Norrtälje, Sweden
Norrtälje, Sweden

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Foldemo A.,Linköping University | Wardig R.,Linköping University | Bachrach-Lindstrom M.,Linköping University | Edman G.,Karolinska Institutet | And 5 more authors.
Schizophrenia Research | Year: 2014

Improved Health-related quality of life (HRQoL) is an alternative treatment goal for individuals with psychosis, who have up to two times greater prevalence of type 2 diabetes, hypertension and obesity than the general population. Aim: to compare HRQoL in patients with psychosis, especially schizophrenia, with a reference sample and explore the relationship between HRQoL and metabolic risk factors in these patients. Methods: a prospective cohort study was carried out in specialized psychiatric outpatient departments in Sweden. The patients were invited consecutively. A prospective population-based study of public health in the south-east of Sweden served as reference group. Patients were assessed with psychiatric questionnaires that included Global Assessment of Functioning (GAF). Health-related quality of life was assessed using the questionnaire EQ5D, both for patients and the population, and several other health status outcomes were used. Results: At 73%, schizophrenia and schizoaffective disorder were the most common diagnoses in the patient group. The results in patients (n. = 903) and population (n. = 7238) showed significant differences in lower EQ5D among patients. According to the definition by the International Diabetes Federation (IDF), elevated blood pressure was the only metabolic risk associated with lower HRQoL in patients. Raised LDL-cholesterol levels were also significantly related to lower HRQoL. Conclusion: patients suffering from psychosis had significantly lower HRQoL regarding all components in EQ5D, except for the pain/discomfort component. Almost half of the patient group met the criteria for metabolic syndrome. According to the IDF criteria, elevated blood pressure was the only metabolic risk factor that had an impact on HRQoL. © 2013 Elsevier B.V.


Westman J.,Karolinska Institutet | Hallgren J.,Karolinska Institutet | Wahlbeck K.,Finnish National Institute for Health and Welfare | Erlinge D.,Lund University | And 3 more authors.
BMJ Open | Year: 2013

Objective: To estimate the cardiovascular mortality among persons with bipolar disorder in Sweden compared to the general population. Design: Population register-based cohort study with a 20-year follow-up. Setting: Sweden. Participants: The entire population of Sweden (n=10.6 million) of whom 17 101 persons were diagnosed with bipolar disorder between 1987 and 2006. Main outcome measures: Mortality rate ratios (MRR), excess mortality (excess deaths), cardiovascular disorder (CVD) and specifically cerebrovascular disease, coronary heart disease, acute myocardial infarction, sudden cardiac deaths and hospital admission rate ratio (ARR). Results: Persons with bipolar disorder died of CVD approximately 10 years earlier than the general population. One third (38%) of all deaths in persons with bipolar disorder were caused by CVD and almost half (44%) by other somatic diseases, whereas suicide and other external causes accounted for less than a fifth of all deaths (18%). Excess mortality of both CVD (n=824) and other somatic diseases (n=988) was higher than that of suicide and other external causes (n=675 deaths). MRRs for cerebrovascular disease, coronary heart disease and acute myocardial infarction were twice as high in persons with bipolar disorder compared to the general population. Despite the increased mortality of CVD, hospital admissions (ARR) for CVD treatment were only slightly increased in persons with bipolar disorder when compared to the general population. Conclusions: The increased cardiovascular mortality in persons with bipolar disorder calls for renewed efforts to prevent and treat somatic diseases in this group. Specifically, our findings further imply that it would be critical to ensure that persons with bipolar disorder receive the same quality care for CVD as persons without bipolar disorder.


Reutfors J.,Karolinska Institutet | Bahmanyar S.,Karolinska Institutet | Bahmanyar S.,Golestan University of Medical Sciences | Jonsson E.G.,Karolinska Institutet | And 6 more authors.
Schizophrenia Research | Year: 2013

Introduction: Patients with schizophrenia are at increased risk of suicide, but data from controlled studies of pharmacotherapy in relation to suicide risk is limited. Aim: To explore suicide risk in schizophrenia in relation to medication with antipsychotics, antidepressants, and lithium. Methods: Of all patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n=4000), patients who died by suicide within five years from diagnosis were defined as cases (n=84; 54% male). Individually matched controls were identified from the same population. Information on prescribed medication was retrieved from psychiatric records in a blinded way. Adjusted odds ratios [OR] of the association between medication and suicide were calculated by conditional logistic regression. Results: Lower suicide risk was found in patients who had been prescribed a second generation antipsychotic (clozapine, olanzapine, risperidone, or ziprasidone; 12 cases and 20 controls): OR 0.29 (95% confidence interval [CI], 0.09-0.97). When the 6 cases and 8 controls who had been prescribed clozapine were excluded, the OR was 0.23 (95% CI 0.06-0.89). No significant association was observed between suicide and prescription of any antipsychotic, depot injection antipsychotics, antidepressants, SSRI, or lithium. Conclusions: Lower suicide risk for patients who had been prescribed second generation antipsychotics may be related to a pharmacological effect of these drugs, to differences in adherence, or to differences in other patient characteristics associated with lower suicide risk. © 2013 Elsevier B.V.


Garnevall B.,Karolinska Institutet | Rabey M.,Medical Port | Edman G.,Tiohundra AB
Scandinavian Journal of Pain | Year: 2013

Background and purpose: Nirschl's lateral epicondylalgia (LE) classification appears prognostic but is based upon an outdated model of tendinopathy. Psychosocial factors which may negatively influence treatment outcomes, central nervous system mediated hypersensitivity and motor impairment all occur in epicondylalgia. This study examines psychosocial/personality factors and physical measures in LE correlating them with Nirschl's sub-groups. Methods: Fifty-four subjects with LE and 43 healthy controls, recruited from primary care in Norway were assessed. Measures included: pressure pain threshold (PPT), isometric maximal load pain tolerance (MLT) and isometric low load (sustained hold of 0.5. kg weight) pain tolerance (LLT) of the wrist extensors, all of which were undertaken bilaterally; the Örebro Musculoskeletal Pain Questionnaire (ÖMPSQ), and the Swedish Scales of Personality. Results: Patients had significantly lower pain thresholds than controls especially at the common extensor origin, but thresholds did not differentiate Nirschl's groups. MLT did not differentiate between controls and patients or between pain groups. LLT differentiated pain patients from controls but not between different pain groups. The ÖMPSQ score was significantly different between three out of four of Nirschl's pain groups and both pain thresholds and MLT in both the painful and non-/less painful arms were significantly but negatively correlated with the ÖMPSQ score. Somatic anxiety was significantly different between healthy controls and Nirschl's most symptomatic pain group; and also correlated with the ÖMPSQ score. Conclusions: The ÖMPSQ differentiated Nirschl's sub-groups more effectively than the PPT, MLT or LLT, but the control group did not complete the ÖMPSQ, so a comparison of the subjects with LE to symptom-free subjects was not possible. Elevated somatic anxiety in the most symptomatic patients may indicate possible alexithymia or an inability to understand or cope with somatic symptoms of distress. The subjects in this study with epicondylalgia exhibited widespread, likely central nervous system mediated hypersensitivity, motor impairment and psychosocial factors in keeping with a modern model of LE. This hypersensitivity suggests epicondylalgia should not be considered a localised pathology and management should be tailored towards underlying multidimensional biopsychosocial pain mechanisms. Possible pain mechanisms driving this hypersensitivity are postulated. LLT, a novel impairment test, is significantly reduced in LE and should be examined in this patient group, and possibly rehabilitated specifically. Based upon physical and psychological data from this study, Nirschl's sub-grouping seems too detailed and our results suggest that the four groups should be reduced to two. Thus, for diagnostic purposes the Nirschl's groups I and II could be collapsed to one group, and groups III and IV to a second group. Implications: Psychosocial and personality factors should be measured in subjects with epicondylalgia as they correlate with physical signs. Management should therefore be tailored to patient presentations, particularly where significant psychosocial factors or specific motor impairments exist. © 2013 Scandinavian Association for the Study of Pain.


Ivarsson B.,Skåne University Hospital | Ekmehag B.,TioHundra AB | Sjoberg T.,Skåne University Hospital
European Journal of Cardiovascular Nursing | Year: 2013

Background: Heart or lung recipients are taught about a new lifestyle, risk factors, medication, food restrictions and exercise so they can take an active role and responsibility for disease management after transplantation. However, little is known about patients' experiences of information and support in these situations. Objective: The aim of the study was to illuminate how patients, six months after a heart or lung transplantation, experienced the information and support they received in connection with the transplantation. Methods: Sixteen patients were included in the study, and interviews were analysed using a qualitative content analysis method. Results: The findings are presented in three themes: Alternating between gratitude and satisfaction and resignation, Striving to follow treatment strategies and Returning to a relatively normal life. The patients expressed gratitude when their health improved markedly but resignation when complications or side effects occurred due to the lack of information and support they received. Conclusions: Healthcare professionals can make specific improvements in the information they provide to patients to increase their preparedness. Information and support should be provided regularly so as to avoid non-adherence to essential guidelines. To return to a normal life, patients need support from healthcare organizations, families, employers and society in general. These findings should be taken into account in the clinical management of transplant patients, particularly those with dependent children or failing social networks. © 2012 The European Society of Cardiology.


Dimberg I.,Karolinska Institutet | Grzymala-Lubanski B.,Umeå University | Hagerfelth A.,Tiohundra AB | Rosenqvist M.,Karolinska Institutet | And 2 more authors.
European Journal of Internal Medicine | Year: 2012

Background: Well-managed warfarin treatment with a high time in therapeutic range (TTR) corresponds to fewer bleedings or thromboembolic complications. Many small centres manage their warfarin dosing manually, with little or no knowledge of their treatment quality as measured by TTR. AuriculA is a Swedish National web-based anticoagulation dosing system. Our hypothesis was that the web based dosing system, compared to manual dosing, would improve the TTR. Methods: Retrospective cohort study of medical records from patients with atrial fibrillation on warfarin treatment from two centres, with previously manual warfarin dosing regimens. Data for calculation of TTR was extracted manually from medical records from the time when using manual dosing and compared with the computerised regimen. Results: In centre 1, the mean TTR was significantly increased after the introduction of AuriculA, from 64.3% (95% CI 58.8-69.8) to 71.3% (95% CI 67.7-74.8), p = 0.03. In centre 2, a high TTR of 73.6% (95% CI 71.3-75.9) was maintained after the implementation, 74.0% (95% CI 71.6-76.3). INR tests were prescribed significantly more frequent after the introduction of AuriculA in both centres; 20% more often at centre 1 and 21% at centre 2. Conclusion: Computerised dosing assistance within the Swedish national quality registry AuriculA improves or maintains a high treatment quality with warfarin as measured by TTR. © 2012 European Federation of Internal Medicine.


Askelsdottir B.,Karolinska Institutet | Jonge W.L.D.,Karolinska Institutet | Edman G.,Tiohundra AB | Wiklund I.,Karolinska Institutet
Midwifery | Year: 2013

Objective: to compare early discharge with home care versus standard postpartum care in terms of mothers' sense of security; contact between mother, newborn and partner; emotions towards breast feeding; and breast-feeding duration at one and three months after birth. Design: retrospective case-control study. Setting: a labour ward unit in Stockholm, Sweden handling both normal and complicated births. Participants: 96 women with single, uncomplicated pregnancies and births, and their healthy newborns. Intervention: early discharge at 12-24 hours post partum with 2-3 home visits during the first week after birth. The intervention group consisted of women who had a normal vaginal birth (. n=45). This group was compared with healthy controls who received standard postnatal care at the hospital (. n=51). Instruments: mothers' sense of security was measured using the Parents' Postnatal Sense of Security Scale. Contact between mother, child and father, and emotions towards breast feeding were measured using the Alliance Scale, and breast-feeding rates at one and three months post partum were recorded. Findings: women in the intervention group reported a greater sense of security in the first postnatal week but had more negative emotions towards breast feeding compared with the control group. At three months post partum, 74% of the newborns in the intervention group were fully breast fed versus 93% in the control group (. p=0.021). Contact between the mother, newborn and partner did not differ between the groups. Conclusion: early discharge with home care is a feasible option for healthy women and newborns, but randomised controlled studies are needed to investigate the effects of home care on breast-feeding rates. © 2012 Elsevier Ltd.


Fatouros-Bergman H.,Karolinska Institutet | Cervenka S.,Karolinska University Hospital | Flyckt L.,Karolinska Institutet | Edman G.,Tiohundra AB | And 2 more authors.
Schizophrenia Research | Year: 2014

Cognitive deficits represent a significant characteristic of schizophrenia. However, a majority of the clinical studies have been conducted in antipsychotic drug treated patients. Thus, it remains unclear if significant cognitive impairments exist in the absence of medication. This is the first meta-analysis of cognitive findings in drug-naïve patients with schizophrenia. Cognitive data from 23 studies encompassing 1106 patients and 1385 controls published from 1992 to 2013 were included. Tests were to a large extent ordered in cognitive domains according to the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery. Analysis was performed with STATA using the random-effects model and heterogeneity as well as Egger's publication bias was assessed. Overall the results show that patients performed worse than healthy controls in all cognitive domains with medium to large effect sizes. Verbal memory, speed of processing and working memory were three of the domains with the greatest impairments. The pattern of results is in line with previous meta-analytic findings in antipsychotic treated patients. The present meta-analysis confirms the existence of significant cognitive impairments at the early stage of the illness in the absence of antipsychotic medication. © 2014 The Authors.


Melas P.A.,Neurogenetics Unit | Rogdaki M.,Neurogenetics Unit | Osby U.,Neurogenetics Unit | Osby U.,Tiohundra AB | And 3 more authors.
FASEB Journal | Year: 2012

Even though schizophrenia has a strong hereditary component, departures from simple genetic transmission are prominent. DNA methylation has emerged as an epigenetic explanatory candidate of schizophrenia's nonmendelian characteristics. To investigate this assumption, we examined genome-wide (global) and gene-specific DNA methylation levels, which are associated with genomic stability and gene expression activity, respectively. Analyses were conducted using DNA from leukocytes of patients with schizophrenia and controls. Global methylation results revealed a highly significant hypomethylation in patients with schizophrenia (P<2.0×10-6) and linear regression among patients generated a model in which antipsychotic treatment and disease onset explained 11% of the global methylation variance (adjusted R 2=0.11, ANOVA P<0.001). Specifically, haloperidol was associated with higher ("control-like") methylation (P=0.001), and early onset (a putative marker of schizophrenia severity) was associated with lower methylation (P=0.002). With regard to the gene-specific methylation analyses, and in accordance with the dopamine hypothesis of psychosis, we found that the analyzed region of S-COMT was hypermethylated in patients with schizophrenia (P=0.004). In summary, these data support the notion of a dysregulated epigenome in schizophrenia, which, at least globally, is more pronounced in early-onset patients and can be partly rescued by antipsychotic medication. In addition, blood DNA-methylation signatures show promise of serving as a schizophrenia biomarker in the future. © FASEB.


Alenius M.,TioHundra AB | Graf P.,TioHundra AB
CIN - Computers Informatics Nursing | Year: 2016

Concerns have been raised about the effects of current medication administration processes on the safety of many of the aspects of medication administration. Keeping electronic medication administration records could decrease many of these problems. Unfortunately, there has not been much research on this topic, especially in nursing homes. A prospective case-control survey was consequently performed at two nursing homes; the electronic record system was introduced in one, whereas the other continued to use paper records. The personnel were asked to fill in a questionnaire of their perceptions of stress and risk of medication errors at baseline (n = 66) and 20 weeks after the intervention group had started recording medication administration electronically (n = 59). There were statistically significant decreases in the perceived risk of omitting a medication, of medication errors occurring because of communication problems, and of medication errors occurring because of inaccurate medication administration records in the intervention group (all P <.01 vs the control group). The perceived overall daily stress levels were also reduced in the intervention group (P <.05). These results indicate that the utilization of electronic medication administration records will reduce many of the concerns regarding the medication administration process. © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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