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Overton M, Skoog J, Laukka EJ, Bodin TH, Mattsson AD, Sjöberg L, Hofer SM, Johansson L, Kulmala J, Kivipelto M, Solomon A, Skoog I, Kåreholt I, Sindi S. Sleep disturbances and change in multiple cognitive domains among older adults: a multicenter study of five Nordic cohorts. Sleep 2024; 47:zsad244. [PMID: 37708350 PMCID: PMC10925948 DOI: 10.1093/sleep/zsad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
STUDY OBJECTIVES We examined and compared cross-sectional and longitudinal associations between self-reported sleep disturbances and various cognitive domains in five separate Nordic European longitudinal aging studies (baseline N = 5631, mean age = 77.7, mean follow-up = 4.16 years). METHODS Comparable sleep parameters across studies included reduced sleep duration/quality, insomnia symptoms (sleep latency, waking up at night, and early awakenings), short and long sleep duration, and daytime napping. The cognitive domains were episodic memory, verbal fluency, perceptual speed, executive functioning, and global cognition (aggregated measure). A series of mixed linear models were run separately in each study and then compared to assess the level and rate of change in cognitive functioning across each sleep disturbance parameter. Models were adjusted for age, sex, education, hypnotic usage, depressive symptoms, lifestyle factors, cardiovascular, and metabolic conditions. By using a coordinated analytic approach, comparable construct-level measurements were generated, and results from identical statistical models were qualitatively compared across studies. RESULTS While the pattern of statistically significant results varied across studies, subjective sleep disturbances were consistently associated with worse cognition and steeper cognitive decline. Insomnia symptoms were associated with poorer episodic memory and participants sleeping less or more than 7-8 hours had a steeper decline in perceptual speed. In addition, daytime napping (>2 hours) was cross-sectionally and longitudinally associated with all examined cognitive domains. Most observed associations were study-specific (except for daytime napping), and a majority of association estimates remained significant after adjusting for covariates. CONCLUSION This rigorous multicenter investigation further supports the importance of sleep disturbance, including insomnia, long and short sleep duration, and daytime napping on baseline cognitive functioning and rate of change among older adults. These sleep factors may be targeted in future lifestyle interventions to reduce cognitive decline.
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Affiliation(s)
- Marieclaire Overton
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Johan Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Erika J Laukka
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Timothy Hadarsson Bodin
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Alexander Darin Mattsson
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Linnea Sjöberg
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Scott M Hofer
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Lena Johansson
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jenni Kulmala
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
- Theme Inflammation and Aging. Karolinska University Hospital, Stockholm, Sweden
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Alina Solomon
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
- Theme Inflammation and Aging. Karolinska University Hospital, Stockholm, Sweden
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ingemar Kåreholt
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Institute of Gerontology, School of Health and Welfare, Aging Research Network – Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
| | - Shireen Sindi
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
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Triolo F, Vetrano DL, Sjöberg L, Calderón-Larrañaga A, Belvederi Murri M, Fratiglioni L, Dekhtyar S. Somatic disease burden and depression risk in late life: a community-based study. Epidemiol Psychiatr Sci 2024; 33:e6. [PMID: 38327092 PMCID: PMC10894701 DOI: 10.1017/s2045796024000064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
AIMS Co-occurring somatic diseases exhibit complex clinical profiles, which can differentially impact the development of late-life depression. Within a community-based cohort, we aimed to explore the association between somatic disease burden, both in terms of the number of diseases and their patterns, and the incidence of depression in older people. METHODS We analysed longitudinal data of depression- and dementia-free individuals aged 60+ years from the population-based Swedish National Study on Aging and Care in Kungsholmen. Depression diagnoses were clinically ascertained following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision over a 15-year follow-up. Somatic disease burden was assessed at baseline through a comprehensive list of chronic diseases obtained by combining information from clinical examinations, medication reviews and national registers and operationalized as (i) disease count and (ii) patterns of co-occurring diseases from latent class analysis. The association of somatic disease burden with depression incidence was investigated using Cox models, accounting for sociodemographic, lifestyle and clinical factors. RESULTS The analytical sample comprised 2904 people (mean age, 73.2 [standard deviation (SD), 10.5]; female, 63.1%). Over the follow-up (mean length, 9.6 years [SD, 4 years]), 225 depression cases were detected. Each additional disease was associated with the occurrence of any depression in a dose-response manner (hazard ratio [HR], 1.16; 95% confidence interval [CI]: 1.08, 1.24). As for disease patterns, individuals presenting with sensory/anaemia (HR, 1.91; 95% CI: 1.03, 3.53), thyroid/musculoskeletal (HR, 1.90; 95% CI: 1.06, 3.39) and cardiometabolic (HR, 2.77; 95% CI: 1.40, 5.46) patterns exhibited with higher depression hazards, compared to those without 2+ diseases (multimorbidity). In the subsample of multimorbid individuals (85%), only the cardiometabolic pattern remained associated with a higher depression hazard compared to the unspecific pattern (HR, 1.71; 95% CI: 1.02, 2.84). CONCLUSIONS Both number and patterns of co-occurring somatic diseases are associated with an increased risk of late-life depression. Mental health should be closely monitored among older adults with high somatic burden, especially if affected by cardiometabolic multimorbidity.
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Affiliation(s)
- Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Linnea Sjöberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Wu J, Grande G, Triolo F, Pyko A, Sjöberg L, Ljungman P, Eneroth K, Bellander T, Rizzuto D. Air pollution, social engagement, and depression in older adults: Results from a Swedish population-based cohort study. Environ Pollut 2023; 336:122394. [PMID: 37597733 DOI: 10.1016/j.envpol.2023.122394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/20/2023] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Abstract
Although emerging research has investigated the relationship between outdoor air pollution and depression risk in older adults, the results remain inconclusive. We aimed to determine the relationship between long-term exposure to ambient air pollution and depression among older adults and explore whether active social engagement may modify this association. At baseline (2001-2004), 2812 depression-free older adults from Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) were included. SNAC-K is a longitudinal population-based cohort in Stockholm, Sweden. Incident depression cases occurred during 2004-2013 were ascertained using the Diagnostic and Statistical Manual of Mental Disorders 4th Edition. Air pollution [particulate matter (PM) and nitrogen oxides (NOx)] at the residency were estimated using dispersion models. Social engagement was measured as active participation in social activities (at least twice/week) or inactive (less than twice/week) in the last 12 months. The hazard ratios (HR) and 95% confidence intervals of depression from air pollution exposure of 3-year moving average before diagnosis (1-μg/m3 difference in PM2.5 and PM10, and 10-μg/m3 difference in NOx) were obtained from Cox models considering greenspace and noise. A product term of air pollutant and social activity was added to test the multiplicative interaction and attributable proportion due to interaction was calculated for assessing additive interaction. We identified 137 (4.9%) incident depression cases. Participants exposed to higher concentrations of PM2.5, NOx, and PM10 had 53% (HR:1.53 [1.22, 1.93]), 26% (HR:1.26 [1.01, 1.58]), and 7% (HR:1.07 [0.98, 1.18]) increased hazard of depression, respectively. These associations were largely attenuated in people with active social engagement (HR for PM2.5: 1.04 [0.70, 1.55]; HR for PM10: 0.98 [0.81, 1.18]; and HR for NOx: 1.09 [0.71, 1.66]). Our findings suggest long-term exposure to air pollution may be a risk factor for depression among older adults. An active social engagement might however decrease this risk.
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Affiliation(s)
- Jing Wu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Andrei Pyko
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden; Center for Occupational and Environmental Medicine, Stockholm Region, Stockholm, Sweden
| | - Linnea Sjöberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | | | - Tom Bellander
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden; Center for Occupational and Environmental Medicine, Stockholm Region, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
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Triolo F, Sjöberg L, Calderón-Larrañaga A, Belvederi Murri M, Vetrano DL, Fratiglioni L, Dekhtyar S. Late-life depression and multimorbidity trajectories: the role of symptom complexity and severity. Age Ageing 2023; 52:6974845. [PMID: 36735844 PMCID: PMC9897302 DOI: 10.1093/ageing/afac315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/31/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION as late-life depression is associated with poor somatic health, we aimed to investigate the role of depression severity and symptom phenotypes in the progression of somatic multimorbidity. METHODS we analysed data from 3,042 dementia-free individuals (60+) participating in the population-based Swedish National Study on Aging and Care in Kungsholmen. Using the baseline clinical assessment of 21 depressive symptoms from the Comprehensive Psychopathological Rating Scale, we: (i) diagnosed major, minor (in accordance with DSM-IV-TR) and subsyndromal depression; (ii) extracted symptom phenotypes by applying exploratory network graph analysis. Somatic multimorbidity was measured as the number of co-occurring chronic diseases over a 15-year follow-up. Linear mixed models were used to explore somatic multimorbidity trajectories in relation to baseline depression diagnoses and symptom phenotypes, while accounting for sociodemographic and behavioural factors. RESULTS in multi-adjusted models, relative to individuals without depression, those with major (β per year: 0.33, 95% confidence interval [CI]: 0.06-0.61) and subsyndromal depression (β per year: 0.21, 95%CI: 0.12-0.30) experienced an accelerated rate of somatic multimorbidity accumulation, whereas those with minor depression did not. We identified affective, anxiety, cognitive, and psychomotor symptom phenotypes from the network analysis. When modelled separately, an increase in symptom score for each phenotype was associated with faster multimorbidity accumulation, although only the cognitive phenotype retained its association in a mutually adjusted model (β per year: 0.07, 95%CI: 0.03-0.10). CONCLUSIONS late-life major and subsyndromal depression are associated with accelerated somatic multimorbidity. Depressive symptoms characterised by a cognitive phenotype are linked to somatic health change in old age.
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Affiliation(s)
- Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Linnea Sjöberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Triolo F, Saadeh M, Sjöberg L, Fratiglioni L, Welmer AK, Calderón-Larrañaga A, Dekhtyar S. Pre-pandemic Physical Function and Social Network in Relation to COVID-19-Associated Depressive Burden in Older Adults in Sweden. Innov Aging 2022; 6:igac041. [PMID: 35837440 PMCID: PMC9273957 DOI: 10.1093/geroni/igac041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Objectives
The coronavirus disease 2019 (COVID-19) pandemic, as well as the measures intended to limit its spread, have likely affected older adults’ depressive burden. Good physical functioning and a rich social network may benefit older adults’ mental health. We examined whether pre-pandemic physical functioning and social network were associated with depressive burden during the first wave of the COVID-19 pandemic in Stockholm, Sweden.
Research Design and Methods
A telephone assessment of depressive burden using the symptoms of sadness, anxiety, worrying, reduced sleep, and reduced appetite was conducted in May–September 2020 in 930 older adults from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), an ongoing population-based study. Objective measures of gait speed, muscle strength, and balance; and self-reports of social connections and support were collected in 2016–2019. Logistic models were adjusted for sociodemographic, clinical, lifestyle, and pandemic-related factors (loneliness, change in physical and social engagement, and experience of death due to COVID-19).
Results
Only good muscle strength (odds ratio [OR]: 0.53; 95% confidence interval [CI]: 0.32–0.85; ref: poor strength, ≥17 s) and rich social support (OR: 0.67; 95% CI: 0.45–0.99; ref: poor support) exhibited an independent association with depressive burden, even after accounting for pandemic-related factors. A combination of good muscle strength and rich social support were associated with the greatest reduction in depressive burden (OR: 0.35; 95% CI: 0.18–0.66; ref: poor social support and poor muscle strength).
Discussion and Implications
Prepandemic social support and muscle strength could supply older adults with resilience against the depressive burden associated with the COVID-19 pandemic.
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Affiliation(s)
- Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University , Solna , Sweden
| | - Marguerita Saadeh
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University , Solna , Sweden
| | - Linnea Sjöberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University , Solna , Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University , Solna , Sweden
- Stockholm Gerontology Research Center , Stockholm , Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University , Solna , Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University , Solna , Sweden
- Stockholm Gerontology Research Center , Stockholm , Sweden
| | - Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University , Solna , Sweden
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Sjöberg L, Triolo F, Saadeh M, Dekhtyar S, Calderón-Larrañaga A, Welmer AK. Factors associated with physical activity reduction in Swedish older adults during the first COVID-19 outbreak: a longitudinal population-based study. Eur Rev Aging Phys Act 2022; 19:9. [PMID: 35365065 PMCID: PMC8972725 DOI: 10.1186/s11556-022-00287-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/02/2022] [Indexed: 12/03/2022] Open
Abstract
Background Physical activity (PA) decreased during the COVID-19 pandemic, especially among older adults, potentially leading to adverse consequences for their health. However, factors associated with reductions of PA during the pandemic have not been examined in a population-based sample of older adults. Thus, the aim of this study was to explore the association of pre-pandemic physical, mental, social and lifestyle factors with reductions in PA in older adults during the first wave of COVID-19, and whether the associations differed by age and sex. Methods A population-based sample of 624 participants aged 65-99 years were identified from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) COVID19 Study. Information on pre-pandemic factors was collected through clinical examinations, interviews, and self-administered questionnaires in 2016-2019. Changes in light and intense PA during the first wave of the pandemic (May-September 2020) were self-reported. Data were analyzed using multiple logistic regression models, stratified by age (<70 vs. >80 years) and sex. Results There was an association between pre-pandemic levels of higher depressive symptom burden (Odds Ratio (OR): 2.6, 95% Confidence Interval (CI): 1.1-6.4, <70 years), and impaired balance (OR: 1.7, 95% CI: 1.0-2.8, >80 years old) with reductions in light-intensity PA. Furthermore, the presence of musculoskeletal disease (OR: 1.8, 95% CI: 1.1-2.9, <70 years; OR: 2.3, 95% CI: 1.2-4.4, men), moderate/high levels of neuroticism (OR: 1.6, 95% CI: 1.0-2.6, <70 years; OR: 2.2, 95% CI: 1.3-3.5, women), and poor levels of social support (OR: 2.2, 95% CI: 1.2-4.3, >80 years) were related to reductions in higher-intensity PA. Those who were current smokers (OR: 0.3, 95% CI: 0.1-0.8, <70 years; OR: 0.2, 95% CI: 0.06-0.7, women), or had impaired balance (OR: 0.4, 95% CI: 0.2-0.8, >80 years) were less likely to reduce their levels of higher-intensity PA. Conclusions For future pandemics or waves of COVID-19, development of strategies is warranted for older individuals with psychiatric- or physical illness/dysfunction, as well as those with poor social support to counteract reductions in physical activities. Supplementary Information The online version contains supplementary material available at 10.1186/s11556-022-00287-z.
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Affiliation(s)
- Linnea Sjöberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Tomtebodavägen 18ASE-171 65, Solna, Stockholm, Sweden.
| | - Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Tomtebodavägen 18ASE-171 65, Solna, Stockholm, Sweden
| | - Marguerita Saadeh
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Tomtebodavägen 18ASE-171 65, Solna, Stockholm, Sweden
| | - Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Tomtebodavägen 18ASE-171 65, Solna, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Tomtebodavägen 18ASE-171 65, Solna, Stockholm, Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Tomtebodavägen 18ASE-171 65, Solna, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden.,Women´s Health and Allied Health Professionals Theme, Medical Unit Medical Psychology, Karolinska University Hospital, Stockholm, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Calderón-Larrañaga A, Pérez L, Vetrano D, Triolo F, Sjöberg L, Darin-Mattsson A, Inzitari M, Sindi S. Sleep Disturbances and the Speed of Multimorbidity Development in Old Age. Innov Aging 2021. [PMCID: PMC8970567 DOI: 10.1093/geroni/igab046.1462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Sleep disturbances are prevalent among older adults and are associated with various individual diseases. The goal of this study was to investigate whether sleep disturbances are associated with the speed of multimorbidity development among older adults. Data were gathered from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K), an ongoing population-based study of subjects aged 60+ (N=3363). The study included a subsample (n=1189) without multimorbidity at baseline (<2 chronic diseases). Baseline sleep disturbances were assessed using the Comprehensive Psychiatric Rating Scale, and categorized as none, mild, moderate-severe. The number of chronic conditions throughout the nine-year follow-up was obtained from clinical examinations. Linear mixed models were used to study the association between sleep disturbances and the speed of chronic diseases accumulation, adjusting for sex, age, education, physical activity, smoking, alcohol consumption, depression, pain, and psychotropic drug use. We repeated the analyses including only cardiovascular, neuropsychiatric, and musculoskeletal diseases as the outcome. Moderate-severe sleep disturbances were associated with a higher speed of chronic disease accumulation (ß/year=0.142, p=0.008), regardless of potential confounders. Significant positive associations were also found between moderate-severe sleep disturbances and neuropsychiatric (ß/year=0.041, p=0.016) and musculoskeletal (ß/year=0.038, p=0.025) disease accumulation, but not with cardiovascular diseases. Results remained stable when participants with baseline dementia, cognitive impairment, or depression were excluded. The finding that sleep disturbances are associated with faster chronic disease accumulation points towards the importance of early detection and treatment of sleep disturbances as a possible strategy to reduce chronic multimorbidity among older adults.
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Affiliation(s)
| | - Laura Pérez
- Parc Sanitari Pere Virgili, Barcelona, Catalonia, Spain
| | | | | | | | | | | | - Shireen Sindi
- Karolinska Institutet, Solna, Stockholms Lan, Sweden
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Sindi S, Kåreholt I, Ngandu T, Rosenberg A, Kulmala J, Johansson L, Wetterberg H, Skoog J, Sjöberg L, Wang H, Fratiglioni L, Skoog I, Kivipelto M. Sex differences in dementia and response to a lifestyle intervention: Evidence from Nordic population-based studies and a prevention trial. Alzheimers Dement 2021; 17:1166-1178. [PMID: 34255432 PMCID: PMC8361986 DOI: 10.1002/alz.12279] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Evidence on sex differences in the risk for dementia has been mixed. The goal was to assess sex differences in the development of dementia, and in the effects of a lifestyle intervention. METHODS Two strategies were adopted, one using combined data from three large Nordic population-based cohort studies (n = 2289), adopting dementia as outcome, and 2-year multidomain lifestyle intervention (n = 1260), adopting cognitive change as outcome. RESULTS There was higher risk for dementia after age 80 years in women. The positive effects of the lifestyle intervention on cognition did not significantly differ between men and women. Sex-specific analyses suggested that different vascular, lifestyle, and psychosocial risk factors are important for women and men in mid- and late-life. CONCLUSION Women had higher risk for dementia among the oldest individuals. Lifestyle interventions may be effectively implemented among older men and women.
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Affiliation(s)
- Shireen Sindi
- Division of Clinical GeriatricsCenter for Alzheimer ResearchKarolinska Institutet and Karolinska University HospitalStockholmSweden
- Ageing Epidemiology (AGE) Research UnitSchool of Public HealthImperial College LondonLondonUK
| | - Ingemar Kåreholt
- Aging Research CenterKarolinska Institutet and Stockholm UniversityStockholmSweden
- Institute of GerontologySchool of Health and WelfareAging Research Network – Jönköping (ARN‐J)Jönköping UniversityJönköpingSweden
| | - Tiia Ngandu
- Public Health Promotion UnitNational Institute for Health and WelfareHelsinkiFinland
| | - Anna Rosenberg
- Institute of Public Health and Clinical Nutrition and Institute of Clinical MedicineNeurologyUniversity of Eastern FinlandKuopioFinland
| | - Jenni Kulmala
- Division of Clinical GeriatricsCenter for Alzheimer ResearchKarolinska Institutet and Karolinska University HospitalStockholmSweden
- Public Health Promotion UnitNational Institute for Health and WelfareHelsinkiFinland
| | - Lena Johansson
- Institute of Neuroscience and PhysiologyCenter for Health and Ageing AGECAPSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Hanna Wetterberg
- Institute of Neuroscience and PhysiologyCenter for Health and Ageing AGECAPSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Johan Skoog
- Department of PsychologyCenter for Health and Ageing (AGECAP)University of GothenburgGothenburgSweden
| | - Linnea Sjöberg
- Aging Research CenterKarolinska Institutet and Stockholm UniversityStockholmSweden
| | - Hui‐Xin Wang
- Aging Research CenterKarolinska Institutet and Stockholm UniversityStockholmSweden
- Stress Research InstituteStockholom UniversityStockholmSweden
| | - Laura Fratiglioni
- Aging Research CenterKarolinska Institutet and Stockholm UniversityStockholmSweden
- Stockholm Gerontology Research CenterStockholmSweden
| | - Ingmar Skoog
- Institute of Neuroscience and PhysiologyCenter for Health and Ageing AGECAPSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Miia Kivipelto
- Division of Clinical GeriatricsCenter for Alzheimer ResearchKarolinska Institutet and Karolinska University HospitalStockholmSweden
- Ageing Epidemiology (AGE) Research UnitSchool of Public HealthImperial College LondonLondonUK
- Institute of Public Health and Clinical Nutrition and Institute of Clinical MedicineNeurologyUniversity of Eastern FinlandKuopioFinland
- Theme AgingKarolinska University HospitalStockholmSweden
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9
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Sindi S, Pérez LM, Vetrano DL, Triolo F, Kåreholt I, Sjöberg L, Darin-Mattsson A, Kivipelto M, Inzitari M, Calderón-Larrañaga A. Sleep disturbances and the speed of multimorbidity development in old age: results from a longitudinal population-based study. BMC Med 2020; 18:382. [PMID: 33280611 PMCID: PMC7720467 DOI: 10.1186/s12916-020-01846-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/06/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sleep disturbances are prevalent among older adults and are associated with various individual diseases. The aim of this study was to investigate whether sleep disturbances are associated with the speed of multimorbidity development among older adults. METHODS Data were gathered from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K), an ongoing population-based study of subjects aged 60+ (N = 3363). The study included a subsample (n = 1189) without multimorbidity at baseline (< 2 chronic diseases). Baseline sleep disturbances were derived from the Comprehensive Psychiatric Rating Scale and categorized as none, mild, and moderate-severe. The number of chronic conditions throughout the 9-year follow-up was obtained from clinical examinations. Linear mixed models were used to study the association between sleep disturbances and the speed of chronic disease accumulation, adjusting for sex, age, education, physical activity, smoking, alcohol consumption, depression, pain, and psychotropic drug use. We repeated the analyses including only cardiovascular, neuropsychiatric, or musculoskeletal diseases as the outcome. RESULTS Moderate-severe sleep disturbances were associated with a higher speed of chronic disease accumulation (ß/year = 0.142, p = 0.008), regardless of potential confounders. Significant positive associations were also found between moderate-severe sleep disturbances and neuropsychiatric (ß/year = 0.041, p = 0.016) and musculoskeletal (ß/year = 0.038, p = 0.025) disease accumulation, but not with cardiovascular diseases. Results remained stable when participants with baseline dementia, cognitive impairment, or depression were excluded. CONCLUSION The finding that sleep disturbances are associated with faster chronic disease accumulation points towards the importance of early detection and treatment of sleep disturbances as a possible strategy to reduce chronic multimorbidity among older adults.
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Affiliation(s)
- Shireen Sindi
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden. .,Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK.
| | - Laura Monica Pérez
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,REFiT Barcelona Research Group, Vall d'Hebrón Research Institute and Parc Sanitari Pere Virgili, Barcelona, Spain
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Centro di Medicina dell'Invecchiamento, IRCCS Fondazione Policlinico "A. Gemelli" and Catholic University of Rome, Rome, Italy
| | - Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Ingemar Kåreholt
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Institute of Gerontology, School of Health and Welfare, Aging Research Network - Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
| | - Linnea Sjöberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Alexander Darin-Mattsson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK.,Institute of Public Health and Clinical Nutrition and Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden.,Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Marco Inzitari
- REFiT Barcelona Research Group, Vall d'Hebrón Research Institute and Parc Sanitari Pere Virgili, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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10
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Triolo F, Harber-Aschan L, Belvederi Murri M, Calderón-Larrañaga A, Vetrano DL, Sjöberg L, Marengoni A, Dekhtyar S. The complex interplay between depression and multimorbidity in late life: risks and pathways. Mech Ageing Dev 2020; 192:111383. [DOI: 10.1016/j.mad.2020.111383] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/14/2020] [Accepted: 10/05/2020] [Indexed: 12/20/2022]
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11
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Triolo F, Sjöberg L, Vetrano DL, Darin-Mattsson A, Bertolotti M, Fratiglioni L, Dekhtyar S. Social engagement in late life may attenuate the burden of depressive symptoms due to financial strain in childhood. J Affect Disord 2020; 263:336-343. [PMID: 31969263 DOI: 10.1016/j.jad.2019.11.163] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/22/2019] [Accepted: 11/30/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND It remains poorly understood if childhood financial strain is associated with old-age depression and if active social life may mitigate this relationship. AIMS To investigate the association between childhood financial strain and depressive symptoms during aging; to examine whether late-life social engagement modifies this association. METHOD 2884 dementia-free individuals (aged 60+) from the Swedish National study of Aging and Care-Kungsholmen were clinically examined over a 15-year follow-up. Presence of childhood financial strain was ascertained at baseline. Depressive symptoms were repeatedly assessed with the Montgomery-Åsberg Depression Rating Scale. Social engagement comprised information on baseline social network and leisure activities. Linear, logistic and mixed-effect models estimated baseline and longitudinal associations accounting for sociodemographic, clinical, and lifestyle factors. RESULTS Childhood financial strain was independently associated with a higher baseline level of depressive symptoms (β = 0.37, 95%CI 0.10-0.65), but not with symptom change over time. Relative to those without financial strain and with active social engagement, depressive burden was increased in those without financial strain but with inactive social engagement (β = 0.43, 95%CI: 0.15-0.71), and in those with both financial strain and inactive engagement (β = 0.99, 95%CI: 0.59-1.40). Individuals with financial strain and active social engagement exhibited similar depressive burden as those without financial strain and with active social engagement. LIMITATIONS Recall bias and reverse causality may affect study results, although sensitivity analyses suggest their limited effect. CONCLUSIONS Early-life financial strain may be of lasting importance for old-age depressive symptoms. Active social engagement in late-life may mitigate this association.
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Affiliation(s)
- Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Division of Geriatric Medicine, Department di Biomedical, Metabolic e Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
| | - Linnea Sjöberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alexander Darin-Mattsson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Marco Bertolotti
- Division of Geriatric Medicine, Department di Biomedical, Metabolic e Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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12
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Sjöberg L, Fratiglioni L, Lövdén M, Wang HX. Low Mood and Risk of Dementia: The Role of Marital Status and Living Situation. Am J Geriatr Psychiatry 2020; 28:33-44. [PMID: 31522861 DOI: 10.1016/j.jagp.2019.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study aims to explore whether low mood is related to an increased dementia risk in two cohorts of older adults of different generations, and whether marital status and living situation modify this association. METHODS Participants (≥70 years), free from dementia and living at home, were identified from two population-based studies: the Kungsholmen Project (KP; n = 1,197) and the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K; n = 1,402). Low mood was obtained by self-report (KP and SNAC-K) at baseline in 1987-89 (KP) and 2001-04 (SNAC-K). Incident dementia cases were ascertained over 9 years, using the same diagnostic procedures and comparable criteria for the two cohorts (DSM-III-R in KP and DSM-IV-TR in SNAC-K). Hazard ratios (HR) were derived from Cox proportional hazards models. RESULTS Those having low mood at baseline were at higher risk of dementia in both cohorts combined (HR: 1.2, 95% confidence interval (CI): 1.0-1.4) than those without low mood. However, an increased risk was detected only in those who did not have a partner (HR: 1.5, 95% CI: 1.2-1.9), or lived alone (HR: 1.5, 95% CI: 1.2-1.9), but not among those who had a partner or lived with someone (HR: 0.8, 95% CI: 0.5-1.2). CONCLUSION Marital status and living situation have the potential to buffer the detrimental effects of low mood on dementia onset. Thus, specific attention from health care should target individuals having low mood and who do not have a partner or live alone.
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Affiliation(s)
- Linnea Sjöberg
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University (LS, LF. ML, H-XW), Stockholm, Sweden.
| | - Laura Fratiglioni
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University (LS, LF. ML, H-XW), Stockholm, Sweden; Stockholm Gerontology Research Center (LF), Stockholm, Sweden
| | - Martin Lövdén
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University (LS, LF. ML, H-XW), Stockholm, Sweden
| | - Hui-Xin Wang
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University (LS, LF. ML, H-XW), Stockholm, Sweden; Stress Research Institute, Stockholm University (H-XW), Stockholm, Sweden
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13
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Triolo F, Sjöberg L, Vetrano D, Darin-Mattsson A, Bertolotti M, Fratiglioni L, Dekhtyar S. OLD-AGE DEPRESSIVE SYMPTOMS: THE ROLE OF EARLY-LIFE FINANCIAL STRAIN AND LATE-LIFE SOCIAL ENGAGEMENT. Innov Aging 2019. [PMCID: PMC6840625 DOI: 10.1093/geroni/igz038.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
It remains unclear if childhood socioeconomic disadvantage is associated with depression in old age. This study aims to investigate the effect of childhood financial strain on depressive symptoms in old age, and to examine whether late-life social engagement modifies this association. Data from the Swedish National study of Aging and Care in Kungsholmen, a community-based longitudinal study of aging, spanning clinical assessments over 15 years of follow-up were used. Information on financial strain in childhood was collected at baseline. Repeated measures of the Montgomery–Åsberg Depression Rating Scale were used to define depressive trajectories. A social engagement index comprised information on baseline social network and leisure activities. Linear mixed models were used to estimate depressive trajectories. Childhood financial strain was associated with a higher level of depressive symptoms (β = 0.36; p<0.05), but not the rate of symptom accumulation over time. Relative to those with a combination of no financial strain and active social engagement, the level of depressive symptoms was progressively increased in those without financial strain but with inactive social engagement (β = 0.29; p<0.05), as well as in those with both financial strain and inactive engagement (β= 0.83; p<0.05). Individuals with financial strain who had active social engagement exhibited a similar burden of symptoms as those without financial strain and with rich social engagement. Early-life financial strain may have a lasting effect on old age depressive symptoms, although its detrimental consequences may be modified by active social engagement in late life.
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Affiliation(s)
- Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Linnea Sjöberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Davide Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Alexander Darin-Mattsson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Marco Bertolotti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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14
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Power JEM, Sjöberg L, Kee F, Kenny RA, Lawlor B. Comparisons of the discrepancy between loneliness and social isolation across Ireland and Sweden: findings from TILDA and SNAC-K. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1079-1088. [PMID: 30863870 DOI: 10.1007/s00127-019-01679-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/25/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Loneliness may have different cultural meanings in different countries. This may manifest as differing levels of Social Asymmetry-the discrepancy between loneliness and social isolation. Since loneliness is thought to be low in Sweden relative to more southerly countries, we hypothesised that more number of individuals would also fall into the "discordant robust" category of Social Asymmetry, i.e. that more individuals in Sweden would have lower loneliness levels relative to social isolation than in Ireland. We also explored the clinical relevance of Social Asymmetry in both countries, by examining its association with cognitive functioning. METHODS We derived Social Asymmetry metrics in two representative cohort studies: the Irish Longitudinal Study on Ageing (TILDA) and the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Data pertaining to a dementia-free sample of 4565 Irish participants and 3042 Swedish participants, all aged over 60 years, were analysed using a multilevel modelling approach, with country as a higher-order variable. RESULTS Contrary to the expected, more individuals in Ireland were "discordant robust" than in Sweden. We also found evidence for superior performance in global cognitive functioning among those in the "discordant robust" category relative to those in the discordant susceptible (i.e. those with higher levels of loneliness than social isolation) category, β = 0.61, p < .001, across both countries. CONCLUSIONS Irish older adults may be more robust to the impact of social isolation on loneliness than those in the Swedish cohort. Social Asymmetry was related to cognitive functioning in both countries, suggesting that Social Asymmetry is a clinically relevant construct.
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Affiliation(s)
- Joanna E McHugh Power
- School of Business, National College of Ireland, IFSC, Mayor Street, Dublin 1, Ireland. .,UK CRC Centre of Excellence for Public Health, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, UK.
| | - Linnea Sjöberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Frank Kee
- UK CRC Centre of Excellence for Public Health, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, UK
| | - Rose Ann Kenny
- School of Medical Gerontology and Institute of Neuroscience, Trinity College, Dublin 2, Ireland
| | - Brian Lawlor
- School of Medical Gerontology and Institute of Neuroscience, Trinity College, Dublin 2, Ireland
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Zuidersma M, Sjöberg L, Pantzar A, Fratiglioni L, Wang HX. A bi-factor model of the Montgomery Åsberg depression rating scale and future cognitive impairments in older adults: A 6-year follow-up study. J Psychiatr Res 2019; 109:1-9. [PMID: 30453181 DOI: 10.1016/j.jpsychires.2018.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 10/15/2018] [Accepted: 11/09/2018] [Indexed: 11/15/2022]
Abstract
Depression has been found to be associated with cognitive decline. This study evaluated the association of general depressive symptoms and motivational-related symptoms with cognitive impairment 6 years later and to explore the role of potential underlying mechanisms. In 2690 cognitively healthy persons aged ≥60 from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) depressive symptoms were derived from the Montgomery Åsberg Depression Rating Scale (MADRS). Cognitive performance was assessed at baseline and 6 years later in 1810 persons with the Mini Mental State Examination (global cognition), Digit Span Forward (short-term memory), Digit Span Backward (working memory), Clock-test (visuospatial construction), and the 5-item test (immediate and delayed recall). Bi-factor analysis on the MADRS yielded a General Depression factor and an unrelated Motivational factor. After adjusting for demographics, the General Depression factor was only associated with 6-year impairment in delayed recall (OR (95% CI): 1.18 (1.04-1.34)). This association was no longer significant after adjusting for demographics, cardiovascular risk, lifestyle factors and medication use. The Motivational factor was not significantly associated with future cognitive impairments after adjusting for demographics. Concluding, almost all associations of general depressive symptoms and motivational-related symptoms with future cognitive impairments appeared to be confounded by demographics. Only the association of general depressive symptoms with future memory impairments appeared to be explained by a combination of demographics, cardiovascular risk, lifestyle and medication use.
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Affiliation(s)
- Marij Zuidersma
- University Center of Psychiatry & Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Linnea Sjöberg
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | | | - Laura Fratiglioni
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Hui-Xin Wang
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden; Stress Research Institute, Stockholm University, Sweden.
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16
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Sjöberg L, Mossberg M, Rogenfelt Å, Mcgreevy P, Karlsteen M. Development of a prototype for referees to monitor whip use in horse racing. J Vet Behav 2019. [DOI: 10.1016/j.jveb.2018.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Ek S, Rizzuto D, Fratiglioni L, Calderón-Larrañaga A, Johnell K, Sjöberg L, Xu W, Welmer AK. Risk Factors for Injurious Falls in Older Adults: The Role of Sex and Length of Follow-Up. J Am Geriatr Soc 2018; 67:246-253. [PMID: 30496601 PMCID: PMC7379536 DOI: 10.1111/jgs.15657] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 09/17/2018] [Accepted: 09/17/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To identify sex-specific associations between risk factors and injurious falls over the short (<4 years) and long (4-10 years) term. DESIGN Longitudinal cohort study between 2001 and 2011. SETTING Swedish National Study on Aging and Care, Kungsholmen, Sweden. PARTICIPANTS Community-dwelling adults aged 60 and older (N = 3,112). MEASUREMENTS An injurious fall was defined as a fall that required inpatient or outpatient care. Information was collected on participant and exposure characteristics using structured interviews, clinical examinations, and physical function tests at baseline. RESULTS The multivariate model showed that, in the short term, living alone (hazard ratio (HR)=1.83, 95% confidence interval (CI)=1.13-2.96), dependency in instrumental activities of daily living (IADLs) (HR=2.59, 95% CI=1.73-3.87), and previous falls (HR=1.71, 95% CI=1.08-2.72) were independently associated with injurious falls in women. Low systolic blood pressure (HR=1.96, 95% CI=1.04-3.71), impaired chair stands (HR=3.00, 95% CI=1.52-5.93), and previous falls (HR=2.81, 95% CI=1.32-5.97) were associated with injurious falls in men. Long-term risk factors were underweight (HR=2.03, 95% CI=1.40-2.95), cognitive impairment (HR=1.49, 95% CI=1.08-2.06), fall-risk increasing drugs (HR=1.67, 95% CI=1.27-2.20 for ≥2 drugs), and IADL dependency (HR=1.58, 95% CI=1.32-5.97) for women and smoking (HR=1.71, 95% CI=1.03-2.84), heart disease (HR=2.20, 95% CI=1.5-3.24), impaired balance (HR=1.68, 95% CI=1.08-2.62), and a previous fall (HR=3.61, 95% CI=1.98-6.61) for men. CONCLUSION Men and women have different fall risk profiles, and these differences should be considered when developing preventive strategies. Some risk factors were more strongly predictive of injurious falls over shorter than longer periods and vice versa, suggesting that it may be possible to identify older men and women at short- and long-term risk of injurious falls. J Am Geriatr Soc 67:246-253, 2019.
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Affiliation(s)
- Stina Ek
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Kristina Johnell
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Linnea Sjöberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Allied Health Professionals, Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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Abstract
OBJECTIVES This study aimed at investigating the point prevalence of life weariness and suicidal thoughts and their relationship with socio-demographic characteristics in a population of older adults in Sweden. METHOD Data from 7913 individuals aged 60 years and older were drawn from the Swedish National Study on Aging and Care, a collaborative study in Sweden. Life weariness and suicidal thoughts were measured by one item derived from the Montgomery-Åsberg Depression Rating Scale. A multinomial regression model was used to investigate the relationships of socio-demographic characteristics with life weariness and suicidal thoughts. RESULTS Living in urban and semi-urban areas, being of advanced age, being divorced and having lower educational levels were related to life weariness. Living in a residential care facility, being widowed or unmarried, being born in a non-Nordic European country and experiencing financial difficulties were related to both life weariness and suicidal thoughts. Sex was found to be unrelated to either life weariness or suicidal thoughts. CONCLUSION This study found that several socio-demographic variables were associated with life weariness and suicidal thoughts among older adults. Specific attention to older individuals with these characteristics may be warranted as they might be more vulnerable to life weariness and suicidal thoughts.
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Affiliation(s)
- Hanna Tuvesson
- a Department of Health , Blekinge Institute of Technology , Karlskrona , Sweden
| | - A Hellström
- b Department of Health and Caring Sciences , Linnaeus University , Kalmar , Sweden
| | - L Sjöberg
- c Aging Research Center , Department of Neurobiology, Care Sciences and Society , Karolinska Institutet and Stockholm University , Stockholm , Sweden
| | - B-M Sjölund
- c Aging Research Center , Department of Neurobiology, Care Sciences and Society , Karolinska Institutet and Stockholm University , Stockholm , Sweden.,d Faculty of Health and Occupational Studies , University of Gävle , Gävle , Sweden
| | - E Nordell
- e Department of Geriatric Medicine , Skåne University Hospital , Malmö , Sweden
| | - C Fagerström
- f Blekinge Centre of Competence , Blekinge County Hospital , Karlskrona , Sweden
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Sindi S, Johansson L, Skoog J, Mattsson AD, Sjöberg L, Wang HX, Fratiglioni L, Kulmala J, Soininen H, Solomon A, Johansson B, Skoog I, Kivipelto M, Kåreholt I. Sleep disturbances and later cognitive status: a multi-centre study. Sleep Med 2018; 52:26-33. [PMID: 30216820 DOI: 10.1016/j.sleep.2017.11.1149] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/13/2017] [Accepted: 11/13/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the associations between sleep disturbances in mid-life and late-life and late-life cognitive status. METHODS In four population-based studies (three Swedish studies: H70 study, Kungsholmen Project (KP) and The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD); and one Finnish study: Cardiovascular Risk Factors, Aging and Dementia (CAIDE)), participants provided self-reports on insomnia, nightmares and general sleep problems. Late-life cognitive status was measured by the Mini Mental State Exam (MMSE). The associations between late-life sleep disturbances and cognition 3-11 years later were investigated across all studies (n = 3210). Mean baseline ages were 70 (CAIDE, H70 and SWEOLD), and 84 years (KP). Additional analyses examined the association between midlife sleep and late-life cognition using CAIDE (21 and 31 years follow-up, n = 1306, mean age 50 years), and SWEOLD (20-24 years follow-up, n = 2068, mean age 58 years). Ordered logistic regressions, adjusted for potential baseline confounders, were used in the analyses. RESULTS Late-life sleep disturbances were associated with poorer cognition after 3-11 years (fully adjusted β = -0.12, 95% CI = -0.24 to -0.01). Midlife nightmares and insomnia were also associated with lower MMSE scores (fully adjusted β = -0.28, 95% CI = -0.49 to -0.07 and β = -0.20, 95% CI = -0.39 to -0.01), although the latter association was attenuated after adjusting for lifestyle/health-related confounders. Midlife general sleep problems were not associated with late-life MMSE performance. CONCLUSIONS Sleep disturbances and midlife nightmares were associated with lower MMSE scores, which suggests that sleep disturbances in earlier life stages can be associated with worse late-life cognition.
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Affiliation(s)
- Shireen Sindi
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, United Kingdom.
| | - Lena Johansson
- Institute of Neuroscience and Physiology, Center for Health and Ageing AGECAP, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Skoog
- Institute of Neuroscience and Physiology, Center for Health and Ageing AGECAP, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Psychology, Center for Health and Ageing AGECAP, University of Gothenburg, Gothenburg, Sweden
| | - Alexander Darin Mattsson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Linnea Sjöberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Hui-Xin Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Jenni Kulmala
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland; Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Alina Solomon
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Boo Johansson
- Department of Psychology, Center for Health and Ageing AGECAP, University of Gothenburg, Gothenburg, Sweden
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology, Center for Health and Ageing AGECAP, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, United Kingdom; Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland; Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Ingemar Kåreholt
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Institute of Gerontology, School of Health and Welfare, Aging Research Network - Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
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Sjöberg L, Karlsson B, Atti AR, Skoog I, Fratiglioni L, Wang HX. Prevalence of depression: Comparisons of different depression definitions in population-based samples of older adults. J Affect Disord 2017. [PMID: 28645024 DOI: 10.1016/j.jad.2017.06.011] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Depression prevalence in older adults varies largely across studies, which probably reflects methodological rather than true differences. This study aims to explore whether and to what extent the prevalence of depression varies when using different diagnostic criteria and rating scales, and various samples of older adults. METHODS A population-based sample of 3353 individuals aged 60-104 years from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) were examined in 2001-2004. Point prevalence of depression was estimated by: 1) diagnostic criteria, ICD-10 and DSM-IV-TR/DSM-5; 2) rating scales, MADRS and GDS-15; and 3) self-report. Depression prevalence in sub-samples by dementia status, living place, and socio-demographics were compared. RESULTS The prevalence of any depression (including all severity grades) was 4.2% (moderate/severe: 1.6%) for ICD-10 and 9.3% (major: 2.1%) for DSM-IV-TR; 10.6% for MADRS and 9.2% for GDS-15; and 9.1% for self-report. Depression prevalence was lower in the dementia-free sample as compared to the total population. Furthermore, having poor physical function, or not having a partner were independently associated with higher depression prevalence, across most of the depression definitions. LIMITATIONS The response rate was 73.3% and this may have resulted in an underestimation of depression. CONCLUSION Depression prevalence was similar across all depression definitions except for ICD-10, showing much lower figures. However, independent of the definition used, depression prevalence varies greatly by dementia status, physical functioning, and marital status. These findings may be useful for clinicians when assessing depression in older adults and for researchers when exploring and comparing depression prevalence across studies.
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Affiliation(s)
- Linnea Sjöberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Björn Karlsson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Anna-Rita Atti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Hui-Xin Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden
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Sjöberg L, Fratiglioni L, Wang H. LOW MOOD AND 9-YEAR INCIDENCE OF DEMENTIA: THE ROLE OF MARITAL STATUS AND LIVING SITUATION. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L. Sjöberg
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden,
| | - L. Fratiglioni
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden,
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - H. Wang
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden,
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Sjöberg L, He L, Kaaja R, Tuomilehto J, Pitkäniemi J. Parity and mortality in cases of childhood-onset diabetes mellitus. Diabetes Metab Res Rev 2016; 32:607-14. [PMID: 26787459 DOI: 10.1002/dmrr.2778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 12/29/2015] [Indexed: 11/09/2022]
Abstract
AIMS This study aims to assess the association between parity and mortality in adults with childhood-onset type 1 diabetes (T1D) and their matched controls. METHODS Individual data (308 617 person-years) on mortality and the reproductive histories of a Finnish cohort of 2307 women and 2819 men with T1D, each with two matched controls, were obtained from the National Population Register. All persons with diabetes had been diagnosed with T1D in 1965-1979 at the age of 17 or under. RESULTS All-cause mortality in people without offspring was significantly higher than that in people with children among both people with diabetes and non-diabetic control persons in both sexes (all p-values <0.01). In men with offspring, the decrease of mortality rate compared with men without offspring was less marked among those with diabetes (9% reduction in mortality hazard ratio (HR) with one offspring, 47% with two) than among those without diabetes (33% HR (p = 0.025) and 61% HR (p = 0.023) reduction, respectively). In women with offspring, the association between parity and mortality was independent of diabetes status. Having at least two offspring was associated with a decreased hazard of diabetes-related death regardless of sex; among women with diabetes, even having one offspring was associated with a decreased hazard of dying from diabetes (HR = 0.46; 95% CI 0.31, 0.69). CONCLUSIONS The association between parity and mortality follows different patterns in men and women with T1D. To what extent this reflects effects of health on family planning decisions in people with T1D cannot be defined without further studies. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- L Sjöberg
- University of Helsinki, Department of Public Health, Helsinki, Finland
- University of Helsinki, Department of General Practice and Primary Health Care, Helsinki, Finland
- National Institute of Health and Welfare, Department of Chronic Disease Prevention, Diabetes Prevention Unit, Helsinki, Finland
| | - L He
- University of Helsinki, Department of Public Health, Helsinki, Finland
| | - R Kaaja
- University Hospital of Turku and University of Turku, Turku, Finland
| | - J Tuomilehto
- University of Helsinki, Department of Public Health, Helsinki, Finland
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - J Pitkäniemi
- University of Helsinki, Department of Public Health, Helsinki, Finland
- Finnish Cancer Registry, Helsinki, Finland
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Abstract
AIMS/HYPOTHESIS To assess the number of live births in a population-based, retrospective cohort of women and men with childhood-onset type 1 diabetes, and matched controls. METHODS The reproductive histories of people in a Finnish cohort of 2,307 women and 2,819 men with type 1 diabetes and two matched controls (for each case) were obtained from National Population Register data. All persons with diabetes were diagnosed with the disease in 1965-1979 at the age of 17 or under. A proportional hazards model was used to model the association between the rate of live births as a function of the age of an individual and the observed covariates (sex and age at onset of diabetes). RESULTS Both women and men with diabetes had a smaller number of live births than the controls; the HR of having a first child for diabetic women compared with controls was 0.66 (95% CI 0.62, 0.71) and for men was 0.77 (95% CI 0.72, 0.83). In women, a birth cohort effect was detected; in more recent birth cohorts, the difference between diabetic women and controls as regards having children was significantly smaller than in earlier cohorts. Later age at onset of diabetes was associated with a higher rate of having a first child among men (p = 0.04) and having a second live birth among women (p = 0.002). CONCLUSIONS/INTERPRETATION Type 1 diabetes affects the number of live births in both women and men. The age at onset of diabetes is associated with the pattern of reproduction in both diabetic women and men.
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Affiliation(s)
- L Sjöberg
- Hjelt Institute, Department of Public Health, University of Helsinki, Helsinki, Finland.
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24
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Kuikka L, Nevalainen MK, Sjöberg L, Salokekkilä P, Karppinen H, Torppa M, Liira H, Eriksson J, Pitkälä KH. The perceptions of a GP's work among fifth-year medical students in Helsinki, Finland. Scand J Prim Health Care 2012; 30:121-6. [PMID: 22339369 PMCID: PMC3378002 DOI: 10.3109/02813432.2012.654194] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore medical students' potential interest in family medicine in the future and their perceptions of a GP's work. DESIGN A cross-sectional survey in 2008-2010. SETTING AND SUBJECTS Fifth-year medical students prior to their main course in General Practice at the University of Helsinki. MAIN OUTCOME MEASURES The students' opinions regarding the GP's work and their perceptions of the main aims of a GP's work. RESULTS 309/359 medical students (mean age 25.7 years, 64% females) responded to the survey. Among the students, 76% considered the most attractive feature in the GP's work to be that it is versatile and challenging. The least attractive features included: too hasty, pressing work, too lonely work, and too many non-medical problems. The majority of the students considered the main aim of a GP's work as to identify serious diseases/disorders in order to refer those patients for specialized care (82%). Treatment of chronic diseases is an important responsibility of a GP's work according to 63% of the students. Only 38% considered health promotion to be an important aim. CONCLUSIONS Medical students may have perceptions of the GP's work that influence their career choices to specialize in other fields.
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Affiliation(s)
- L Kuikka
- University of Helsinki, Department of General Practice, Helsinki, Finland.
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25
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Abstract
OBJECTIVES Many severe strokes are preceded by warning signs such as a transient ischemic attack or stroke with minor deficits. Carotid endarterectomy (CEA) of a symptomatic carotid artery stenosis can prevent future strokes, but should be performed within 2 weeks after the initial symptom to maximize the benefit. The aim of this study was to determine the time delays between symptom and CEA. METHODS We performed a single center observational retrospective study at a tertiary stroke center. A total of 142 carotids in 139 patients with symptomatic stenoses between 2002 and 2006 were included. The main outcome measure was time between qualifying cerebrovascular symptom and CEA. RESULTS The median time between symptom and CEA was 26 days. The longest delays were between the last diagnostic examination and carotid conference, and between carotid conference and surgery. The median time was shorter for those who received emergency medical care (median 21 days) and for those who were admitted immediately to hospital (median 20 days). CONCLUSIONS The time between symptom and surgery is often longer than desirable. There are several measures to improve the chain of procedures for patients with carotid artery stenosis. These may include omitting the formal carotid conference for uncomplicated cases and minimizing waiting time for surgery.
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Affiliation(s)
- S Andgren
- Department of Internal Medicine, Helsingborg Hospital, Sweden.
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26
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Abstract
Investigated the reliability and validity of a new verbal cathexis test, based on objectively scored achievement data. Criteria were based on interviews about goal orientations and mood ratings, performed three times a day for a week. Goals were scored analogously with the cathexis test, viz. in the three dimensions hetero-homo, active-passive, and positive-negative. Average mood scores and mood variabilities were estimated. The Oedipal and combined cathexis adjustment indices correlated with goal ratings. Moods correlated with cathectic balance indices. Strong correlations were found to exist between average moods and goal ratings in both active-passive and positive-negative dimensions, as well as sex differences in mood variability and Oedipal orientation as measured by the cathexis test.
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Affiliation(s)
- L Sjöberg
- Dept. of Psychology, University of Göteborg, S-400 Göteborg, Sweden
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Berglund C, Mölling P, Sjöberg L, Söderquist B. Predominance of staphylococcal cassette chromosome mec (SCCmec) type IV among methicillin-resistant Staphylococcus aureus (MRSA) in a Swedish county and presence of unknown SCCmec types with Panton-Valentine leukocidin genes. Clin Microbiol Infect 2005; 11:447-56. [PMID: 15882194 DOI: 10.1111/j.1469-0691.2005.01150.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an established nosocomial pathogen, but has recently begun to appear in the community. The clones in the community may not have originated in the hospital setting, and are referred to as community-acquired MRSA (CA-MRSA). Resistance to methicillin is mediated by the gene mecA, which is carried by the mobile genetic element staphylococcal cassette chromosome mec (SCCmec). SCCmec typing (I-IV) of all clinical isolates of MRSA (n = 92) from 1987 to 2004 in Orebro County, Sweden, was performed by real-time LightCycler PCR to detect the essential genetic components mecA, mecR1, IS1272, ccrA and ccrB. Forty-one isolates harboured type IV SCCmec, of which ten could be classified further as subtype IVa, and 27 as subtype IVc. No isolates belonged to subtype IVb, but four isolates could not be subtyped, and may be examples of novel type IV SCCmec subtypes. Thirty-five MRSA isolates, assigned to six different pulsotypes by pulsed-field gel electrophoresis, did not belong to SCCmec types I-IV. The Panton-Valentine leukocidin (PVL) genes were identified in two of these pulsotypes. Only SCCmec type IV has been associated previously with the PVL toxin, but the results suggest that new PVL-positive clones with novel SCCmec types may be arising and disseminating in the community.
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Affiliation(s)
- C Berglund
- Department of Clinical Microbiology, Orebro University Hospital, Orebro, Sweden
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Norén T, Akerlund T, Bäck E, Sjöberg L, Persson I, Alriksson I, Burman LG. Molecular epidemiology of hospital-associated and community-acquired Clostridium difficile infection in a Swedish county. J Clin Microbiol 2004; 42:3635-43. [PMID: 15297509 PMCID: PMC497655 DOI: 10.1128/jcm.42.8.3635-3643.2004] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
All episodes of Clostridium difficile associated diarrhea (CDAD) diagnosed in a defined population of 274,000 including one tertiary and two primary hospitals and their catchment areas were studied during 12 months. The annual CDAD incidence in the county was 97 primary episodes per 100,000, and 78% of all episodes were classified as hospital associated with a mean incidence of 5.3 (range, 1.4 to 6.5) primary episodes per 1,000 admissions. The incidence among hospitalized individuals was 1,300-fold higher than that in the community (33,700 versus 25 primary episodes per 100,000 persons per year), reflecting a 37-fold difference in antibiotic consumption (477 versus 13 defined daily doses [DDD]/1,000 persons/day) and other risk factors. Three tertiary hospital wards with the highest incidence (13 to 36 per 1,000) had CDAD patients of high age (median age of 80 years versus 70 years for other wards, P < 0.001), long hospital stay (up to 25 days versus 4 days), or a high antibiotic consumption rate (up to 2,427 versus 421 DDD/1,000 bed days). PCR ribotyping of C. difficile isolates available from 330 of 372 CDAD episodes indicated nosocomial acquisition of the strain in 17 to 27% of hospital-associated cases, depending on the time interval between index and secondary cases allowed (2 months or up to 12 months), and only 10% of recurrences were due to a new strain of C. difficile (apparent reinfection). In other words, most primary and recurring episodes were apparently caused by the patient's endogenous strain rather than by one of hospital origin. Typing also indicated that a majority of C. difficile strains belonged to international serotypes, and the distribution of types was similar within and outside hospitals and in primary and relapsing CDAD. However, type SE17 was an exception, comprising 22% of hospital isolates compared to 6% of community isolates (P = 0.008) and causing many minor clusters and a silent nosocomial outbreak including 36 to 44% of the CDAD episodes in the three high-incidence wards.
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Affiliation(s)
- T Norén
- Department of Infectious Diseases, Orebro University Hospital, S-701 85 Orebro, Sweden.
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Persson L, Vikerfors T, Sjöberg L, Engervall P, Tidefelt U. Increased incidence of bacteraemia due to viridans streptococci in an unselected population of patients with acute myeloid leukaemia. Scand J Infect Dis 2002; 32:615-21. [PMID: 11200370 DOI: 10.1080/003655400459513] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The aetiology, clinical characteristics and outcome of bacteraemia in patients with acute myeloid leukaemia were studied. All positive blood cultures collected at a haematological ward during 2 7-y periods were evaluated. Altogether, 274 episodes of bacteraemia in 152 patients were recorded, 80 episodes during 1980-86 and 194 during 1990-96. During the 2 periods, trimethoprim-sulfamethoxazol in combination with amikacin was the first-line empirical therapy in patients with neutropaenia and fever. In 1990, antimicrobial prophylaxis with ciprofloxacin and fluconazole was introduced. The incidence of bacteraemia due to viridans streptococci or coagulase-negative staphylococci increased from the first period to the second, whereas the incidence of Enterobacteriaceae decreased. In granulocytopaenic patients during 1990-96, viridans streptococci accounted for 21% of the isolates and in patients treated prophylactically with fluoroquinolone, viridans streptococci accounted for 31%. All viridans streptococci were sensitive to penicillin. At the time of the positive blood cultures, the patients of the second period were granulocytopaenic in 83% of the episodes. The mortality related to septicaemia during the later period was 13% and only 1 of 33 (3%) of the patients with viridans streptococci died. Eight patients (9%) died in relation to septicaemia following curative antileukaemic therapy.
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Affiliation(s)
- L Persson
- Department of Infectious Diseases, Orebro Medical Centre Hospital, Sweden
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Bränström R, Brandberg Y, Holm L, Sjöberg L, Ullén H. Beliefs, knowledge and attitudes as predictors of sunbathing habits and use of sun protection among Swedish adolescents. Eur J Cancer Prev 2001; 10:337-45. [PMID: 11535876 DOI: 10.1097/00008469-200108000-00007] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In 1996, a random population sample of 2615 adolescents completed a questionnaire concerning habitual sun-related behaviours, attitudes towards sunbathing, and knowledge about skin cancer. Females, older adolescents, those with less sun-sensitive skin, those with higher knowledge and those with a positive attitude towards sunbathing were more likely to be frequent sunbathers. Younger adolescents, those who today sunbathe moderately, and those with sensitive skin were more likely to believe that they would sunbathe more often in the future. Males, adolescents with less sensitive skin, those with a positive attitude towards sunbathing and those sunbathing often, were less likely to use protection when sunbathing. Interventions to decrease sun exposure among adolescents should focus on changing attitudes toward sunbathing and having a tan, since knowledge of skin cancer and the damaging affect of sunbathing did not seem to effect current sunbathing habits, or use of sun protection.
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Affiliation(s)
- R Bränström
- Department of Cancer Prevention, Stockholm Center of Public Health, M8, Karolinska Hospital, SE-171 76 Stockholm, Sweden.
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Abstract
Risks related to information technology (IT) are becoming a focus of concern in current risk debates. The use of IT is rapidly spreading in the population, as is access to computers in general. The present article reviews the literature on IT use (especially electronic mail and various Internet applications) and the related risks. In addition, the results from a survey about IT use and risk perception, given to a random sample of the Swedish population, are reported. In general, participants were quite positive to IT and were, to some extent, aware of the related risks. However, risks of IT were mostly seen as pertinent to other people, a finding in contrast with other results on perceived technology hazards. The attitude toward the use of IT was strongly related to general attitude toward computers, and less clearly to risk perception. Only a small percentage of the respondents reported having had negative experiences with IT hazards such as Internet addiction, depression, and social isolation. When extrapolated to the general population, however, these small percentages amount to large groups in the population that have been negatively affected by IT use.
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Affiliation(s)
- L Sjöberg
- Stockholm School of Economics, Center for Risk Research, Sweden.
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Abstract
Perceived risk and related attitudes have been implicated as major factors in many of the difficult policy problems that face modern society (nuclear power, genetically modified food, etc). Experts often argue that no or very small risks are involved; people are still worried. Why? The standard answer is lack of trust. Data on trust and risk perception, however, point to only a weak relationship between the two (r approximately 0.3). It is suggested here that the reason for the surprisingly minor importance of trust is that people believe that there are clear limits to how much science and experts know. Results are presented from studies of risk perception of the public, experts, and politicians. Politicians and members of the public believe that there are many unknown effects of technology and such beliefs were strongly related to their perceived risk. Experts on nuclear waste, on the other hand, seemed to believe that little is unknown in their field of expertise. Regression analyses of risk perception showed the unknown-effects factor to be a more important explanatory factor than trust for the public and politicians.
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Affiliation(s)
- L Sjöberg
- Center for Risk Research, Stockholm School of Economics, Sweden.
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Abstract
This is a study of risk perception and a test of a model of perceived risk. A scale measuring fear was factor analyzed and the resulting five fear factors were related to a large number of risk dimensions, both personal and general. Fear was only rather weakly related to perceived risk. Furthermore, perceived risk of two ionizing radiation hazards (nuclear power, X-rays) were investigated in more detail. These risk ratings were modelled on the basis of attitude, risk sensitivity, specific perceived risk of radiation, trust and an extended version of the traditional Psychometric Model, enhanced by the introduction of a factor of Tampering with Nature. It was found that risk perception could be well explained with this approach and the importance of Tampering with Nature, as well as specific perceived risk, were stressed.
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Affiliation(s)
- L Sjöberg
- Center for Risk Research, Stockholm School of Economics, Sweden
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35
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Sjöberg L. [Can tests like Rorschach be used for more than severe psychopathologic assessment?]. Lakartidningen 2000; 97:1164. [PMID: 10750390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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36
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Sjöberg L. [Projective tests and evaluations based on the psychodynamic theory are not reliable]. Lakartidningen 2000; 97:56-9. [PMID: 10668333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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37
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Abstract
A review is given of general principles of risk perception, with some historical highlights of the field. It is pointed out that the risk target is of great importance (i.e., that personal risks are almost always perceived as smaller than risks to others). The implications of perceived personal and general risks are different, with general risks being more important for policy attitudes. The concepts needed to investigate risk perception are different, depending on what kind of risk is studied. Alcohol consumption risks give rise to uniquely strong risk denial, closely tied to control notions. Consumption of alcohol is found to be related to personal alcohol risk in a positive manner; the larger the consumption, the larger is the perceived risk. However, no such relationship is found for general risk. At the societal level, alcohol was the most common explanation that people gave for the prevalence of violence.
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Affiliation(s)
- L Sjöberg
- Center for Risk Research, Stockholm, Sweden
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38
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Abstract
In 1996 a randomized sample of 4,020 Swedish adolescents from three birth cohorts were sent a questionnaire consisting of 50 items concerning habitual sun-related behaviours and attitudes, knowledge about melanoma, risk perception and self-image. A total of 2,615 questionnaires were returned. Girls sunbathed and used sunbeds more than boys at all ages. Sunbathing and sunbed use increased with age. Boys who were most satisfied and girls least satisfied with themselves sunbathed most. Those who were least satisfied with themselves used sunbeds most frequently. Girls reported a higher perceived susceptibility to melanoma than did boys. The perception of susceptibility increased with age. Those who were least satisfied with themselves reported feeling most susceptible. The overall main reason for sunbathing was appearance, both for own sunbathing, and to an even higher degree, as a supposed reason for other adolescents' behaviour, and was reported most frequently by girls and the older age groups. The second most 'important' reason for sunbathing was 'feeling warm and comfortable'. Preventive programmes aimed at a change of sun related behaviours among Swedish adolescents have to be tailored to the climate and cultural conditions and must take into account that having a tan, and the warmth of the sun, are highly valued by most adolescents.
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Affiliation(s)
- Y Brandberg
- Department of Oncology, Karolinska Hospital, Stockholm, Sweden
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39
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Arneborn P, Bäck E, Sjöberg L. [Unnecessarily complicated hygienic routines in diagnostic lumbar puncture]. Lakartidningen 1998; 95:1510. [PMID: 9564136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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40
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Abstract
Risk perception is sometimes measured by means of judgments about worry, sometimes as perceived risk more directly. However, perceived level of risk calls for a more intellectual judgment and worry tends to refer to emotional reactions. These two are therefore not the same and need not be strongly correlated. Results reported here show that perceived risk and worry are indeed weakly correlated, both for generalized worry and for more specific measures of worry matched with the same hazard as risk ratings. A distinction is suggested between cognitive, abstract hazards and concrete, sensory hazards, with implications for the worry-perceived risk relationship. It was furthermore found by means of cluster analysis that there were groups of subject displaying different dynamics of risk and worry.
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Affiliation(s)
- L Sjöberg
- Center for Risk Research, Stockholm School of Economics
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41
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Abstract
This article presents the results of analyses of employee subjective risk assessments caused by platform movements on an offshore oil installation in the Norwegian sector of the North Sea. The results are based on a self-completion questionnaire survey conducted among 179 respondents covering three shifts on the platform. The data collection was carried out during the spring of 1994. A minority expressed worry due to platform movements. A greater proportion of the personnel stated worry about the construction of the platform. The personnel were more unsafe when they assessed their own safety attitudes with regard to specific potentially hazardous consequences of platform movements. Two approaches aimed at modeling worry and concern caused by platform movements were tested. The models were the mental imagery approach and the rationalistic approach. The rationalistic and mental imagery models fitted equally well. Implications of the results for risk communication are discussed.
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Affiliation(s)
- T Rundmo
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Abstract
In this article, we discuss under what conditions an estimated cost per statistical life saved can be interpreted as an implied lifevalue. Furthermore, we state optimality conditions with respect to variation in implied lifevalues. The cost-effectiveness, together with references, are presented for 165 lifesaving interventions in Sweden. The cost-effectiveness of interventions has been found in publicly available analyses, or in some cases been calculated by us. Several of these interventions produce net savings for society. The most expensive interventions cost several hundred million SEK, or more, per life saved. To improve the comparability of the interventions, certain criteria have been used to standardize the estimates. Still, dissimilarities in the calculation of implied life values remain and the quality of the original data is in some cases uncertain. Despite this and the fact that the interventions are not a representative sample, it is nevertheless possible to conclude that implied life values vary greatly both within and between different sectors of the Swedish society, much in the same manner as in current U.S. analyses.
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Affiliation(s)
- J A Ramsberg
- Center for Risk Research, Stockholm School of Economics, Sweden
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Sundman K, Arneborn P, Blad L, Sjöberg L, Vikerfors T. One bolus dose of gentamicin and early oral therapy versus cefotaxime and subsequent oral therapy in the treatment of febrile urinary tract infection. Eur J Clin Microbiol Infect Dis 1997; 16:455-8. [PMID: 9248749 DOI: 10.1007/bf02471910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The efficacy and safety of two different regimens for parenteral treatment of presumed severe febrile urinary tract infection were compared in a randomized study. One hundred fifty-eight patients were treated with either cefotaxime 2 g i.v. twice daily for at least two days followed by norfloxacin 400 mg twice daily orally or one bolus dose of gentamicin 3 mg/kg i.v. and norfloxacin from the start. Three patients randomized to cefotaxime died. Of the 101 patients with verified urinary tract infection, clinical response to assigned therapy was seen in 79% and 74%, respectively. There was no difference in fever duration between the two regimens. The results indicate that one bolus dose of gentamicin with early oral therapy is a safe and effective alternative to common parenteral regimens for empirical treatment of febrile urinary tract infection.
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Affiliation(s)
- K Sundman
- Department of Infectious Diseases, Orebro Medical Center Hospital, Sweden
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Abstract
All cases of neonatal septicaemia during 1981-94 were studied at Orebro Medical Centre Hospital, Sweden. One hundred and thirty-two children fulfilled laboratory and clinical criteria for neonatal septicaemia and were included. Staphylococcus aureus (n = 41), Group B streptococcus (GBS) (n = 32) and coagulase-negative staphylococci (CoNS) (n = 27) were the dominating aetiologies. The annual incidence of septicaemia increased significantly, from 2.3 cases during the first 7-year period to 3.3 per 1000 live births during 1988-94. This increase was caused by S. aureus and CoNS, which mainly affected premature children and had an onset more than 48 h after delivery. GBS, on the other hand, slightly decreased and affected full-term children within 48 h. The overall mortality was 11%. CoNS isolated during the latter 7-year period were more resistant to antibiotics than those isolated during 1981-87; resistance to methicillin increased from 14 to 45% and to gentamicin from 0 to 20%. These changes in aetiology and antibiotic susceptibility should be considered when selecting antibiotic treatment in neonatal septicaemia.
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Affiliation(s)
- J Källman
- Department of Infectious Diseases, Orebro Medical Centre Hospital, Sweden
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Torell E, Fredlund H, Törnquist E, Myhre EB, Sjöberg L, Sundsfjord A. Intrahospital spread of vancomycin-resistant Enterococcus faecium in Sweden. Scand J Infect Dis 1997; 29:259-63. [PMID: 9255886 DOI: 10.3109/00365549709019039] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
During a 17-week period vancomycin-resistant Enterococcus faecium (VRE) was found in clinical specimens from 4 in-patients. All bacterial isolates were phenotypically VanA, showing high-level resistance to vancomycin (MIC 256 micrograms/ml) and teicoplanin (MIC 24-256 micrograms/ml). The corresponding gene (vanA) was detected with PCR in strains from 3 of the patients. Three patients had been hospitalized at the renal unit at Orebro Medical Centre Hospital (OMCH). The fourth patient, diagnosed in another hospital, had received treatment in the oncology unit at OMCH. All patients recovered without treatment specific for VRE. Isolates from 2 patients were indistinguishable by pulsed-field gel electrophoresis of genomic DNA. Genetically, these strains were related to the VRE isolates from the 2 other patients. Screening of hospital staff and other in-patients for gastrointestinal carriage of VRE was negative. Glycopeptide-resistant enterococci have not previously been found in OMCH. No new cases were identified during a 10-month follow-up period. Our cases represent the first nosocomial outbreak of VRE in Sweden.
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Affiliation(s)
- E Torell
- Department of Microbiology, University Hospital, Uppsala, Sweden
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Abstract
The aim of our study was to establish whether pregnancy affects long-term development and progression of retinopathy and nephropathy in diabetic women compared to nulliparous diabetic women. Twenty-eight diabetic women who had delivered in 1983-85 at Helsinki University Central Hospital and 17 nulliparous controls matched according in age, duration of diabetes, and degree of vascular complications were personally interviewed and the current retinal status and renal function were assessed 7 years later, in 1990-92. Serum creatinine, creatinine clearance, nocturnal albuminuria, and HbA1c were measured and colour fundus photography carried out. The results were compared to the status in 1983-85. Of those who had been pregnant, 5 of 26 (19.2%) had experienced worsening of retinopathy. In 3 of these, proliferative retinopathy had developed from only minimal background changes. In the control group, progression had occurred in 8 cases of 16 (50%, p < 0.05). The groups did not differ from each other regarding progression or development of nephropathy. This suggests that pregnancy does not seem to affect development or progression of diabetic nephropathy whereas progression of retinopathy seems to occur less often after pregnancy compared to nulliparous women.
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Affiliation(s)
- R Kaaja
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Finland
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47
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Abstract
The aim of our study was to establish whether pregnancy affects long-term development and progression of retinopathy and nephropathy in diabetic women compared to nulliparous diabetic women. Twenty-eight diabetic women who had delivered in 1983-85 at Helsinki University Central Hospital and 17 nulliparous controls matched according in age, duration of diabetes, and degree of vascular complications were personally interviewed and the current retinal status and renal function were assessed 7 years later, in 1990-92. Serum creatinine, creatinine clearance, nocturnal albuminuria, and HbA1c were measured and colour fundus photography carried out. The results were compared to the status in 1983-85. Of those who had been pregnant, 5 of 26 (19.2%) had experienced worsening of retinopathy. In 3 of these, proliferative retinopathy had developed from only minimal background changes. In the control group, progression had occurred in 8 cases of 16 (50%, p < 0.05). The groups did not differ from each other regarding progression or development of nephropathy. This suggests that pregnancy does not seem to affect development or progression of diabetic nephropathy whereas progression of retinopathy seems to occur less often after pregnancy compared to nulliparous women.
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Affiliation(s)
- R Kaaja
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Finland
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48
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Abstract
BACKGROUND The aim of the study was to analyze the reasons for the failure of contraception and the reasons for not using any contraception among women seeking a legal abortion on social grounds. The women were also asked about their knowledge of contraception methods, including postcoital contraception. METHODS We interviewed 200 women applying for a legal abortion within the first trimester of pregnancy about contraception, the contraceptive methods used, and the possible reasons for failure of contraception. RESULTS Of all the women interviewed, 93% claimed to have adequate knowledge of contraception. At the time of conception 11.5% used safe methods (OCs 8%, IUDs 3.5%), 63% used less safe methods, and 26% were without contraception. Only 25% of the pill users had no explanation for the failure. 76.7% of the condom users reported that the condom was broken, had slipped off or its use had been irregular. The concern about side effects was the most common reason for not using safe contraceptives (25%). CONCLUSIONS The women claimed to have enough information about contraceptives, and postcoital contraception was also familiar, but the knowledge on how to use them in practice was inadequate. Irregular use and breaks in contraception were common. Despite the data based on Pearl indices, pills failed twice as often as IUDs. Counseling about the proper use of contraceptives is important, although the concern about the side effects appeared to be a big, unsolved problem.
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Affiliation(s)
- H Savonius
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Finland
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Sjöberg L. [Inquiry about the risk of malignant melanoma. One in two adults is more careful now than ever when sunbathing]. Lakartidningen 1995; 92:868-71. [PMID: 7885115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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50
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Hambraeus A, Karlberg I, Malmquist H, Nyström B, Sjöberg L. [Microbiological purity during medical intervention]. Lakartidningen 1995; 92:525-6. [PMID: 7853934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- A Hambraeus
- Avdelningen för klinisk mikrobiologi, Akademiska sjukhuset, Uppsala
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