| 1. |
- Sundström, Johan, Professor, 1971-, et al.
(författare)
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Risk factors for subarachnoid haemorrhage : a nationwide cohort of 950 000 adults
- 2019
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Ingår i: International Journal of Epidemiology. - : Oxford University Press. - 0300-5771 .- 1464-3685. ; 48:6, s. 2018-2025
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium.METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries.RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH.CONCLUSIONS: The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.
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| 2. |
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| 3. |
- Arnell, Matilda, 1987-, et al.
(författare)
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Reproductive success, fruit removal and local distribution patterns in the early-flowering shrub Daphne mezereum
- 2023
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Ingår i: Nordic Journal of Botany. - 0107-055X .- 1756-1051. ; :10
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Tidskriftsartikel (refereegranskat)abstract
- In insect-pollinated, bird-dispersed plants, both investment in reproduction and reproductive success involve interactions between plants and their pollinators and dispersers. The outcome of these plant–animal interactions may be affected by the number of flowers and fruits, as well as by the plants' local environment and by spatial associations among plants. In this study we mapped the spatial distribution of individuals in a population of the early flowering, fleshy-fruited shrub Daphne mezereum, in a forest in boreo-nemoral Sweden. For all mapped individuals we collected data on numbers of flowers and fruits and fruit removal, for three consecutive years. We analysed spatial associations among individuals, and the effects on reproductive performance and fruit removal of plant height, numbers of flowers and fruits, distance to forest edge, and neighbouring flower and fruit density. Our results show that the density of D. mezereum increases with increasing proximity to forest edge. The number of flowers produced, as well as fruit set and fruit removal, show the same positive relationship with increasing proximity to forest edges. We further show that individuals are aggregated up to distances of about 10 m. The flower production of neighbouring conspecific individuals within 10 m is negatively related to fruit set whereas the fruit production of neighbours is positively related to fruit removal. Our main conclusion is that the spatial distribution of D. mezereum affects reproductive success and fruit removal, which in turn has the potential to feed back to the spatial distribution pattern. Combining studies of reproduction with spatial analyses is important to advance our understanding of the dynamics of plant populations.
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| 4. |
- Bixby, H., et al.
(författare)
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Rising rural body-mass index is the main driver of the global obesity epidemic in adults
- 2019
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 569:7755, s. 260-4
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Tidskriftsartikel (refereegranskat)abstract
- Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.
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| 5. |
- Eriksson, Johan, 1956-
(författare)
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Polybrominated diphenyl ethers and Tetrabromobisphenol A : Chemical synthesis, X-ray crystallography and Photochemical degradation
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the 1960s’ several manmade chemicals were detected in the environment, far from their sources. The most well known, and most likely those with the largest impact on the society, were DDT and its related compounds, and PCBs. These anthropogenic compounds were characterised as persistent organic pollutants (POPs). Following these POPs, several other chemicals have found their way to the environment. Over the last two decades, brominated flame retardants (BFRs) have become a matter of concern. Among all BFRs being commercially produced, tetrabromobisphenol A (TBBPA) and polybrominated diphenyl ethers (PBDEs) are the ones with the largest annual production. TBBPA is a very well defined compound while PBDEs consist of a large number of isomers and homologues (congeners). TBBPA does not seem to accumulate in biota as the PBDEs do, but is still of concern since it is found in e.g. sediments. The PBDEs can reach accumulation levels up in the ppm range. Still there is a lack of basic data for both TBBPA and PBDEs. Hence the present thesis is aimed to fill some of the data gaps by pursuing work on 1) photochemical degradation of TBBPA, some related compounds, and PBDEs; 2) synthesis of PBDE congeners and of TBBPA degradation products and 3) structural identifications of a selected set of BFRs by X-ray crystallography.An apparatus was designed for carrying out photochemical degradation test of chemicals in general but in particular for BFRs. Quantum yield, rate of degradation and to some extent, identification of degradation products were performed on TBBPA, the corresponding chlorinated compound and a number of TBBPA degradation products and on 15 single PBDE congeners. In order to make this work possible all three nonaBDE isomers were synthesised via a reductive pathway applying sodium borohydride as a reducing agent. The three nona-BDEs were all characterised by X-ray crystallography. The results of the photochemical degradation of TBBPA in water show a rapidly degradable compound also at pH’s that are environmentally relevant. Hence it is likely that TBBPA is not transported long distances, when exposed to sunlight, without undergoing photochemical degradation. It is notable that the TBBPA is degraded through cleavage between the two phenol rings. When the method was applied to study quantum yields and rate constants for the reaction of PBDE congeners it is evident that the decabromodiphenyl ether (BDE-209) is rapidly transformed. The reaction rate differ drastically from PBDEs with four or five bromine substituents that have very long half-lives when subjected to UV-light under the same conditions as for BDE-209. Lower brominated diphenyl ethers and polybrominated dibenzofurans were identified as PBDE degradation products. The synthesis of PBDEs and of TBBPA degradation products expanded the study as did the X-ray structure identifications.
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| 6. |
- Eriksson, John, et al.
(författare)
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Surgery and radiofrequency ablation for treatment of liver metastases from midgut and foregut carcinoids and endocrine pancreatic tumors
- 2008
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 32:5, s. 930-938
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Many neuroendocrine tumors (NETs) have a tendency to metastasize to the liver. In case of limited number of metastases, liver surgery or radiofrequency ablation (RFA) may result in apparently total clearance of metastases. However, it is not clear whether such therapy will provide symptom reduction or increased survival.METHODS: Seventy-three patients with foregut (n=6) or midgut carcinoids (n=37) or endocrine pancreatic tumors (n=28), and two patients with NETs without discernable origin were studied. Symptoms were evaluated using a Symptom Severity Score. Liver surgery was performed in 42 operations and RFA on 205 lesions.RESULTS:Apparently total clearance of liver metastases was attained in 1 of 6 patients with foregut carcinoids, 15 of 37 with midgut carcinoids, and 13 of 28 with EPT. Symptom improvement was noted in 12 of 17 (70.6%) patients with carcinoid syndrome, and 75% also reduced their 5-HIAA and P-CgA by at least 50%. Patients with nonfunctioning EPT generally had no improvement of symptoms after surgical/RFA liver treatment, but eight patients had functioning EPT, and four of these reduced their biochemical markers by at least 50%. NETs with higher Ki67 index tended to recur more often. Complications occurred in 9 of 45 open surgery procedures, and in 8 of 203 RFA procedures.CONCLUSIONS:Treatment of liver metastases is successful in midgut carcinoid patients with limited liver metastases. Patients with foregut carcinoid and EPTs recur more often, possibly related to higher Ki67 index, and treatment of liver lesions less often reduces symptoms. Liver resections and RFA may be safely performed, and RFA is associated with few complications.
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| 7. |
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| 8. |
- Hieronymus, Fredrik, 1986, et al.
(författare)
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Consistent superiority of selective serotonin reuptake inhibitors over placebo in reducing depressed mood in patients with major depression.
- 2016
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Ingår i: Molecular psychiatry. - : Springer Science and Business Media LLC. - 1476-5578 .- 1359-4184. ; 21:4, s. 523-30
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Tidskriftsartikel (refereegranskat)abstract
- The recent questioning of the antidepressant effect of selective serotonin reuptake inhibitors (SSRIs) is partly based on the observation that approximately half of company-sponsored trials have failed to reveal a significant difference between active drug and placebo. Most of these have applied the Hamilton depression rating scale to assess symptom severity, the sum score for its 17 items (HDRS-17-sum) serving as effect parameter. In this study, we examined whether the negative outcomes of many SSRI trials may be partly caused by the use of this frequently questioned measure of response. We undertook patient-level post-hoc analyses of 18 industry-sponsored placebo-controlled trials regarding paroxetine, citalopram, sertraline or fluoxetine, and including in total 6669 adults with major depression, the aim being to assess what the outcome would have been if the single item depressed mood (rated 0-4) had been used as a measure of efficacy. In total, 32 drug-placebo comparisons were reassessed. While 18 out of 32 comparisons (56%) failed to separate active drug from placebo at week 6 with respect to reduction in HDRS-17-sum, only 3 out of 32 comparisons (9%) were negative when depressed mood was used as an effect parameter (P<0.001). The observation that 29 out of 32 comparisons detected an antidepressant signal from the tested SSRI suggests the effect of these drugs to be more consistent across trials than previously assumed. Further, the frequent use of the HDRS-17-sum as an effect parameter may have distorted the current view on the usefulness of SSRIs and hampered the development of novel antidepressants.Molecular Psychiatry advance online publication, 28 April 2015; doi:10.1038/mp.2015.53.
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| 9. |
- Hieronymus, Fredrik, 1986, et al.
(författare)
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The alleged ineffectiveness of SSRIs in depression is an artefact caused by the use of an inappropriate measure of efficacy
- 2014
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Ingår i: International Journal of Neuropsychopharmacology vol. 17 Supplement 1. 29th CINP World Congress of Neuropsychopharmacology, Vancouver, Canada, 22–26 June 2014. - New York : Cambridge University Press. - 1461-1457 .- 1469-5111.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective: Many studies have questioned if summation of the scores of the 17 disparate items constituting the Hamilton Depression Rating Scale (HDRS-17) is a reliable index of severity in depression; yet the cur- rent questioning of the ef fi cacy of antidepressant drugs is to a large extent based on the assumption that response to treatment is reliably re fl ected by this instrument. We aimed to investigate the possibility that the shortcom- ings of the HDRS may contribute to the failure of antidepressants to out- perform placebo in many trials. Methods: We analyzed thirteen industry-sponsored trials of selective serotonin reuptake inhibitors (SSRIs) comprising twenty-four drug- placebo comparisons and including patient-level data from 5381 subjects (administered paroxetine, citalopram, fl uoxetine, or placebo), the aim being to assess what the outcome would have been if the single item de- pressed mood (rated 0 – 4) had been used as measure of ef fi cacy. Results: While 12 out of 24 comparisons (50%) revealed a signi fi cant difference between active drug and placebo at week 6 with respect to re- duction in HDRS-17-sum, 23 out of 24 comparisons (96%) showed the ac- tive drug to be superior to placebo in reducing depressed mood. Correspondingly, a pooled analysis of all cases showed the effect size when assessed using the HDRS-17-sum to be 0.30, whereas it, when mea- sured using the depressed mood item alone, was 0.42. Conclusion: While not claiming that measuring one item only is the most appropriate way of recording symptom severity in depression, we do suggest that the inclusion of a number of varying symptoms in the as- sessment, some of which may be side-effects of treatment and/or are unre- lated to the disorder, reduces the sensitivity to detect a difference between active drug and placebo. This lack of sensitivity of HDRS-17 might partly explain why a high fraction of antidepressant trials fail to reveal a signi fi - cant difference between treatment groups
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| 10. |
- Lind, Lars, et al.
(författare)
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Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)
- 2021
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Ingår i: eLife. - : eLife Sciences Publications Ltd. - 2050-084X. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.
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