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- Bjurbom, Markus, et al.
(författare)
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Type A Aortic Dissection Repair in Patients With Prior Cardiac Surgery
- 2023
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 0003-4975 .- 1552-6259. ; 115:3, s. 591-598
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Tidskriftsartikel (refereegranskat)abstract
- Background: Emergency surgery for acute type A aortic dissection in patients with previous cardiac surgery is controversial. This study aimed to evaluate the association between previous cardiac surgery and outcomes after surgery for acute type A aortic dissection, to appreciate whether emergency surgery can be offered with acceptable risks. Methods: All patients operated on for acute type A aortic dissection between 2005 and 2014 from the Nordic Consortium for Acute Type A Aortic Dissection database were eligible. Patients with previous cardiac surgery were compared with patients without previous cardiac surgery. Univariable and multivariable statistical analyses were performed to identify predictors of 30-day mortality and early major adverse events (a secondary composite endpoint comprising 30-day mortality, perioperative stroke, postoperative cardiac arrest, or de novo dialysis). Results: In all, 1159 patients were included, 40 (3.5%) with previous cardiac surgery. Patients with previous cardiac surgery had higher 30-day mortality (30% vs 17.8%, P = .049), worse medium-term survival (51.7% vs 71.2% at 5 years, log rank P = .020), and higher unadjusted prevalence of major adverse events (52.5% vs 35.7%, P = .030). In multivariable analysis, previous cardiac surgery was not associated with 30-day mortality (odds ratio 0.78; 95% CI, 0.30-2.07; P = .624) or major adverse events (odds ratio 1.07; 95% CI, 0.45-2.55, P = .879). Conclusions: Major adverse events after surgery for acute type A aortic dissection were more frequent in patients with previous cardiac surgery. Previous cardiac surgery itself was not an independent predictor for adverse events, although the small sample size precludes definite conclusions. Previous cardiac surgery should not deter from emergency surgery.
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| 3. |
- Geirsson, Magnus
(författare)
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Alcohol prevention in Swedish primary health care
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abstract Aims: The objectives of this thesis are to describe attitudes among general practitioners (GPs) and district nurses (DN) towards working with risk alcohol drinking and focus on the achievements of the Swedish Risk drinking project (RDP). Special attention has been devoted to the gender perspective and to the limits of sensible/safe drinking. Methods: The data sources used are a postal survey to GPs and nurses in the primary health care (PHC) in the County of Skaraborg, Sweden, 2002 and two national postal surveys (2006 and 2009) which had the aim to evaluate the effect of the Risk Drinking Project (RDP). To evaluate a change in clinical practice following RDP, we triangulated the results with two population surveys in which the participants reported whether they had been asked about alcohol when visiting the PHC and if the number of alcohol-related diagnoses increased in PHC. Results: Counseling skills to reducing alcohol consumption and effectiveness in helping patients reducing alcohol consumption ranked lower than working with other lifestyle behaviours for both GPs and DNs. The main obstacles for the GPs to carry out alcohol intervention were lack of training in counselling for reducing alcohol consumption, time constraints, and that the doctors did not know how to identify problem drinkers. Both the gender of the patients and of the GPs influenced the advice given and the referrals the patients received. Women were more often recommended to stop drinking while men were recommended to reduce drinking. Men were less often referred to any treatment, odds ratio 0.33. The upper limit of alcohol consumption before the GPs would advise the patient to cut down was significantly higher for GPs having an AUDIT-C score ≥ 3, 146 g/week for men and 103 g/week for women, than for GPs with an AUDIT-C score ≤ 2, 89 and 68 g/week, respectively. GPs lacking post-graduate education stated lower limits for safe drinking than GPs with some education. We found a significant increase for all three competence-related parameters analyzed (discussion, knowledge and effectiveness) between 2006 and 2009, with a higher increase for DNs than GPs. The population surveys showed no changes concerning how often the inhabitants were asked about alcohol. There was only a small increase of alcohol-related diagnoses over this time period. Conclusion: Some of the implications of these findings are that there is a need to increase the awareness of male excessive drinking and that gendered perceptions might bias alcohol management recommendations. If the GPs would take action on the limits they proposed, it would mean that they would intervene with a very large proportion of their patients that are drinking moderately and that will be both unmanageable and unnecessary. Finally there is conflicting evidence to whether RDP, which mainly was an educational enterprise, has been a sufficient means of increasing screening and brief intervention in PHC
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| 5. |
- Geirsson, Magnus, et al.
(författare)
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Does gender matter? A vignette study of general practitioners' management skills in handling patients with alcohol-related problems.
- 2009
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Ingår i: Alcohol and alcoholism (Oxford, Oxfordshire). - : Oxford University Press (OUP). - 1464-3502 .- 0735-0414. ; 44:6, s. 620-5
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The aims of this study were to analyse the perceptions of female and male primary care physicians (PCPs) of alcohol problems in male and female patients, their recommendations to reduce or abstain from alcohol, their referrals to treatment and their views of safe levels of drinking for male and female patients. These factors were related to the physicians' own alcohol consumption. METHODS: A slightly adjusted version of the WHO Collaborative Study Questionnaire for General Practitioners was posted to all PCPs (n = 132) in the district of Skaraborg, Sweden, of whom 68 PCPs responded. In the questionnaire, the PCPs' perceptions of two patient vignettes were analysed. RESULTS: Both the gender of the patients in the vignettes and of the PCPs influenced the advice and the referrals that the patients received: 83% of male excessive drinkers and 47% of female excessive drinkers were recommended to cut down on drinking. In 50% of cases, the male excessive drinker was not referred, compared with 25% for the female excessive drinker. This was statistically significant only for excessive drinkers. The odds ratio for referral to any treatment was 0.33 (CI = 0.12-0.93) for the male excessive drinker compared with the female excessive drinker. The male PCP referred the excessive drinker less often to any treatment than did the female PCP, odds ratio 0.26 (CI = 0.08-0.90). The upper limit of alcohol consumption before the PCPs would advise the patient to cut down was significantly higher for PCPs with the AUDIT-C score >or= 3. The limit was 146 g/week for male patients and 103 g/week for female patients. Corresponding figures for PCP with the AUDIT-C score
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| 6. |
- Holmqvist, Marika, 1959-, et al.
(författare)
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Asking patients about their drinking - A national survey among primary health care physicians and nurses in Sweden
- 2008
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Ingår i: Addictive Behaviors. - : Elsevier BV. - 0306-4603. ; 33:2, s. 301-314
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Tidskriftsartikel (refereegranskat)abstract
- Aims To investigate the extent to which Swedish primary health care (PHC) general practitioners (GPs) and nurses discuss alcohol issues with their patients, their reasons for and against addressing alcohol issues, their perceived importance of these issues, and factors that could facilitate increased alcohol intervention activity among the PHC professionals. Methods All Swedish GPs and nurses who have the authority to issue prescriptions were surveyed with a postal questionnaire. The questionnaire was returned by 1821 GPs (47% response rate) and 3125 nurses (55% response rate). Results Fifty percent of the GPs and 28% of the nurses stated that they “frequently” discussed alcohol with their patients. The two most common reasons for asking patients about their drinking were that the GPs and nurses considered it part of their routines and the belief that the patient had alcohol-related symptoms. GPs said that improved opportunities for referral to specialists and provision of more knowledge about counselling techniques for use when alcohol-related symptoms are evident were the most important facilitators to increased intervention activity. Concerning the nurses, 93% stated that more time devoted to health-oriented work could facilitate increased alcohol intervention activity. Conclusions The findings highlight a considerable gap between the recognition of the significance of the alcohol problem and Swedish PHC intervention activity. Keywords: Primary health care; Alcohol intervention; Risk consumption
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| 10. |
- Steinthorsdottir, V, et al.
(författare)
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Genetic predisposition to hypertension is associated with preeclampsia in European and Central Asian women
- 2020
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Ingår i: Nature communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 11:1, s. 5976-
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Tidskriftsartikel (refereegranskat)abstract
- Preeclampsia is a serious complication of pregnancy, affecting both maternal and fetal health. In genome-wide association meta-analysis of European and Central Asian mothers, we identify sequence variants that associate with preeclampsia in the maternal genome at ZNF831/20q13 and FTO/16q12. These are previously established variants for blood pressure (BP) and the FTO variant has also been associated with body mass index (BMI). Further analysis of BP variants establishes that variants at MECOM/3q26, FGF5/4q21 and SH2B3/12q24 also associate with preeclampsia through the maternal genome. We further show that a polygenic risk score for hypertension associates with preeclampsia. However, comparison with gestational hypertension indicates that additional factors modify the risk of preeclampsia.
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