| 1. |
- Axelsson, Kristian F, et al.
(författare)
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Fracture risk after gastric bypass surgery – a retrospective cohort study
- 2018
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Ingår i: Journal of Bone and Mineral Research. - : Wiley-Blackwell Publishing Inc.. - 0884-0431 .- 1523-4681. ; 33:12, s. 2122-2131
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Tidskriftsartikel (refereegranskat)abstract
- Gastric bypass surgery constitutes the most common and effective bariatric surgery to treat obesity. Gastric bypass leads to bone loss, but fracture risk following surgery has been insufficiently studied. Furthermore, the association between gastric bypass and fracture risk has not been studied in patients with diabetes, which is a risk factor for fracture and affected by surgery. In this retrospective cohort study using Swedish national databases, 38 971 obese patients undergoing gastric bypass were identified, 7758 with diabetes and 31 213 without. An equal amount of well-balanced controls were identified through multivariable 1:1 propensity score matching. The risk of fracture and fall injury was investigated using Cox proportional hazards and flexible parameter models. Fracture risk according to weight loss and degree of calcium and vitamin D supplementation one-year post- surgery was investigated. During a median follow-up time of 3.1 (IQR 1.7-4.6) years, gastric bypass was associated with increased risk of any fracture, in patients with and without diabetes using a multivariable Cox model (HR 1.26, 95% CI 1.05- 1.53 and HR 1.32, 95% CI 1.18-1.47, respectively). Using flexible parameter models, the fracture risk appeared to increase with time. The risk of fall injury without fracture was also increased after gastric bypass. Larger weight loss or poor calcium and vitamin D supplementation after surgery were not associated with increased fracture risk. In conclusion, gastric bypass surgery is associated with an increased fracture risk, which appears to be increasing with time and not associated with degree of weight loss or calcium and vitamin D supplementation following surgery. An increased risk of fall injury was seen after surgery, which could contribute to the increased fracture risk. This article is protected by copyright. All rights reserved.
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| 2. |
- Axelsson, Kristian F, 1973, et al.
(författare)
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Risk of fracture in adults with type 2 diabetes in Sweden: A national cohort study
- 2023
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Ingår i: Plos Medicine. - : Public Library of Science (PLoS). - 1549-1277 .- 1549-1676. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Author summary Why was this study done? Type 2 diabetes mellitus (T2DM) is considered a risk factor for fracture but the evidence regarding the impact of T2DM on fracture risk is conflicting.We sought to determine if patients with T2DM had increased fracture risk and if so, to identify T2DM-related risk factors. What did the researchers do and find? We used a national register covering nearly all adult patients with T2DM in Sweden to compare the risk of fracture between T2DM patients ( = 580,127) and population controls ( = 580,127) without T2DM.In general, the risk of fracture was only marginally increased (by 1% for major osteoporotic fracture (MOF) and by 6% for hip fracture) for patients with T2DM compared to controls, but for patients with presence of risk factors, such as low BMI, long T2DM duration, insulin treatment, and/or low physical activity, the risk increase was more substantial (20% or higher) and potentially clinically relevant. What do these findings mean? Our findings suggest that T2DM per se should not be considered an important risk factor for fracture.Special consideration of the T2DM-related risk factors can be used to identify T2DM patients with a clinically relevant increased fracture risk.Further studies are needed to develop fracture risk calculators for different settings and populations for T2DM patients specifically. BackgroundType 2 diabetes mellitus (T2DM) is considered a risk factor for fracture but the evidence regarding the impact of T2DM on fracture risk is conflicting. The objective of the study was to determine if patients with T2DM have increased fracture risk and if T2DM-related risk factors could be identified. Methods and findingsIn this national cohort study in Sweden, we investigated the risk of fracture in 580,127 T2DM patients, identified through the national diabetes register including from both primary care and hospitals, and an equal number of population-based controls without diabetes matched for age, sex, and county from 2007 to 2017. The mean age at entry was 66.7 years and 43.6% were women. During a median follow-up time of 6.6 (interquartile range (IQR) 3.1 to 9.8) years, patients with T2DM had a marginally but significantly increased risk of major osteoporotic fracture (MOF) (hazard ratio (HR) 1.01 (95% confidence interval [CI] 1.00 to 1.03)) and hip fracture (HR 1.06 (95% CI 1.04 to 1.08)) compared to controls, associations that were only minimally affected (HR 1.05 (95% CI 1.03 to 1.06) and HR 1.11 (95% CI 1.09 to 1.14), respectively) by multivariable adjustment (age, sex, marital status, and an additional 20 variables related to general morbidity, cardiovascular status, risk of falls, and fracture). In a multivariable-adjusted Cox model, the proportion of the risk for all fracture outcomes (Heller's R2) explained by T2DM was below 0.1%. Among the T2DM patients, important risk factors for fracture were a low BMI (<25 kg/m(2)), long diabetes duration (>= 15 years), insulin treatment, and low physical activity. In total, 55% of the T2DM patients had none of these risk factors and a significantly lower fracture risk than their respective controls. The relatively short mean duration of T2DM and lack of bone density data, constitute limitations of the analysis. ConclusionIn this study, we observed only a marginally increased fracture risk in T2DM, a condition that explained less than 0.1% of the fracture risk. Consideration of the herein identified T2DM-related risk factors could be used to stratify T2DM patients according to fracture risk.
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| 3. |
- Berg, Hans-Yngve, et al.
(författare)
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Learner drivers and lay instruction : how socio-economic standing and lifestyle are reflected in driving practice from the age of 16
- 1999
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Ingår i: Transportation Research Part F: Traffic Psychology and Behaviour. - 1369-8478. ; 2:3, s. 167-179
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Tidskriftsartikel (refereegranskat)abstract
- On September 1st 1993, a new law came into effect in Sweden, permitting instructor-supported driving practice from the age of 16 instead of 17 years and 6 months. The intention was to enable young people to gain more experience of driving a car before they acquire a driver's permit and thereby to reduce their accident risk. The study was conducted by means of a questionnaire posted to 601 17-year-olds throughout Sweden. The participants were analysed concerning gender, socio-economic standing (blue-collar and white-collar), and lifestyle (friend-oriented, externally-oriented and parent-oriented). The results show that men obtain a learner's permit more often than women (67.4% vs 57.2%) and that youngsters in white-collar families acquire a learner's permit in more cases than those in blue-collar families (67.4% vs 52.4%). One of the reasons for the latter group not acquiring a permit is that they cannot afford it, while children in white-collar families state that they have neither the time nor the desire. No significant difference was found between the three lifestyle groups. When it comes to the amount of practice, the men have been out on the road on average 39.9 h during their first 13 months, compared to 19.9 h for the women. In the lifestyle groups, those who belong to the so-called externally-oriented lifestyle have practised most. They have reported 39.2 h compared to the parent-oriented group with the least amount of training, 27.9 h on average. The friend-oriented group has 22.2 h of practice. When both lifestyle and socio-economic standing were considered, even greater differences were found. The white-collar group of the externally-oriented lifestyle reported as much as 51.5 h, compared to the blue-collar group of the parent-oriented lifestyle with only 18.4 h of practising. The above result is important because it is not in accordance with the intentions of the new driving practice system. The idea behind the new system was that all young people should have the opportunity for a longer period of driving practice in order to reduce the high accident risk during the first year with a driver’s license. If it is impossible for certain groups of youngsters to start their driving practice at the age of 16, the situation will become socially unjust and measures must be taken to remedy this situation.
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| 4. |
- Bjerklöv, Kristian, Docent, et al.
(författare)
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Positive fibered lyapunov exponents for some quasi-periodically driven circle endomorphisms with critical points
- 2020
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Ingår i: Astérisque. - : Societe Mathematique de France. - 0303-1179 .- 2492-5926. ; 415, s. 181-193
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Tidskriftsartikel (refereegranskat)abstract
- In this paper we give examples of skew-product maps T : T-2 -> T-2 of the form T (x, y) = (x + omega, x + f(y)), where f : T -> T is an explicit C-1-endomorphism of degree two with a unique critical point and omega belongs to a set of positive measure, for which the fibered Lyapunov exponent is positive for a.e. (x, y) is an element of T-2. The critical point is of type f '(+/- e(-epsilon)) approximate to e(-beta s/(ln s)2) for all large s, where beta > 0 is a small numerical constant.
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| 7. |
- Engstrom, Arvid, et al.
(författare)
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Association of glucagon-like peptide-1 receptor agonists with serious liver events among patients with type 2 diabetes: A Scandinavian cohort study
- 2023
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Ingår i: HEPATOLOGY. - 0270-9139 .- 1527-3350. ; 79:6, s. 1401-1411
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aims:Clinical trials suggest that glucagon-like peptide-1 (GLP-1) receptor agonists may have beneficial effects on NAFLD, but the impact on hard hepatic end points is unknown. We assessed the association between the use of GLP-1 receptor agonists and the risk of serious liver events in routine clinical practice. Approach and Results:Cohort study using data from nationwide registers in Sweden, Denmark, and Norway, 2007-2020, including 91,479 initiators of GLP-1 receptor agonists and 244,004 initiators of the active comparator, dipeptidyl peptidase-4 inhibitors, without a history of chronic liver disease other than NAFLD/NASH. The primary outcome was serious liver events: a composite of incident compensated and decompensated cirrhosis and HCC. Secondary outcomes were the individual components of the primary outcome. Cox regression was used to estimate HRs, using propensity score weighting to control for confounding. Users of GLP-1 receptor agonists had 608 serious liver events (adjusted incidence rate: 16.9 events per 10,000 person-years), compared with 1770 events among users of dipeptidyl peptidase-4 inhibitors (19.2 events per 10,000 person-years). The adjusted HR was 0.85 (95% CI: 0.75 to 0.97), and the rate difference was -2.1 (-4.4 to 0.1) events per 10,000 person-years. In secondary outcome analyses, the adjusted HR was 0.85 (0.75 to 0.97) for compensated and decompensated cirrhosis and 1.05 (0.80 to 1.39) for HCC. Conclusions:The use of GLP-1 receptor agonists was associated with a significantly reduced risk of serious liver events, driven by a reduction of compensated and decompensated cirrhosis.
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| 8. |
- Gerner, Kristian, et al.
(författare)
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Pollution of the Natural Environment and the Dissolution of the Soviet Union
- 2006
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Ingår i: Miljöhistoria över gränser. - 1652-2761. - 9171040374 ; 3, s. 140-159
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Gorbachev’s environmental policies aimed at raising the masses and incite them to action for the common good. A side effect was the introduction of the factor information in Soviet society. Thereby centrifugal political forces were released. These forces rallied behind environmental issues of local, and thus local ethnic significance. The ensuing political mobilization was nationalist in spirit.
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| 9. |
- Pasternak, Bjorn, et al.
(författare)
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Glucagon-like peptide 1 receptor agonist use and risk of thyroid cancer: Scandinavian cohort study
- 2024
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Ingår i: BMJ-BRITISH MEDICAL JOURNAL. - 0959-535X .- 1756-1833. ; 385
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE To investigate whether use of glucagon-like peptide 1 (GLP1) receptor agonists is associated with increased risk of thyroid cancer. DESIGN Scandinavian cohort study. SETTING Denmark, Norway, and Sweden, 2007-21. PARTICIPANTS Patients who started GLP1 receptor agonist treatment were compared with patients who started dipeptidyl peptidase 4 (DPP4) inhibitor treatment, and in an additional analysis, patients who started sodiumglucose cotransporter 2 (SGLT2) inhibitor treatment. MAIN OUTCOME MEASURES Thyroid cancer identified from nationwide cancer registers. An active -comparator new user study design was used to minimise risks of confounding and time related biases from using real world studies of drug effects. Cox regression was used to estimate hazard ratios, controlling for potential confounders with propensity score weighting. RESULTS The mean follow-up time was 3.9 years (standard deviation 3.5 years) in the GLP1 receptor agonist group and 5.4 years (standard deviation 3.5 years) in the DPP4 inhibitor group. 76 of 145 410 patients (incidence rate 1.33 events per 10 000 person years) treated with GLP1 receptor agonists and 184 of 291 667 patients (incidence rate 1.46 events per 10 000 person years) treated with DPP4 inhibitors developed thyroid cancer. GLP1 receptor agonist use was not associated with increased risk of thyroid cancer (hazard ratio 0.93, 95% confidence interval 0.66 to 1.31; rate difference -0.13, 95% confidence interval -0.61 to 0.36 events per 10 000 person years). The hazard ratio for medullary thyroid cancer was 1.19 (0.37 to 3.86). In the additional analysis comparing the GLP1 receptor agonist group with the SGLT2 inhibitor group, the hazard ratio for thyroid cancer was 1.16 (0.65 to 2.05). CONCLUSIONS In this large cohort study using nationwide data from three countries, GLP1 receptor agonist use was not associated with a substantially increased risk of thyroid cancer over a mean follow-up of 3.9 years. In the main analysis comparing GLP1 receptor agonists with DPP4 inhibitors, the upper limit of the confidence interval was consistent with no more than a 31% increase in relative risk.
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| 10. |
- Sahm, Constantin D., et al.
(författare)
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Imidazolium-modification enhances photocatalytic CO2 reduction on ZnSe quantum dots
- 2021
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Ingår i: Chemical Science. - : Royal Society of Chemistry. - 2041-6520 .- 2041-6539. ; 12:26, s. 9078-9087
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Tidskriftsartikel (refereegranskat)abstract
- Colloidal photocatalysts can utilize solar light for the conversion of CO2 to carbon-based fuels, but controlling the product selectivity for CO2 reduction remains challenging, in particular in aqueous solution. Here, we present an organic surface modification strategy to tune the product selectivity of colloidal ZnSe quantum dots (QDs) towards photocatalytic CO2 reduction even in the absence of transition metal co-catalysts. Besides H-2, imidazolium-modified ZnSe QDs evolve up to 2.4 mmol(CO) g(ZnSe)(-1) (TONQD > 370) after 10 h of visible light irradiation (AM 1.5G, lambda > 400 nm) in aqueous ascorbate solution with a CO-selectivity of up to 20%. This represents a four-fold increase in CO-formation yield and 13-fold increase in CO-selectivity compared to non-functionalized ZnSe QDs. The binding of the thiolated imidazolium ligand to the QD surface is characterized quantitatively using H-1-NMR spectroscopy and isothermal titration calorimetry, revealing that a subset of 12 to 17 ligands interacts strongly with the QDs. Transient absorption spectroscopy reveals an influence of the ligand on the intrinsic charge carrier dynamics through passivating Zn surface sites. Density functional theory calculations indicate that the imidazolium capping ligand plays a key role in stabilizing the surface-bound *CO2- intermediate, increasing the yield and selectivity toward CO production. Overall, this work unveils a powerful tool of using organic capping ligands to modify the chemical environment on colloids, thus enabling control over the product selectivity within photocatalyzed CO2 reduction.
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