| 1. |
- Bergqvist, Erik, et al.
(författare)
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Health care utilisation two years prior to suicide in Sweden: a retrospective explorative study based on medical records
- 2022
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective Previous literature has suggested that identifying putative differences in health care seeking patterns before death by suicide depending on age and gender may facilitate more targeted suicide preventive approaches. The aim of this study is to map health care utilisation among individuals in the two years prior to suicide in Sweden in 2015 and to examine possible age and gender differences. Methods Design: A retrospective explorative study with a medical record review covering the two years preceding suicide. Setting: All health care units located in 20 of Sweden's 21 regions. Participants: All individuals residing in participating regions who died by suicide during 2015 (n = 949). Results Almost 74% were in contact with a health care provider during the 3 months prior to suicide, and 60% within 4 weeks. Overall health care utilisation during the last month of life did not differ between age groups. However, a higher proportion of younger individuals (< 65 years) were in contact with psychiatric services, and a higher proportion of older individuals (>= 65 years) were in contact with primary and specialised somatic health care. The proportion of women with any type of health care contact during the observation period was larger than the corresponding proportion of men, although no gender difference was found among primary and specialised somatic health care users within four weeks and three months respectively prior to suicide. Conclusion Care utilisation before suicide varied by gender and age. Female suicide decedents seem to utilise health care to a larger extent than male decedents in the two years preceding death, except for the non-psychiatric services in closer proximity to death. Older adults seem to predominantly use non-psychiatric services, while younger individuals seek psychiatric services to a larger extent.
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| 2. |
- Doering, Sabrina, et al.
(författare)
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Anxiety symptoms preceding suicide: A Swedish nationwide record review.
- 2024
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Ingår i: Journal of Affective Disorders. - 0165-0327 .- 1573-2517. ; 355, s. 317-324
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Tidskriftsartikel (refereegranskat)abstract
- The literature on the relationship between anxiety and suicidal behaviors is limited and findings are mixed. This study sought to determine whether physicians noted anxiety symptoms and suicidality in their patients in the weeks and months before suicide.Data were derived from a nationwide medical record review of confirmed suicides in Sweden in 2015. Individuals with at least one documented physician consultation in any health care setting during 12months before suicide (N=956) were included. Clinical characteristics were compared between decedents with and without a notation of anxiety symptoms. Odds ratios were calculated to estimate associations between anxiety symptoms and suicidality in relation to suicide proximity.Anxiety symptoms were noted in half of individuals 1week before suicide. Patients with anxiety were characterized by high rates of depressive symptoms, ongoing substance use issues, sleeping difficulties, and fatigue. After adjustment for mood disorders, the odds of having a notation of elevated suicide risk 1week before death were doubled in persons with anxiety symptoms. Associations were similar across time periods (12months - 1week). Two-thirds had been prescribed antidepressants at time of death.Data were based on physicians' notations which likely resulted in underreporting of anxiety depending on medical specialty. Records were not available for all decedents.Anxiety symptoms were common in the final week before suicide and were accompanied by increases in documented elevated suicide risk. Our findings can inform psychiatrists, non-psychiatric specialists, and GPs who meet and assess persons with anxiety symptoms.
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| 3. |
- Exarchou, Sofia, et al.
(författare)
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Mortality in patients with psoriatic arthritis in Sweden: a nationwide, population-based cohort study
- 2024
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Ingår i: ANNALS OF THE RHEUMATIC DISEASES. - : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 83:4, s. 446-456
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo compare all-cause mortality and causes of death between patients with psoriatic arthritis (PsA) and the general population in Sweden.MethodsAdults with at least one main PsA diagnosis (International Classification of Diseases-10: L40.5/M07.0-M07.3) from outpatient rheumatology/internal medicine departments 2001-2017 were identified from the National Patient Register. Each case was matched to five population comparator-subjects on sex/county/age at the case's first arthritis diagnosis. Follow-up ran from 1 January 2007, or from first PsA diagnosis thereafter, until death, emigration or 31 December 2018. Mortality was assessed overall, and stratified by sex and duration since diagnosis (diagnosis before/after 1 January 2007), using matched Cox proportional hazard regression (excluding/including adjustments for comorbidity) or Breslow test, as appropriate. Incidence rate ratios (IRR) of death, overall and stratified by sex/duration since diagnosis/age, as well as causes of death in PsA cases and comparator-subjects were also described.ResultsAll-cause mortality was elevated in PsA (HR: 1.11 (95% CI: 1.07 to 1.16); IRR: 1.18 (95% CI: 1.13 to 1.22)), mainly driven by increased risks in women (HR: 1.23 (95% CI: 1.16 to 1.30)) and cases with longer time since diagnosis (HR: 1.18 (95% CI: 1.12 to 1.25)). IRR of death were significantly increased for all ages except below 40 years, with the numerically highest point-estimates for ages 40-59 years. When adjusted for comorbidity, however, the elevated mortality risk in PsA disappeared. Causes of death were similar among PsA cases/comparator-subjects, with cardiovascular disease and malignancy as the leading causes.ConclusionsMortality risk in PsA in Sweden was about 10% higher than in the general population, driven by excess comorbidity and with increased risks mainly in women and patients with longer disease duration.
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| 4. |
- Lindström, Sara, et al.
(författare)
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Forest cover change in Sri Lanka: The role of small scale farmers
- 2012
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Ingår i: Applied Geography. - : Elsevier BV. - 0143-6228. ; 34, s. 680-692
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Tidskriftsartikel (refereegranskat)abstract
- Forest cover in Sri Lanka has decreased rapidly during the last century and only fragments of the once widespread natural forest cover remain. This paper analyzes forest cover change and small scale farmers' relation to natural forests around two protected forest areas in Sri Lanka; Kanneliya Forest Reserve and Knuckles Conservation Forest. Methods used are spatial analysis to observe changes in forest cover from the 1980s until 2010, interviews with small scale farmers and key informants as well as field observations. In Kanneliya Forest Reserve, a decrease in forest cover is observed, particularly due to population increase and expanding tea plantations. In Knuckles Conservation Forest on the other hand, we find an overall increase in forest cover due to expansion of tree plantations, a ban on shifting cultivation and emigration from the area followed by natural forest regeneration. Agriculture is the most common source of income in both study areas and there is a clear link between conversions of forests to agricultural expansion. The profits from agricultural activities are in general insufficient to sustain small scale farmers' needs and the most common alternative source of income is achieved through resources extracted from the forest. Since 2001, demarcation of forest boundaries around the two forest reserves has reduced encroachment and illegal felling of timber. However, this policy has simultaneously threatened the livelihoods of peripheral communities in the forest buffer zones, especially in the investigated villages around Knuckles Conservation Forest. Despite successful attempts to reduce deforestation rates through governmental interventions, further incorporation of local people into the management of forests as stipulated in the current forest policy should be continued. (C) 2012 Elsevier Ltd. All rights reserved.
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| 5. |
- Markström, Ida, et al.
(författare)
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Impact of postoperative skin disinfection with chlorhexidine on bacterial colonisation following shoulder arthroplasty surgery : a controlled randomised study
- 2024
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Ingår i: Infection Prevention in Practice. - : Elsevier. - 2590-0889. ; 6:2
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Surgical site infections are a significant threat to patient safety. Shoulder arthroplasty carries an increased risk due to foreign implants. Skin preparation in general is a key preoperative preventive intervention, and the use of chlorhexidine can have a prolonged effect on bacterial colonisation. There is a lack of evidence regarding whether postoperative disinfection has an impact on bacterial colonisation during the first 48 hours after surgery. Our hypothesis was that applying postoperative antiseptic with 5 mg/ml chlorhexidine in 70% ethanol would lead to reduced bacterial colonisation with Staphylococcus aureus, coagulase-negative staphylococcus and Cutibacterium acnes around the surgical wound within the initial 48 hours after elective shoulder surgery, compared with the use of sodium chloride. METHODS: A single-blinded, controlled study was conducted at a county hospital in Sweden. Swabs from the skin were collected four times: at baseline, preoperatively, after the intervention and after 48 hours.RESULTS: Our hypothesis was not confirmed. Although not statistically significant, the chlorhexidine group had a higher prevalence of bacterial colonisation of clinically relevant bacteria.CONCLUSIONS: Our study could not confirm that postoperative disinfection with chlorhexidine reduces bacterial colonisation compared with sodium chloride. The results highlight the complexity of SSIs and the importance of evidence-based preventive skin preparation to ensure patient safety. Further research is needed, considering the study's limitations, to explore and evaluate the effectiveness of different skin cleansing solutions and preventive strategies in diverse surgical contexts.
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| 6. |
- Olsson, Sara K., et al.
(författare)
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Elevated levels of kynurenic acid in the cerebrospinal fluid of patients with bipolar disorder
- 2010
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Ingår i: Journal of Psychiatry & Neuroscience. - : CMA Joule Inc.. - 1180-4882 .- 1488-2434. ; 35:3, s. 195-199
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with schizophrenia show elevated brain levels of the neuroactive tryptophan metabolite kynurenic acid (KYNA) This astrocyte] derived mediator acts as a neuroprotectant and modulates sensory gating and cognitive functiona We measured the levels of KYNA in the cerebrospinal fluid T vSyU of patients with bipolar disorder and healthy volunteers to investigate the putative involvement of KYNA in bipolar disorder. Methods: We obtained CSF by lumbar puncture from 23 healthy men and 31 euthymic men with bipolar disorder. We analyzed the samples using high] performance liquid chromatography. Results: Patients with bipolar disorder had increased levels of KYNA in their CSF compared with healthy volunteers (1.71 nM, standard error of the mean [SEM] cad, va dad, nM, SEM cacln p = 0.002. The levels of KYNA were positively correlated with age among bipolar patients but not healthy volunteersa Limitations: The influence of ongoing drug treatment among patients cannot be ruled outa We conducted our study during the euthymic phase of the diseasea Conclusion: Brain KYNA levels are increased in euthymic men with bipolar disorder. In addition, KYNA levels increased with age in these patientsa These findings indicate shared mechanisms between bipolar disorder and schizophrenia. Elevated levels of brain KYNA may provide further insight to the pathophysiology and progression of bipolar disorder.
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| 7. |
- Palmqvist Öberg, Nina Margareta, et al.
(författare)
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Last general practitioner consultation during the final month of life : a national medical record review of suicides in Sweden
- 2024
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Ingår i: BMC Primary Care. - : BioMed Central (BMC). - 2731-4553. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Individuals who die by suicide often consult their general practitioners (GPs) in their final weeks of life. The aim of this study was to gain a deeper knowledge of the clinical characteristics and GP assessments and treatments among individuals who consulted their GPs during the month preceding suicide. Further, we compared these features in those with and without contact with psychiatric services (PC and NPC, respectively) during the two years that preceded the suicide.Design: A nationwide retrospective explorative study investigating medical records.Setting: Primary care in Sweden.Participants: Individuals who died by suicide in Sweden in 2015 with a GP visit within 30 days of death.Results: The study cohort corresponds to one fifth (n = 238) of all suicides that occurred in Sweden in 2015 (n = 1179), representing all those with available primary care records showing contact with a GP during the final 30 days of life (NPC: n = 125; PC: n = 113). The mean age was 58 years +/- 19. Patients in the NPC group were older (NPC: 63 years +/- 19 vs. PC: 53 years +/- 18, p < 0.0001) and presented psychiatric symptoms less often (NPC: 50% vs. PC: 67%, p < 0.006). Somatic symptoms were as common as psychiatric symptoms for the whole sample, being present in more than half of individuals. Suicide risk was noted in only 6% of all individuals. Referral to psychiatric services occurred in 14%, less commonly for the NPC group (NPC: 6% vs. PC: 22%, p < 0.001). Cardiovascular or respiratory symptoms were noted in 19%, more often in the NPC group (NPC: 30% vs. PC: 6%, p < 0.001), as were diagnoses involving the circulatory system (all 10%, NPC:14% vs. PC: 5%, p < 0.020).Conclusion: A high level of somatic symptoms was observed in primary care patients both with and without psychiatric contact, and this might have influenced GPs' management decisions. Psychiatric symptoms were noted in two thirds of those with psychiatric contact but only half of those without. While GPs noted psychiatric symptoms in over half of all individuals included in the study, they seldom noted suicide risk. These findings highlight the need for increased attention to psychiatric symptoms and suicide risk assessment, particularly among middle-aged and older individuals presenting with somatic symptoms.Strengths and limitations of this study: The National Cause of Death Register has excellent coverage of suicide deaths and access to medical records was very good. The medical record review provided detailed information regarding primary care utilization before death by suicide. Because of the lack of statistical power, due to the limited number of persons with GP contact during the last month of life, we chose not to correct for multiple comparisons. Our study approach did not capture the reasons behind GPs' documentation of elevated suicide risk. No systematic inter-rater reliability (IRR) testing was made, however, reviewers received training and continuous support from the research group.
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| 8. |
- Ried, Janina S., et al.
(författare)
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A principal component meta-analysis on multiple anthropometric traits identifies novel loci for body shape
- 2016
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Ingår i: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- Large consortia have revealed hundreds of genetic loci associated with anthropometric traits, one trait at a time. We examined whether genetic variants affect body shape as a composite phenotype that is represented by a combination of anthropometric traits. We developed an approach that calculates averaged PCs (AvPCs) representing body shape derived from six anthropometric traits (body mass index, height, weight, waist and hip circumference, waist-to-hip ratio). The first four AvPCs explain >99% of the variability, are heritable, and associate with cardiometabolic outcomes. We performed genome-wide association analyses for each body shape composite phenotype across 65 studies and meta-analysed summary statistics. We identify six novel loci: LEMD2 and CD47 for AvPC1, RPS6KA5/C14orf159 and GANAB for AvPC3, and ARL15 and ANP32 for AvPC4. Our findings highlight the value of using multiple traits to define complex phenotypes for discovery, which are not captured by single-trait analyses, and may shed light onto new pathways.
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| 9. |
- Uhlén, Mathias, et al.
(författare)
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The human secretome
- 2019
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Ingår i: Science Signaling. - : American Association for the Advancement of Science (AAAS). - 1945-0877 .- 1937-9145. ; 12:609
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Tidskriftsartikel (refereegranskat)abstract
- The proteins secreted by human cells (collectively referred to as the secretome) are important not only for the basic understanding of human biology but also for the identification of potential targets for future diagnostics and therapies. Here, we present a comprehensive analysis of proteins predicted to be secreted in human cells, which provides information about their final localization in the human body, including the proteins actively secreted to peripheral blood. The analysis suggests that a large number of the proteins of the secretome are not secreted out of the cell, but instead are retained intracellularly, whereas another large group of proteins were identified that are predicted to be retained locally at the tissue of expression and not secreted into the blood. Proteins detected in the human blood by mass spectrometry-based proteomics and antibody-based immuno-assays are also presented with estimates of their concentrations in the blood. The results are presented in an updated version 19 of the Human Protein Atlas in which each gene encoding a secretome protein is annotated to provide an open-access knowledge resource of the human secretome, including body-wide expression data, spatial localization data down to the single-cell and subcellular levels, and data about the presence of proteins that are detectable in the blood.
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