| 1. |
- Banefelt, Jonas, et al.
(författare)
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Statin dose titration patterns and subsequent major cardiovascular events in very high-risk patients: estimates from Swedish population-based registry data.
- 2020
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Ingår i: European heart journal. Quality of care & clinical outcomes. - : Oxford University Press (OUP). - 2058-1742 .- 2058-1742 .- 2058-5225. ; 6:4, s. 323-331
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Tidskriftsartikel (refereegranskat)abstract
- Clinical studies have demonstrated the efficacy of intensive statin therapy in lowering low-density lipoprotein cholesterol and cardiovascular (CV) events. Our objective was to examine statin titration patterns and the association between titration patterns and subsequent CV events in very high-risk patients.Using Swedish national population-based registry data, we identified 192435 patients with very high risk of atherosclerotic CV disease initiated on moderate-intensity statin therapy between 2006 and 2013. Outcomes of interest were titration to high-intensity therapy and the major adverse cardiovascular events (MACE) composite (myocardial infarction, ischaemic stroke, and CV death) outcome. Cumulative incidence of MACE was assessed by titration status 1-year post-treatment initiation in patients adherent to treatment during the first year, using a 12-week cut-off from initiation to define early, delayed and no up-titration to high-intensity statins. Cox regression analysis was used to estimate adjusted hazard ratios (HRs). In 144498 eligible patients, early titration was associated with significantly lower risk of MACE in the subsequent 2 years compared to no up-titration (HR 0.76, P<0.01]. Delayed up-titration was associated with a smaller reduction (HR 0.88, P=0.08). The majority of patients did not up-titrate.Early up-titration to high-intensity statins was independently associated with lower risk of subsequent CV events compared to no up-titration. Delayed up-titration was not associated with the same benefit. Despite the higher risk associated with no up-titration, few patients at very high CV risk who started treatment on moderate-intensity up-titrated to high intensity, indicating a potential need for more aggressive lipid management of these patients in clinical practice.
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| 2. |
- Björkqvist, Maria, et al.
(författare)
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Somatostatin, misoprostol and galanin inhibit gastrin- and PACAP-stimulated secretion of histamine and pancreastatin from ECL cells by blocking specific Ca(2+) channels.
- 2005
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Ingår i: Regulatory Peptides. - : Elsevier BV. - 1873-1686 .- 0167-0115. ; 130:1-2, s. 81-90
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Tidskriftsartikel (refereegranskat)abstract
- The oxyntic mucosa is rich in ECL cells. They secrete histamine and chromogranin A-derived peptides, such as pancreastatin, in response to gastrin and pituitary adenylate cyclase-activating peptide (PACAP). Secretion is initiated by Ca2+ entry. While gastrin stimulates secretion by opening L-type and N-type Ca2+ channels, PACAP stimulates secretion by activating L-type and receptor-operated Ca2+ channels. Somatostatin, galanin and prostaglandin E2 (PGE2) inhibit gastrin- and PACAP-stimulated secretion from the ECL cells. In the present study, somatostatin and the PGE2 congener misoprostol inhibited gastrin- and PACAP-stimulated secretion 100%, while galanin inhibited at most 60–65%. Bay K 8644, a specific activator of L-type Ca2+ channels, stimulated ECL-cell secretion, an effect that was inhibited equally effectively by somatostatin, misoprostol and galanin (75–80% inhibition). Pretreatment with pertussis toxin, that inactivates inhibitory G-proteins, prevented all three agents from inhibiting stimulated secretion (regardless of the stimulus). Pretreatment with nifedipine (10 μM), an L-type Ca2+ channel blocker, reduced PACAP-evoked pancreastatin secretion by 50–60%, gastrin-evoked secretion by not, vert, similar 80% and abolished the response to Bay K 8644. The nifedipine-resistant response to PACAP was abolished by somatostatin and misoprostol but not by galanin. Gastrin and PACAP raised the intracellular Ca2+ concentration in a biphasic manner, believed to reflect mobilization of internal Ca2+ followed by Ca2+ entry. Somatostatin and misoprostol blocked Ca2+ entry (and histamine and pancreastatin secretion) but not mobilization of internal Ca2+. The present observations on isolated ECL cells suggest that Ca2+ entry rather than mobilization of internal Ca2+ triggers exocytosis, that gastrin and PACAP activate different (but over-lapping) Ca2+ channels, that somatostatin, misoprostol and galanin interact with inhibitory G-proteins to block Ca2+ entry via L-type Ca2+ channels, and that somatostatin and misoprostol (but not galanin) in addition block N-type and/or receptor-operated Ca2+ channels.
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| 3. |
- Nilsson, Lena Maria, 1965-, et al.
(författare)
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Consumption of filtered and boiled coffee and the risk of fist acute myocardial infarction : a nested case/referent study
- 2010
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Ingår i: NMCD. Nutrition Metabolism and Cardiovascular Diseases. - : Elsevier. - 0939-4753 .- 1590-3729. ; 20:7, s. 527-535
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Tidskriftsartikel (refereegranskat)abstract
- Background and aimIn northern Sweden, consumption of both filtered and boiled coffee is common. Boiled coffee, especially popular in rural areas, is known to raise blood lipids, a risk factor for acute myocardial infarction (MI). To our knowledge, only one epidemiological study, a case-control study from Sweden, has investigated boiled coffee in MI, noting an increased risk at high consumption levels in men, and no association in women. The aim of the present nested case-referent study was to relate consumption of filtered and boiled coffee to the risk of first MI.Methods and resultsThe study subjects were 375 cases (303 men, 72 women) and 1293 matched referents from the population-based Northern Sweden Health and Disease Study. Coffee consumption was assessed by food frequency questionnaire. Risk estimates were calculated by conditional logistic regression. A statistically significant positive association was found between consumption of filtered coffee and MI risk in men [odds ratio for consumption ≥4 times/day versus ≤1 time/day 1.73 (95% CI 1.05–2.84)]. In women, a similar association was observed, but for boiled coffee [odds ratio 2.51 (95% CI 1.08–5.86)]. After adjustment for current smoking, postsecondary education, hypertension, and sedentary lifestyle, the results for women were no longer statistically significant.ConclusionConsumption of filtered coffee was positively associated with the risk of a first MI in men. A similar tendency was observed for boiled coffee in women, but the result was not statistically significant in multivariate analysis. Further investigation in a larger study is warranted.
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| 4. |
- Olofsson, Charlotta S, 1971, et al.
(författare)
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Impaired insulin exocytosis in neural cell adhesion molecule-/- mice due to defective reorganization of the submembrane F-actin network.
- 2009
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Ingår i: Endocrinology. - : The Endocrine Society. - 1945-7170 .- 0013-7227. ; 150:7, s. 3067-75
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Tidskriftsartikel (refereegranskat)abstract
- The neural cell adhesion molecule (NCAM) is required for cell type segregation during pancreatic islet organogenesis. We have investigated the functional consequences of ablating NCAM on pancreatic beta-cell function. In vivo, NCAM(-/-) mice exhibit impaired glucose tolerance and basal hyperinsulinemia. Insulin secretion from isolated NCAM(-/-) islets is enhanced at glucose concentrations below 15 mM but inhibited at higher concentrations. Glucagon secretion from pancreatic alpha-cells evoked by low glucose was also severely impaired in NCAM(-/-) islets. The diminution of insulin secretion is not attributable to defective glucose metabolism or glucose sensing (documented as glucose-induced changes in intracellular Ca(2+) and K(ATP)-channel activity). Resting K(ATP) conductance was lower in NCAM(-/-) beta-cells than wild-type cells, and this difference was abolished when F-actin was disrupted by cytochalasin D (1 muM). In wild-type beta-cells, the submembrane actin network disassembles within 10 min during glucose stimulation (30 mM), an effect not seen in NCAM(-/-) beta-cells. Cytochalasin D eliminated this difference and normalized insulin and glucagon secretion in NCAM(-/-) islets. Capacitance measurements of exocytosis indicate that replenishment of the readily releasable granule pool is suppressed in NCAM(-/-) alpha- and beta-cells. Our data suggest that remodeling of the submembrane actin network is critical to normal glucose regulation of both insulin and glucagon secretion.
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| 5. |
- Oskarsson, Magnus, 1962-, et al.
(författare)
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PISA 2015 - Bakgrund och metoder med exempel
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- År 2015 genomfördes för sjätte gången OECD:s internationella kunskaps-undersökning PISA (Programme for International Student Assessment). Studien har sedan 2000 genomförts vart tredje år och undersöker 15-åriga elevers kunskaper i naturvetenskap, läsförståelse och matematik. PISA syftar också till att öka förståelsen för orsakerna till och konsekvenserna av observerade skillnader i kunskaper.Vid varje mätning turas de tre kunskapsområdena om att vara huvud-område. I PISA 2015 är naturvetenskap huvudområde för andra gången. Innehållet i PISA utformas utifrån ett ramverk som uppdateras varje gång kunskapsområdet är huvudområde. Denna rapport beskriver ramverket för naturvetenskap, läsförståelse och matematik och är en svensk sammanfattning av PISA 2015 Assessment and Analytical Framework. Science, Reading, Mathematic and Financial Literacy, som tagits fram av OECD. Rapporten innehåller också exempel på provuppgifter till eleverna. Rapporten är en bilaga till Skolverkets rapport 450, PISA 2015. 15-åringars kunskaper i naturvetenskap, läsförståelse och matematik, där några av de viktigaste resultaten från PISA 2015 presenteras med fokus på Sverige.Författarna till denna rapport är de forskare som ansvarat för naturveten-skap, läsförståelse och matematik i PISA 2015.Eva Lundgren på Skolverket har det övergripande ansvaret för PISA i Sverige. På Skolverkets uppdrag har PISA 2015 genomförts av Mittuniversitetet i samarbete med Stockholms universitet. Mittuniversitetet har haft det operativa ansvaret och även ansvarat för naturvetenskap medan Stockholms universitet ansvarat för matematik och läsförståelse. Magnus Oskarsson har varit nationell projektledare och har tillsammans med Maria Lundgren och Lena Lenner ansvarat för studiens praktiska genomförande. Magnus Oskarsson har också tillsammans med Nina Eliasson och K-G Karlsson ansvarat för naturvetenskap. Ulf Fredriksson och Maria Rasmusson har ansvarat för läsförståelse, samt Astrid Pettersson och Samuel Sollerman ansvarat för matematik.Skolverket vill rikta ett stort tack till alla som arbetat med PISA 2015 och framför allt till de cirka 5 500 elever som deltagit och till deras lärare och rektorer!
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| 6. |
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| 7. |
- Sahli, David, et al.
(författare)
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Assessment of toe blood pressure is an effective screening method to identify diabetes patients with lower extremity arterial disease.
- 2004
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Ingår i: Angiology. - : SAGE Publications. - 0003-3197 .- 1940-1574. ; 55:6, s. 641-51
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Tidskriftsartikel (refereegranskat)abstract
- The authors evaluated a screening program for lower extremity arterial disease (LEAD) in diabetic patients and focused on the value of toe blood pressure assessment. They recruited 437 subjects, ages 30-70 years (134 healthy controls, 166 type 1 and 137 type 2 diabetic patients; control [Ctr], DM1, and DM2) with no previous history of LEAD. They were enrolled in a longitudinal study with a planned follow-up of 10 years. Patients were consecutively enrolled from outpatient diabetes units of 2 university hospitals. Subjects were screened with respect to peripheral circulation by use of established noninvasive techniques. These included arm, ankle (AP), and toe (TP) blood pressure measurements; evaluation of peripheral neuropathy; and a standardized physical examination. Results from the baseline examination are presented in this report. The number of patients who presented peripheral pressures or indices below normal (< mean -2 SD for controls) was higher among diabetic patients; 24% of DM1 and 31% of DM2, as compared to 6% of Ctr, had at least 1 lower limb with a low TP, AP, toe/arm index (TI), or ankle/arm index (AI), and these subjects were mainly identified by using the toe/arm index. TI was independently and negatively associated with fasting blood glucose in both patient groups, and with smoking, age, and diabetes duration in DM1. The mean AP was higher in the DM1 and DM2 groups compared to Ctr, whereas overall TP, TI, and AI were similar in the groups. It was also shown that abnormally low TI was significantly more common than low AI among diabetics (p<0.001), and this was true for TP vs AP as well (p<0.05). It is beneficial to include assessment of toe blood pressure and toe/arm blood pressure index to detect early LEAD in diabetic patients. Ankle blood pressure and indices alone are less efficient, owing probably to medial sclerosis in diabetic patients. Up to 30% of diabetic patients with no ischemic symptoms may have signs of impaired arterial circulation.
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| 8. |
- Törmä, Johanna, et al.
(författare)
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Comparison of dietary trends between two counties with and without a cardiovascular prevention program : a population-based cross-sectional study in northern Sweden
- 2022
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Ingår i: Public Health Nutrition. - : Cambridge University Press. - 1368-9800 .- 1475-2727. ; 25:7, s. 1835-1843
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare temporal trends, over a 20-year period, in dietary habits between a county (Västerbotten) with a cardiovascular disease (CVD) prevention program and a county (Norrbotten) without such a program.Design: Cross-sectional data from the Northern Sweden MONICA study (survey period 1994, 1999, 2004, 2009, 2014). Dietary habits were assessed by a semi-quantitative food frequency questionnaire.Setting: Counties of Norrbotten and Västerbotten, Northern Sweden.Participants: Five thousand four hundred Swedish adults (mean age 56.9 years; 51.2% women) from Västerbotten (47%) and Norrbotten (53%).Results: No differences in temporal trend for estimated percentage of energy intake from total carbohydrates, total fat, total protein, and alcohol were observed between the counties (p for interaction ≥0.33). There were no between-county difference in temporal trends for overall diet quality (assessed by the Healthy Diet Score; p for interaction = 0.36). Nor were there any between-county differences for intake of whole grain products, fruits, vegetables, fish, sweetened beverages or fried potatoes (p for interaction ≥ 0.09). Consumption of meat (p for interaction = 0.05) increased to a greater extent in Norrbotten from 2009 and onwards, mainly in men (sex-specific analyses, p for interaction = 0.04). Men in Västerbotten decreased their intake of sweets to a greater extent than men in Norrbotten (p for interaction <0.01).Conclusions: Over a 20-year period in northern Sweden, only small differences in dietary habits were observed in favor of a county with a CVD prevention program compared to a county without such a program.
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| 9. |
- Afghahi, Henri, 1966, et al.
(författare)
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Ongoing treatment with renin-angiotensin-aldosterone-blocking agents does not predict normoalbuminuric renal impairment in a general type 2 diabetes population.
- 2013
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Ingår i: Journal of diabetes and its complications. - : Elsevier BV. - 1873-460X .- 1056-8727. ; 27:3, s. 229-34
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To examine the prevalence and the clinical characteristics associated with normoalbuminuric renal impairment (RI) in a general type 2 diabetes (T2D) population. METHODS: We included 94 446 patients with T2D (56% men, age 68.3±11.6years, BMI 29.6±5.3kg/m(2), diabetes duration 8.5±7.1years; means±SD) with renal function (serum creatinine) reported to the Swedish National Diabetes Register (NDR) in 2009. RI was defined as estimated glomerular filtration (eGFR)<60ml/min/1.73m(2) and albuminuria as a urinary albumin excretion rate (AER)>20μg/min. We linked the NDR to the Swedish Prescribed Drug Register, and the Swedish Cause of Death and the Hospital Discharge Register to evaluate ongoing medication and clinical outcomes. RESULTS: 17% of the patients had RI, and 62% of these patients were normoalbuminuric. This group of patients had better metabolic control, lower BMI, lower systolic blood pressure and were more often women, non-smokers and more seldom had a history of cardiovascular disease as compared with patients with albuminuric RI. 28% of the patients with normoalbuminuric RI had no ongoing treatment with any RAAS-blocking agent. Retinopathy was most common in patients with RI and albuminuria (31%). CONCLUSIONS: The majority of patients with type 2 diabetes and RI were normoalbuminuric despite the fact that 25% of these patients had no ongoing treatment with RAAS-blocking agents. Thus, RI in many patients with type 2 diabetes is likely to be caused by other factors than diabetic microvascular disease and ongoing RAAS-blockade.
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| 10. |
- Ait Ali, Abderrahman, 1991-
(författare)
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Methods for Capacity Allocation in Deregulated Railway Markets
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Faced with increasing challenges, railways around Europe have recently undergone major reforms aiming to improve the efficiency and competitiveness of the railway sector. New market structures such as vertical separation, deregulation and open access can allow for reduced public expenditures, increased market competition, and more efficient railway systems.However, these structures have introduced new challenges for managing infrastructure and operations. Railway capacity allocation, previously internally performed within monopolistic national companies, are now conferred to an infrastructure manager. The manager is responsible for transparent and efficient allocation of available capacity to the different (often competing) licensed railway undertakings.This thesis aims at developing a number of methods that can help allocate capacity in a deregulated (vertically separated) railway market. It focuses on efficiency in terms of social welfare, and transparency in terms of clarity and fairness. The work is concerned with successive allocation of capacity for publicly controlled and commercial traffic within a segmented railway market.The contributions include cost benefit analysis methods that allow public transport authorities to assess the social welfare of their traffic, and create efficient schedules. The thesis also describes a market-based transparent capacity allocation where infrastructure managers price commercial train paths to solve capacity conflicts with publicly controlled traffic. Additionally, solution methods are developed to help estimate passenger demand, which is a necessary input both for resolving conflicts, and for creating efficient timetables.Future capacity allocation in deregulated markets may include solution methods from this thesis. However, further experimentations are still required to address concerns such as data, legislation and acceptability. Moreover, future works can include prototyping and pilot projects on the proposed solutions, and investigating legal and digitalisation strategies to facilitate the implementation of such solutions.
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