| 1321. |
- Svartengren, Magnus, et al.
(författare)
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The impact of body mass index, central obesity and physical activity on lung function : results of the EpiHealth study
- 2020
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Ingår i: ERJ Open Research. - : European Respiratory Society (ERS). - 2312-0541. ; 6:4
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Tidskriftsartikel (refereegranskat)abstract
- Study objectives: Obesity is often associated with lower lung function; however, the interaction of lung function with central obesity and physical inactivity is less clear. As such, we investigated the effect on lung function of body size (body mass index (BMI)), central obesity (waist circumference (WC)) and self-reported physical activity.Methods: Lung function, height, weight and WC were measured in 22 743 participants (12 791 women), aged 45-75 years, from the EpiHealth cohort study. Physical activity, gender and educational level were assessed using a questionnaire.Results: Obesity, central obesity and physical inactivity were all associated with lower forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). However, in participants without central obesity there was an increase in both FEV1 and FVC by BMI (% predicted FVC increasing from median 98%, interquartile range (IQR) 89-110% in underweight participants (BMI <20) to 103%, IQR 94-113% in obese participants (BMI ≥30)). In contrast, there was a decrease in % predicted FVC in participants with central obesity (from 98%, IQR 89-109% in the normal weight group to 95%, IQR 85-105% in the obese weight group). We further found a negative association between physical activity and lung function among those with low and high levels of physical activity (% predicted FEV1 97%, IQR 86-107% versus 103%, IQR 94-113%, respectively and % predicted FVC 96%, IQR 85-106% versus 103%, IQR 94-113%, respectively). All results remained when calculated by z-scores.Conclusions: The association between BMI and lung function is dependent on the presence of central obesity. Independent of obesity, there is an association between physical activity and lung function.
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| 1322. |
- Sylven, C., et al.
(författare)
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Myocardial Doppler tissue velocity improves following myocardial gene therapy with VEGF-A(165) plasmid in patients with inoperable angina pectoris
- 2001
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Ingår i: Coronary Artery Disease. - : Ovid Technologies (Wolters Kluwer Health). - 0954-6928 .- 1473-5830. ; 12:3, s. 239-243
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Tidskriftsartikel (refereegranskat)abstract
- Background Myocardial tissue velocity and perfusion were studied in patients with severe angina pectoris following gene therapy by intramyocardial injection of phVEGF-A(165) via thoracotomy. Plasma concentrations of VEGF-A increased postoperatively. Two months after treatment anginal status and myocardial tissue velocity improved and perfusion showed a tendency to improve. Tissue velocity imaging appears to be a sensitive, objective method for detecting changes in myocardial function following gene therapy. Objective To study effects on myocardial tissue velocity and perfusion in patients with angina pectoris following intramyocardial injection of phVEGF-A(165) via thoracotomy. Design Open label, phase I/II. Methods Six patients with Canadian Cardiovascular Society (CCS) angina pectoris functional Glass III - IV and with major defects at adenosine stress single-photon emission computerized tomography (SPECT) were studied. In addition to SPECT, coronary angiography and dobutamine stress echocardiography with tissue Doppler velocity imaging were performed before and two months after gene transfer. Results Plasma concentrations of VEGF-A increased 2 to 3 times (P < 0.04) over baseline from 2 to 14 days after injection with normalization after 4 weeks. The CCS class improved about 40%, from 3.3 +/- 0.2 to 2.0 +/- 0.3 (P < 0.02) and nitroglycerine consumption decreased 30 - 40%, from 44 +/- 17 to 15 +/- 5 tablets per week (P < 0.05). The maximal systolic myocardial tissue velocity increased in all patients about 25% (P < 0.02) but did not reach the reference range. Myocardial perfusion at SPECT improved in four of the six patients. Conclusions Anginal status, myocardial tissue velocity and perfusion can be improved by phVEGF-A(165) intramyocardial injection. Tissue velocity imaging appears to be a sensitive, objective method for detecting changes in myocardial function following gene therapy. Coron Artery Dis 12:239-243
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| 1323. |
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| 1324. |
- Säfwenberg, Urban, et al.
(författare)
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Differences in Long-term Mortality for Different Emergency Department Presenting Complaints
- 2008
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Ingår i: Academic Emergency Medicine. - : Wiley. - 1069-6563 .- 1553-2712. ; 15:1, s. 9-16
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To characterize long-term mortality based on previous emergency department (ED) presenting complaints. METHODS: The authors followed, for 10 years, all of the 12,667 nonsurgical patients visiting an ED during 1995/1996. Differences in standardized mortality ratio (SMR) depending on presenting complaints were then investigated. RESULTS: During follow-up, 5,324 deaths occurred (mortality rate 6.6 per 100 person-years at risk), giving a SMR of 1.33 (95% CI = 1.30 to 1.37, p < 0.001) when compared with the expected mortality in the catchment area. Different presenting complaints were associated with different long-term mortality rates, independent of age and gender (p < 0.0001). The subjects with seizures had the highest SMR (2.62, 95% CI = 2.13 to 3.22) followed by intoxications (2.51, 95% CI = 2.11 to 2.98), asthmalike symptoms (1.84, 95% CI = 1.65 to 2.06), and hyperglycemia (1.67, 95% CI = 1.42 to 1.95). The largest complaint group, chest pain, had a 20% higher mortality rate than the background population (95% CI = 1.13 to 1.26). Patients with a discharge diagnosis of myocardial infarction, but without chest pain as the presenting complaint, had an increased long-term mortality (hazard ratio [HR] 1.70, 95% CI = 1.15 to 2.42) compared to the group with chest pain. In contrast, stroke patients without strokelike symptoms had a reduced mortality (HR 0.74, 95% CI = 0.65 to 0.84) compared to patients with strokelike symptoms. CONCLUSIONS: Long-term age- and gender-adjusted mortality is the highest with seizures out of 33 presenting complaints and differs markedly between different ED admission complaints. Furthermore, depending on the admission complaint, long-term mortality differs within the same discharge diagnosis. Hence, the presenting complaint adds unique information to the discharge diagnosis regarding long-term mortality in nonsurgical patients.
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| 1325. |
- Säfwenberg, Urban, et al.
(författare)
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Increased long-term mortality in patients with repeated visits to the emergency department
- 2010
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Ingår i: European journal of emergency medicine. - 0969-9546 .- 1473-5695. ; 17:5, s. 274-279
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Tidskriftsartikel (refereegranskat)abstract
- Background Revisits to the emergency department (ED) are common. It is not clear whether the number of revisits, the time between revisits or the reason for the revisits are associated with increased mortality. Methods During 1 year, the number of visits, the reason for the visit and the time between visits were recorded in 15 607 nonsurgical ED patients and related to 1-year and 5-year mortality. Results Five-year mortality was dependent on the number of revisits in an inverse U-shaped manner. When compared with one-time visitors, patients with three visits showed an increased 5-year mortality (hazard ratio 1.85, 95% confidence interval 1.58-2.16, P < 0.0001), whereas in patients with four or five visits mortality decreased. Patients with six or more visits had a 5-year mortality not different from one-time visitors. The impact of the number of visits was, however, dependent on the presenting complaint (P < 0.0001). Furthermore, the time between two adjacent visits influenced long-term mortality in an inverse U-shaped manner. In patients not admitted to the ward, a revisit after 2-3 days was associated with increased mortality (hazard ratio 1.89, 95% confidence interval 1.06-3.35, P = 0.03). In patients revisiting the ED with the same adjacent presenting complaint, mortality differed depending on the complaint (P < 0.0001). Conclusion In nonsurgical patients revisiting the ED, long-term mortality was dependent on both the number of revisits, as well as the time between two visits in an inverse U-shaped manner. This indicates a possibility of detecting the transition level between appropriate medical utilization and inappropriate frequent ED use.
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| 1326. |
- Säfwenberg, Urban, 1960-
(författare)
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Presenting complaint and mortality in non-surgical emergency medicine patients
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In 1995 and 2000 a total of 29 886 non surgical ED visits at Uppsala University Hospital were registered. Presenting complaint, admittance to a ward, length of stay, in-hospital mortality, discharge diagnoses, 30-day and long-term mortality were registered. The presenting complaints were sorted into 33 presenting complaint groups (PCGs). For different PCGs there was different in-hospital fatality rate. Compared to the largest PCG, chest pain, the gender and age adjusted OR was 2.12 (95% CI 1.01 – 4.44) for the miscellaneous complaint group and 2.04 (95 % CI 1.35 – 3.08) for the stroke–like symptom group. Within a given PCG the in-hospital mortality could vary depending on discharge diagnoses. By relating PCG and long term mortality to the expected mortality in the population, the Standardized Mortality Ratio (SMR) could be calculated. The SMR was found to be highest in seizure 2.62 (95 % CI 2.13 – 3.22), intoxication 2.51 (95% CI 2.11-2.98) and symptoms of asthma 1.8 (1.65 – 2.06). For the same discharge diagnoses the long term mortality could differ considerably depending on PCG at ED arrival (p<0.001). Between 1995 and 2000 there was a 30 % increase in ED visits at the non surgical ED. PCGs representing lesser severe conditions had increased. Demographic changes could account for 45 % of the increment and the remaining increase could be ascribed to change in visiting pattern. In the 2000 cohort 41.0 % of all visits were performed by re-visitors. The number of revisits and five-year mortality had an inversed u-shaped relationship were patients with three re-visits within the same year had an increased mortality compared to patients with more or less visits. Conclusion: It is possible to define presenting complaint groups (PCGs) that are robust and consistent over time and useful as a tool for epidemiological studies in the ED.
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| 1327. |
- Säfwenberg, Urban, et al.
(författare)
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The Emergency Department presenting complaint as predictor of in-hospital fatality
- 2007
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Ingår i: European journal of emergency medicine. - 0969-9546 .- 1473-5695. ; 14:6, s. 324-331
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Tidskriftsartikel (refereegranskat)abstract
- Background: The relationship between major discharge diagnoses and prediction of in-hospital death has been intensively studied. The relation between the presenting complaint at the Emergency Department (ED) and in-hospital fatality, however, is less well known. Objective: To investigate if presenting complaints add information regarding in-hospital fatality risk for nonsurgical ED patients. Methods: Investigating the relationship of in-hospital fatality rate and presenting complaint by comparing the presenting complaints, discharge diagnoses and in-hospital fatality for all nonsurgical patients visiting the ED during 1 year. Results: Of 12 995 nonsurgical admissions, 40% were treated as in-hospital patients. Among these, 328 in-hospital deaths occurred. Age was the most powerful predictor of death in hospitalized patients (P<0.0001). After adjustment for age, the female sex was found to be protective [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.92, P=0.007)]. Compared with the largest complaint group, chest pain with an in-hospital fatality rate of 2.5%, there was a significantly increased risk of dying among those with stroke-like symptoms (OR 2.04, 95% CI 1.35-3.08, P=0.0007), dyspnoea (OR 1.95, 95% CI 1.27-3.00, P=0.002) or general disability (OR 1.81, 95% CI 1.17-2.79, P=0.008). Conclusions: The presenting complaint at the ED carries valuable information of the risk for in-hospital fatality in nonsurgical patients. This knowledge can be valuable in the prioritization between different patient groups in the process of initiating diagnostics and treatment procedures at the ED.
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| 1328. |
- Söderqvist, Emil, et al.
(författare)
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Feasibility of creating estimates of left ventricular flow-volume dynamics using echocardiography
- 2006
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Ingår i: Cardiovascular Ultrasound. - : Springer Science and Business Media LLC. - 1476-7120. ; :4:40
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Tidskriftsartikel (refereegranskat)abstract
- Background:This study explores the feasibility of non-invasive assessment of left ventricular volume and flow relationship throughout cardiac cycle employing echocardiographic methods.Methods:Nine healthy individuals and 3 patients with severe left-sided valvular abnormalities were subject to resting echocardiography with automated endocardial border detection allowing real-time estimation of left ventricular volume throughout the cardiac cycle. Global and regional (6 different left ventricular segments) estimates of flow-volume loops were subsequently constructed by plotting acquired instantaneous left ventricular 2-D area data (left ventricular volume) vs. their first derivatives (flow).Results:Flow-volume loop estimates were obtainable in 75% of all echocardiographic images and displayed in normal individuals some regional morphological variation with more pronounced isovolumic events in the paraseptal segments and significantly delayed maximal systolic flow paraapically. In patients with aortic stenosis, maximal systolic flow occurred at a lower estimated left ventricular systolic volume whereas in mitral stenosis, maximal diastolic flow was observed at a higher estimated left ventricular diastolic volume. Aortic regurgitation caused a complex alteration of the estimated flow-volume loop shape during diastole.Conclusion:Non-invasive assessment of left ventricular flow-volume relationship with echocardiography is technically feasible and reveals the existence of regional variation in flow-volume loop morphology. Valvular abnormalities cause a clear and specific alteration of the estimates of the normal systolic or diastolic flow-volume pattern, likely reflecting the underlying pathophysiology.
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| 1329. |
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| 1330. |
- Tan, Xiao, et al.
(författare)
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Association Between Self-Reported Sleep Duration and Body Composition in Middle-Aged and Older Adults
- 2019
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Ingår i: Journal of Clinical Sleep Medicine (JCSM). - : American Academy of Sleep Medicine (AASM). - 1550-9389 .- 1550-9397. ; 15:3, s. 431-435
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVES: The current study sought to examine whether self-reported sleep duration is linked to an adverse body composition in 19,709 adults aged 45 to 75 years. METHODS: All variables used in the current study were derived from the Swedish EpiHealth cohort study. Habitual sleep duration was measured by questionnaires. Body composition was assessed by bioimpedance. The main outcome variables were fat mass and fat-free mass (in kg). Analysis of covariance adjusting for age, sex, fat mass in the case of fat-free mass (and vice versa), leisure time physical activity, smoking, and alcohol consumption was used to investigate the association between sleep duration and body composition. RESULTS: Short sleep (defined as ≤ 5 hours sleep per day) and long sleep (defined as 8 or more hours of sleep per day) were associated with lower fat-free mass and higher fat mass, compared with 6 to 7 hours of sleep duration (P < .05). CONCLUSIONS: These observations could suggest that both habitual short and long sleep may contribute to two common clinical phenotypes in middle-aged and older humans, ie, body adiposity and sarcopenia. However, the observational nature of our study does not allow for causal interpretation.
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