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  • 151.
    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.

  • 152.
    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.

  • 153.
    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, 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.

  • 154.
    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.

  • 155.
    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).

  • 156.
    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.

  • 157.
    Sylwander, Charlotte
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Centre, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Centre, Halmstad, Sweden & Lund University, 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). Spenshult Research and Development Centre, Halmstad, Sweden & Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden.
    Bergman, Stefan
    Spenshult Research and Development Centre, Halmstad, Sweden & Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden & The Sahlgrenska Academy, University of Gothenburg, Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Gothenburg, Sweden.
    Andersson, Maria L.E.
    Spenshult Research and Development Centre, Halmstad, Sweden & Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden.
    Pressure pain thresholds and the associations with chronic widespread pain, knee osteoarthritis and obesity in individuals with knee pain2020Conference paper (Refereed)
  • 158.
    Sylwander, Charlotte
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Centre, 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 Centre, Halmstad, Sweden.
    Andersson, Maria L.E.
    Spenshult Research and Development Centre, Halmstad, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bergman, Stefan
    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.
    The impact of chronic widespread pain on health status and long-term health predictors: a general population cohort study2020In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 21, no 1, article id 36Article in journal (Refereed)
    Abstract [en]

    Background: Chronic widespread pain (CWP) has a negative impact on health status, but results have varied regarding gender-related differences and reported health status. The aim was to study the impact of CWP on health status in women and men aged 35-54 years in a sample of the general population. The aim was further to investigate lifestyle-related predictors of better health status in those with CWP in a 12- and 21-year perspective.

    Method: A general population cohort study including 975 participants aged 35‒54 years, with a 12- and 21-year follow-up. CWP was measured with a pain mannequin, and the questionnaire included questions on lifestyles factors with SF-36 for measurement of health status. Differences in health status were analysed with independent samples t-test and health predictors with logistic regression analysis.

    Results: The prevalence of CWP was higher in women at all time points, but health status was reduced in both women and men with CWP (p < 0.001) with no gender differences of clinical relevance. At the 12-year follow-up, a higher proportion of women than men had developed CWP (OR 2.04; CI 1.27‒3.26), and at the 21-year follow-up, a higher proportion of men had recovered from CWP (OR 3.79; CI 1.00‒14.33). In those reporting CWP at baseline, a better SF-36 health status (Physical Functioning, Vitality or Mental Health) at the 12-year follow-up was predicted by male gender, having personal support, being a former smoker, and having no sleeping problems. In the 21-year follow-up, predictors of better health were male gender, a weekly intake of alcohol, and having no sleeping problems.

    Conclusion: Women and men with CWP have the same worsening of health status, but men recover from CWP to a greater extent in the long-term. Being male, having social support, being a former smoker, and having no sleeping problems were associated with better health status in those with CWP. © 2020 The Author(s).

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  • 159.
    Sylwander, Charlotte
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Centre, Halmstad, Sweden.
    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; Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Centre, Halmstad, Sweden; Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden .
    Bergman, Stefan
    Spenshult Research and Development Centre, Halmstad, Sweden; Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Andersson, Maria L.E.
    Halmstad University, School of Business, Innovation and Sustainability. Spenshult Research and Development Centre, Halmstad, Sweden; Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden .
    Pressure pain thresholds in individuals with knee pain: a cross-sectional study2021In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 22, article id 516Article in journal (Refereed)
    Abstract [en]

    Background: Knee osteoarthritis (KOA), chronic widespread pain (CWP) and overweight/obesity are public health problems that often coincide, and there is a multifactorial and unclear relationship between them. The study aimed to (1) investigate pain sensitivity, assessed by pressure pain thresholds (PPTs), among women and men with knee pain and (2) associations with, respectively, radiographic KOA (rKOA), CWP, and overweight/obesity.

    Methods: Baseline data from an ongoing longitudinal study involving 280 individuals with knee pain in the 30–60 age group. Pain sensitivity was assessed by PPTs on eight different tender points using a pressure algometer. The participants' knees were x-rayed. Self-reported CWP and number of pain sites were assessed with a pain figure, and overweight/obesity was measured using body mass index (BMI), visceral fat area (VFA), and body fat percentage, assessed with a bioimpedance. Associations were analysed using regression analyses.

    Results: Women reported lower PPTs than men (p < 0.001), but no PPTs differences were found between those with and without rKOA. Low PPTs was associated with female sex, more pain sites, CWP, and a higher VFA and body fat percentage. The tender points second rib and the knees were most affected. The prevalence of CWP was 38 %.

    Conclusions: The modifiable factors, increased VFA, and body fat could be associated with increased pain sensitivity among individuals with knee pain. Longitudinal studies are needed to further investigate the associations. © 2021, The Author(s).

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  • 160.
    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.

  • 161.
    Söderlin, Maria
    et al.
    R&D Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Bergman, Stefan
    R&D Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Andersson, Maria L.E.
    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

  • 162.
    Söderlin, Maria K.
    et al.
    Research and Development Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Andersson, Maria L.E.
    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.

  • 163.
    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.

  • 164.
    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. 

  • 165.
    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.

  • 166.
    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.

  • 167.
    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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