non-European immigrant groups, especially from the Middle East and South Asian regions, in some cases 10 times the risk of the indigenous population, with the highest relative risks among women. No excess risk was found among European immigrants, with the possible exception of Finnish women. Conflicting results were found in studies with a low number of diabetic cases, with a failure to show statistically significant excess risks among non-European groups. There were also some other methodological problems, e.g. low participation rate in population- based clinical studies, and probable underestimation of known diabetes by self-report. A genetic sensitivity seems likely in the Middle East and South Asian groups, combined with lifestyle factors. © 2010 Bentham Science Publishers Ltd.


Szulkin R.,Karolinska Institutet | Szulkin R.,Center for Family and Community Medicine | Holmberg E.,Gothenburg University | Stattin P.,Umeå University | And 6 more authors.
Prostate | Year: 2012

BACKGROUND Currently used prognostic markers are limited in their ability to accurately predict disease progression among patients with localized prostate cancer. We examined 23 reported prostate cancer susceptibility variants for association with disease progression. METHODS Disease progression was explored among 4,673 Swedish patients treated for clinically localized prostate cancer between 1997 and 2002. Prostate cancer progression was defined according to primary treatment as a composed event reflecting termination of deferred treatment, biochemical recurrence, local progression, or presence of distant metastasis. Association between single variants, and all variants combined, were performed in Cox regression analysis assuming both log-additive and co-dominant genetic models. RESULTS Three of the 23 genetic variants explored were nominally associated with prostate cancer progression; rs9364554 (P = 0.041) on chromosome 6q25 and rs10896449 (P = 0.029) on chromosome 11q13 among patients treated with curative intent; and rs4054823 (P = 0.008) on chromosome 17p12 among patients on surveillance. However, none of these associations remained statistically significant after correction for multiple testing. The combined effect of all susceptibility variants was not associated with prostate cancer progression neither among patients receiving treatment with curative intent (P = 0.14) nor among patients on surveillance (P = 0.92). CONCLUSIONS We observed no evidence for an association between any of 23 established prostate cancer genetic risk variants and disease progression. Accumulating evidence suggests separate genetic components for initiation and progression of prostate cancer. Future studies systematically searching for genetic risk variants associated with prostate cancer progression and prognosis are warranted. Copyright © 2011 Wiley Periodicals, Inc.


PubMed | Center for Family and Community Medicine and Gothenburg University
Type: Journal Article | Journal: Scandinavian journal of caring sciences | Year: 2015

To investigate mothers perceived satisfaction with support from antenatal care (AC), postpartum care (PC) and child health care (CHC), respectively, during the first two weeks after childbirth.Cross-sectional survey, mixed-method design.The study was approved by the Regional Research and Ethics Committee at the Karolinska Insititutet, Sweden.Data were collected using a study-specific questionnaire that focused on mothers satisfaction with support from AC, PC and CHC during the first 2 weeks after childbirth. All mothers in Stockholm County (n = 546) who gave birth to a live infant during a 1-week period in 2009 were invited to participate. Descriptive and logistic regression analyses and a content analysis were performed.A large discrepancy was found between levels of satisfaction with AC, PC and CHC. Mothers were satisfied with the support from CHC healthcare nurses, but missed follow-up contact from AC and PC midwives. Nearly 40% of all mothers commented on insufficient support including that continuity in the chain of care was lacking and support for mothers physical and emotional health was insufficient. Delivery at <37 weeks of gestation was associated with reduced satisfaction with both AC and CHC, but not with PC. Mothers who made emergency visits during the first two weeks were more likely to be dissatisfied with support from PC.All links in the chain of care are important for the support of mothers during the first 2 weeks after childbirth, but continuity needs to be improved to raise the quality of care for mothers.

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