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Social Support and Sleep. Longitudinal Relationships from the WOLF-Study  [PDF]
Maria Nordin, Peter Westerholm, Lars Alfredsson, Torbjorn Akerstedt
Psychology (PSYCH) , 2012, DOI: 10.4236/psych.2012.312A181

Aim: To investigate the relationship between two social support dimensions (network and emotional support) and sleep quality and between two social support sources (at and outside work) and sleep quality. Methods: The three-wave prospective Work Lipids and Fibrinogen (WOLF) study from Northern Sweden was used including 2420 participants who had filled out a questionnaire on working life, life style and health. Sleep quality was assessed by the Karolinska Sleep Questionnaire (KSQ). Structure and function of social support were measured as network support both at and outside work by Availability of Social Integration (AVSI) and emotional support both at and outside work by Availability of Attachment (AVAT). Logistic regression was used, utilizing variables created to assess development over time. Moreover, reversed causation was tested. Results: Improved network support at work decreased the risk of disturbed sleep (OR .65; 95% CI .47 - .90) as did improved emotional support outside work (OR .69; 95% CI .49 - .96). Reporting a constant poor network support at work increased the risk of disturbed sleep (OR 1.53, 95% CI 1.10 - 2.11) as did reporting a constant poor emotional support outside work (OR 1.46; 95% CI 1.02

Genes and environment in arthritis: can RA be prevented?
Lars Klareskog, Johnny Lorentzen, Leonid Padyukov, Lars Alfredsson
Arthritis Research & Therapy , 2002, DOI: 10.1186/ar566
Abstract: Rheumatoid arthritis (RA) is a condition that is today defined from a set of rather arbitrarily built criteria; those criteria have been very helpful in identifying an entity for which new therapies can be investigated, and such therapies have lately been amazingly successful [1-4]. Despite the continuing successes in developing therapies, the underlying etiology of the disease, i.e. what eventually triggers it and what genetic context allows it to progress, have remained elusive. Consequently, only vague and often scientifically unproven thoughts have been prevalent in the public as well as in the professional arena when ways of achieving primary or secondary prevention of the disease are being considered.In parallel, it has often been claimed that the disease is so complicated and multifaceted that it may be an insurmountable task to elucidate the interactions between genes and environment that ultimately determine whether arthritis will occur and persist.In one way, this situation of rapidly emerging new genetic technologies in genetics but prevalent vague ideas of etiology recalls the situation in the late 1980s, when new knowledge in the field of molecular immunology was paralleled by a rather vague understanding of the molecular pathology of RA. It was frequently claimed then that the situation was far too complicated to permit targeted therapy against single components of the immune system, such as tumor necrosis factor.Taking the dramatic demonstration in recent years that complicated problems such as finding targeted therapies for RA can indeed be resolved by less complicated solutions than hitherto for unravelling the remaining difficult questions, we have contemplated the issue of gene–environment interactions in RA and subsequent preventive strategies towards the disease as being a reasonable research effort to discuss at the current symposium and in this supplement to Arthritis Research.Knowledge about environmental influences on the development of RA a
Mannan Binding Lectin (MBL) genotypes coding for high MBL serum levels are associated with rheumatoid factor negative rheumatoid arthritis in never smokers
Saedis Saevarsdottir, Bo Ding, Kristjan Steinsson, Gerdur Grondal, Helgi Valdimarsson, Lars Alfredsson, Lars Klareskog, Leonid Padyukov
Arthritis Research & Therapy , 2011, DOI: 10.1186/ar3321
Abstract: In this population-based EIRA study, rheumatoid factor (RF), ACPA, smoking, SE and PTPN22*620W status was determined in incident RA cases and matched controls. MBL-high (n = 1330) and MBL-low (n = 1257) genotypes predicting MBL levels were constructed from four promoter and exon-1 polymorphisms in the MBL2 gene. Odds ratios with 95% confidence interval (OR, 95% CI) were calculated by logistic regression. In extended families (n = 316), previously reported data were re-analyzed, considering RF and smoking.MBL-high genotypes tended to be associated with RF-negative (OR = 1.20, 95% CI 0.96-1.51) but not RF-positive (OR = 1.00, 95% CI 0.83-1.20) RA. Results divided by ACPA status did not differ. When stratified for smoking, MBL-high genotype was strongly associated with RF-negative RA in never smokers (OR = 1.82, 95% CI 1.24-2.69) but not in ever smokers (OR = 0.96, 95% CI 0.73-1.30). In never smokers, the association was observed in both the RF-negative/ACPA-negative (OR = 1.67, 95% CI 1.10-2.55) and RF-negative/ACPA-positive subgroups (OR = 3.07, 95% CI 1.37-6.89), and remained on an SE/PTPN22*620W negative background. In the extended families, the reported association between high MBL and RA was in fact confined to never smokers.High MBL may predispose to RF-negative RA but only in individuals who have never smoked. This illustrates the importance of phenotypic subgrouping in genetic studies.In recent years, it has become evident that the subsets of rheumatoid arthritis (RA) that are autoantibody positive and negative, that is have rheumatoid factor (RF) or anti-citrullinated peptide antibody (ACPA) or both, not only differ clinically but also have distinct genetic and environmental risk profiles [1]. Thus, the risk associated with the strongest known environmental (smoking) and genetic (HLA-DRB1 shared epitope, or SE) susceptibility factors for RA seems to be restricted mainly to autoantibody-positive disease [2-4]. This also applies to several other risk alleles, i
Usage of skin care products and risk of rheumatoid arthritis: results from the Swedish EIRA study
Berit M Sverdrup, Henrik K?llberg, Lars Klareskog, Lars Alfredsson, Epidemiological Investigation of Rheumatoid Arthritis Study Group
Arthritis Research & Therapy , 2012, DOI: 10.1186/ar3749
Abstract: A population-based case-control study of incident cases of RA was performed among the population aged 18 to 70 years in a defined area of Sweden during May 1996 to December 2003. A case was defined as an individual from the study base, who received for the first time a diagnosis of RA according to the 1987 American College of Rheumatology criteria. Controls were randomly selected from the study base with consideration taken for age, gender and residential area. Cases (n = 1,419) and controls (n = 1,674) answered an extensive questionnaire regarding environmental and lifestyle factors including habits of cosmetic usage. The relative risk of developing RA was calculated for subjects with different cosmetic usage compared with subjects with low or no usage. Analysis was also performed stratifying the cases for presence/absence of rheumatoid factor and antibodies to citrulline-containing peptides.The relative risks of developing RA associated with use of cosmetics were all close to one, both for women and men, for different exposure categories, and in relation to different subgroups of RA.This study does not support the hypothesis that ordinary usage of common cosmetics as body lotions, skin creams, and ointments, often containing mineral oil, increase the risk for RA in the population in general. We cannot exclude, however, that these cosmetics can contribute to arthritis in individuals carrying certain genotypes or simultaneously being exposed to other arthritis-inducing environmental agents.Rheumatoid arthritis (RA) is a disease that is dependent on genetic as well as environmental factors, as seen from both concordance data in twins and from a number of epidemiological and genetic studies [1,2]. Whereas knowledge of the genetic basis of this disease is rapidly advancing [3-5], there is a scarcity of data on environmental agents that may cause arthritis [6-9]. In particular, very little information exists in humans on environmental factors with a known capacity to in
The effect of leisure-time physical activity on the risk of acute myocardial infarction depending on Body Mass Index: a population-based case-control study
Eleonor Fransson, Ulf de Faire, Anders Ahlbom, Christina Reuterwall, Johan Hallqvist, Lars Alfredsson
BMC Public Health , 2006, DOI: 10.1186/1471-2458-6-296
Abstract: Data from the SHEEP (Stockholm Heart Epidemiology Program) study were used. The SHEEP study is a large Swedish population-based case-control study, comprising 1204 male and 550 female cases, and 1538 male and 777 female controls, conducted in Stockholm County, Sweden, during the period 1992–1994. Odds ratios (OR), together with 95 % confidence intervals (95% CI), were calculated using unconditional logistic regression, as estimates of the relative risks.Regular leisure-time physical activity was associated with a decreased risk of myocardial infarction among lean, normal-weight and overweight subjects, but not among obese subjects. Obese (BMI ≥ 30) and physically active persons had an almost twofold risk of myocardial infarction, compared with normal-weight and sedentary persons (OR 1.85, 95% CI 1.07–3.18). The results were similar for men and women.While regular leisure-time physical activity seems to provide protection against myocardial infarction among lean, normal-weight and overweight subjects, this does not appear to be the case in obese subjects.Both excess body weight and lack of leisure-time physical activity have been identified as important risk factors for cardiovascular mortality, as well as coronary heart disease [1-13]. These two risk factors are also associated with each other [14,15].Regular physical activity seems to attenuate much of the increased risk associated with overweight or obesity, and furthermore, active obese persons seem to have lower all-cause mortality and CHD morbidity compared with those who are of normal weight but physically inactive [16]. However, this association needs to be further analyzed in various populations that include both men and women.In a previous study we have reported on the relation between various forms of physical activity and the risk of acute myocardial infarction [17].The aim of the present study was to evaluate whether the relationship between leisure-time physical activity and risk of acute myocardial inf
The long-term effects of naprapathic manual therapy on back and neck pain - Results from a pragmatic randomized controlled trial
Eva Skillgate, Tony Bohman, Lena W Holm, Eva Ving?rd, Lars Alfredsson
BMC Musculoskeletal Disorders , 2010, DOI: 10.1186/1471-2474-11-26
Abstract: Subjects with non-specific pain/disability in the back and/or neck lasting for at least two weeks (n = 409), recruited at public companies in Sweden, were included in this pragmatic randomized controlled trial. The two interventions compared were naprapathic manual therapy such as spinal manipulation/mobilization, massage and stretching, (Index Group), and advice to stay active and on how to cope with pain, provided by a physician (Control Group). Pain intensity, disability and health status were measured by questionnaires.89% completed the 26-week follow-up and 85% the 52-week follow-up. A higher proportion in the Index Group had a clinically important decrease in pain (risk difference (RD) = 21%, 95% CI: 10-30) and disability (RD = 11%, 95% CI: 4-22) at 26-week, as well as at 52-week follow-ups (pain: RD = 17%, 95% CI: 7-27 and disability: RD = 17%, 95% CI: 5-28). The differences between the groups in pain and disability considered over one year were statistically significant favoring naprapathy (p ≤ 0.005). There were also significant differences in improvement in bodily pain and social function (subscales of SF-36 health status) favoring the Index Group.Combined manual therapy, like naprapathy, is effective in the short and in the long term, and might be considered for patients with non-specific back and/or neck pain.Current Controlled Trials ISRCTN56954776.Back and neck pain are very common, have multiple etiologies, and often recurs [1-4], and are among the most common reasons for seeking primary health care [5]. The existing literature suggests that there is little difference in effect between the available treatments [6].One common non-invasive treatment is manual therapy, which is provided by several groups of health care providers such as naprapaths, physiotherapists, chiropractors and osteopaths. Manual therapy involves a variety of procedures directed at the neuromusculoskeletal structures.The most well studied manual techniques for back and neck pain is
Short and Long Term Mortality after Coronary Artery Bypass Grafting (CABG) Is Influenced by Socioeconomic Position but Not by Migration Status in Sweden, 1995–2007
Dashti Ali M. Dzayee, Torbj?rn Ivert, Omid Beiki, Lars Alfredsson, Rickard Ljung, Tahereh Moradi
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0063877
Abstract: Background There are no nationwide studies on mortality after coronary artery bypass grafting (CABG) among foreign-born populations that include detailed information about country of birth and information about socioeconomic position. The objective was to investigate the risk of mortality after CABG considering socioeconomic position, sex and country of birth. Material and Methods We included all 72 333 patients undergoing a first isolated CABG in Sweden, during 1995 - 2007 of whom 12.7% were foreign-born. The patients were classified according to educational level, sex, and country of birth and were followed up to December 2007. We estimated the risk of short and long term mortality after CABG in a multivariable model adjusted for age, calendar year of surgery, diabetes, educational level, and waiting time for surgery. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated based on the Cox proportional hazard model. Findings There were 15,284 deaths during the follow-up, 10.4% of whom were foreign-born. The foreign-born patients were 3 to 4 years younger than Sweden-born patients at the time of CABG surgery. There were no significant differences in overall early or late mortality between foreign-born and Sweden-born men and women after CABG. All-cause mortality differed in between regions and was highest in foreign-born men from Eastern Africa (HR 3.80, 95% CI 1.58–9.17), China (HR 3.61, 95% CI 1.50–8.69), and in Chile (HR 2.12, 95% CI 1.01–4.47). Patients with low level of education had worse survival compared to those with longer than 12 years of education irrespective of sex and country of birth. This difference was more pronounced among foreign-born women (HR 1.50, 95% CI 1.00–2.33). Conclusion This national study showed higher CABG mortality in patients from lower socioeconomic position. Early and late mortality did not differ after isolated CABG in foreign-born and Sweden-born patients.
Likelihood of Treatment in a Coronary Care Unit for a First-Time Myocardial Infarction in Relation to Sex, Country of Birth and Socioeconomic Position in Sweden
Dong Yang, Stefan James, Ulf de Faire, Lars Alfredsson, Tomas Jernberg, Tahereh Moradi
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0062316
Abstract: Objective To examine the relationship between sex, country of birth, level of education as an indicator of socioeconomic position, and the likelihood of treatment in a coronary care unit (CCU) for a first-time myocardial infarction. Design Nationwide register based study. Setting Sweden. Patients 199 906 patients (114 387 men and 85,519 women) of all ages who were admitted to hospital for first-time myocardial infarction between 2001 and 2009. Main outcome measures Admission to a coronary care unit due to myocardial infarction. Results Despite the observed increasing access to coronary care units over time, the proportion of women treated in a coronary care unit was 13% less than for men. As compared with men, the multivariable adjusted odds ratio among women was 0.80 (95% confidence interval 0.77 to 0.82). This lower proportion of women treated in a CCU varied by age and year of diagnosis and country of birth. Overall, there was no evidence of a difference in likelihood of treatment in a coronary care unit between Sweden-born and foreign-born patients. As compared with patients with high education, the adjusted odds ratio among patients with a low level of education was 0.93 (95% confidence interval 0.89 to 0.96). Conclusions Foreign-born and Sweden-born first-time myocardial infarction patients had equal opportunity of being treated in a coronary care unit in Sweden; this is in contrast to the situation in many other countries with large immigrant populations. However, the apparent lower rate of coronary care unit admission after first-time myocardial infarction among women and patients with low socioeconomic position warrants further investigation.
Effects of GSTM1 in Rheumatoid Arthritis; Results from the Swedish EIRA study
Emeli Lundstr?m,Toinette Hartshorne,Kelly Li,Staffan Lindblad,Marius C. Wick,Camilla Bengtsson,Lars Alfredsson,Lars Klareskog,Leonid Padyukov
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0017880
Abstract: Glutathione-S-transferases (GSTs) play an important role in tobacco smoke detoxification, interestingly approximately 50% of individuals in most human populations lack the gene GSTM1 due to copy number variation (CNV). We aimed to investigate GSTM1 CNV in Rheumatoid Arthritis (RA) in relation to smoking and HLA-DRB1 shared epitope; the two best known risk factors for RA and in addition, to perform subanalyses in patients where relations between variations in GSTM1 and RA have previously been described.
Analysis of Neuropeptide S Receptor Gene (NPSR1) Polymorphism in Rheumatoid Arthritis
Mauro D'Amato,Marco Zucchelli,Maria Seddighzadeh,Francesca Anedda,Staffan Lindblad,Juha Kere,Lars Alfredsson,Lars Klareskog,Leonid Padyukov
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0009315
Abstract: Polymorphism in the neuropeptide S receptor gene NPSR1 is associated with asthma and inflammatory bowel disease. NPSR1 is expressed in the brain, where it modulates anxiety and responses to stress, but also in other tissues and cell types including lymphocytes, the lungs, and the intestine, where it appears to be up-regulated in inflammation. We sought to determine whether genetic variability at the NPSR1 locus influences the susceptibility and clinical manifestation of rheumatoid arthritis (RA).
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