Skövde, Sweden
Skövde, Sweden

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Zou D.,Gothenburg University | Eder D.N.,Gothenburg University | Eskandari D.,Gothenburg University | Grote L.,Gothenburg University | And 3 more authors.
Journal of Hypertension | Year: 2013

Objectives: Apnea hypopnea index (AHI) is used to study the association between obstructive sleep apnea (OSA) and hypertension, but the independent contributions of total sleep time (TST) and apnea/hypopnea event count to hypertension have not been previously investigated. We studied the relationship between polysomnographically assessed TST and hypertension in a sex-balanced community-dwelling cohort of hypertensive patients and normotensive controls (Skara Sleep Cohort). Methods: Participants (n = 344, men 173, age 61.2 ± 6.5 years, BMI 28.6 ± 4.8 kg/m, mean ± SD) underwent ambulatory home polysomnography. Hypertension was defined according to contemporary Swedish national guidelines. A multivariate logistic regression model was used to predict hypertension status from TST and apnea/hypopnea count (total events/night) adjusting for sex, age and BMI. Results: OSA was highly prevalent in this population (AHI 26 ± 24 events/h). Hypertensive patients had shorter TST than normotensive patients (353 ± 81 vs. 389 ± 65 min, P < 0.001), whereas total apnea/hypopnea count did not differ (167 ± 138 vs. 146 ± 148 events/night, P = 0.2). Multivariate logistic regression analysis revealed that short TST was associated with hypertension status [odds ratio 2.0; 95% confidence interval (95% CI) 1.2-3.3; P = 0.0015]. The significant association between apnea/hypopnea count and hypertension status was nonlinear (odds ratio 2.6; 95% CI 1.2-5.8; P = 0.04). The type of antihypertensive treatment was not found to significantly influence TST. Conclusion: Short sleep time assessed by polysomnography was associated with hypertension in this community-dwelling population. Short sleep and presence of sleep apnea appear to independently link to hypertension. © 2013 Wolters Kluwer Health | Lippincott Williams Wilkins.


Bengtsson Bostrom K.,R and nter Skaraborg Primary Care | Bengtsson Bostrom K.,Skåne University Hospital | Hedner J.,Gothenburg University | Grote L.,Gothenburg University | And 7 more authors.
International Journal of Hypertension | Year: 2010

The sympathetic nervous system and the adrenergic receptors play an important role in regulation of blood pressure. This study explored the associations between functional polymorphisms of the α 2B -, β 1 -, and β 2 -adrenergic receptor genes and obstructive sleep apnea (OSA) in hypertensive patients and hypertension in patients with OSA in a populationbased sample of 157 hypertensive patients and 181 healthy control subjects. Only the Arg389Gly polymorphism of the β 1 -adrenergic receptor gene was associated with increased risk for mild OSA in hypertensive patients (Arg/Arg versus Gly/Arg/Gly/Gly, 2.1, 95% CI, 1.02-4.7). Hypertensive men carrying the Arg389Arg genotype had higher crude and age-adjusted AHI than carriers of the Arg389Gly/Gly389Gly genotypes. When adjusted also for BMI this difference became borderline significant. This difference was not observed in women. The risk of hypertension in mild OSA was associated with increasing number of Arg-alleles (Arg/Arg OR 5.4, 95 CI 1.4-21.2). © 2010 Kristina Bengtsson Bostrom et al.


Lindblad U.,Gothenburg University | Lindblad U.,Skaraborg Institute | Lindberg G.,Skåne University Hospital | Lindberg G.,NEPI Foundation | And 13 more authors.
Diabetes, Obesity and Metabolism | Year: 2010

The Nepi ANtidiabetes StudY (NANSY) is a 5 year randomized, double-blind, placebo-controlled trial in Swedish primary care, examining whether the development of type 2 diabetes (T2D) and retinopathy (separately reported) would be delayed in 40 to 70 year old subjects with impaired fasting glucose (IFG) who, in addition to lifestyle changes, were treated with either placebo or low-dosage sulphonylurea (SU) (1 mg glimepiride; Amaryl®). Of 274 subjects (163 men, 111 women), 138 were allocated to placebo (46.0% men, 56.8% women) and 136 to glimepiride (54.0% men, 43.2% women). The primary endpoint was conversion to diabetes. Average follow-up time was 3.71 years; 96 subjects converted to diabetes, 55 allocated to placebo and 41 to glimepiride (absolute difference 9.8%; p = 0.072). In conclusion, the study failed to support the notion that low-dose SU added to lifestyle changes in IFG subjects would help to delay the conversion to diabetes. © 2010 Blackwell Publishing Ltd.


Ljungkrona-Falk L.,Child Health Care Centres of Skaraborg | Ljungkrona-Falk L.,Skaraborg Institute | Brekke H.,Gothenburg University | Nyholm M.,Skaraborg Institute | Nyholm M.,Halmstad University
Health Promotion International | Year: 2014

To increase the understanding of difficulties in promoting healthy habits to parents, we explore barriers in healthcare provision. The aim of this study is to describe nurses' perceived barriers when discussing with parents regarding healthy food habits, physical activity and their child's body weight. A mixed method approach was chosen. Nurses (n = 76) working at 29 different Child Health Care Centers' in an area in west Sweden were included in the study. Three focus group interviews were conducted and 17 nurses were selected according to maximum variation. Data were categorized and qualitative content analysis was the chosen analysis method. In the second method, data were obtained from a questionnaire distributed to all 76 nurses. The latent content was formulated into a theme: even with encouragement and support, the nurses perceive barriers of both an external and internal nature. The results identified four main barriers: experienced barriers in the workplace - internal and external; the nurse's own fear and uncertainty; perceived obstacles in nurse - parent interactions and modern society impedes parents' ability to promote healthy habits. The nurses' perceived barriers were confirmed by the results from 62 of the nurses who completed the questionnaire. Despite education and professional support, the health professionals perceived both external and internal barriers in promoting healthy habits to parents when implementing a new method of health promotion in primary care. Further qualitative studies are needed to gain deeper understanding of the perceived barriers when promoting healthy habits to parents. © The Author (2013). Published by Oxford University Press. All rights reserved.


Lundqvist-Persson C.,Skaraborg Institute | Lundqvist-Persson C.,Lund University | Lau G.,SAS | Nordin P.,Skaraborg Institute | And 3 more authors.
Early Human Development | Year: 2010

Background: The requirement of essential fatty acids (EFA) for the development of the brain is well documented. Objective: To investigate the early neurological development at term and 44. weeks gestational age in preterm infants in relation to EFA concentrations in breast milk and in infants' and mothers' plasma phospholipids. Method: Fifty-one premature infants and their mothers were consecutively included in the study. The median gestational age was 34. weeks (range 24-36). The motor quality, motor and behavioural development were assessed by General Movements (GMs), the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) and a Self Regulation Scale. Results: Mother's education and gestational age correlated to several outcome variables. Multiple regression with correction for background factors showed negative associations between early breast milk concentrations of Mead acid and GMs and between AA and the BNBAS clusters Orientation and Range of States, respectively. Between 40 and 44. weeks gestational age, no expected increased scores were observed for Regulation of States, Range of States and Self Regulation. During the corresponding time, increased concentration of linoleic acid in mothers' plasma was negatively associated with improvement in Orientation and increased concentration of EPA in the infants' plasma was positively associated with improvement in Autonomic Stability. Conclusions: The major omega-6 fatty acids and Mead acid were negatively associated with early development and omega-3 fatty acids positively associated. Mother's education and the gestational age influenced the outcome more strongly than mother's and infant's morbidities. Further follow-up will elucidate the significance of these early findings. © 2010 Elsevier Ltd.


Weidinger P.,Gothenburg University | Nilsson J.L.G.,Skaraborg Primary Care Research and Development Unit | Lindblad U.,Gothenburg University | Lindblad U.,Skaraborg Institute
BMC Family Practice | Year: 2014

Background: There is a gap between prescribed asthma medication and diagnosed asthma in children and adolescents. However, few studies have explored this issue among adults, where asthma medication is also used for the treatment of chronic obstructive pulmonary disease (COPD). The aim of this study was to examine the relationship between prescribing of medications indicated for asthma and COPD and the recorded diagnosis for these conditions. Method. In a register-based study, individuals prescribed a medication indicated for asthma and COPD during 2004-2005 (Group A; n = 14 101) and patients with diagnoses of asthma or COPD recorded during 2000-2005 (Group B; n = 12 328) were identified from primary health care centers in Skaraborg, Sweden. From a 5% random sample of the medication users (n = 670), the written medical records were accessed. Primary outcomes: prevalence of medication and diagnoses, reasons for prescription. Secondary outcomes: type and number of prescribed drugs and performance of peak expiratory flow or spirometry. Results: Medications indicated for asthma and COPD was prescribed to 5.6% of the population in primary care (n = 14 101). Among them, an asthma diagnosis was recorded for 5876 individuals (42%), 1116 (8%) were diagnosed with COPD and 545 (4%) had both diagnoses. The remaining 6564 individuals (46%) were lacking a recorded diagnosis. The gap between diagnosis and medication was present in all age-groups. Medication was used as a diagnostic tool among 30% of the undiagnosed patients and prescribed off-label for 54%. Missed recording of ICD-codes for existing asthma or COPD accounted for 16%. Conclusion: There was a large discrepancy between prescribing of medication and the prevalence of diagnosed asthma and COPD. Consequently, the prevalence of prescriptions of medications indicated for asthma and COPD should not be used to estimate the prevalence of these conditions. Medication was used both as a diagnostic tool and in an off-label manner. Therefore, the prescribing of medications for asthma and COPD does not adhere to national clinical guidelines. More efforts should be made to improve the prescribing of medication indicated for asthma and COPD so that they align with current guidelines. © 2014 Weidinger et al.; licensee BioMed Central Ltd.


Larsson C.A.,Skåne University Hospital | Kroll L.,Skåne University Hospital | Bennet L.,Skåne University Hospital | Gullberg B.,Skåne University Hospital | And 3 more authors.
Metabolism: Clinical and Experimental | Year: 2012

The objective was to study obesity and insulin resistance in relation to leisure time physical activity (LTPA) and occupational physical activity (OPA) in a Swedish population, with particular focus on sex differences. Using a cross-sectional design, waist circumference, body mass index (BMI), glucose/insulin metabolism, blood pressure, heart rate, self-reported education, smoking, alcohol consumption, LTPA, and OPA were assessed in 1745 men and women (30-74 years) randomly chosen from 2 municipalities in southwestern Sweden. In both men and women, LTPA was inversely associated with BMI, waist circumference, and the homeostasis model assessment of insulin resistance (HOMA-IR), respectively. These associations remained statistically significant after adjustments for age, OPA, education, alcohol consumption, smoking, and study area, and also for BMI in the analyses concerning waist circumference and HOMA-IR. A statistically significant interaction term (P =.030), adjusted for multiple confounders, revealed a stronger association between LTPA and HOMA-IR in women compared with men. Occupational physical activity was positively associated with BMI (P <.001), waist circumference (P <.001), and HOMA-IR (P =.001), however, only in women. These associations remained when adjusting for multiple confounders. The sex differences were confirmed by statistically significant interaction terms between sex and OPA in association with BMI, waist circumference, and HOMA-IR, respectively. The observed sex differences regarding the strength of the association between LTPA and insulin resistance, and the positive association between OPA and obesity and insulin resistance found solely in women, warrant further investigation. Although exploration of the metabolic effects of OPA appears to be needed, thorough measurement of potential confounders is also vital to understand contextual effects. © 2012 Elsevier Inc. All rights reserved.


Bennet L.,Lund University | Larsson C.,Lund University | Sderstrm M.,Skaraborg Hospital | Rstam L.,Lund University | And 2 more authors.
Scandinavian Journal of Primary Health Care | Year: 2010

Objectives. Left ventricular diastolic dysfunction with preserved systolic function (DD-PSF) is associated with an increased risk of morbidity and mortality. Population-based surveys studying the associations between DD-PSF and lifestyle-associated risk factors, such as leisure time physical activity (LTPA) and smoking, are scarce. Thus, the aims were to explore the associations between DD-PSF and LTPA and smoking, employing optimal echocardiographic techniques. Design. Cross-sectional study conducted from 2001 to 2003. Setting.The study was conducted in a random sample of a rural Swedish population. Subjects. Men and women of 3075 years of age were consecutively invited for conventional echocardiography and tissue velocity imaging (n 1149). Structured questionnaires and physical examinations were conducted using standardized methods. Main outcome measures. DD-PSF was defined according to the European Society of Cardiology criteria excluding subjects with ejection fraction < 45%, or a self-reported history of heart failure. Results. Complete information was available in 500 men and 538 women. In a multivariate model, DD-PSF was independently associated with sedentary LTPA and smoking in females; sedentary LTPA odds ratio (OR) 2.91, 95% confidence interval (CI) 1.02 to 8.27, and smoking OR 3.42, 95% CI 1.35 to 8.64. The probability of identifying DD-PSF in females with a sedentary LTPA was 37% and increased to 80% if they also had hypertension and were obese. Conclusions. Sedentary LTPA and smoking are independently associated with DD-PSF in females. Identification of a sedentary lifestyle in females increases the probability of diagnosing DD-PSF. © 2010 Informa Healthcare.


PubMed | Skaraborg Institute
Type: Journal Article | Journal: Early human development | Year: 2010

The requirement of essential fatty acids (EFA) for the development of the brain is well documented.To investigate the early neurological development at term and 44 weeks gestational age in preterm infants in relation to EFA concentrations in breast milk and in infants and mothers plasma phospholipids.Fifty-one premature infants and their mothers were consecutively included in the study. The median gestational age was 34 weeks (range 24-36). The motor quality, motor and behavioural development were assessed by General Movements (GMs), the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) and a Self Regulation Scale.Mothers education and gestational age correlated to several outcome variables. Multiple regression with correction for background factors showed negative associations between early breast milk concentrations of Mead acid and GMs and between AA and the BNBAS clusters Orientation and Range of States, respectively. Between 40 and 44 weeks gestational age, no expected increased scores were observed for Regulation of States, Range of States and Self Regulation. During the corresponding time, increased concentration of linoleic acid in mothers plasma was negatively associated with improvement in Orientation and increased concentration of EPA in the infants plasma was positively associated with improvement in Autonomic Stability.The major omega-6 fatty acids and Mead acid were negatively associated with early development and omega-3 fatty acids positively associated. Mothers education and the gestational age influenced the outcome more strongly than mothers and infants morbidities. Further follow-up will elucidate the significance of these early findings.


Lindblad U.,Gothenburg University | Lindblad U.,Skaraborg Institute | Ek J.,Gothenburg University | Eckner J.,Gothenburg University | And 3 more authors.
Scandinavian Journal of Primary Health Care | Year: 2012

Objective. To describe the prevalence, awareness, and control of hypertension in a Swedish population during the early 2000s to address implications for care and prevention. Design. A cross-sectional population survey. Setting. Primary health care in Skaraborg, a rural part of western Sweden. Subjects. Participants (n = 2816) in a population survey of a random sample of men and women between 30 and 75 years of age in the municipalities of Vara (81% participation rate) and Skövde (70%), in western Sweden during 20012005. Main outcome measures. Anthropometric measures, blood pressure, leisure-time physical activity, current smoking, fasting glucose, and cholesterol. Hypertension was defined as ongoing treatment for hypertension, or three consecutive blood pressure readings ≥140 systolic and/or ≥90 mmHg diastolic. Hypertension was considered controlled when the blood pressure was <140/90 mm Hg (both). Results. The prevalence of hypertension was 20% in both men and women with a steep increase by age. Among hypertensive subjects, 33% were unaware, 36% aware but uncontrolled, and 31% aware and controlled, with no statistically significant differences between men and women. Patients with diabetes had a higher awareness (87% vs. 64%, p <0.001), but the same control rate (56% vs. 44%, p = 0.133), when compared with those without diabetes. Conclusion. A large proportion of subjects with hypertension are still unaware of their condition, or aware but not controlled. It is important to emphasize population-based prevention to reduce the prevalence of hypertension, to perform screening to increase awareness, and to improve implementation of expert guidelines in clinical practice to improve control. © 2012 Informa Healthcare.

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