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- Sönnerstam, Eva, 1984-
(författare)
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Potentially inappropriate drug treatment among older people with cognitive impairment
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The aging process contributes to alterations in organ systems, which lead to an increased risk for chronic conditions. Drug treatment is an important strategy in the management of chronic conditions; however, pharmacokinetic and pharmacodynamic alterations contribute to increased sensitivity to drug effects. This sensitivity is even more pronounced among older people with major neurocognitive disorder. Nevertheless, this group of people is often exposed to potentially inappropriate drug treatment associated with serious adverse drug reactions.Aim: To identify patterns of potentially inappropriate drug treatment and factors associated with this type of drug treatment among older people with cognitive impairment to enable further improvement of drug treatment and diminish the risk of adverse drug reactions among this vulnerable group of people.Method: Explicit criteria were utilized to identify inappropriate prescriptions based on renal function, potentially inappropriate medications according to age and clinically relevant drug-drug interactions among older people with cognitive impairment admitted to two hospitals in Northern Sweden. The first two studies included 428 people and the third study 458 people. Medical records were used as the data source. Moreover, explicit criteria were used to identify potentially inappropriate medications according to age among 1,881 and 1,305 nursing home residents in Västerbotten county in 2007 and 2013, respectively. The association between the length of nursing home stay and the use of potentially inappropriate medications were investigated based on information in questionnaires. Finally, the use of potentially inappropriate medications according to age were investigated three years pre- and post-diagnosis of major neurocognitive disorder among 67,226 older people registered in the Swedish registry for cognitive/dementia disorders.Results: Every tenth of the people admitted to hospital had at least one inappropriate prescription based on their estimated renal function. Moreover, 40.9% had at least one potentially inappropriate medication and 43.2% had at least one clinically relevant drug-drug interaction. Pharmacodynamic interactions were found to be the most common type. Increasing number of prescribed medications was significantly associated with having at least one potentially inappropriate medication according tovage and at least one clinically relevant drug-drug interaction, respectively. Moreover, potentially inappropriate medications were common among nursing home residents but had decreased 2013 compared to 2007 and were only to a lesser extent associated with the length of stay. In the nationwide study population, it was found that potentially inappropriate medications according to age were overall low and decreased continuously three years pre-diagnosis until three years post-diagnosis of major neurocognitive disorder. Consequently, the use of potentially inappropriate medications was found to be significantly lower post- diagnosis except when concerning antipsychotic drug treatment, which was significantly higher post-diagnosis when compared with the pre- diagnosis period.Conclusion: Potentially inappropriate drug treatment is common among older people with cognitive impairment admitted to the hospitals in Västerbotten regardless of their type of living. Increasing number of medications was significantly associated with potentially inappropriate medications and clinically relevant drug-drug interactions. The decreasing trend of potentially inappropriate medications among nursing home residents and among older people with a major neurocognitive disorder is positive and indicates an increased awareness of potentially inappropriate drug treatment in healthcare.
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- Sjölander, Maria, 1970-
(författare)
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Use of secondary preventive drugs after stroke
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Stroke is a serious condition that can have significant impact on an individual’s health and is a significant burden on public health and public finances. Secondary preventive drug treatment after stroke is important for decreasing the risk of recurrent strokes. Non-adherence to drug treatment hampers the treatment effect, especially in long-term preventive treatments. The aim of this thesis was to study the use of secondary preventive drugs after stroke among Swedish stroke patients in terms of inequalities in implementation in clinical practice and patient adherence to treatment over time.Methods Riks-Stroke, the Swedish stroke register, was used to sample stroke patients and as a source of information on background characteristics and medical and health care-related information including information on prescribed preventive drugs. The patients that were included had a stroke between 2004 and 2012. Individual patient data on prescriptions filled in Swedish pharmacies were retrieved from the Swedish Prescribed Drug Register and used to estimate patient adherence to drug treatment. Data on education, income, and country of birth were included from the LISA database at Statistics Sweden. A questionnaire survey was used to collect information about patients’ perceptions about stroke, beliefs about medicines, and self-reported adherence.Results Results showed that a larger proportion of men than women were prescribed statins and warfarin after stroke. There was also a social stratification in the prescribing of statins. Patients with higher income and a higher level of education were more likely to be prescribed a statin compared to patients with low income and low level of education. Statins were also more often prescribed to patients born in Nordic countries, Europe, or outside of Europe compared to patients born in Sweden. Primary non-adherence (not continuing treatment at all within 4 months of discharge from hospital) was low for preventive drug treatment after stroke. Data on filled prescriptions, however, indicated that the proportion of patients who continued to use the drugs declined during the first 2 years after stroke. For most drugs, refill adherence in drug treatment was associated with female sex, good self-rated health, and living in institutions and (for antihypertensive drugs and statins) having used the drug before the stroke. For statins and warfarin, a first-ever stroke was also associated with continuous drug use. Self-reported adherence 3 months after stroke also showed associations with patients’ personal beliefs about medicines; non-adherent patients scored higher on negative beliefs and lower on positive beliefs about medicines.Conclusion Inequalities between men and women and between different socioeconomic groups were found in the prescribing of secondary preventive drugs after stroke. Only a small proportion of Swedish stroke patients did not continue treatment after discharge from hospital, but the proportion of non-adherent patients increased over time. Poor adherence to preventive drug treatment after stroke is a public health problem, and improving adherence to drug treatment requires consideration of patients’ personal beliefs and perceptions about drugs.
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| 3. |
- Atusingwize, Edwinah, et al.
(författare)
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Social media use and alcohol consumption among students in Uganda : a cross sectional study
- 2022
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Ingår i: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Globally, alcohol use significantly contributes to the disease burden. Alcohol consumption in Uganda is related to several health consequences among young people, including university students. Social media is commonly used by students to share academic information and create social networks. Among young people in high-income countries, previous studies have also shown that social media use can have negative health outcomes related to alcohol use, and associated problems. To date, similar studies conducted in low- and middle-income countries are largely missing. Objective To assess the prevalence of and associations between social media use and alcohol consumption among university students in Uganda. Method This was a cross-sectional study among 996 undergraduate students at Makerere University. Data were collected using a questionnaire. Alcohol use in the previous 12 months was the dependent variable. The independent variable was social media use categorised as general use, alcohol-related use, and social media lurking/passive participation. Multinomial logistic regression was used to assess associations. Crude and adjusted odds ratios were reported. Results Nearly all students (97%) used social media and 39% reported alcohol use. Regular alcohol use was significantly associated with moderate (OR = 2.22, CI: 1.35-3.66) and high level general social media use (OR = 2.45, CI: 1.43-4.20). Regular alcohol use was also associated with alcohol-related social media (OR = 6.46, CI: 4.04-10.30), and alcohol-related lurking (OR = 4.59, CI: 2.84-7.39). Similar, although weaker associations were identified for occasional alcohol use. Conclusions Approximately four in ten students reported alcohol use in the past year, and almost all students used social media. Alcohol-related social media use was associated with occasional and regular alcohol use, with stronger associations for regular use. These findings may guide further research and present an opportunity for potential alcohol control interventions to improve health among young populations in low- and middle-income countries.
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| 6. |
- Nilsson, Lena Maria, 1965-
(författare)
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Sami lifestyle and health : epidemiological studies from northern Sweden
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this PhD thesis was to expand the current knowledge of “traditional Sami” diet and lifestyle, and to test aspects of the Sami diet and lifestyle, specifically dietary pattern, macronutrient distribution and coffee consumption, in population-based epidemiological studies of mortality and incident cardiovascular disease and cancer in a general population.In Paper I, semi-structured interviews were conducted with 20 elderly Sami concerning their parent’s lifestyle and diet 50-70 years ago. Questionnaire data from 397 Sami and 1842 matched non-Sami were also analyzed, using non-parametric tests and partial least square methodology. In Papers II-IV, mortality data and incident cancer data for participants in the Västerbotten Intervention Program (VIP) cohort were used for calculations of hazard ratios by Cox regression. In Paper II, a Sami diet score (0-8 points) was constructed by adding one point for each intake above the median for red meat, fatty fish, total fat, berries and boiled coffee, and one point for each intake below the median for vegetables, bread and fibre. In Paper III, deciles of energy-adjusted carbohydrate (descending) and protein (ascending) intake were added to create a Low-Carbohydrate, High-Protein (LCHP) score (2-20 points). In Paper IV, filtered and boiled coffee consumption was studied in relation to incident cancer. In Paper V, a nested case-control study of filtered and boiled coffee consumption and acute myocardial infarction, risk estimates were calculated by conditional logistic regression.Surprisingly, fatty fish may have been more important than reindeer meat for the Sami of southern Lapland in the 1930’s to 1950’s, and it is still consumed more frequently by reindeer-herding Sami than other Sami and non-Sami. Other dietary characteristics of the Sami 50-70 years ago and present-day reindeer-herding Sami were high intakes of fat, blood, and boiled coffee, and low intakes of bread, fibre and cultivated vegetables (Paper I). Stronger adherence to a “traditional Sami” diet, i.e. a higher Sami diet score, was associated with a weak increase in all-cause mortality, particulary apparent in men (Paper II). A diet relatively low in carbohydrates and high in protein, i.e. a high LCHP score, did not predict all-cause mortality compared with low LCHP score, after accounting for saturated fat intake and established risk factors (Paper III). Neither filtered nor boiled coffee consumption was associated with cancer for all cancer sites combined, or for prostate or colorectal cancer. For breast cancer, consumption of boiled coffee ≥4 versus <1 occasions/day was associated with a reduced risk. An increased risk of premenopausal and a reduced risk of postmenopausal breast cancer were found for both total and filtered coffee. Boiled coffee was positively associated with the risk of respiratory tract cancer, a finding limited to men (Paper IV). A positive association was found between consumption of filtered coffee and the risk of acute myocardial infarction in men (Paper V).In conclusion, the findings of Paper I, in particular the relative importance of fatty fish compared to reindeer meat in the “traditional Sami” diet of the 1930’s-1950’s, suggest that aspects of cultural importance may not always be of most objective importance. The findings of Papers II-V generally did not support health benefits for the factors studied. The relatively good health status of the Sami population is therefore probably not attributable to the studied aspects of the “traditional Sami” lifestyle, but further investigation of cohorts with more detailed information on dietary and lifestyle items relevant for “traditional Sami” culture is warranted.
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| 7. |
- Sjölander, Johan, 1988-
(författare)
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Timing is everything: exploring the role of the circadian clock in plant growth and adaptation
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Due to their sessile nature, plants must precisely time and coordinate their physiological processes with daily and seasonal changes in the environment. In this PhD thesis, I explored the interaction between an internal timekeeper, or circadian clock, and hormonal regulation, and how it may control plant growth and adaptation in the model species Arabidopsis thaliana (Arabidopsis) and hybrid aspen (Populus tremula x P. tremuloides). Our research showed how the circadian clock component ZEITLUPE (ZTL) regulates abscisic acid (ABA)-mediated stomatal closure, indicating its central role in environmental adaptation. We investigated the effects of manipulating gibberellin (GA) metabolism in hybrid aspen by the strategic expression of the Arabidopsis GIBBERELLIN20-OXIDASE1 gene, using a clock-controlled promoter. This approach struck a delicate balance between enhanced growth and seasonal adaptation and showed potential for increased tree performance through biotechnological means.Our studies on the circadian clock components LATE ELONGATED HYPOCOTYL (LHY) and EARLY BIRD (EBI) in hybrid aspen suggested their involvement in regulating GA metabolism and overall plant growth.Taken together, these findings improve our understanding of how plants regulate growth and respond to environmental stresses and help to provide solutions for enhancing plant resilience and productivity.
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