| 1. |
- Andersson, Sofia, 1972-, et al.
(författare)
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End-of-life discussions in residential care homes improves symptom control : a national register study
- 2021
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Ingår i: BMJ Supportive & Palliative Care. - : BMJ Publishing Group Ltd. - 2045-435X .- 2045-4368.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In Europe, residential care homes (RCHs) rather than hospitals are the most common care facilities for the older adult and the place where most deaths occur in this age group. There is a lack of knowledge regarding end-of-life (EOL) discussions and how they correlate with symptoms and symptom relief.OBJECTIVE: The aim was to examine the correlation between EOL discussions and symptom occurrence, symptom relief and prescriptions or PRN drugs against symptoms for care home residents.METHODS: All expected deaths at RCHs from 1 October 2015 to 31 December 2016 and registered in the Swedish Register of Palliative Care were included. Univariate and multivariate logistic regression were used to compare the RCH residents, or their family members, who had received documented EOL discussions with a physician (the EOL discussion group) and the non-EOL discussion group.RESULTS: The EOL discussion group (n=17 071) had a higher prevalence of pain, nausea, anxiety, death rattles and shortness of breath reported, compared with the non-EOL discussion group (n=4164). Those with symptoms were more often completely relieved and had more often been prescribed PRN drugs against that symptom in the EOL discussion group. All differences remained significant when adjusting for age, time living in unit and cause of death.CONCLUSION: The results indicate that EOL discussions are correlated with higher prevalence of symptoms, but also with better symptom relief and prescription of symptom drugs PRN when symptomatic. A possible explanation for this is that the EOL discussion can work as an opportunity to discuss symptoms and treatment for symptom relief.
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| 2. |
- Andersson, Ulrika, 1977, et al.
(författare)
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Ovisshetens tid – inledningskapitel
- 2023
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Ingår i: Ovisshetens tid. - Göteborg : Göteborgs universitet. - 9789189673540 ; , s. 11-24
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Bokkapitel (refereegranskat)abstract
- Vi befinner oss i ovisshetens tid. Säkerhetsläget i omvärlden är påtagligt försämrat. Det rasar ett krig i Europas östligaste delar. Ingen vet hur länge det kommer att pågå, om fler länder kommer att drabbas eller hur omfattande förlusterna kommer att bli. Kriget pågår här och nu. Men det påverkar generationer framöver. Ovisshet och oro kring vårt eget lands säkerhet har bidragit till ett paradigmskifte där tvåhundra års alliansfrihet brutits i samband med att Sverige ansökte om medlemskap i Nato. När det svenska inträdet kommer att ske är oklart. Det har sagts att ovisshet ofta härstammar från en känsla av förvåning, och förvåning är nog en adekvat beskrivning av reaktionerna på Turkiets, och senare även Ungerns, rävspel kring ratificeringen av Sveriges ansökan. När känslan av förvåning hunnit pågå under en tid övergår den ofta i ovisshet. Och det är ungefär där vi står nu. I detta inledande kapitel riktar vi blicken mot hur den svenska befolkningen upplever utvecklingen i Sverige, både generellt och med avseende på den ekono- miska situationen. Allmänhetens oro för ekonomisk kris, ett nytt världskrig och inskränkningar i yttrandefriheten granskas, likaså i vilken mån och i vilka situationer det möjligen skulle vara befogat att begränsa det fria ordet. I kapitlet analyseras också förtroendet för våra politiska institutioner och för våra politiker; det senare med utgångspunkt i hur uppskattade olika partiledare är.
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| 3. |
- Bertilsson, Monica, et al.
(författare)
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Association of stigmatizing attitudes with people's opinion of depression as a valid reason for sickness absence: A Swedish vignette study
- 2022
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Ingår i: WORK-A JOURNAL OF PREVENTION ASSESSMENT & REHABILITATION. - : IOS Press. - 1051-9815. ; 73:2, s. 495-504
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Depression is a common cause of sickness absence (SA) and also highly associated with stigma. Few studies have addressed the role of stigma in relation to SA. OBJECTIVE: To investigate if attitudes to depression were associated with the public's opinion of depression as a valid reason of SA. METHODS: The study population (n = 2413) originated from a web-based panel of citizens. The survey included a short vignette describing a person with symptoms of depression and the person's work tasks, followed by a question on recommendation of SA. Negative attitudes were measured by the Depression Stigma Scale. Logistic regressions were used to estimate the odds ratios (OR) for the likelihood of not recommending SA, controlling for individual and work-related co-variates. RESULTS: The crude association between negative attitudes and not recommending SA was OR 2.15 (95% CI, 1.76-2.62). In the fully adjusted model the OR was 1.76 (95% CI, 1.40 - 2.21) for not recommending SA. CONCLUSIONS: Participants with negative attitudes to depression were more likely to not consider depression as a valid reason of sickness absence. The study supports theories on layered stigma; attitudes from one arena are related to other arenas. Future studies are needed to confirm our findings.
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| 4. |
- Björklund, Erik, et al.
(författare)
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Comparison of Midterm Outcomes Associated With Aspirin and Ticagrelor vs Aspirin Monotherapy After Coronary Artery Bypass Grafting for Acute Coronary Syndrome.
- 2021
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Ingår i: JAMA network open. - : American Medical Association (AMA). - 2574-3805. ; 4:8
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Tidskriftsartikel (refereegranskat)abstract
- Guidelines recommend dual antiplatelet therapy after coronary artery bypass grafting (CABG) for patients with acute coronary syndrome (ACS). However, the evidence for these recommendations is weak.To compare midterm outcomes after CABG in patients with ACS treated postoperatively with acetylsalicylic acid (ASA) and ticagrelor or with ASA monotherapy.This cohort study used merged data from several national registries of Swedish patients who were diagnosed with ACS and subsequently underwent CABG. All included patients underwent isolated CABG in Sweden between 2012 and 2017 with an ACS diagnosis less than 6 weeks before the procedure, survived 14 days after discharge from hospital, and were treated postoperatively with ASA plus ticagrelor or ASA monotherapy. A multivariable Cox regression model was used for the main analysis, and propensity score-matched models were performed as sensitivity analysis. Data were analyzed between May and September 2020.Postoperative antiplatelet treatment, defined as filled prescriptions, with either ASA and ticagrelor or ASA only.Major adverse cardiovascular events (MACE), defined as all-cause mortality, myocardial infarction, and stroke, and major bleeding, at 12 months and at the end of follow-up.A total of 6558 patients (5281 [80.5%] men; mean [SD] age at surgery, 67.6 [9.3] years) were included; 1813 (27.6%) were treated with ASA plus ticagrelor and 4745 (72.4%) were treated with ASA monotherapy. Crude MACE rate was 3.0 per 100 person years (95% CI, 2.5-3.6 per 100 person years) in the ASA plus ticagrelor group and 3.8 per 100 person years (95% CI, 3.5-4.1 per 100 person years) in the ASA group. After adjustment, there was no significant difference in MACE risk between ASA plus ticagrelor vs ASA only, neither during the first 12 months (adjusted hazard ratio [aHR], 0.84; 95% CI, 0.58-1.21; P = .34) or during total follow-up (aHR, 0.89; 95% CI, 0.71-1.11; P = .29). The use of ASA plus ticagrelor was associated with a significantly increased risk for major bleeding during the first 12 months (aHR, 1.90; 95% CI, 1.16-3.13; P = .011). Sensitivity analyses confirmed the results.In patients with ACS who survived 2 weeks after CABG, no significant difference in the risk of death or ischemic events could be demonstrated between ASA plus ticagrelor and patients treated with ASA only, while the risk for major bleeding was higher in patients treated with ASA plus ticagrelor. Sufficiently powered prospective randomized trials comparing different antiplatelet therapy strategies after CABG are warranted.
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| 5. |
- Björklund, Erik, et al.
(författare)
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Postdischarge major bleeding, myocardial infarction, and mortality risk after coronary artery bypass grafting
- 2023
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Ingår i: HEART. - 1355-6037 .- 1468-201X.
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate the incidence and mortality risk associated with postdischarge major bleeding after coronary artery bypass grafting (CABG), and relate this to the incidence of, and mortality risk from, postdischarge myocardial infarction.Methods All patients undergoing first-time isolated CABG in Sweden in 2006-2017 and surviving 14 days after hospital discharge were included in a cohort study. Individual patient data from the SWEDEHEART Registry and five other mandatory nationwide registries were merged. Piecewise Cox proportional hazards models were used to investigate associations between major bleeding, defined as hospitalisation for bleeding, with subsequent mortality risk. Similar Cox proportional hazards models were used to investigate the association between postdischarge myocardial infarction and mortality risk.Results Among 36 633 patients, 2429 (6.6%) had a major bleeding event and 2231 (6.1%) had a myocardial infarction. Median follow-up was 6.0 (range 0-11) years. Major bleeding was associated with higher mortality risk <30 days (adjusted HR (aHR)=20.2 (95% CI 17.3 to 23.5)), 30-365 days (aHR=3.8 (95% CI 3.4 to 4.3)) and >365 days (aHR=1.8 (95% CI 1.7 to 2.0)) after the event. Myocardial infarction was associated with higher mortality risk <30 days (aHR=20.0 (95% CI 16.7 to 23.8)), 30-365 days (aHR=4.1 (95% CI 3.6 to 4.8)) and >365 days (aHR=1.8 (95% CI 1.7 to 2.0)) after the event.Conclusions The increase in mortality risk associated with a postdischarge major bleeding after CABG is substantial and is similar to the mortality risk associated with a postdischarge myocardial infarction.
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| 6. |
- Chen, Hao Yu, et al.
(författare)
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Association of FADS1/2 Locus Variants and Polyunsaturated Fatty Acids With Aortic Stenosis
- 2020
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Ingår i: JAMA cardiology. - : American Medical Association (AMA). - 2380-6583 .- 2380-6591. ; 5:6, s. 694-702
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Aortic stenosis (AS) has no approved medical treatment. Identifying etiological pathways for AS could identify pharmacological targets.Objective: To identify novel genetic loci and pathways associated with AS.Design, Setting, and Participants: This genome-wide association study used a case-control design to evaluate 44 703 participants (3469 cases of AS) of self-reported European ancestry from the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort (from January 1, 1996, to December 31, 2015). Replication was performed in 7 other cohorts totaling 256 926 participants (5926 cases of AS), with additional analyses performed in 6942 participants from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium. Follow-up biomarker analyses with aortic valve calcium (AVC) were also performed. Data were analyzed from May 1, 2017, to December 5, 2019.Exposures: Genetic variants (615 643 variants) and polyunsaturated fatty acids (ω-6 and ω-3) measured in blood samples.Main Outcomes and Measures: Aortic stenosis and aortic valve replacement defined by electronic health records, surgical records, or echocardiography and the presence of AVC measured by computed tomography.Results: The mean (SD) age of the 44 703 GERA participants was 69.7 (8.4) years, and 22 019 (49.3%) were men. The rs174547 variant at the FADS1/2 locus was associated with AS (odds ratio [OR] per C allele, 0.88; 95% CI, 0.83-0.93; P = 3.0 × 10-6), with genome-wide significance after meta-analysis with 7 replication cohorts totaling 312 118 individuals (9395 cases of AS) (OR, 0.91; 95% CI, 0.88-0.94; P = 2.5 × 10-8). A consistent association with AVC was also observed (OR, 0.91; 95% CI, 0.83-0.99; P = .03). A higher ratio of arachidonic acid to linoleic acid was associated with AVC (OR per SD of the natural logarithm, 1.19; 95% CI, 1.09-1.30; P = 6.6 × 10-5). In mendelian randomization, increased FADS1 liver expression and arachidonic acid were associated with AS (OR per unit of normalized expression, 1.31 [95% CI, 1.17-1.48; P = 7.4 × 10-6]; OR per 5-percentage point increase in arachidonic acid for AVC, 1.23 [95% CI, 1.01-1.49; P = .04]; OR per 5-percentage point increase in arachidonic acid for AS, 1.08 [95% CI, 1.04-1.13; P = 4.1 × 10-4]).Conclusions and Relevance: Variation at the FADS1/2 locus was associated with AS and AVC. Findings from biomarker measurements and mendelian randomization appear to link ω-6 fatty acid biosynthesis to AS, which may represent a therapeutic target.
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| 7. |
- Chen, H.Y., et al.
(författare)
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Dyslipidemia, inflammation, calcification, and adiposity in aortic stenosis: a genome-wide study
- 2023
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 44:21, s. 1927-1939
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Tidskriftsartikel (refereegranskat)abstract
- Aims Although highly heritable, the genetic etiology of calcific aortic stenosis (AS) remains incompletely understood. The aim of this study was to discover novel genetic contributors to AS and to integrate functional, expression, and cross-phenotype data to identify mechanisms of AS. Methods and results A genome-wide meta-analysis of 11.6 million variants in 10 cohorts involving 653 867 European ancestry participants (13 765 cases) was performed. Seventeen loci were associated with AS at P ≤ 5 × 10−8, of which 15 replicated in an independent cohort of 90 828 participants (7111 cases), including CELSR2–SORT1, NLRP6, and SMC2. A genetic risk score comprised of the index variants was associated with AS [odds ratio (OR) per standard deviation, 1.31; 95% confidence interval (CI), 1.26–1.35; P = 2.7 × 10−51] and aortic valve calcium (OR per standard deviation, 1.22; 95% CI, 1.08–1.37; P = 1.4 × 10−3), after adjustment for known risk factors. A phenome-wide association study indicated multiple associations with coronary artery disease, apolipoprotein B, and triglycerides. Mendelian randomization supported a causal role for apolipoprotein B-containing lipoprotein particles in AS (OR per g/L of apolipoprotein B, 3.85; 95% CI, 2.90–5.12; P = 2.1 × 10−20) and replicated previous findings of causality for lipoprotein(a) (OR per natural logarithm, 1.20; 95% CI, 1.17–1.23; P = 4.8 × 10−73) and body mass index (OR per kg/m2, 1.07; 95% CI, 1.05–1.9; P = 1.9 × 10−12). Colocalization analyses using the GTEx database identified a role for differential expression of the genes LPA, SORT1, ACTR2, NOTCH4, IL6R, and FADS. Conclusion Dyslipidemia, inflammation, calcification, and adiposity play important roles in the etiology of AS, implicating novel treatments and prevention strategies. © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
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| 8. |
- Cho, J. H., et al.
(författare)
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Desulfurization Behavior of Incoloy® 825 Superalloy by CaO-Al2O3-MgO-TiO2 Slag
- 2021
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Ingår i: Metallurgical and materials transactions. B, process metallurgy and materials processing science. - : Springer Nature. - 1073-5615 .- 1543-1916. ; 52:6, s. 3660-3670
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Tidskriftsartikel (refereegranskat)abstract
- Ni-based superalloy, which has excellent high-temperature strength and corrosion resistance, is mainly used in aviation materials, high-performance internal combustion engines, and turbines for thermal and nuclear power generation. For this reason, refining the impurities in Ni-based superalloys is a very important technical task. Nevertheless, the original technology for the melting and refining of Ni-based superalloys is still insufficient. Therefore, in this study, the effect of the CaO-Al2O3-MgO-TiO2 slag on the removal efficiency of an impurity element sulfur in Incoloy® 825 superalloy, one of the representative Ni-based superalloys, was investigated. The desulfurization behavior according to the change of TiO2 content and CaO/Al2O3 (=C/A, basicity) ratio as experimental variables was observed at 1773 K (1500 °C). Although the TiO2 content in the slag increases to 15 mass pct, the mass transfer coefficient of sulfur in molten alloy showed a constant value. Alternatively, under the condition of C/A > 1.0 of slag, the mass transfer coefficient of sulfur showed a constant value, whereas under the condition of C/A < 1.0, the mass transfer coefficient of sulfur greatly decreased as CaO decreased. Hence, in the desulfurization of Incoloy® 825 superalloy using the CaO-Al2O3-MgO-TiO2 slag, the TiO2 content in the slag does not have a considerable effect on the desulfurization rate and desulfurization mechanism (metal phase mass transfer controlled regime), but the basicity of the slag has a significant effect on desulfurization mechanism. When the slag basicity decreases below the critical level, i.e., C/A < 1.0, which is corresponding to sulfur distribution ratio, Ls < 200, it was confirmed that the desulfurization mechanism shifts from the metal phase mass transfer-controlled regime to the slag phase mass transfer-controlled regime due to the variation in the physicochemical properties of the slag such as viscosity and sulfide capacity. In addition, the different desulfurization rates between steel and Ni alloy melts were discussed by employing the diffusivity of sulfur in both systems.
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| 9. |
- Eriksson Stenström, Kristina, et al.
(författare)
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Identifying radiologically important ESS-specific radionuclides and relevant detection methods
- 2020
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Bok (refereegranskat)abstract
- The European Spallation Source (ESS) is under construction in the outskirts of Lund in southern Sweden. When ESS has entered the operational phase in a few years, an intense beam of high-energy protons will not only produce the desired spallation neutrons from a large target of tungsten, but a substantial number of different radioactive by-products will also be generated. A small part of these will be released to the environment during normal operation. During an accident scenario, a wide range of gases and aerosols may be released from the tungsten target. The palette of radionuclides generated in the ESS target will differ from that of e.g. medical cyclotrons or nuclear power plants, thus presenting new challenges e.g. in the required environmental monitoring to ensure that dose limits to the public are not exceeded. This project (SSM2018-1636), financed by the Swedish Radiation Safety Authority (SSM), aimed to strengthen competence at Lund University for measurement and analysis of ESS-specific radionuclides. First, an extensive literature review, including modelling as well as experimental analyses, of ESS-relevant radionuclides was performed. We found that radionuclide production in particle accelerators is well-known, while experience with tungsten targets is very limited. As a second part of the project, an independent simplified model of the ESS target sector for the calculations of radionuclide production in the ESS tungsten target was developed using the FLUKA code. We conclude that we have a fairly good agreement with results of other authors, except for 148Gd, and that the calculated radionuclide composition is sensitive to the nuclear interaction models used.In the third part of the project, known environmental measurement technologies for various ESS-relevant radionuclides were reviewed, focussing on pure difficult-to-measure alpha- and beta-emitters. Liquid scintillation counting (LSC) is a suitable technique e.g. for the important beta emitters 3H, 14C, 35S, 31P and 33P. Several ESS radionuclides of relevance for dose estimates have never been investigated by environmental analytical techniques, due to their absence in the normal environment. Alpha spectrometry seems promising for the analysis of alpha-emitting lanthanides, in particular for 148Gd. Among the many types of mass spectrometry techniques, ICP-MS (inductively coupled plasma mass spectrometry) and AMS (accelerator mass spectrometry) seem to be the most suitable for the analysis of long-lived ESS radionuclides in environmental samples (e.g. 243Am and possibly lanthanides for ICP-MS and 10Be, 14C, 32Si, 36Cl, 60Fe and 129I for AMS).Three experimental parts were performed during the project, related to initiation of radioactivity measurements of aerosols at Lund University, mapping of environmental tritium in the Lund area, and establishment of a method to measure tritium in urine followed by a study of tritium in persons presently living or working in Lund. Aerosols were collected at a rural background station (Hyltemossa near Perstorp, northern Skåne) using a high-volume aerosol sampler with automatic filter change (DHA-80, Digitel). Gamma spectrometry measurements of 7Be agreed rather well with results from a nearby air monitoring station (SSM/FOI). Tritium (radioactive hydrogen) is expected to dominate the source term from the ESS target station to the environment. We have performed several investigations to monitor the current situation of tritium in Lund using LSC: the matrices investigated included air humidity, precipitation, pond water, indoor air at one accelerator facility and urine from the general public as well as from persons who may be occupationally exposed to tritium. Environmental tritium was generally very low (<3.4 Bq L-1), with somewhat higher concentration in the springtime than during the rest of the year. Tritium in the vast majority of the 55 urine samples was also very low: only a few exposed workers were found to have up to 11 Bq L-1 in their urine, which still is very low compared to e.g. reactor workers. Suggestions for further actions and work related to measurement and analysis of ESS relevant radionuclides are presented.
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| 10. |
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