| 1. |
- Kajiura, M., et al.
(författare)
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Variant autonomic regulation during active standing in Swedish and Japanese junior high school children
- 2008
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Ingår i: Clinical Physiology and Functional Imaging. - 1475-0961 .- 1475-097X. ; 28:3, s. 174-181
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Tidskriftsartikel (refereegranskat)abstract
- The present investigation is about cardiovascular responses and relevant autonomic function in Swedish and Japanese pubertal children on active standing using non-invasive continuous beat-to-beat finger arterial pressure (FAP) monitoring and power spectral analysis. Examined were 54 Swedish and 57 Japanese children (13-15 years). FAP and heart rate (HR) was continuously recorded in the supine position and during standing. Supine FAP was significantly higher in Swedish compared with Japanese children (121/62 versus 103/53 mmHg, P < 0.001). Swedish children showed a higher increase in arterial pressure and HR upon uprising, resulting in a higher vasoconstrictor index (5.04 ± 0.22 versus 2.31 ± 0.11 mmHgs-1, P < 0.001, respectively). There were also higher increases in arterial pressure and HR in the following steady state period (1-7min) between the two groups. These differences were also found after adjustment of body weight and height. Frequency domain analysis of HR and arterial pressure variability indicated significantly higher low/high frequency power of HR and low frequency power of arterial pressure. These results suggest that Swedish pubertal children have higher basal blood pressure and enhanced cardiovascular sympathetic responses. These differences in the two cohorts might be caused by genetic factors. © 2008 The Authors Journal compilation © 2008 Scandinavian Society of Clinical Physiology and Nuclear Medicine.
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| 2. |
- Åkesson, Torsten, et al.
(författare)
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Tracking performance of the transition radiation tracker prototype for the ATLAS experiment
- 2002
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Ingår i: Nuclear Instruments & Methods in Physics Research. Section A: Accelerators, Spectrometers, Detectors, and Associated Equipment. - 0167-5087. ; 485:3, s. 298-310
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Tidskriftsartikel (refereegranskat)abstract
- A prototype of the Transition Radiation Tracker (TRT) for the ATLAS experiment at the CERN LHC has been built and tested at the CERN SPS. Detailed studies of the drift-time measurements, alignment technique, hit registration efficiency, track and momentum accuracy were performed. A coordinate measurement accuracy of 150 Pin for a single TRT drift tube and momentum resolution of 0.8% for 20 GeV pions in a 1.56 T magnetic field were achieved. The results obtained are in agreement with the expected tracking performance of the ATLAS TRT. (C) 2001 Published by Elsevier Science B.V.
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| 3. |
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| 4. |
- Al-Hussaini, M, et al.
(författare)
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Prokinetic effect of duodenal extract on ovine gallbladders
- 2000
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Ingår i: Medical principles and practice. - 1011-7571 .- 1423-0151. ; 9:1, s. 74-80
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Tidskriftsartikel (refereegranskat)abstract
- Objective: It is known that the macrolide antibiotic erythromycin stimulates gastrointestinal and gallbladder motility by an as yet unidentified mechanism. It was the objective of this study to investigate the mechanism of the gallbladder motility-stimulating effect of erythromycin. Methods: In our experiments we used strips of sheep gallbladders measuring isometric tension in organ baths. Since erythromycin itself did not induce contraction we examined the prokinetic effects of sheep duodenal extract, incubated with (DEX) or without (blank) erythromycin (10(-5) M). Results: Both DEX and blank elicited gallbladder contraction associated with heat-stable, water-soluble but not with lipid-soluble duodenal prokinetic factor. The factor is unrelated to motilin or cholecystokinin and is only partially (<20%) blocked by atropine (10(-6) M) and not affected by the pretreatment with dexamethasone or somatostatin. Conclusion: It was concluded that erythromycin indirectly stimulates contraction of ovine gallbladders through the endogenous release of a duodenal prokinetic factor. Copyright (C) 2000 S. Karger AG, Basel.
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| 5. |
- Albertsson, Daniel M, 1957, et al.
(författare)
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Hip and fragility fracture prediction by 4-item clinical risk score and mobile heel BMD: a women cohort study
- 2010
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Ingår i: BMC Musculosceletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background One in four Swedish women suffers a hip fracture yielding high morbidity and mortality. We wanted to revalidate a 4-item clinical risk score and evaluate a portable heel bone mineral density (BMD) technique regarding hip and fragility fracture risk among elderly women. Methods In a population-based prospective cohort study we used clinical risk factors from a baseline questionnaire and heel BMD to predict a two-year hip and fragility fracture outcome for women, in a fracture preventive program. Calcaneal heel BMD was measured by portable dual X-ray laser absorptiometry (DXL) and compared to hip BMD, measured with stationary dual X-ray absorptiometry (DXA) technique. Results Seven women suffered hip fracture and 14 women fragility fracture/s (at hip, radius, humerus and pelvis) among 285 women; 60% having heel BMD ≤ -2.5 SD. The 4-item FRAMO (Fracture and Mortality) Index combined the clinical risk factors age ≥80 years, weight <60 kg, prior fragility fracture, and impaired rise-up ability. Women having 2-4 risk factors showed odds ratio (OR) for hip fracture of 5.9 and fragility fracture of 4.4. High risk group hip fracture risk was 2.8% annually compared to 0.5% for the low risk majority (69%). Heel BMD showed hip fracture OR of 3.1 and fragility fracture OR of 2.6 per SD decrease. For 30 DXA assessed participants mean hip BMD at -2.5 SD level corresponded to a lower BMD at the heel. Five of seven hip fractures occurred within a small risk group of 32 women, identified by high FRAMO Index + prior fragility fracture + heel T-score ≤-3.5 SD. Conclusions In a follow-up study we identified high risk groups for hip and fragility fracture with our plain 4-item risk model. Increased fracture risk was also related to decreasing heel BMD in calcaneal bone, measured with a mobile DXL technique. A combination of high FRAMO Index, prior fragility fracture, and very low BMD restricted the high risk group to 11%, among whom most hip fractures occurred (71%). These practical screening methods could eventually reduce hip fracture incidence by concentrating preventive resources to high fracture risk women.
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| 6. |
- Luethold, Renata Vidonscky, et al.
(författare)
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Understanding older patients' willingness to have medications deprescribed in primary care : a protocol for a cross-sectional survey study in nine European countries
- 2022
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Ingår i: BMC Geriatrics. - : BioMed Central (BMC). - 1471-2318. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: To reduce inappropriate polypharmacy, deprescribing should be part of patients' regular care. Yet deprescribing is difficult to implement, as shown in several studies. Understanding patients' attitudes towards deprescribing at the individual and country level may reveal effective ways to involve older adults in decisions about medications and help to implement deprescribing in primary care settings. In this study we aim to investigate older adults' perceptions and views on deprescribing in different European countries. Specific objectives are to investigate the patients' willingness to have medications deprescribed by medication type and to have herbal or dietary supplements reduced or stopped, the role of the Patient Typology (on medication perspectives), and the impact of the patient-GP relationship in these decisions. Methods and analysis: This cross-sectional survey study has two parts: Part A and Part B. Data collection for Part A will take place in nine countries, in which per country 10 GPs will recruit 10 older patients (>= 65 years old) each (n = 900). Part B will be conducted in Switzerland only, in which an additional 35 GPs will recruit five patients each and respond to a questionnaire themselves, with questions about the patients' medications, their willingness to deprescribe those, and their patient-provider relationship. For both Part A and part B, a questionnaire will be used to assess the willingness of older patients with polypharmacy to have medications deprescribed and other relevant information. For Part B, this same questionnaire will have additional questions on the use of herbal and dietary supplements. Discussion: The international study design will allow comparisons of patient perspectives on deprescribing from different countries. We will collect information about willingness to have medications deprescribed by medication type and regarding herbal and dietary supplements, which adds important information to the literature on patients' preferences. In addition, GPs in Switzerland will also be surveyed, allowing us to compare GPs' and patients' views and preferences on stopping or reducing specific medications. Our findings will help to understand patients' attitudes towards deprescribing, contributing to improvements in the design and implementation of deprescribing interventions that are better tailored to patients' preferences.
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| 7. |
- Streit, Sven, et al.
(författare)
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Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old.
- 2018
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Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 36:1, s. 89-98
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (>80 years) between countries. We wanted to explore whether differences in country-specific cardiovascular disease (CVD) burden and life expectancy could explain the differences.DESIGN: This is a survey study using case-vignettes of oldest-old patients with different comorbidities and blood pressure levels. An ecological multilevel model analysis was performed.SETTING: GP respondents from European General Practice Research Network (EGPRN) countries, Brazil and New Zeeland.SUBJECTS: This study included 2543 GPs from 29 countries.MAIN OUTCOME MEASURES: GP treatment probability to start or not start antihypertensive treatment based on responses to case-vignettes; either low (<50% started treatment) or high (≥50% started treatment). CVD burden is defined as ratio of disability-adjusted life years (DALYs) lost due to ischemic heart disease and/or stroke and total DALYs lost per country; life expectancy at age 60 and prevalence of oldest-old per country.RESULTS: Of 1947 GPs (76%) responding to all vignettes, 787 (40%) scored high treatment probability and 1160 (60%) scored low. GPs in high CVD burden countries had higher odds of treatment probability (OR 3.70; 95% confidence interval (CI) 3.00-4.57); in countries with low life expectancy at 60, CVD was associated with high treatment probability (OR 2.18, 95% CI 1.12-4.25); but not in countries with high life expectancy (OR 1.06, 95% CI 0.56-1.98).CONCLUSIONS: GPs' choice to treat/not treat hypertension in oldest-old was explained by differences in country-specific health characteristics. GPs in countries with high CVD burden and low life expectancy at age 60 were most likely to treat hypertension in oldest-old. Key Points • General practitioners (GPs) are in a clinical dilemma when deciding whether (or not) to treat hypertension in the oldest-old (>80 years of age). • In this study including 1947 GPs from 29 countries, we found that a high country-specific cardiovascular disease (CVD) burden (i.e. myocardial infarction and/or stroke) was associated with a higher GP treatment probability in patients aged >80 years. • However, the association was modified by country-specific life expectancy at age 60. While there was a positive association for GPs in countries with a low life expectancy at age 60, there was no association in countries with a high life expectancy at age 60. • These findings help explaining some of the large variation seen in the decision as to whether or not to treat hypertension in the oldest-old.
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| 8. |
- Streit, Sven, et al.
(författare)
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Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries.
- 2017
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 17:1, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack of knowledge has led to inconsistent guidelines, mainly based on systolic blood pressure (SBP), cardiovascular disease (CVD) but not on frailty despite the high prevalence in oldest-old. This may lead to variation how General Practitioners (GPs) treat hypertension. Our aim was to investigate treatment variation of GPs in oldest-olds across countries and to identify the role of frailty in that decision.METHODS: Using a survey, we compared treatment decisions in cases of oldest-old varying in SBP, CVD, and frailty. GPs were asked if they would start antihypertensive treatment in each case. In 2016, we invited GPs in Europe, Brazil, Israel, and New Zealand. We compared the percentage of cases that would be treated per countries. A logistic mixed-effects model was used to derive odds ratio (OR) for frailty with 95% confidence intervals (CI), adjusted for SBP, CVD, and GP characteristics (sex, location and prevalence of oldest-old per GP office, and years of experience). The mixed-effects model was used to account for the multiple assessments per GP.RESULTS: The 29 countries yielded 2543 participating GPs: 52% were female, 51% located in a city, 71% reported a high prevalence of oldest-old in their offices, 38% and had >20 years of experience. Across countries, considerable variation was found in the decision to start antihypertensive treatment in the oldest-old ranging from 34 to 88%. In 24/29 (83%) countries, frailty was associated with GPs' decision not to start treatment even after adjustment for SBP, CVD, and GP characteristics (OR 0.53, 95%CI 0.48-0.59; ORs per country 0.11-1.78).CONCLUSIONS: Across countries, we found considerable variation in starting antihypertensive medication in oldest-old. The frail oldest-old had an odds ratio of 0.53 of receiving antihypertensive treatment. Future hypertension trials should also include frail patients to acquire evidence on the efficacy of antihypertensive treatment in oldest-old patients with frailty, with the aim to get evidence-based data for clinical decision-making.
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| 9. |
- Tanaka, H, et al.
(författare)
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Blood pressure and cardiovascular autonomic function in healthy children and adolescents
- 2000
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Ingår i: Journal of Pediatrics. - : Elsevier BV. - 0022-3476 .- 1097-6833. ; 137:1, s. 63-67
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate the relationship between blood pressure levels and cardiovascular autonomic function in adolescents and preadolescents. Study design: We measured variability of beat-to-beat arterial pressure and R-R intervals using power spectral analysis in 56 adolescents (aged 13-16 16 years, mean age, 9.0 +/- 1.4 years) and 71 preadolescents (6-12 years, mean age, 13.5 +/- 1.1 years) in the supine and standing positions. Results: Adolescents had higher levels of systolic arterial pressure and lower high-frequency power of RR intervals than preadolescents. Correlation between the basal level of arterial pressure and autonomic function rn as observed in adolescents but not in preadolescents. Tn adolescents, multivariate analysis indicated that tho basal level of arterial pressure was inversely related with the high-frequency power of RR intervals and positively with the ratio of low-frequency and high-frequency pow er. No significant relation was found in preadolescents. During standing, adolescents had a more marked increase in diastolic arterial pressure, heart rate, low frequency of R-R intervals, and low frequency of arterial pressure compared with those of preadolescents, Changes in diastolic pressure showed a significant negative correlation with changes in high frequency of R-R intervals. Conclusion: Cardiovascular autonomic function plays an important role in increasing blood pressure levels associated with increased modulation of vagal tone of the heart after puberty but does not in the preadolescent.
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| 10. |
- Tanaka, H., et al.
(författare)
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Evidence of decreased sympathetic function in children with psychosomatic symptoms
- 2002
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Ingår i: Clinical Autonomic Research. - : Springer Science and Business Media LLC. - 0959-9851 .- 1619-1560. ; 12:6, s. 477-482
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Tidskriftsartikel (refereegranskat)abstract
- We investigated cardiovascular autonomic function using power spectral analysis of heart rate variation and beat-to-beat finger arterial pressure at rest and while standing and correlated these findings with self-reported psychosomatic and psychosocial symptoms in 122 schoolchildren. Children with three or more psychosomatic and psychosocial symptoms (somatizers) were found to have significantly lower blood pressure than children without symptoms. Somatizers had the more decreased spectral power of the low frequency (LF) band of arterial pressure and RR intervals in the supine position. The high frequency (HF) power did not differ between the two groups. Somatizers showed a more marked reduction in systolic arterial pressure at the onset of standing than did subjects without symptoms but somatizers showed an identical response in systolic arterial pressure when compared to subjects without symptoms during the later stage of standing. The increases in the LF band of arterial pressure and LF/HF of RR intervals during standing were higher in somatizers. These results suggest that somatizers have decreased sympathetic modulation. We conclude that psychosomatic and psychosocial symptoms in children might be associated with low blood pressure and decreased sympathetic modulation.
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