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- Jansson, C, et al.
(författare)
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Relation between gastroesophageal reflux symptoms and socioeconomic factors : a population-based study (the HUNT Study)
- 2007
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Ingår i: Clinical Gastroenterology and Hepatology. - : Elsevier BV. - 1542-3565 .- 1542-7714. ; 5:9, s. 1029-1034
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: Gastroesophageal reflux constitutes a major public health problem in the Western world. Few population-based studies have addressed socioeconomic factors in relation to reflux. METHODS: We conducted a case-control study based on 2 health surveys performed in the Norwegian county of Nord-Trondelag in 1984-1986 and 1995-1997, respectively. Reflux was assessed in the second survey, comprising 65,333 participants representing 70% of the county's adult population. Among 58,596 persons responding to questions regarding reflux symptoms, 3153 persons reporting severe symptoms represented the cases, and 40,210 persons without symptoms represented the controls. Data collected in questionnaires included socioeconomic status (SES) based on occupation, education, and material deprivation; family situation; and potential confounders. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated from unconditional logistic regression in crude models and models adjusted for age, sex, smoking, and body mass. RESULTS: The risk of reflux increased with decreasing levels of SES based on occupation, education, and material deprivation. Increased risks of reflux were seen among unskilled laborers (OR, 1.6; 95% CI, 1.3-2.0), skilled laborers (OR, 1.4; 95% CI, 1.1-1.7), and self-employed and farmers (OR, 1.3; 95% CI, 1.1-1.6). A 1.9-fold (95% CI, 1.7-2.2) increased risk of reflux was observed among persons with low education, compared with highly educated persons. Reflux was more common among materially deprived persons (OR, 3.4; 95% CI, 2.9-4.1). The results were similar in crude and adjusted models. CONCLUSIONS: This large population-based study reveals a link between low SES and reflux symptoms that is not explained by the known risk factors of smoking or obesity. This finding deserves further research.
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- Jansson, Saga, et al.
(författare)
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Incidence of acute myocardial injury and its association with left and right ventricular systolic dysfunction in critically ill COVID-19 patients
- 2022
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Ingår i: Annals of Intensive Care. - Heidelberg, Germany : Springer. - 2110-5820. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous studies have found an increase in cardiac troponins (cTns) and echocardiographic abnormalities in patients with COVID-19 and reported their association with poor clinical outcomes. Whether acute injury occurs during the course of critical care and if it is associated with cardiac function is unknown.The purpose of this study was to document the incidence of acute myocardial injury (AMInj) and echocardiographically defined left ventricular (LV) and right ventricular (RV) systolic dysfunction in consecutive patients admitted to an intensive care unit (ICU) for COVID-19. The relationship between AMInj and echocardiographic abnormalities during the first 14 days of ICU admission was studied. Finally, the association between echocardiographic findings, AMInj and clinical outcome was evaluated.Methods: Seventy-four consecutive patients (≥18 years) admitted to the ICU at Linköping University Hospital between 19 Mar 2020 and 31 Dec 2020 for COVID-19 were included. High-sensitivity troponin-T (hsTnT) was measured daily for up to 14 days. Transthoracic echocardiography was conducted within 72 h of ICU admission. Acute myocardial injury was defined as an increased hsTnT > 14ng/l and a > 20% absolute change with or without ischaemic symptoms. LV and RV systolic dysfunction was defined as at least 2 abnormal indicators of systolic function specified by consensus guidelines.Results: Increased hsTnT was observed in 59% of patients at ICU admission, and 82% developed AMInj with peak levels at 8 (3–13) days after ICU admission. AMInj was not statistically significantly associated with 30-day mortality but was associated with an increased duration of invasive mechanical ventilation (10 (3–13) vs. 5 days (0–9), p=0.001) as well as ICU length of stay (LOS) (19.5 (11–28) vs. 7 days (5–13), p=0.015). After adjustment for SAPS-3 and admission SOFA score, the effect of AMInj was significant only for the duration of mechanical ventilation (p=0.030).The incidence of LV and RV dysfunction was 28% and 22%, respectively. Only indices of LV and RV longitudinal contractility (mitral and tricuspid annular plane systolic excursion) were associated with AMInj. Echocardiographic parameters were not associated with clinical outcome.Conclusions: Myocardial injury is common in critically ill patients with COVID-19, with AMInj developing in more than 80% after ICU admission. In contrast, LV and RV dysfunction occurred in approximately one-quarter of patients. AMInj was associated with an increased need for mechanical ventilation and ICU LOS but neither AMInj nor ventricular dysfunction was significantly associated with mortality.
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