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Sökning: swepub > Umeå universitet > Linnéuniversitetet

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1.
  • Årestedt, Kristofer, 1968-, et al. (författare)
  • Symptom relief and palliative care during the last week of life among patients with heart failure : a national register study
  • 2018
  • Ingår i: Journal of Palliative Medicine. - : Mary Ann Liebert. - 1096-6218 .- 1557-7740. ; 21:3, s. 361-367
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Heart failure is a disease with high morbidity, mortality, and physical and psychological burden. More knowledge about the care provided for patients with heart failure close to death is needed.OBJECTIVE: The aim was to describe key aspects of palliative care during the last week of life in patients with heart failure, as reported by healthcare professionals.DESIGN: This is a national register study.SETTING/SUBJECTS: The study included 3981 patients with diagnosed heart failure as the underlying cause of death.MEASUREMENTS: Data were obtained from the Swedish Register of Palliative Care, a national quality register that focuses on patients' last week of life, independent of diagnosis or care setting. The register includes information about care interventions connected with key aspects of palliative care. Data are reported retrospectively by a nurse or physician at the healthcare unit where the patient dies.RESULTS: Only 4.2% of patients with heart failure received specialized palliative care. In their last week of life, symptom prevalence was high, validated scales were seldom used, and symptoms were unsatisfactorily relieved. Around one-fifth (17%) of the patients in the study died alone. Less than half of family members had been offered bereavement support (45%). Moreover, one-third (28%) of the patients and more than half (61%) of the family members were reported to have had end-of-life discussions with a physician during the illness trajectory.CONCLUSION: The results indicate inadequate palliative care for patients with heart failure during their last week of life.
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2.
  • Theorell, Töres, et al. (författare)
  • A systematic review of studies in the contributions of the work environment to ischaemic heart disease development
  • 2016
  • Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 26:3, s. 470-477
  • Forskningsöversikt (refereegranskat)abstract
    • Background: There is need for an updated systematic review of associations between occupational exposures and ischaemic heart disease (IHD), using the GRADE system. Methods: Inclusion criteria: (i) publication in English in peer-reviewed journal between 1985 and 2014, (ii) quantified relationship between occupational exposure (psychosocial, organizational, physical and other ergonomic job factors) and IHD outcome, (iii) cohort studies with at least 1000 participants or comparable case-control studies with at least 50 + 50 participants, (iv) assessments of exposure and outcome at baseline as well as at follow-up and (v) gender and age analysis. Relevance and quality were assessed using predefined criteria. Level of evidence was then assessed using the GRADE system. Consistency of findings was examined for a number of confounders. Possible publication bias was discussed. Results: Ninety-six articles of high or medium high scientific quality were finally included. There was moderately strong evidence (grade 3 out of 4) for a relationship between job strain and small decision latitude on one hand and IHD incidence on the other hand. Limited evidence (grade 2) was found for iso-strain, pressing work, effort-reward imbalance, low support, lack of justice, lack of skill discretion, insecure employment, night work, long working week and noise in relation to IHD. No difference between men and women with regard to the effect of adverse job conditions on IHD incidence. Conclusions: There is scientific evidence that employees, both men and women, who report specific occupational exposures, such as low decision latitude, job strain or noise, have an increased incidence of IHD.
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4.
  • Järhult, Josef D., et al. (författare)
  • Environmental levels of the antiviral oseltamivir induce development of resistance mutation H274Y in influenza A/H1N1 virus in mallards
  • 2011
  • Ingår i: PLOS ONE. - San Francisco, CA : Public Library of Science (PLoS). - 1932-6203. ; 6:9
  • Tidskriftsartikel (refereegranskat)abstract
    • Oseltamivir (Tamiflu®) is the most widely used drug against influenza infections and is extensively stockpiled worldwide as part of pandemic preparedness plans. However, resistance is a growing problem and in 2008-2009, seasonal human influenza A/H1N1 virus strains in most parts of the world carried the mutation H274Y in the neuraminidase gene which causes resistance to the drug. The active metabolite of oseltamivir, oseltamivir carboxylate (OC), is poorly degraded in sewage treatment plants and surface water and has been detected in aquatic environments where the natural influenza reservoir, dabbling ducks, can be exposed to the substance. To assess if resistance can develop under these circumstances, we infected mallards with influenza A/H1N1 virus and exposed the birds to 80 ng/L, 1 µg/L and 80 µg/L of OC through their sole water source. By sequencing the neuraminidase gene from fecal samples, we found that H274Y occurred at 1 µg/L of OC and rapidly dominated the viral population at 80 µg/L. IC₅₀ for OC was increased from 2-4 nM in wild-type viruses to 400-700 nM in H274Y mutants as measured by a neuraminidase inhibition assay. This is consistent with the decrease in sensitivity to OC that has been noted among human clinical isolates carrying H274Y. Environmental OC levels have been measured to 58-293 ng/L during seasonal outbreaks and are expected to reach µg/L-levels during pandemics. Thus, resistance could be induced in influenza viruses circulating among wild ducks. As influenza viruses can cross species barriers, oseltamivir resistance could spread to human-adapted strains with pandemic potential disabling oseltamivir, a cornerstone in pandemic preparedness planning. We propose surveillance in wild birds as a measure to understand the resistance situation in nature and to monitor it over time. Strategies to lower environmental levels of OC include improved sewage treatment and, more importantly, a prudent use of antivirals.
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5.
  • Hoffmann, Mikael, et al. (författare)
  • Guiding principles for the use of knowledge bases and real-world data in clinical decision support systems : report by an international expert workshop at Karolinska Institutet
  • 2020
  • Ingår i: Expert Review of Clinical Pharmacology. - : Taylor & Francis. - 1751-2433 .- 1751-2441. ; 13:9, s. 925-934
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction Technical and logical breakthroughs have provided new opportunities in medicine to use knowledge bases and large-scale clinical data (real-world) at point-of-care as part of a learning healthcare system to diminish the knowledge-practice gap. Areas covered The article is based on presentations, discussions and recommendations from an international scientific workshop. Value, research needs and funding avenues of knowledge bases and access to real-world data as well as transparency and incorporation of patient perspectives are discussed. Expert opinion Evidence-based, publicly funded, well-structured and curated knowledge bases are of global importance. They ought to be considered as a public responsibility requiring transparency and handling of conflicts of interest. Information has to be made accessible for clinical decision support systems (CDSS) for healthcare staff and patients. Access to rich and real-world data is essential for a learning health care ecosystem and can be augmented by data on patient-reported outcomes and preferences. This field can progress by the establishment of an international policy group for developing a best practice guideline on the development, maintenance, governance, evaluation principles and financing of open-source knowledge bases and handling of real-world data.
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6.
  • Frisendahl, Nathalie, et al. (författare)
  • Predictive Performance of the FIF Screening Tool in 2 Cohorts of Community-Living Older Adults
  • 2020
  • Ingår i: Journal of the American Medical Directors Association. - : Elsevier. - 1525-8610 .- 1538-9375. ; 21:12, s. 1900-1905
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The First-time Injurious Fall (FIF) screening tool was created to identify fall risk in communityliving older adults who may benefit from primary preventive interventions. The aim of this study was to evaluate the predictive performance of the FIF tool in 2 cohorts of older adults. Design: Longitudinal cohort study. Setting and Participants: The Swedish National Study on Aging and Care in Skane (SNAC-S) and Blekinge (SNAC-B), Sweden. Community-living people aged >= 60 years (n = 2766). Methods: Nurses and physicians collected data in the 2 cohorts through interviews and testing. Data on injurious falls were collected from register data and were defined as receipt of care after a fall. The FIF tool, consisting of 3 questions and 1 balance test, was examined in relation to injurious falls for up to 5 years of follow-up using Cox proportional hazards models. The predictive performance of the FIF tool was further explored using Harrell C statistic and Youden cut-off for sensitivity and specificity. Results: The hazard ratios (HRs) of an injurious fall in the high-risk group for women and men were 3.80 (95% confidence interval [CI] 2.53, 5.73) and 5.10 (95% CI 2.57, 10.12) in SNAC-S and 4.45 (95% CI 1.86, 10.61) and 32.58 (95% CI 4.30, 247.05) in SNAC-B compared with those in the low risk group. The sensitivity and specificity of the Youden cut-off point (3 or higher for high-risk) were 0.64 and 0.69 for women and 0.68 and 0.69 for men in SNAC-S, and 0.64 and 0.74 for women and 0.94 and 0.68 for men in SNAC-B. The predictive values (Harrell C statistic) for the scores for women and men were 0.73 and 0.74 in SNAC-S and 0.72 and 0.89 in SNAC-B. Conclusions and Implications: Our results suggest that the FIF tool is a valid tool to use for prediction of first-time injurious falls in community-living older adults. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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7.
  • Haemig, Paul, et al. (författare)
  • Red fox and tick-borne encephalitis (TBE) in humans: Can predators influence public health?
  • 2008
  • Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 40:6-7, s. 527-532
  • Tidskriftsartikel (refereegranskat)abstract
    • Analysing datasets from hunting statistics and human cases of tick-borne encephalitis (TBE), we found a positive correlation between the number of human TBE cases and the number of red fox (Vulpes vulpes). Time lags were also present, indicating that high numbers of red fox in 1 y translated into high numbers of human TBE cases the following y. Results for smaller predators were mixed and inconsistent. Hares and grouse showed negative correlations with human TBE cases, suggesting that they might function as dilution hosts. Combining our findings with food web dynamics, we hypothesize a diversity of possible interactions between predators and human disease – some predators suppressing a given disease, others enhancing its spread, and still others having no effect at all. Larger-sized predators that suppress red fox numbers and activity (i.e. wolf, Canis lupus; European lynx, Lynx lynx) were once abundant in our study area but have been reduced or extirpated from most parts of it by humans. We ask what would happen to red foxes and TBE rates in humans if these larger predators were restored to their former abundances.Read More: http://informahealthcare.com/doi/abs/10.1080/00365540701805446
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8.
  • Harnek, Jan, et al. (författare)
  • The 2011 outcome from the Swedish Health Care Registry on Heart Disease (SWEDEHEART)
  • 2013
  • Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 47, s. 1-10
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives. The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) collects data to support the improvement of care for heart disease. Design. SWEDEHEART collects on-line data from consecutive patients treated at any coronary care unit n = (74), followed for secondary prevention, undergoing any coronary angiography, percutaneous coronary intervention, percutaneous valve or cardiac surgery. The registry is governed by an independent steering committee, the software is developed by Uppsala Clinical Research Center and it is funded by The Swedish national health care provider independent of industry support. Approximately 80,000 patients per year enter the database which consists of more than 3 million patients. Results. Base-line, procedural, complications and discharge data consists of several hundred variables. The data quality is secured by monitoring. Outcomes are validated by linkage to other registries such as the National Cause of Death Register, the National Patient Registry, and the National Registry of Drug prescriptions. Thanks to the unique social security number provided to all citizens follow-up is complete. The 2011 outcomes with special emphasis on patients more than 80 years of age are presented. Conclusion. SWEDEHEART is a unique complete national registry for heart disease.
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9.
  • Varenhorst, Christoph, 1977-, et al. (författare)
  • Stent thrombosis rates the first year and beyond with new- and old-generation drug-eluting stents compared to bare metal stents
  • 2018
  • Ingår i: Clinical Research in Cardiology. - : Springer. - 1861-0684 .- 1861-0692. ; 107:9, s. 816-823
  • Tidskriftsartikel (refereegranskat)abstract
    • Old-generation drug-eluting coronary stents (o-DES) have despite being safe and effective been associated with an increased propensity of late stent thrombosis (ST). We evaluated ST rates in o-DES, new-generation DES (n-DES) and bare metal stents (BMS) the first year (< 1 year) and beyond 1 year (> 1 year). We evaluated all implantations with BMS, o-DES (Cordis Cypher, Boston Scientific Taxus Libert, and Medtronic Endeavor) and n-DES in the Swedish coronary angiography and angioplasty registry (SCAAR) between 1 January 2007 and 8 January 2014 (n = 207 291). All cases of ST (n = 2 268) until 31 December 2014 were analyzed. The overall risk of ST was lower in both n-DES and o-DES compared with BMS up to 1 year (n-DES versus BMS: adjusted risk ratio (RR) 0.48 (0.41-0.58) and o-DES versus BMS: 0.56 (0.46-0.67), both p < 0.001). From 1 year after stent implantation and onward, the risk for ST was higher in o-DES compared with BMS [adjusted RR, 1.82 (1.47-2.25], p < 0.001). N-DES were associated with similar low ST rates as BMS from 1 year and onward [adjusted RR 1.21 (0.94-1.56), p = 0.135]. New-generation DES were associated with lower ST rates in comparison to BMS during the first-year post-stenting. After 1 year, n-DES and BMS were associated with similar ST rates. This study was a retrospective observational study and as such did not require clinical trial database registration.
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10.
  • Capo, Eric, et al. (författare)
  • Expression Levels of hgcAB Genes and Mercury Availability Jointly Explain Methylmercury Formation in Stratified Brackish Waters
  • 2022
  • Ingår i: Environmental Science and Technology. - : American Chemical Society (ACS). - 0013-936X .- 1520-5851. ; 56:18, s. 13119-13130
  • Tidskriftsartikel (refereegranskat)abstract
    • Neurotoxic methylmercury (MeHg) is formed by microbial methylation of inorganic divalent Hg (Hg-II) and constitutes severe environmental and human health risks. The methylation is enabled by hgcA and hgcB genes, but it is not know nif the associated molecular-level processes are rate-limiting or enable accurate prediction of MeHg formation in nature. In this study, we investigated the relationships between hgc genes and MeHg across redox-stratified water columns in the brackish Baltic Sea. We showed, for the first time, that hgc transcript abundance and the concentration of dissolved Hg-II-sulfide species were strong predictors of both the Hg-II methylation rate and MeHg concentration, implying their roles as principal joint drivers of MeHg formation in these systems. Additionally, we characterized the metabolic capacities of hgc(+) microorganisms by reconstructing their genomes from metagenomes (i.e., hgc(+) MAGs), which highlighted the versatility of putative Hg-II methylators in the water column of the Baltic Sea. In establishing relationships between hgc transcripts and the Hg-II methylation rate, we advance the fundamental understanding of mechanistic principles governing MeHg formation in nature and enable refined predictions of MeHg levels in coastal seas in response to the accelerating spread of oxygen-deficientzones.
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