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Thulesius, Hans
Publications (10 of 65) Show all publications
Sanden, U., Nilsson, F., Thulesius, H., Hägglund, M. & Harrysson, L. (2019). Cancer, a relational disease exploring the needs of relatives to cancer patients. International Journal of Qualitative Studies on Health and Well-being, 14(1), Article ID 1622354.
Open this publication in new window or tab >>Cancer, a relational disease exploring the needs of relatives to cancer patients
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2019 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, no 1, article id 1622354Article in journal (Refereed) Published
Abstract [en]

Purpose: In this qualitative interview study we investigated the experiences of family members to cancer patients. Our objective was to explore and to differentiate their needs from the needs of cancer patients. Methods: Five focus groups and six individual narrative interviews with 17 family members to cancer patients in Sweden were conducted and compared with 19 cancer patient interviews. Our analysis was inspired by classic grounded theory. Results: Family members to cancer patients expressed own morbidity connected to high stress levels and difficulties in recognizing own stress due to ongoing comparisons with the cancer patient. Family members were trapped in a momentary terror-like situation where they became their sick relative's safety net. A percieved inability to improve their loved one's well being contributed to a feeling of guilt. The longing for it all to end was encumbered with shame since the end included possible death. Conclusions: By recognizing cancer as a disease striking both body and relationships, family members are given precedence over their own struggles, differentiated from the patient's experiences. We define differences in needs between cancer patients and family members. Family members to cancer patients may be supported in developing balancing strategies towards less stress, increased safety and moments of contentment.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
Health, family members, carers, cancer care, grounded theory, waiting, safety, momentary contentment, salutogenesis, informal caregiver
National Category
Other Health Sciences
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-84845 (URN)10.1080/17482631.2019.1622354 (DOI)000468976100001 ()31122166 (PubMedID)2-s2.0-85066847390 (Scopus ID)
Available from: 2019-06-12 Created: 2019-06-12 Last updated: 2019-08-29Bibliographically approved
Lindow, T., Kron, J., Thulesius, H., Ljungström, E. & Pahlm, O. (2019). Erroneous computer-based interpretations of atrial fibrillation and atrial flutter in a Swedish primary health care setting. Scandinavian Journal of Primary Health Care, 37(4), 426-433
Open this publication in new window or tab >>Erroneous computer-based interpretations of atrial fibrillation and atrial flutter in a Swedish primary health care setting
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2019 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, no 4, p. 426-433Article in journal (Refereed) Published
Abstract [en]

Objective: To describe the incidence of incorrect computerized ECG interpretations of atrial fibrillation or atrial flutter in a Swedish primary care population, the rate of correction of computer misinterpretations, and the consequences of misdiagnosis. Design: Retrospective expert re-analysis of ECGs with a computer-suggested diagnosis of atrial fibrillation or atrial flutter. Setting: Primary health care in Region Kronoberg, Sweden. Subjects: All adult patients who had an ECG recorded between January 2016 and June 2016 with a computer statement including the words 'atrial fibrillation' or 'atrial flutter'. Main outcome measures: Number of incorrect computer interpretations of atrial fibrillation or atrial flutter; rate of correction by the interpreting primary care physician; consequences of misdiagnosis of atrial fibrillation or atrial flutter. Results: Among 988 ECGs with a computer diagnosis of atrial fibrillation or atrial flutter, 89 (9.0%) were incorrect, among which 36 were not corrected by the interpreting physician. In 12 cases, misdiagnosed atrial fibrillation/flutter led to inappropriate treatment with anticoagulant therapy. A larger proportion of atrial flutters, 27 out of 80 (34%), than atrial fibrillations, 62 out of 908 (7%), were incorrectly diagnosed by the computer. Conclusions: Among ECGs with a computer-based diagnosis of atrial fibrillation or atrial flutter, the diagnosis was incorrect in almost 10%. In almost half of the cases, the misdiagnosis was not corrected by the overreading primary-care physician. Twelve patients received inappropriate anticoagulant treatment as a result of misdiagnosis.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
ECG, atrial fibrillation, atrial flutter, computer-based interpretation, cardiovascular disease
National Category
Cardiac and Cardiovascular Systems
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-90199 (URN)10.1080/02813432.2019.1684429 (DOI)000494058900001 ()31684791 (PubMedID)
Available from: 2019-11-21 Created: 2019-11-21 Last updated: 2019-12-06Bibliographically approved
Harris, M., Thulesius, H., Neves, A. L., Harker, S., Koskela, T., Petek, D., . . . Esteva, M. (2019). How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis. BMJ Open, 9(9), 1-10, Article ID e030169.
Open this publication in new window or tab >>How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 9, p. 1-10, article id e030169Article in journal (Refereed) Published
Abstract [en]

Background National European cancer survival rates vary widely. Prolonged diagnostic intervals are thought to be a key factor in explaining these variations. Primary care practitioners (PCPs) frequently play a crucial role during initial cancer diagnosis; their knowledge could be used to improve the planning of more effective approaches to earlier cancer diagnosis. Objectives This study sought the views of PCPs from across Europe on how they thought the timeliness of cancer diagnosis could be improved. Design In an online survey, a final open-ended question asked PCPs how they thought the speed of diagnosis of cancer in primary care could be improved. Thematic analysis was used to analyse the data. Setting A primary care study, with participating centres in 20 European countries. Participants A total of 1352 PCPs answered the final survey question, with a median of 48 per country. Results The main themes identified were: patient-related factors, including health education; care provider-related factors, including continuing medical education; improving communication and interprofessional partnership, particularly between primary and secondary care; factors relating to health system organisation and policies, including improving access to healthcare; easier primary care access to diagnostic tests; and use of information technology. Re-allocation of funding to support timely diagnosis was seen as an issue affecting all of these. Conclusions To achieve more timely cancer diagnosis, health systems need to facilitate earlier patient presentation through education and better access to care, have well-educated clinicians with good access to investigations and better information technology, and adequate primary care cancer diagnostic pathway funding.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
Delivery of Health Care, Primary Health Care, General Practitioners, Cancer, Diagnosis, Consultation and Referral
National Category
Cancer and Oncology
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-90930 (URN)10.1136/bmjopen-2019-030169 (DOI)000497787600252 ()31551382 (PubMedID)
Available from: 2020-01-15 Created: 2020-01-15 Last updated: 2020-01-15Bibliographically approved
Melin, E. O., Thulesius, H., Hillman, M., Svensson, R., Landin-Olsson, M. & Thunander, M. (2019). Lower HDL, a known marker of cardiovascular risk, was associated with depression in type 1 diabetes. Paper presented at 87th Congress of the European-Atherosclerosis-Society (EAS), MAY 26-29, 2019, Maastricht, NETHERLANDS. Atherosclerosis, 287, E228-E228
Open this publication in new window or tab >>Lower HDL, a known marker of cardiovascular risk, was associated with depression in type 1 diabetes
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2019 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 287, p. E228-E228Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Psychology
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-89263 (URN)10.1016/j.atherosclerosis.2019.06.699 (DOI)000482110800697 ()
Conference
87th Congress of the European-Atherosclerosis-Society (EAS), MAY 26-29, 2019, Maastricht, NETHERLANDS
Available from: 2019-09-25 Created: 2019-09-25 Last updated: 2019-09-25Bibliographically approved
Melin, E. O., Thulesius, H., Hillman, M., Svensson, R., Landin-Olsson, M. & Thunander, M. (2019). Lower HDL-cholesterol, a known marker of cardiovascular risk, was associated with depression in type 1 diabetes: a cross sectional study. Lipids in Health and Disease, 18, 1-10, Article ID 65.
Open this publication in new window or tab >>Lower HDL-cholesterol, a known marker of cardiovascular risk, was associated with depression in type 1 diabetes: a cross sectional study
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2019 (English)In: Lipids in Health and Disease, ISSN 1476-511X, E-ISSN 1476-511X, Vol. 18, p. 1-10, article id 65Article in journal (Refereed) Published
Abstract [en]

Background: Depression, metabolic disturbances and inflammation have been linked to cardiovascular disease and mortality. Low levels of high-density lipoprotein cholesterol (HDL-cholesterol), a known marker of cardiovascular risk, have been observed in patients with major depression in psychiatric populations. Our main aim was to explore associations between depression, antidepressants, and metabolic and inflammatory variables in patients with type 1 diabetes (T1D). A secondary aim was to explore variables associated with HDL-cholesterol. Methods: Cross-sectional design. T1D patients (n = 292, men 55%, age 18-59 years, diabetes duration >= 1 year) were consecutively recruited from one specialist diabetes clinic. Depression was defined as 8 points for Hospital Anxiety and Depression Scale-Depression sub scale. Blood samples, anthropometrics, blood pressure, and data regarding medication and life style were collected from electronic health records. Non-parametric tests, multiple logistic and linear regression analyses were performed. Results: The depression prevalence was 10 and 8% used antidepressants. Median (q(1), q(3)) HDL-cholesterol (mmol/l) was for the depressed 1.3 (1.2, 1.5) and for the non-depressed 1.6 (1.3, 1.8), p = 0.001. HDL-cholesterol levels (per mmol/l) were negatively associated with depression (Adjusted odds ratio (AOR) 0.2, p = 0.007), and the use of antidepressants was positively associated with depression (AOR 8.1, p < 0.001). No other metabolic or inflammatory variables, or life style factors, were associated with depression when adjusted for antidepressants. Abdominal obesity was associated with antidepressants in women (AOR 4.6, p = 0.029). Decreasing HDL-cholesterol levels were associated with increasing triglyceride levels (p < 0.001), increasing high-sensitive C-reactive protein (hs-CRP) levels (p = 0.021), younger age (p < 0.001), male sex (p < 0.001), and depression (p = 0.045). Conclusions: Lower HDL-cholesterol levels, known predictors of cardiovascular disease, were associated with depression in patients with T1D. The use of antidepressants was associated with abdominal obesity in women. Depression, low-grade inflammation measured as hs-CRP, higher triglycerides, male sex, and lower age were independently associated with lower HDL-cholesterol levels.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Type 1 diabetes, Depression, Antidepressants, Serum-lipids, Low-grade inflammation
National Category
Psychology
Research subject
Social Sciences, Psychology; Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-81698 (URN)10.1186/s12944-019-1009-4 (DOI)000461945400002 ()30885233 (PubMedID)2-s2.0-85063129830 (Scopus ID)
Available from: 2019-04-05 Created: 2019-04-05 Last updated: 2019-08-29Bibliographically approved
van der Ploeg, M. A., Streit, S., Achterberg, W. P., Beers, E., Bohnen, A. M., Burman, R. A., . . . Poortvliet, R. K. E. (2019). Patient Characteristics and General Practitioners' Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries. Journal of general internal medicine, 34(9), 1751-1757
Open this publication in new window or tab >>Patient Characteristics and General Practitioners' Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries
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2019 (English)In: Journal of general internal medicine, ISSN 0884-8734, E-ISSN 1525-1497, Vol. 34, no 9, p. 1751-1757Article in journal (Refereed) Published
Abstract [en]

Background Statins are widely used to prevent cardiovascular disease (CVD). With advancing age, the risks of statins might outweigh the potential benefits. It is unclear which factors influence general practitioners' (GPs) advice to stop statins in oldest-old patients. Objective To investigate the influence of a history of CVD, statin-related side effects, frailty and short life expectancy, on GPs' advice to stop statins in oldest-old patients. Design We invited GPs to participate in this case-based survey. GPs were presented with 8 case vignettes describing patients > 80 years using a statin, and asked whether they would advise stopping statin treatment. Main Measures Cases varied in history of CVD, statin-related side effects and frailty, with and without shortened life expectancy (< 1 year) in the context of metastatic, non-curable cancer. Odds ratios adjusted for GP characteristics (ORadj) were calculated for GPs' advice to stop. Key Results Two thousand two hundred fifty GPs from 30 countries participated (median response rate 36%). Overall, GPs advised stopping statin treatment in 46% (95%CI 45-47) of the case vignettes; with shortened life expectancy, this proportion increased to 90% (95CI% 89-90). Advice to stop was more frequent in case vignettes without CVD compared to those with CVD (ORadj 13.8, 95%CI 12.6-15.1), with side effects compared to without ORadj 1.62 (95%CI 1.5-1.7) and with frailty (ORadj 4.1, 95%CI 3.8-4.4) compared to without. Shortened life expectancy increased advice to stop (ORadj 50.7, 95%CI 45.5-56.4) and was the strongest predictor for GP advice to stop, ranging across countries from 30% (95%CI 19-42) to 98% (95% CI 96-99). Conclusions The absence of CVD, the presence of statin-related side effects, and frailty were all independently associated with GPs' advice to stop statins in patients aged > 80 years. Overall, and within all countries, cancer-related short life expectancy was the strongest independent predictor of GPs' advice to stop statins.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
hydroxymethylglutaryl-CoA reductase inhibitors, cardiovascular diseases, drug therapy, palliative care, general practitioners, clinical decision-making
National Category
Geriatrics
Research subject
Medicine, Gerontology
Identifiers
urn:nbn:se:lnu:diva-89544 (URN)10.1007/s11606-018-4795-x (DOI)000483539200022 ()30652277 (PubMedID)
Available from: 2019-10-11 Created: 2019-10-11 Last updated: 2019-11-29
Munoz, M.-A., Vaillant-Roussel, H., Glynn, L., Assenova, R., Torsza, P., Gril, L., . . . Abellana, R. (2019). Precipitant Factors of Heart Failure Decompensation in Patients Attended in Primary Care, the Hefestos Study. Paper presented at the American Heart Association's 2019 Scientific Sessions. Circulation, 140, Article ID A10647.
Open this publication in new window or tab >>Precipitant Factors of Heart Failure Decompensation in Patients Attended in Primary Care, the Hefestos Study
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2019 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 140, article id A10647Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Introduction: Most knowledge about the main causes of heart failure decompensation come from hospital setting. However, evidence coming from primary care is scarce.

Hypothesis: It is possible to identify the main causes of decompensation of HF in order to prevent and treat them

Methods: HEFESTOS is a multinational collaborative cohort study carried out in 10 European countries, aimed at knowing the main precipitant factors related to a heart failure decompensation, attended in primary care setting and its relationship to the prognosis at short term. Patients were consecutively recruited and followed for one month after the decompensation

Results: 685 patients were prospectively included. Women represented 54.5% and mean age was 81.2 (DE 8.90) years. Potential causative factors for decompensated heart failure were identified in 77.9 % of cases. More than one factor was identified in 35.9% of patients. Respiratory infections, Non-compliance with fluid or salt restriction, non-medication adherence, and atrial fibrillation, were the most commonly identified factors (28.2%, 26.8%, 22.8% and 14.5%, respectively). A total of 28.2% of patients were hospitalized and 3.5% died. After adjusting for potential confounding factors, only respiratory infections and atrial fibrillation were significantly associated with hospitalization or mortality (OR 1.19, 95%CI 1.09-1.19 and 1.22, 95%CI, 1.10-1.35), respectively

Conclusions: An early identification and treatment of respiratory infection and atrial fibrillation would help to prevent hospitalizations and mortality in heart failure patients presenting heart failure decompensation.

National Category
Cardiac and Cardiovascular Systems
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-90812 (URN)
Conference
the American Heart Association's 2019 Scientific Sessions
Available from: 2020-01-09 Created: 2020-01-09 Last updated: 2020-01-15Bibliographically approved
Ekman, B., Thulesius, H., Wikens, J., Lindgren, A., Cronberg, O. & Arvidsson, E. (2019). Utilization of digital primary care in Sweden: Descriptive analysis of claims data on demographics, socioeconomics, and diagnoses. International Journal of Medical Informatics, 127, 134-140
Open this publication in new window or tab >>Utilization of digital primary care in Sweden: Descriptive analysis of claims data on demographics, socioeconomics, and diagnoses
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2019 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 127, p. 134-140Article in journal (Refereed) Published
Abstract [en]

Objective

As digital technologies for health continue to develop, the ability to provide primary care services to patients with new symptoms will grow. In Sweden, two providers of digital primary care have expanded rapidly over the past years giving rise to a heated debate with clear policy implications. The purpose of the study is to present a descriptive review of digital primary care as currently under development in Sweden.

Methods

Descriptive analysis of national coverage data on the utilization of digital care by sex, age, place of residence, socioeconomic status, and most common diagnoses. The data are compared with samples of corresponding data on traditional, office-based primary care, out-of-hours care, and on non-emergency telephone consultations to obtain a comparative analysis of digital care.

Results

Digital primary care in Sweden has increased rapidly over the past two years. Currently, more than 30,000 digital consultations are made per month, equivalent to around two percent of all physician-led primary care. Digital care differs in some ways to that of traditional care as users are generally younger and seek for different conditions compared with office-based primary care. Digital care is also similar to traditional care as utilization is higher in metropolitan areas compared with rural areas. Similar to general health care use, there is a negative correlation between use of digital care and socioeconomic status. User profiles by age and sex of digital care are also similar to those of out-of-hours care and non-emergency telephone medical consultations.

Conclusions

By providing a detailed description of the development of digital primary care the study contributes to a growing understanding of the contributions that digital technologies can make to health care. Based on current trends digital primary care is likely to continue to increase in frequency over the coming years. As technologies develop and the public becomes more familiar to interacting with medical providers over the Internet also the scope of digital care is likely to expand. As the provision of digital primary care expands across Europe and beyond, policy makers will need to develop regulating capacities to ensure its safe, effective and equitable integration into existing health systems.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Other Medical Sciences not elsewhere specified
Research subject
Health and Caring Sciences, Health Informatics
Identifiers
urn:nbn:se:lnu:diva-90809 (URN)10.1016/j.ijmedinf.2019.04.016 (DOI)
Available from: 2020-01-09 Created: 2020-01-09 Last updated: 2020-01-15Bibliographically approved
Thulesius, H. (2019). Work incentives, chronic illnesses and how sickness certificates are written affect sickness absence.. Scandinavian Journal of Primary Health Care, 37(1), 1-2
Open this publication in new window or tab >>Work incentives, chronic illnesses and how sickness certificates are written affect sickness absence.
2019 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, no 1, p. 1-2Article in journal, Editorial material (Refereed) Published
Place, publisher, year, edition, pages
Taylor & Francis, 2019
National Category
Other Medical Sciences not elsewhere specified
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-81293 (URN)10.1080/02813432.2019.1571000 (DOI)30784344 (PubMedID)
Available from: 2019-03-22 Created: 2019-03-22 Last updated: 2019-04-15Bibliographically approved
Melin, E. O., Thulesius, H., Hillman, M., Landin-Olsson, M. & Thunander, M. (2018). Abdominal obesity in type 1 diabetes associated with gender, cardiovascular risk factors and complications, and difficulties achieving treatment targets: a cross sectional study at a secondary care diabetes clinic. BMC obesity, 5, 1-10, Article ID 15.
Open this publication in new window or tab >>Abdominal obesity in type 1 diabetes associated with gender, cardiovascular risk factors and complications, and difficulties achieving treatment targets: a cross sectional study at a secondary care diabetes clinic
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2018 (English)In: BMC obesity, E-ISSN 2052-9538, Vol. 5, p. 1-10, article id 15Article in journal (Refereed) Published
Abstract [en]

Background: Abdominal obesity is linked to cardiovascular diseases in type 1 diabetes (T1D). The primary aim was to explore associations between abdominal obesity and cardiovascular complications, metabolic and inflammatory factors. The secondary aim was to explore whether achieved recommended treatment targets differed between the obese and non-obese participants.

Methods: Cross sectional study of 284 T1D patients (age 18-59 years, men 56%), consecutively recruited from one secondary care specialist diabetes clinic in Sweden. Anthropometrics, blood pressure, serum-lipids and high-sensitivity C-reactive protein (hs-CRP) were collected and supplemented with data from the patients' medical records and from the Swedish National Diabetes Registry. Abdominal obesity was defined as waist circumference men/women (meters): ≥1.02/≥0.88. Hs-CRP was divided into low-, moderate-, and high-risk groups for future cardiovascular events (< 1, 1 to 3, and > 3 to ≤8.9 mg/l). Treatment targets were blood pressure ≤ 130/≤ 80, total cholesterol ≤4.5 mmol/l, LDL: ≤ 2.5 mmol/l, and HbA1c: ≤5 2 mmol/mol (≤ 6.9%). Different explanatory linear, logistic and ordinal regression models were elaborated for the associations, and calibrated and validated for goodness of fit with the data variables.

Results: The prevalence of abdominal obesity was 49/284 (17%), men/women: 8%/29% (P < 0.001). Women (adjusted odds ratio (AOR) 6.5), cardiovascular complications (AOR 5.7), HbA1c > 70 mmol/mol (> 8.6%) (AOR 2.7), systolic blood pressure (per mm Hg) (AOR 1.05), and triglycerides (per mmol/l) (AOR 1.7), were associated with abdominal obesity. Sub analyses (n = 171), showed that abdominal obesity (AOR 5.3) and triglycerides (per mmol/l) (AOR 2.8) were associated with increasing risk levels of hs-CRP. Treatment targets were obtained for fewer patients with abdominal obesity for HbA1c (8% vs 21%, P = 0.044) and systolic blood pressure (51% vs 68%, P = 0.033). No patients with abdominal obesity reached all treatment targets compared to 8% in patients without abdominal obesity.

Conclusions: Significant associations between abdominal obesity and gender, cardiovascular disease, and the cardiovascular risk factors low-grade inflammation, systolic blood pressure, high HbA1c, and triglycerides, were found in 284 T1D patients. Fewer patients with abdominal obesity reached the treatment targets for HbA1c and systolic blood pressure compared to the non-obese.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Abdominal obesity, Cardiovascular complications, Diabetes mellitus type 1, Gender, Glycemic control, Hyperlipidemia, Hypertension, Inflammation, Treatment targets
National Category
Endocrinology and Diabetes
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-81296 (URN)10.1186/s40608-018-0193-5 (DOI)29785272 (PubMedID)
Available from: 2019-03-22 Created: 2019-03-22 Last updated: 2019-04-10Bibliographically approved
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