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  • Bosworth, H. B., et al. (författare)
  • Medication adherence: a call for action
  • 2011
  • Ingår i: American heart journal. - 1097-6744. ; 162:3, s. 412-24
  • Tidskriftsartikel (refereegranskat)abstract
    • Poor adherence to efficacious cardiovascular-related medications has led to considerable morbidity, mortality, and avoidable health care costs. This article provides results of a recent think-tank meeting in which various stakeholder groups representing key experts from consumers, community health providers, the academic community, decision-making government officials (Food and Drug Administration, National Institutes of Health, etc), and industry scientists met to evaluate the current status of medication adherence and provide recommendations for improving outcomes. Below, we review the magnitude of the problem of medication adherence, prevalence, impact, and cost. We then summarize proven effective approaches and conclude with a discussion of recommendations to address this growing and significant public health issue of medication nonadherence.
  • Gellanki, Jnaneswari, et al. (författare)
  • Extensive Gamma-ray Spectroscopy of Band Structures in 62Zn
  • 2012
  • Ingår i: Physical Review C (Nuclear Physics). - American Physical Society. - 0556-2813. ; 86:3
  • Tidskriftsartikel (refereegranskat)abstract
    • An experimental study of the Zn-62 nucleus has been performed by combining the data sets from four fusion-evaporation reaction experiments. Apart from the previously published data, the present results include ten new rotational band structures and two more superdeformed bands. The Gammasphere Ge-detector array in conjunction with the 4 pi charged-particle detector array Microball allowed for the detection of gamma rays in coincidence with evaporated light particles. The deduced level scheme includes some 260 excited states, which are connected with more than 450 gamma-ray transitions. Spins and parities of the excited states have been determined via directional correlations of. rays emitted from oriented states. The experimental characteristics of the rotational bands are analyzed and compared with results from cranked Nilsson-Strutinsky calculations. The present analysis, combined with available experimental results in the A similar to 60 mass region, can be used to improve the current set of Nilsson parameters in the N = 3 and N = 4 oscillator shells.
  • Gladnishki, KA, et al. (författare)
  • Angular Momentum Population in the Projectile Fragmentation of 238U at 750 MeV/nucleon
  • 2004
  • Ingår i: Physical Review C (Nuclear Physics). - American Physical Society. - 0556-2813. ; 69:2
  • Tidskriftsartikel (refereegranskat)abstract
    • A systematic study of the population probabilities of nanosecond and microsecond isomers produced following the projectile fragmentation of U-238 at 750 MeV/nucleon has been undertaken at the SIS/FRS facility at GSI. Approximately 15 isomeric states in neutron-deficient nuclei around A similar to 190 were identified and the corresponding. isomeric ratios determined. The results are compared with a model based on the statistical abrasion-ablation description of relativistic fragmentation and simple assumptions concerning gamma cascades in the final nucleus (sharp cutoff). This model represents an upper limit for the population of isomeric states in relativistic projectile fragmentation. When the decay properties of the states above the isomer are taken into account, as opposed to the sharp cutoff approximation, a good agreement between the experimental and calculated angular momentum population is obtained.
  • Granger, B. B., et al. (författare)
  • Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial
  • 2005
  • Ingår i: Lancet. - 1474-547X (Electronic). ; 366:9502, s. 2005-11
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Chronic heart failure (CHF) is an important cause of hospital admission and death. Poor adherence to medication is common in some chronic illnesses and might reduce the population effectiveness of proven treatments. Because little is known about adherence in patients with CHF and about the consequences of non-adherence, we assessed the association between adherence and clinical outcome in the CHARM (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) programme. METHODS: CHARM was a double-blind, randomised, controlled clinical trial, comparing the effects of the angiotensin receptor blocker candesartan with placebo in 7599 patients with CHF. Median follow-up was 38 months. The proportion of time patients took more than 80% of their study medication was defined as good adherence and 80% or less as poor adherence. We used a Cox proportional hazards regression model, with adherence as a time-dependent covariate in the model, to examine the association between adherence and mortality in the candesartan and placebo groups. FINDINGS: We excluded 187 patients because of missing information on adherence. In the time-dependent Cox regression model, after adjustment for predictive factors (demographics, physiological and severity-of-illness variables, smoking history, and number of concomitant medications), good adherence was associated with lower all-cause mortality in all patients (hazard ratio [HR] 0.65, 95% CI 0.57-0.75, p<0.0001). The adjusted HR for good adherence was similar in the candesartan (0.66, 0.55-0.81, p<0.0001) and placebo (0.64, 0.53-0.78, p<0.0001) groups. INTERPRETATION: Good adherence to medication is associated with a lower risk of death than poor adherence in patients with CHF, irrespective of assigned treatment. This finding suggests that adherence is a marker for adherence to effective treatments other than study medications, or to other adherence behaviours that affect outcome. Understanding these factors could provide an opportunity for new interventions, including those aimed at improving adherence.
  • Hamnerius, Y., et al. (författare)
  • Design of Safe Wireless Power Transfer Systems for Electric Vehicles
  • 2018
  • Ingår i: 2018 2nd URSI Atlantic Radio Science Meeting, AT-RASC 2018. - 9789082598735
  • Konferensbidrag (refereegranskat)abstract
    • Wireless charging of electric vehicles is convenient but in order to make it safe the exposure of humans to electromagnetic fields must be below acceptable limits. We have designed a prototype system that transmits 3 kW with an efficiency of 85% where the magnetic fields around and inside the vehicle are below the EU council recommendation of 6.25μT at 85 kHz.
  • Jendle, Johan, 1963-, et al. (författare)
  • Real-world cost-effectiveness of insulin degludec in type 1 and type 2 diabetes in a Swedish setting
  • 2019
  • Konferensbidrag (övrigt vetenskapligt)abstract
    • Background and aims: Randomised controlled trials and observational studies have shown lower risk of hypoglycemia in patients with type 1-diabetes (T1D) and type 2-diabetes (T2D) on treatment with insulinde gludec (IDeg) vs insulin glargine 100 units/mL (IGlar). This study assessed cost-effectiveness (C/E) of IDeg vs insulin treatment before switch to IDeg in a Swedish real-world setting in people with T1D and T2D.Materials and methods: ReFLeCT is a prospective, observational study in T1D (n=566) and T2D (n=611) in seven European countries and comprised a four-week baseline period (pre-switch basal insulin) and a 12-month follow-up period (IDeg). Data from ReFLeCT was used to assess C/E of IDeg compared with basal insulin treatment prior to switching to IDeg. Basal insulin unit costs were weighted to represent the basal insulin present at baseline (T1D: IGlar 63.8%, Insulin detemir (IDet) 22.7%, other/missing 13.5%. T2D: IGlar 59.1%, IDet 20.8%, other/missing 20.1%). The Swedish original IGlar price was used as base case. IGlar biosimilar price was used in a sensitivity analysis. Where information on basal insulin at baseline was missing, the lowest basal insulin price (insulin NPH) was used as a conservative approach. C/E was analysed over a 1-year time horizon from a Swedish societal perspective (price level 2019). Only differences with p&lt;0.05 were included in the analysis.Results: Basal and bolus insulin doses at baseline were 25.0 IU and 27.3 IU (T1D) and 37.5 IU and 24.4 IU (T2D). At 12 months estimated basal and bolus insulin dose ratios were 0.91 (95% C.I. 0.83-0.91) and 0.87 (0.83-0.91) for T1D and 0.98 (0.95-1.01) and 0.96 (0.94-1.01) for T2D. For T1D riskratios (RR) for non-severe daytime hypoglycaemia was 0.85 (0.78-0.93), non-severe nocturnal hypoglycaemia 0.63 (0.52-0.76) and severe hypoglycaemia 0.28 (0.14-0.56). Corresponding RR for T2D were 0.56 (0.46-0.69), 0.38 (0.22-0.64) and 2.87 (0.33-24.65). In T1D IDeg was cost-saving compared to previous basal therapy (Table 1). In T2D, IDeg was highly cost-effective, with a cost per quality-adjusted life-year (QALY) of SEK 15,000-24,000 (Table 1). A treatment is considered cost-effective in Sweden if cost/QALY is below SEK 500,000. Sensitivity analyses showed that the results were robust to changes in efficacy and cost parameters in both T1D and T2D.Conclusion: In this C/E-analysis, treatment with IDeg was cost-saving (T1D) or highly cost-effective (T2D) relative to the treatment used before switch in a Swedish setting after one year. C/E of IDeg in clinical practice is driven by lower insulin doses (T1D) and reduced risk of hypoglycaemia (T1D and T2D).
  • Jendle, Johan, 1963-, et al. (författare)
  • Switching to insulin degludec is a cost-saving therapy for patients with type 1 and type 2 diabetes in the Swedish setting based on real world data
  • 2019
  • Ingår i: Value in Health. - Elsevier. - 1098-3015 .- 1524-4733. ; 22:Suppl. 3, s. 575-576
  • Tidskriftsartikel (övrigt vetenskapligt)abstract
    • Objectives: The Europe-based, prospective, observational ReFLeCT study recently showed that switching to the ultralong-acting basal insulin analogue degludec (IDeg) was associated with improved glycemic control and reductions in hypoglycemic events versus previous basal insulin therapies in patients with type 1 (T1D) or type 2 diabetes (T2D). The present analysis aimed to assess the impact of thesefindings on long-term cost-effectiveness outcomes in the Swedish setting.Methods: Cost-effectiveness was evaluated separately in patients with T1D and T2D over a 50-year time horizon using the IQVIA CORE Diabetes Model (version 9.0). Patients were assumed to receive IDeg or continue previous insulin therapy (with or without bolus insulin) for 5 years, before all patients intensified to insulin degludec plus bolus insulin for the remainder of their lifetimes. Baseline cohort characteristics were sourced from ReFLeCT where possible. Treatment effects on initiation of IDeg were based on data from ReFLeCT. Costs were estimated from a Swedish societal perspective and expressed in 2018 Swedish krona (SEK).Results: IDeg was associated with improvements in quality-adjusted life expectancy of 0.14 and 0.07 quality-adjusted life years versus continuation of previous insulin therapy in patients with T1D and T2D, respectively, resulting from improved glycemic control and fewer hypoglycemic events. Combined direct and indirect costs were estimated to be SEK 137,020 and SEK 2,009 lower for insulin degludec versus previous insulin therapy in patients with T1D and T2D, respectively, with higher treatment costs offset by cos tsavings from avoidance of diabetes-related complications. IDeg was therefore considered dominant versus continuation of previous insulin therapies for the treatment of both T1D and T2D.Conclusions: Based on real-world evidence, IDeg represents an effective and cost-saving treatment option versus other basal insulin therapies for patients with T1D and T2D in Sweden.
  • Johansson, V., et al. (författare)
  • Microscopic Particles in Two Fractions of Fresh Cerebrospinal Fluid in Twins with Schizophrenia or Bipolar Disorder and in Healthy Controls
  • 2012
  • Ingår i: Plos One. - 1932-6203. ; 7:9
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Using scanning electron microscopy, microscopic structures have been identified in fresh cerebrospinal fluid (CSF) in patients with schizophrenia and bipolar disorder, but only rarely in control subjects. However, it has not been determined whether these microscopic particles represent state or trait markers, i.e. if their presence is related to clinical manifestations of the disease or if they also can be found in as yet asymptomatic individuals with a genetic liability. This question can be addressed by studying twins discordant or concordant for schizophrenia or bipolar disorder. Methodology/Principal Findings: We investigated microscopic structures in CSF in 102 individuals: 21 monozygotic and 16 dizygotic twins affected or not affected with schizophrenia, schizoaffective disorder or bipolar disorder and in 65 healthy singleton controls. A first and a second fraction of CSF was freshly applied on filters and examined by scanning electron microscopy technique. Spherical particles with lipid appearance averaging between 0.1 to 8.0 mu m in diameter were detected in the center of the filter as well as located in the margins of larger aggregates binding in a viscous state. Structures were found in 12 of 17 probands, 5 of 12 healthy co-twins and 3 of 73 healthy controls. Thus, a positive microscopic finding significantly increased the likelihood of belonging to the proband group (OR = 48, 95% CL: 8.2-550, p<0.0001) and the co-twin-group (OR = 16, 95% CL: 2.0-218, p = 0.006). Age, sex, history of alcohol abuse or anxiety syndrome, somatic disorder and markers of acute inflammatory activity did not account for group differences; nor did exposure to psychotropic medication. Conclusion: Presence of microscopic particles in CSF may possibly reflect trait dependent genetic or environmental vulnerability in patients with schizophrenia, schizoaffective disorder or bipolar disorder.
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