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  • 101.
    Lindgren, H.
    et al.
    Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden & Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
    Gottsäter, A.
    Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden & Vascular Centre, Skåne University Hospital, Malmö, Sweden.
    Qvarfordt, P.
    Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
    Bergman, Stefan
    Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden & Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden & Spenshult Research and Development Centre, Halmstad, Sweden.
    All Cause Chronic Widespread Pain is Common in Patients with Symptomatic Peripheral Arterial Disease and is Associated with Reduced Health Related Quality of Life2016In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 52, no 2, p. 205-210Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Invasive treatment of peripheral arterial disease (PAD) does not always lead to improvement, as concomitant diseases might affect walking ability and health related quality of life (HRQoL). Patients with chronic widespread pain (CWP) report worse outcome when treated for cancer and rheumatic diseases. The aim of the present study was to evaluate the prevalence of CWP and its potential association with reduced HRQoL in patients treated for PAD.

    METHOD: This was a longitudinal cohort study conducted between May 2011 and April 2014, including patients with planned invasive treatment of symptomatic PAD at two vascular clinics in Sweden. In 240 patients with planned treatment of PAD, HRQoL and pain distribution were assessed using the Short Form 36 Health Survey (SF-36), EuroQoL 5 dimensions (EQ5D), Walking Impairment Questionnaire (WIQ), and a questionnaire concerning musculoskeletal pain (Epipain manikin) before and 12 months after treatment. HRQoL was compared in patients with no chronic pain (NCP), with chronic regional pain (CRP), and with CWP. The SF-36 subscales PF, VT, and MH, representing important aspects of HRQoL (physical function, vitality, and mental health), were the main outcome measures.

    RESULTS: Before treatment 22 (10%) patients reported NCP, 133 (61%) CRP, and 64 (29%) CWP. These proportions did not differ between patients with intermittent claudication (IC) and critical limb ischemia (CLI, p = .150). CWP was more common in women than in men (36% vs. 24%, p = .035.) HRQoL improved significantly after treatment in all groups, but was still significantly reduced in CWP patients. CWP predicted worse outcome in HRQoL after treatment.

    CONCLUSION: CWP is common and is strongly associated with reduced HRQoL in patients with PAD. Treatment led to significant improvement, but patients with CWP still had significantly reduced HRQoL after treatment. CWP measured by a pain manikin should therefore be taken into account when evaluating disease severity, treatment options, and effect of treatment in PAD.

  • 102.
    Lindgren, Hans
    et al.
    Research and Development Centre Spenshult, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden & Department of Radiology, Helsingborg County Hospital, Helsingborg, Sweden.
    Bergman, Stefan
    Research and Development Centre Spenshult, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Chronic musculoskeletal pain predicted hospitalisation due to serious medical conditions in a 10 year follow up study2010In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 11, article id 127Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim was to examine if self reported chronic regional pain (CRP) and chronic widespread pain (CWP) predicted inpatient care due to serious medical conditions such as cerebrovascular diseases, ischemic heart diseases, neoplasms and infectious diseases in a general population cohort over a ten year follow-up period.

    METHODS: A ten-year follow up of a cohort from the general adult population in two health care districts with mixed urban and rural population in the south of Sweden, that in 1995 participated in a survey on health and musculoskeletal pain experience. Information on hospitalisation for each subject was taken from the regional health care register. Multiple logistic regression analyses were used to study the associations between chronic musculoskeletal pain and different medical conditions as causes of hospitalisation.

    RESULTS: A report of CRP (OR = 1.6; p < 0.001) or CWP ( OR = 2.1; p < 0.001) predicted at least one episode of inpatient care over a ten year period, with an increased risk in almost all diagnostic subgroups, including cerebrovascular diseases, ischemic heart diseases, and infectious diseases. There was however no increased risk of hospitalisation due to neoplasms.

    CONCLUSIONS: The presence of especially CWP was associated with hospital inpatient care due to several serious medical disorders. This may imply a general vulnerability to different medical conditions that has to be addressed in the assessment and management of subjects with chronic musculoskeletal pain.

  • 103.
    Lindgren, Hans
    et al.
    Helsingborg County Hospital, Helsingborg, Sweden.
    Bergman, Stefan
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    The use and diagnostic yield of radiology in subjects with longstanding musculoskeletal pain - an eight year follow up2005In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 6, article id 53Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Longstanding musculoskeletal pain is common in the general population and associated with frequent use of health care. Plain radiography is a common diagnostic approach in these patients despite knowledge that the use in the investigation of musculoskeletal pain is associated with low diagnostic yield, substantial costs and high radiation exposure. The aim of this study was to assess the use of diagnostic imaging and the proportion of pathological findings with regard to duration and distribution of pain in a cohort from the general population.

    METHODS: An eight-year longitudinal study based on questionnaires at three occasions and medical records on radiological examinations done in medical care. Thirty subjects were selected from an established population based cohort of 2425 subjects that in 1995 answered a postal survey on pain experience. At baseline there were ten subjects from each of three pain groups; No chronic pain, Chronic regional pain, and Chronic widespread pain (CWP). Those who presented with CWP at two or all three occasions were considered to have a longstanding or re-occurring CWP. In total the thirty subjects underwent 102 radiological examinations during the eight year follow up.

    RESULTS: There was a non-significant (p = 0.10) finding indicating that subjects with chronic pain at baseline (regional or widespread) were examined three times more often than those with no chronic pain. When the indication for the examination was pain, there was a low proportion of positive findings in subjects with longstanding CWP, compared to all others (5.3% vs 28.9%; p = 0.045). On the other hand, in examinations on other indications than pain the proportion of positive findings was high in the CWP group (62.5% vs 14.8%; p = 0.001).

    CONCLUSION: Radiological examinations had a low diagnostic yield in evaluation of pain in subjects with longstanding/reoccurring CWP. These subjects had on the other hand more often positive findings when examined on other indications than pain. This may indicate that subjects with longstanding/reoccurring CWP are more prone to other diseases. It is a challenge for caregivers, often primary care physicians, to use radiological examinations to the best for their patients.

  • 104.
    Lindgren, Hans
    et al.
    Faculty of Medicine, Lund University, Lund, Sweden & Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
    Gottsäter, Anders
    Vascular Centre, Skåne University Hospital, Malmö, Sweden.
    Qvarfordt, Peter
    Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Troëng, Thomas
    Department of Surgery, Blekinge Hospital, Karlskrona, Sweden.
    Invasive Treatment for Infrainguinal Claudication Has Satisfactory 1 Year Outcome in Three out of Four Patients: A Population-based Analysis from Swedvasc2014In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 47, no 6, p. 615-620Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: In spite of recommendations advocating conservative best medical treatment, many patients with infrainguinal intermittent claudication (IC) are treated by invasive open and endovascular methods. This study aims to evaluate the incidence and 1-year results of all such treatments during 2009 in Sweden.

    METHODS: The design was a one-year follow-up through the Swedish Vascular Registry (Swedvasc) of all 775 patients from the Swedish population of 10 million inhabitants in whom 843 invasive infrainguinal procedures (796 index procedures and 47 secondary procedures) were performed for IC in 2009. Index procedures were open surgery in 290 (37%) patients, bilateral in nine cases, giving a total of 299 limbs, endovascular treatment in 447 (58%) patients, bilateral in 10, giving a total of 457 limbs, and hybrid treatment in 38 (5%) patients, bilateral in two cases, giving a total of 40 limbs. Data were analysed both with regard to the number of patients (775) and the number of procedures (843). Clinical outcome was calculated from patient-reported leg function (unchanged, improved, deteriorated) and whether amputation had been necessary or death had occurred. Patent reconstruction at 1 year was also counted as improvement.

    RESULTS: Improvement at 1 year was seen in 567 (73.2%) patients, (225 [77.6%] in the open surgery group, 320 [71.6%] in the endovascular treatment group, and 22 [57.9%] in the hybrid treatment group). No significant difference was found between the open surgery and endovascular treatment groups comprising 737/775 patients (p = .350). Hybrid treatment gave significantly worse results (p = .046). Fifty-seven (7.3%) patients reported unchanged limb function and 32 (4.1%) patients reported deterioration. Within 30 days two patients died and one patient underwent amputation. Within 1 year 10 patients underwent 11 amputations: five (1.7%) in the open surgery group, three (0.6%) in the endovascular treatment group, and two (7.5%) in the hybrid treatment group; one underwent bilateral amputation (p = .07). Twenty-two patients died: 10 (3.4%) in the open surgery group, 12 (2.7%) in the endovascular treatment group and none in the hybrid treatment group (p = .465).

    CONCLUSIONS: Reported improvement at 1 year was 73.2% in patients invasively treated for infrainguinal IC. Patients reporting an unchanged or deteriorated clinical state are a considerable clinical challenge. Further studies to determine whether or not invasive treatment of infrainguinal IC is appropriate are justified. © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  • 105.
    Lindholm, Annelie
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Almquist-Tangen, Gerd
    Child Health Care Unit, Region Halland, Halmstad, Sweden.
    Alm, Bernt
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Dahlgren, Jovanna
    Roswall, Josefine
    Staland-Nyman, Carin
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Early life risk factors for an elevated waist-to-height ratio at 5 years of ageManuscript (preprint) (Other academic)
    Abstract [en]

    Objective: To examine early life risk factors for an elevated waist-to-height ratio (WHtR) at 5 years of age. A second aim was to examine if the same risk factors also were associated with overweight or obesity at the same age.

    Methods: A population-based longitudinal birth cohort study of 1,540 children, from the southwestern part of Sweden, born between October 2007 and December 2008. The children were classified as having ≥ 1 or < 1 in WHtR standard deviation scores (SDS) at five years of age, according to Swedish reference values and as having overweight/obesity or normal weight/underweight according to the IOTF. 

    Results: At five years of age, 15% of the children had WHtRSDS ³ 1 and 11% had overweight or obesity. In multivariable analyses, RWG during 0-6 months (OR: 1.90, 95% CI: 1.23, 2.95), maternal pre- pregnancy BMI (1.06, 1.01,1.11) and paternal BMI (1.11, 1.01-1.21) were associated with a WHtRSDS ³ 1 at five years. RWG during 0-6 months (2.53, 1.53, 4,20), during 6-12 months (2.82, 1.37, 5.79) and maternal pre-pregnancy BMI (1.12, 1.06,1.17) was associated with overweight or obesity at 5 years of age.

    Conclusions: Risk factors operating early in life are associated with an elevated WHtR and overweight or obesity at 5 years of age. Preventive interventions should especially address early RWG and parental overweight.

  • 106.
    Lindholm, Annelie
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Research and Development Center Spenshult, Halmstad, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Research and Development Center Spenshult, Halmstad, Sweden & Department of Public Health and Community Medicine, The Primary Health Care Unit at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Alm, Bernt
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Almquist-Tangen, Gerd
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Child Health Care Unit, Region Halland, Kungsbacka, Sweden.
    Dahlgren, Jovanna
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Roswall, Josefine
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Department of Pediatrics, County Hospital, Halmstad, Sweden.
    Infant body mass index growth patterns predicted overweight at five years, waist-to-height ratio did not add to this predictivity2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 5, p. 945-953Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the present study was to examine body mass index (BMI) and waist‐to‐height ratio (WHtR) growth patterns from birth until five years regarding their ability to predict overweight or obesity in children at five years of age.

    Methods: Population‐based longitudinal birth cohort study of 1540 children from the south‐west region of Sweden, recruited at the first visit to the child health care centres in 2007–2008. The children were followed for five years and classified into two weight groups according to the 2012 International Obesity Task Force criteria. BMI and WHtR standard deviation scores (SDS) were analysed with Student's t‐tests and multiple logistic regression models. ©2018 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd

    Results: BMI‐SDS and WHtR‐SDS growth patterns were from an early age different in children with overweight or obesity, compared to in children with normal weight or underweight. Overweight or obesity was significantly predicted by BMI‐SDS at 0–1 month (p < 0.001), ΔBMI‐SDS between 0–1 and 12 months (p < 0.001) and between 18 and 48 months (p < 0.001), but not by WHtR‐SDS, except for a negative association between 18 and 48 months in the boys (p = 0.040).

    Conclusion: Overweight or obesity at five years could be predicted by early BMI‐SDS growth patterns, and WHtR‐SDS did not add to the predictivity with regard to BMI‐SDS. ©2018 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd

  • 107.
    Lindholm, Annelie
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Alm, Bernt
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Dahlgren, Jovanna
    Roswall, Josefine
    Staland-Nyman, Carin
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Almquist-Tangen, Gerd
    Child Health Care Unit, Region Halland, Halmstad, Sweden.
    Nutrition- and feeding practice-related risk factors for rapid weight gain during the first year of lifeManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Rapid weight gain (RWG) during infancy increases the risk of later adiposity and the association between early nutrition and RWG needs to be further studied.

    Objectives: The present study aimed to examine nutrition- and feeding practice-related risk factors for RWG during the first year. 

    Methods: A population-based longitudinal birth cohort study of 1,869 children, classified as having RWG or non-RWG during 0–6 and 6–12 months. RWG was defined as a change > 0.67 in weight standard deviation scores. Associations between nutrition- and feeding practice-related risk factors and RWG were investigated with logistic regression models.

    Results: In the population, 46% had RWG during 0-6 months and 8% during 6-12 months. In the fully adjusted models, bottle feeding at birth, 3-4 and 6 months and nighttime meals containing formula milk at 3-4 months were positively associated with RWG during 0-6 months (p<0.001). Breastfeeding at 3-4 and 6 months was negatively associated with RWG (p<0.01). During 6-12 months, only bottle feeding at 3-4 months was positively associated with RWG (p<0.05).

    Conclusions: RWG was more common during the first 6 months of life, and bottle feeding and formula milk given at night were risk factors for RWG during this period.

  • 108.
    Lindholm, Annelie
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Almquist-Tangen, Gerd
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Alm, Bernt
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Dahlgren, Jovanna
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Roswall, Josefine
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    BMI Growth Patterns over First Five Years Differs between Children Being Obese and Overweight at Five Years of Age Compared with Normal/under Weight Children2016Conference paper (Refereed)
  • 109.
    Lindholm, Annelie
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Roswall, Josefine
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Alm, Bernt
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Almquist-Tangen, Gerd
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Dahlgren, Jovanna
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Staland Nyman, Carin
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Department of Public Health and Community Medicine, The Primary Health Care Unit at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Body mass index classification misses to identify children with an elevated waist-to-height ratio at 5 years of age2019In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 85, no 1, p. 30-32Article in journal (Refereed)
    Abstract [en]

    Background:  Abdominal adiposity is an important risk factor in the metabolic syndrome. Since BMI does not reveal fat distribution, waist-to-height ratio (WHtR) has been suggested as a better measure of abdominal adiposity in children, but only a few studies cover the preschool population. The aim of the present study was to examine BMI and WHtR growth patterns and their association regarding their ability to identify children with an elevated WHtR at 5 years of age.

    Methods: A population-based longitudinal birth cohort study of 1540 children, followed from 0 to 5 years with nine measurement points. The children were classified as having WHtR standard deviation scores (WHtRSDS) <1 or ≥1 at 5 years. Student’s t-tests and Chi-squared tests were used in the analyses.

    Results: Association between BMISDS and WHtRSDS at 5 years showed that 55% of children with WHtRSDS ≥1 at 5 years had normal BMISDS (p < 0.001). Children with WHtRSDS ≥1 at 5 years had from an early age significantly higher mean BMISDS and WHtRSDS than children with values <1.

    Conclusions: BMI classification misses every second child with WHtRSDS ≥1 at 5 years, suggesting that WHtR adds value in identifying children with abdominal adiposity who may need further investigation regarding cardiometabolic risk factors.

    © 2018, International Pediatric Research Foundation, Inc.

  • 110.
    Lindholm, Annelie
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Research and Development Centre Spenshult, Halmstad, Sweden.
    Roswall, Josefine
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Halland Hospital, Halmstad, Sweden.
    Almqvist-Tangen, Gerd
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Child Health Care Unit, Region Halland, Sweden.
    Alm, Bernt
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Child Health Care Unit, Region Halland, Sweden.
    Dahlgren, Jovanna
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bergman, Stefan
    Research and Development Centre Spenshult, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Changes in Waist-to-Height Ratio during Preschool Years Differ between Children being Obese or Overweight at Five Years of Age Compared with not Overweight Children2016In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 86, no Suppl. 1, p. 308-308, article id P1-P465Article in journal (Other academic)
  • 111.
    Lindström, Ulf
    et al.
    Rheumatology and Inflammation Research, Sahlgrenska Academy, Gothenburg, Sweden.
    Bremander, Ann
    Lund University, Lund, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden.
    Haglund, Emma
    Lund University, Lund, Sweden.
    Petersson, Ingemar F.
    Orthopedics, Clinical Sciences, Lund University, Lund, Sweden.
    Jacobsson, Lennart
    Rheumatology and Inflammation Research, Sahlgrenska Academy, Gothenburg, Sweden.
    Patients with Non-AS Axial SpA Have Similar Prevalence Compared to AS, but Worse Perceived Health. Results from a Population Based Study2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, p. A667-A668Article in journal (Refereed)
    Abstract [en]

    Background: Non-radiographic axial spondyloarthritis (SpA) is emerging as a treatable disease comparable to ankylosing spondylitis (AS), but less well studied. Previous studies have described a reversed gender distribution, with AS being more prevalent in the male population and non-radiographic axial SpA more prevalent in the female population. Recent studies have also indicated a similar benefit from treatment with TNF-inhibitors.

    Objectives: The aim of this study was to estimate the prevalence of non-radiographic axial SpA and compare the patient reported outcome measures (PROMS) to that of AS, in Southern Sweden.

    Methods: All health care seeking individuals, ≥18 years, given a SpA-diagnosis, according to the ICD-10 (M45.9, M072, M460, M461, M468, M469, M074, M705 and L405 or M071 or M073), either in primary or specialized care, (N = 5771), during 2003 - 2007, were identified through the regional health care register in Skåne, a county in Southern Sweden with 1.2 million inhabitants (SpAScania cohort). In 2009 they were all sent a questionnaire (response rate; 48%), including questions concerning inflammatory back pain (IBP), the SpA-associated comorbidities constituting the ASAS-criteria (IBD, Ps, Uveitis/tendinitis, heredity), PROMS (BAS-indices, VAS-pain/fatigue/global, EQ5D) and previous/current medication.Non-AS axial SpA was defined as having an ICD10 code supporting a diagnosis of SpA without having one of AS (M45.9), in combination with > 3 months of back pain the last year and the presence of ≥2 of the SpA associated comorbidities. Record review support the notion of using AS as a substitute for radiographic changes. For the “non imaging arm” of the ASAS criteria for axial disease, we used the ICD10 codes above as a substitute for HLA-B27 status. Assuming similar answers from the questionnaire non-responders, prevalence rates were estimated for non-AS axial SpA and AS.

    Results: Among responders 742 had an AS-diagnosis and 640 fulfilled the study criteria for non-AS axial SpA. The frequency of men was 60.5% in the AS group and 29.5% in the non-AS axial SpA group. The prevalence of AS was 0.13% (95% CI; 0.115-0.148) and for non-AS axial SpA 0.11 % (95% CI; 0.096-0.130), with a reverse gender distribution. The means of the PROMs and frequency of comorbidities were higher in the non-AS axial SpA vs both the AS, and the subgroup of AS individuals reporting back pain (BP) > 3months during the last year. Self-reported present use of TNF-inhibitors were similar between the groups (Image 1).

    Conclusions: Prevalence rates for AS and non-AS axial SpA were similar, with a reverse gender distribution. The results suggest that at a population level the proportion with non-AS axial SpA is at least as large as that of AS and report lower levels of perceived health status and similar frequencies of SpA-related comorbidities (except psoriasis) and treatment with TNF-inhibitors, supporting the validity for the used definition in future research.

    Disclosure of Interest: None Declared

  • 112.
    Lindström, Ulf
    et al.
    University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden & Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Petersson, Ingemar F.
    Lund University, Lund, Sweden.
    Jacobsson, Lennart T. H.
    University of Gothenburg, Gothenburg, Sweden & Lund University, Lund, Sweden.
    Back pain and health status in patients with clinically diagnosed ankylosing spondylitis, psoriatic arthritis and other spondyloarthritis: a cross-sectional population-based study2016In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, no 1, article id 106Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In the broader spectrum of back pain, inflammatory back pain (IBP) is a symptom that may indicate axial spondyloarthritis (SpA). The objectives of this study were to determine the frequency of current IBP, as a hallmark sign of possible axial SpA, in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA) and other SpA and to compare self-reported health between the groups with current IBP.

    METHODS: Five-thousand seven hundred seventy one patients identified in the regional healthcare register of the most southern county of Sweden, diagnosed at least once by a physician (based on ICD-codes) with any type of SpA in 2003-2007, were sent a postal survey in 2009. Patients with current IBP were identified, based on self-reported back pain ≥3 months in the preceding year and fulfilling the Berlin criteria for IBP. The frequencies of IBP in AS, PsA and other SpA (including the remaining subgroups of SpA) were determined, and the groups were compared with regard to patient reported outcome measures (PROMs).

    RESULTS: The frequency and proportion of patients with current IBP in AS, PsA and other SpA were 319 (43 %), 409 (31 %) and 282 (39 %) respectively, within the responders to the survey (N = 2785). The proportion was statistically higher in AS, compared to PsA (p < 0.001), but not for AS compared to other SpA (p = 0.112). PsA and other SpA, with current IBP, had similar (BASFI, EQ-5D, patients global assessment, fatigue, spinal pain) or worse (BASDAI) PROMs, compared to AS with current IBP. PsA with current IBP received pharmacological, anti-rheumatic, treatment more frequently than AS with current IBP, while AS and other SpA received treatment to a similar degree.

    CONCLUSION: The proportion of patients with current IBP was substantial in all three groups and health reports in the non-AS groups were similar or worse compared to the AS group supporting the severity of IBP in these non-AS SpA groups. These findings may indicate a room for improvement concerning detection of axial disease within different subtypes of non-AS SpA, and possibly also for treatment.

  • 113.
    Malm, Karina
    et al.
    Lund University, Lund, Sweden, Spenshult Research and Development Center, Oskarström, Sweden & Capio Movement, Halmstad, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Andersson, Maria
    Lund University, Lund, Sweden & Spenshult Research and Development Center, Oskarström, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Lund University, Lund, Sweden & Spenshult Research and Development Center, Oskarström, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Lund University, Lund, Sweden & Spenshult Research and Development Center, Oskarström, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Spenshult Research and Development Center, Oskarström, Sweden.
    THU0628-HPR Lifestyle Habits Relates to Quality of Life in Patient with Longstanding Rheumatoid Arthritis2015In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, no Suppl. 2, p. 1318-1318Article in journal (Refereed)
    Abstract [en]

    Background: Fatigue, pain, stiffness, impaired muscle function and impaired physical function are some of the most pronounced symptoms in rheumatoid arthritis (RA) and these may be related to lifestyle habits such as physical activity, diet, smoking and alcohol.There is limited knowledge about how patient with longstanding RA understand their lifestyles habits in relation to their disease and quality of life.

    Objectives: To describe experiences of how lifestyle habits relate to quality of life in patients with longstanding RA.

    Methods: A qualitative study with a deductive content analysis design, including 17 patients from the Swedish BARFOT (Better Anti-Rheumatic FarmacoTherapy) cohort. BARFOT is a long time follow up study of early RA. Informants were strategically selected by gender (ten women and seven men), age (range 30-84 years), disease duration (8-23 years), function as measured by HAQ, and quality of life as measured by EQ5D. Semi-structured interviews focused on four lifestyle habits (main categories); Physical activity, Diet, Smoking, and Alcohol. The interviews were recorded, transcribed verbatim and coded into subcategories within each of the four main categories.

    Results: In patients with longstanding RA quality of life was related to the four given main categories (lifestyle habits). Each main category included two to three subcategories; (1) Physical activity means barrier, opportunities and well-being, (2) Diet means shame, well-being and social relationship, (3) Smoking means reward and fear, and (4) Alcohol means ambivalence and social relationship.

    Conclusions: In longstanding RA, lifestyle habits relates to quality of life through both positive and negative experiences. This has to be taken into account in clinical care for a better understanding of how patients conceive and adherer to advice on lifestyle.

    References: Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010;376(9746):1094-108.

    Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative health research. 2005;15(9):1277-88.

  • 114.
    Malm, Karina
    et al.
    Research and Development Center, Spenshult, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Research and Development Center, Spenshult, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Andersson, Maria
    Research and Development Center, Spenshult, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Research and Development Center, Spenshult, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    BARFOT study group,
    Predictors of severe self-reported disability in RA in a long-term follow-up study2014In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 8, p. 686-691Article in journal (Refereed)
    Abstract [en]

    Purpose: Identify factors predictive for severe self-reported disability in patients with rheumatoid arthritis. Methods: Patients (n = 1910) were sent a questionnaire 5-18 years after disease onset. Outcomes were the Health Assessment Questionnaire (HAQ), Rheumatoid Arthritis Outcome Score (RAOS) and physical activity. The tertile of patients most affected by the disease were compared to those less affected. Proposed predictive factors were function, pain, general health, radiographic joint damage, swollen/tender joints and disease activity measures at baseline. Age, gender and disease duration were controlled for in logistic regression analyses. Results: Seventy-three percent (n = 1387) responded to the questionnaire, mean age 65 years (SD 15) and 70% were women. Worse scores in function, pain, general health and tender joints at baseline increased the risk of being in the most affected group, as measured by HAQ and RAOS 5-18 years after disease onset (p < 0.000). Conclusion: High levels of pain and worse reports of function at disease onset were risk factors for being in the most disabled tertile of patients after 5-18 years. Pain and function proved to be predictors of the outcome while some measures of inflammation were not. It is important to recognize these patients who may be in need of multidisciplinary treatments already at disease onset.

    Implications for Rehabilitation

    • Health care providers should be aware of the subgroup of patients with more severe symptoms of pain and impaired function at disease onset since they have an increased risk of being in the most disabled tertile of rheumatoid arthritis patients several years later.
    • Health care providers should assess pain and function and act on high pain and impaired function already at disease onset as they proved to be predictors of patient-reported outcomes controlled for inflammatory parameters.
    • These findings support European guidelines and research findings that patients with high pain and impaired function despite of well-managed inflammatory parameters should early in the disease course be referred to multidisciplinary treatment for supplementary regime.
  • 115.
    Malm, Karina
    et al.
    Research and Development Centre, Spenshult, Oskarström.
    Bergman, Stefan
    Research and Development Centre, Spenshult, Oskarström & Lund University, Lund, Sweden.
    Andersson, Maria
    Research and Development Centre, Spenshult, Oskarström & Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Research and Development Centre, Spenshult, Oskarström.
    BARFOT Study Group,
    Worse physical function at disease onset predicts a worse outcome in physical function, but not in meeting who physical activity recommendations, nine years later2013Conference paper (Refereed)
    Abstract [en]

    Background: Long term disease impact on physical functioning in the most affected patients with RA is not well described. Impaired function and inability to be physically active are associated features and it is well known that people with RA are less physically active compared with the general population.

    Objectives: To study predictive variables for a worse outcome in physical function and physical activity measures in a long time follow-up study.

    Methods: Between 1992 and 2005 all patients with newly diagnosed RA according to criteria of the American College of Rheumatology were asked to participate in the BARFOT study, a collaboration between six Swedish rheumatology departments. In 2010 all patients (n=2114) included in the study received a follow-up questionnaire 5-18 years after disease onset. Using logistic regression analyses, the dependent variables physical function (dichotomized by their mean value) were measured with the HAQ (scores 0 to 3, best to worst), the RAOS (Rheumatoid Arthritis Outcome Score) subscales ADL and sport/rec (0-100, worst to best) and meeting vs. not meeting WHO recommendations of physical activity (WHOrec) for a healthy life style (moderate intensity ≥150 min/week or higher intensity for at least 30 minutes 2-3 times/week). Possible predictive variables at baseline were function (HAQ and SOFI, Signals of Functional Impairment, 0-44, best to worse), disease activity (CRP, swollen and tender joints), pain (VAS 0-100, best to worst) and age. We also controlled for sex and disease duration in 2010.

    Results: Questionnaire response was 72% (n=1525), mean (m) age 65 years (SD 14), m follow-up time 9 years (SD 3.7) and 70% (n=1069) were women.

    At inclusion the patients reported a disease duration of m 8 (SD 9) months, HAQ m 1.0 (SD 0.6), VAS pain m 46 (SD24), SOFI m 8.0 (SD6.0). Disease activity was CRP m 30.2 (SD 35.9), swollen joints m 10.2 (SD 5.7) and tender joints m 8.2 (SD 6.2).

    In the 2010 survey, time from inclusion was m 9.4 (SD 3.8) years, the HAQ m 0.6 (SD 0.6), and VAS pain m 35.5 (SD 25.6) had decreased (p<0.001). RAOS ADL was m 71,1 (SD 22.0), RAOS sport/rec m 40.0 (SD 30.0) and 61% (N=894) met the WHOrec.

    Worse scores in the HAQ, VAS pain and SOFI at baseline increased the risk for worse physical function in the 2010 survey measured with the HAQ (VAS pain OR 1.02, SOFI OR 1.09 and HAQ OR 3.98, p<0.000), the RAOS ADL scale (VAS pain OR 1.02, SOFI OR 1,09 and HAQ OR 2.66, p<0.000) and the RAOS sport/rec scale (VAS pain OR 1.02, SOFI OR 1.11 and HAQ OR 2.57, p<0.000). Being a woman, higher age at inclusion and longer disease duration at follow-up also predicted a worse function in the HAQ and both RAOS subscales while none of the studied variables could predict who did/did not meet the WHOrec in 2010.

    Conclusions: Worse physical function and worse pain at disease onset can predict a worse physical function several years later. However, it does not predict the amount of physical activity actually being performed. It is of importance to already at disease onset recognize patients with impaired function and higher pain levels who are in need of multidisciplinary treatments. It is also important to early in the disease recommend a healthy life style according to the WHOrec since measures of function and being physically active are different entities.

    Disclosure of Interest: None Declared

  • 116.
    Malm, Karina
    et al.
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden; Rheumatology, Capio Movement, Halmstad, Sweden & FoU Spenshult, Halmstad, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Andersson, Maria LE
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing. Spenshult Research and Development Center, Halmstad, Sweden.
    Quality of life in patients with established rheumatoid arthritis: A phenomenographic study2017In: SAGE Open Medicine, E-ISSN 2050-3121, Vol. 5, article id 2050312117713647Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Patients with rheumatoid arthritis perceive reduced quality of life in several domains, such as physical health, level of independence, environment and personal beliefs, compared with the healthy population. There is an increasing interest in quality of life in clinical and medical interventions. Few studies have explored patients' individual conceptions of quality of life, and interviews can thus complement quantitative studies. There is a need for a deeper understanding of the patients' experiences of quality of life, with regard to living with a long-term condition such as rheumatoid arthritis. The aim of this study was to explore the variation of ways in which patients with established rheumatoid arthritis understand the concept of quality of life.

    METHODS: The study had a qualitative design with a phenomenographic approach, which was used to describe variations in how individuals experience their quality of life. The study is based on interviews with 22 patients with established rheumatoid arthritis enrolled in the BARFOT (better anti-rheumatic pharmacotherapy) study.

    RESULTS: The concept of quality of life could be understood in three different ways: (1) independence in terms of physical functioning and personal finances, (2) empowerment in how to manage life and (3) participation as an experience of belonging in a social context.

    CONCLUSION: The different conceptions of quality of life reflect the complexity in the concept, including physical, psychological and social aspects. This complexity is important to have in mind when health professionals support patients in enhancing their quality of life. © The Author(s) 2017

  • 117.
    Malm, Karina
    et al.
    R&D-centre, Spenshult, Halmstad, Sweden & Capio Movement, Halmstad, Sweden.
    Bergman, Stefan
    R&D-centre, Spenshult, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    R&D-centre, Spenshult, Halmstad, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). R&D-centre, Spenshult, Halmstad, Sweden.
    Andersson, Maria L.
    R&D-centre, Spenshult, Halmstad, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden.
    Discussions of lifestyle habits as an integral part of care management in patients with established rheumatoid arthritis2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 1817-1817, article id FRI10741-HPRArticle in journal (Refereed)
    Abstract [en]

    Background: Rheumatoid arthritis (RA) is associated with an increased risk of developing comorbidities which are known to be associated with lifestyle-related habits; such as having a sedentary lifestyle, having an unhealthy diet, smoking, and over-consumption of alcohol. In 2010, the European League Against Rheumatism (EULAR) published general guidelines on risk management in patients with RA, with an update 2017 (1,2) in which health professionals are encouraged to prioritize discussions with patients regarding their lifestyle and it is of interest to study the extent to which these discussions actually occur.

    Objectives: To study if lifestyle habits; physical activity, diet, smoking and alcohol had been discussed with patients having RA during health care visits.

    Methods: A cross-sectional postal survey in 2017 included 1542 eligible patients from the BARFOT (Better Anti-Rheumatic Pharmacotherapy) study. All patients received a questionnaire including lifestyle habits (physical activity, diet, smoking, and alcohol), and whether these habits had been discussed during health care visits. There was also a question regarding if they would have wanted such a discussion.

    Results: 1,061 patients (68%) responded to the survey (mean age 67 years (SD 13); 73% women). Physical activity was discussed with 49% of the patients (figure 1A). Those who reported that they were active on a health-enhancing level were more likely to have discussed physical activity with health professionals. Diet had been discussed with 23% of the patients (figure 1B). Patients who reported a non-traditional mixed diet were more likely to have discussed diet. Smoking was discussed with 25% of the patients (figure 1C). Current smokers had more often discussed smoking habits with healthcare professionals compared with never smokers (32% vs. 17%; p=0.000). Alcohol had been discussed with 17% of the patients (figure 1D). Of the patients with hazardous drinking habits, 77% had not had a discussion regarding alcohol.

  • 118.
    Malm, Karina
    et al.
    Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden & Spenshult Research and Development Centre, Halmstad, Sweden & Rheumatology, Capio Movement, Halmstad, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden & Spenshult Research and Development Centre, Halmstad, Sweden & Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden & Spenshult Research and Development Centre, Halmstad, Sweden & Department of Regional Health Research, University of Southern Denmark, Odense, Denmark & Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Centre, Halmstad, Sweden.
    Andersson, Maria L. E.
    Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden & Spenshult Research and Development Centre, Halmstad, Sweden.
    Discussions of lifestyle habits as an integral part of care management: a cross-sectional cohort study in patients with established rheumatoid arthritis in Sweden2019In: Rheumatology Advances in Practice, E-ISSN 2514-1775, Vol. 3, no 2, article id rkz039Article in journal (Refereed)
    Abstract [en]

    Objectives: The primary aim was to determine whether patients with RA recalled having discussions concerning lifestyle habits during their health-care visits. The secondary aim was to study the association between patients' reported lifestyle and their wish to discuss it.

    Methods: A postal questionnaire sent to 1542 eligible patients from the Better Anti-Rheumatic Pharmacotherapy (BARFOT) study included questions on lifestyle habits (physical activity, diet, smoking and alcohol), on whether these were discussed during health-care visits and on whether there was an interest in such discussions.

    Results: A total of 1061 patients (68%) responded [mean age 67 (s.d. 13) years, 73% women]. Half of the patients (49%) recalled discussions on physical activity, and 23% recalled discussions about diet. Those who reported health-enhancing levels of physical activity were more likely to discuss physical activity with their health professionals. Likewise, patients who reported having a non-traditional mixed diet were more likely to discuss diet. Smoking was discussed with 25% of the patients, more often with current smokers than with non-smokers (32 vs 17%; P < 0.001). Alcohol was discussed with 17% of the patients. Of those patients who reported having hazardous drinking habits, 77% had not discussed alcohol use with any health professional.

    Conclusion: Discussions about lifestyle were recalled by half of the patients with established RA. There is a need for improvement, because lifestyle habits may affect the long-term outcome in a chronic disease, such as RA. Patient education concerning lifestyle habits should be an integral part of care management and an interactive process. © Malm et al. 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology.

  • 119.
    Malm, Karina
    et al.
    Spenshult Research and Development Center, Oskarström, Sweden & Rheumatology, Capio Movement, Halmstad, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Spenshult Research and Development Center, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Andersson, Maria
    Spenshult Research and Development Center, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, Gothenburg, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Oskarström, Sweden.
    Quality of Life in Patient with Established Rheumatoid Arthritis: A Qualitative Study2016In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 75, no Suppl 2, article id 1308Article in journal (Refereed)
    Abstract [en]

    Background: Fatigue, pain, stiffness and impaired physical function are some of the most pronounced symptoms in rheumatoid arthritis (RA) that may affect quality of life. Quality of life is an individual experience composed of a wide range of factors, including physical health, psychological state, level of independence, social relationships, and the patients' relationship to salient features of their environment. There is a need to describe and assess quality of life in chronic diseases like established RA. Previous research has mainly focused on disease-specific instruments for assessing quality of life. A deeper understanding of patients' experience of quality of life in established RA is important in both clinical research and daily clinical practice.

    Objectives: To describe variations in patients' experiences of quality of life in established RA.

    Methods: The study had a qualitative design with a phenomenographic approach, including 22 interviews with patients from the Swedish BARFOT (Better Anti-Rheumatic FarmacoTherapy) cohort, BARFOT, a long time follow up study of early RA. Patients were strategically selected by gender (14 women and 8 men), age (30 to 84 years old), disease duration (8–23 years), function as measured by HAQ (0–1.38), and quality of life as measured by EQ5D (0.52–1.00). The interviews were recorded, transcribed verbatim and coded into categories.

    Results: Four categories emerged from the patients' experiences of quality of life in established RA: well-being, freedom, empowerment, and participation. Quality of life as well-being meant pleasure and being physical active. Quality of life as freedom meant dependence or independence in the ability to manage daily life activities. Quality of life as empowerment meant different coping strategies, such as positive thinking and resources to manage fatigue, pain and physical function. Quality of life as participation meant togetherness in different contexts with other people.

    Conclusions: Quality of life in established RA could be understood by the patients in different ways. The patients experienced quality of life as well-being, freedom, empowerment, and participation. This is important knowledge when evaluating the concept of quality of life in RA research, and for health professionals when promoting quality of life in patients with RA.

  • 120.
    Malm, Karina
    et al.
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden & Rheumatology, Capio Movement, Halmstad, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden .
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Andersson, Maria L E
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden & Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    The influence of lifestyle habits on quality of life in patients with established rheumatoid arthritis: A constant balancing between ideality and reality2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, article id 30534Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Rheumatoid arthritis (RA) is a chronic, inflammatory, and systemic disease with symptoms that limit activities and affect quality of life. RA is associated with an increased risk of developing comorbidities, some of which are also known to be associated with lifestyle habits such as physical activity, diet, smoking, and alcohol. There has been an augmented focus on the implementation and maintenance of healthy lifestyle habits even for patients with RA in the past decade, but little is known about the link between patients' experiences of lifestyle habits and quality of life. The aim of the study was thus to describe and explore how patients with established RA experience the influence of lifestyle habits on quality of life.

    METHODS: The study had a descriptive and explorative design, based on qualitative content analysis. Strategic sampling was used in order to achieve variations in experiences. Twenty-two patients with RA (14 women and 8 men) from 30 to 84 years old, with a disease duration ranging from 8 to 23 years, were interviewed.

    RESULTS: The analysis of the influence of lifestyle habits on quality of life resulted in the theme balancing between ideality and reality. Three categories emerged about how lifestyle habits influenced quality of life by limitations (including insufficiency and adaptation), self-regulation (including guilt and motivation), and companionship (including belonging and pleasure).

    CONCLUSIONS: Quality of life for patients with established RA was influenced by the balance between ideality and reality in the lifestyle habits: physical activity, diet, smoking, and alcohol. This is important new knowledge for health professionals when discussing lifestyle habits with RA patients.

  • 121.
    Malmborg, Julia
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS).
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. FoU Spenshult, Halmstad, Sverige.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). FoU Spenshult, Halmstad, Sverige.
    Orthorexic Eating Behavior in Relation to Health Status and Physical Activity: A Comparison Between Students in Two University Programs2015In: Book of Abstracts of the 20th Annual Congress of the European College of Sport Science - 24th - 27th June 2015, Malmö - Sweden / [ed] Radmann, A., Hedenborg, S., Tsolakidis, E., Cologne: SporTools , 2015, p. 497-498Conference paper (Refereed)
    Abstract [en]

    Background

    Orthorexia nervosa (ON) is a condition described as ‘unhealthy’ behaviors regarding diet and physical activity. There is an ongoing discussion if ON is more common among adolescents studying in the area of health care and exercise. The research on ON is scarce and few studies assess ON and its association to health related quality of life (HRQoL).

    Aim

    The aim was to study orthorexic eating behavior, levels of physical activity and HRQoL in students enrolled at university programs focusing on health and exercise compared to those enrolled in business programs.

    Method

    128 subjects, 32 men and 38 women from Biomedicine – Athletic Training (Biomedicine) and 22 men and 36 women from Construction and Real Estate Business (Business) participated in this cross-sectional study. The subjects completed the Short Form-36 Health Survey (SF-36) to measure HRQoL, the International Physical Activity Questionnaire (IPAQ) to measure levels of physical activity and ORTO-15 which examines eating behavior. A score less than 40 on ORTO-15 (score ranging from 0-60, worst to best) indicated an unhealthy relation to diet and was considered as ON in this study (Donini et al., 2005). Differences between groups were analyzed with t-tests and chi-square test.

    Results

    A total of 105 out of 128 (82%) subjects had a score indicating ON. Students from Biomedicine had a higher frequency of ON in comparison to Business (p < 0.000) and in the SF-36 subscale bodily pain, Biomedicine students reported a higher frequency of pain (p = 0.006). Results from measurements of physical activity did not differ significantly between Biomedicine and Business students, but there was a trend for high-intensity physical activity to occur more frequently in men than in women in general (p = 0.014).

    Conclusion

    ON is a common condition in university students and even more frequent in students enrolled in a program directed towards health and nutrition. The high frequency of ON seen in Biomedicine students could be a problem that needs to be addressed since the students, after graduation, are expected to coach other people to a healthy living. Further studies are needed to explore associations with ON to health and physical activity. There is also a need to develop valid and reliable instruments for assessing the condition.

  • 122.
    Malmborg, Julia
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Olsson, Charlotte M.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Pain and its association to health, orthorexia nervosa, sports performance, and physical maturity in sport school adolescents2017In: Proceedings of the Nordic Sport Science Conference – ‘The Double-Edged Sword of Sport: Health Promotion Versus Unhealthy Environments’ / [ed] Hertting, K. & Johnson, U., Halmstad: Halmstad University Press, 2017, p. 56-57Conference paper (Refereed)
  • 123.
    Malmborg, Julia
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden & Lund University, Lund, Sweden.
    Olsson, Charlotte M.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). University of Gothenburg, Gothenburg, Sweden; Spenshult Research and Development Center, Halmstad, Sweden & Lund University, Lund, Sweden.
    Health status, physical activity, and orthorexia nervosa: A comparison between exercise science students and business students2017In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 109, p. 137-143Article in journal (Refereed)
    Abstract [en]

    Orthorexia nervosa is described as an exaggerated fixation on healthy food. It is unclear whether students in health-oriented academic programs, highly focused on physical exercise, are more prone to develop orthorexia nervosa than students in other educational areas. The aim was to compare health status, physical activity, and frequency of orthorexia nervosa between university students enrolled in an exercise science program (n = 118) or a business program (n = 89). The students completed the Short Form-36 Health Survey (SF-36), the International Physical Activity Questionnaire (IPAQ), and ORTO-15, which defines orthorexia nervosa as a sensitive and obsessive behavior towards healthy nutrition. The SF-36 showed that exercise science students scored worse than business students regarding bodily pain (72.8 vs. 82.5; p = 0.001), but better regarding general health (83.1 vs. 77.1; p = 0.006). Of 188 students, 144 (76.6%) had an ORTO-15 score indicating orthorexia nervosa, with a higher proportion in exercise science students than in business students (84.5% vs. 65.4%; p = 0.002). Orthorexia nervosa in combination with a high level of physical activity was most often seen in men in exercise science studies and less often in women in business studies (45.1% vs. 8.3%; p < 0.000). A high degree of self-reporting of pain and orthorexia nervosa in exercise science students may cause problems in the future, since they are expected to coach others in healthy living. Our findings may be valuable in the development of health-oriented academic programs and within student healthcare services. © 2016 Elsevier Ltd

  • 124.
    Malmborg, Julia
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Olsson, M. Charlotte
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bergman, A.-C.
    Spenshult Research and Development Center, Halmstad, Sweden.
    Brorsson, Sofia
    Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sleeping Problems and Anxiety is Associated to Chronic Multisite Musculoskeletal Pain in Swedish High School Students2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, no Suppl. 2, p. 226-226, article id OP0361-HPRArticle in journal (Refereed)
    Abstract [en]

    Background: The relationship between chronic multisite musculoskeletal pain (CMP) and sleep is complex, where pain can lead to sleeping problems and lack of sleep can intensify the pain perception. Most previous studies relates to adults, but adolescents may also suffer from CMP, and there is a need for more knowledge regarding the relationships between CMP and sleeping problems, stress, anxiety, depression, and health status.

    Objectives: To study background factors associated to CMP in first year Swedish high school students.

    Methods: First year Swedish high school students (n=296) were invited to complete questionnaires on chronic pain (mannequin with 18 body regions), sleeping problems (Uppsala Sleep Inventory, four items scored from 1–5), stress (ELO questions, scored from 1–5), anxiety and depression (Hospital Anxiety and Depression Scale, scored from 0–21), health status (EQ-5D, scored from 0 to 1, worst to best) and physical activity (International Physical Activity Questionnaire, categorised into low, moderate and high levels). Stress and sleeping items were dichotomized into 1–3 points (best) vs 4–5 points (worst). Individuals scoring at least severe problems (4 points) at one or more sleeping items were classified as having severe sleeping problems. HADS were categorised as non-cases (0–7), possible7–10 and probable cases (11–21 points). Students were grouped as having CMP (pain present in ≥3 regions) or not (no chronic pain or chronic pain in 1–2 regions). Multiple logistic regression analyses (adjusted for sex) with CMP as dependent variable were performed in SPSS, version 24.

    Results: 254 students (86% of total sample, 87 boys and 167 girls) with a mean age of 16.1 (SD 0.6) years participated in the study. CMP was present in 25 (9.8%) students with no differences between boys and girls (8.0% vs 10.8%; p=0.488). Having CMP was associated with reporting severe sleeping problems (OR 2.49, 95% CI: 1.06 to 5.81, p=0.035) with initiating sleep, maintaining sleep, early morning awakenings and/or not feeling restored after sleep in comparison to the other students. Students with CMP were more likely to be categorised as probable cases for anxiety (OR 3.06, 95% CI: 1.09 to 8.61, p=0.034), but there were no associations for possible cases for anxiety (OR 1.15, 95% CI: 0.38 to 3.51, p=0.800), possible cases (OR 2.03, 95% CI: 0.63 to 6.54), or probable cases for depression (OR 3.35, 95% CI: 0.33 to 33.83). There was a nearly significant association between stress and belonging to the CMP group (OR 2.31, 95% CI: 0.97 to 5.53, p=0.059). A higher self-reported health status was associated to a lower likelihood for CMP (OR 0.04, 95% CI: 0.01 to 0.27, p=0.001). Distribution of physical activity levels of low, moderate and high was not significantly associated to having CMP in comparison with not having it.

    Conclusions: One in ten high school students fulfilled criteria for having chronic multisite musculoskeletal pain. CMP was associated to sleeping problems, anxiety, and a worse health status. The results from this study may be used by school health-care professionals in their preventive work to promote student’s health.

    Disclosure of Interest: None declared

  • 125.
    Malmborg, Julia
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Olsson, Charlotte M.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bergman, Stefan
    Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Daily Musculoskeletal Pain Affects Health And Sports Performance Negatively In Youth Athletes2017In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 49, p. 972-972Article in journal (Refereed)
    Abstract [en]

    In sports, musculoskeletal pain (MSP) is often studied from the perspective of sport specific injuries, why little is known about the prevalence of daily or multisite MSP that does not affect participation in sports. It is also unclear if daily or multisite MSP is a risk factor for worse health-related quality of life (HRQoL) and worse sports performance in youth athletes.

    PURPOSE: To study how HRQoL and sports performance is affected by daily MSP in youth athletes that are able to participate in sports.

    METHODS: 136 Swedish youth athletes attending a sport school (13 to 14 years, boys n=83, girls n=53) completed the EQ-5D measuring HRQoL (range 0 to 1, worst to best), a pain questionnaire including current pain (yes/no), pain in 18 body regions (never to rarely/monthly to weekly/more than once a week to almost daily), and pain intensity in the last week (0 to 10, best to worst), anthropometric measures to estimate biological age, and sports performance tests (grip strength, 20 meter sprint, and countermovement jump(CMJ)).

    RESULTS: 109 to 117 of the 136 students answered the different pain questions. 53 of 113 (47%) reported current MSP, and 28 of 109 (26%) experienced MSP ‘more than once a week to almost daily’ from one or more body regions (frequent MSP group), while 28% (n=30) stated ‘never to rarely’ in MSP (no MSP group). Boys in the frequent MSP group reported worse HRQoL, higher pain intensity, performed worse in all sports performance tests, and had a younger biological age than boys in the no MSP group. Girls in the frequent MSP group reported worse HRQoL and higher pain intensity than the girls in the no MSP group. No other differences were found (table).

    CONCLUSIONS: Every other youth athlete attending a sport school reported current MSP and one out of four reported almost daily MSP. MSP affects HRQoL negatively in both boys and girls, and sports performance negatively in boys. The prevalence of MSP in youth athletes is concerning since pain in younger ages may predict pain in adult ages.

    © 2017 American College of Sports Medicine

  • 126.
    Malmborg, Julia
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Olsson, M Charlotte
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Malmö Sports Academy, Malmö, Sweden.
    Bergman, Stefan
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden.
    Musculoskeletal pain and its association with maturity and sports performance in 14-year-old sport school students2018In: BMJ Open Sport & Exercise Medicine, ISSN 2055-7647, Vol. 4, no 1, article id e000395Article in journal (Refereed)
    Abstract [en]

    Objectives: In youth sports, musculoskeletal pain is often studied from the standpoint of sports injuries, but little is known about pain conditions in which athletes still participate. The aim was to study the frequency of pain and associations with maturity offset, health status and sports performance in 14-year-old sport school students.

    Methods: Cross-sectional design. One hundred and seventy-eight students (108 boys and 70 girls) completed anthropometric measures for maturity offset (height, weight and sitting height), questionnaires (pain mannequin and EQ-5D for health status) and sports performance tests (sprint, agility, counter-movement jump and grip strength). Differences between groups were analysed with Student’s t-test and analysis of covariance.

    Results: Thirty-one students (18.6%) reported infrequent pain, 85 (50.9%) frequent pain and 51 (30.5%) constant pain. Students in the constant pain group had worse health status than those in the infrequent pain group. Boys with constant pain (n=27) had a lower mean maturity offset (–0.38 vs 0.07 years; p=0.03) than boys with infrequent pain (n=22), and pain was associated with worse sports performance. There was no difference in maturity or sports performance between girls with constant pain (n=24) and girls with infrequent pain (n=9).

    Conclusion: Musculoskeletal pain is common in sport school students and coincides with worse health status and with a younger biological age in boys. The high prevalence of pain should be acknowledged by coaches and student healthcare workers in order to promote a healthy and sustainable development in young athletes. © Author(s) (or their employer(s)) 2018.

  • 127.
    Malmborg, Julia S
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Bremander, Ann
    University of Southern Denmark, Odense, Denmark & University Hospital of Southern Denmark, Sønderborg, Denmark & Lund University, Lund, Sweden.
    Olsson, M. Charlotte
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bergman, Anna-Carin
    Spenshult Research and Development Center, Halmstad, Sweden.
    Brorsson, A Sofia
    Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden..
    Worse health status, sleeping problems, and anxiety in 16-year-old students are associated with chronic musculoskeletal pain at three-year follow-up2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, no 1, article id 1565Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Chronic musculoskeletal pain is common in adolescents, and it has been shown that adolescents with pain may become young adults with pain. Pain often coincides with psychosomatic symptoms in adults, but little is known about longitudinal associations and predictors of pain in adolescents. The aim was to investigate chronic musculoskeletal pain and its associations with health status, sleeping problems, stress, anxiety, depression, and physical activity in 16-year-old students at baseline, and to identify risk factors using a three-year follow-up.

    METHODS: This was a longitudinal study of 256 students attending a Swedish upper secondary school. Questionnaires regarding chronic musculoskeletal pain and distribution of pain (mannequin), health status (EQ-5D-3 L), sleeping problems (Uppsala Sleep Inventory), stress symptoms (single-item question), anxiety and depression (Hospital Anxiety and Depression Scale), and physical activity (International Physical Activity Questionnaire) were issued at baseline and follow-up. Student's t-test and chi2 test were used for descriptive statistics and logistic regression analyses were used to study associations between chronic pain and independent variables.

    RESULTS: Fifty-two out of 221 students at baseline (23.5%) and 39 out of 154 students at follow-up (25.3%) were categorized as having chronic musculoskeletal pain. Chronic musculoskeletal pain at follow-up was separately associated with reporting of an EQ-5D value below median (OR 4.06, 95% CI 1.83-9.01), severe sleeping problems (OR 3.63, 95% CI 1.69-7.82), and possible anxiety (OR 4.19, 95% CI 1.74-10.11) or probable anxiety (OR 3.82, 95% CI 1.17-12.48) at baseline. Similar results were found for associations between chronic musculoskeletal pain and independent variables at baseline. In multiple logistic regression analysis, chronic musculoskeletal pain at baseline was a predictor of chronic musculoskeletal pain at follow-up (OR 2.99, 95% CI 1.09-8.24, R2 = 0.240).

    CONCLUSION: Chronic musculoskeletal pain at baseline was the most important predictor for reporting chronic musculoskeletal pain at the three-year follow-up, but a worse health status, severe sleeping problems, and anxiety also predicted persistence or development of chronic musculoskeletal pain over time. Interventions should be introduced early on by the school health services to promote student health.

  • 128.
    Meesters, Jorit
    et al.
    Epidemiology and Register Centre South Skåne, Skåne University Hospital, Lund, Sweden & Department of Orthopaedics, Leiden University Medical Centre, Leiden, the Netherlands.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult, Research and Development Center, Oskarström, Sweden.
    Bergman, Stefan
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult, Research and Development Center, Oskarström, Sweden.
    Petersson, Ingemar F.
    Epidemiology and Register Centre South Skåne, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden & Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Turkiewicz, Aleksandra
    Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Englund, Martin
    Epidemiology and Register Centre South Skåne, Skåne University Hospital, Lund, Sweden; Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden & Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, USA.
    The risk for depression in patients with ankylosing spondylitis: a population-based cohort study2014In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 16, no 5, article id 418Article in journal (Refereed)
    Abstract [en]

    Introduction: Depression is frequent in ankylosing spondylitis (AS) patients. However, epidemiological data about the potential increase in risk are lacking. This study compares the rate of doctor-diagnosed depression in a well defined cohort of AS patients to the general population seeking care.

    Methods: The Skåne Healthcare Register comprises healthcare data of each resident in Region Skåne, Sweden (population 1.2 million), including ICD-10 diagnoses. Using physician coded consultation data from years 1999 to 2011, we calculated depression consultation rates for all AS patients. We obtained standardized depression-rate ratios by dividing the observed depression rate in AS patients by the expected rate based on the corresponding age- and sex-specific rates of depression in the general population seeking care. A ratio >1 equals a higher rate of depression among AS patients.

    Results: The AS cohort consisted of 1738 subjects (65% men) with a mean age of 54 years. The reference population consisted of 967,012 subjects. During the 13-year observation period 10% (n = 172) of the AS cohort had a doctor-diagnosed depression compared to 6% (n = 105) to be expected. The standardized estimate of depression-rate ratio was 1.81 (95% confidence interval 1.44 to 2.24) in women men and 1.49 (1.20 to 1.89) in men.

    Conclusions: The rate of doctor-diagnosed depression is increased about 80% in female and 50% in male AS patients. Future challenges are to timely identify and treat the AS patients who suffer from depression. © 2014 Meesters et al.; licensee BioMed Central Ltd.

  • 129.
    Meesters, Jorit
    et al.
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden & Department of Orthopaedics, Rehabilitation and Physical Therapy, LUMC, Leiden, Netherlands.
    Bremander, Ann
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Petersson, Ingemar
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden & Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Bergman, Stefan
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Englund, Martin
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden; Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden & Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, United States.
    Depression is More Common in Patients with Ankylosing Spondylitis as Compared to the General Population Seeking Health-Care2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, p. A556-A556Article in journal (Refereed)
    Abstract [en]

    Background: Ankylosing spondylitis (AS) affects physical function and health related quality of life. Depression has been reported to be frequent in AS patients. However, available epidemiological data are limited and estimates of the potentially increase in risk are lacking.

    Objectives: To compare the rate of doctor-diagnosed depression in a well-defined cohort of AS patients to the general health-care seeking population.

    Methods: The Skåne Health Care Register comprises data from each single health care consultation in the Skåne County, Sweden (population 1.2 million). Data include information about date of consultation and all ICD-10 diagnoses. Linking this register to the Swedish population register adds data regarding death and residency. We studied all patients who were registered with an AS diagnosis (ICD-10 code M45) at least once during 4 calendar years (2004 to 2007). To obtain depression rates we calculated the person-time from the day after the first occurrence of the AS diagnosis within the study period until the day of diagnosis of depression (F32 or F33) or another censoring event (death/relocation). We then obtained standardized depression-rate ratios by dividing the observed depression rate in AS patients by the expected rate based on the corresponding age- and sex specific rates of doctor-diagnosed depression in the general population of the county seeking care (reference population). A ratio >1 equals a higher rate of depression among AS patients than in the reference population of corresponding age and sex distribution.

    Results: We identified 935 AS patients, 67.2% men, mean age (SD) 52.3 (14.8) years. The reference population consisted of 761,210 subjects. During the 4-year observation period 10% (n=94) of the AS cohort had a doctor-diagnosed depression compared to 7% (n=66) to be expected based on data from the reference population. The standardized depression-rate ratio in men (1.41, 95% CI 1.04–1.87) and women with AS (1.43, 95% CI 1.05–1.91) were both significantly elevated in the same order of magnitude (Table).

    Conclusions: The rate of doctor-diagnosed depression was increased by about 40% in both male and female AS patients compared to the general population seeking care. Future challenges are to identify and treat the AS patients who suffer from depression as early as possible.

  • 130.
    Meesters, Jorit J. L.
    et al.
    Epi-centre Skåne, Skåne University Hospital, Medicon village, Lund, Sweden & Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands.
    Petersson, Ingemar F.
    Epi-centre Skåne, Skåne University Hospital, Medicon village, Lund, Sweden & Department of Orthopedics, Clinical Sciences, University of Lund, Lund, Sweden.
    Bergman, Stefan
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult, Research and Development Center, Oskarström, Sweden.
    Haglund, Emma
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult, Research and Development Center, Oskarström, Sweden.
    Jacobsson, Lennart T. H.
    Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult, Research and Development Center, Oskarström, Sweden.
    Sociodemographic and disease-related factors are associated with patient-reported anxiety and depression in spondyloarthritis patients in the Swedish SpAScania cohort2014In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 33, no 11, p. 1649-1656Article in journal (Refereed)
    Abstract [en]

    Anxiety and depression are common among patients with rheumatic diseases. This study aims to explore which factors are associated with self-reported anxiety and depression in a well-defined cohort of spondyloarthritis (SpA) patients. In 2009, 3,711 patients from the SpAScania cohort were sent a postal questionnaire to assess health-related quality of life (HRQoL) and physical and mental functioning. The Hospital Anxiety and Depression Scale measured anxiety (HADS-A) and depression (HADS-D), subscales 0-21, best-worst. HADS ≥8 indicates possible cases of anxiety or depression. One-way ANOVA (p < 0.05) tested for differences among the SpA subtypes in HADS scores. Linear regression analysis adjusted for age, gender, and disease duration was used to test for associations between HADS and independent variables. In total, 2,167 (58 %) patients (52 % females, mean age 55.4 years) returned the questionnaire. In total, 683 (32 %) cases were classified as "possible anxiety" and 305 (14 %) as "possible depression" cases with mean (SD) HADS-A 5.9 (4.3) and HADS-D 4.4 (3.6). There were no differences among the SpA subtypes in HADS-A and HADS-D. HADS-A and HADS-D were associated with lower education, lower physical activity (HADS-D only), chronic pain problems, more fatigue, lower general health, lower HRQoL, lower level of functioning, higher disease activity, and lower self-efficacy. Associations with anxiety and/or depression appear multifactorial in patients with SpA including both personal and disease-related factors. Since these comorbidities are increased in SpA and treatable, they should be screened for in clinical practice, possibly with instruments like the HADS. © 2014, Clinical Rheumatology

  • 131.
    Meesters, Jorit
    et al.
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden & Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands.
    Petersson, Ingemar
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden & Department of Orthopedics, Clinical Sciences, University of Lund, Lund, Sweden.
    Bergman, Stefan
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Haglund, Emma
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Jacobsson, Lennart
    Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Factors Associated with Anxiety and Depression in Spondyloarthritis Patients: Results from the Swedish Population Based SpA Scania Cohort2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, p. A531-A532Article in journal (Refereed)
    Abstract [en]

    Background: Anxiety and depression are more common among patients with rheumatic diseases and can influence treatment options and outcome. However insight in factors associated with anxiety and depression in patients with Spondyloarthritis (SpA) is scarce.

    Objectives: To identify factors associated with self-reported anxiety and depression in a well-defined population based cohort of patients with SpA.

    Methods: In 2009, 3711 adult SpA patients from the SpaScania cohort were identified and involved in a questionnaire survey including patient reported outcome measures (PROMs) to assess quality of life, physical and mental functioning. To assess depression and anxiety the Hospital Anxiety and Depression Scale (HADS-A and HADS-D) was used. Each subscale ranges from 0-21; best to worst. HAD scores of ≥ 8 indicate probable cases of anxiety or depression.Differences in HADS subscale scores among the SpA subgroups were tested by using one-way ANOVA (p<.05). Associations between PROMs and the HADS subscales, were studied with linear regression analysis including each independent variable separately (adjusted for age, gender and disease duration) and presented as β-estimates (95%CI).

    Results: In total 2851 patients (76%) responded to the study invitation, 684 (18%) declined participation and 2167 (58%) returned the questionnaire. Mean age 55.4 (SD 13.9) years, mean disease duration 14.4 (12.1) years and 52% female. SpA subgroups were: Ankylosing spondylitis 501 (23%), Psoriatic arthritis 1171 (54%), and undifferentiated SpA 495 (23%).Mean HADS-A was 5.9 (4.3) and mean HADS-D 4.4 (3.6) respectively for the whole SpA group. In total 683 (32%) cases were classified as probable anxiety cases and 305 (14%) as probable depression cases. No differences in HADS were found among the different SpA subgroups for anxiety or depression (p>0.6).Higher scoring on HADS-A and HADS-D was associated with (table): lower education, lower physical activity (HADS-D only), chronic pain problems, more fatigue, lower general health, lower HRQoL (EQ-5D), lower level of functioning (BASFI), higher disease activity (BASDAI), lower self-efficacy (ASES).

    Conclusions: Patients with SpA do report problems with anxiety and/or depression and associations appear highly multifactorial with a profile of impaired health in general. Screening patients with SpA for anxiety and depression in the clinic is important but using a simple proxy is discouraged. Instead HADS or other comprehensive instruments to assess anxiety or depression should be considered.

  • 132.
    Mogard, E.
    et al.
    Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    Lindqvist, E.
    Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden & Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Risk factors for development and persistence of chronic widespread pain, in ankylosing spondylitis and undifferentiated spondyloarthritis2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no Suppl. 2, p. 922-922Article in journal (Refereed)
    Abstract [en]

    Background Chronic back pain is a prominent symptom in Spondyloarthritis (SpA), and an important contributor to diminished quality of life (1,2). Chronic pain can develop in intensity, become more spread, and progress to chronic widespread pain (2). Mechanisms for this are yet inconsistent (3), and in SpA, knowledge of progression to chronic widespread pain (CWP) is lacking.

    Objectives To study the development of CWP in patients with SpA, and to identify risk factors for development and persistence of CWP.

    Methods A cohort study with baseline and 2.5-year follow-up postal surveys. 644 patients (47% women) with ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (SpA) answered both surveys, and were categorized as no chronic pain (NCP), chronic regional pain (CRP), and CWP. Logistic regression analyses, with CWP as the main outcome were performed. Due to multicollinearity, each risk factor candidate (disease duration, BMI, smoking, and different patient-reported outcome measures; PROMs) were analysed in separate logistic regression models together with a base model (age, sex, and SpA-subgroup).

    Results At follow-up, prevalence estimates for NCP, CRP and CWP were similar to those at baseline, but 38% of the patients had transitioned between the groups. A large group, 72% of the patients with initial CWP, also reported persistent CWP at follow-up (Figure). Risk factors (OR and 95% CI) for development of CWP from initial NCP/CRP were more pain regions (1.36; 1.20–1.53), pain intensity (1.35; 1.20–1.52), fatigue (1.25; 1.13–1.38), global health (1.35; 1.19–1.54), EQ-5D (0.05; 0.01 – 0.19), BASDAI (1.25; 1.07 – 1.45), BASFI (1.32; 1.16 – 1.50), ASES pain (0.97; 0.96 – 0.99), ASES symtom (0.98; 0.97 – 0.99), and HADb (1.10; 1.02 – 1.19). The risk factors for persistent CWP, compared to patients transitioning to NCP or CRP, were similar to those predicting development of CWP, but in addition, also higher age (1.02; 1.00–1.04), and female sex (1.82; 1.06–3.10), predicted the outcome. © 2017 BMJ Publishing Group Limited.

  • 133.
    Mogard, E.
    et al.
    Lund University, Lund, Sweden.
    Olofsson, T.
    Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bergman, Stefan
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Kristensen, L-E
    Copenhagen University Hospital Fredriksberg and Bispebjerg, Copenhagen, Denmark.
    Kvistgaard Olsen, J.
    Copenhagen University Hospital Fredriksberg and Bispebjerg, Copenhagen, Denmark.
    Wallman, JK
    Lund University, Lund, Sweden.
    Lindqvist, E.
    Lund University, Lund, Sweden.
    Chronic Pain in Patients With Established Axial Spondyloarthritis and Assessment of Pain Sensitivity by Computerized Pneumatic Cuff Pressure Algometry: Results from the Spartakus Cohort2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no Suppl. 2, p. 651-651Article in journal (Refereed)
    Abstract [en]

    Background: Pain is a common symptom in all arthritides, and remains a problem also with better treatment options. In axial spondyloarthritis (ax-SpA), data on chronic pain remain scarce.

    Objectives: To study pain distribution, duration and intensity in ax-SpA, and relate this to disease status and measurement of pressure pain sensitivity.

    Methods: Consecutive patients (n=115) with clinical ax-SpA diagnoses (ankylosing spondylitis (AS) or undifferentiated axial spondyloarthritis (USpA)) were examined and answered pain questionnaires. Patients were categorised as having no chronic pain (NCP), chronic regional pain (CRP) or chronic widespread pain (CWP). Pressure pain sensitivity was assessed by computerized pneumatic cuff pressure algometry (CPA) on the dominant lower leg, and pain threshold, pain tolerance and temporal summation (assessed by the temporal summation index, TSI) were recorded. Differences in disease status and pressure pain sensitivity between patients with CWP versus NCP were assessed (Chi-square or Mann-Whitney U-test). Pressure pain sensitivity was also compared between patients with/without unacceptable pain levels (VAS pain >40 versus ≤40; Mann-Whitney U-test).

    Results: Fifty percent of patients reported CWP, irrespective of clinical diagnosis (AS 47%, USpA 53%), and more women than men reported CWP (59% versus 37%, p<0.001). Only 18% of all patients reported NCP. Overall, higher disease activity, pain intensity, worse fatigue, global health and function were observed among patients with CWP compared to those with NCP. There was a trend towards lower pain tolerance in patients with CWP compared to NCP (Table). Lower pain tolerance and higher TSI scores were observed among patients reporting VAS pain >40 versus those with VAS pain scores ≤40 ((mean (SD)) 51.9 (21.2) versus 68.1 (28.1), p=0.007; 0.73 (0.60) versus 0.55 (0.59), p=0.045). 2017, BMJ Publishing Group Limited.

  • 134.
    Mogard, Elisabeth
    et al.
    Lund University, Lund, Sweden.
    Lindqvist, Elisabet
    Lund University, Lund, Sweden.
    Bergman, Stefan
    Spenshult Research & Development Center, Halmstad, Sweden.
    Bremander, Ann
    Lund University, Lund, Sweden.
    Differences in spinal mobility measures in relation to disease duration and between subgroups with axial spondylarthritis2013In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 65, no Special issue, Supplement 10, p. S896-S896, Meeting Abstract: 2105Article in journal (Refereed)
    Abstract [en]

    Background/Purpose: Spinal mobility is a core domain for research and clinical practice in Ankylosing Spondylitis (AS) but less studied in undifferentiated SpA (USpA). Our objective was to study the change of commonly used spinal mobility measures stratified on disease duration in patients with AS and differences in these measures in AS vs. USpA.

    Methods: Patients with AS or USpA were identified from a cohort attending a specialist clinic. A cross sectional studie were the first measures of spinal mobility for each patient recorded during 1999 to 2012 were analyzed. Disease duration was split into tertiles, (<17 years (G1), 18-30 years (G2) and >31 years (G3)). Differences between AS G1/G2/G3 were calculated with Kruskal-Wallis. Differences between AS and USpA were controlled for sex and disease duration (ANCOVA).

    Results: 126 patients with AS vs. 57 with USpA were included in the study, mean (SD) age 48.4 (13.7) vs. 41.6 (11.4) years and 23% vs. 46% were women. In AS, lumbar, and thoracic measures, vital capacity and the BASMI composite score were the first measures to deteriorate in relation to disease duration (G1 vs. G2, p<0.035). Late in the disease all measures had deteriorated (G1 vs. G3, p<0.036). Patients with USpA presented better scores in lumbar, hip and thoracic spinal measures (p<0.05), data controlled for sex and disease duration. In early disease (<17 years) also cervical measures (p<0.05) were less affected compared to patients with AS.

    Conclusion: The first measures to significantly change during the disease course in AS were the lumbar and thoracic mobility measures and the BASMI score. As expected, patients with USpA were less affected in mobility than patients with AS.

  • 135.
    Mogard, Elisabeth
    et al.
    Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    Lindqvist, Elisabet
    Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Spinal Mobility in Axial Spondyloarthritis: A Cross-Sectional Clinical Study2017In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 15, no 1, p. 36-48Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Research concerning spinal mobility in axial spondyloarthritis (axSpA) has focused on ankylosing spondylitis (AS), and data on the clinical diagnosis of undifferentiated spondyloarthritis (USpA) are limited. The objective was to study differences in spinal mobility between axSpA subgroups AS and USpA, including gender differences.

    METHODS: A total of 183 patients with axSpA from a rheumatology clinic were included in the study. The earliest recorded spinal mobility measures (cervical rotation/flexion/extension/lateral flexion, tragus-to-wall distance, vital capacity, chest expansion, thoracic flexion, thoracolumbar flexion, lateral spinal flexion, lumbar flexion and intermalleolar distance) were obtained by specialized physiotherapists. Differences between subgroups were analysed using analysis of covariance, controlled for gender and disease duration.

    RESULTS: In the USpA group (n = 57), the mean [standard deviation (SD)] age was 41.6 (11.4) years, and disease duration was 13 (10.6) years, with 54% men. In the AS group (n = 126), the mean (SD) age was 48.4 (13.5) years, and disease duration 24.6 (13.3) years, with 77% men. Spinal mobility was less restricted in USpA versus AS patients (p ≤ 0.05), with a median (interquartile range) tragus-to-wall distance of 11 (10-12) cm versus 13 (11.3-18.5) cm; thoracolumbar flexion 9 (7-10) cm versus 6.5 (4-9) cm; lateral spinal flexion 29 (25-36) cm versus 21.3 (12-31) cm; lumbar flexion 4.5 (3.5-5.0) cm versus 3.5 (2.0-4.5) cm and intermalleolar distance 113 (102-121) cm versus 101 (86-114) cm. There were no differences between the subgroups in cervical mobility, vital capacity, chest expansion or thoracic flexion, and there were few gender differences, besides anthropometric measures.

    CONCLUSION: Patients with USpA and AS had similar cervical and chest mobility, while thoracic and lumbar mobility were more severely restricted in AS. There were few gender differences in either subgroup. Further studies, to understand the full impact of USpA on spinal mobility, are needed. Copyright © 2016 John Wiley & Sons, Ltd.

  • 136.
    Roswall, J.
    et al.
    Department of Paediatrics, County Hospital Halmstad, Halmstad, Sweden & Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Karlsson, A.-K.
    Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Allvin, K.
    Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Tangen, G. A.
    Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Niklasson, A.
    Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Alm, B.
    Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Child Health Care Unit, County of Halland, Halland, Sweden.
    Dahlgren, J.
    Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Preschool children born moderately preterm have increased waist circumference at two years of age despite low body mass index2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 11, p. 1175-1181Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate the development of waist circumference (WC) in preschool children born preterm compared with a population-based reference.

    BACKGROUND: Children born preterm are reported to be insulin resistant, despite being lean during early childhood. We hypothesize that the mechanism is through increased visceral adiposity.

    METHODS: Data from 4446 preschool children (2169 girls/2277 boys) born in 2001-2006 from a population-based study were compared with longitudinal measurements of body mass index (BMI) and WC from a cohort of 152 children (64 girls/88 boys) born moderately preterm in 2002-2004 (gestational age, 32-37 weeks).

    RESULTS: In the preterm children, the mean WC was 2.8 cm larger compared with the reference group (p < 0.001) at 2 years of age but not at 5 years of age. There was no significant difference in the mean BMI at 2 years of age. The preterm group was significantly leaner at 5 years of age, with a mean BMI of 15.13 compared with 15.98 in the reference group (p < 0.001).

    CONCLUSION: Children born moderately preterm present as lean during early childhood but have an increased waist circumference in infancy, pointing towards a change in fat distribution with more abdominal fat. This may have implications for their metabolic status.

  • 137.
    Roswall, Josefine
    et al.
    Department of Paediatrics, Halland Hospital, Halmstad, Sweden & Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Almqvist-Tangen, Gerd
    Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Child Health Care Unit, Region Halland, Kungsbacka, Sweden.
    Holmén, Anders
    Department of Research and Development, Region Halland, Halmstad, Sweden.
    Alm, Bernt
    Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Child Health Care Unit, Region Halland, Kungsbacka, Sweden.
    Bergman, Stefan
    Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Research and Development Centre Spenshult, Halmstad, Sweden.
    Dahlgren, Jovanna
    Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Strömberg, Ulf
    Department of Research and Development, Region Halland, Halmstad, Sweden & Health Metrics Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Overweight at four years of age in a Swedish birth cohort: Influence of neighbourhood-level purchasing power2016In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, no 1, article id 546Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A number of child/parental factors have been shown to be significant predictors of childhood overweight, although a better understanding of possible contextual influences of neighbourhood-level characteristics might provide new insights leading to tailored, targeted interventions. The aim of this study was to explore the impact of neighbourhood purchasing power and its relationship with other known risk factors related to childhood overweight in a prospective birth cohort.

    METHODS: A prospective, population-based, birth-cohort study was conducted in south-western Sweden, comprising 2,666 infants born in 2007-2008. Childhood overweight was assessed by body mass index (BMI) data from follow-up examinations at four years of age (n = 2,026) and overweight defined according to the International Obesity Task Force. Using logistic regression analysis, the influential child/parental predictors were identified from the candidate predictors, viz. child's gender, as well as birth weight adjusted for gestational age and parental factors at recruitment, including maternal smoking status, maternal BMI (before pregnancy), paternal BMI and parental educational level. The children's residential parishes at follow-up were stratified by parish-level household purchasing power (<10 %, 10-19.9 %, 20-29.9 % and ≥30 % of all resident families with low purchasing power) and the "contextual" influence was analysed. In each such neighbourhood stratum, the adjusted overweight ratio (AOR), i.e. the ratio between the observed number of overweight children and the expected number, taking account of the influential child/parental predictors, was estimated.

    RESULTS: The prevalence of overweight at four years of age was 11.9 %. In the economically strongest neighbourhoods (i.e. <10 % of resident families with low purchasing power), the AOR was 0.60 (95 % confidence interval (CI): 0.34-0.98). The corresponding empirically Bayes-adjusted AOR was 0.73 (95 % CI: 0.46-1.02; 97 % posterior probability of AOR <1). In the other neighbourhood strata, the statistical evidence of a deviant AOR was weaker.

    CONCLUSION: The economically strongest neighbourhoods had a lower prevalence than expected of overweight at four years of age. This finding should prompt studies to acquire more knowledge of potentially modifiable factors that differ between neighbourhoods and are related to childhood overweight, providing a basis for tailored, targeted interventions.

  • 138.
    Roswall, Josefine
    et al.
    Department of Paediatrics, University of Gothenburg, Sahlgrenska Academy, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Almqvist-Tangen, Gerd
    Department of Paediatrics, University of Gothenburg, Sahlgrenska Academy, Sweden & Child Healthcare Team, County of Halland, Sweden.
    Alm, Bernt
    Department of Paediatrics, University of Gothenburg, Sahlgrenska Academy, Sweden.
    Niklasson, Aimon
    Department of Paediatrics, University of Gothenburg, Sahlgrenska Academy, Sweden.
    Nierop, Andreas F. M.
    MUVARA, Leiderdorp, Netherlands.
    Dahlgren, Jovanna
    Department of Paediatrics, University of Gothenburg, Sahlgrenska Academy, Sweden.
    Population-based waist circumference and waist-to-height ratio reference values in preschool children2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 10, p. 1632-1636Article in journal (Refereed)
    Abstract [en]

    AIM: To establish new reference values for measurements of waist circumference and waist-to-height ratio in preschool children.

    METHODS: A population-based, cross-sectional study of 4502 children aged 0-5 years derived from child health care in a Swedish county. Measurements of weight, height and waist circumference were recorded using a standardized procedure.

    RESULTS: New reference values for waist circumference and waist-to-height ratio for preschool children are presented. Reference charts were constructed and are presented. Waist circumference increased with age (r = 0.80, p < 0.001). After adjustment to the individual height, expressed as waist-to-height ratio, there was an inverse correlation to age during the first 5 years of age (r = -0.87, p < 0.001).

    CONCLUSION: The new reference values for waist circumference and waist-to-height ratio for Swedish preschool children enable future identification of new risk populations for childhood obesity. For clinicians, new reference charts for these two variables are provided for practical use.

  • 139.
    Simonsson, M.
    et al.
    Department of Rheumatology, University Hospital, Lund, Sweden & Department of Rheumatology, University Hospital, Lund, Sweden.
    Bergman, Stefan
    Hertig Knut Health Care Center, Halmstad, Sweden.
    Jacobsson, L. T.
    Unit of Rheumatology, University Hospital, Malmö, Sweden.
    Petersson, I. F.
    Spenshult's Hosp. for Rheum. D., Halmstad, Sweden.
    Svensson, B.
    Spenshult's Hosp. for Rheum. D., Halmstad, Sweden.
    The prevalence of rheumatoid arthritis in Sweden1999In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 28, no 6, p. 340-343Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to ascertain the prevalence of rheumatoid arthritis (RA) in a Swedish general adult population. A questionnaire about chronic pain was mailed to a total of 3928 subjects who were chosen as a random sample of the population in two communities in the county of Halland. All persons answering affirmatively to questions intended to identify patients with RA were invited to a clinical examination. X-rays of hands and feet, and analyses of rheumatoid factor and C reactive protein were performed provided that the patients fulfilled two or more of the five clinical items of the 1987 ARA criteria. Furthermore, non-participants were searched for in a patient register and in medical records from the local rheumatology unit in an attempt to identify further cases. Using the modified 1987 ARA criteria for population studies the prevalence rate of RA was calculated to 0.51% (95%, CI = 0.31-0.79).

  • 140.
    Skärsäter, Ingela
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Barkström, Magdalena
    Region Halland, Halmstad, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Dahlqvist Jönsson, Patrik
    Region Halland, Halmstad, Sweden.
    Halila, Fawzi
    Halmstad University, School of Business, Engineering and Science, Centre for Innovation, Entrepreneurship and Learning Research (CIEL).
    Hertz, Anne-Christine
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS).
    Nygren, Jens
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Sant'Anna, Anita
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS).
    Sjöberg, Jeanette
    Halmstad University, School of Education, Humanities and Social Science, Center for Social Analysis (CESAM).
    Tylenius, Andreas
    Theme Health Innovation at Halmstad University  - research, education and collaboration for welfare technology2015In: Abstracts: 19th International Philosophy of Nursing Society (IPONS) conference August 24-26, 2015 Karolinska Institutet, Stockholm, Sweden: Technology, Health Care and Person-centeredness: Beyond Utopia and Dystopia. Thinking the Future., Stockholm: Karolinska Institutet , 2015, p. 41-41Conference paper (Refereed)
    Abstract [en]

    In face of escalating health care costs, new technology holds great promise for innovative solutions and new more sustainable health care model. Welfare technology around a person allowing for greater autonomy and control in health issues and access to tailored information and personalized health behavior interventions. While this offers good opportunities for both public health impact, it also emphasizes the need for properly knowledge base and organizational structure to support a person- centred approach in the development of welfare technology in society. 

    Halmstad University initiated in 2014 a thematic research and educational initiative that has been named Theme Health Innovation. The initiative includes research, education and interaction with the community, region and industry, which in collaboration can contribute with innovative and sustainable solutions to social challenges in the health field. The starting point for the work is action based on societal and individual needs and development of venues for collaboration between different actors and levels of organization. 

    Theme Health Innovation aims to develop and affect people's ability to maintain and promote their health and prevent ill health. Health Innovations developed in encounters between different knowledge, skills and experiences, both within the university's research and education in collaboration with industry and the public sector. Health Innovations that are developed should be based on the needs from the people who will use the innovation, thus have an end user perspective. 

    At the conference, the Theme Health Innovation will be presented including the organizational structure, research as well as training in higher education that support the welfare technical development.

  • 141.
    Söderlin, M. K.
    et al.
    Research and Development Centre, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Petersson, I. F.
    Department of Orthopaedics, Lund University, Skåne University Hospital, Lund, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Svensson, B.
    Department of Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden.
    Smoking at onset of rheumatoid arthritis (RA) and its effect on disease activity and functional status: Experiences from BARFOT, a long-term observational study on early RA2011In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 40, no 4, p. 249-255Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To assess the effects of smoking on disease outcome in a large cohort of patients with early rheumatoid arthritis (RA).

    METHODS: Between 1996 and 2004, 1787 adult patients (disease duration ≤ 1 year) were included in the BARFOT early RA study in Sweden. Smoking status was recorded at inclusion in the study. Disease Activity Score using 28 joint counts (DAS28), C-reactive protein (CRP), Health Assessment Questionnaire (HAQ) score, rheumatoid factor (RF), antibodies to cyclic citrullinated peptide (anti-CCP), general health (GH) and pain visual analogue scales (VAS), and drug treatment were registered at inclusion and at follow-up at 3, 6, and 12 months. European League Against Rheumatism (EULAR) response and remission criteria were applied at 3, 6, and 12 months.

    RESULTS: The proportion of patients who smoked at inclusion in the study fell from 29% in 1996 to 20% in 2004. There were no significant differences in disease activity at inclusion stratified according to smoking status. At 12 months of follow-up, 18% of current smokers at inclusion, 12% of previous smokers, and 11% of never smokers had high disease activity (DAS28 > 5.1, p = 0.005). Significantly fewer current smokers were in remission at 12 months (33%) compared to never smokers (36%) and previous smokers (42%) (p = 0.013). Current smoking at inclusion independently predicted poor EULAR response up to 12 months of follow-up.

    CONCLUSION: The present study gives some support to earlier data indicating that RA patients who smoke have a more active disease but further studies are needed to confirm this.

  • 142.
    Söderlin, Maria
    et al.
    R&D Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Bergman, Stefan
    R&D Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Andersson, Maria
    R&D Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    The Effect of Socioeconomic Class and Immigrant Status on Disease Activity in Rheumatoid Arthritis. Data from BARFOT, A Multicenter Study of Early RA2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, p. A395-A395Article in journal (Refereed)
    Abstract [en]

    Background: There are no studies reporting the effect of immigrant status and socioeconomic status on outcome in rheumatoid arthritis (RA) in Sweden.

    Objectives: We wanted to study the effect of immigration and socioeconomic class on outcome in RA in Sweden.

    Methods: Between 1992 and 2005, 2,800 adult patients were included in the BARFOT early RA study in Sweden. Disease Activity Score 28 joints (DAS28), Health Assessment Questionnaire (HAQ), drug treatment and European League Against Rheumatism (EULAR) response criteria were applied up to 8 years. The patients completed in 2010 a questionnaire enquiring about demographics and lifestyle factors

    Results: A total of 139/1430 (9.5%) of the patients were immigrants. Immigrants had higher baseline mean HAQ (immigrants 1.2 vs. non-immigrants 0.97, p=0.001), DAS28 (5.6 vs. 5.2, p=0.0001), visual analog scale (VAS) pain (56 mm vs. 45 mm, p=0.0001), VAS global health (53 mm vs. 44 mm, p=0.0001) and tender joint count (TJC) (10 vs. 8, p=0.0001), these differences persisting up to 2 years of follow-up and for HAQ up to 8 years of follow-up. Immigrant status did not have effect on swollen joint count (SJC), ESR, CRP or EULAR response. Socioeconomic class did not have impact on treatment or outcome.

    Conclusions: Immigrants scored worse in pain, function and TJC up to 2 years of follow-up, but did not differ in objective measures of inflammation or EULAR outcome as compared to non-immigrants. This could be due to different perceptions of health and pain and/or the stress of immigration. Socioeconomic class did not have impact on treatment or outcome and this could be due to the relatively egalitarian society in Sweden.

    Disclosure of Interest: M. Söderlin Consultant for: Pfizer, Speakers bureau: Abbott, MSD, BMS, Pfizer, S. Bergman: None Declared, M. Andersson: None Declared

  • 143.
    Söderlin, Maria K.
    et al.
    Research and Development Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Andersson, Maria
    Research and Development Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Bergman, Stefan
    Research and Development Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Second-hand exposure to tobacco smoke and its effect on disease activity in Swedish rheumatoid arthritis patients. Data from BARFOT, a multicenter study of RA2013In: Clinical and Experimental Rheumatology, ISSN 0392-856X, E-ISSN 1593-098X, Vol. 31, no 1, p. 122-124Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We studied the prevalence and effect on disease activity of ever having had second-hand exposure to tobacco smoke in Swedish rheumatoid arthritis (RA) patients who had never smoked.

    METHODS: Between 1992 and 2005, 2,800 patients were included in the BARFOT early-RA study in Sweden. Disease Activity Score 28 joints (DAS28), C-reactive protein (CRP), Health Assessment Questionnaire (HAQ), rheumatoid factor (RF), general health and pain visual analogue scales (VAS), and drug treatment were registered at inclusion and at follow-up at 3, 6, and 12 months and 2 and 5 years. EULAR response criteria were applied at the same follow-up points. In 2010, a self-completion postal questionnaire was sent to 2,102 patients in the BARFOT study enquiring about lifestyle habits such as whether they had ever been exposed to tobacco smoke as a result of someone else smoking.

    RESULTS: A total of 963/1,421 patients (68%) had had second-hand exposure to tobacco smoke. At 3, 6, and 12 months, at 2 years, and at 5 years of follow-up, there were no differences in EULAR response between patients who had never smoked and who had been exposed or had not been exposed second-hand to tobacco smoke (p=0.91, p=0.88, p=0.84, p=0.61 and p=0.85, respectively).

    CONCLUSIONS: We did not find any association between second-hand exposure to tobacco smoke and disease activity in RA. © Clinical and Experimental Rheumatology 2013.

  • 144.
    Söderlin, Maria K.
    et al.
    R and D Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Bergman, Stefan
    R and D Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Absent "Window of Opportunity" in smokers with short disease duration. Data from BARFOT, a multicenter study of early rheumatoid arthritis2011In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 38, no 10, p. 2160-2168Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the effect of disease duration and smoking on outcome in early rheumatoid arthritis (RA).

    METHODS: Between 1996 and 2004, 1587 patients were included in the BARFOT early RA (disease duration ≤ 1 year) study in Sweden. European League Against Rheumatism (EULAR) response, Health Assessment Questionnaire (HAQ), rheumatoid factor (RF), and antibodies to cyclic citrullinated peptide (anti-CCP) were recorded at study start and at 3, 6, and 12 months.

    RESULTS: In total, 180 RA patients (11%) had disease duration ≤ 12 weeks. These patients achieved good EULAR response significantly more often at 3 and 12 months than patients with a longer disease duration despite having more aggressive disease [EULAR good response was achieved by 35% and 35% at 3 and 12 months, respectively, among the patients with disease duration ≤ 12 weeks, by 35% and 41% of patients with disease duration of 13-24 weeks, and by 28% and 33% of patients with disease duration of 25-52 weeks (p = 0.02 for 3 months; p = 0.02 for 12 months)]. There was a significant correlation between improvement in Disease Activity Score-28 (DAS28), its individual variables, and Health Assessment Questionnaire (HAQ) and disease duration up to 12 months after study start. For smokers, no such trend was seen.

    CONCLUSION: Up to 12 months after inclusion in the study, there was a significant correlation between improvement in DAS28, its individual components, and HAQ and disease duration, with patients who had a shorter disease duration improving most. Smokers had poorer EULAR response and showed no improvement with regard to disease duration. The Journal of Rheumatology Copyright © 2011. All rights reserved.

  • 145.
    Torell, A.
    et al.
    Ängelholms sjukhus, Ängelholm, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden & Spenshult R&D center, Halmstad, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden; Spenshult R&D center, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult R&D center, Halmstad, Sweden.
    Symptoms of pain, fatigue and self-efficacy in young patients with spondyloarthritis: – a comparison between women and men2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no Suppl. 2, p. 1515-1515Article in journal (Refereed)
    Abstract [en]

    Background; The disease spondyloarthritis (SpA) have often an early onset, and can debuts already in teenagers or young adults.  Knowledge of how these patients reporting pain, fatigue and self-efficacy can help to better understand the characteristics of women and men with SpA.

    Objectives: To study the differences between young women and men with SpA with regards to self-reported questionnaires on pain, fatigue and self-efficacy.

    A cross sectional population based cohort were used to create a young patients with SpA.

    Methods: The study is created on a cross-sectional population based cohort of patients with SpA.  They were identified through a health care register by searching for ICD-10 codes for SpA between the years 2003-2007, responding to a questionnaire survey in 2009. 201 patients, 18-36, 29% with the diagnosis of ankylosing spondylitis, 39% with psoriatic arthritis, and 32% with undifferentiated spondyloarhtritis form a subgroup of young patients eligible for analysis.  The surveys including questions concerning self-reported pain (NRS 0-10 and pain mannequin), fatigue (NRS 0-10), self-efficacy (ASES 10-100, low-high). The pain mannequin was used to categorize patients into groups; non chronic pain, chronic regional pain or chronic generalized pain. Self-reported disease activity (BASDAI 0-10) and health related quality of life (EQ5D, 0-1) were used to describe the group. Characteristic symptoms are reported as mean, standard deviation (SD) and frequencies. Mann- Whitney U test and Chi2 test were used to study gender differences.

    Results: The mean age (SD) was, 30 (5) years, 60 % were women. The group reported disease activity (BASDAI) of 3.8 (2.3), quality of life 0.75 (0.16), and that they had their diagnosis for 7 (5) years. One third were smokers or former smokers, and 69 % reached WHO’s recommended level of health enhancing physical activity. Women reported higher pain 3.9 (2.4) compared to men 2.9 (2.1), p=0.001. In the group of both women and men 21 % reported regional chronic pain, 41 % generalized chronic pain and the remaining 38 % reported non chronic pain. More women reported regional and generalized chronic pain than men, p=0.026. Women reported more fatigue 5.0 (2.6) compared to men 3.9 (2.7), p=0.003, less self-efficacy for pain 53 (20), compared to men 59 (21), p=0.041 and for symptoms 59 (19) compared to men 65 (20), p=0.045.

    Conclusion: A significant proportion of both women and men reported symptoms consistent with chronic generalized pain. Women reported generally impaired health compared to men, with a greater percentage with chronic pain, higher rates of pain and fatigue and reduced self-efficacy to manage pain and symptoms. This information could be valuable for clinicians in the care of young patients with SpA. 

  • 146.
    Waldheim, E.
    et al.
    Unit of Rheumatology, Karolinska University Hospital, Huddinge,Stockholm, Sweden & Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden.
    Elkan, A.-C.
    Unit of Rheumatology, Karolinska University Hospital, Huddinge, Stockholm, Sweden & Department of Medicine, Karolinska Institutet, Huddinge, Sweden & Institute of Environmental Medicine, Karolinska Institutet, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Sweden & Department of Rheumatology, Clinical Sciences, Lund University, Sweden.
    Frostegård, J.
    Institute of Environmental Medicine, Unit of Immunology and Chronic Disease, Karolinska Institutet, Sweden.
    Van Vollenhoven, R.
    Unit of Rheumatology, Karolinska University Hospital, Huddinge, Stockholm, Sweden & Department of Medicine, Karolinska Institutet, Solna, Sweden.
    Henriksson, E. W.
    Unit of Rheumatology, Karolinska University Hospital, Huddinge, Stockholm, Sweden & Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden.
    Extent and characteristics of self-reported pain in patients with systemic lupus erythematosus2013In: Lupus, ISSN 0961-2033, E-ISSN 1477-0962, Vol. 22, no 2, p. 136-143Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Patients' own experiences of subjective symptoms are scarcely covered, and the objective of this study was to investigate the extent and characteristics of self-reported pain in patients with systemic lupus erythematosus (SLE).

    METHODS: This study comprised a cross-sectional design where 84 patients with SLE were asked to complete self-assessments: visual analogue scale of pain and the Short-Form McGill Pain Questionnaire. Medical assessments, including ESR, SLAM, SLEDAI, and SLICC, were also performed.

    RESULTS: Of the study population, 24% reported higher levels of SLE-related pain (≥40 mm on VAS). This group had a significantly shorter disease duration, higher ESR, and higher disease activity, according to the SLAM and SLEDAI, compared to the rest of the study population. This group mainly used the words "tender," "aching," and "burning" to describe moderate and severe pain, and they used a greater number of words to describe their pain. Of the patients with higher levels of pain, 70% reported their present pain as "distressing." The most common pain location for the whole patient population was the joints. Patients rated their disease activity significantly higher than physicians did.

    CONCLUSION: These findings expand the current knowledge of the extent of SLE-related pain and how patients perceive this pain. The results can contribute to affirmative, supportive and caring communication and especially highlight SLE-related pain in patients with a short disease duration and high disease activity.

  • 147.
    Waldheim, E.
    et al.
    Unit of Rheumatology, Karolinska University Hospital, Sweden & Division of Nursing, Department of Neurobiology, Karolinska Institutet, Sweden.
    Elkan, A.-C.
    Innovation and Development SRQ (Swedish Rheumatology Quality Register), Dept. of Rheumatology, Karolinska University Hospital, Sweden & Institute of Environmental Medicine, Karolinska Institutet, Sweden.
    Pettersson, S.
    Unit of Rheumatology, Karolinska University Hospital, Sweden & Division of Nursing, Department of Neurobiology, Karolinska Institutet, Sweden.
    Van Vollenhoven, R.
    Unit of Rheumatology, Karolinska University Hospital, Sweden & Department of Medicine, Solna, Karolinska Institutet, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Sweden & Department of Rheumatology, Clinical Sciences, Lund University, Sweden.
    Frostegård, J.
    Institute of Environmental Medicine, Unit of Immunology and Chronic Disease, Karolinska Institutet, Sweden.
    Welin Henriksson, E.
    Unit of Rheumatology, Karolinska University Hospital, Sweden & Division of Nursing, Department of Neurobiology, Karolinska Institutet, Sweden.
    Health-related quality of life, fatigue and mood in patients with SLE and high levels of pain compared to controls and patients with low levels of pain2013In: Lupus, ISSN 0961-2033, E-ISSN 1477-0962, Vol. 22, no 11, p. 1118-1127Article in journal (Refereed)
    Abstract [en]

    Objective The objective of this paper is to investigate health-related quality of life (HRQoL), fatigue, anxiety and depression in patients with systemic lupus erythematosus (SLE) and higher levels of pain and to compare them to patients with lower levels of pain and controls.

    Method Patients were dichotomized into two groups based on SLE-related pain score on the visual analog scale (VAS): low-pain group (76%, n=64, VAS 0-39 mm) and high-pain group (24%, n=20, VAS 40-100 mm). Sex- and age-matched controls were randomly selected from the general population. Participants were asked to complete questionnaires regarding self-reported pain, HRQoL, fatigue, anxiety and depression. Medical assessments also were recorded.

    Result Fatigue score in the high-pain group (median, 36.5; interquartile range (IQR), 32.5-39.7) was significantly higher (p<0.001) compared to the low-pain group (median, 23; IQR, 14.6-34.1), as well as scores for anxiety (median, 9; IQR, 6.5-11.5) and depression (median, 7.5; IQR, 5.5-9) (p<0.001). The high-pain group had significantly lower scores compared to the low-pain group in all dimensions in the SF-36 (p ≤ 0.001-0.007). No statistical differences were detected between the low-pain group and controls in any measurement except for the dimensions physical function, general health, vitality and social function in SF-36.

    Conclusion Patients with SLE scoring higher degrees of pain were burdened with more fatigue, anxiety and depression and lower levels of HRQoL compared to patients with lower levels of pain who did not differ significantly from the general population in most dimensions. These results elucidate the importance of identifying patients with higher degrees of pain who are probably in need of more extensive multidimensional interventions to decrease symptom burden.

  • 148.
    Åsenlöf, Pernilla
    et al.
    Uppsala University, Uppsala, Sweden.
    Demmelmaier, Ingrid
    Uppsala University, Uppsala, Sweden.
    Emilson, Christina
    Uppsala University, Uppsala, Sweden.
    Pettersson, Susanne
    Uppsala University, Uppsala, Sweden.
    Bergman, Stefan
    Spenshult Centre for Rheumatic Disease, Oskarström, Sweden.
    Step-Up: An Innovative Stepped-Care Protocol for Tailored Behavioral Medicine Treatment in the Management of Musculoskeletal Pain in Primary Care2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, p. A120-A120Article in journal (Refereed)
    Abstract [en]

    Background: Multimodal rehabilitation and tailored behavioral medicine treatments should be provided to patients suffering from persistent and activity limiting pain according to current state-of-science. There is also evidence that a minimal intervention including 'stay-active advice' can produce effects comparable to effects of comprehensive treatment packages. Nevertheless, there is a gap of knowledge regarding which individuals who benefit the most from which modalities of pain treatment, at what time point, and with the highest cost-effectiveness. Accordingly, we have set up an innovative stepped-care protocol for the management of musculoskeletal pain in primary care, which is evaluated in a randomized controlled trial.

    Objectives: The aim is to compare effects and cost-effectiveness of a stepped care model including advice and tailored behavioral medicine pain treatment (experimental condition) with a stepped care model including advice and physical exercises (comparison condition) for patients with low back and neck pain and/or widespread pain including fibromyalgia in primary care. A further aim is to characterize patients who benefit/do not benefit from the respective steps i.e. treatments varying in dose and content.

    Methods: A stratified randomized stepped care design is applied. Stratification is based on primary care center and psychological risk profile. A consecutive selection is performed at primary care centers in southern, central and northern Sweden. After having received a minimal intervention (step 1) comprising 'stay-active advice', participants scoring high on the Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) according to preset criteria are randomly allocated to an eight-week treatment in step 2. The experimental condition includes supervised physical exercises integrated with either (a) graded activity, or (b) hierarchical graded exposure depending on psychological risk profile. The comparison condition includes supervised physical exercises irrespective of risk profile. Primary outcome is pain-related disability complemented with a comprehensive set of secondary outcomes adhering to the IMMPACT recommendations.

    Results: The stepped-care design will be presented including illustrations of conclusions possible to draw with this kind of innovative design.

    Conclusions: There is a call for stepped-care interventions within pain intervention research, particularly in the primary care setting. However, published studies are still lacking. This study will contribute to an important progression of behavioral medicine pain treatments by the way treatments are tailored in accordance with psychological risk profile. This will be discussed to stimulate research activities and collaboration within this area of research and clinical implementation.

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