| 1. |
- Balducci, Marco, et al.
(författare)
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SARS-CoV-2 vaccination and risk of infectious diseases in hospitalized older patients
- 2024
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Ingår i: European Geriatric Medicine. - 1878-7649 .- 1878-7657. ; 15:2, s. 509-517
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Vaccinations, for example flu vaccine, may be a cause of cross-reactive immunostimulation that prevents a larger spectrum of infections. However, whether SARS-CoV-2 vaccinations may also determine this effect is unclear. This study aims, first, to assess the incidence of infections at hospital admission and during the hospitalization in older inpatients vaccinated and unvaccinated against SARS-CoV-2; second, to compare length of hospital stay and in-hospital mortality between vaccinated and unvaccinated individuals.Methods This retrospective study included 754 older inpatients admitted to the Geriatrics and Orthogeriatrics Units of the University Hospital of Ferrara (Italy) between March 2021 and November 2021. Sociodemographic and health-related data, and the diagnosis of infections at hospital admission and during hospitalization were collected from medical records.Results The sample’s mean age was 87.2 years, 59.2% were females, and 75.5% were vaccinated against SARS-CoV-2. Vaccinated individuals had 36% lower odds of intra-hospital infections (OR = 0.64, 95%CI 0.44–0.94) and 39% lower in-hospital death (HR = 0.61, 95%CI 0.39–0.95), also after adjusting for potential confounders, while no significant results emerged about infections at hospital admission. Considering the hospitalization’s endpoints, SARS-CoV-2 vaccination was associated with a lower probability of being transferred to long-term care or other hospital departments than returning home (OR = 0.63, 95%CI 0.40–0.99).Conclusions In older inpatients, SARS-CoV-2 vaccination seems to be associated with a lower likelihood of intra-hospital infectious diseases not caused by SARS-CoV-2 and all-cause in-hospital mortality. The vaccination coverage in the older population could limit not only the onset and severity of COVID-19 but also the occurrence of other infectious diseases.
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| 2. |
- Bombarda, F., et al.
(författare)
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Runaway electron beam control
- 2019
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Ingår i: Plasma Physics and Controlled Fusion. - : IOP Publishing. - 1361-6587 .- 0741-3335. ; 61:1
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Tidskriftsartikel (refereegranskat)
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| 3. |
- Klatte, Derk C F, et al.
(författare)
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Association between proton pump inhibitor use and risk of progression of chronic kidney disease
- 2017
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Ingår i: Gastroenterology. - : Elsevier BV. - 0016-5085 .- 1528-0012. ; 153:3, s. 702-710
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: Proton pump inhibitors (PPI) have been associated with acute kidney injury (AKI) and recent studies suggest that they may be associated with the risk of chronic kidney disease (CKD).METHODS: We performed a retrospective analysis using the Stockholm creatinine measurements database, which contains information on diagnoses, dispensation claims, and laboratory test results for all citizens in the Stockholm region from 2007 through 2010. We identified new users of PPIs (n= 105305) and new users of H2 blockers (H2B; n= 9578); data on renal outcomes were collected for a median 2.7 years. The primary outcome was progression CKD, defined as doubling of creatinine or decrease in estimated glomerular filtration rate of 30% or more. Secondary outcomes were end-stage renal disease and acute kidney injury (AKI). Complete collection of repeated PPI and H2B dispensations at pharmacies in Sweden allowed modeling the time-dependent risk associated to cumulative PPI exposure.RESULTS: Users of PPIs, compared to users of H2Bs, had an increased risk for doubled levels of creatinine (1985 events; adjusted hazard ratio [HR], 1.26; 95% CI, 1.05-1.51) and decrease in estimated glomerular filtration rate of 30% or more (11045 events; 1.26; 95% CI, 1.16-1.36). PPI use also associated with development of end-stage renal disease (HR, 2.40; 0.76-7.58) and AKI (HR, 1.30; 95% CI, 1.00-1.69). There was a graded association between cumulative exposure to PPIs and risk of CKD progression. This was not the case for cumulative H2B use.CONCLUSIONS: Initiation of PPI therapy and cumulative PPI exposure associate with increased risk of CKD progression in a large, North European healthcare system. Although consistent, the association was modest in magnitude, and cannot exclude residual confounding.
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| 4. |
- Meyer, H., et al.
(författare)
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Overview of progress in European medium sized tokamaks towards an integrated plasma-edge/wall solution
- 2017
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Ingår i: Nuclear Fusion. - : Institute of Physics Publishing (IOPP). - 0029-5515 .- 1741-4326. ; 57:10
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Tidskriftsartikel (refereegranskat)abstract
- Integrating the plasma core performance with an edge and scrape-off layer (SOL) that leads to tolerable heat and particle loads on the wall is a major challenge. The new European medium size tokamak task force (EU-MST) coordinates research on ASDEX Upgrade (AUG), MAST and TCV. This multi-machine approach within EU-MST, covering a wide parameter range, is instrumental to progress in the field, as ITER and DEMO core/pedestal and SOL parameters are not achievable simultaneously in present day devices. A two prong approach is adopted. On the one hand, scenarios with tolerable transient heat and particle loads, including active edge localised mode (ELM) control are developed. On the other hand, divertor solutions including advanced magnetic configurations are studied. Considerable progress has been made on both approaches, in particular in the fields of: ELM control with resonant magnetic perturbations (RMP), small ELM regimes, detachment onset and control, as well as filamentary scrape-off-layer transport. For example full ELM suppression has now been achieved on AUG at low collisionality with n = 2 RMP maintaining good confinement H-H(98,H-y2) approximate to 0.95. Advances have been made with respect to detachment onset and control. Studies in advanced divertor configurations (Snowflake, Super-X and X-point target divertor) shed new light on SOL physics. Cross field filamentary transport has been characterised in a wide parameter regime on AUG, MAST and TCV progressing the theoretical and experimental understanding crucial for predicting first wall loads in ITER and DEMO. Conditions in the SOL also play a crucial role for ELM stability and access to small ELM regimes.
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| 5. |
- Meyer, H., et al.
(författare)
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Overview of progress in European medium sized tokamaks towards an integrated plasma-edge/wall solution
- 2017
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Ingår i: Nuclear Fusion. - : Institute of Physics Publishing (IOPP). - 0029-5515 .- 1741-4326. ; 57:10
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Tidskriftsartikel (refereegranskat)abstract
- Integrating the plasma core performance with an edge and scrape-off layer (SOL) that leads to tolerable heat and particle loads on the wall is a major challenge. The new European medium size tokamak task force (EU-MST) coordinates research on ASDEX Upgrade (AUG), MAST and TCV. This multi-machine approach within EU-MST, covering a wide parameter range, is instrumental to progress in the field, as ITER and DEMO core/pedestal and SOL parameters are not achievable simultaneously in present day devices. A two prong approach is adopted. On the one hand, scenarios with tolerable transient heat and particle loads, including active edge localised mode (ELM) control are developed. On the other hand, divertor solutions including advanced magnetic configurations are studied. Considerable progress has been made on both approaches, in particular in the fields of: ELM control with resonant magnetic perturbations (RMP), small ELM regimes, detachment onset and control, as well as filamentary scrape-off-layer transport. For example full ELM suppression has now been achieved on AUG at low collisionality with n = 2 RMP maintaining good confinement H-H(98,H-y2) approximate to 0.95. Advances have been made with respect to detachment onset and control. Studies in advanced divertor configurations (Snowflake, Super-X and X-point target divertor) shed new light on SOL physics. Cross field filamentary transport has been characterised in a wide parameter regime on AUG, MAST and TCV progressing the theoretical and experimental understanding crucial for predicting first wall loads in ITER and DEMO. Conditions in the SOL also play a crucial role for ELM stability and access to small ELM regimes.
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| 6. |
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| 7. |
- Savarese, Gianluigi, et al.
(författare)
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Incidence, Predictors, and Outcome Associations of Dyskalemia in Heart Failure With Preserved, Mid-Range, and Reduced Ejection Fraction
- 2019
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Ingår i: JACC. Heart failure. - : ELSEVIER SCI LTD. - 2213-1779 .- 2213-1787. ; 7:1, s. 65-76
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES This study investigated 1-year incidence and predictors of dyskalemia (dysK) and its outcome associations in heart failure with preserved ejection fraction (HFpEF), HF with mid-range EF (HFmrEF), and HF with reduced EF (HFrEF). BACKGROUND DysK in real-world HF is insufficiently characterized. Fear of dyskalemia may lead to underuse or underdosing of renin-angiotensin-aldosterone system inhibitors. METHODS Patients enrolled in the SwedeHF (Swedish Heart Failure) Registry from 2006 to 2011 in Stockholm, Sweden were included in the analyses. Multivariate Cox regression analysis identified independent predictors of dysK within 1 year. Time-dependent Cox models assessed outcomes associated with incident dysK (all-cause death, HF, and other cardiovascular disease [CVD] hospitalizations) within 1 year from baseline. RESULTS Of 5,848 patients, 24.4% experienced hyperkalemia (hyperK [K amp;gt; 5.0 mmol/l]) at least once, and 10.2% had moderate or severe hyperK (K amp;gt; 5.5 mmol/l). Adjusted risk of moderate or severe hyperK was highest in HFpEF and HFmrEF. Similarly, 20.3% of patients had at least one episode of hypokalemia (hypoK [amp;lt;3.5 mmol/l]), and 3.7% had severe hypoK (amp;lt;3.0 mmol/l). Adjusted risk of any hypoK was highest in HFpEF. Independent predictors of both hyperK and hypoK were sex, baseline potassium and estimated glomerular filtration rate, low hemoglobin, chronic obstructive pulmonary disease (COPD), inpatient status, and higher New York Heart Association functional class. Incident dysK was associated with increased risk of mortality. Furthermore, hypoK was associated with increased CVD hospitalizations (HF-related excluded). There was no association between dysK and HF hospitalization risk, regardless of EF. CONCLUSIONS DysK is common in HF and is associated with increased mortality. Risk of moderate or severe hyperK was highest in HFpEF and HFmrEF, whereas risk of hypoK was highest in HFpEF. HF severity, low hemoglobin, COPD, baseline high and low potassium, and low eGFR were relevant predictors of dysK occurrence. (C) 2019 by the American College of Cardiology Foundation.
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| 8. |
- Trevisan, Caterina, et al.
(författare)
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Trajectories of cognitive and physical performance after accidental falls in nursing home residents : A prospective study
- 2022
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Ingår i: Geriatric Nursing. - : Elsevier BV. - 0197-4572 .- 1528-3984. ; 47, s. 100-106
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Tidskriftsartikel (refereegranskat)abstract
- This prospective study evaluated cognitive and physical trajectories of nursing home (NH) residents after fall occurrence and their predictors. In 167 residents aged ≥60, we considered the closest pre-fall assessment and up to the first three post-fall assessments of cognitive and physical functions performed through Mini-Mental State Examination (MMSE) and Tinetti tests. Mixture models identified three post-fall cognitive and physical trajectories: stability, slow decline, and rapid decline. At logistic regression, older age, fewer informal visits, and falls within one month from institutionalization increased the probability of experiencing a decline in MMSE and Tinetti scores. Worse pre-fall cognitive function increased the likelihood of cognitive and physical decline, while worse pre-fall Tinetti score negatively impacted only physical decline.In conclusion, the impact of falls on the cognitive and physical health of NH residents may be modulated by their pre-fall cognitive function and some modifiable factors, such as social interactions and physical function.
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| 9. |
- Trevisan, Marco
(författare)
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Drug safety and effectiveness in relation to kidney function : a pharmacoepidemiological approach
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Kidney function plays an important role in drug safety and effectiveness. As many medications are excreted by the kidneys, patients with reduced kidney function are at a higher risk of supra-therapeutic or toxic drug levels. At the same time, drug-induced nephrotoxicity is common due to the high filtration capacity and metabolic activity of the kidneys. Patients with chronic kidney disease (CKD) are at high risk for adverse drug event and drug overdosing. Therefore, randomized controlled trials (RCTs) have generally excluded patients with CKD or included only a small proportion that precludes strong conclusions about the safety and effectiveness in this segment of the population. Pharmacoepidemiological studies performed in real-world settings can help provide complementary evidence and expand findings of RCTs to the general population. However, existing observational studies are often limited in sample size, length of follow-up and inappropriate management of confounding and biases. The presented work aims to expand existing knowledge on drug safety and effectiveness of common cardiovascular and antidiabetic medications used in routine practice and to investigate differences in drug risk-benefit across levels of kidney function. Study I describes the frequency of hyperkalemia in a cohort of new users of mineralocorticoid receptor antagonist (MRA) identified from the Stockholm CREAtinine Measurement (SCREAM) project during 2007-2010. During the 1-year follow-up after treatment initiation, 18% of the patients experienced hyperkalemia in the overall cohort and 26% among patients with heart failure history. After hyperkalemia, 47% of patients discontinued the therapy and only 10% reduced the dose. CKD was common (28%) and it was a major risk factor for both hyperkalemia and MRA discontinuation. Study II examines safety and effectiveness associated with continuing vs stopping MRA treatment after an episode of hyperkalemia in routine care. A cohort of new users of MRA surviving an incident hyperkalemia during 2007-2018 was identified from the SCREAM project. Target trial emulation methods were applied to assess the association between treatment strategies (stopping vs continuing MRA within 6 months after hyperkalemia) and subsequent outcomes. Compared to the “continue MRA” strategy, patients who stopped MRA were at higher risk of cardiovascular events and mortality but lower risk of recurrent hyperkalemia. These associations were consistent across eGFR strata. Study III investigates the cardiovascular effectiveness associated to Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs) use, compared to a standard diabetic care, after an acute myocardial infarction (MI). A cohort of patients with diabetes surviving an acute MI during 2010-2017 were selected from the Swedish Web‐system for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry. Results from the multivariable Cox regression showed a 28% relative risk reduction associated with GLP-1 RAs use compared with standard care. There was no suggestion of effect modification across stages of CKD. Study IV compares the risk of cardiorenal outcomes among patients with non-valvular atrial fibrillation (AF) initiating direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA) treatment. Using data from the SCREAM project, we identified a cohort of patients who started oral anticoagulants (OAC) between 2011 and 2018. Propensity-score weighted Cox regression was used to estimate the treatment-outcomes associations adjusting for 50 measured confounders. Results showed a lower risk of CKD progression, acute kidney injury (AKI) and major bleeding associated with DOAC use compared to VKA treatment. No statistical difference was observed between treatment groups for the composite outcome of stroke/systemic embolism and mortality. The observed associations were mostly similar across levels of baseline kidney function. In conclusion, this work emphasizes the importance of pharmacoepidemiology in expanding trial evidence on the safety and effectiveness of medications in real-world settings. Moreover, this thesis also highlights the important role of kidney function in assessing the risk–benefit of medications.
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| 10. |
- Trevisan, Marco, et al.
(författare)
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Patterns of chronic and transient hyperkalaemia and clinically important outcomes in patients with chronic kidney disease
- 2022
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Ingår i: Clinical Kidney Journal. - : Oxford University Press. - 2048-8505 .- 2048-8513. ; 15:1, s. 153-161
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Tidskriftsartikel (refereegranskat)abstract
- Background: Whether hyperkalaemia in CKD is chronic or transient, and whether this has different outcome implications, is not known.Methods: This was an observational study of adults with CKD G3-5 from Stockholm, Sweden 2006-11. We examined individual trajectories of potassium from all measurements obtained through routine outpatient care. For each month of follow-up, we created a rolling assessment of the proportion of time in which potassium was abnormal during the previous 12 months. We defined patterns of hyperkalaemia as transient (<= 50% of time during the previous year with potassium >5.0 mmol/L) and chronic (>50% of time with potassium >5.0mmol/L), and examined whether previous hyperkalaemia pattern offers additional predictive value beyond that provided by the most recent (current) potassium value.Results: We included 36 511 participants (56% women) with CKD G3-5 and median estimated glomerular filtration rate 46 mL/min/1.73m(2). Transient and chronic hyperkalaemia, respectively, were observed in 15% and 4% of patients with CKD G3a, and in 50% and 17% of patients with CKD G5. In fully adjusted models, transient (hazard ratio 1.36, 95% confidence interval 1.29-1.46) or chronic (1.16, 1.04-1.32) hyperkalaemia patterns, but not current hyperkalaemia, were associated with major adverse cardiovascular events (MACE), compared with normokalaemia. Transient hyperkalaemia (1.43, 1.35-1.52) and current potassium values, but not chronic hyperkalaemia, were associated with the risk of death.Conclusions: Between 4% and 17% of patients with CKD G3-5 develop chronic hyperkalaemia. In general, hyperkalaemia predicted MACE and death; however, the lack of effect of current potassium on MACE when adjusted for the previous pattern, and the stronger effects on death than on MACE, lead us to question whether hyperkalaemia is causal in these relationships.
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