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- Freedman, Ben, et al.
(författare)
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Screening for Atrial Fibrillation A Report of the AF-SCREEN International Collaboration
- 2017
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Ingår i: Circulation. - : LIPPINCOTT WILLIAMS & WILKINS. - 0009-7322 .- 1524-4539. ; 135:19, s. 1851-
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Tidskriftsartikel (refereegranskat)abstract
- Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country-and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.
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- Hallberg, Inger, et al.
(författare)
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Health-related quality of life after osteoporotic fractures
- 2004
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 15:10, s. 834-841
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To estimate the impact of osteoporosis fractures on health-related quality of life (HRQOL) in postmenopausal women. Methods: To compare the impact on HRQOL of different osteoporotic fractures, 600 consecutive women 55-75 years old with a new fracture (inclusion fracture) were invited by mail. After exclusions by preset criteria (high-energy fractures, ongoing osteoporosis treatment, or unwillingness to participate), 303 women were included, 171 (56%) of whom had a forearm, 37 (12%) proximal humerus, 40 (13%) hip, and 55 (18%) vertebral fracture, respectively, and all were investigated and treated according to the current local consensus program for osteoporosis. In addition, HRQOL was evaluated by the SF-36 questionnaire and compared with local, age-matched reference material. Examinations were performed 82 days (median) after the fracture and 2 years later. Results: HRQOL was significantly reduced at baseline regarding all SF-36 domains after vertebral fractures and most after hip fractures, but only regarding some domains after forearm and humerus fracture. After 2 years, improvements had occurred after all types of fractures, and after forearm or humerus fracture, HRQOL was completely normalized in all domains. However, 2 years after hip fracture, HRQOL was still below normal regarding physical function, role-physical and social function, while after vertebral fracture, scores were still significantly lower for all domains, physical as well as mental. Patients with one or more previous fractures before the inclusion fracture had lower HRQOL at baseline and after 2 years, compared with those with no previous fracture. Patients with osteoporosis (T-score < - 2.5 in hip or spine) had lower HRQOL than those with normal BMD. Conclusion: Vertebral and hip fractures have a considerably greater and more prolonged impact on HRQOL than forearm and humerus fractures. The number of fractures was inversely correlated to HRQOL. These differences should be taken into account when making priorities in health care programs.
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- Hesser, Hugo, 1982-, et al.
(författare)
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Preventing intimate partner violence via the Internet : A randomized controlled trial of emotion-regulation and conflict-management training for individuals with aggression problems
- 2017
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Ingår i: Clinical Psychology and Psychotherapy. - : John Wiley & Sons. - 1063-3995 .- 1099-0879. ; 24:5, s. 1163-1177
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this randomized controlled trial was to investigate the effect of an Internet-delivered cognitive behaviour therapy (iCBT), which incorporated emotion-regulation and conflict-resolution techniques, on intimate partner violence (IPV). Another aim was to test the theoretical underpinnings of the treatment model using mediation analysis.Method: Sixty-five participants with aggression problems in intimate adult relationships were recruited from the community and were randomly assigned to iCBT or to a monitored waitlist control. Participants were assessed with standardized self-report measures of IPV or aggression (Multidimensional Measure of Emotional Abuse, Revised Conflict Tactics Scale, and Aggression Questionnaire), relationship quality (Dyadic Adjustment Scale), anxiety or depression symptomatology (Patient Health Questionnaire; Generalized Anxiety Disorder Screener), at pretreatment, posttreatment (8weeks), and 1-year follow-up. Process variables (subscales of Dysfunctional and Emotional Regulation Scale and Anger Rumination Scale) were assessed weekly over the active treatment phase.Results: Robust linear regression analysis of all randomized participants showed significant treatment effects on emotional abuse relative to control at postassessment. Mediation analysis using growth curve modeling revealed that the treatment effect was partially mediated by changes in emotion-regulation ability. Controlled effects on secondary outcomes were also observed. Analyses of uncontrolled effects indicted that gains on IPV were maintained at 1-year follow-up.Conclusions: iCBT focusing on enhancing conflict-resolution skills and emotion-regulation ability has the potential to reduce IPV among self-recruited individuals with mild forms of abusive behaviour in intimate relationships. Emotion-regulation ability is potentially a key therapeutic process of change.Key Practitioner Message:Internet-delivered clinician-guided cognitive behaviour therapy is a viable treatment option for reducing intimate partner violence among self-recruited individuals with mild forms of abusive behaviour.For persons who display patterns of frequent and severe violence, other treatments are most likely needed.Emotion-regulation training is potentially a key therapeutic component that ought to be incorporated in interventions targeting IPV.
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- Stenestrand, Ulf, 1961-, et al.
(författare)
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Comorbidity and myocardial dysfunction are the main explanations for the higher 1-year mortality in acute myocardial infarction with left bundle-branch block
- 2004
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Ingår i: Circulation. - 0009-7322 .- 1524-4539. ; 110:14, s. 1896-1902
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Tidskriftsartikel (refereegranskat)abstract
- Background - The purpose of this study was to assess the independent contribution of left bundle-branch block (LBBB) on cause-specific 1-year mortality in a large cohort with acute myocardial infarction (MI). Methods and Results - We studied a prospective cohort of 88 026 cases of MI from the Register of Information and Knowledge about Swedish Heart Intensive care Admissions in 72 hospitals in 1995 to 2001. Long-term mortality was calculated by Cox regression analysis, adjusted for multiple covariates that affect mortality by calculation of a propensity score. LBBB was present in 9% (8041 of 88 026) of the MI admissions. Patients with LBBB were older and had a higher prevalence of comorbid conditions than patients with no LBBB. The unadjusted relative risk of death within 1 year was 2.16 (95% CI, 2.08 to 2.24, P<0.001) for LBBB (42%, 3350 of 8041) compared with those with no LBBB (22%, 17 044 of 79 011). After adjustment for a propensity score that takes into account differences in risk factors and acute intervention, LBBB was associated with a relative risk of death of 1.19 (95% CI, 1.14 to 1.24, P<0.001). In a subgroup of 11 812 patients for whom left ventricular ejection fraction was available and could be added to the analysis, the contributing relative risk of LBBB for death was only 1.08 (95% CI, 0.93 to 1.25, P=0.33). The most common cause of death in both groups was ischemic heart disease. Conclusions - MI patients with LBBB have more comorbid conditions and an increased unadjusted 1-year mortality. When adjusted for age, baseline characteristics, concomitant diseases, and left ventricular ejection fraction, LBBB does not appear to be an important independent predictor of 1-year mortality in MI.
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