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- Eriksson, Marie, 1970-
(författare)
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Aspects on stroke outcome : survival, functional status, depression and sex differences in Riks-Stroke, the National Quality Register for Stroke Care
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Stroke is a major cause of death and disability worldwide. In Sweden, about 30 000 strokes occur each year. The aim of this thesis was to analyse survival, functional outcome and self-reported depression after stroke, and to explore possible differences between men and women in stroke care and outcome. These studies were based on Riks-Stroke, the Swedish national quality register for stroke care. Information on background variables and treatment were collected during the hospital stay. The patient’s situation and outcome after stroke were followed-up after 3 months. Long term survival was retrieved from the Swedish Population Register (Folkbokföringen). Possible sex-differences in stroke care and outcome 3 months after stroke were explored in 24 633 strokes, registered during 2006. In conscious patients, the proportions treated at stroke units were similar for men and women. Men and women had equal chance to receive thrombolytic therapy or secondary prevention with oral anticoagulants. Compared to men, women were less likely to develop pneumonia, but more likely to experience deep venous thromboses and fractures during hospital stay. Women had worse 3-month survival and functional outcome, differences that were explained by their higher age and impaired level of consciousness on admission. Women felt more depressed and perceived their health as worse than men did. Women were also less satisfied with the care they had received in the hospital. The agreement between self-reported functional outcome 3 months after stroke and the commonly used modified Rankin Scale (mRS) was explored in 555 stroke survivors from 4 hospitals during May-September 2005. Riks-Stroke’s self-reported questions classified 76% of the patients into correct mRS grade. The association between functional outcome 3 months after stroke and 3-year survival was assessed in 15 959 men and women who had had a stroke during 2001-2002. Patients with estimated mRS grades 3, 4 and 5 had hazard ratios for death of 1.7, 2.5 and 3.8, respectively, as compared with patients with lower grades, 0-2. Depressed mood, male sex, high age, diabetes, smoking, antihypertensive therapy at onset and atrial fibrillation were also identified as predictors of poor survival. Self-reported depression 3 months after stroke and use of antidepressants were analysed in 15 747 stroke survivors from 2002. Fourteen percent felt depressed 3 months after stroke. Female sex, age <65, previous stroke, living alone or in institution, or being dependent in activities of daily living (ADL) were factors associated with self-reported depression. At the follow-up, 22% of the men and 28% of the women were using antidepressant medication, which were approximately twice as many as in the general population. Still, 8% of all patients in Riks-Stroke reported depressive mood but no treatment with antidepressants. In conclusion, men and women with stroke in Sweden experience similar treatment and outcome in most aspects. Patient-reported functional outcome can be reliably transformed to a standard disability scale. Impaired functional outcome three months after stroke is an independent predictor of poor long-term survival. Depressive mood is common after stroke and is associated with poor survival and impaired functional outcome.
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- Lundh, Thomas, et al.
(författare)
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Spårelement i blodkroppar från väster- och norrbottningar 1990-99
- 2002
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Sexton spårelement bestämdes i blodkroppar från 600 kvinnor och män i åldrarna 25-74 år från Västerbotten och Norrbotten. Med Induktiv kopplad plasma (ICP-MS) bestämdes aluminium (Al), vanadin (V), mangan (Mn), kobolt (Co), nickel (Ni), koppar (CU), zink (Zn), selen (Se), rodium (Rh), palladium (Pd), kadmium (Cd), antimon (Sb), wolfram (W), platina (Pt) och bly (Pb). Dessutom bestämdes med atomfluorescens kvicksilver (Hg). Cd-koncentrationerna är av en nivå som kopplats samman med lätt toxicitet. Medianhalterna av Pb och Hg ligger långt under de som satts i samband med toxiska effekter. Variationen var emellertid hög; de högsta halterna är i nivå med dem som anses kunna orsaka ogynnsamma effekter. I en multivariat modell utvärderades effekter av kön, ålder, rökvanor och kalenderår. Framför allt för Cd, men i viss mån också för Hg, hade rökare högre halter än icke-rökare. Kvinnor hade högre halter av Cd och Pb än män. Det fanns klart stigande halter av Cd och Hg med stigande ålder. Vid jämförelse mellan prover tagna 1990, 1994 och 1999 hade en markant sänkning skett av Pb (ca 6% per år), Hg (ca 6% per år) och Cd, men i det fallet bara för män (6% per år), inte för kvinnor. Detta beror sannolikt på minskade utsläpp av dessa metaller, med sjunkande exponering som följd. För Pb och Cd bör sänkningen i exponering ha varit högre än 6% per år, eftersom tidigare ådragen kroppsbörda har en tendens att fördröja en sänkning i blodkroppar. Det finns skäl att även fortsättningsvis följa utvecklingen av metallhalter i blod. För halterna av Al, V, Mn, Co, Ni, Cu, Zn, Se, Rh, Pd, Sb, W och Pt i prover tagna 1999 finns mindre möjligheter att jämföra med andra studier. De funna halterna är emellertid i paritet med det fåtal andra undersökningar som finns. Det fanns en rad associationer mellan halter av olika element. Av särskilt intresse är korrelationerna mellan Pt, Pd and Rh, vilka har spritts i miljön genom användning av katalytiska avgasrenare i bilar. Detta fynd förtjänar vidare undersökningar. Se och Hg var också relaterade, troligen p g a gemensam källa i form av fisk, möjligen också gemensamma bindningar i kroppen.
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