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- Alkmark, Mårten, 1973, et al.
(författare)
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Induction of labour at 41weeks of gestation versus expectant management and induction of labour at 42weeks of gestation: a cost-effectiveness analysis
- 2022
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Ingår i: BJOG: An International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 129:13, s. 2157-2165
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the cost-effectiveness of induction of labour (IOL) at 41weeks of gestation compared with expectant management until 42weeks of gestation. Design: A cost-effectiveness analysis alongside the Swedish Post-term Induction Study (SWEPIS), a multicentre, randomised controlled superiority trial. Setting: Fourteen Swedish hospitals during 2016–2018. Population: Women with an uncomplicated singleton pregnancy with a fetus in cephalic position were randomised at 41weeks of gestation to IOL or to expectant management and induction at 42weeks of gestation. Methods: Health benefits were measured in life years and quality-adjusted life years (QALYs) for mother and child. Total cost per birth was calculated, including healthcare costs from randomisation to discharge after delivery, for mother and child. Incremental cost-effectiveness ratios (ICERs) were calculated by dividing the difference in mean cost between the trial arms by the difference in life years and QALYs, respectively. Sampling uncertainty was evaluated using non-parametric bootstrapping. Main outcome measures: The cost per gained life year and per gained QALY. Results: The differences in life years and QALYs gained were driven by the difference in perinatal mortality alone. The absolute risk reduction in mortality was 0.004 (from 6/1373 to 0/1373). Based on Swedish life tables, this gives a mean gain in discounted life years and QALYs of 0.14 and 0.12 per birth, respectively. The mean cost per birth was €4108 in the IOL group (n=1373) and €4037 in the expectant management group (n=1373), with a mean difference of €71 (95%CI −€232 to €379). The ICER for IOL compared with expectant management was €545 per life year gained and €623 per QALY gained. Confidence intervals were relatively wide and included the possibility that IOL had both lower costs and better health outcomes. Conclusions: Induction of labour at 41weeks of gestation results in a better health outcome and no significant difference in costs. IOL is cost-effective compared with expectant management until 42weeks of gestation using standard threshold values for acceptable cost per life year/QALY. Tweetable abstract: Induction of labour at 41weeks of gestation is cost-effective compared with expectant management until 42weeks of gestation.
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| 2. |
- Bergh, Cecilia, 1972-
(författare)
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Life-course influences on occurrence and outcome for stroke and coronary heart disease
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Although typical clinical onset does not occur until adulthood, cardiovascular disease (CVD) may have a long natural history with accumulation of risks beginning in early life and continuing through childhood and into adolescence and adulthood. Therefore, it is important to adopt a life-course approach to explore accumulation of risks, as well as identifying age-defined windows of susceptibility, from early life to disease onset. This thesis examines characteristics in adolescence and adulthood linked with subsequent risk of CVD. One area is concerned with physical and psychological characteristics in adolescence, which reflects inherited and acquired elements from childhood, and their association with occurrence and outcome of subsequent stroke and coronary heart disease many years later. The second area focuses on severe infections and subsequent delayed risk of CVD. Data from several Swedish registers were used to provide information on a general population-based cohort of men. Some 284 198 males, born in Sweden from 1952 to 1956 and included in the Swedish Military Conscription Register, form the basis of the study cohort for this thesis. Our results indicate that characteristics already present in adolescence may have an important role in determining long-term cardiovascular health. Stress resilience in adolescence was associated with an increased risk of stroke and CHD, working in part through other CVD factors, in particular physical fitness. Stress resilience, unhealthy BMI and elevated blood pressure in adolescence were also associated with aspects of stroke severity among survivors of a first stroke. We demonstrated an association for severe infections (hospital admission for sepsis and pneumonia) in adulthood with subsequent delayed risk of CVD, independent of risk factors from adolescence. Persistent systemic inflammatory activity which could follow infection, and that might persist long after infections resolve, represents a possible mechanism. Interventions to protect against CVD should begin by adolescence; and there may be a period of heightened susceptibility in the years following severe infection when additional monitoring and interventions for CVD may be of value.
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| 3. |
- Bergh, Cecilia, 1972-, et al.
(författare)
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Stress resilience in male adolescents and subsequent stroke risk : cohort study
- 2014
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Ingår i: Journal of Neurology, Neurosurgery and Psychiatry. - : BMJ Publishing Group Ltd. - 0022-3050 .- 1468-330X. ; 85:12, s. 1331-1336
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Tidskriftsartikel (refereegranskat)abstract
- Objective Exposure to psychosocial stress has been identified as a possible stroke risk, but the role of stress resilience which may be relevant to chronic exposure is uncertain. We investigated the association of stress resilience in adolescence with subsequent stroke risk.Methods Register-based cohort study. Some 237 879 males born between 1952 and 1956 were followed from 1987 to 2010 using information from Swedish registers. Cox regression estimated the association of stress resilience with stroke, after adjustment for established stroke risk factors.Results Some 3411 diagnoses of first stroke were identified. Lowest stress resilience (21.8%) compared with the highest (23.7%) was associated with increased stroke risk, producing unadjusted HR (with 95% CIs) of 1.54 (1.40 to 1.70). The association attenuated slightly to 1.48 (1.34 to 1.63) after adjustment for markers of socioeconomic circumstances in childhood; and after further adjustment for markers of development and disease in adolescence (blood pressure, cognitive function and pre-existing cardiovascular disease) to 1.30 (1.18 to 1.45). The greatest reduction followed further adjustment for markers of physical fitness (BMI and physical working capacity) in adolescence to 1.16 (1.04 to 1.29). The results were consistent when stroke was subdivided into fatal, ischaemic and haemorrhagic, with higher magnitude associations for fatal rather than non-fatal, and for haemorrhagic rather than ischaemic stroke.Conclusions Stress susceptibility and, therefore, psychosocial stress may be implicated in the aetiology of stroke. This association may be explained, in part, by poorer physical fitness. Effective prevention might focus on behaviour/lifestyle and psychosocial stress.
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| 5. |
- Henriksson, Malin, et al.
(författare)
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Effects of exercise on symptoms of anxiety in primary care patients: A randomized controlled trial.
- 2022
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Ingår i: Journal of affective disorders. - : Elsevier BV. - 1573-2517 .- 0165-0327. ; 297, s. 26-34
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Tidskriftsartikel (refereegranskat)abstract
- There is a need for high-quality research regarding exercise interventions for persons with anxiety disorders. We investigate whether a 12-week exercise intervention, with different intensities, could reduce anxiety symptoms in patients with anxiety disorders.286 patients were recruited from primary care in Sweden. Severity of symptoms was self-assessed using the Beck Anxiety Inventory (BAI) and the Montgomery Åsberg Depression Rating Scale (MADRS-S). Participants were randomly assigned to one of two group exercise programs with cardiorespiratory and resistance training and one control/standard treatment non-exercise group, with 1:1:1 allocation.Patients in both exercise groups showed larger improvements in both anxiety and depressive symptoms compared to the control group. No differences in effect sizes were found between the two groups. To study a clinically relevant improvement, BAI and MADRS-S were dichotomized with the mean change in the control group as reference. In adjusted models the odds ratio for improved symptoms of anxiety after low-intensity training was 3.62 (CI 1.34-9.76) and after moderate/high intensity 4.88 (CI 1.66-14.39), for depressive symptoms 4.96 (CI 1.81-13.6) and 4.36 (CI 1.57-12.08) respectively. There was a significant intensity trend for improvement in anxiety symptoms.The use of self-rating measures which bears the risk of an under- or overestimation of symptoms.A 12-week group exercise program proved effective for patients with anxiety syndromes in primary care. These findings strengthen the view of physical exercise as an effective treatment and could be more frequently made available in clinical practice for persons with anxiety issues.
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| 10. |
- Rydén, Petra, 1972-
(författare)
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Toward an understanding of the barriers to and facilitators of dietary change :
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Healthy dietary changes would be beneficial for society, as the economic burden of diet-related diseases is massive, and for the individual, who would reduce their risk of ill health. However, it is not easy to change dietary habits. Therefore, the aim of this thesis was to better understand dietary change, focusing on the barriers to and facilitators of healthy dietary change by i) examining changes in food choices when dietary change is imposed by a medical diagnosis, ii) examining experiences related to dietary change and its sustainability after participation in a study where healthy dietary changes were required, and iii) examining diet cost in relation to healthiness of the diet. Methods Eighty children aged 13 who were diagnosed with celiac disease (CD) by a screening study reported their food intake in a food frequency questionnaire before and 1,5 years after commencing a gluten-free diet. Changes in food intake and the healthiness of the diet were examined, controlling for societal changes through the use of an age- and sex-matched control group. Diet healthiness was assessed using the National Food Administration’s (NFA) food index and the Diet Quality Index-Swedish Nutritional Recommendations. Qualitative interviews were conducted with 14 individuals who participated in an intervention study five years earlier where they had been randomly selected to adhere to a Mediterranean-like diet for three months. Analyses of the transcribed interviews focused on their experiences of barriers to and facilitators of dietary change and its sustainability. The costs related to healthy diets were examined by comparing consumer food prices with dietary intake data collected in two separate studies. The first study collected dietary intake data through a diet history interview with participants who had been randomized to either a Mediterranean-like diet or to continue their normal diet. The second study collected dietary intake data from 4-, 8-, and 11-year-old children by means of food diaries and was conducted by the NFA. Diet healthiness was assessed using the Healthy Eating Index 2005. Results The screened CD group made relatively few changes to their diets. They decreased their intake of certain gluten-containing products, including pizza, chicken nuggets, fish sticks, and pastries. There were no changes in the healthiness of their diet. The narratives of the individuals changing their diets showed that social relationships were the main barrier to sustainability. Social relationships within the household were especially troublesome, and various coping strategies were required on an everyday basis. Dietary change also increased the burden of food work (e.g., planning, shopping, cooking), which was another major barrier to dietary change. Comparisons between consumer costs of healthy and less healthy diets showed that those consuming the healthier diets also had consumed more expensive diets. Conclusion More barriers to healthy dietary changes were found than facilitators of these transitions. For instance, the impact of social relationships on sustainability of dietary change was found to be high, indicating the importance of participation of other household members when dietary changes are implemented. The higher cost of the healthier diets may be another barrier for healthy dietary changes, especially for those with limited resources. Even though it is possible to eat healthily at a lower cost, such a diet would likely require both cooking skills and time, thus making the task more difficult. However, the finding that children diagnosed with CD only made minor changes in their consumption of, for instance, bread and pasta, indicates that one way of increasing the healthiness of a diet is to substitute healthier alternatives within the same food group for less healthy food items.
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