| 11. |
- Aagaard Nohr, Ellen, et al.
(author)
-
Evidence-based midwifery
- 2022
-
In: Theories and perspectives for midwifery: a Nordic view. - Lund : Studentlitteratur. - 9789144143194 ; , s. 79-94
-
Book chapter (peer-reviewed)abstract
- In this chapter, the history of evidence-based care and practice and their main principles will be presented, including a special focus on the field of obstetrics and midwifery. We will describe and discuss the main components of evidence-based midwifery and how they have been applied on important topics within maternal and newborn care. Finally, we will discuss the opportunities and challenges that midwives in the Nordic countries face when applying evidence-based care in a clinical setting that is dominated by large obstetric wards.
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| 12. |
- Aagaard, P., et al.
(author)
-
Early repolarization in ECG. Definition, prevalence and prognostic significance
- 2015
-
In: Läkartidningen. - 0023-7205. ; 112
-
Journal article (peer-reviewed)abstract
- Early repolarization defined as antero-lateral ST-segment elevation exists in 1-2 % of the general population and has been considered a benign ECG finding for decades. However, early repolarization, defined as infero-lateral J-waves, has in recent studies been associated with an increased - albeit low - risk of sudden and cardiovascular death. This ECG pattern is present in 3-13% of the general population. However, exercise training can induce all types of early repolarization, and the prevalence in the athletic population rises to 20-90%. There is large variability between sports (higher in endurance athletes) and also throughout the season (higher during times of peak fitness). In athletes, early repolarization, regardless of type, is considered benign. In asymptomatic non-athletes, the absolute risk is too low to use this ECG finding in clinical practice. In individuals with J-wave syndrome, on the other hand, ICD implantation should be strongly considered to prevent sudden cardiac death.
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| 13. |
- Aagaard, Philip, et al.
(author)
-
Early Repolarization in Middle-Age Runners-Cardiovascular Characteristics.
- 2014
-
In: Medicine & Science in Sports & Exercise. - 0195-9131 .- 1530-0315. ; 46:7, s. 1285-1292
-
Journal article (peer-reviewed)abstract
- Purpose: This study aimed to assess the prevalence and patterns of early repolarization (ER) in middle-age long-distance runners, its relation to cardiac structure and function, and its response to strenuous physical activity. Methods: Male first-time cross-country race participants >45 yr were assessed pre-and postrace by medical history and physical examination, 12-lead ECG, vectorcardiography, blood tests, and echocardiography. ER was defined either as ST elevation or J wave and categorized according to localization and morphology. Results: One hundred and fifty-one subjects (50 +/- 5 yr) were evaluated before the race, and 47 subjects were evaluated after the race. Altogether, 67 subjects (44%) had ER. Subjects with versus without ER had a lower resting HR (56 +/- 8 vs 69 +/- 9 bpm, P = 0.02), lower body mass index (24 +/- 2 vs 25 +/- 3 kg.m(-2), P < 0.001), higher training volume (3.0 +/- 2.6 vs 2.1 +/- 2.7 h.wk(-1), P = 0.03), and faster 30-km running times (194 +/- 28 vs 208 +/- 31 min, P = 0.01). Vectorcardiography parameters in subjects with ER showed more repolarization heterogeneity: vector gradient (QRS-T-area) (120 +/- 25 vs 92 +/- 29 mu Vs, P < 0.001), T-area (105 +/- 18 vs 73 +/- 23 mu Vs, P < 0.001), and T-amplitude (0.63 +/- 0.13 vs 0.53 +/- 0.16 mm, P < 0.001); these parameters were inversely related to HR (r = -0.37 to -0.48, P < 0.001). ER disappeared in 15 (75%) of 20 subjects after the race. Conclusions: ER is a common finding in middle-age male runners. This ECG pattern, regardless of morphology and localization, is associated with normal cardiac examinations including noninvasive electrophysiology, features of better physical conditioning, and disappears after strenuous exercise in most cases. These findings support that ER should be regarded as a common and training-related finding also in middle-age physically active men.
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| 14. |
- Aagaard, P., et al.
(author)
-
Heart Rate and Its Variability in Response to Running-Associations with Troponin
- 2014
-
In: Medicine and Science in Sports and Exercise. - : Ovid Technologies (Wolters Kluwer Health). - 0195-9131. ; 46:8, s. 1624-1630
-
Journal article (peer-reviewed)abstract
- Purpose: The objective of this study is to investigate the time course of autonomic tone changes after a first-time endurance running race participation and associations with postexertional high-sensitivity troponin (hsTnT) levels in middle-aged males. Methods: Male (n = 42) first-time long-distance running race (Lidingoloppet 30 km) participants >= 45 yr (50.5 +/- 5) were examined. HR and HR variability (HRV) in the time domain (SDANN) was measured continuously from 2 d before to 4 d after the race using a wireless cardiovascular monitor that also recorded arrhythmia episodes. In addition, subjects were assessed pre- and postrace by medical history and physical examination, 12-lead ECG, blood tests including hsTnT, and echocardiography. Results: Compared with corresponding prerace values, nighttime (2: 00-4: 00 a.m.) HR was significantly elevated (63.6 +/- 9.4 vs 53.9 +/- 8.3 bpm, P < 0.001) on the first night postrace, whereas HRV remained reduced for a median of 64 h (interquartile range, 51-102 h). A prolonged HR recovery period (r = 0.48, P = 0.005) and a larger reduction in postrace HRV (r = -0.49, P = 0.003) correlated with higher postrace hsTnT levels. The association between reduced HRV and higher hsTnT remained significant after multivariate analysis (A = -0.48, P = 0.01). No sustained ventricular arrhythmias were recorded, but atrial fibrillation occurred in two subjects. Conclusion: Endurance running race participation caused a prolonged alteration of autonomic tone. More marked and prolonged changes were associated with higher levels of hsTnT, suggesting that the magnitude of troponin increase after strenuous exercise may reflect the magnitude of exercise-induced cardiovascular stress.
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| 15. |
- Aagaard, P, et al.
(author)
-
Preparticipation Evaluation of Novice, Middle-Age Long-Distance Runners.
- 2013
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In: Medicine and science in sports and exercise. - 0195-9131 .- 1530-0315. ; 45:1
-
Journal article (peer-reviewed)abstract
- Abstract PURPOSE: To assess the cardiovascular health and risk profile in middle-aged males making an entry to participate for their first time in a long-distance race. METHODS: Male first-time participants ≥45 years in the world's largest cross-country running race, the Lidingöloppet, were evaluated with a medical history and physical exam, European risk-SCORE, 12-lead ECG, echocardiography and blood tests. Further diagnostic work-up was performed when clinically indicated. RESULTS: Of 265 eligible runners, 153 (58%, age 51±5 y) completed the study. While the 10-year fatal cardiovascular event risk was low (SCORE: 1% (IQR: 0 - 1%)), mild abnormalities were common, e.g. elevated blood-pressure (19%), left ventricular hypertrophy (6%), elevated LDL cholesterol (5%). ECG changes compatible with "athlete's heart" were present in 82%, e.g. sinus bradycardia (61%) and/or early repolarization (32%). ECG changes considered training-unrelated were found in 24%, e.g. prolonged QTc: 13%; left axis deviation: 5.3%; left atrial enlargement: 4%). In 14 runners (9%) additional diagnostic work-up was clinically motivated, and 4 (2%) were ultimately discouraged from vigorous exercise due to QTc intervals >500 ms (n=2), symptomatic atrioventricular block (n=1), and a cardiac tumor (n=1). The physician exam and the ECG identified 12 of the 14 subjects requiring further evaluation. CONCLUSIONS: Cardiovascular evaluation of middle-aged men, including a physician exam and a 12-lead ECG, appears useful to identify individuals requiring further testing prior to vigorous exercise. The additional yield of routine echocardiography was small.
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| 16. |
- Aagaard, Philip, et al.
(author)
-
Tidig repolarisation på EKG - Definitioner, prevalens och prognostisk betydelse.
- 2015
-
In: Läkartidningen. - 1652-7518. ; 112
-
Journal article (peer-reviewed)abstract
- Early repolarization defined as antero-lateral ST-segment elevation exists in 1-2 % of the general population and has been considered a benign ECG finding for decades. However, early repolarization, defined as infero-lateral J-waves, has in recent studies been associated with an increased - albeit low - risk of sudden and cardiovascular death. This ECG pattern is present in 3-13% of the general population. However, exercise training can induce all types of early repolarization, and the prevalence in the athletic population rises to 20-90%. There is large variability between sports (higher in endurance athletes) and also throughout the season (higher during times of peak fitness). In athletes, early repolarization, regardless of type, is considered benign. In asymptomatic non-athletes, the absolute risk is too low to use this ECG finding in clinical practice. In individuals with J-wave syndrome, on the other hand, ICD implantation should be strongly considered to prevent sudden cardiac death.
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| 17. |
- Aagerup, Ulf, 1969, et al.
(author)
-
Green consumer behavior: Being good or seeming good?
- 2016
-
In: Journal of Product & Brand Management. - Bingley : Emerald Group Publishing Limited. - 1061-0421. ; 25:3, s. 274-284
-
Journal article (peer-reviewed)abstract
- Purpose This paper aims to expand the emerging field of symbolic green consumer behavior (GCB) by investigating the impact of anticipated conspicuousness of the consumption situation on consumers’ choice of organic products. In addition, the paper also explores whether self-monitoring ability and attention to social comparison information (ATSCI) influence GCB in situations of anticipated high conspicuousness. Design/methodology/approach Two experiments test the study’s hypotheses. Findings The results of both experiments show that the anticipation of conspicuousness has a significant effect on GCB. Moreover, in Experiment 2, this effect is moderated by consumers’ level of ATSCI but not by their self-monitoring ability. Research limitations/implications Because ATSCI significantly interacts with green consumption because of the anticipation of a conspicuous setting, although self-monitoring ability does not, we conclude that social identification is an important determinant of green consumption. Practical implications Marketers who focus on building green brands could consider designing conspicuous consumption situations to increase GCB. Social implications Policymakers could enact change by making the environmental unfriendliness of non-eco-friendly products visible to the public and thus increase the potential for GCB. Originality/value The results validate the emerging understanding that green products are consumed for self-enhancement, but also expand the literature by highlighting that a key motivating factor of GCB is the desire to fit in.
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| 18. |
- Aakre, K. M., et al.
(author)
-
Analytical Considerations in Deriving 99th Percentile Upper Reference Limits for High-Sensitivity Cardiac Troponin Assays: Educational Recommendations from the IFCC Committee on Clinical Application of Cardiac Bio-Markers
- 2022
-
In: Clinical chemistry. - : Oxford University Press (OUP). - 0009-9147 .- 1530-8561. ; 68:8
-
Journal article (peer-reviewed)abstract
- The International Federation of Clinical Chemistry Committee on Clinical Application of Cardiac Bio-Markers provides evidence-based educational documents to facilitate uniform interpretation and utilization of cardiac biomarkers in clinical laboratories and practice. The committee's goals are to improve the understanding of certain key analytical and clinical aspects of cardiac biomarkers and how these may interplay in clinical practice. Measurement of high-sensitivity cardiac troponin (hs-cTn) assays is a cornerstone in the clinical evaluation of patients with symptoms and/or signs of acute cardiac ischemia. To define myocardial infarction, the Universal Definition of Myocardial Infarction requires patients who manifest with features suggestive of acute myocardial ischemia to have at least one cTn concentration above the sex-specific 99th percentile upper reference limit (URL) for hs-cTn assays and a dynamic pattern of cTn concentrations to fulfill the diagnostic criteria for MI. This special report provides an overview of how hs-cTn 99th percentile URLs should be established, including recommendations about prescreening and the number of individuals required in the reference cohort, how statistical analysis should be conducted, optimal preanalytical and analytical protocols, and analytical/biological interferences or confounds that can affect accurate determination of the 99th percentile URLs. This document also provides guidance and solutions to many of the issues posed.
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| 19. |
- Aakre, Kristin M, et al.
(author)
-
Lower Limits for Reporting High-Sensitivity Cardiac Troponin Assays and Impact of Analytical Performance on Patient Misclassification.
- 2024
-
In: Clinical chemistry. - 0009-9147 .- 1530-8561. ; 70:3, s. 497-505
-
Journal article (peer-reviewed)abstract
- Cardiac troponin measurements are indispensable for the diagnosis of myocardial infarction and provide useful information for long-term risk prediction of cardiovascular disease. Accelerated diagnostic pathways prevent unnecessary hospital admission, but require reporting cardiac troponin concentrations at low concentrations that are sometimes below the limit of quantification. Whether analytical imprecision at these concentrations contributes to misclassification of patients is debated.The International Federation of Clinical Chemistry Committee on Clinical Application of Cardiac Bio-Markers (IFCC C-CB) provides evidence-based educational statements on analytical and clinical aspects of cardiac biomarkers. This mini-review discusses how the reporting of low concentrations of cardiac troponins impacts on whether or not assays are classified as high-sensitivity and how analytical performance at low concentrations influences the utility of troponins in accelerated diagnostic pathways. Practical suggestions are made for laboratories regarding analytical quality assessment of cardiac troponin results at low cutoffs, with a particular focus on accelerated diagnostic pathways. The review also discusses how future use of cardiac troponins for long-term prediction or management of cardiovascular disease may require improvements in analytical quality.Clinical guidelines recommend using cardiac troponin concentrations as low as the limit of detection of the assay to guide patient care. Laboratories, manufacturers, researchers, and external quality assessment providers should extend analytical performance monitoring of cardiac troponin assays to include the concentration ranges applicable in these pathways.
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| 20. |
- Aalberg, Toril, et al.
(author)
-
Strategy and Game Framing
- 2017
-
In: Comparing Political Journalism - (eds.) Claes de Vreese, Frank Esser & David Nicolas Hopmann. - New York : Routledge. - 9781138655867
-
Book chapter (peer-reviewed)
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