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- Akerblom, H., et al.
(författare)
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Association of Gastric Bypass Surgery With Risk of Developing Diabetic Retinopathy Among Patients With Obesity and Type 2 Diabetes in Sweden: An Observational Study
- 2021
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Ingår i: Jama Ophthalmology. - : American Medical Association (AMA). - 2168-6165 .- 2168-6173. ; 139:2, s. 200-205
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Knowledge of the incidence and progression of diabetic retinopathy (DR) after gastric bypass surgery (GBP) in patients with obesity and diabetes could guide the management of these patients. OBJECTIVE To investigate the incidence of diabetic ocular complications in patients with type 2 diabetes after GBP compared with the incidence of diabetic ocular complications in a matched cohort of patients with obesity and diabetes who have not undergone GBP. DESIGN, SETTING, AND PARTICIPANTS Data from 2 nationwide registers in Sweden, the Scandinavian Obesity Surgery Registry and the National Diabetes Register, were used for this cohort study. A total of 5321 patients with diabetes from the Scandinavian Obesity Surgery Registry who had undergone GBP from January 1, 2007, to December 31, 2013, were matched with 5321 patients with diabetes from the National Diabetes Register who had not undergone GBP, based on sex, age, body mass index (BMI), and calendar time (2007-2013). Follow-up data were obtained until December 31, 2015. Statistical analysis was performed from October 5, 2018, to September 30, 2019. EXPOSURE Gastric bypass surgery. MAIN OUTCOMES AND MEASURES Incidence of new DR and other diabetic ocular complications. RESULTS The study population consisted of 5321 patients who had undergone GBP (3223 women [60.6%]; mean [SD] age, 49.0 [9.5] years) and 5321 matched controls (3395 women [63.8%]; mean [SD] age, 47.1 [11.5] years). Mean (SD) follow-up was 4.5 (1.6) years. The mean (SD) BMI and hemoglobin A1c concentration at baseline were 42.0 (5.7) and 7.6%(1.5%), respectively, in the GBP group and 40.9 (7.3) and 7.5%(1.5%), respectively, in the control group. The mean (SD) duration of diabetes was 6.8 (6.3) years in the GBP group and 6.4 (6.4) years in the control group. The risk for new DR was reduced in the patients who underwent GBP (hazard ratio, 0.62 [95% CI, 0.49-0.78]; P <.001). The dominant risk factors for development of DR at baseline were diabetes duration, hemoglobin A1c concentration, use of insulin, glomerular filtration rate, and BMI. CONCLUSIONS AND RELEVANCE This nationwide matched cohort study suggests that there is a reduced risk of developing new DR associated with GBP, and no evidence of an increased risk of developing DR that threatened sight or required treatment. (c) 2021 American Medical Association. All rights reserved.
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- Andersson, Mikael, et al.
(författare)
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Measuring walking speed in COPD: test-retest reliability of the 30-metre walk test and comparison with the 6-minute walk test
- 2011
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Ingår i: Primary Care Respiratory Journal. - : Springer Science and Business Media LLC. - 1471-4418 .- 1475-1534. ; 20:4, s. 434-440
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To examine test-retest reliability of the 30-metre walk test (30mWT) in patients with chronic obstructive pulmonary disease (COPD) and to compare the 30mWT with the 6-minute walk test (6MWT). Methods: Forty-nine subjects with stable COPD were included. The 30mWT consists of walking at different walking intensities over a distance of 30 metres - self-selected speed (ss-30mWT) and maximal speed (ms-30mWT). The test was conducted twice and the time to walk 30 metres was recorded. The 6MWT was performed in duplicate on the same day. Results: Test-retest reliability was high: intraclass correlation coefficient (ICC2.1) = 0.93 (95% CI 0.87 to 0.97) for maximal walking speed and 0.87 (95% CI 0.78 to 0.93) for self-selected walking speed. Both maximal and self-selected speed had a standard error of measurement (SEM) of 0.07 m/s and SEM% was 4.4 for maximal speed and 5.9 for self-selected speed. The correlation, criterion validity, between ms-30mWT and the 6MWT was r=0.78 (p<0.001). Heart rate, dyspnoea, exertion and oxygen saturation were more affected after the 6MWT than after the 30mWT (p<0.001). Conclusions: The 30mWT is a reliable submaximal test that is easy to perform and can be used to measure physical function (walking ability) in patients with COPD. It may be well suited for primary care settings. (C) 2011 Primary Care Respiratory Society UK. All rights reserved. M Andersson, et al. Prim Care Respir J 2011; 20(4): 434-440 http://dx.doi.org/10.4104/pcrj.2011.00082
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| 5. |
- Duffy, Stephen W., et al.
(författare)
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Mammography screening reduces rates of advanced and fatal breast cancers : Results in 549,091 women
- 2020
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Ingår i: Cancer. - : John Wiley & Sons. - 0008-543X .- 1097-0142. ; 126:13, s. 2971-2979
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Tidskriftsartikel (refereegranskat)abstract
- Background: It is of paramount importance to evaluate the impact of participation in organized mammography service screening independently from changes in breast cancer treatment. This can be done by measuring the incidence of fatal breast cancer, which is based on the date of diagnosis and not on the date of death.Methods: Among 549,091 women, covering approximately 30% of the Swedish screening‐eligible population, the authors calculated the incidence rates of 2473 breast cancers that were fatal within 10 years after diagnosis and the incidence rates of 9737 advanced breast cancers. Data regarding each breast cancer diagnosis and the cause and date of death of each breast cancer case were gathered from national Swedish registries. Tumor characteristics were collected from regional cancer centers. Aggregated data concerning invitation and participation were provided by Sectra Medical Systems AB. Incidence rates were analyzed using Poisson regression.Results: Women who participated in mammography screening had a statistically significant 41% reduction in their risk of dying of breast cancer within 10 years (relative risk, 0.59; 95% CI, 0.51‐0.68 [P < .001]) and a 25% reduction in the rate of advanced breast cancers (relative risk, 0.75; 95% CI, 0.66‐0.84 [P < .001]).Conclusions: Substantial reductions in the incidence rate of breast cancers that were fatal within 10 years after diagnosis and in the advanced breast cancer rate were found in this contemporaneous comparison of women participating versus those not participating in screening. These benefits appeared to be independent of recent changes in treatment regimens.
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| 7. |
- Nowicka, Paulina, 1974-, et al.
(författare)
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Systematic Development of National Guidelines for Obesity Care : the Swedish Approach
- 2024
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Ingår i: Obesity Facts. - : S. Karger. - 1662-4025 .- 1662-4033. ; 17:2, s. 183-190
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: With the rapid development of treatment modalities for obesity management, there is a growing need for guidelines. This was acknowledged by the Swedish National Board of Health and Welfare and in 2020 the process of producing the first national guidelines for obesity care, including both children and adults, was initiated. The main aim was to ensure equal high standard care throughout Sweden by supporting decision makers to allocate resources to the best knowledge-based care.METHODS: The standardized procedures of the National Board of Health and Welfare were applied to construct guidelines in a systematic and transparent way, including priority setting of recommendations and quality indicators to evaluate the progress of implementation. The process involved independent expert committees including professionals and patient representatives, and the guidelines were reviewed through an open public consultation.RESULTS: In total, 20 recommendations were issued encompassing a broad scope, from identification and diagnosis to multiple treatment modalities, embedded in a life course perspective from pregnancy to the elderly, as well as highlighting the need for improved knowledge and competence of health care providers.CONCLUSIONS: National guidelines for improved standard care and evidence based and efficient use of health care resources for obesity treatment can be developed in a systematic way with professionals and patient representatives.
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| 8. |
- Nowicka, Paulina, 1974-, et al.
(författare)
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Systematic Development of National Guidelines for Obesity Care: The Swedish Approach
- 2024
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Ingår i: OBESITY FACTS. - : S. Karger. - 1662-4025 .- 1662-4033. ; 17:2, s. 183-190
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: With the rapid development of treatment modalities for obesity management, there is an increasing demand for guidance to facilitate the prioritization of interventions. In 2020, the Swedish National Board of Health and Welfare started the process of producing the first national guidelines for obesity care directed to decision makers who allocate resources to the best knowledge-based care. The main aim of this paper was to describe the systematic development of these guidelines, designed to guarantee uniformly high standards of care throughout the whole country. Methods: The standardized procedures of the National Board of Health and Welfare were applied to construct guidelines in a systematic and transparent way, including priority setting of recommendations and quality indicators to evaluate the progress of implementation. The process involved independent expert committees including professionals and patient representatives, and the guidelines were reviewed through an open public consultation. Results: National guidelines were issued in 2023, encompassing a broad scope, from identification and diagnosis to multiple treatment modalities, embedded in a life-course perspective from pregnancy to the elderly, as well as highlighting the need for improved knowledge and competence of health care providers. Conclusions: National guidelines for improved standard care and evidence-based and efficient use of health care resources for obesity treatment can be developed in a systematic way with professionals and patient representatives.
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