| 1. |
|
|
| 2. |
- Erlinge, D., et al.
(författare)
-
Bivalirudin versus Heparin Monotherapy in Myocardial Infarction
- 2017
-
Ingår i: New England Journal of Medicine. - : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 377:12, s. 1132-1142
-
Tidskriftsartikel (refereegranskat)abstract
- Background The comparative efficacy of various anticoagulation strategies has not been clearly established in patients with acute myocardial infarction who are undergoing percutaneous coronary intervention (PCI) according to current practice, which includes the use of radial-artery access for PCI and administration of potent P2Y12 inhibitors without the planned use of glycoprotein IIb/IIIa inhibitors. Methods In this multicenter, randomized, registry-based, open-label clinical trial, we enrolled patients with either ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) who were undergoing PCI and receiving treatment with a potent P2Y12 inhibitor (ticagrelor, prasugrel, or cangrelor) without the planned use of glycoprotein IIb/IIIa inhibitors. The patients were randomly assigned to receive bivalirudin or heparin during PCI, which was performed predominantly with the use of radial-artery access. The primary end point was a composite of death from any cause, myocardial infarction, or major bleeding during 180 days of follow-up. Results A total of 6006 patients (3005 with STEMI and 3001 with NSTEMI) were enrolled in the trial. At 180 days, a primary end-point event had occurred in 12.3% of the patients (369 of 3004) in the bivalirudin group and in 12.8% (383 of 3002) in the heparin group (hazard ratio, 0.96; 95% confidence interval [CI], 0.83 to 1.10; P=0.54). The results were consistent between patients with STEMI and those with NSTEMI and across other major subgroups. Myocardial infarction occurred in 2.0% of the patients in the bivalirudin group and in 2.4% in the heparin group (hazard ratio, 0.84; 95% CI, 0.60 to 1.19; P=0.33), major bleeding in 8.6% and 8.6%, respectively (hazard ratio, 1.00; 95% CI, 0.84 to 1.19; P=0.98), definite stent thrombosis in 0.4% and 0.7%, respectively (hazard ratio, 0.54; 95% CI, 0.27 to 1.10; P=0.09), and death in 2.9% and 2.8%, respectively (hazard ratio, 1.05; 95% CI, 0.78 to 1.41; P=0.76). Conclusions Among patients undergoing PCI for myocardial infarction, the rate of the composite of death from any cause, myocardial infarction, or major bleeding was not lower among those who received bivalirudin than among those who received heparin monotherapy. (Funded by the Swedish Heart-Lung Foundation and others; VALIDATE-SWEDEHEART ClinicalTrialsRegister.eu number, 2012-005260-10 ; ClinicalTrials.gov number, NCT02311231 .).
|
|
| 3. |
- Ho, Peh Joo, et al.
(författare)
-
Comparison of self-reported and register-based hospital medical data on comorbidities in women
- 2019
-
Ingår i: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 9:1
-
Tidskriftsartikel (refereegranskat)abstract
- Breast cancer patients commonly present with comorbidities which are known to influence treatment decisions and survival. We aim to examine agreement between self-reported and register-based medical records (National Patient Register [NPR]). Ascertainment of nine conditions, using individually-linked data from 64,961 women enrolled in the Swedish KARolinska MAmmography Project for Risk Prediction of Breast Cancer (KARMA) study. Agreement was assessed using observed proportion of agreement (overall agreement), expected proportion of agreement, and Cohen's Kappa statistic. Two-stage logistic regression models taking into account chance agreement were used to identify potential predictors of overall agreement. High levels of overall agreement (i.e. ≥86.6%) were observed for all conditions. Substantial agreement (Cohen's Kappa) was observed for myocardial infarction (0.74), diabetes (0.71) and stroke (0.64) between self-reported and NPR data. Moderate agreement was observed for preeclampsia (0.51) and hypertension (0.46). Fair agreement was observed for heart failure (0.40) and polycystic ovaries or ovarian cysts (0.27). For hyperlipidemia (0.14) and angina (0.10), slight agreement was observed. In most subgroups we observed negative specific agreement of >90%. There is no clear reference data source for ascertainment of conditions. Negative specific agreement between NPR and self-reported data is consistently high across all conditions.
|
|
| 4. |
- von Tottleben, Malte, et al.
(författare)
-
An Integrated Care Platform System (C3-Cloud) for Care Planning, Decision Support, and Empowerment of Patients With Multimorbidity: Protocol for a Technology Trial
- 2022
-
Ingår i: JMIR Research Protocols. - : JMIR Publications. - 1929-0748. ; 11:7
-
Tidskriftsartikel (refereegranskat)abstract
- Background: There is an increasing need to organize the care around the patient and not the disease, while considering the complex realities of multiple physical and psychosocial conditions, and polypharmacy. Integrated patient-centered care delivery platforms have been developed for both patients and clinicians. These platforms could provide a promising way to achieve a collaborative environment that improves the provision of integrated care for patients via enhanced information and communication technology solutions for semiautomated clinical decision support.Objective: The Collaborative Care and Cure Cloud project (C3-Cloud) has developed 2 collaborative computer platforms for patients and members of the multidisciplinary team (MDT) and deployed these in 3 different European settings. The objective of this study is to pilot test the platforms and evaluate their impact on patients with 2 or more chronic conditions (diabetes mellitus type 2, heart failure, kidney failure, depression), their informal caregivers, health care professionals, and, to some extent, health care systems.Methods: This paper describes the protocol for conducting an evaluation of user experience, acceptability, and usefulness of the platforms. For this, 2 “testing and evaluation” phases have been defined, involving multiple qualitative methods (focus groups and surveys) and advanced impact modeling (predictive modeling and cost-benefit analysis). Patients and health care professionals were identified and recruited from 3 partnering regions in Spain, Sweden, and the United Kingdom via electronic health record screening.Results: The technology trial in this 4-year funded project (2016-2020) concluded in April 2020. The pilot technology trial for evaluation phases 3 and 4 was launched in November 2019 and carried out until April 2020. Data collection for these phases is completed with promising results on platform acceptance and socioeconomic impact. We believe that the phased, iterative approach taken is useful as it involves relevant stakeholders at crucial stages in the platform development and allows for a sound user acceptance assessment of the final product.Conclusions: Patients with multiple chronic conditions often experience shortcomings in the care they receive. It is hoped that personalized care plan platforms for patients and collaboration platforms for members of MDTs can help tackle the specific challenges of clinical guideline reconciliation for patients with multimorbidity and improve the management of polypharmacy. The initial evaluative phases have indicated promising results of platform usability. Results of phases 3 and 4 were methodologically useful, yet limited due to the COVID-19 pandemic.
|
|
| 5. |
- Beckman, Linda, 1980-, et al.
(författare)
-
Effects on alcohol use of a Swedish school-based prevention program for early adolescents: a longitudinal study
- 2017
-
Ingår i: BMC Public Health. - London, United Kingdom : Springer Science and Business Media LLC. - 1471-2458. ; 17
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of the study was to address the lack of evaluations of school-based substance use prevention programs and to conduct a quasi-experimental evaluation of the alcohol use part of the Triad intervention. Methods: Eleven Swedish intervention schools (285 pupils) and three control schools (159 pupils) participated in the evaluation. Baseline measurements were conducted in 2011 before the alcohol part in the prevention program was implemented in the intervention schools (school year 6, ages 12-13). We estimated an Intention-To-Treat (ITT) Difference-in-Difference (DD) model to analyze the effectiveness of the intervention on subsequent alcohol use measured in grades 7, 8 and 9. Results: The main results show no effect on the likelihood of drinking alcohol or drinking to intoxication. Conclusions: The lack of positive effects highlights the need for policy-makers and public health officials need to carefully consider and evaluate prevention programs in order to ensure that they are worthwhile from school, health, and societal perspectives.
|
|
| 6. |
- Behrens, Thomas, et al.
(författare)
-
Pesticide exposure in farming and forestry and the risk of uveal melanoma
- 2012
-
Ingår i: Cancer Causes and Control. - : Springer. - 0957-5243 .- 1573-7225. ; 23:1, s. 141-151
-
Tidskriftsartikel (refereegranskat)abstract
- Since pesticides are disputed risk factors for uveal melanoma, we studied the association between occupational pesticide exposure and uveal melanoma risk in a case-control study from nine European countries.Incident cases of uveal melanoma and population as well as hospital controls were included and frequency-matched by country, 5-year age groups and sex. Self-reported exposure was quantified with respect to duration of exposure and pesticide application method. We calculated the exposure intensity level based on application method and use of personal protective equipment. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated by unconditional logistic regression analyses and adjusted for several potential confounders.293 case and 3,198 control subjects were interviewed. We did not identify positive associations with activities in farming or forestry, pesticide application or pesticide mixing. No consistent positive associations were seen with exposure intensity level scores either. The only statistically significantly raised association in this study was for exposure to chemical fertilizers in forestry (OR = 8.93; 95% CI 1.73-42.13), but this observation was based on only six exposed subjects. Results did not change when we restricted analyses to morphologically verified cases and excluded proxy interviews as well as cancer controls. We did not observe effect modification by sex or eye color.Risk estimates for pesticide exposures and occupational activities in agriculture and forestry were not increased and did not indicate a hormonal mechanism due to these exposures.
|
|
| 7. |
- Berghammer, Malin, 1970, et al.
(författare)
-
Self-reported health status (EQ-5D) in adults with congenital heart disease
- 2013
-
Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 165:3, s. 537-543
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: Today, more patients with congenital heart disease (CHD) reach adulthood. There are conflicting findings concerning the relationship between quality of life (QoL) or health state for adults with CHD and the complexity of their CHD. The aim of the study was, firstly, to compare the reported health status and health perception of adult patients with CHD and, secondly, to investigate what variables influenced the patients' health status and health perception. Methods: Data from 1435 patients completing the EQ-5D questionnaire, which includes reported health status and health perception, were analyzed. Results: Valid EQ-5D data were reported by 1274 patients, showing overall results indicating a good health status. Problems were most frequently reported in the dimension "pain/discomfort" (31.9%) and "anxiety/depression" (29.8%). Higher occurrence of problems were reported by patients with complex disease i.e. single ventricle (p<0.001) and by female patients (p<0.0001). Symptomatic patients reported a lower health status (p<0.0001) and a lower perceived health on EQ-VAS (p<0.0001). Of the asymptomatic patients, 20.5% nevertheless reported problems in "pain/discomfort" and 22.2% in the "anxiety/depression" dimension. Conclusion: The health status of adults with CHD is influenced by symptoms, NYHA-classification, age and gender. Adults with CHD report a lower occurrence of problems in comparison to previously published results from a general population, but the importance of actively asking about the patient's experience is demonstrated by the high degree of asymptomatic patients reporting problems on EQ-5D. (c) 2011 Elsevier Ireland Ltd. All rights reserved.
|
|
| 8. |
- Björklund, Lars
(bidragsgivare, creator_code:cre_t)
-
Vård av extremt för tidigt födda barn : en vägledning för vård av barn födda före 28 fullgångna graviditetsveckor
- 2014
-
Rapport (refereegranskat)abstract
- När ett barnföds extremt för tidigt, det vill säga före 28 fullgångna graviditetsveckor, krävs särskilda resurser och kompetenser. Vården av dessa barn är komplicerad och vårdpersonalen ställs ofta inför svåra medicinska bedömningar. Denna vägledning är tänkt att stödja vårdgivare och verksamhetschefer ansvariga för neonatalvård att ge en god vård till alla extremt för tidigt födda barn. Vägledningen innehåller rekommendationer inom områden där behovet av stöd har ansetts som störst.Extremt för tidigt födda barn som fötts på regionklinik har visats ha en väsentlig högre överlevnad än barn födda på andra sjukhus. Detta motiverar att omhändertagandet av mor och barn bör ske på sjukhus med stor erfarenhet av specialiserad obstetrik och neonatal intensivvård. Det bör även finnas tillgång till en väl fungerande transportorganisation med specialiserad personal både för mammor med hotande förtidsbörd och för de extremt för tidigt födda barn som är i behov av att flyttas efter födelsen.Barnen drabbas ofta av allvarliga komplikationer och sjukdomar som kan leda till både akuta och framtida problem. Nästan alla extremt för tidigt födda barn behöver någon form avandningsunderstöd och många behöver avancerad respiratorvård. Många barn har ett långvarigt behov av extra syrgas och alla måste övervakas noga för att undvika ögonskador (prematuritets-retinopati). Cirkulationsproblem är vanliga och över hälften av barnen får behandling för att stänga ductus arteriosus, vilket är en fosterförbindelse i cirkulationen och om den kvarstår öppen kan det få negativa effekter. Akut lungsjukdom och sviktande cirkulation bidrar till att extremt för tidigt födda barn ofta drabbas av blödningar och syrebrist i centrala nervsystemet. Barnens omogna hjärnor bör därför bedömas fortlöpande och faktorer som kan påverka hjärnans utveckling och funktion negativt bör minimeras.För att främja de omogna barnens hälsa och utveckling är det centralt att vården bedrivs på ett sådant sätt att vårdrelaterade infektioner förebyggs och att smärta och stress minimeras. Smärtbehandling bör i första hand ske genom icke-farmakologiska metoder, men vid behov även med läkemedel.För att optimera tillväxten bör utarbetade nutritionsrekommendationer följas. De extremt för tidigt födda barnen har ett näringsbehov som vida överstiger det hos fullgångna nyfödda, samtidigt som näringstillförseln ofta försvåras av omogna organfunktioner och komplikationer från magtarmkanalen.Att få ett extremt för tidigt fött barn innebär en stor påfrestning för familjen. Vården bör organiseras så att den är patient- och familjecentrerad, där barnets och familjens individuella behov respekteras så långt det är möjligt och där föräldrarna stödjs och kontinuerligt informeras om barnets tillstånd och prognos.Extremt för tidigt födda barn bör följas på kort och lång sikt för att öka vårdenskunskap om följderna av en extremt för tidig födelse. Ett strukturerat uppföljningssystem ger förutsättningar för att utvärdera och ständigt förbättra vården för dessa barn.
|
|
| 9. |
- Ericson, Helena, 1980-
(författare)
-
A Salutogenic perspective on resistance training : a study on healthy old adult women
- 2018
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The number of people aged 60 years and over has doubled since 1980and the World Health Organization predicts that the population of over60s will reach 2 billion by the year 2050. An ageing population poses bothchallenges and opportunities for society and for individuals. Whilst theseare positive statements, increases in life spans do not directly lead to increasesin health spans. The naturally occurring ageing process can leadto reductions in functionality and, in order to address this, scholars haveargued the benefits of regularly engaging in physical activity, and especiallyresistance training. Therefore, an important challenge for modernsociety is to develop strategies that delay the onset of disease, such as interventionsthat include physical activity. This licentiate thesis investigatesolder women’s physical activity in a resistance training context and howthis affects different aspects of their health.The overall aim of the thesis is to explore healthy and physically activeolder women’s experiences of what maintains and enhances their healthafter starting resistance training.This thesis used a quantitative and a qualitative approach to investigatea group of old adult women. Data collection was structured in questionnaires(n=32) with one intervention group and one control group for thepaper I, and focus group interviews (n=14) in paper II. Paper I studied theeffects of resistance training on physically active and healthy olderwomen. Paper II relates to the women who continued to exercise after theresistance training intervention ended in order to explore their health resources.The theoretical framework used in this thesis is a movement towardshealth as explained by salutogenic theory.This thesis showed that resistance training has positive effects on psychologicalwell-being and is important because it not only benefits thosewho are physically inactive, but also those who are already physically activeand healthy.From a salutogenic perspective, physical activity provides a meaningful,comprehensible and manageable way for older women to engage in theongoing process of maintaining health.
|
|
| 10. |
|
|
