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- Hasselqvist-Ax, Ingela, et al.
(författare)
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Dispatch of Firefighters and Police Officers in Out-of-Hospital Cardiac Arrest : A Nationwide Prospective Cohort Trial Using Propensity Score Analysis.
- 2017
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Ingår i: Journal of the American Heart Association. - 2047-9980. ; 6:10
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Dispatch of basic life support-trained first responders equipped with automated external defibrillators in addition to advanced life support-trained emergency medical services personnel in out-of-hospital cardiac arrest (OHCA) has, in some minor cohort studies, been associated with improved survival. The aim of this study was to evaluate the association between basic life support plus advanced life support response and survival in OHCA at a national level.METHODS AND RESULTS: This prospective cohort study was conducted from January 1, 2012, to December 31, 2014. People who experienced OHCA in 9 Swedish counties covered by basic life support plus advanced life support response were compared with a propensity-matched contemporary control group of people who experienced OHCA in 12 counties where only emergency medical services was dispatched, providing advanced life support. Primary outcome was survival to 30 days. The analytic sample consisted of 2786 pairs (n=5572) derived from the total cohort of 7308 complete cases. The median time from emergency call to arrival of emergency medical services or first responder was 9 minutes in the intervention group versus 10 minutes in the controls (P<0.001). The proportion of patients admitted alive to the hospital after resuscitation was 31.4% (875/2786) in the intervention group versus 24.9% (694/2786) in the controls (conditional odds ratio, 1.40; 95% confidence interval, 1.24-1.57). Thirty-day survival was 9.5% (266/2786) in the intervention group versus 7.7% (214/2786) in the controls (conditional odds ratio, 1.27; 95% confidence interval, 1.05-1.54).CONCLUSIONS: In this nationwide interventional trial, using propensity score matching, dispatch of first responders in addition to emergency medical services in OHCA was associated with a moderate, but significant, increase in 30-day survival.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02184468.
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- Ingelsson, Erik, et al.
(författare)
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Diurnal blood pressure pattern and risk of congestive heart failure
- 2006
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Ingår i: Journal of the American Medical Association (JAMA). - 0098-7484 .- 1538-3598. ; 295:24, s. 2859-2866
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: High blood pressure is the most important risk factor for congestive heart failure (CHF) at a population level, but the relationship of an altered diurnal blood pressure pattern to risk of subsequent CHF is unknown. OBJECTIVES: To explore 24-hour ambulatory blood pressure characteristics as predictors of CHF incidence and to investigate whether altered diurnal blood pressure patterns confer any additional risk information beyond that provided by conventional office blood pressure measurements. DESIGN, SETTING, AND PARTICIPANTS: Prospective, community-based, observational cohort in Uppsala, Sweden, including 951 elderly men free of CHF, valvular disease, and left ventricular hypertrophy at baseline between 1990 and 1995, followed up until the end of 2002. Twenty-four-hour ambulatory blood pressure monitoring was performed at baseline, and the blood pressure variables were analyzed as predictors of subsequent CHF. MAIN OUTCOME MEASURE: First hospitalization for CHF. RESULTS: Seventy men developed heart failure during follow-up, with an incidence rate of 8.6 per 1000 person-years at risk. In multivariable Cox proportional hazards models adjusted for antihypertensive treatment and established risk factors for CHF (myocardial infarction, diabetes, smoking, body mass index, and serum cholesterol level), a 1-SD (9-mm Hg) increase in nighttime ambulatory diastolic blood pressure (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.02-1.55) and the presence of "nondipping" blood pressure (night-day ambulatory blood pressure ratio > or =1; HR, 2.29; 95% CI, 1.16-4.52) were associated with an increased risk of CHF. After adjusting for office-measured systolic and diastolic blood pressures, nondipping blood pressure remained a significant predictor of CHF (HR, 2.21; 95% CI, 1.12-4.36 vs normal night-day pattern). Nighttime ambulatory diastolic blood pressure and nondipping blood pressure were also significant predictors of CHF after exclusion of all participants who had an acute myocardial infarction before baseline or during follow-up. CONCLUSIONS: Nighttime blood pressure appears to convey additional risk information about CHF beyond office-measured blood pressure and other established risk factors for CHF. The clinical value of this association remains to be established in future studies.
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- Lithell, Hans, et al.
(författare)
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Epidemiological and clinical studies on insulin resistance and diabetes
- 2000
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Ingår i: Upsala Journal of Medical Sciences. - 0300-9734. ; 105:2, s. 135-150
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- In Uppsala, extensive epidemiological and clinical studies on insulin resistance and diabetes have been ongoing for the past 30 years. A prospective cohort study of men born 1920-24, living in Uppsala County, was initiated during 1969-74 (the Uppsala Longitudinal Study of Adult Men, ULSAM). Risk factors for cardiovascular disease were examined in 2,322 men, and re-examinations have been performed every 10 years. At the first follow-up, when the men were 60 years old, insulin resistance was found to be a risk factor for development of hypertension and diabetes. In addition, treatment with antihypertensive medication was an independent risk factor for development of diabetes. These findings resulted in a series of clinical studies on metabolic effects of antihypertensive agents. At the second follow-up, when the men were 70 years old, the development of hypertension and diabetes was once again in focus, but at this time, cross-sectional and prospective studies of other cardiovascular determinants, such as circadian blood pressure pattern, left ventricular geometry and function, muscle morphology, ion status, fibrinolysis and cognitive function, were also performed. The cohort has furthermore been linked to the Swedish census and hospital discharge and cause of death registries, it has been used for studies on relationships between birth weight and cardiovascular disease, and genetic analyses have been performed, taking advantage of the long observation time obtained in this cohort. The cohort is currently being re-examined for the third time, and will hopefully continue to provide valuable information on the epidemiology of diabetes and cardiovascular disease in the future.
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- Plink Björklund, Piret, 1969, et al.
(författare)
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Sedimentary documentation of the break-up of Rodinia, Offerdal Nappe, Swedish Caledonides
- 2005
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Ingår i: Precambrian Research. - : Elsevier BV. - 0301-9268. ; 136:1, s. 1-26
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Tidskriftsartikel (refereegranskat)abstract
- Late Riphean to early Vendian metasedimentary rocks of the Offerdal Nappe, central Scandinavian Caledonides, were studied by field mapping and measured sections. Even though the rocks have been metamorphosed and tectonically deformed, preserved sedimentary structures and outcrop exposure permit the interpretation of a little-known area with respect to the break-up of Rodinia. This work shows that although the primary sedimentary textures are strongly altered during metamorphism the primary sedimentary structures and bed geometries are commonly preserved. Moreover, the sedimentary structures, where identified, can be used to hydrodynamically estimate the primary grain-size of the metasedimentary rocks. Seven sedimentary facies, were identified in three tectonostratigraphic units. The lower tectonostratigraphic unit consists of polymict conglomerates deposited in alluvial fans. The lower part of the middle tectonostratigraphic unit consists of channelled turbidite deposits. The upper part of the middle tectonostratigraphic unit consists of a regressive to transgressive succession with southeast to northwest transition from fluvial deposits, to storm-dominated deposits and into offshore mudstones. The lower part of the upper tectonostratigraphic unit consists of a regressive succession with southeast to northwest transition from channelled turbidites into sheet-like turbidites. The upper part consists of fluvial deposits in updip (southeast) areas, whereas in downdip (northwest) areas the sheet-like turbidites reflect continued deepwater deposition. (1) The similar to 1500 in thickness of the Offerdal succession, (2) the occurrence of > 300 m thickness of the pebble- to boulder-bearing continental-basement derived alluvial fan conglomerates, (3) the high sediment input rates, and (4) the high subsidence rates suggest an actively subsiding basin and a relatively uplifted hinterland. Furthermore, the arkosic composition of the Offerdal metasandstones, as well as the Precambrian porphyry, syenite and quartzite clast composition of the lithic conglomerates, recognised from the subjacent continental basement of Baltica, suggest a continental sediment source. The rapid accommodation changes, and especially the simultaneous subsidence of downdip areas and uplift of updip areas in UTU2 suggest syn-depositional extensional block rotation. Collectively, this evidence suggests that the Offerdal succession was deposited in a continental rift basin related to break-up of Rodinia. (C) 2004 Elsevier B.V. All rights reserved.
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- Ahnström, Johan, et al.
(författare)
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Farmers' Interest in Nature and Its Relation to Biodiversity in Arable Fields
- 2013
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Ingår i: International Journal of Ecology. - : Hindawi Publishing Corporation. - 1687-9708 .- 1687-9716.
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Tidskriftsartikel (refereegranskat)abstract
- Biodiversity declines in farmland have been attributed to intensification of farming at the field level and loss of heterogeneity at the landscape level. However, farmers are not solely optimizing production; their actions are also influenced by social factors, tradition and interest in nature, which indirectly influence biodiversity but rarely are incorporated in studies of farmland biodiversity. We used social science methods to quantify farmers’ interest in nature on 16 farms with winter wheat fields in central Sweden, and combined this with biodiversity inventories of five organism groups (weeds, carabid beetles, bumblebees, solitary bees, and birds) and estimates of landscape composition andmanagement intensity at the field level.Agricultural intensity,measured as crop density, and farmers’ interest in nature explained variation in biodiversity, measured as the proportion of the regional species richness found on single fields. Interest in nature seemed to incorporate many actions taken by farmers and appeared to be influenced by both physical factors, for example, the surrounding landscape, and social factors, for example, social motivations.This study indicates that conservation of biodiversity in farmland, and design of new agri-environmental subsidy systems, would profit from taking farmers’ interest in nature and its relation to agricultural practices into account.
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| 10. |
- Albèr, Cathrine, et al.
(författare)
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Effects of water gradients and use of urea on skin ultrastructure evaluated by confocal Raman microspectroscopy
- 2013
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Ingår i: Biochimica et Biophysica Acta - Biomembranes. - : Elsevier. - 0005-2736 .- 1879-2642 .- 0006-3002. ; 1828:11, s. 2470-2478
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Tidskriftsartikel (refereegranskat)abstract
- The rather thin outermost layer of the mammalian skin, stratum corneum (SC), is a complex biomembrane which separates the water rich inside of the body from the dry outside. The skin surface can be exposed to rather extreme variations in ambient conditions (e.g. water activity, temperature and pH), with potential effects on the barrier function. Increased understanding of how the barrier is affected by such changes is highly relevant for regulation of transdermal uptake of exogenous chemicals. In the present study we investigate the effect of hydration and the use of a well-known humectant, urea, on skin barrier ultrastructure by means of confocal Raman microspectroscopy. We also perform dynamic vapor sorption (DVS) microbalance measurements to examine the water uptake capacity of SC pretreated with urea. Based on novel Raman images, constructed from 2D spectral maps, we can distinguish large water inclusions within the skin membrane exceeding the size of fully hydrated corneocytes. We show that these inclusions contain water with spectral properties similar to that of bulk water. The results furthermore show that the ambient water activity has an important impact on the formation of these water inclusions as well as on the hydration profile across the membrane. Urea significantly increases the water uptake when present in skin, as compared to skin without urea, and it promotes formation of larger water inclusions in the tissue. The results confirm that urea can be used as a humectant to increase skin hydration.
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